WOMEN miscarry so frequently, that if any curious Persons will diligently observe and examine that Matter, they will find the Number of Miscarriages to exceed That of timely Births: Wherefore I have reason to think, that this Head deserves to be handled more at large, and to be more particularly insisted upon, in the following manner.
THE Modern Practisers in MIDWIFERY, distinguish Miscarriages, by four different Appellations; according to the four different Times of the Constitution of the CONCEPTION. viz.
A Miscarriage happening in the Time of Spumification, is call’d an Effluxion of the GENITURA: That which happeneth in the Vegetation, or Time of Ramification, or (as some will have it) before the 40th Day, is call’d a Deperdition of the Embryo: That which falls out in the sensitive Progression, or Time of Carnification, or (as others will have it) before the 90th Day from CONCEPTION, they call an Abortion of the Foetus. But what so happens afterwards preceding the 7th Month, is properly call’d an entire Abortion of the Infant.
HOWEVER, Others will have a fifth Distinction made; namely, what so happens in the 7th, 8th, and preceding the 20th Day of the 9th Month, to be call’d an untimely BIRTH; because tho’ born with Life, they alledge it to be very seldom, or never really Vital, or likely to Live: Upon which I shall, in good Time, introduce my own Sentiment in the subsequent Chapters of this Section.
NOTWITHSTANDING, this Definition signifies but little to the Purpose; let the MISCARRIAGE happen when it will, and under whatsoever Name or Denomination, It is nothing else in general, than an untimely Exclusion of an imperfect and immature Birth; which unhappy Accident may proceed from a vast Variety of Causes, stimulating Nature to such a violent Expulsion.
IN treating therefore of this Accidental BIRTH, I shall make use of none of those Distinctions; but rather (to prevent Mistakes) shall call all its several Species, of whatsoever Time, by the general (and most common) Name of ABORTION.
AND of this ABORTION, happen when it will, the proximous Cause is always the Expulsive Faculty of the Womb; which being hurt, or violently disorder’d in any respect, irritates and debilitates the Retentive Power: And then again, on the other hand, this Retentive Faculty (tho’ not the proximous Cause) is sometimes first hurt or injur’d, and by that means incapacitated to retain the INFANT; which (in that Case) offends and provokes the Expulsive Power[93], which is the proper proximous Cause of all ABORTIONS.
BUT most commonly the Expulsive receives the First Hurt; from whence the Retentive is oblig’d to Sympathize, and yield to its over-ruling Motions. And, according to Galen[94], the Expulsive Faculty may be injur’d and irritated by Three different Causes; viz. 1. By the Bulk of the Infant, when the Womb cannot distend itself far enough to contain it: 2. By its Weight, when heavier than the Womb and Ligaments can bear: And, 3. By the Humours (when the Membranes break) flowing into the Womb; occasioning a Mordacious Itching there, or putrefying the Infant in its Place.
TO which three Efficients, some Modern Authors have thought it sufficient to add the similar, organical, and common Diseases of the Womb; together with some Procatarctick Causes.
HOWEVER, because I have generally observ’d Those, to be very promiscuously and confusedly treated of, I shall (according to my best Ability) endeavour to reduce the many different Causes of ABORTION to such plain Heads, and set them in such a clear Light, that they shall prove evident and manifest to the meanest Capacity: That Women (whose peculiar Good I have only at Heart in the Performance of this Work) may readily conceive them, and thereby be enabled (in most Cases) to prevent their greatest Misfortunes. And that whether the Cause happens proximously and immediately from a stimulated Expulsive, or mediately from a læs’d and injur’d Retentive Faculty.
WHEREFORE I shall now reduce those Causes to the following Four general Heads; namely, 1. To the Constitution of the Mother: 2. The Constitution of the Infant: 3. The Symptoms of the Months: And, 4. To the various Procatarctick Causes of this Tragical Case.
