In the after-treatment of a case of abortion there is little to call for attention if strict antisepsis has been observed, and the case follows an aseptic course. Many operators prefer to pack the uterine cavity lightly with gauze after clearing it out, with the object of preventing any further hxmorrhage. Should this have been done the gauze should be withdrawn at the end of 24 hours, and a daily douche administered for a week, during which the patient should be kept in bed. After that time has elapsed, she may be allowed to get up and go about. Should the case be septic from the first, or become so in process of treatment, it should be treated on the same lines as a case of Puerperal Sepsis (q.v.).
Habitual Abortion.—When a woman aborts more than once an en deavour should be made to discover and to remedy the cause of the repeated failure to carry the ovum to term. The first thing to do is to make sure that the abortions are not caused instrumentally or by drugs, a practice which is on the increase to an alarming extent, especially among town-dwellers. Such a practice may be suspected when the doctor is only called in after the loss has lasted for some time and the uterus is perhaps already septic, when the patient is quite unconcerned about the untimely fate of her offspring, or is even undisguisedly relieved by it. Some diplomacy in quwstioning must be observed if the practitioner does not want to lose his patient, but if the diagnosis be once made, a faithful warning should be given of the dangers and the criminality of the practice. It was an old observation that one abortion was often followed by a second, and that a " habit of abortion " was likely to be set up. In most cases this so-called habit is due to the inefficient treatment of the first abortion, part of the secundines being left adherent to the endometrium, and setting up a localised endometritis sufficient to form the starting-point of a second miscarriage. The remedy is obvious, and in the case of a healthy woman, with no malposition of the uterus, repeated abortion should be the strongest indication for a careful curetting, which will usually put a stop to the trouble.
A pelvic examination will often show some gross lesion of the uterus, which may act as a predisposing cause. Such are retroversion, extensive cervical laceration with endometritis, and fibroid of the uterus. The appropriate treatment for these troubles will often be effectual in enabling the patient to carry her child to term.
In other cases the symptoms of a systemic or general disease will be found. Of these, a very common cause of abortion is syphilis. The possibility of syphilis being at the bottom of the trouble should always be remembered by the practitioner, as the mother may show practically no symptom of the disease except the tendency to abort. It is well to have a private conversation with the husband, and to learn his previous sexual history. and if there is any doubt as to the diagnosis a sample of blood should be taken and Wassermann's test performed. Cases which are established as syphilitic should be given a careful and thorough course of treatment with salyarsan and mercury, and the Wassermann test again applied at the termination of the course (see Syphilis). When the patient becomes pregnant again, she should be put on i gr. of grey powder three times a day for three weeks, then a week's interval should be allowed, then the mercury again for three weeks, and so on till term. The other general diseases which lead to abortion are renal and cardiac trouble. For the treatment of these see appropriate headings. It should be remembered that certain drugs may cause or predispose to abortion. Chief among these are phosphorus, lead, and alcohol, and the possibility of poisoning by one of these should be inquired into in a doubtful case. Aloes, scrims, savin, pennyroyal, ergot and cottonroot have the reputation of abortifacients, and probably in a sensitive patient and in large doses may justify it.
Lastly, in a patient who has shown a tendency to abortion, care should be taken to warn her as to the advisability of exercising precaution during pregnancy, especially at the time when the menstrual flow should come on in the ordinary course. She should then keep her bed for a day or two, live on light diet, keep the bowels relaxed but avoid purgation, and sexual intercourse should be strictly forbidden. Bromides may be given in small doses, or 20 mins. of the fluid extract of viburnum prunifolium every .1 hours, or r-3 grs. of quinine with ro-15 mins. of ext. ergot. liq. three times a day. She should he warned to take to bed on the first sign of pains or hemorrhage.
Missed Abortion.—This name is given to those rare cases in which signs of abortion conic on and pass off, leaving a dead ovum contained in the uterine cavity it may be for months. The proper treatment is to dilate up the cervix and clear out the uterus.—R. J. J.