The above words, to the medical mind, signify different things. The first means the casting off of the foetus before the life has quickened it. The second implies the same event subsequent to that period, or to the fifth month.
No child, however, born previous to the seventh month, has any chance of being reared; and to the majority brought into the world even thus far matured, existence is very problematical.
Abortion, however, will in this Essay serve, as it does in general language, to convey a notion of immature or premature delivery. Any one not in the profession can hardly conceive how frequently such circumstances occur in private families. The health of many ladies is positively ruined by these events; they become debilitated, feverish, hectic, dropsical; and, in short, they are the habitats of almost every disease to which the female frame is liable.
Not a few of these evils are induced by the unjustifiable interference of medical men. These gentlemen are frequently far too officious their remedies far too powerful; and their manipulations often unwarranted and uncalled for.
The lady subjected to them naturally aborts. The wonder would be, could she do otherwise; and, by the act, a disposition is promoted which renders very doubtful the full period of gestation being subsequently undergone. It is well known, and proved, that a habit of abortion is easily engendered. Nay, so readily do some women imbibe this propensity, that there are now many ladies alive who periodically relieve the uterus, and are even hardly conscious when that event occurs.
For the above reason, ladies are entreated to hold themselves sacred from all those meddlings, which, indeed, present weakness, and ultimately destroy the constitution.
It is the natural function of a healthy woman to bear children.
This ordination may entail upon her certain pangs; but the Being who made her, framed her equal to undergo these sufferings, and ordained that the agonies of maternity should not otherwise than benefit the constitution. In proof of this, how many smiling, happy, and blooming mothers do we not encounter; and who expects an old maid to be otherwise than debilitated and disappointed.
The premonitory symptoms of abortion are those of general derangement of the system. A certain lassitude or weakness steals over the entire frame. The lady feels desirous of retiring to bed before she is well aware of the cause, being thoroughly wearied previous to any conscious exertion; there occurs a pain in the back; the breasts become flaccid; and a general uneasiness rapidly increases.
After a little time pains occur, and a liquid drains from the body; this liquid may be perfectly colourless, or may be more or less soiled; but with its appearance the pains generally augment; the loins, abdomen, and thighs are involved; the agonies recur at certain periods, and each time with augmented strength. The stomach frequently rejects its contents; the pulse is accelerated; the skin is feverish; the patient cannot forbear from certain voluntary efforts, and the climax is soon attained.
The pain attending upon the above symptoms may, or may not, be fully equal to those attending actual labour.
There is no rule in cases of this kind; but during the first three months the lady usually suffers least; though I have attended cases in which the reverse has been exhibited.
The cause of abortion are varied and numerous. A few only of the most prominent will here be mentioned. They are, severe coughs, a blow or sudden compression of the uterine region, violent vomiting, sea-sickness, sudden fright, the extraction of the tooth, the repeated use of irritating medicines and drastic purgatives, repeated bleedings, strong mental emotions, or unusual bodily efforts. For these latter causes ladies should be careful how they exert themselves during the period of gestation. I do not mean that they should avoid everything like healthful exercise, but that they are not to encounter any of those domestic broils in which some females are too apt to engage.
I would likewise advise ladies to avoid excitement; and, for the above reasons, I would recommend those who may be about them at this time to shun every topic of irritation. While obeying this injunction, it does not follow that I am recommending a patient should be pampered in her fancies, or humoured in her whims. But I simply mean, that the feelings and passions of a lady in this critical situation, deserve, and should receive, a certain degree of respect.
Any sudden fright will frequently induce premature labour. Often, causes which in themselves would appear harmless, at this time have an injurious influence. A great deal necessarily depends upon the susceptibility of the patient; but as the extent of this can only be learned through symptoms by which it is declared, a certain degree of caution and forbearance is requisite in all those moving around a lady at this particular period.
It is customary with some medical men to endeavour to arrest a miscarriage. Attempts of this kind usually add much to sufferings of the patient, weaken the constitution, and endanger the life of the lady. Too many cases are known of the abnormal retention of the foetus to render such a course either safe or expedient.
Delivery, when once announced, should be expedited by every means in the physician’s power; and if this is done, none of those distressing measures will be necessary which students are taught to employ by books which treat of midwifery.