FIRST the Causes of ABORTION, proceeding from the Constitution of the Mother, are Three-fold, and respect either her whole Body, her Womb only, or its neighbouring Parts. Those respecting her whole Body, are,
I. THE four Intemperatures of the Body; as the Calid, which, by its Hot Quality, exhausts the Humours (that are naturally necessary) to the Prejudice and Loss of the Infant.
II. THE Frigid; which, by its Cold Quality, vitiates and attenuates the Infant’s Aliment, to a starving Condition.
III. THE Siccid; which, by its adust dry Quality, scorches and consumes the Ligaments, that they break, like so many Strings that snap before the Sun: Upon which the Infant (being deprived of those Mediums, through which Nature has appointed its Sustenance) corrupts and decays, like a PLANT in Arid Sandy Ground.
IV. THE Humid Intemperature; which, by its moist Quality, debilitates the Retentive Faculty, hinders the Ligaments to consolidate and close firmly, and opens the shut Orifice of the Womb. But besides all This also, by filling the ACETABULA with superfluous Humours, it may suffocate and stifle the INFANT.
V. A nimious and too great an Obesity or Fatness, and too great a Gracility or Leanness of the Woman’s Body: For the One converts the CHILD’s Nourishment to itself; and the Other starves the INFANT for want of its natural Requisites.
VI. A PLETHORY, or too great a Repletion of Blood in her Body; which frequently choaks and suffocates the INFANT.
VII. ALL Corporeal Causes, exagitating the Spirits and Humours; which have the same Effect and Force to irritate the Expulsive Faculty.
VIII. ALL Diseases incident to the Body, whether they be Acute, Remiss, or Diuturnal; which may easily effect ABORTION. But
SECONDLY, The Causes on the part of the Womb, are not to be lightly or slightly considered; because if it be not both naturally well constituted, and carefully well dispos’d, it can neither foment, cherish, nor retain the Infant. For the least Flaw of its morbifick Causes, stimulates to a great Degree the expulsive Faculty: which Causes are, in my Opinion, as follow; viz.
I. THE Womb’s Præternatural SIZE, either in Magnitude, or Exiguity: The one giving room for the Infant’s too much tumbling or too frequent Motion; and the other restraining the CHILD too much, even to the suppressing and stifling of it.
II. ITS præternatural CONSTRICTION or Coarctation; which may resist its necessary due Extension, for containing the growing Infant.
III. ITS præternatural DENSITY; which may not only hinder the requisite Distention, but also prevent the Secundine[95] from being firmly connected to the Vessels.
IV. ITS LAXITY of the Orifice, or Lavity of the interiour Surface; proceeding from pituitous[96] or viscous Humours, which slacken the Ligaments, and give way to the Foetus.
V. THE Womb’s too frigid and siccid Intemperature; which Qualities are the greatest Enemies to Nature and all the Actions of Female LIFE.
VI. ITS frigid and humid Intemperature; which (abounding with Mucosities or slimy Humours) so relaxes the Ligaments, that they cannot hold or detain the INFANT.
VII. ALL obdurated and confirmed Tumours and Ulcers, all Erysipelas and Inflammations of the Womb: Which often prove the Causes of the same Effect.
VIII. A præternatural Situation, or an oblique Position may become the 8th and last Cause of ABORTION, which I shall mention on part of the Womb.
FROM hence I come, Thirdly, in a due Method, to Those Causes respecting the neighbouring Parts; which I humbly conceive to be as follow.
I. ALL Diseases, Pains, and what Causes soever of those Parts, may tend much to deject or affect the Spirits, and stir up the Humours with unusual Alteration.
II. ALL Causes and bad Affections compressing the lower Belly, and exagitating or straining its Muscles.
III. A præternatural Site and inapt CONFORMATION[97] of the Umbilical Vessels, for their due Operation.
BUT then again, Secondly, It also often happens that, tho’ the pregnant Woman labours under no Disease or Misfortune, either in Body, Womb, or neighbouring Parts, yet notwithstanding the Expulsive Faculty is irritated to Ejection by several Causes of the Constitution of the INFANT itself, as follow; viz.
