fundus uteri, stretching equally down on the two faces of the uterus,
with the membranes hanging perpendicularly from it. But it lies
chiefly on one face of the uterus, whilst the membranes are turned to
the other. The centre of the membranous bag, therefore, at this early
period, is not directed to the os uteri, but either to the fore or
back part of the uterus. In proportion, however, as the bag enlarges,
it elongates, its centre, or apex, descends, and ultimately
corresponds with the long axis of the uterus.
Footnote 4:
In some instances, the uterus seems to have the power of forming a
vascular substance from its inner surface, although impregnation have
not taken place; and, in this case, we may have the symptom of early
abortion attending its expulsion. But much oftener we find that this
appears as a derangement of the menstrual action, the vessels
secreting a semi-organized substance, instead of the usual quantity of
bloody fluid; hence, as has been observed by that ingenious and
excellent practitioner, Dr. Denman, we have sparing and painful
menstruation.
Footnote 5:
For a fuller explanation and defence of this doctrine, I beg leave to
refer the reader to some observations on the animal economy, prefixed
to the first volume of my Dissertation on Inflammation.
Footnote 6:
Vide Dissertations on Inflammation, Vol. I.
Footnote 7:
This contraction is sometimes so firm after the membranes have burst,
as to produce the same effect upon the child, as the natural pains
would have done had the pelvis been deformed; that is to say, the
presentation becomes unshapely, and the part below the stricture is
swelled and livid. This spasm, like that which sometimes retains the
placenta, is very difficult to be relaxed, and, in general, requires
artificial management. If it come on at the full time, before the
membranes break, it may give such a feeling to the lower part of the
ovum, as to make it resemble a preternatural presentation, although
the head really present. In this case, the band is generally pretty
broad, but its contraction is not violent. It has the effect, however,
of retarding labour, until we break the membranes, which excites a
more general and effective action in the uterine fibres.
Footnote 8:
The same effect is observable in the stomach and other organs. If a
delicate person, after a hearty meal, use exercise to the extent of
fatigue, he feels that the food is not digested, the stomach having
been weakened or injured in its actions.
Footnote 9:
It has even been known, that, in consequence of the death of one
child, the uterus has suffered partially, and expulsion takes place;
but the other child continuing to live, has preserved the action of
gestation in that part of the uterus, which, properly speaking,
belonged to it, and pregnancy has still gone on. This, however, is an
extremely rare occurrence; for, in almost every instance, the death of
one child produces an affection of the action of gestation in the
whole uterus, and the consequent expulsion of both children.
Footnote 10:
It is an old observation, that these purgatives, which produce much
tenesmus, will excite abortion; and this is certainly true, if their
operation be carried to a considerable extent, and continue long
violent. Hence dysentery is also apt to bring on a miscarriage. Those
strong purges which are sometimes taken to promote premature
expulsion, not only act by exciting tenesmus, but likewise by
inflaming the stomach and bowels, and thus affect the uterus in two
ways. It cannot be too generally known, that when these medicines do
produce abortion, the mother can seldom survive their effects. It is a
mistaken notion, that abortion can be most readily excited by drastic
purges, frequent and copious bleeding, &c. immediately after the woman
discovers herself to be pregnant; on the contrary, the action of the
uterus is then more independent of that of other organs, and therefore
not so easily injured by changes in their condition. I have already
shewn, that abortion more frequently happens when the pregnancy is
farther advanced, because then not only the uterus is more easily
affected, but the fœtus seems to suffer more readily. It is apt,
either from diseases directly affecting itself, or from changes in the
uterine action, to die about the middle of the third month, in which
case expulsion follows within a fortnight.
Footnote 11:
In these circumstances I have sometimes found the children liable to a
formidable disease, described by Dr. Heberden, in his little treatise
on the diseases of children, “Cap. De Duritie Cutis.” I have met with
this oftener than once in the same family, until the constitution of
the mother was attended to, on the principle I have mentioned, after
which the children were healthy.
Footnote 12:
Hiccup sometimes accompanies this complaint: at other times it attacks
the patient as a disease by itself, or alternates with palpitation. It
is best treated by giving large doses of ether. It is also necessary
to clear the bowels; afterwards the compound tincture of bark is
useful.
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TRANSCRIBER’S NOTES
1. Items mentioned in the ERRATA were corrected.
2. Silently corrected obvious typographical errors and variations in
spelling.
3. Retained archaic, non-standard, and uncertain spellings as printed.
4. Enclosed italics font in _underscores_.