Part 17

Women, affected with this disease, should by no means indulge in the use of tea and other warm slops of a relaxing nature; but should lie on a mattress in preference to a feather bed; and they should rise early, and take such daily exercise as their strength will admit, particularly on horseback. When there is much languor, with chilliness, friction with the flesh-brush, and wearing flannel next the skin, must not be omitted.

FALLING DOWN OF THE WOMB.

This is a much more common complaint than the former, and takes place in women of every age, and every rank. As its name implies, it consists of change in the situation of the womb, by which that organ lies much lower than it ought to do. In some cases it absolutely protrudes entirely without the parts. The slightest degrees are styled bearing down; and the more violent ones descent or falling down of the womb.

In general, the first symptom of this complaint is an uneasy sensation in the lower part of the back while standing or walking, with now and then a kind of pressure and bearing down.

If these feelings be disregarded, the complaint increases, and the patient becomes incapable of making water without first lying down, or pushing up a swelling which seems to stop the discharge of urine; and if the disease continues to increase, the womb is actually forced out of the parts, and takes on the form of a bulky substance hanging down between the thighs. This extreme degree of the complaint can seldom happen, excepting in women who have had a great many children, but the less degrees of it occur occasionally in very young unmarried women.

The causes of descent of the womb ought to be known to every woman, as many of them may be avoided. Every disease which induces weakness of the habit in general, or of the passage leading to the womb, in particular, must lay the foundation for the complaint. Frequent miscarriages, improper treatment during labour, too early or violent exercise after delivery, are in married women, the most frequent circumstances by which falling down of the womb is produced. In the unmarried, it is apt to take place in consequence of violent exercise, as in dancing, riding, &c., while out of order, a fact that ought to be impressed on the mind of every young woman.

In the treatment of this complaint, the means must be adapted to the degree of its violence. When the descent is inconsiderable, and the case is of recent date, the daily use of the cold bath, invigorating diet, very moderate exercise, and the injection of any mild astringent liquor into the passage, evening and morning, will probably prove successful. But should the disease be in a great degree or of long standing, a course of tonics, with the frequent use of astringent injections, as a strong solution of alum in water, or decoction of red oak bark, must be added to the above means.

Dr. Leak advises, that after the parts are reduced, the intention of contracting the relaxed vagina so as to prevent its future descent, may be effected by the frequent use of the following astringent injection. Take of alum, and white vitriol, each, one drachm, boiling water, one pound, mix and filter through paper. Inject it into the vagina, milk warm, with a womb syringe. At the same time endeavour to strengthen the whole bodily system by nourishing diet, and tonic medicines.

When the complaint resists such remedies, or when, from its degree, it may appear unnecessary to employ them, the only relief which can be afforded, unless the womb become pregnant, is to be obtained by wearing an instrument called a pessary. It is made of wood or ivory, and if properly adapted to the passage, and of a proper construction, it can be worn without much inconvenience, and it never occasions pain. Certain attentions are however necessary, whenever such an instrument is used. Thus, the pessary should never be allowed to remain in the passage above a few days at a time, otherwise it becomes the source of great irritation. It should, therefore, be occasionally withdrawn on going to bed, well cleaned and reintroduced in the morning, before the patient rises. In some instances, after a pessary of a certain size has been worn for several months, one of a smaller size becomes better adapted to the passages, and in other cases one of a larger size is required.

Sponges of such a size as, when expanded, fill up the cavity of the vagina, are very good pessaries. They support the uterus, and, by putting a string through them, the end of which is to be left hanging out of the os externum, the woman can take them away and apply them herself very conveniently.

To answer this purpose, a fine sponge, wrung out in alum water, may be dried in a compressed state, and cut into any convenient form, so as to be introduced as high as possible: this will act by its astringency, and by its pressure, in a gentle and uniform manner. During the use of this application, an astringent injection may be used twice a day; and the sponge tent should be made gradually smaller as the vagina contracts.

The application of the bandage round the whole belly, with a moderate degree of firmness, often gives great relief to the uneasy feelings. The T bandage has also been worn in this case with considerable advantage.

If a woman liable to falling down of the womb, become pregnant, there is no occasion for the pessary after the third month, and by proper treatment after delivery, the return of the complaint may be prevented.

MISCARRIAGE OR ABORTION.

We now come to the consideration of a subject, in respect to which there exists much misapprehension and ignorance, causing useless and unnecessary alarm and anxiety to those who may be so unfortunate as to be subject, at particular periods of gestation, to abortion or miscarriage.

