ABORTION.
Threatened Abortion.- When a woman in the first few months of her pregnancy begins to lose blood or Liq. Amnii, she should at once be put to bed. So as the loss is moderate in amount—i.e., not much exceeding the average menstrual llow—and so long as there are no signs of death or decomposition of the ovum, the case should be treated on expectant principles. An examination with the speculum should he made to ascertain the source of the bleeding, as it may be coming from a granular or eroded cervix, from a polypus or from a cancer, and may not be due to a threatened abortion. The possibility of hydatidiform mole should also be kept in mind. Should the patient's general health begin to suffer from the amount or continuance of the haemorrhage, should large or numerous clots he passed, or fragments of the ovum or decidua, or should lector or rise of temperature be noted, it is well to hasten the clearing out of the uterus.
Complete rest in bed is the most important of the expectant measures. It should be insisted on, no matter how slight the hamorrhage, and should be maintained until a week after bleeding has ceased. While the patient is in bed she should have light diet, avoiding all highly seasoned dishes and stimulants of any kind. Purgatives should not be given, but a gentle aperient, such as Liquid Cascara and Glycerin, to be followed in the morning by a saline draught if required, may be administered to prevent constipation. As to drug treatment, it is advisable to give Morphia, A gr., on first seeing the patient if the hemorrhage is considerable in amount, and if it continues the close may he repeated at intervals of three hours until a grain has been given. It is doubt ful whether any drug will save an ovum if rest in bed fails. Ergot in to-min. doses and Quinine in 5-gr. closes three times a day have been recommended, and have the advantage that if abortion is inevitable matters are brought to a head in a shorter time. Ext. Viburni I'runifolii in 2o-min. doses or Liquor Sedans (Parke Davis) in t-dr. doses is unlikely to precipitate the catas
trophe, and may have a sedative effect.
When the urgent symptoms have passed off, and the patient is con valescent, she should he warned against any extra exertion, againt con stipation, coitus, strong purgatives, and hot vaginal douches. Should the loss have occurred at the time when menstruation would have taken place in the ordinary course of events, she should keep her bed for four or five clays at the next recurrence of that epoch, and she should be warned of the importance of taking to bed on the first sign of a return of the hamorrhage or of pain in the back.
Should the haemorrhage last several days, and be accompanied by the retention of clots in the vagina, it is well to wash out the vagina with a very gentle lukewarm douche of creolin or lysol, i dr. to the pint.
Inevitable Abortion.— When the progress of events has shown that a threatened abortion has heroine inevitable, or when the initial symptoms have been copious hemorrhage accompanied by strong uterine contrac tions and pain in the hack, when the case is already septic on his first visit, or when he has reason to suspect a criminal abortion, which almost invariably results in sepsis, the practitioner's object should be to accom plish the safe, rapid, and complete emptying of the uterus. When this object has been achieved, the hemorrhage stops, the uterus contracts firmly, and unless the case is septic recovery rapidly ensues.
If the practitioner finds on arrival that the haemorrhage has ceased and the uterus has firmly contracted, he has presumptive evidence that the ovum has been expelled. This presumption becomes a certainty should he find the ovum in the vagina or should he be able to satisfy him self of its presence in the clots passed per vaginam. When this is the case, there is nothing to do hut to enforce rest in bed for a few days, and to see that the patient's vulva is sponged with an antiseptic and covered by a sterile pad.