I. ITS præternatural Bulk, or vitious Conformation, oppressing and straining the Womb, either in Whole or in Part.
II. ITS Debility and Weakness, or contracted, infirm, feeble Constitution, as mentioned in the preceding Chapter.
III. THE Death of the INFANT, emitting nauseous Vapours and putrefy’d Matter, stimulates the Womb sooner or later to Expulsion: And (in this tragical Case) the sooner the Better; as will hereafter appear.
AND moreover, Thirdly, the SYMPTOMS of the Months, frequently prove Causes of ABORTION; of which SYMPTOMS, having already treated particularly, I shall in this place repeat little or nothing, only refer the Reader to their respective Chapters in the preceding Part of this Section: And yet under this present Head, may be also comprehended all Acute Diseases, which (too often) prove of the same bad Consequence; as is evident from Chap. 28.
FOURTHLY, There is a great Variety of Procatarctick Causes, distinct from all those above-mentioned, which most frequently occasion ABORTION: And Those are Two-fold, INTERNAL and EXTERNAL. Of which the Internal are as follow, in my Judgment.
I. THE Passions of the Mind (mentioned in Sect. I. Chap. 5.) because such immoderate Affections too much excite the Humours, and incense the Spirits.
II. VICTUALS; if taken too much at a time, suffocate the INFANT; if too little, it is starved, and the MOTHER brought to a very low Condition of Life; and if improper, or of ill Concoction, the CHILD is thereby either much weaken’d, or (which is worse) it dies of course.
III. DRINKING immoderately, extinguisheth the natural Calidity of the Womb and the INFANT; as certainly strong or hot Liquors impress a vitious Intemperature upon Both.
IV. WATCHINGS a-Nights, too much exhaust and dissipate the Spirits; as too much Sleep, on the other hand, dulls, lessens, and obtunds the natural Heat.
V. ALL inward disorderly Causes dissolving the Uterine Acetabula, Ligaments, or Vessels, by which the INFANT attracts its Nourishment.
VI. ALL Venenated, Cathartick, and Diaphoretick MEDICINES, Acrimonious Clysters, Venæ-Sections, Baths, &c: Which partly by exagitating the Spirits and Humours, and partly by diminishing the Aliment, occasion frequent ABORTIONS. Again
THE external Procatarctick Causes are These, which ensue in their due Order.
I. ALL inclement Constitutions or bad Influences of the Weather, Winds,[98]and Air; such as Cold, which pinches; or as Heat, which intercepts the Breath, and stifles the INFANT, &c.
II. SMELLING or Touching, Sitting, or Treading upon some Sorts of pernicious Herbs.
III. ALL violent Motions, immoderate Exercises, &c. such as Running, Leaping, Dancing, Riding, or Coaching, Lifting, or Carrying a heavy Weight, also long Fasting, strait Lacing, a Fall, a Blow on the Back or the Belly, &c. as I hinted before occasionally.
IV. ALL frightful Objects, and sudden Surprizes by hasty News, Fire, or such like terrifying Accidents.
V. ALL astonishing and terrible affecting NOISES; such as sudden Claps of Thunder, Cannons, Guns &c.
VI. ALL nauseous Stinks, on the one hand, and odoriferous Smells, &c. on the other, being both disagreeable and dangerous.
THOSE, and many other trifling Matters, such as the Smell of an extinguished Light, or Candle, are known (too often) to be the Reason and Cause of ABORTION: which made (that great Naturalist) Pliny[99] justly take occasion to deplore the Frailty of Man.
“HE bewails and is asham’d (as he expresseth it) to think how frivolous the ORIGIN of the proudest of Creatures is; such a mere Trifle (as is mentioned) being frequently the Cause of his FATALITY. And the Philosopher most pertinently adds, that He who now glories in so many VANITIES, trusting in the Strength of his Body, vaunting in the Riches of his Possessions, and upon every Smile of Fortune, believes himself to be a God, &c. little considers how many ways he might have miscarried in coming into the World, or how many ways he may yet, even to-day, go out of it, and come to his last GASP, as Anacreon, the wanton Lyrick Poet, did, who was suddenly choak’d with the Stone of a Grape; or as Fabius (that noble Dictator of Rome) dy’d, who was immediately strangl’d by a HAIR in a Draught of Milk.”
