THE TREATMENT OF MISCARRIAGE.
Whatever the causes of miscarriage, we have seen that they induce one or another of the three following phenomena: 1. Either they deter mine the death of the fcetus, and thus necessitate miscarriage; 2. Or else they induce congestions, hemorrhages, which, by causing the prem ature detachment of the ovum, thus compromise, either directly or indirectly, the existence of the product of conception; 3. Or, finally, they excite premature contractions of the uterus, and then follow expulsion of the ovum and of the ketus. To combat these causes, such is the indication which the prophylactic treatment of miscarriage, as it has been called, must fulfil. When this prophylactic treatment has failed, or has not been instituted, and the miscarriage seems inevitable, then, by means of the curative treatment of miscarriage, we still seek to stop it, and thus allow pregnancy to continue, or else, if we cannot, to avoid complications, and to successfully overcome them.
Prophylactic The death of the product of conception within the uterus, whenever it is not accidental, or caused by independent disease of the fcetus, or of its appendages, is the result of one of the pathological causes, usually hereditary or acquired, which we have men tioned." This sentence, which we have quoted from Jacquemier, resumes in a word the greater portion of the indications for prophylactic treatment. We say the greater part, because it only applies to those cases where the product of conception is dead, before the symptoms of miscarriage are evident; and in a large proportion of cases the ovum is expelled living, and long before term, under the influence of some Iocal morbid state of the mother, without one being able to lay its death to any special diathetic cause. When this diathesis exists, and causes the death of the fcetus, we must determine it, and fight it by appropriate treatment, before we allow a second pregnancy. If the woman is of a lymphatic, chloro-anemic constitution, we must have recourse to tonic and strengthening means; the preparations of iron, or arsenic, sea baths, hydrotherapy, mineral waters containing sulphur or iron, used as baths or douches, quinine, these are indicated; but, be it understood, such treatment must be continued for a long time, in order to give good results, and a second pregnancy, supervening too rapidly, not only would not go to term, but the woman would lose the little benefit which had resulted from the treatment.
Among these diatheses, there is one which leads all the others, and this is the syphilitic, and we have seen already how frequent it is, and also how deadly to the product of conception. We have seen also that, in habitual miscarriage, syphilis, possibly latent, either of the father or of the mother, is the cause. Anti-syphilitic treatment, therefore, as well for the father as for the mother, especially the latter, should be rigorously enforced.
In regard to syphilis, we would make the following statements: 1. Syphilis may be latent both in the father and in the mother, and yet neither possess any symptom, and it may be only the recurrence of mis carriages without known cause which awakens the suspicion of syphilis. 2. Both father and mother may be syphilitic, either recent or old, and both may know it. 3. Very often the father alone is syphilitic, and the mother is ignorant of the symptoms she has had or still has. 4. In rare instances it is the mother who is contaminated, and the husband has escaped oontagion.
In any instance anti-syphilitic treatment must be resorted to. The following is our practice in this respect: 1. Syphilis is latent, and there are habitual miscarriages. We give a teaspoonful of Van Swieten's liquor every morning during four to five months, interrupting the treatment for a few days in case of colic and gastralgia; then the treatment is interrupted during two or three months, and resumed for four weeks. At the end of a few months we allow a second pregnancy. 2. Syphilis exists in both the father and the mother. Here it is necessary to subject both to treatment. 3. Syphilis exists in but one of the couple. The suspicions of the other must not be awakened, but the treatment must be as persistent.