The dangers of abortion or miscarriage are often magnified and exaggerated. It is dangerous if produced by a fall, a blow, a kick from a horse, or any other external bodily violence or injury, causing internal contusion, or rupture of some blood-vessels; and, also, but not to the same extent, if produced by sudden fright, violent fits of passion, &c., or from general debility or disease of the uterus; but the danger arises more from the cause which produces the miscarriage, than from the miscarriage itself; as it is well known by those versed in obstetrics that, where it is deemed indispensable to effect a miscarriage, either because of the existence of a deformed pelvis, diseased uterus, or other causes, if skilfully effected, it is attended with no danger, especially in the earlier stages of pregnancy.

Symptoms.

When miscarriage is about to take place, its first symptoms are generally occasional stinging pains at the bottom of the belly, extending across and around the loins and hips; a feeling of fatigue of the legs, pain in the forehead, burning sensation of the eyes. The breasts, which before were distended, become soft and flabby, hot and cold flashes, attended with thirst, fever, and shiverings. In a day or two after the appearance of these symptoms, a discharge from the womb takes place of yellow matter, tinctured with red. If not arrested at this stage, the pains across the loins become more severe and frequent, attended with a sense of dead weight, and bearing down about the womb, the water is discharged, and the expulsion of the contents of the womb takes place. The symptoms of miscarriage, however, vary with the causes which produce them, or the state of habit, age, or health of the patient; some recovering immediately, and rapidly, and with but little inconvenience. Where miscarriage arises from a serious accident, such as violent falls, bruises, &.c., the symptoms are somewhat aggravated, and more severe, and are often preceded and accompanied with violent and profuse floodings and discharges of coagula, in addition to the other symptoms; although moderate flowing is not an unfrequent symptom in miscarriages.

It is always accompanied with two circumstances, separation of the membranous bag, and expulsive efforts or contraction of the womb itself. The first is productive of discharge, the second of pains like those of labor. Sometimes the separation or detachment of part of the conception takes place before any pain is felt; on other occasions, the pain, or contraction of the womb, takes place first, and produces a separation. In the first of these cases, the symptoms of abortion take place suddenly, and are usually occasioned by fatigue, sudden exertion, or fright. In the second, the pains come on, and there are particular feelings, and changes, which indicate that a miscarriage is likely to take place; as, for instance, the cessation of the morning sickness, the subsidence of the breasts, &c.

Miscarriage is preceded by floodings, pains in the back, loins, and lower part of the abdomen, evacuation of the water, shiverings, palpitation of the heart, nausea, anxiety, fainting, subsiding of the breasts and belly, pain in the inside of the thighs, opening and moisture of the womb.

Causes.

The principal causes of miscarriage are blows or falls; great exertion or fatigue; sudden frights and other violent emotions of the mind; a diet too sparing or too nutritious; the abuse of spirituous liquors; other diseases, particularly fevers and hæmorrhages; likewise excessive bleeding, profuse diarrhœa or colic, particularly from accumulated fæces; immoderate venery, &c.

Treatment.

When a woman is threatened with a miscarriage, there are two objects to attend to; the first is, to prevent it if we can; the second is to manage it so that as little blood as possible be lost; and both these are obtained by the same means. With this view, the patient should immediately, on the first alarm, undress and go to bed, lightly covered, with a firm determination not to rise till the process be either checked or completely over. There should be little fire in the room, though it be winter; and in summer, the windows must be opened. Cloths wet with cold water, should instantly be applied to the lower part of the belly, and back: the drink must be cold, and everything stimulating should carefully be avoided.

In robust habits, or when the symptoms have been brought on suddenly by some such cause as a fall or exertion, it is proper to bleed; and, in cases of sickness or great feebleness, to give a dose of laudanum; or, what is better, to administer the anodyne clysters.

Opiates are useful in every case where we hope to prevent abortion, and must be repeated more often or seldom, according to the effect they produce. They are, however, improper in those cases where miscarriages must decidedly take place. Their tendency to occasion costiveness, when employed, must be obviated by clysters, or some gentle laxative medicine, such as calcined magnesia, Epsom salts, or a little castor oil. If there be a continued but trifling discharge, great advantage may be derived from injecting, three or four times a day, up the vagina, a solution of alum. Indeed, in all protracted cases, this is of much benefit. The solution ought to be thrown up pretty high, that it may reach the womb.

When these means produce not the desired effect, and along with the discharge of blood large clots come off attended with bearing down or pains in the back and loins, especially if the symptoms which precede abortion have appeared, there must be every probability that the threatening event cannot be avoided; then we must conduct the patient through the process.

In all cases during the last stage of pregnancy, where our endeavors to stop or repress the hemorrhage prove abortive, it will be advisable to deliver her as soon as possible.