Miscarriage

“ As for the disastrous effect which a miscarriage may have on the whole country I will quote the words of a medicine-man and rain-maker of the Ba-Pedi tribe: "When a woman has had a miscarriage, when she has allowed her blood to flow, and has hidden the child, it is enough to cause the burning winds to blow and to parch the country with heat. The rain no longer falls, for the country is no longer in order. When the rain approaches the place where the blood is, it will not dare to approach. ”

“ The same care is required after a miscarriage as after a labor; indeed, a patient requires to be treated much in the same manner—that is to say, she ought for a few days to keep her bed, and should live upon the diet I have recommended after a confinement, avoiding for the first few days stimulants of all kinds. Many women date their ill state of health to a neglected miscarriage; it therefore behooves a lady to guard against such a catastrophe.
406. A patient prone to miscarry, ought, before she become pregnant again, to use every means to brace and strengthen her system. ”

“ Treatment of Threatened Miscarriage.—Not all of the cases of beginning miscarriage end in miscarriage. If the physician is sent for in time he can very frequently give directions that will, if carried out faithfully, avert the disaster. Success is more likely to attend those cases in which the trouble has been caused by some accidental injury, as a fall, or blow, or extra exertion. This is more especially the case if the woman has previously borne children, is healthy and in good condition and whose womb is known not to be diseased. ”

“ Doctors are not likely to use the word miscarriage, but will describe as an abortion a termination of pregnancy which occurs before the end of the seventh month and as premature labors those occurring from that time until the expected date of confinement. In the minds of lay people, however, the term abortion is often associated with criminal practice, miscarriage being a term loosely applied to all births occurring before the seventh month, while the premature baby is the one born after the seventh month of pregnancy but before the expected date of confinement. ”

“ Abortion or miscarriage, which usually is accidental, sometimes becomes habitual; and at about the same period of conception, on many successive occasions, this disappointment will happen.
If there is a strong claim in the ordinary occurrences of pregnancy, for an attentive regard to the condition of mind as well as [Pg 33] body, it acquires its utmost urgency in those conditions in which habitual miscarriage happens. ”

“ In the later stages of pregnancy any appearance of blood should likewise be noted and reported without delay. These symptoms may not always be serious, but they are also associated with grave complications, and should, therefore, be given prompt attention.
MISCARRIAGE
Abortion is a term used to designate the loss of the embryo prior to or at the third month. Miscarriage applies to the expulsion of the fetus or emptying of the uterus after the third month. It is possible for a miscarriage to occur anytime during the interim between the fourth and ninth months. ”

“ Miscarriage also arises in many females from a rigid state of the muscular fibres of the womb, which not relaxing sufficiently to allow that organ to expand become irritated by the pressure they experience, and begin to contract. This contraction of the womb of course soon leads to the expulsion of its contents, the same as in real labor. Women with their first children are more liable to miscarriage than others on this account, the womb not having become habituated as it were to the necessary relaxation. ”

“ It is necessary and it is the physician's duty to insist on it being done in the interest of the woman. Many of the multitude of diseases of women are caused by disregarding advice on such occasions.
The Tendency to Miscarry.—If a woman, for any reason, has had a miscarriage, her womb will tend to miscarry at the same period during a subsequent pregnancy. If the miscarriage should occur during her first pregnancy the tendency to miscarry will be greater than if acquired after she has had a baby. ”

“ Convulsions have already been mentioned as being frequent causes of miscarriage, and all strong mental or moral impressions. Indeed these last causes operate more than is suspected, and make it necessary for a pregnant female to be kept as calm in her mind as it is possible for her to be. I have even known one to miscarry from a fright in a dream. ”

“ These accidents are so intimately connected with flooding, that many writers always treat of them together, considering the flooding merely as the most frequent cause and symptom of miscarriage or abortion. In speaking therefore of the immediate causes of premature expulsion of the fœtus, we place hemorrhage first, and the causes before enumerated which produce that as being its most frequent remote ones.
A full habit, with tendency to local congestion, seems to predispose a female very much to miscarriage; every one so constituted should carefully avoid luxurious living and an inactive life. ”

“ Sometimes the primary cause of a miscarriage is to be found in some hygienic act, such as a hot bath, too prolonged or too many hot douches near the menstrual periods. A blow or a fall, even a fright or shock may cause a miscarriage. Anything that violently shakes or agitates the womb, which may at this time be irritable because of its condition, will be sufficient to excite it to contract and miscarry. ”

“ When the miscarriage has really taken place, and the fœtus, or child, is expelled, together with the contents of the womb, the same precautions should in general be observed as in childbirth.
TO PREVENT MISCARRIAGE, when it is threatened, or on the appearance of the first symptoms, the patient should lie down and be as quiet as possible; live on very light diet; bowels be kept freely open; and an injection of thirty drops of laudanum should be given in half a pint of slippery elm tea. ”

“ There is a proneness for a young wife to miscarry, and woe betide her, if she once establish the habit! for it, unfortunately, often becomes a habit. A miscarriage is a serious calamity, and should be considered in that light; not only to the mother herself, whose constitution frequent miscarriages might seriously injure, and eventually ruin ”

“ If an abortion be threatened from any cause, the same general practice must be adopted as recommended for flooding, the indications being the same. I believe myself that in most cases, except from accidental violence or internal disease, miscarriage may be averted. ”

“ It is probable that there are many constitutional and individual peculiarities predisposing to miscarriage, with which we are not much acquainted, and which may account for the constant occurrence of that accident in many females, notwithstanding all we can do. ”

