I. A sanguineous discharge together with pains in the loins, the abdomen and the sacrum. The pains which precede abortion are very much like those which precede or accompany a catamenial period. They may also precede the hemorrhage in cases of the threatened abortion; and may subside and the danger pass away before hemorrhage appears. But after the occurrence of this latter symptom, abortion will almost result sooner or later, unless the progress of the mischief is arrested by suitable treatment.
II. Bearing down sensation, or feeling of weight in the abdomen and pelvis. These sensations may be independent of the more positive pains; some women abort without having suffered much if any decided pain.
After the rupture of the membranes by accident, by instruments, and other artificial means, after the placenta or membranes become separated from the walls of the uterus, or after the death of the foetus, chills, or rigors make their appearance, the pains become more frequent and decided, and the the hemorrhage more free. But before the expulsion of the foetus the hemorrhage is seldom very profuse. The placenta almost always remains after the expulsion of the foetus, and then, as in natural labor, the loss of blood may be severe until arrested by the removal of the placenta and subsequent more complete contraction of the uterine walls. Instances have been observed, however, in which the placenta or membranes have remained for weeks after the extrusion of the embryo, occasioning an almost constant loss of blood during the entire period.
In some instances the placenta remains in the uterus till decomposed; putrid fever, uterine phlebitis, and death, may result from the reabsorption of particles of the putrifying mass. In embryonic abortion, however, after the expulsions of the embryo itself, the membranes may remain without danger of the putrefactive decomposition which usually attacks the retained placenta of later months. In other cases, after the gradual death of the embryo, from imperfect nutrition, organic, ovular disease, or other constitutional cause, the placenta enlarges, assumes unusual forms and a singular structure, exhibiting a cavity in which the remains of the foetus can scarcely be found; or the entire ovum becomes transformed into a fleshy mole or hydatiginous mass.
DIAGNOSIS OF ABORTION.
An abortion may be deemed possible, probable, threatening, or inevitable, in any given case, according to the nature and intensity of the influences present and capable of more or less rapidly producing such a result. But it is necessary first to determine the existence of pregnancy; and when, as in the first two months, it becomes difficult or even impossible to ascertain this with absolute conclusiveness, the question arises, whether the pains and discharge of blood result from a return of interrupted menses, or from an approaching abortion. And this question is the less easy to decide in advance, since the pains and other consequences of an impending abortion at this early period greatly resemble those of irregular and difficult menstruation. ( “Les douleurs qui accompagnent la menstruation difficile, surtout apres une suspension, de plusieurs mois resemblent beaucoup, par leur siege, leur intermittence, a celles de l’avortement. Cazeaux, p. 343).
In general, it may be states that in abortion the os uteri is open; the hemorrhage precedes the pains, and that the pains themselves are not sensibly relieved by the flow. While, in difficult menstruation, the pains usually precede the hemorrhage; the mouth of the uterus is closed; and the pains either entirely cease or sensibly diminish when the discharge is well established. In some instances of dysmenorrhoea the pains continue during the entire period of the flow, but the fact of the occurrence of such severe dysmenorrhoea as a habit of the individual, either removes at once the suspicion of her being pregnant at any particular period, or entirely neutralizes this exceptional symptom as a sign indicative of pregnancy. Nor, indeed, is it essential for the Homoeopathic physician to determine with certainty the exact condition, in any given case, in order to do for his patient all that her case requires, or all that it is possible to accomplish. Since prescribing carefully and accurately for the existing symptoms, he will moderate the violence of the suffering in dysmenorrhoea; of if the case is one of pregnancy and threatened ovular abortion, the same remedies will be the best to subdue the violence of the abnormal action and thus preserve, if possible, the product of conception.
