regularly and with very considerable severity for ten or twelve hours, and yet the os uteri was only very partially dilated. The pains then subsided and almost disappeared. The nausea and vomiting had rendered it impossible for her to take sufficient stimulus, and her strength was extremely exhausted. She was for the first time restless and tossing, her spirits greatly depressed, countenance anxious, the pulse quick. In this situation of things, I gave her hot brandy and water, as freely as the stomach could receive it, until the extreme exhaustion was somewhat relieved, and then gave another portion of ergot of about fifteen grains. By this means the pains were again excited, and advanced with more rapidity than before. In about three hours, they had begun to assume the character of bearing down, and every thing indicated a speedy delivery. Unfortunately at this moment her feelings were agitated by being suddenly informed of the severe illness of a friend, and by some other circumstances connected with it; and the pains again subsided. The exhaustion returned, but was not suffered to proceed so far as it had previously gone; by repeating the ergot the pains were again brought back. They now became quite vigorous, and the labor advanced rapidly, and about two o'clock in the afternoon of the second day, the fœtus was expelled. It was dead, but had not been long so; for it had every appearance of having recently been alive, and motion had been distinctly felt by the mother in the course of the morning. Through all the last part of the labour, the patient had

complained of a very peculiar sensation during the pains, as of something which prevented the uterus from bearing down; and rather drew upwards. The feeling was so peculiar and so strong that she could scarcely be persuaded that such pains could ever accomplish the delivery, and it continued until the fœtus was expelled. It was afterwards explained, by finding that the placenta adhered very firmly by a small portion to the upper part of the uterus, and could not be thrown off by the natural efforts, although the pains were strong. It was necessary to introduce the hand, and gently separate the placenta with the fingers. This operation was attended with some difficulty, inasmuch as from the smallness of the foetus the parts were not very fully dilated, and was accompanied by a considerable hemorrhage. She was so much exhausted as to make it necessary to continue the stimulants cautiously for several hours after she was put into bed, but by great care she recovered to nearly her previous state of health.

It can hardly be doubted that both the suffering and the danger were in this case greatly increased by prolonging the time of delivery to so late a period, until the strength of the patient was so much exhausted as to leave little more than a desperate chance of recovery. It is true that we have no very certain means, applicable to all cases, of preventing labor from coming on when it is threatened. But it is no less true that we have means which have a

tendency to do this, and which in many cases will effectually do it; and we have always the means of bringing on labor when that is necessary. And if a physician should prescribe in any such case without having a definite object in view, and considering whether his remedies are to promote or to retard labor, his practice is in the highest degree empirical.

It is stated by Burns that 'whenever the muscular contraction is universally established, marked by regular pains, and attempts to distend the cervix and os uteri, nothing can check the process."* If it be meant, and such appears from these and other similar expressions to be his meaning, that after the occurrence of regular pains there is no longer room for any hope of preventing abortion, his prognosis is much too unfavorable. We surely need not so easily give up the expectation of a more favorable result, or our efforts to procure it. Every practitioner of experience must have seen cases in which regular pains, of some hours continuance, and sometimes even accompanied by a slight discharge, have been arrested, and abortion prevented. So long as there is any reasonable hope of effecting this, without danger to the patient, it must be our object to do it.

Still I believe the danger of trusting to the hope of preventing miscarriage, after it has ceased to

* Observations on Abortion. p. 39. New York edition.

have any sufficient foundation, to be much more common. In the first stages of the attack, if the hemorrhage is not violent, and there are no other threatening symptoms, we need not interfere to hasten the process of expelling the ovum; and if the character of the case is not at once decisive of the result, we may very properly use remedies to retard and prevent that process. But if the symptoms are not very speedily arrested, or if they are of a character to forbid the expectation of arresting them, the sooner the ovum is expelled the better. Every thing that delays this result, adds to the sufferings of the patient, and increases her danger. There are some remedies which may be equally proper in certain cases, whichever result of the case is anticipated, such as bleeding where there is plethora, or danger of inflammation, and at times some of the astringents. But bleeding, I believe, is often practised with little consideration of the purpose it is designed to accomplish; and of the astringents there is some room for selection, whether our object be to allay or to excite uterine contraction. In the use of opiates we must be guided entirely by a consideration of the result aimed at. The contents of the uterus cannot of course be expelled without pain; and therefore the exhibition of opium can only be proper when it is desirable to prevent their expulsion.

It is a common error in practice to make use of means to retard labor, in all cases of threatened

abortion indiscriminately, almost without considering whether there is any reasonable prospect of preventing the miscarriage from actually taking place. By this means the sufferings of the patient are not only greatly prolonged, but there is much less disposition in the system to such labor pains as are necessary to expel the foetus, and much less ability to bear them. It is highly probable that if the early practice were adopted with more discrimination, we should have less occasion to quicken the action of the uterus in the subsequent stages, by artificial means. In the present practice it is no uncommon occurrence to see the strength of the patient greatly reduced, and her life endangered, by a long continued hemorrhage, without sufficient contraction of the uterus to expel its contents. In such cases the ergot is a most valuable remedy. It is not indeed fully settled that it will excite the uterus to action without first puncturing the membranes. But where the symptoms are urgent, such an objection should have no influence. The membranes are easily ruptured, and if the uterus does not then contract spontaneously, the ergot will easily excite it to action. At the same time it is by no means certain that this operation is an indispensable preliminary to the efficient action of the ergot. Further observation must determine whether it may not be given safely and effectually at any period, whenever it becomes necessary to bring on premature labor.