[The preparation of mercury used will depend on the preference of the individual physician. The most efficient means of bringing tbe system rapidly under the influence of the drug is by inunction with the oleate of mercury, and, further, thus there is less risk of interfering with the digestive organs. In this country the biniodide of mercury is usually preferred to Van Swieten's liquor, which is entirely too irritating to the digestive tract. The necessity of tonic treatment in conjunction with the mercurial, should never be forgotten.—Ed.] Under diathetic affections, we would class ulcerations of the cervix, and chronic endometritis. Especially is it of importance in these cases to subject the woman to local treatment, in order to cure these affections before allowing a second conception.
[There is one cause of miscarriage, the importance of which is not recognized by the author, and this is laceration of the cervix. Although in certain instance,s, laceration of the cervix would seem to favor concep tion, because the cervical canal being widely open, the spermatozoa have readier access to the uterine cavity, still, remembering that this laceration is a direct irritant to the uterus, keeps it in a state of congestion, and is at the bottom of a chronic cervical catarrh, we must believe that this is a frequent cause of habitual misc,arriage. Many cases have been recorded of late years where this habit has been broken up trough the repair of the lacerated cervix. In any case, therefore, where this lesion exists, and the woman habitually miscarries, the operation is indicated as a prophylactic measure.
In cases of habitual miscarriage, where the causal factor is apparently impoverishment of the mother's blood, the tincture of the chloride of iron, together with the chlorate of potash, administered daily throughout pregnancy, will frequently enable the woman to go to term.—Ed.] Aside from diathetic and uterine affections, there are a number of causes which call for prophylactic treatment. Pregnancy itself, we have seen, through the influence which it exerts over every organ in the body, predisposes to miscarriage, especially by causing abnormal irritability of the uterus; and again, in certain women, the uterus is in such a condition of atony, that it becomes congested with the greatest ease. It is in such cases that rest in bed is absolutely indicated. But we must be careful not to err to the other side, for too much rest may cause loss of appetite and weaken our patients. Ordinarily, we only require our patients to stay in bed at the time corresponding to the menses, for two days before, during this time, and for forty-eight hours afterward.
Usually, at the fourth month it is no longer necessary to follow this rule.: In this manner we have often been able to carry to term, women who had before miscarried a number of times. If the irritability do not yield to rest alone, and if, above all, the pain in the back persists, aCCOM pan ied by slight uterine contractions, then opiates should be associated with rest. Opium should be administered in enemata fifteen to twenty drops morniug and evening for a few days, taking the precaution to avoid constipation. In women who object to enemata, suppositories of belhulonna and the chlor-hydrate of morphia will be of service. It is remarkable the amount .of opium which the gravida can take. We have often administered from forty to one hundred drops of the tincture of opium in twenty-four hours, without causing narcotism.
Phlebotomy is often of great assistance, and this too in women who are not plethoric. General bleeding from the arm is, in our opinion, far preferable to local. It should be practiced with the woman in the recumbent position, in order to avoid syncope. Depaul, Devilliers, Triaire, agree with us in thinking that general venesection is preferable to local.
In a certain number of instances the means indicated above do not suffice. The symptoms of miscarriage, hemorrhage, uterine contrac tions, appear. What are the means at our disposal? Curative as we have seen. is absolutely in evitable only if the fcetus is dead, or the ovum is not intact. Up to the fourth month, signs of fcetal death are absent, and yet we ought to act, always, as though we were certain of the vitality of the fcetus, that is to say, turn all our. endeavors toward preventing the miscarriage. In the presence of hemorrhage and of uterine contractions, especially if neither is marked, we must act quickly.
The first thing to do is to put the woman to bed, keep her absolutely quiet, and administer opium enemata. At the outset we give twenty five drops of the tincture with a syringe, in order to be certain that she receives the entire dose. At the end of six, or of twelve hours, accord ing to the urgency of the case, this is renewed, and so on for twenty four to seventy-two hours, if necessary. When opium is thus admin istered continously for a number of days, each morning the woman should receive a large enema of glycerine and water, in order to avoid constipa tion.