However, subsequent to abortion, copious and even dangerous flooding may ensue. This is not invariably the case. The haemorrhage may be so slight as to hardly deserve notice; and in other, but exceptional cases, may be so great as to endanger existence.
It is customary for medical men of the Allopathic ranks to bleed from the arm, as though the patient had not been sufficiently drained by emission from another source. It is also the custom with practitioners of this doctrine, to order that the patient be kept perfectly quiet. I certainly would advise all excitement, and anything calculated to distress the mind, should be withheld after so serious a juncture; but as to that kind of quiet which approaches to a deathly silence, and depresses the individual who is forced to endure it, I assuredly must object. The patient herself, under most circumstances, will be the best able to judge who should be admitted to her presence; of course, everybody about the sickbed fully understanding that nothing ought to be permitted which possibly might tax the patience or fatigue the mind.
I know ladies, after a misfortune of this kind, are often so much debilitated as to require absolute rest. In this case the feelings should be respected, but when a desire is expressed for quiet society, such a wish should not be ruthlessly opposed. The medical man is, in these circumstances, the best judge. There are times when the slightest exertion may be followed by symptoms which shall endanger the life: only when this peril has passed, too absolute a seclusion should not be enforced. When haemorrhage occurs, it is common to endeavour to arrest it by means of a plug formed of different materials. Now, to confine a discharge is not necessarily to stop it; therefore I object to this mode of practice; especially as the warm fluid filling the vacant cavity is likely to promote further depletion.
Cold applications have a decided effect over white fibre, of which the muscular coat of the uterus is composed. Could we induce the viscus to contract with the lessened dimensions, the sinuses would be obliterated, and the possibility of further flooding be rendered impracticable.
The Gullet has, in its composition, a certain amount of white fibre; and everybody is aware of the opposition which renders it impossible to take a long draught of very cold water.
I may here allude to another and more convincing instance. The muscular coat of the bladder is likewise composed of white fibre. Every person is aware how much fluid can be imbibed while seated in a warm room; but no sooner have they left the apartment, and entered the cold air, than a desire for relief is experienced; which last effect is occasioned by the lower temperature producing contraction of the muscular coat of that viscus.
Cold therefore should, in every form, be restored to; as drinks, injections, baths, etc.; and it is the more to be recommended because it exists in every house, and requires little skill in its application.
Certain gentlemen of the old school like warm applications, and recommend their unscrupulous use; but I have yet to learn upon what rational or physiological grounds such a practice is established.
It is the popular belief that abortion is attended with much more danger than natural labour.
In the early months, I am sure, such is not the case; though in the after periods the peril may be almost balanced. After every process of labour, however, a certain period of rest is advisable. The patient should recline on a mattress; never on a feather bed. The chamber should be large, cheerful, airy, and well ventilated. The bedclothes light; all anxiety and depression of spirits should be encountered by a calm and gentle persuasion of a successful termination.
The food, under ordinary circumstances, should be light, easy of digestion and moderate in quantity.
The beverage should be mild and cooling- such as plain barley-water, lemonade, toast-and-water, plain water, and a little light claret; either of which may be iced, particularly if the weather be hot.
The first quitting of the bed should be to repose upon the sofa, and thence- fine weather permitting- a gentle stroll in the open air.
DURATION OF PREGNANCY
There is nothing so unpleasant, or tends more to disarrange a household, and there is nothing more inconvenient to a medical man, than a miscalculation in the period of pregnancy.
Married ladies would do well to make themselves acquainted with a few simple particulars concerning this all-important subject.
Strange and curious stories do we sometimes hear of one lady having been brought to bed of a seven months’ child; another of an eleven months’ monster; when, if either of these ladies had only attended to the simple and well-established rules of pregnancy, neither infant would have been considered as a being born in violation of nature’s laws.
