Observations on Abortion / Containing an account of the manner in which it is accomplished, the causes which produced it, and the method of preventing or treating it

by John Burns

[1]. Both arteries and veins enlarge, but the latter increase more rapidly in size than the former, so much so, that even before the descent of the ovum into the uterus, and while the viscus is not itself materially enlarged, the venous system has assumed the appearance of sinews, each branch being larger than a goose quill.

[2]. Vide Anatomy of the gravid uterus, with practical inferences relative to pregnancy and labour.

[3]. The placenta, contrary to some plans, is not formed exactly at the fundus uteri, stretching equally down on the two faces of the uterus, with the membranes hanging perpendicularly from it. But it lies chiefly on one face of the uterus, whilst the membranes are turned to the other. The centre of the membranous bag, therefore, at this early period, is not directed to the os uteri, but either to the fore or back part of the uterus. In proportion, however, as the bag enlarges, it elongates, its centre, or apex, descends, and ultimately corresponds with the long axis of the uterus.

[4]. In some instances, the uterus seems to have the power of forming a vascular substance from its inner surface, although impregnation have not taken place; and, in this case, we may have the symptom of early abortion attending its expulsion. But much oftener we find that this appears as a derangement of the menstrual action, the vessels secreting a semi-organized substance, instead of the usual quantity of bloody fluid; hence, as has been observed by that ingenious and excellent practitioner, Dr. Denman, we have sparing and painful menstruation.

[5]. For a fuller explanation and defence of this doctrine, I beg leave to refer the reader to some observations on the animal economy, prefixed to the first volume of my Dissertation on Inflammation.

[6]. Vide Dissertations on Inflammation, Vol. I.

[7]. This contraction is sometimes so firm after the membranes have burst, as to produce the same effect upon the child, as the natural pains would have done had the pelvis been deformed; that is to say, the presentation becomes unshapely, and the part below the stricture is swelled and livid. This spasm, like that which sometimes retains the placenta, is very difficult to be relaxed, and, in general, requires artificial management. If it come on at the full time, before the membranes break, it may give such a feeling to the lower part of the ovum, as to make it resemble a preternatural presentation, although the head really present. In this case, the band is generally pretty broad, but its contraction is not violent. It has the effect, however, of retarding labour, until we break the membranes, which excites a more general and effective action in the uterine fibres.

[8]. The same effect is observable in the stomach and other organs. If a delicate person, after a hearty meal, use exercise to the extent of fatigue, he feels that the food is not digested, the stomach having been weakened or injured in its actions.

[9]. It has even been known, that, in consequence of the death of one child, the uterus has suffered partially, and expulsion takes place; but the other child continuing to live, has preserved the action of gestation in that part of the uterus, which, properly speaking, belonged to it, and pregnancy has still gone on. This, however, is an extremely rare occurrence; for, in almost every instance, the death of one child produces an affection of the action of gestation in the whole uterus, and the consequent expulsion of both children.

[10]. It is an old observation, that these purgatives, which produce much tenesmus, will excite abortion; and this is certainly true, if their operation be carried to a considerable extent, and continue long violent. Hence dysentery is also apt to bring on a miscarriage. Those strong purges which are sometimes taken to promote premature expulsion, not only act by exciting tenesmus, but likewise by inflaming the stomach and bowels, and thus affect the uterus in two ways. It cannot be too generally known, that when these medicines do produce abortion, the mother can seldom survive their effects. It is a mistaken notion, that abortion can be most readily excited by drastic purges, frequent and copious bleeding, &c. immediately after the woman discovers herself to be pregnant; on the contrary, the action of the uterus is then more independent of that of other organs, and therefore not so easily injured by changes in their condition. I have already shewn, that abortion more frequently happens when the pregnancy is farther advanced, because then not only the uterus is more easily affected, but the fœtus seems to suffer more readily. It is apt, either from diseases directly affecting itself, or from changes in the uterine action, to die about the middle of the third month, in which case expulsion follows within a fortnight.