Volume 1

A dictionary of practical medicine, comprising general pathology, the nature and treatment of diseases, morbid structures and the disorders especially incidental to climates, to the sex, and to the different epochs of life. With ... prescriptions, ... bibliography ... formulae / [James Copland].

  • James Copland
Date:
1832-1858
Catalogue details

Licence: Public Domain Mark

Credit: A dictionary of practical medicine, comprising general pathology, the nature and treatment of diseases, morbid structures and the disorders especially incidental to climates, to the sex, and to the different epochs of life. With ... prescriptions, ... bibliography ... formulae / [James Copland]. Source: Wellcome Collection.

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    preserving the infant, unless the discharge con- tinues or becomes more copious; the uterine pains, with the other symptoms of commencing abortion, still persist or increase ; and the woman be advanced in pregnancy ; when little advan- tage will be obtained, particularly if the orifice of the womb dilate. When this is the case, attempts at preservation will entirely fail, and we must adopt the second intention. 36. II. The palliative measures now required consist, in addition to those recommended (§ 33.), of cold applications to the genital fissure and in- sides of the thighs, and the tampon, or plug, as recommended by a number of authors, and sanc- tioned by Denman, Hamitton, Burns, Merrt- MAN, Dewers, Ryan, &c. These are especially requisite where the hemorrhage is great, particu- larly when the abortion takes place between the third and sixth month. Opium, with the super- acetate of lead, given in a very large dose at the first, and repeated according to circumstances, should also be exhibited. Opium, as well as plugging the vagina, are chiefly serviceable where the hemorrhage continues after the expulsion of the embryo. The plug recommended by Dr. DeweEts is a sponge squeezed out of vinegar. Dr. Ryan advises either old linen or a sponge to be wetted with a saturated solution of alum, and smeared with some oleaginous matter, to be passed up the vagina, so as completely to fill it. BuiunbeE tt directs a scruple of alum, dissolved in a pint of water, to be injected into the uterine cavity. 37. The practitioner should in every instance be satisfied as to the expulsion of the embryo and the whole of its appendages, for he may be de- ceived in this matter (§ 19-); a small remnant of the placenta or of the membranes, when still left in the cavity of the uterus, or even lodged m its orifice, being often sufficient to keep up an ex- hausting, or even dangerous discharge. When the embryo onlyis expelled, the appendages being still retained, or when the hemorrhage is great, the entire ovum still remaining in the uterus, the ergot of rye will often prove of inestimable service : and when given in the form of decoction, with as much borax as it will dissolve, will seldom disappoint our expectations. When a portion of the append- ages remain at the orifice of the womb, it may be drawn down by the finger, or by a curved dress- ing forceps. In cases of great hemorrhage in the early months of pregnancy, the ovum being re- tained, Dr. Burns advises the use of smart clys- ters, and plugging the vagina. In every case of hemorrhage from abortion, as well as after deli- very at the full period, but particularly when the hemorrhage proceeds from inefficient contraction of the uterus and retention of the ovum, or some portion of the appendages of the embryo, I have prescribed, with complete success,an enema, with from one to two ounces of theoleum terebinthine in a pint of water-gruel. 38. The injection of water into the rectum, or a solution of acetate of lead and opium, has been advised by Dr. Dewrrs and Dr, Conquest. When the hemorrhage occurs in robust and plethoric females, and the discharge has not produced much exhaustion, venesection may be tried. In cases of this description, digitalis, in half-drachm doses, has been recommended: but, owing to the loss of blood, the effect, although not | produced with the necessary celerity, will often be too violent and unmanageable, and will so en- danger the patient as not to justify its use unless under very peculiar circumstances. I once pre- scribed colchicum in large doses in a case of he- moptysis, with violent paroxysms of cough and threatened abortion, occurring in a plethoric lady at the fourth month of pregnancy. Full vene- section was performed, chiefly on account of the severity of the pulmonary disease; the col- chicum was directed with an anodyne; and the patient left under the care of the family practi- tioner, Abortion took place, and was attributed chiefly to the sickness, retching, and depression occasioned by the colchicum ; it having been un- remittingly administered until my next visit, on the third day from that on which it had been pre- scribed, notwithstanding the discretionary power with which the practitioner had been invested. (See also, on this subject, the Treatment of Hx- MORRHAGE from the Urerus.) 39. III. The remedial treatment of abortions is next to be considered. It occasionally happens that the retention of the ovum, or of a portion of the appendages of the embryo, produces much constitutional disturbance, particularly nervous symptoms and uirritative fever, which sometimes assume serious features, with disorder of the bowels, typhoid or ataxic signs, and an offensive vaginal discharge. The decoction of cinchona and muriatic acid, or this decoction with the liquor of the acetate of ammonia, or the following, will prove extremely serviceable : — No. 1. R Mist. Camphore 3j.; Liq. Ammon. Acet. 3 ijss. ; Acidi Acetici Pyrolignei 11] xxv.; Syrup. Zingiberis. 38s. M. Fiat haustus ter quaterve in die sumendus. No. 2. R Camphore rasex, gr. ij.—iij.; Extr. Cinchon. Resin. gr. iij.—v. ; Conserv. Ros. q. s, ut fiant Pilule ij., ter die capiende. In cases of this description a turpentine enema, administered every second or third day, is ex- tremely beneficial : and advantage will be derived from injections of a solution of the chloruret of lime, or of Labarraque’s liquor, per vaginam. No. 3. R Liq. Labarraquii Chloro-Sod. 3jss. ; Mist. Cam- phore, 3vijss. M. Fiat injectio. ; 40. When troublesome diarrhoea is present, im cases of this description, the chloruret of lime, either in the form of pill or solution, is extremely efficacious. I have prescribed it as follows : — No. 4. BR Chlorureti Calcis gr. viij.—xvij.; Pulv. Traga- canth. Comp. 3 jss.; Syrup. q.s. M. Fiant Pilule xxiv., quarum capiat binas ter quaterve in die. No. 5. R Chlorureti Calcis gr. vj. —xij. ; Tinct. Calumbee 3iij. 5; Aq. Menth. Virid., vel Aq. €arui, vel Aq. Anethi, 3 vj.—3 vijss. Fiat Mist., cujus sumat coch. j. vel ix larga ter quaterve quotidié. The chloruret of lime may also be administered in water gruel, as an enema, in doses of viij. to Xlj. grains, once er twice daily. 41. The debility occasioned by abortions re- quire the use of tonics, with mineral acids, nou- rishing but light diet, a wholesome air, gentle exercise, and the tepid or cold salt-water bath :— the mineral waters of Bath, Baréges, or Tun- bridge; those of Ems, Spa, Pyrmont, and Geil- nau ; or the artificial mineral waters of the last- named places, are also beneficial. When nervous or hysterical symptoms supervene, the exhibition of antispasmodics, with gentle tonics, and the oc- casional use of cooling aperients, are required. The treatment of the effects of abortion is, in every respect, the same as that recommended in