An illustration applicable to this subject occurred not long since, in a village not a dozen miles from the metropolis of England. A lady calculated, or rather mis-calculated, that parturition would set in at the close of the second week of a certain month. The nurse was summoned to her presence. The swiftest horse in her husband’s stable was saddled and bridled, and the most trusty servant was selected to start at a moment’s notice on the important mission of summoning a London doctor to the lying-in chamber. But day after day, night after night, week after week passed away, without either pain or twitch being felt by the anxious and expectant mother; and it was not till two more months had elapsed that the premonitory sufferings announced the crisis to be at hand.
How different do we find it with other ladies, who deem it neither indicate to seek the counsel to their medical adviser, nor consider it too much trouble to note certain changes upon the private pages of their pocket-books. A lady who engaged me to attend her at the close of 1861, calculated that my services would be required on the 11th of-. My calculations were to the same effect: both our conjectures proved well founded; for on the morning of that date I was summoned to her presence, and on the evening of the same day she was safely delivered.
I mention these little instances with no desire to draw invidious comparisons, but solely with the view to direct the attention of married ladies to the necessity of observing those changes which serve as landmarks to a correct diagnosis.
The duration of pregnancy, from the time of conception to the hour of labour, is estimated at nine calendar months, ten lunar months, forty weeks, or two hundred and eighty days.
If the foetus be expelled prior to the completion of four lunar months, subsequent to conception, the lady is said to “abort”.
But if delivery takes place after the fourth, and before the end of the seventh month, then she is said to “miscarry”. While if the labour occurs after the seventh, and before the completion of the tenth lunar month, then the birth is said to be “premature labour”; though, with care, the child may frequently be preserved at this period of its existence.
Most practitioners commence their calculations from the date of the last periodic discharge. Thus, supposing the “monthly reliefs” to cease on the 1st of January, labour may be expected, about the 7th of October; or, dating from the 1st of April, confinement may be expected about the 31st of December; making 275 days, or NINE calendar months.
To make the matter still more simple, I arrange here a series of dates in a tabular form, and venture to designate it, the “Married Lady’s Ready Reckoner”. It consists of two columns- one for calendar months, the other for lunar months; which may be read as follows:-
A lady has ceased to menstruate on the 1st of July: her confinement may be expected about the 31st of March, the end of nine calendar months; or, at latest, on the 6th of April, the end of ten lunar months.
Another lady has observed the like change on the 29th of January: her confinement may be expected on the 30th of September, plus twenty days, the end of nine calendar months, at soonest; or on the 7th of October, plus twenty days, the end of ten lunar months, at latest.
TABLE FOR CALCULATING THE PERIOD OF PREGNANCY
NINE CALENDAR MONTHS TEN LUNAR MONTHS
FROM TO DAYS TO DAYS
January 1 September 30 273 October 7 280
February 1 October 31 273 November 7 280
March 1 November 30 275 December 5 280
April 1 December 31 275 January 5 280
May 1 January 31 276 February 4 280
June 1 February 28 273 March 7 280
July 1 March 31 274 April 6 280
August 1 April 30 273 May 7 280
September 1 May 31 273 June 7 280
October 1 June 30 273 July 7 280
November 1 July 31 273 August 7 280
December 1 August 31 274 September6 280
The “quickening,” or first perceptible movement of the child by the mother, is another method of estimating the duration of pregnancy.
Quickening generally takes place at, or about, the twentieth week: if we add twenty weeks more to the previous time, we obtain a probable calculation of the full period. But ladies are cautioned not to place too much reliance on such an index, as quickening is varied in its advent; sometimes appearing as early as the third, at other times as late as the fifth, or even sixth month of parturition: therefore no absolute dependence can be placed on this last indication; nor are either of the calculations to be regarded as more than a probable approach to truth.
Dr. Desberger, an eminent French physician, has arranged a far more elaborate table, which I here append with a few slight alternations.
It is a calendar for “nine months”, and so arranged as to enable the reader to form a tolerably correct reckoning from the commencement, or the time of IMPREGNATION, to the middle, or the time of QUICKENING, to the end of the first indications of LABOUR. It is termed DESBERGER’S LADIES’ PERPETUAL CALENDAR: WITH ALTERNATIONS FROM PETERS’ “DISEASES OF MARRIED FEMALES”.