“ To the mother there may happen correspondingly frequent and serious results. Not alone death, immediate or subsequent, may occur, from metritis, hemorrhage, peritonitic or phlebitic inflammation, from almost every cause possibly attending not merely labor at the full period, comparatively safe, but miscarriage,—increased and multiplied by ignorance, by wounds and violence; but if life still remain, it is too often rendered worse than death. ”

“ In the first case we find a woman married at nineteen having 11 children and 2 miscarriages in 20 years, her husband’s wages being 20s. a week. In the second case there are 5 children and one miscarriage in 9 years; in the third 5 children and 5 miscarriages in 121⁄2 years; and in the fourth 9 children and 1 miscarriage in 24 years. These cases have been taken more or less at random, and nothing could be more significant than the bare fact that out of 386 women who have written these letters, 348 have had 1,396 live children, 83 still-births, and 218 miscarriages. ”

“ INJURIOUS EFFECTS.—Miscarriage is a very serious difficulty, and the health and the constitution may be permanently impaired. Any one prone to miscarriage should adopt every measure possible to strengthen and build up the system; avoid going up stairs or doing much heavy lifting or hard work. ”

“ It is well for young husbands and wives to know that by incautiousness in their relations during this period miscarriage is often easily and actually produced, and unsuspecting parents have oftentimes been the authors, not only of the death of their own child, but the consequences have entailed permanent injuries upon the young wife, and oftentimes resulted in death itself. ”

“ When we cannot prevent abortion, the next thing is to conduct the patient safely through the process; and the first point which naturally claims our attention is the hemorrhage. Many practitioners, upon a general principle, bleed, in order to check this, and prevent miscarriage: but miscarriage cannot be prevented, if the uterine contraction have commenced; and the discharge cannot be prudently moderated by venesection, unless there be undue or strong action in the vessels. ”

“ The pain, the discharge, and, at the same time, the danger of an abortion, are in proportion to the advancement of the pregnancy. When a miscarriage goes on, the pains increase in force and frequency, and continue, with discharge of blood, fluid or in clots, until the ovum, or first formation of the child, is expelled; after which both become moderated till they cease altogether and the [130] red flow gives place to a colorless one. It is very important that those in attendance upon the patient should examine every clot that comes away. ”

“ HABITUAL MISCARRIAGE.—Experience teaches that women who have had one miscarriage must be more careful than other prospective mothers if they would escape a repetition of the accident. Persons who know themselves to be subject to miscarriage should regard no precaution as too burdensome. Not only should they avoid motoring, driving, railroad journeys, sea voyages, and every kind of strenuous exertion, they must accept every opportunity to be quiet and rest. Often such hygienic care yields sufficient protection; but occasionally medicine is also necessary. ”

“ This matter of conception and gestation, after a miscarriage, has of late been made the subject of special study, and there is little doubt that from this, as the primal origin, arises much of the nervous, mental, and organic derangement and deficiency that, occurring in children, cuts short or embitters their lives. ”

“ A condition of debility, or the presence of certain special poisons in the blood, may prevent conception, or, what is to all intents the same thing, cause miscarriage. Many apparently feeble women have large families. But in numerous instances a tonic and sometimes an alternative constitutional treatment is required before pregnancy will take place. On the contrary, there are well-authenticated cases of women who were stout and barren in opulence becoming thin and prolific in poverty. ”

“ When a woman is infected at the conception of her child miscarriage takes place before the child is viable, from the first to the sixth month; later other miscarriages occur; later still, living but syphilitic children are born, of whom one-fourth die within the first six months ”

“ If she fails to follow this advice it is quite possible that she may have a hemorrhage during the course of the miscarriage of a sufficiently serious character to endanger her life or from the effects of which she may suffer for the remainder of her life. ”

“ In early gestation, the gelatinous ovum is sometimes excluded several days before the membranes; in other cases,{367} there is a discharge of serum days and weeks before miscarriage. Abortion is usually preceded by nausea, pain in the back and loins, frequent micturition, tenesmus, discharge from the womb of water or of blood. If not in their immediate, yet in their future consequences, miscarriages are much more fatal to puerperal women than appears in the registers.
Floodings are seldom fatal to women before the two or three last months of pregnancy ”

“ Premature labor designates the time of expulsion as between the twenty-eighth week to within a few weeks before the normal termination of pregnancy. Miscarriage is the term popularly used for the accidental loss of the products of conception. Abortion, in the popular mind, expresses the intentional loss of the products of conception. Abortion in the medical sense, takes place about once in every four or five pregnancies. ”

“ A woman may experience some threatening or warning symptoms of miscarriage for one or two days before those of labor supervene. There is usually a feeling of languor or weariness, of lassitude and depression of spirits, and a sense of uneasiness, and then, after these premonitory symptoms have lasted for some time, there may be a discharge of mucus or blood from the vagina. The show may increase to flooding, and soon there may be pain, at first slight and irregular, afterwards of a grinding character, and subsequently severe, irregular, and bearing down. ”

“ As an intimate knowledge of pathology is often necessary to recognize the underlying, and therefore the actual, cause of the miscarriage, it is not at all surprising that patients frequently err in their interpretations of such accidents, and emphasize unimportant matters. ”

“ To prevent a miscarriage, observe faithfully the hygienic rules laid down in this book. Make the best possible conditions for health in every direction. Especially observe the law of continence. Once threatened with abortion, hemorrhage ever so slight having set in, a woman should by all means take her bed and observe perfect quiet. She must run no risks. Apply compresses and take frequent short, tepid sitz-baths, live on a mild, cooling diet, and the danger may be averted. ”