It is not meant to say that the common hysterical fits which may attack women about the early period of pregnancy, or at quickening, require the lancet, or that these fits, at any period, demand it, unless accom panied with much plethora. They may be overcome by purgatives, light diet. and antispasmodics, aided sometimes by tonics. But there is no fallacy more dangerous than the doctrine, that venesection is impro per, merely because the complaint assumes the ap pearance of hysteria. There are few disorders in the pregnant state, which, when severe, are not relieved by bleeding, unless they evidently are dependent on a state of debility. The very sickness and vomiting of pregnant women are best relieved by this remedy, which subdues the excessive irritation of the stomach; or, if it fail, the application of leeches to the epigastric region is almost certainly beneficial ; whilst a general plan is followed for the relief of a systematic condi tion, particular remedies must be employed for ob viating special symptoms : thus heartburn must be re moved by antacids, such as chalk or magnesia, com bined with ammonia or soda; flatulent pains, by laxa tives and carminatives, or antispasmodics ; continued sickness, with bitter taste, by very gentle doses of calo mel ; convulsions, by instantaneous venesection ; faint ing fits, by cool air, application of cold water, and the use of volatiles ; anasarca depending on pregnancy, by the lancet, and aperients, with mild diuretics. To en ter more into the detail of the different diseases of pregnancy, would swell this article beyond reasonable bounds ; nor, is it necessary, as the general principles of treatment have been freely and without reserve laid 1 down. It will not, however, be proper to conclude this part, without adverting to a mechanical disease, which sometimes takes place between the third and fourth month of pregnancy, and which is known under the name of retro: ersion of the womb. It may at this period be produced by improper retention of the urine, by which the bladder is distended, the lower part of the uterus raised and brought forward, whilst the upper part is turned back, and thrown down be tween the vagina and rectum But it is quite a mis take to suppose that retention of urine is the sole cause, or, in many instances, more Itan a secondary one, of in creasing that displacement which had begun to exist. FrIA11 a cal dui examination of the progress and symp toms of this disorder, the writer is convinced that ire gut ntly it arises from an undue degree of prolapsus. The os uteri is brought lower and more forward than it ought to be, anti the fundus lies back in the hollow of the sacrum. The uterus enlarges in this situation, and the funuus sinks lower, whilst the os uteri projects more forward, and obstructs the urine. The bladder becomes distended, and the retroversion is completed or increased thereby, if it had already taken place, by the mere subsidence of the lunch's and consequent ele vation of the opposite end, the uterus turning to a greater or less extent, like a beam of a balance on its axis. A moderate degree of malposition produces in convenience, chiefly from the pressure it occasions on the orifice of the bladder. by which the urine cannot be evacuated. This not only occasions the usual pain ful sensations which accompany retention of urine, but very soon excites severe bearing-down pains, like those of labour. Partly from the effect produced on the lower part of the uterus by the distended bladder, but chiefly by the pressure of the superincumbent viscera, occa sioned by the contraction of the abdominal muscles, the fundus is pressed lower, and the retroversion rendered more complete, and the bladder is still more closed up. The two prominent symptoms then of this complaint are. retention of urine, and hearing•down pains. These pains are more dependent on the state of the bladder than on the position of the uterus, for they are always worst when the bladder is fullest, or most irritated. Last of all, if the complaint be neglected, and the bladder continues unrelieved, inflammation takes place, and generally proves fatal. Our first and great object, therefore, ought to be, immediately to relieve the blad der, by introducing the catheter ; and a regular recourse to this, keeping the bowels open, and allaying irrita tion, if necessary, by opiates, seldom fails in curing the patient. The best catheter to be employed is the gum one, and advantage may sometimes be derived from allowing it to remain in the bladder, so as to keep it constantly empty for sonic time. We have been urged to replace the uterus by pressure, but this often is not to be accomplished without much force, and in some cases, is almost impracticable. No in stance has occurred to the writer where bad conse quences followed from neglecting this attempt, and them efore he is still inclined to advise the more lenient though slower mode of trusting to the use of the ca theter, rather than using force in endeavouring to re place the womb. At the same time, he has no objec tion. after the urine is drawn olf, to make gentle pressure upwards on the fundus uterus, with the hand introduced into the vagina ; hut no strong efforts to elevate are advisable, nor, in any case, ought the at tempt to be .made, till the bladder be completely emptied.
Of Abortion and Hemorrhage.