BEGINNING MIDDLE END
JANUARY MAY OCTOBER
1 Harold 20 Frances 8 Ephraim
2 Abel 21 Prudence 9 Denyson
3 Enoch 22 Helena 10 Amelia
4 Titus 23 Alfred 11 Dennis
5 Simeon 24 Esther 12 Fritz
6 Laura 25 Urban 13 Edward
7 Percy 26 Augustine 14 William
8 Lucian 27 Bede 15 Edwin
9 Caspar 28 William 16 Alphonso
10 Paul 29 Maximilian 17 Etheldred
11 Amy 30 Edward 18 LUKE
12 Reynolds 31 Ellen 19 Ptolemy
13 Hilarius 1 Lilian 20 Wilkie
14 Felix 2 Florence 21 Ursula
15 Albert 3 Erasmus 22 Martha
16 Marcellus 4 Rosa 23 Severus
17 Anthony 5 Richard 24 Solomon
18 Priscilla 6 Lily 25 Louis
19 Ferdinand 7 Lucretia 26 Clara
20 Fabian 8 Mark 27 Sabina
21 Agnes 9 Benjamin 28 SIMON
22 Vincent 10 Thomas 29 Kate
23 Herbert 11 BARNABAS 30 Sarah
24 Timothy 12 Jemima 31 Joseph
25 Bertrand 13 Richard 1 Mary
26 Polycarp 14 Samuel 2 Thomas
27 Florence 15 Frederick 3 Augustus
28 Charles 16 Justina 4 Charlotte
29 Samuel 17 Alban 5 Eric
30 Maude Mary 18 Paulina 6 Leonard
31 Mary Eleanor 19 Gervase 7 Alexander
BEGINNING MIDDLE END
FEBRUARY JUNE NOVEMBER
1 Bridget 20 Edward 8 Claude
2 Julius 21 Jacobina 9 Theodore
3 Joseph 22 Ellen 10 Jonas
4 Veronica 23 Basilius 11 Martin
5 Agatha 24 JOHN BAPTIST 12 Walter
6 Dorothea 25 Duncan 13 Julian
7 Richard 26 Jeremiah 14 Lewin
8 Solomon 27 Frank 15 Machutus
9 Apollonia 28 Leo 16 Ottoman
10 Lucy 29 PETER 17 Hugh
11 Euphrosyne 30 Paul 18 Godfrey
12 Helen 1 Theobald 19 Elizabeth
13 Benigna 2 Ernest 20 Edmund
14 Valentine 3 Cornelius 21 Alex
15 Formosus 4 Martin 22 Cecilia
16 Julia 5 Anselm 23 Clement
17 Constantia 6 Isaiah 24 Macbeth
18 Concordia 7 Fred 25 Catharine
19 Susanna 8 Kilian 26 Conrad
20 Jane 9 Cyril 27 Launcelot
21 Eleanor 10 Felicity 28 Gunter
22 Peter 11 Pius 29 Noah
23 Reynard 12 Henry 30 ANDREW
24 MATTHIAS 13 Margaret 1 Arnold
25 Victor 14 Bonaventura 2 Candida
26 Nestor 15 Swithin 4 Cassian
27 Hector 16 Eustace 5 Barbara
28 Justus 17 Alexis 5 Abigail
BEGINNING MIDDLE END
MARCH JULY DECEMBER
1 Alban 18 Caroline 6 Nicholas
2 Louisa 19 Ruth 7 Antonia
3 Bertram 20 Elias 8 Jabez
4 Adrian 21 Daniel 9 John
5 Frederick 22 Magdalen 10 Judith
6 Everard 23 Albertina 11 Waldemar
7 Perpetua 24 Christina 12 Chas. Frederick
8 Philemon 25 JAMES 13 Lucy
9 Prudentius 26 Anne 14 Israel
10 Henrietta 27 Berthold 15 Johanna
11 Rosina 28 Innocent 16 Laura
12 Gregory 29 Martha 17 Lazarus
13 Ernest 30 Beatrice 18 Christopher
14 Zacchary 31 Germain 19 Nora
15 Isabella 1 Peter 20 Abraham
16 Matthias 2 Gustavus 21 THOMAS
17 Patrick 3 Augustus 22 Beata