I say, He little considers, how many Trials and Hardships he was expos’d to, before he had Being: or, how many ways he might have been stifled before he had Breath, and have been dead even before he was Born.
WHICH Consideration leads me to the Thought of another Cause of ABORTION, mentioned by the holy Prophet[100]Hosea, where he says: “Because they have deeply corrupted themselves, and separated themselves unto that Shame at Baalpeor, (i. e. defiled themselves at the Statues of Priapus) their Glory shall fly away like a Bird, from the Womb, from the Conception, and from the Birth; dry Breasts, and a miscarrying Womb shall be given them, &c.”
AND having thus far briefly defin’d and descanted upon ABORTION, and the Nature of its Efficients, I come now, in the next place, to shew by what DIAGNOSTICK SIGNS, every Woman may infallibly know an approaching or instant MISCARRIAGE, either in herself or another: As also to set forth, by what PROGNOSTICK SIGNS, she may know the Danger she is threatned with upon that Occasion.
WHICH Undertaking, I hope, may prove conducive to the Welfare of that tender Sex; it being too common for Women to neglect the proper Means, through a supine Ignorance of the Nature, and Danger of their CONDITION. But This, however, is generally owing to indiscreet Old Women about them; (as I have often observ’d, and oft’ner had Occasion to hear) who either keep the PATIENT in Suspence, wheedling and telling her idle Stories, that the Case is not so dangerous, the Pains, Floodings, &c. will go off in good Time, and the like: Or afterwards (upon appearance of more severe growing Symptoms) they extenuate the Danger, telling her to submit with Patience, the common Misfortune cannot possibly be prevented, &c.
TO which usual Suggestions, I answer; that as the one is an ignorant and imprudent Insinuation, the other is a downright Falsity: For in the first CASE, the Woman is diverted by foolish Hopes from applying for proper Advice, until perhaps it is past all Remedy; and in the second, she is misled very often to her utter RUIN: Since whatever hath not yet happen’d, may peradventure be happily prevented; and even upon the last Extremity of the most violent Occasion, the Severity of the Case may possibly be averted by good Management, and the Danger entirely compounded for by proper Conduct.
WHEREFORE, I cannot but think, it is worth any Woman’s while to know the Marks of an approaching and instant ABORTION: Whereof the DIAGNOSTICKS are as follow, viz.
I. A sudden Extenuation and Falling of the Breasts[101]; sometimes only of One, but more commonly of Both: That of One denoting the Woman to bear Twins, of which she is about to lose One; and which, if the right Breast falls, is a Male; but if the left, a Female.
II. A Watery Milk flows[102] in Abundance from those FALLEN BREASTS, discovering the future Danger.
III. PALPITATIONS of the Heart, frequently accompany’d with a Coarctation of the Sides and Upper Belly, very much incommoding the Patient.
IV. A GRAVITY or Heaviness of the Loins, and Thighs; Gnawing of the Stomach, Pains of the Head and Eyes.
V. A TREMOR, or Trembling and Quaking FITS, attended with a Frigidity of the exteriour Limbs.
VI. A Rigor and Stiffness, or a Vibration and Concussion of the SKIN and MUSCLES of the whole Body, with a concomitant Chilness.
VII. HORROUR, Fevers, Faintings, Swoonings, and sometimes Convulsions, Cramps, &c. all foreboding the coming Malady. These are the usual and principal Marks of an approaching ABORTION: Which when Instant, and the Time at Hand, then the
VIIIth DIAGNOSTICK plainly appears; which is a corrupt WATER flowing first, next a bloody WATER, then pure Blood, after that small Clods of Blood, and at length, the Infant itself (form’d or inform’d) follows of Course.
