A system of practical medicine. By American authors. Vol. 4

by Unknown

(2) Causes acting through the nervous system, neurotic;

(3) Physical or traumatic;

And (4) I shall classify what I might term social causes, such as result from custom and fashion, which form an important element in the etiology of abortion, and one more particularly open to and demanding prevention.

b. Local causes on the part of the uterus and its adnexa.

2. Causes on the part of the ovum.

1. Causes Maternal.—These may be general or local. General causes, arising either in the maternal system or exterior to it, but acting upon it, may be either physical or nervous, arising from diseased morbid conditions of the maternal system.

a. General causes acting through or resulting from changes within the maternal system.

The premature interruption of pregnancy may frequently be traced to disturbance of the maternal system or external influences which act upon it, either directly by traumatism or indirectly through the nervous system, and the uterus, hypersensitive in this state of intense physiological activity, responds. It is the point of least resistance to which the shock is conducted; as the electric current invariably passes through the best conductor in a network of wires to the point of greatest attraction, so shock follows the course of the uterine nerves, at the time most tense, and the explosion follows in that organ.

(1) Disease, acute and chronic, on the part of mother and father interferes with the nutrition and development of the ovum—on the part of the father, through the semen; on the part of the mother, by malnutrition of the growing germ.

Acute Diseases.—A vitiated condition of the blood, as well as the increase of temperature, local and general, which accompanies constitutional disturbance, affects nutrition and development of the ovum. Zymotic infectious diseases, as well as those accompanied by congestion of the pelvic viscera, are most liable to affect gestation: the excessively high temperature of the nutrient fluid and of the surrounding viscera, if not direct infection of the germ, leads to death of the embryo and consequent abortion in the course of zymotic disease. The localization of the morbid affection in the vicinity of the uterus affects the existence of the embryo by reason of the consequent congestion and irritation, as well as by depletion of the system, as in dysentery; direct infection, as in variola or scarlatina. This delicate existence is threatened in various ways by traumatic injury, as may occur in eclampsia. Fortunately, abortion in the course of disease is not the rule, but the exception, and usually accompanies morbid conditions of the system only if most intense or if predisposing causes exist; yet gestation is at all periods endangered by intercurrent disease in the early as well as the later stages. It is in the later stages only that the existence of direct infection can be determined, and, though perhaps not common, well-authenticated cases are recorded: I have myself delivered a mother, just recovering from a severe case of variola, of a seventh-month foetus covered with a typical eruption. That abortion occurs in the course of malarial fever is well known in the valleys and deltas of our great rivers, and it has been most erroneously ascribed by some to the energetic medication which is called for. If the disease attacks pregnant women, its continuance, but not the medication, may lead to abortion: it is not quinine given upon correct indications—it is the existing disease—which causes the accident, and must hence be checked as speedily as possible; it is the uterus which shelters the developing ovum, congested, hyperæsthetic, which is at the time the centre of physiological activity, and, we may say, the most sensitive portion of the body, most easily affected by an accidentally existing disease, as the non-pregnant woman, one more sensitive or feeble, always suffers most during an accidentally existing disease in that organ which is habitually most sensitive or weak or at the time under an unusual strain; if throat, lungs, or heart is weakened, it is that part which suffers most in the acme of malarial fever; if a woman is exposed to cold during the menstrual period, the pelvic viscera will respond most readily.