18 Edward 4 Perpetua 23 Ignatius
19 Joseph 5 Dominick 24 Adam
20 Rupert 6 Frank 25 Eliza
21 Benedict 7 Donatus 26 STEPHEN
22 Casimer 8 Samuel 27 JOHN
23 Everard 9 Romanus 28 Adaliga
24 Gabriel 10 Lawrence 29 Jonathan
25 Matthew 11 Titus 30 David
26 Emanuel 12 Clara 31 Sylvester
27 Hubert 13 Hildebrand 1 Dora
28 Gideon 14 Eusebius 2 Abel
29 Eustace 15 Charles 3 Enoch
30 Guido 16 Isaac 4 Titus
31 Philip 17 Bertram 5 Simeon
BEGINNING MIDDLE END
APRIL AUGUST JANUARY
1 Theodore 18 Emilia 6 Reginald
2 Theodosia 19 Sebald 7 Harry
3 Christian 20 Bernard 8 Lucian
4 Ambrose 21 Athanasius 9 Caspar
5 Maximus 22 Oswald 10 Geo. Henry
6 Sixtus 23 Zaccheus 11 Erhard
7 Celestine 24 BARTHOLOMEW 12 Raynard
8 Adelaide 25 Lewis 13 Hilarius
9 Victoria 26 Irenaeus 14 Felix
10 Ezekiel 27 Gebard 15 Bayard
11 Herman 28 Augustine 16 Marcellus
12 Julius 29 John 17 Anthony
13 Justin 30 Benjamin 18 Prisca
14 Tiburtius 31 Rebecca 19 Ferdinand
15 Obadiah 1 Giles 20 Fabian
16 Leopold 2 Rachel 21 Agnes
17 Rodolph 3 Wilkie 22 Vincent
18 Florence 4 Moses 23 Frank
19 Werner 5 Nathaniel 24 Timothy
20 Sulpitius 6 Magnus 25 PAUL
21 Adolphus 7 Enurchus 26 Polycarp
22 Lothario 8 Mary 27 Hale
23 GEORGE 9 Bruno 28 Charles
24 Albert 10 Sosthenes 29 Samuel
25 MARK 11 Gerard 30 James
26 Raymar 12 Otilia 31 Valerius
27 Anastasius 13 Alfred John 1 Bridget
28 Theresa 14 Eustace 2 Harriet
29 Sibylla 15 Constantia 3 Phoebe
30 Joshua 16 Euphemia 4 Veronica
BEGINNING MIDDLE END
MAY SEPTEMBER FEBRUARY
1 PHILIP 17 Lambert 5 Agatha
2 Sigismund 18 Bessie 6 Dorothea
3 Elbert 19 Iona 7 Cicely
4 Florian 20 Frederica 8 Solomon
5 Gothard 21 MATTHEW 9 Apollonia
6 Matilda 22 Maurice 10 Renata
7 Godfrey 23 Joel 11 Euphrosya
8 John 24 John 12 Severinus
9 Job 25 Cleophas 13 Benigna
10 Gordian 26 Cyprian 14 Valentine
11 Mamertus 27 Cosmo 15 Formosus
12 Pancratius 28 Wenzel 16 Juliana
13 Servatius 29 MICHAEL 17 Constantia
14 Christiana 30 Jerome 18 Concordia
15 Sophia 1 Remigius 19 Susanna
16 Betsy 2 Argyle 20 Narcissa
17 Pascal 3 Ewald 21 Eleanor
18 James 4 Francis 22 Peter
19 Dunstan 5 Charity 23 Reynard
20 Frances 6 Faith 24 MATTHIAS
21 Prudens 7 Hope 25 Victor
22 Helena 8 Ephraim 26 Nestor
23 Nina 9 Denys 27 Hector
24 Esther 10 Amelia 28 Justus
25 Urban 11 Burkard 1 Albin
26 Augustine 12 Ruth 2 Louisa
27 Bede 13 Edward 3 Julia
28 William 14 William 4 Adrian
29 Maximilian 15 Campbell 5 Frederick
30 Wigan 16 Gallus 6 Everard
31 Petronella 17 Etheldreda 7 Perpetua
BEGINNING MIDDLE END
JUNE OCTOBER MARCH