The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 1).

Date:
1845
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Licence: Public Domain Mark

Credit: The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 1). Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    less evident than those now enumerated, are also usually admitted by authors : for example, leu- corrhoea, irritability or too great contractility and rigidity of the uterine fibres and blood-vessels. Those who have insisted on rigidity of the uterine fibres as a cause of abortion have been led into error, by supposing that the uterus enlarges during pregnancy by the mere force of the mechanical distension of the ovum, and not by the gradual developement of all the textures of the organ, in exact correspondence with the growth of the organs of the foetus. But by far the most frequent cause of abortion is in the product of conception itself; viz. in a diseased condition of the foetus, or its involucra, by which it is deprived of life, and afterwards expelled from the uterus like a foreign body. The blighted ovum is thrown off from the parent, as fruit which has become withered is separated from the branch of the tree on which it has been pro- duced. We have examined numerous ova which have been prematurely expelled, and in many of these, where no disease was obvious at first, some morbid state of the membranes, placenta, or em- bryo itself, has been detected, sufficient to account for the accident, wholly independent of any con- stitutional or local affection of the mother. Some- times the chorion has been thickened, opaque, and extremely irregular, or lobulated, on its internal surface. The amnion, in some cases, has under- gone similar changes, so that the healthy appear- ance of the involucra has been entirely lost. A collection of serum, or blood, has not unfrequently, also, taken place, between the chorion and amnion. The placenta, in some cases of abortion after the third month, has been hard, like cartilage, small and imperfectly formed, with calcareous particles deposited in its substance : in others, the placenta has been unusually large, and its vascular struc- ture has been changed into a soft yellow fatty substance ; or hydatids have been developed in its tissue. The umbilical cord, in these instances, has been remarkably slender, and the foetus has appeared to perish for want of a proper supply of nourishment ; and not from any defect in the organization of its internal parts. The brain of the foetus, or the thoracic or ab- dominal viscera, may all undergo various altera- tions of structure incompatible with life; and where the life of the foetus is extinct, it becomes an extraneous body ; expulsive efforts on the part of the uterus are usually soon set up, and abortion ensus as the necessary consequence. When the ovum is healthy, it adheres to the uterus with great force ; but when diseased, the slightest shock to the mother, the most trifling mental affliction, is sufficient to cause it to be expelled. Women have had the bones of the extremities fractured during pregnancy, and have suffered other grievous injuries, without miscarrying. A woman men- tioned by Mauriceau escaped by a window from the third floor of her house when on fire, and in her fall to the ground fractured her arm, yet abortion did not follow. The case of a young woman with a narrow pelvis is related by Madame Lachapelle, who threw herself into a deep pit, and suffered injuries of which she subsequently died, yet the foetus was not expelled. All cases of abortion cannot, however, be referred to organic diseases of the uterine organs, or of the embryo and its involucra ; since it can- not be doubted that the process often arises from accidental detachment of the placenta, in conse- quence of an unusual determination of blood to the vessels of the uterus, or contraction of its parictes. The placenta adheres to the uterus by means of the deciduous membrane alone, which is directly applied to the openings of the uterine sinuses. If the impetus of the blood in these be increased by an excited state of the general circu- lation, or by irritation of the uterus itself, an unu- sual afflux of blood to these vessels will take place, and the placenta will be forced from its connexion with the uterus, more or less exten- sively, by the extravasation of blood from the openings of the uterine sinuses, between the placenta and uterus. If this takes place to a con- siderable extent, the process of gestation will be arrested, and in a longer or shorter period the ovum will be expelled. In plethoric women, or in those who menstruate copiously, very slight causes may give rise to a hemorrhagic effort in the uterine vessels, and to the extravasation of blood between the uterus and placenta, with the other consequences now described. A plethoric state of the uterine organs is most frequently met with in those who lead luxurious lives, who sleep in warm soft beds, and indulge to excess in animal enjoyments. This plethoric state of the uterus commonly gives rise to a sense of weight in the hypogastric region, or irregular pains of the uterus; but it sometimes happens that the blood suddenly bursts from the uterine vessels, and detaches the placenta, where there has existed no previous sign of unusual determination of blood to the parts. Besides these causes, there are others which excite undue determination of blood to the uterine organs, as violent exercise, dancing, the use of the warm bath, the employment of acrid cathartics and emetics, spontaneous diarrhoea, the irritation of hemorrhoids, injurious pressure of the hypogas- trium, and violent passions of the mind. Opening the membranes of the ovum and evacuating the liquor amnii certainly gives rise to premature expulsion of the contents of the gravid uterus. [Occasionally a habit of aborting is acquired ; so that it is extremely difficult for the female to pass the period at which the accident has occurred in previous pregnancies. Cases have occurred in which it has happened upwards of twenty times in succession, about the same period of gestation.] The symptoms which precede abortion will be greatly modified by the exciting cause. For the most part, the expulsive process is preceded by unusual depression of strength and spirits; by attacks of faintness, sense of coldness in the pelvis, palpitation, flaccidity of the breasts, a disordered state of the stomach and bowels, and other symp- toms, which indicate that the embryo has been deprived of life. Where an unusual afflux of blood to the uterus is the cause, the uterine pains or contractions are usually preceded for some days by rigours, lassi- tude, heat of skin, thirst, loss of appetite, excited state of the circulation, and sense of weight in the pelvis and loins. A greater or smaller quantity of blood then escapes from the uterus and vagina, with pains occurring at intervals, like the pains of natural labour. Where the discharge of blood is great, the placenta has usually been extensively detached from the uterus, and all efforts to prevent