It is of course unnecessary to recount here the indications already fully state in a preceding chapter, but which the existence of pregnancy is rendered probable in the earlier months. If these are present in number more or less conclusive, especially if the patient having formerly been very regular, and having now missed her courses for one or two or more periods, experiences a return of the discharge, accompanied with pains which rather increase than abate as the flow continues, the flow itself being more profuse than was usual with her in menstruating, and the mouth of the uterus sufficiently dilated to admit the end of the finger, she has every reason to believe herself suffering from abortion, rather than dysmenorrhoea. And this conclusions will be greatly strengthened, or otherwise, by the comparison of this attack with her usual monthly periods, and by considering whether, in case she were actually enceinte, she had been subjected to any influences capable of producing an abortion. If the patient knows herself to have menstruated while pregnant on former occasions, this circumstance, while it might to some extent predispose to abortion, would require a more particular examination of the condition of the os and cervix uteri, and of the coagula or other matters discharged. And the final detection of portions of an aborted ovum, in such cases would become an important point of reference in the future conditions of the patient.
So much for the diagnosis of abortion in the earlier months, as distinguished from dysmenorrhoea, where the existence of pregnancy had not been definitely ascertained. The diagnosis of abortion, in the more advanced stages, where there is no doubt of the existence of pregnancy, is a very different matter. Here an opinion must be given, usually, with the same caution that we should employ as to the recovery of sick person in critical circumstances. The question being, not whether it is impending or actual abortion, or dysmenorrhoea, but whether the threatened abortion must necessarily become absolute destruction of the product of conception. Here, except in cases already very far advanced, we should never affirm an abortion to be inevitable until we have faithfully employed all the means within our knowledge to arrest the destructive process. Dr. Whit-head relates some remarkable cases of successful treatment, in which the abortion seemed necessarily inevitable; one of them, a woman who had aborted in six successive pregnancies, and who enabled to go through the seventh successfully, in spite of repeated attacks of venous congestion to the pelvis with apparent death of the foetus, by repeated bleedings and the employment of extract of Hyoscyamus and camphor. And where such apparently desperate cases are rescued under the Allopathic regime, how much more ought we not to expect with the more varied and efficient resources at our command?
A certain dilatation of the internal orifice of the uterus, in which, under the influence of the uterine contractions, the cervix gradually tapers from the os externum up to the body of the uterus, and can no longer be distinguished from the uterus, is mentioned by Cazeaux as having been originally observed by him to be a sign of inevitable abortion.
But generally speaking, abortion is only inevitable when the foetus is already dead; or when the separation of the placenta is so great that the remaining utero-placental attachments are incapable of supporting the foetal life. Thus the diagnosis of abortion in the earlier periods of gestation is dependent upon the determination of two “unknown quantities, that of pregnancy on the one side, which may or may not be actually present; and that of the power of the remedies used to arrest the progress of the mischief, remedies whose success or failure in any given case only be determined by the experiment. But in the more advanced stages of pregnancy we escape, in many instances, both these sources of doubt, since the existence of the pregnancy itself is undoubted on the one hand, and the determination of the death of the foetus, which is often possible with sufficient certitude, on the other hand removes all hope of change from the action of medicines. In all cases of threatened abortion, however violent the symptoms, we may still find some ground of hope in the administration of the indicated remedies, so long as the foetus continues to live. But the condition in manifestly different where the symptoms either result from, or indicate the of the child. The principal circumstances which indicate the death of foetus, are: 1. The diminution instead of the increase of the size of the abdomen; 2. The flaccidity and shrinking of the breasts; the dragging sensation in the loins and sense of weight in the hypogastrium; 3. The cessation of motion formerly perceived in the uterus. 4. The impossibility of hearing the sound of the foetal heart becomes, after the fifth month, an almost infallible sign of the death of the foetus. And where this death occurs as a consequence of disease or failure of nutrition on the part of mother, and so takes place in a gradual manner, the danger, which the foetus is undergoing, may be detected by observing the gradually increasing faintness of the beating of its heart. But this means of judging of the health and death of the foetus, since it is hardly applicable before the fourth month of pregnancy, is of no use in the majority of cases of threatened abortion.