\Vhen the child is expelled so prematurely as to be unfit for living, the mother is said to suffer an abor tion. This is always accompanied with separation of
the ovum, and contraction of the womb itself. The first is production of discharge of blood, the second of pains analogous to those of labour. Sometimes the se paration, and, in other cases. the contraction, is the first indication of abortion. If this event arise from any exertion, fright, or any other cause operating on the vessels, and occasioning detachment, the symptoms come on unexpectedly, and in general, the first is he morrhage. If, however, it proceed from more latent causes, influencing the vitality of the fcettis itself, we usually observe certain precursory signs, which spew that the embryo or child is no longer alive. The morning sickness ceases, the breasts become flatter or fall off in size, the abdomen feels slack, and a sensa tion of heaviness is perceived in the lower part of it. If the patient be past the time of quickening, she now feels motion no more. Any one of these signs is not to be considered as evidence that abortion is inevitable, but when they are conjoined, there can be no doubt.
If the ovum be very inconsiderable in size, the symp toms attendant on abortion are chiefly those of uterine irritation, accompanied with hemorrhage, and differ lit tle from those of painful menorrhagia. Nothing but coagula can be detected.
If the ovum be distinct, as in the second month, we have an attempt to contract, pains more or less regular, and greater disturbance of the abdominal viscera, and not unfrequently a tendency to syncope.
\Vhen the organization is more complete, and Elio ovum larger, as in the third month, we have still more distinct and regular pains, accompanied with hemor rhage and sympathetic symptoms. Sometimes the wa ter is first discharged, then the foetus, and last of all, the secundines ; in other cases, the membranous hag comes away entire, enclosing the fcetus, and bringing along with it the foetal posture of the placenta, and part of the decidua ; the rest is afterwards thrown off.
\Vhen farther advanced, the process resembles still more nearly labour, except in being accompanied with greater discharge.
When the foetus is expelled in abortion, it is usual for the discharge to mitigate, or stop for a time, then it returns, and sometimes with redoubled violence, pre vious to the expulsion of the secundines. These are thrown off, at different periods, from an hour to some days, but the general time is within 12 hours.
The duration of the whole process, as the nature and extent of the accompanying and sympa thetic effects, vary much in different cases, and in some a portion, or the whole of the secundines, is so long retained as to become putrid, and produce bad con sequences. In general, abortion is not attended with danger, if the constitution he not previously ruined, or the patient much sunk ; but repeated miscarriages ultimately impair the health, and predispose to other diseases. Nor is the process itself altogether void of danger. Very lately, the author was consulted respect ing a lady who had suffered a miscarriage in the second month, and who, when he saw her, was just expiring from hemorrhage, although she had been carefully and zealously attended by two intelligent gentlemen from the first.
A predisposition may be given to abortion by that imperfection which takes place in the uterus in ad vanced life. Repeated miscarriages also not only oc casion a debility in the womb, but also, by the power of habit, give a tendency to injurious changes and ac tions about the same time in future pregnancies. Ge neral or local debility, produced in any way, has also a predisposing effect,and this is particularly the case when there is a relative plethora, or greater quantity of blood circulating in the vessels than their debilitated condi tion can sustain. An absolute plethora is another fre quent predisposing cause, and is generally combined with an hemorrhagic disposition. Excessive irritability of the uterine system, or of the body altogether, ren ders abortion very apt to occur, and the same holds true of undue sympathy between the uterus and other organs. Some conditions of the ovum itself, too ob scure to be detected, or which, either from the minute ness of the part, or destruction of organization which takes place, cannot be observed, must also be includ ed. Delicacy of the membranes, excessive quantity of liquor amnii, diseased cord, or placenta, are amongst the number of causes. The exciting causes are numer ous, and vary in different individuals. One of the most certain is, the death of the child, arising from affec tions or changes peculiar to itself, or from disorders and affections of the mother, such as sudden and se vere cramp in the stomach or bowels. Passions of the mind have much influence on the uterus, disordering the circulation, and causing rupture of the connecting vessels, or exciting the muscular action of the womb. Violent sensations, as sudden immersion in cold water, or a large draught of cold drink, may cause abortion. Acrid medicine, or strong purgatives, or the irritation of piles, Sec. are likewise exciting causes. Violent or sudden exertion, or any effort beyond the safe degree, will cause abortion ; and in those who are predisposed to it, the most trifling exciting causes are sufficient.