A dictionary of practical medicine : comprising general pathology, the nature and treatment of diseases ... with numerous prescriptions ... a classification of diseases ... a copious bibliography, with references; and an appendix of approved formulae / ... By James Copland.
- James Copland
- Date:
- 1844-58
Licence: Public Domain Mark
Credit: A dictionary of practical medicine : comprising general pathology, the nature and treatment of diseases ... with numerous prescriptions ... a classification of diseases ... a copious bibliography, with references; and an appendix of approved formulae / ... By James Copland. Source: Wellcome Collection.
Provider: This material has been provided by the University of Massachusetts Medical School, Lamar Soutter Library, through the Medical Heritage Library. The original may be consulted at the Lamar Soutter Library at the University of Massachusetts Medical School.
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![breasts, sometimes with aslight discharge of serum ; a flow of a sanious, then of a sanguineous, fluid, and afterwards of blood, either in a fluid or gru- mous stale, from the vulva ; diminished motion of the child, soon afterwards followed by perfect cessation of motion ; lessened bulk, of the abdo- men or of the hypogastrium ; uterine pains, which become more and more frequent and severe , pro- gressive dilation of the uterine orifice, and pro- minence of the membranes ; and, lastly, expulsion of the amniotic fluid and foetus, followed, at an indefinite time, by the placenta. JNIost frequently the discharge of blood does not cease until the placenta is expelled. (Desormeaux.) 16. Abortion proceeding from the more ener- getic exciting causes is sometimes preceded by pains, and an unusual sense of weight in the loins and at the lower part of the vagina ; by horripilations or rigors, by general uneasiness, and cardialgia or nausea. From the first there is often an appearance of blood, followed by the discharge of a sanguitieous serum, which soon passes into serious haemorrhage. In other cases the action of the cause is instantly followed by a large effusion of blood, which continues until after the expulsion of the foetus and its appendages. Fre- quent lancinating pains dart through the abdo- men, chiefly in the direction of the umbilicus and vulva • the uterus makes efl'orts at expulsion, and the fcEtus is expelled. The more advanced the term of pregnancy, the nearer do the symptoms approach to those of delivery at the full time; and the nearer also do its consequences assimi- late to those following upon a natural confine- ment, as the lochial discharge, after pains, milk- fever, &c. 17. It is sometimes observed, even up to the middle period of utero-gestation, that the foetus is expelled enveloped in its membranes. But it sometimes also occurs in the first months, that, after the rupture of the membranes, the foetus and placenta are retained, decomposed, and discharged, in the form of a brown foetid sanies. In other cases the placenta is not expelled until several weeks alter the foetus, either in the state now de- scribed, or in that of a putrid mass. It occa- sionally is ot)served that the placenta continues attached to the uterus, and is nourished, increas- ing in size, and assuming the appearance of a fleshy mas<, in which are sometimes found simple cysts, or cysts containing hydatids. This latter occurrence takes place either when the foetus had been expelled, or had died at an early period of its formation ; and, whilst it was yet small and nearly gelatinous, being dissolved during the pro- cess of decay in the amniotic fluid, or preserved in it. 18. This change in the placenta forms what has bef-n called by Desohmeaux and others the mule oj'generatinii; the chief character of which is that it possesses a cavity lined with a smooth membrane, the reniains of the amnion. Fre- quently, at the more advanced periods at which abortion takes place, the foetus is expelled alive ; but the duration of its life subsequently clc])en(.'s upon its age, and the circumstances attending its uborticn. It sometimes also is dead before it is expelled, occasionally for a considerable time ; allhou;^h it may have reached the a^e of several months. Its death does not necessarily lead, although it does generally, to its expulsion. In some cases it is retained even up to the full period of utero-gestation, and is then thrown out in a state of peculiar softening and maceration, but without putrefaction : this only occurs when the membranes have remained entire, and air been excluded from the interior of the uterus. In other instances it is converted into a substance resem- bling adipocere, or the fatty substances generated during the decomposition of animal matter. In rarer cases the foetus and envelopes become hard- ened, and even converted into a bony or petrous state, and retained till the natural death of the mother ; or, in the course of some months, or even years, occasion inflammation of the uterus, and suppuration. Sometimes, in cases of this latter description, a portion of the uterus forms adhesions to the parts opposite ; the abscess which is formed extending in that direction, and opening on the surface of the abdomen, or in the interior of the intestinal canal, or into the vagina, and giving issue to purulent matter, mixed with a foetid sanies, and portions of bones arising from the decompo- sition of the textures of the embryo. But these latter consequences of abortion are rarely met with unless in cases of rupture of the womb, or extra-uterine impregnation. 19. In some cases of abortion the haemorrhage from the uterus continues to a serious extent lor several days. This may be the case at various epochs of pregnancy ; and may result from the detachment, partial or general, of the placenta, and its retention along with the foetus in the ute- rine cavity, owing to imperfect action of the uterus to eject it. It may also proceed from the expul- sion of the foetus, and the reti ntion of the placenta, either altogether or paitly separated from the ute- rus. In some cases the presence of the placenta, or of a portion of the membranes in the womb, or in the os uteri and upper part of the vagina, by the irritation thereby occasioned, may have the effect of keeping up a constant and exhausting hemorrhage. In a case of abortion to which 1 was recently called, the practitioner in attendance stated ihe foetus to have come away two or three days previously. Upon inquiring as to the dis- charge of the appendages, I was led to recommend an examination per vaginarn ; when they were found lodged partly in the vagina and os uteri. After their removal the patient rapidly recovered. 20. III. Diagnosis.—Tht diagnosis of abortion should be directed to three objects : 1st, its cause ; 2dly, to the possibility of prevtnting its occur- rence ; and, 3dly, to asceitaining Ihe stage or development of the process. The causes ol abor- tion are generally readily recognised, and admit of an easy explanation. There arc two, however, to which I'lofessor Desoiimeaux has particularly directed attention; namely, rigulity of the fibres of the fundus and body of the uterus, and laxity of its neck. The former of those is generally con- nected with a siiTiilar state of the whole system, and accompanied with scanty or jjainful men- struation. In the first inijiTegnations aboition takes place at an eaily period ; but in subse- quent impregnations the period of gestation ap- proaches more nearly the natural epoch, the female at last beaiing children to the full time. When the abortion is referable chiefly to laxity of the neck of the uterus, a result contrary to the foregoing takes i)lace ; the period of abortion ap- proaching nearer, in successive conceptions, to](https://iiif.wellcomecollection.org/image/b2119709x_0016.jp2/full/800%2C/0/default.jpg)