HENCE I proceed to the usual Prognosticks of ABORTION; which take as follow in their proper Order, viz.
I. ALL Women are more endanger’d in a Miscarriage, than in a Natural Birth: because That happening at a preternatural Time, is of greater Violence than This. For like as ripe Fruit, whose Stalk is so loose in its Season from the Tree, that the Fruit falls of its own Accord: So it is in a Natural Birth, for the Vessels and Ligaments, by which the Infant adheres to the Womb, easily loose and break spontaneously; which in an Abortion, must needs happen by a more dangerous painful Force and Violence.
II. THO’ Women (in this Case) may frequently escape with their Lives, yet their Natural Constitution is thereby too often broke at least, and debilitated, or thereupon subjected to one or other heavy SYMPTOM or DISEASE; if not also rendred quite BARREN.
FOR sometimes, because of the Pains, Flux, or Putrefaction of the retain’d Blood, Fevers, and other Distempers generally ensue: Sometimes by the violent Disruption of the Vessels, great Floodings and Loss of Blood happen; upon which Faintings, Swoonings, Convulsions, and at length Death it self follows: But, in fine, Convulsions happening[103] either at the Time, or after ABORTION, the Case is most dangerous; for then the Patient seldom escapes.
III. THE first MISCARRIAGE is most dangerous to all; because the Genital Parts are more streight or constricted, and less acquainted with such severe distending Pains: And besides the Orifices of the Vessels being so violently dilacerated, the Party often continues afterwards Sterile or Barren the rest of her Life[104].
IV. LEAN and tender Women are much endanger’d in ABORTION, by Reason of their Debility and Infirmity: As Women too fat are, on the other Hand; because of the great Astriction and Narrowness of the Passages.
V. THE younger the Abortive Production happens to be, the less the Woman is endanger’d; because the larger the Infant is, it gives the greater Pains and Ruption of the Vessels.
VI. WHATEVER happens in the 7th or 9th Month, may be reckon’d a safe BIRTH, provided the Child be Alive: Whereas if Dead, it is extremely dangerous. But above All, the Eighth Month is to be most dreaded, not only because of the Largeness of the INFANT, but also because of the pernicious Quality of that Month; as will hereafter more amply appear in Chap. 34.
WHICH Consideration leads me farther to observe; That, from the Beginning of the 5th, until the Middle of the 6th Month, the INFANT is least liable to Danger[105]: So next in the 4th, and from the Middle of the 6th, until the Close of the 7th Month: Then of course it is safer in the 3d and 2d Months, than in the 1st or 9th. For the least Cause may expell the Embryo in the First, and break the Mature Ligaments of the INFANT in the Ninth. But of all the whole Time, as I said before, the 8th Month is the most[106] dangerous, both to MOTHER and INFANT: according to which Consideration and Order of Time, the prudent Physician may, with more or less either Fear on the one hand, or Assurance on the other, exhibit or prescribe proper REMEDIES for the Preservation or Recovery of his Patients.
FROM whence I come in the next place to offer my serious Sentiments upon the Cure of this Malady, and the Prevention of ABORTION: Which difficult Work depends chiefly upon the Preservation of both MOTHER and INFANT; for when the Miscarriage is once over, the Cure then does not much differ from the Case of a natural BIRTH.
HOWEVER in all Cases of this nature, it is an infallible Maxim, that it is more easy to prevent Miscarriage, than to relieve or rectify the Miscarrying Woman; and more proper to begin that Prevention Before, than After Conception: Because the most proper Remedies for obviating many Causes of ABORTION, cannot so well be adhibited to the Woman after she is Pregnant. And besides, as those Causes are very Different and various (as more fully appears from what has been said); so the Manner and Method of Prevention cannot be altogether exactly Uniform; every Cause requiring its respective Cure, before a Prevention can be effected.
