The uterus is in some degree of the same nature with the bladder. In dif ferent people we know the bladder, with. out inconvenience, contains a different quantity of urine ; in one person it will not, without his feeling uncomfortable, contain more than six ounces ; but that is not as much as it can hold, because it will, if necessity urges, contain four times that quantity. In proof that it can dilate, every person may have observed, that at one time the quantity which he retains with convenience will vary from that which be retains at another time. It is the same with the uterus, which may be disposed to hold a certain quantity of contents only, by which die ovum attains not more than a certain size before it excites the involuntary action of the uterus, by which the whole is expelled. That the disposition exists, and that this often produces miscarriage, appears hence, that many women go to the usual time of Miscarriage, and feel all the signs of disposition to abort, and yet, if they keep quiet for a sitffici( nt length of time, they will recover, and go the full time of pregnancy. This is accounted for by the disposition in the uterus to contract at a certain period of gestation. Tumours also may cause a disposition to miscarriage Constipation acts in the same way, for, while it lasts, it produces exactly the same iftct that other tumours would. All circumstances, which, by increasing the circulation, keep up too great a velocity in the motion of the blood. Thus, vio lent exercise will produce miscarriage ; it will, by the increased motions of the blood, separate a portion of the placenta from the uterus, which is very easy to for a certain force, being ap plied to the cells of the maternal part of the placenta, will be sufficient to rapture them; and the cells giving way, the blood will make its escape between the surface Of the placenta and membranes, so as to fbrm hemorrhage. Where the flow of blood from the ruptured part isconsider able, and it finds a different course be tween the membranes leading to the os uteri, it will produce then a considerable degree of hemorrhage. Violent he morrhage will also sometimes arise from the use of spirits in too large proportion. Now and then accidental injuries done to other parts of the body will cause a par tial separation of the placenta from the uterus. Acute diseases of the mother, pleurisy, acute rheumatism, continued fever, small-pox, scarlatina, may any of them produce miscarriage : there is no disease in which abortion is so dangerous as in the small-pox. Passions of the mind will frequently cause it ; and none so surely as those which increase the action of the heart and arteries. Rage may separate the placenta from the uterus very soon. It is not essentially necessary that the force of action of the -heart and arteries in general should be increased, because increased local action of the part is quite sufficient; whence the union of the sexes often causes women to abort; and, to make sure of breaking the habit; the best way is to separate the wife from her husband for a time. Violent exercise of almost any of the passions may produce the same effect.
With regard to the signs of approach ihg abortion, the first and most obvious change is the absence of the morning sickness, which sickness is always a sign of health in the fcetus, and goes away when the fetus dies: Another symptom preceding a miscarriage is, a subsidence of the swelling of the breasts, from be ing hard they become flaccid ; by these signs will any woman, but particularly if she have miscarried before, know the ap proach of this state. There are also pains about the abdomen and back, which are so many evidences that the uterus has taken on this action. Hemorrhage, id general, also attends these symptoms, though sometimes a miscarriagemay happen with very little loss of blood.
Women miscarry in various ways, with regard to the progress of the abortion. In some the ovum is expelled, and in others it will come away in pieces. The ovuni, and its membranes may be thrown off first, while the decidua does not appear till afterdrards; sometimes the ovum will come away in a clot of blood, and it would not be known as an ovum, if the clot were not broken down and examin ed : at times the membranes will break very early, and the fetus will come first. In some abortions there isgreat pain the grindingpains will sometimes equal those of labour t while in others there is very. little, the ovum appearing to drop off from its connection with the uterus, upon the os uteri being relaxed, just as premv ture fruit drops from a tree ; sometimes the loss of blood is great, at others little.
As to the prognosis in miscarriage, it will be influenced by the state of the con stitution : if it depend upon the contrac tion of the uterus alone, the pains will go on as in labour, till the whole ovum is ex pelled. But where the miscarriage de pends on some cause acting on the cir culation, the woman will often lose a large quantity of blood, become cold, faint, and the blood will stop. If during her fainting she be revived by wine and warmth, the hemorrhage will return, and the abortion perhaps be confirmed ; but if these stimuli be avoided the blood will often coagulate, close the breach of con tinuity in the placenta, and the woman will go her full time of pregnancy.
There is very little danger in abortion; generally speaking; when happening in the five first months. We may say, that; provided the constitution be good, there is no danger before the fourth month. l'he vessels at this time are small, and the hemorrhage is seldom rapid, and the safety or danger of the patient will de pend upon the proportional size of the vessels from which the blood issues; together with the time in which it is lost. But if it be continual, though not from large vessels, it may at length kill, either immediately, or by overpowering the con stitution. A child may be bled to death by leeches,and an infant has been knowri to die under the operation of a single leech ; a woman who does not die while the blood is flowing, may die in conse Quence of dropsy caused by the loss of blood. Abortion never ends at once iir death, but it produces weakness and dropsy. All miscarriages are more dan gerous while the woman has an acute disease, and most so with the small-pox the most dangerous days being from the eleventh to the thirteenth day of the eruption. When hemorrhage happens before abortions, it does not follow that the ovum must be destroyed ; enough of the placenta may still remain attached to the uterus to carry on all the purposes of life, and the pregnancy will go on. The constitution, if good, will generally bear the loss of a little blood ; as much should be taken as the patient can bear, for twelve ounces at' once will be more effectual than sixteen ounces at twice in restoring the balance in the system. After which a saline draught may be given every six hours, with about six drops of laudanum in each it is rarely useful or necessary to press the opiates beyond that quantity ; a large dose of opium will frequently increase the force of action in the heart and arteries, while a small one will keep it in the state de sired. The bowels must be kept lax with small doses of the purgative neutral salts ; the patient must at the same time tie kept quiet, with little or no animal food ; farinaceous decoctions, with vege table nutriment are all that should be taken while this state remains, as these do not add to the force of the circulation.