CHAPTER II.
ABORTION.
If a premature expulsion of the fœtus occur before the end of the seventh month, it is called an abortion, or miscarriage; subsequent to this period, premature labor.
The cause of abortion may be in the ovum or in the mother, and it is more liable to occur at the beginning of each month corresponding to the menstrual period. The maternal causes may arise from the condition of the mother or may be accidental; may be anything that injuriously affects the mind or body. Debility of constitution, consumption, leucorrhœa, uterine irritation, febrile complaints, and obstinate constipation may be causes, but some women who are weak or sick retain the ovum with wonderful tenacity. Blows, falls, violent concussions, excessive or sudden exertions, straining, severe coughing, taking long walks, riding on horseback, or over rough roads in a carriage, a long railway journey, fright, sudden shocks, anger, joy, sorrow, good or bad news suddenly told, taking a wrong step in ascending or descending stairs, lifting heavy weights, violent drastic purgatives, calomel, dancing, and tight lacing may excite the uterus to action and effect the expulsion of its contents.
It is an unfortunate thing for a woman if she miscarry with her first and second child, for it often becomes a habit. Having once miscarried, she is more likely to miscarry again, and by repeated miscarriages her constitution is broken, and the chances of her ever having a living child become very small.
A woman may experience some threatening or warning symptoms of miscarriage for one or two days before those of labor supervene. There is usually a feeling of languor or weariness, of lassitude and depression of spirits, and a sense of uneasiness, and then, after these premonitory symptoms have lasted for some time, there may be a discharge of mucus or blood from the vagina. The show may increase to flooding, and soon there may be pain, at first slight and irregular, afterwards of a grinding character, and subsequently severe, irregular, and bearing down. At this stage we may be quite certain that the pains will continue to recur until the fœtus at least, if not the afterbirth, have passed into the vagina.
The progress in different cases is, however, quite dissimilar. In the beginning of pregnancy the expulsion of the ovum might closely follow the accident that caused it. For example, a woman might slip in descending a staircase and fall violently on her seat, causing immediate expulsion of the ovum, with a large quantity of fluid blood. There are some women who have acquired the habit of aborting, and the ovum passes out of the womb with scarcely any pain, little or no hemorrhage, and the woman speedily recovers. But it will very seldom happen, after the first six weeks, that there is not some interval between the accident and the consequent abortion, and that there is not considerable and protracted pain.
If the cause of the abortion affects the mother instead of the ovum, she generally experiences, at the time of the accident, a sharp pain about the loins or abdomen, which may continue slightly for several days, and then be renewed, with violent uterine contractions, and some serous and then bloody discharges from the vagina.
The progress of a miscarriage is not as regular as a labor at full term. In many cases there are shiverings succeeded by fever for a day or more preceding the hemorrhage. Severe indisposition may continue for several days. There may be not only considerable uterine pain, but much pain in the bladder and loins; a sense of sinking in the epigastrium, of weight near the vulva and anus, and an ineffectual desire to urinate.
Such symptoms continue a longer or shorter time, and then usually the fœtus alone is expelled, the placenta being retained. The latter is generally detached after a time, or it may (if within the first three months) be discharged and pass out in a dissolved condition, with the lochia. Very alarming hemorrhage may precede and accompany abortion; this makes the case one of danger at the time, and may permanently affect the health of the woman afterwards. The flooding may continue after the expulsion of the ovum; but I have always found that in such cases there was a portion of the placenta that was detached, and that might be removed, though not perhaps without some difficulty. A good physician should always be called in cases of continued flooding.
The patient ought always to preserve any and every substance discharged, that it may be showed to the physician. He should make a digital examination, and he usually finds the os uteri to be partially dilated, and a portion of the placenta hanging in the orifice. It has always been my practice to see that all was removed before leaving my patient, and I have known very dangerous hemorrhage to occur where this rule was not observed. The placenta can generally be seized by two fingers and removed; but if persevering efforts are necessary, they should not be relinquished until the safety of the mother is assured, which cannot be while the ovum, or membranes, or placenta remain in the uterus separated from their connections.