Our object, in order to prevent abortion in those who are not yet threatened with it, is to counteract, as far as we can, the supposed predisposing causes, and avoid with care those which are existing. As a very frequent cause is plethora, with or without delicacy of the vessels of the ovum, a prominent part of atten tion is, the sanguiferous system. We lessen plethora by light diet, restriction in the quantity of liquids, lax atives, blood-letting, and moderate gentle exercise, if that be practicable, on account of the local condition. Diminution of the quantity of sleep, and avoiding heated rooms, and too warm beds, are also proper. When there is a strong predisposition, every thing which can excite the action of the uterus, or the acti vity of the vessels, must be shunned. Hence, in some cases, it may be necessary to confine the patient for some weeks, or even months, to a recumbent posture. It is needless to add, that all stimulants must be ab stained from in such cases. When the cold bath agrees with the patient, it is useful, by rendering all the func tions more perfect, and lessening the risk of plethora.
In debilitated habits, if the cold bath do not pro duce chilliness or disagreeable effects, it is of great uti lity. The diet ought to be neither so sparing as to continue, far less increase, weakness ; nor, on the other hand, so full as to produce relative plethora.
Extreme irritability is lessened by laxatives, the shower bath, and, if combined with debility, by the use of light infusion of bark. If connected with plethora, as it often is, venesection is the best remedy. The re peated application of leeches to the neighbourhood of the vagina is a favourite remedy with sonic continental practitioners. In very nervous habits, when there is uneasiness in the uterine region, supposed to indicate the existence of spasm, the tepid bath, with antispas modics, has been sometimes of service, and is certainly by no means dangerous.
'When abortion is threatened, if we be not assured that the child is dead, we ought instantly to use means for stopping it. Blood-letting is a very general remedy, and a useful one, but it must not be carried too far ; and the practitioner ought to regulate his conduct by sci entific principles. There are chiefly two objects in employing the lancet ; to lessen the activity of the cir culation, and thereby diminish or check hemorrhage, and stop the farther separation of the ovum ; and to abate irritability.
Spare diet, strict rest, cool air, tranquillity of mind. and the other means of lessening predisposition, must be rigidly enforced. The application of cold water to the back and perineum, by means of cloths, is often highly useful ; and if the discharge be considerable, it ought to be commanded by stuffing the vagina. If
there be any pain or general uneasiness, an opiate la useful ; and, indeed, if there be no idiosyncrasy for bidding it, we ought in general to prescribe it. When there is a continued but moderate discharge, or repeat ed discharges, the use of a styptic injection is proper.
When we cannot prevent abortion from taking place, our next object is to conduct the process to a safe ter mination. The principal danger arises from the loss of blood, and therefore our chief attention ought to be paid to the prevention of this by stuffing, and the judi cious use of cold. Faintness, feeling of sinking, or actual syncope, are removed by cool air, smelling harts horn, opiates, and gentle cordials. The placenta ought, in general, to be left to come away by the uterine ef forts ; but, in the mean time, we must guard against hemorrhage by stuffing, or if the discharge be consider able, and the secundines can be brought away by the finger without irritation, that ought to be done.
When a portion of the placenta remains and putre fies, a febrile or hectic state is excited, the patient be comes sick, and the strength is much reduced both by fever and repeated hemorrhages, during the intervals of which foetid matter is discharged from the vagina. The lower part of the belly is tumid, perhaps tender, and languor alternates with hysterical symptoms. If we can feel the portion, and easily extract it, this ought to be done ; but we must not irritate. Injections of solutions of sulphate of aluminc are proper, or of strong decoc tion of oak bark. The bowels are to be kept regular, the diet should be light aad nourishing ; and the free use of fruit or vegetable acid, with the occasional ex hibition of opiates, are proper. In prolonged cases, a gentle emetic may be of service in procuring the re moval of the putrid mass.
It will be proper, in this place, to notice those he morrhages which occur in the latter months of preg nancy, and which are attended with the greatest dan ger both to the mother and child. These have been divided into two classes ; those arising from the im plantation of the placenta over the os uteri, and those in which the placenta is attached higher up. This di vision is highly proper in one respect, but is neither safe nor useful, if it is to give rise to a rule of practice peculiar to each kind. The only safe rule is a general one, that no patient, in flooding, can be with impunity allowed to remain undelivered, after the state of the os uteri will permit of delivery.