A remarkably excessive nervous irritability or sensibility of the uterus may be the determining cause of the abortion. The irritability is so called because it forms a part of the constitution; such women will abort from sympathy with affections of the bladder, rectum, kidneys, stomach, and parotid, thyroid and mammary glands, or from disorders in other parts, which in other persons would be followed by no such consequence. Ovarian irritation in women who have been subject to dysmenorrhoea, has a strong tendency to produce abortion at the catamenial dates. Lactation usually serves to prevent conception; but where it does not, the irritation of the mammae from constant suckling, like any other long-continued irritation of these glands, may produce abortion. And, finally, a pre-established habit of aborting may of itself become a powerful cause of abortion in each succeeding pregnancy.
II. CONDITIONS PRINCIPALLY DEVELOPED BY PREGNANCY ITSELF. Both the first mentioned and the present class of causes of abortion are included by Dr. Whitehead, under the general head of predisposing causes. “By predisposing causes are meant certain morbid conditions, local or constitutional, already in the system; or a particular susceptibility to morbid action during, by the operation of which the process is liable to be prematurely arrested. ( On the Causes and Treatment of Abortion and Sterility: By James Whitehead, Fr.R.C.S. London, 1847).
In some constitutions any one of the various disorders incident to pregnancy may threaten to lead to abortion; and in some cases several of these seem to combine to produce this result. Among these may be mentioned the different forms of gastric and intestinal disorder, from nausea and vomiting to the obstinate constipation. Although it is not probable that these affections would result in abortion unless there were present some abnormal irritability of the uterus itself, and although they may have their origin in the same psoric miasm that occasions the uterine; still these affections are entirely developed under and by the condition of pregnancy.
Similar in their origin and influence are those local disorders of the uterus and its appendages which appear for the first time in connection with the state of pregnancy, among which may be enumerated dropsies of the uterus; fibrous and polypous tumors, and all the uterine displacements which result from the pregnant condition. Placenta praevia my be the cause of abortion, although this is doubted by Cazeaux; Whitehead says: “When the placenta happens to be implanted with its centre over the os uteri, abortion is inevitable; nd this almost invariably takes place before the end of the fifth month.
Disorders of the ovum itself, in its different stages of development, and of its immediate appendages, may also be enumerated in this place as causes of abortion, since almost all of them are directly and necessarily the results of morbid conditions of the mother. The important exceptions to this general remark are found in certain cases in which the morbid condition of the ovum is derived from the fecundating semen of the male. The mother for example may be perfectly healthy; while yet in every instance the product of conception becomes blighted in its earliest development or destroyed by abortion resulting from disease inherent in the ovum itself. In such cases the source of the mischief will be found in some taint in the system of the husband, syphilitic for instance, which may thus be imparted to the ovum through the semen; sometimes also the wife becomes in this manner infected with constitutional disease. Suitable treatment directed to the husband will remove this cause of abortion, and the subsequent conceptions may terminate in healthy offspring.
Disease of the ovum may excite the uterus of contraction, before the actual death of the ovum has occurred. Moles, hydatids, and in fact every possible form of blighted ova, necessarily involve abortion. And the death of the ovum, rendering it a foreign body in the uterus, will be followed by its expulsion sooner or later; exception in those not very uncommon cases, in which the ovum is entirely reabsorbed. For more particular description of these, and analogous cases of abortion which belong to influences principally developed by the pregnant condition itself, the reader is referred to be preceding chapter on Diseases of Pregnancy.
III. INDEPENDENT INFLUENCES. By this expression we mean simply those influences which appear subsequently to and independent of the pregnant condition.
1. Physical over-exertion of any kind, riding on horseback or in carriages over rough roads; laborious occupations; fatiguing exercises; long walks; violent efforts, such as lifting, running, jumping, by exciting the circulation or straining the part, may occasions uterine hemorrhage or pains, or both, which, unless arrested, will inevitably produce abortion.
2. Accidental or intentional violence, directly applied to the genitalia, leads to a similar result, by causing such rupture or separation of the membranes, or disturbance of the ovum itself, as arouses the contractile and expulsive action of the uterus.
3. Various drugs, administered intentionally, for other purposes, or accidentally, occasion the same result, either by direct action upon the uterus and neighboring organs, or by indirect action through the spinal cord. Among the most remarkable are, Secale c.; Cimicifuga; Sabina; Caulophyllum; Apis; Aloes: Cantharis; Borax; Quinine; Mercury. There are many others, which in larger or smaller quantities are said to have produced abortion. Violently acting emetics and purgative of any kind lead to the same result from uterine sympathy with the gastric and intestinal irritation.
4. Excessive indulgence in coition, especially in the earlier months, by the passional excitation of the uterus and its appendages, disturbs the ovum and occasions its expulsion.
5. Moral over-excitement of every kind; paroxysms of sudden and violent anger; sudden surprises or affright; horrible sights; situations of imminent danger; violent emotions of grief or despair for the departure or loss of friends, may produce abortion.
6. Local diseases of contiguous organs, such as diarrhoea and dysentery, may produce abortion from sympathetic irritation.
7. Gonorrhoea and inflammation of the uterus, where pre- existing, should be classed in the first order of causes of abortion. In such cases it may give rise to the severest form of purulent uterine leucorrhoea, to erosion, induration, ulceration and even fissures of the cervix uteri, conditions from which, if they are not remedied by appropriate treatment, abortion will almost necessarily result. In other instances this disease may have been contracted during the existing pregnancy; and may occasion, especially in strong plethoric women, a high degree of excitement and symptoms of inflammatory fever, which may lead to abortion. Whitehead mentions some remarkable cases illustrative of the influence of gonorrhoea in producing repeated miscarriages. Syphilis as a primary infection may also cause abortion; its powerful influence as a constitutional affection, in destroying the product of conception, has already been noticed.
8. Certain general disorders are very sure to produce abortion, often with very great danger to the mother. This is the case with Intermittent Fever, especially in its severest forms, the abortion which it causes being almost invariably fatal. Variola becomes a no less certain and dangerous cause of abortion. The same may be said of Yellow Fever, and Spotted Fever. This is true principally of the Allopathic practice; so far as these terrible diseases are made to yield more readily to their appropriate Homoeopathic remedies, just so far the danger may be averted both from mother and child.
SYMPTOMS OF ABORTION.
The symptoms which may indicate an impending abortion may be as numerous as are those of the various general or local disorders which have been mentioned as its possible causes; and they will necessarily correspond in constitutional character and intensity to the nature and violence of the influences by which the abortion is immediately occasioned. In the earlier stages of gestation the amount of disturbance of the system is less, in proportion to the comparatively trifling amount of force expended in producing the abortion itself. When this results from pre-existing influences, chronic disease or bad health in the mother, there may be shiverings succeeded by heat, anorexia, nausea, thirst, spontaneous lassitude, palpitations, a sense of coldness in the abdomen, coldness of the extremities, pallid complexion, sadness, tumefaction and lividity of the eyelids, or dark discoloration beneath the eyes, a sense of sinking at the epigastrium or an indescribable deathly feeling, recession of the milk and consequent flaccidity of the breasts from which a serous fluid sometimes exudes, and general malaise and profound melancholy. When the abortion results from more active or violent causes, the more immediate and positive symptoms are:
