WOMENmiscarryso frequently, that if any curious Persons will diligently observe and examine thatMatter, they will find the Number ofMiscarriagesto exceedThatoftimelyBirths: WhereforeI have reason to think, that thisHeaddeserves to be handled more at large, and to be more particularly insisted upon, in the following manner.
THEModern PractisersinMIDWIFERY, distinguishMiscarriages, byfourdifferentAppellations; according to thefourdifferentTimesof theConstitutionof theCONCEPTION. viz.
AMiscarriagehappening in the Time ofSpumification, is call’d anEffluxion of theGENITURA: That which happeneth in theVegetation, or Time ofRamification, or (as some will have it) before the 40thDay, is call’d aDeperditionof theEmbryo:Thatwhich falls out in thesensitiveProgression, or Time ofCarnification, or (as others will have it) before the90th DayfromCONCEPTION, they call anAbortionof theFoetus. But what so happens afterwards preceding the7th Month, is properly call’d an entireAbortionof theInfant.
HOWEVER,Otherswill have afifth Distinctionmade; namely, what so happens in the 7th, 8th, and preceding the 20th Day of the 9thMonth, to be call’d an untimelyBIRTH; because tho’ born withLife, they alledge it to be very seldom, or never reallyVital, or likely toLive: Upon which I shall, in good Time, introduce my ownSentimentin the subsequent Chapters of thisSection.
NOTWITHSTANDING, thisDefinitionsignifies but little to the Purpose; let theMISCARRIAGEhappen when it will, and under whatsoeverNameorDenomination, It is nothing else in general, than an untimelyExclusionof an imperfect and immatureBirth; which unhappyAccidentmay proceed from a vast Variety ofCauses, stimulatingNatureto such a violentExpulsion.
INtreating therefore of thisAccidentalBIRTH, I shall make use of none of thoseDistinctions; but rather (to prevent Mistakes) shall call all its severalSpecies, of whatsoeverTime, by the general (and most common) Name ofABORTION.
ANDof thisABORTION, happen when it will, theproximous Causeis always theExpulsive Facultyof theWomb; which beinghurt, or violentlydisorder’din any respect, irritates and debilitates theRetentive Power: And then again, on the other hand, thisRetentive Faculty(tho’ not theproximous Cause) is sometimesfirst hurtorinjur’d, and by that means incapacitated toretaintheINFANT; which (in that Case) offends and provokes theExpulsive Power[93], which is the properproximous Causeof allABORTIONS.
BUTmost commonly theExpulsivereceives theFirst Hurt; from whence theRetentiveis oblig’d toSympathize, and yield to its over-rulingMotions. And, according toGalen[94], theExpulsive Facultymay be injur’d and irritated byThreedifferentCauses; viz. 1. By theBulkof theInfant, when theWombcannot distend itself far enough to contain it: 2. By itsWeight, when heavier than theWombandLigamentscan bear: And, 3. By theHumours(when theMembranesbreak) flowing into theWomb; occasioning aMordacious Itchingthere, orputrefyingtheInfantin its Place.
TOwhichthree Efficients, some Modern Authors have thought it sufficient to add thesimilar,organical, andcommon Diseasesof theWomb; together with someProcatarctick Causes.
HOWEVER, because I have generally observ’dThose, to be very promiscuously and confusedly treated of, I shall (according to my best Ability) endeavour to reduce the many differentCausesofABORTIONto such plainHeads, and set them in such a clearLight, that they shall prove evident and manifest to the meanestCapacity: ThatWomen(whose peculiarGoodI have only at Heart in the Performance of this Work) may readily conceive them, and thereby be enabled (in mostCases) to prevent their greatestMisfortunes. And that whether theCausehappens proximously and immediatelyfrom astimulated Expulsive, or mediately from alæs’dandinjur’d Retentive Faculty.
WHEREFOREI shall now reduce thoseCausesto the followingFour general Heads; namely, 1. To theConstitutionof theMother: 2. TheConstitutionof theInfant: 3. TheSymptomsof theMonths: And, 4. To the variousProcatarctick Causesof this Tragical Case.
FIRSTtheCauses ofABORTION, proceeding from theConstitutionof theMother, areThree-fold, and respect either herwhole Body, herWombonly, or itsneighbouring Parts.Thoserespecting herwhole Body, are,
I.THEfour Intemperaturesof the Body; as theCalid, which, by itsHot Quality, exhausts theHumours(that are naturally necessary) to the Prejudice and Loss of theInfant.
II.THEFrigid; which, by itsCold Quality, vitiates and attenuates theInfant’sAliment, to a starving Condition.
III.THESiccid; which, by itsadust dry Quality, scorches and consumes theLigaments, that they break, like so manyStringsthat snap before theSun: Upon which theInfant(being deprived of thoseMediums, through whichNaturehas appointed itsSustenance) corrupts and decays, like aPLANTinArid Sandy Ground.
IV.THEHumidIntemperature; which, by itsmoist Quality, debilitates theRetentive Faculty, hinders theLigamentsto consolidate and close firmly, and opens the shutOrificeof theWomb. But besides all This also, by filling theACETABULAwithsuperfluous Humours, it may suffocate and stifle theINFANT.
V. Animiousand too great anObesityorFatness, and too great aGracilityorLeannessof theWoman’s Body: For theOneconverts theCHILD’sNourishmentto itself; and theOtherstarves theINFANTfor want of itsnatural Requisites.
VI. APLETHORY, or too great aRepletionofBloodin her Body; which frequently choaks and suffocates theINFANT.
VII.ALLCorporeal Causes, exagitating theSpiritsandHumours; which have the sameEffectandForceto irritate theExpulsive Faculty.
VIII.ALLDiseasesincident to the Body, whether they beAcute,Remiss, orDiuturnal; which may easily effectABORTION. But
SECONDLY, TheCauseson the part of theWomb, are not to be lightly or slightly considered; because if it be not both naturally wellconstituted, and carefully welldispos’d, it can neither foment, cherish, nor retain theInfant. For the leastFlawof itsmorbifick Causes, stimulates to a great Degree theexpulsive Faculty: whichCausesare, in my Opinion, as follow; viz.
I.THEWomb’sPræternaturalSIZE, either inMagnitude, orExiguity: Theonegiving room for theInfant’s too much tumbling or too frequent Motion; and theotherrestraining theCHILDtoo much, even to thesuppressingandstiflingof it.
II.ITSpræternaturalCONSTRICTIONorCoarctation; which may resist its necessary dueExtension, for containing the growingInfant.
III.ITSpræternaturalDENSITY; which may not only hinder the requisiteDistention, but also prevent theSecundine[95]from being firmly connected to theVessels.
IV.ITSLAXITYof theOrifice, orLavityof the interiourSurface; proceeding frompituitous[96]orviscous Humours, which slacken theLigaments, and give way to theFoetus.
V.THEWomb’stoofrigidandsiccid Intemperature; which Qualities are the greatest Enemies toNatureand all theActionsofFemale LIFE.
VI.ITSfrigidandhumid Intemperature; which (abounding withMucositiesorslimy Humours) so relaxes theLigaments, that they cannot hold or detain theINFANT.
VII.ALLobdurated and confirmedTumoursandUlcers, allErysipelasandInflammationsof theWomb: Which often prove theCausesof the sameEffect.
VIII. Apræternatural Situation, or anoblique Positionmay become the8thandlast CauseofABORTION, which I shall mention on part of theWomb.
FROMhence I come,Thirdly, in a due Method, toThose Causesrespecting theneighbouring Parts; which I humbly conceive to be as follow.
I.ALLDiseases,Pains, and whatCausessoever of thoseParts, may tend much to deject or affect theSpirits, and stir up theHumourswith unusual Alteration.
II.ALLCausesand badAffectionscompressing thelower Belly, and exagitating or straining itsMuscles.
III. Apræternatural Siteand inaptCONFORMATION[97]of theUmbilical Vessels, for their due Operation.
BUTthen again,Secondly, It also often happens that, tho’ thepregnant Womanlabours under noDiseaseorMisfortune, either inBody,Womb, orneighbouringParts, yet notwithstanding theExpulsive Facultyis irritated toEjectionby severalCausesof theConstitutionof theINFANTitself, as follow;viz.
I.ITSpræternaturalBulk, or vitiousConformation, oppressing and straining theWomb, either inWholeor inPart.
II.ITSDebilityandWeakness, or contracted, infirm, feebleConstitution, as mentioned in the precedingChapter.
III.THEDeathof theINFANT, emitting nauseousVapoursand putrefy’dMatter, stimulates theWombsooner or later toExpulsion: And (in thistragical Case) thesoonertheBetter; as will hereafter appear.
ANDmoreover,Thirdly, theSYMPTOMSof theMonths, frequently proveCausesofABORTION; of whichSYMPTOMS, having already treated particularly, I shall in this place repeat little or nothing, only refer theReaderto their respectiveChaptersin the precedingPartof thisSection: And yet under this presentHead, may be also comprehended allAcute Diseases, which (too often) prove of the same badConsequence; as is evident from Chap. 28.
FOURTHLY, There is a greatVarietyofProcatarctick Causes, distinct from allthoseabove-mentioned, which most frequently occasionABORTION: AndThoseareTwo-fold,INTERNALandEXTERNAL. Of which theInternalare as follow, in my Judgment.
I.THEPassionsof the Mind (mentioned inSect.I.Chap.5.) because such immoderateAffectionstoo much excite theHumours, and incense theSpirits.
II.VICTUALS; if takentoo muchat a time, suffocate theINFANT; iftoo little, it isstarved, and theMOTHERbrought to a very low Condition of Life; and ifimproper, or of illConcoction, theCHILDis thereby either muchweaken’d, or (which is worse) it dies of course.
III.DRINKINGimmoderately, extinguisheth thenatural Calidityof theWomband theINFANT; as certainlystrongorhot Liquorsimpress a vitiousIntemperatureuponBoth.
IV.WATCHINGSa-Nights, too much exhaust and dissipate theSpirits; as too muchSleep, on the other hand, dulls, lessens, and obtunds thenatural Heat.
V.ALLinward disorderlyCausesdissolving theUterineAcetabula,Ligaments, orVessels, by which theINFANTattracts itsNourishment.
VI.ALLVenenated,Cathartick, andDiaphoretickMEDICINES,Acrimonious Clysters,Venæ-Sections,Baths, &c: Which partly by exagitating theSpiritsandHumours, and partly by diminishing theAliment, occasion frequentABORTIONS. Again
THEexternal Procatarctick Causesare These, which ensue in their due Order.
I.ALLinclementConstitutionsor badInfluencesof theWeather,Winds,[98]andAir; such asCold, which pinches; or asHeat, which intercepts theBreath, and stifles theINFANT, &c.
II.SMELLINGorTouching,Sitting, orTreadingupon some Sorts of perniciousHerbs.
III.ALLviolentMotions, immoderateExercises, &c. such asRunning,Leaping,Dancing,Riding, orCoaching,Lifting, orCarrying a heavy Weight, alsolong Fasting,strait Lacing, aFall, aBlowon theBackor theBelly, &c. as I hinted before occasionally.
IV.ALLfrightfulObjects, andsudden Surprizesby hastyNews,Fire, or such like terrifying Accidents.
V.ALLastonishingand terrible affectingNOISES; such as sudden Claps ofThunder,Cannons,Guns&c.
VI.ALLnauseousStinks, on the one hand, and odoriferousSmells,&c.on the other, beingbothdisagreeable and dangerous.
THOSE, and many othertrifling Matters, such as theSmellof anextinguished Light, orCandle, are known (too often) to be theReasonandCauseofABORTION: which made (that greatNaturalist)Pliny[99]justly take occasion to deplore theFrailtyof Man.
“HEbewails and is asham’d (as he expresseth it) to think howfrivoloustheORIGINof theproudest of Creaturesis; such a mereTrifle(as is mentioned) being frequently theCauseof hisFATALITY. And thePhilosophermost pertinently adds, thatHewhonow glories in so manyVANITIES, trusting in theStrengthof hisBody, vaunting in theRichesof hisPossessions, and upon everySmile of Fortune, believes himself to be aGod,&c.little considers how many ways he might havemiscarriedin coming into the World, or how many ways he may yet, even to-day, go out of it, and come to hislast GASP, asAnacreon, the wantonLyrick Poet, did, who was suddenly choak’d with theStoneof a Grape; or asFabius(that nobleDictatorofRome) dy’d, who was immediately strangl’d by aHAIRin aDraught of Milk.”
I say,Helittle considers, how manyTrialsandHardshipshe was expos’d to, before he hadBeing: or, how many ways he might have beenstifledbefore he hadBreath, and have beendeadeven before he wasBorn.
WHICHConsideration leads me to the Thought ofanother CauseofABORTION, mentioned by the holy Prophet[100]Hosea, where he says: “Because they have deeply corrupted themselves, and separated themselves unto that Shame atBaalpeor, (i. e. defiled themselves at theStatuesofPriapus)their Glory shall fly away like a Bird, from theWomb,from theConception,and from theBirth;dry Breasts, and a miscarryingWombshall be given them, &c.”
ANDhaving thus far briefly defin’d and descanted uponABORTION, and theNatureof itsEfficients, I come now, in the next place, to shew by whatDIAGNOSTICK SIGNS, everyWomanmay infallibly know an approaching or instantMISCARRIAGE, either inherselforanother: As also to set forth, by whatPROGNOSTICK SIGNS, she may know theDangershe is threatned with upon that Occasion.
WHICHUndertaking, I hope, may proveconduciveto the Welfare of that tenderSex; it being too common forWomento neglect theproper Means, through a supineIgnoranceof theNature, andDangerof theirCONDITION. But This, however, is generally owing to indiscreetOld Womenabout them; (as I have often observ’d, and oft’ner had Occasion to hear) who either keep thePATIENTinSuspence, wheedling and telling her idle Stories, that theCaseis not sodangerous, thePains,Floodings, &c. will go off in good Time, and the like: Or afterwards (upon appearance of more severe growingSymptoms) they extenuate theDanger, telling her to submit withPatience, the commonMisfortunecannot possibly be prevented,&c.
TOwhich usualSuggestions, I answer; that as theoneis an ignorant and imprudentInsinuation, theotheris a downrightFalsity: For in thefirst CASE, theWomanis diverted by foolishHopesfrom applying for properAdvice, until perhaps it is past allRemedy; and in thesecond, she is misled very often to her utterRUIN: Since whatever hath not yethappen’d, may peradventure be happilyprevented; and even upon thelast Extremityof the mostviolent Occasion, theSeverityof theCasemay possibly be averted by good Management, and theDangerentirely compounded for by proper Conduct.
WHEREFORE, I cannot but think, it is worth anyWoman’s while to know theMarksof anapproachingandinstant ABORTION: Whereof theDIAGNOSTICKSare as follow,viz.
I. A suddenExtenuationandFallingof theBreasts[101]; sometimes only ofOne, but more commonly ofBoth: That ofOnedenoting theWomanto bearTwins, of which she is about to loseOne; and which, if therightBreastfalls, is aMale; but if theleft, aFemale.
II. AWatery Milkflows[102]in Abundance from thoseFALLEN BREASTS, discovering the future Danger.
III.PALPITATIONSof theHeart, frequently accompany’d with aCoarctationof theSidesandUpper Belly, very much incommoding thePatient.
IV. AGRAVITYorHeavinessof theLoins, andThighs;Gnawingof theStomach,Painsof theHeadandEyes.
V. ATREMOR, orTremblingandQuaking FITS, attended with aFrigidityof the exteriourLimbs.
VI. ARigorand Stiffness, or aVibrationand Concussion of theSKINandMUSCLESof the whole Body, with a concomitantChilness.
VII.HORROUR,Fevers,Faintings,Swoonings, and sometimesConvulsions,Cramps, &c. all foreboding the comingMalady. These are the usual and principal Marks of anapproaching ABORTION: Which whenInstant, and theTimeat Hand, then the
VIIIthDIAGNOSTICKplainly appears; which is acorrupt WATERflowingfirst, next abloody WATER, thenpureBlood, after that smallClodsofBlood, and at length, theInfantitself (form’dorinform’d) follows of Course.
HENCEI proceed to the usualPrognosticksofABORTION; which take as follow in their proper Order,viz.
I.ALLWomenare more endanger’d in aMiscarriage, than in aNatural Birth: becauseThathappening at apreternatural Time, is of greaterViolencethanThis. For like asripe Fruit, whoseStalkis so loose in its Season from theTree, that theFruitfalls of its own Accord: So it is in aNatural Birth, for theVesselsandLigaments, by which theInfantadheres to theWomb, easily loose and break spontaneously; which in an Abortion, must needs happen by a more dangerous painfulForceandViolence.
II.THO’Women(in thisCase) may frequently escape with theirLives, yet theirNatural Constitutionis thereby too often broke at least, and debilitated, orthereupon subjected to one or other heavySYMPTOMorDISEASE; if not also rendred quiteBARREN.
FORsometimes, because of thePains,Flux, orPutrefactionof the retain’dBlood,Fevers, and otherDistempersgenerally ensue: Sometimes by the violentDisruptionof theVessels, greatFloodingsand Loss ofBloodhappen; upon whichFaintings,Swoonings,Convulsions, and at lengthDeathit self follows: But, in fine,Convulsionshappening[103]eitherat the Time, orafter ABORTION, theCaseis mostdangerous; for then thePatientseldom escapes.
III.THEfirst MISCARRIAGEis mostdangerousto all; because theGenital Partsare more streight or constricted, and less acquainted with such severe distendingPains: And besides theOrificesof theVesselsbeing so violently dilacerated, thePartyoften continues afterwardsSterileorBarrenthe rest of her Life[104].
IV.LEANandtender Womenare much endanger’d inABORTION, by Reason of theirDebilityandInfirmity: As Women too fat are, on the other Hand; because of the greatAstrictionandNarrownessof thePassages.
V.THEyoungertheAbortiveProductionhappens to be, the less theWomanis endanger’d; because thelargertheInfantis, it gives the greaterPainsandRuptionof theVessels.
VI.WHATEVERhappens in the 7th or 9thMonth, may be reckon’d asafe BIRTH, provided theChildbeAlive: Whereas ifDead, it is extremely dangerous. But aboveAll, theEighthMonthis to be mostdreaded, not only because of theLargenessof theINFANT, but also because of thepernicious QualityofthatMonth; as will hereafter more amply appear in Chap. 34.
WHICHConsideration leads me farther to observe; That, from the Beginning of the5th, until the Middle of the6thMonth, theINFANTis least liable toDanger[105]: So next in the4th, and from the Middle of the6th, until the Close of the 7th Month: Then of course it issaferin the3dand2dMonths, than in the1stor9th. For the leastCausemay expell theEmbryoin theFirst, and break theMature Ligamentsof theINFANTin theNinth. But of all the whole Time, as I said before, the8thMonthis themost[106]dangerous, both toMOTHERandINFANT: according to which Consideration and Order ofTime, the prudentPhysicianmay, with more or less eitherFearon theone hand, orAssuranceon theother, exhibit or prescribe properREMEDIESfor thePreservationorRecoveryof hisPatients.
FROMwhence I come in the next place to offer my seriousSentimentsupon theCureof thisMalady, and thePreventionofABORTION: Which difficultWorkdepends chiefly upon thePreservationof bothMOTHERandINFANT; for when theMiscarriageis once over, theCurethen does not much differ from theCaseof anatural BIRTH.
HOWEVERin allCasesof this nature, it is an infallibleMaxim, that it is more easy to preventMiscarriage, than to relieve or rectify theMiscarrying Woman; and more proper to begin thatPreventionBefore, thanAfterConception: Because the most properRemediesfor obviating manyCausesofABORTION, cannot so well be adhibited to theWomanafter she isPregnant. And besides, asthose Causesare veryDifferentand various (as more fully appears from what has been said); so the Manner and Method ofPreventioncannot be altogether exactlyUniform; everyCauserequiring its respectiveCure, before aPreventioncan be effected.
WHEREFORE, in my humble Opinion, thefirst Steptowards thisPreventionis to weigh well and consider carefully theCONSTITUTIONof the yetunimpregnated Woman; in order to know and discover theCauseorCauseseither ofBody, orWomb, which may or can occasion any futureABORTION. Now in thisCase,Womenhaving oncemiscarry’d, or oftner, methinks they may easily find out theCauseThemselves, by the Help of theirMidwives; which being done, they should endeavour to have it remov’d, and effectuallycur’d, before theyconceiveany more. However, if it chance to be neglected at that time, it may be more prudently undertaken afterwards, with suchPrecaution, as theNatureof theCAUSEandCONSTITUTIONof theWomanrequire: Always remembring, but especiallybeforeoraboutthe usualTimeofABORTION, to make use of properCorroborativesfor strengthening both theINFANTandWOMB; sinceWomen,miscarryingfrom any one internalCause, commonly bear theirConceptionsto a certainTime, which they cannot exceed, unless thatCausebe judiciously removed beforehand.
I ONCEhad an accidental Opportunity of being fully satisfied of the Veracity of thisCase, in aWomanof good Note in the City ofDresden; whomiscarried fourteen Timesin less thaneight Years; being never able togobeyond thetenth Dayof thefourth Month, and commonly losing theFoetusabout thelastof theThird.
ATmy Arrival in thatPlace, I found myCredit, for my necessarySupplies, upon a certainMerchant; who (with great Concern) gave me this melancholick Account of hisSpouse, desiring my goodOffices, if possibly any Means could be of Service. Upon which, I first made it my Business to discover,that internal Cause, whereinshe, and her ordinaryMidwives, had been so often mistaken; this being done, I happily performed theCure, tho’ (as aTraveller) I had not the Satisfaction of staying there to see theConsequence. But, however,by my last Advices from the gratefulHusband, I findsheis nowMotherof two prettyBoysand a fineGirl.
THECauseofAbortionthen being duly and discreetlyfirstdiscovered, if it proceeds from anyIntemperatureeither of theBodyor theWomb; thesamemay be prevented chiefly by introducing thecontrary Temperament, according toHippocrates’s[107]Judgment, thatContraries are theRemediesof Contraries.
IFit proceeds from too muchFatness, herBodyis to be reduced; if it comes from too muchLeanness, a convenientDietand goodRegimen, &c. will help to restore her.
IFit happens from aPLETHORY, the too much aboundingBLOODis to be circumspectly lessened: As the Humours are to be judiciously evacuated, if it arises from aCacochymy; and all Causes affecting the Spirits and Humours are to be carefully removed and avoided.
DISEASESof the wholeBodyare to be prevented as much as possible, by aRegularityof properDIETandREGIMENof Health; but wheneverTheseare incident, they ought to be cured, as theNatureof theDISEASEandCONSTITUTIONof theWomanwill prudentially permit.
IFABORTIONhappens from anyCauseon the part of theWomb,thatmust absolutely be removed beforeCONCEPTION, and resisted afterwards during theFOETURA, by the discreetUseof proper Means.
IFit arises from anyCauseof theNeighbouring Parts, that is to be carefully managed or avoided, andpreventedmore easily thancured.
ASto theCauseson the Part of theINFANT, I shall refer theREADERto the precedingChapteronly; as I do likewise if it comes from anySYMPTOMof theMonths, or from anyAcute Disease, to their respectiveChaptersin thisSECTION.
FINALLY, If it proceeds from anyProcatarctick CAUSES, eitherinternalorexternal, all such are to be sedulously avoided and prevented; but wheneverThesehappen, they are generallycuredby properALTERATIVESof anAstringent Quality, for confirming theLigaments; andCORROBORATIVESfor comforting theINFANT, and cherishing theWOMB.
BUTsupposing, at last, theCasedesperate, and past allRemedy, throughNegligenceorDelay, that theCurecannot possibly be effected, nor theMisfortuneofInstantAbortionprevented; why then theWomanought to be carefully comforted and strengthened, theLigamentsrelaxed, thePassagesdilated, and theexpulsive Facultyassisted; so that the worseConsequencesand greaterDangermay be averted.
ANDhaving now, in fine, thus at large treated upon the Subject ofAbortion, it leads me methodically (of Course) to touch upon all otherBirthsrespectingTime; I meanLegitimateandIllegitimateBirths: Which (however) I shall discuss in asSuccinct Termsas I can, to oblige theReader. Andfirst,