WHEREFORE, in my humble Opinion, the first Step towards this Prevention is to weigh well and consider carefully the CONSTITUTION of the yet unimpregnated Woman; in order to know and discover the Cause or Causes either of Body, or Womb, which may or can occasion any future ABORTION. Now in this Case, Women having once miscarry’d, or oftner, methinks they may easily find out the Cause Themselves, by the Help of their Midwives; which being done, they should endeavour to have it remov’d, and effectually cur’d, before they conceive any more. However, if it chance to be neglected at that time, it may be more prudently undertaken afterwards, with such Precaution, as the Nature of the CAUSE and CONSTITUTION of the Woman require: Always remembring, but especially before or about the usual Time of ABORTION, to make use of proper Corroboratives for strengthening both the INFANT and WOMB; since Women, miscarrying from any one internal Cause, commonly bear their Conceptions to a certain Time, which they cannot exceed, unless that Cause be judiciously removed beforehand.
I ONCE had an accidental Opportunity of being fully satisfied of the Veracity of this Case, in a Woman of good Note in the City of Dresden; who miscarried fourteen Times in less than eight Years; being never able to go beyond the tenth Day of the fourth Month, and commonly losing the Foetus about the last of the Third.
AT my Arrival in that Place, I found my Credit, for my necessary Supplies, upon a certain Merchant; who (with great Concern) gave me this melancholick Account of his Spouse, desiring my good Offices, if possibly any Means could be of Service. Upon which, I first made it my Business to discover, that internal Cause, wherein she, and her ordinary Midwives, had been so often mistaken; this being done, I happily performed the Cure, tho’ (as a Traveller) I had not the Satisfaction of staying there to see the Consequence. But, however, by my last Advices from the grateful Husband, I find she is now Mother of two pretty Boys and a fine Girl.
THE Cause of Abortion then being duly and discreetly first discovered, if it proceeds from any Intemperature either of the Body or the Womb; the same may be prevented chiefly by introducing the contrary Temperament, according to Hippocrates’s[107] Judgment, that Contraries are the Remedies of Contraries.
IF it proceeds from too much Fatness, her Body is to be reduced; if it comes from too much Leanness, a convenient Diet and good Regimen, &c. will help to restore her.
IF it happens from a PLETHORY, the too much abounding BLOOD is to be circumspectly lessened: As the Humours are to be judiciously evacuated, if it arises from a Cacochymy; and all Causes affecting the Spirits and Humours are to be carefully removed and avoided.
DISEASES of the whole Body are to be prevented as much as possible, by a Regularity of proper DIET and REGIMEN of Health; but whenever These are incident, they ought to be cured, as the Nature of the DISEASE and CONSTITUTION of the Woman will prudentially permit.
IF ABORTION happens from any Cause on the part of the Womb, that must absolutely be removed before CONCEPTION, and resisted afterwards during the FOETURA, by the discreet Use of proper Means.
IF it arises from any Cause of the Neighbouring Parts, that is to be carefully managed or avoided, and prevented more easily than cured.
AS to the Causes on the Part of the INFANT, I shall refer the READER to the preceding Chapter only; as I do likewise if it comes from any SYMPTOM of the Months, or from any Acute Disease, to their respective Chapters in this SECTION.
FINALLY, If it proceeds from any Procatarctick CAUSES, either internal or external, all such are to be sedulously avoided and prevented; but whenever These happen, they are generally cured by proper ALTERATIVES of an Astringent Quality, for confirming the Ligaments; and CORROBORATIVES for comforting the INFANT, and cherishing the WOMB.
BUT supposing, at last, the Case desperate, and past all Remedy, through Negligence or Delay, that the Cure cannot possibly be effected, nor the Misfortune of Instant Abortion prevented; why then the Woman ought to be carefully comforted and strengthened, the Ligaments relaxed, the Passages dilated, and the expulsive Faculty assisted; so that the worse Consequences and greater Danger may be averted.
AND having now, in fine, thus at large treated upon the Subject of Abortion, it leads me methodically (of Course) to touch upon all other Births respecting Time; I mean Legitimate and Illegitimate Births: Which (however) I shall discuss in as Succinct Terms as I can, to oblige the Reader. And first,