OJ fc! WATSON J: tf WATSON -t 4 COLLEGE STECP/ft Ff-T.'GfO? SYSTEMATIC TREATISE ABORTION: EDWIN M. HALE, M.D., PROFESSOR OF MATERIA MEDICA ASD THERAPEUTICS IN HAHXEMAXX MEDICAL COLLEGE ETC., BTC. CHICAGO . C. S. HALSEY, 147 CLARK STREET. 1866. W & 2 2 Entered according to Act of Congress, in the year 1SGC, BY C. S. HALSEY, In the Clerk's Office of the District Court, for the Northern District of Illinois. CHURCH, GOODMAS AND DONNELLEY, PRINTERS, 51 and 53 LaSalle Street, Chicago. THIS VOLUME 13 INSCRIBED TO A. E. SMALL, A.M., M.D., OF CHICAGO : A MOST EXCELLENT PHYSICIAN, ONE OF THE BEST OF MEN, AND TRUEST OF FRIENDS. PREFACE. IN the Eighth Volume of the North American Journal of Homoeopathy (1860), an article appeared bearing the title, "Abortion: its Pre- vention and Treatment," in which the writer ventured to call the attention of his professiqnal colleagues to medicines not heretofore used by members of the Homoeopathic school, and which he believed to be of considerable value as remedial agents for the removal of certain abnormal conditions of the organs of generation, which are likely to cause an arrest of development, or premature expulsion of the product of conception. The interest that this article aroused in the professional mind was such that the writer felt justified in enlarging and amending the original paper. \i was then issued by the present publisher, in a pamphlet of twenty-two pages, entitled " The Homoeopathic Treatment of Abortion" etc. This small brochure was prefixed by a Prefatory Letter from Dr. R. Ludlam, in which he kindly commended it to the notice of Homoeopathic physicians. That edition of the monograph having been exhausted, the writer engaged in a more thorough and systematic study of the subject. Five years having elapsed since the appearance of the original paper, he had gained increased practical experience upon the subject. He has, therefore, attempted to embody these results in the Treatise herewith presented to the general medical profes- sion, and especially to physicians of the Homoeopathic school. He sincerely hopes this volume will form a useful addition to our medical literature. CHICAGO, April 2, 1866. CONTENTS. PAGE INTRODUCTION xiii PART I. STATISTICS OF ABORTION. Of Foreign Countries . 19 Of New York City 20 Of Boston ....*. 22 Of Chicago , 23 As to the period at which Abortion occurs 25 Of Criminal Abortion 27 PART II. ETIOLOGY OF ABORTION. TABULAR VIEW OF THE CAUSES OF ABORTION 33 SEC* I. PREDISPOSING CAUSES. Plethora 35 Anfemia or Chlorosis 35 Scrofula 36 Return of Menstrual Crisis 36 : Zymotic Diseases: Syphilis v 37 Mercurialization 38 Variola 38 Asiatic Cholera 39 Yellow Fever 39 ' SEC. II. LOCAL CAUSES. Abnormal Condition of the Ovum and its Appendages 39 Moles 40 Hydatids 41 Fatty deterioration of the Chorion and Placenta 42 Congestion of the Placenta. 43 Inflammation of the " 43 Placenta Previa 44 SEC. III. CENTRIC CAUSES. Emotional 45 Physical 45 Medicinal 46 Vlll. CONTENTS. PAGE Galvanism 48 Cerebro- Spinal-Meningitis 49 SEC. IV. CONCENTRIC CAUSES. Parotidean 55 Thyroidean 56 Mammary 56 Gastric 56 Dental 57 Renal 57 Vesical 57 Rectal 57 Vaginal 58 Ovarian 58 Uterine 59 * SEC. V. FUNCTIONAL DISEASES OF THE UTERUS. Congestion 61 Leucorrhoea 62 " Cervical or Mucous 64 " " Sequelae 65 " Vaginal or Epithelial 67 Gonorrhoea 69 SEC. VI. ORGANIC DISEASES OF THE UTERUS AND CERVIX. Ulceration of the Cervix 71 Simple Granulating Ulcer ^ 73 Varicose Fissured Follicular Phagsedenic Corroding Cancerous 76 77 79 80 80 80 Syphilitic " 80 SEC. VII. INDURATION OF THE CERVIX UTERI 82 Displacements of the Uterus 84 Anteversion 84 Prolapsus 84 Retroversion 84 Death of Embryo 87 Coitus 87 Instrumental Irritation 88 Ovarian 89 " Irritation 89 " Congestion 90 " Inflammation 90 CONTENTS. IX. SEC. VIII. PAGE MEDICINAL CAUSES 90 PART III. GENERATION : SYMPTOMS, DIAGNOSIS, PATHOLOGY. MECHANISM AND PROGNOSIS OP ABORTION. SEC. I. GENERATION. To date of Placental Attachments , 115 " Viability 117 " Delivery 118 Dimensions and Weight of the Foetus at the different periods of Uterine Life 119 SEC. II. SYMPTOMS OF ABORTION. Premonitory 123 Actual 124 Chills : 124 Pain 125 Haemorrhage 127 Fever 130 Complications 131 Discharges 131 Subsequent 131 SEC. III. DIAGNOSIS OF ABORTION. Metritis 134 Peritonitis 135 Dysmenorrhcea 135 Dysentery 135 Congestion of Uterus 136 Hydrorrhcea 137 Haemorrhage 138 Retention in Utero of the Ovum and Appendages 140 SEC. IV. PATHOLOGY AND MECHANISM OF ABORTION. Process of Abortion 142 After Conception 1 43 " twenty days to the third month 143 At sixth month 146 SEC. V. PROGNOSIS OF ABORTION. When favorable 148 " unfavorable 1 49 Natural abortions 150 Immediate consequences 151 Remote " , , 151 X. CONTENTS. PART IV. TREATMENT OF ABORTION. SEC. I. PREVENTIVE TREATMENT. PAGE Of Plethora 155 Anaemia or Chlorosis 159 Scrofula 162 Return of Menstrual Crisis 162 Of Zymotic Diseases: Syphilis 163 Mercurialization 164 Variola 164 Scarlatina 166 Diphtheria 168 Cholera 170 SEC. II. OF LOCAL OR ORGANIC DISEASES. Malformation of the Ovum 171 " . " Membranes 171 Placenta Previa 172 Organic Disease of Placenta 173 Fatty Degeneration 173 Hydatid " 173 Calcareous " 175 Molar " 175 SEC. III. OF REFLEX CAUSES. Centric 176 Emotion, Fright, etc 176 Blows, Injuries, etc 177 Medicinal 178 Concentric 178 Parotidean Irritation 178 Thyroidal 179 Mammary 179 Dental 180 Gastric 182 Rectal 183 Vesical * 186 Vaginal 187 Hysterical 189 Epilepsy 189 Falls, Jumping, Blows, etc 189 SEC. IV. OF FUNCTIONAL DISEASES OF THE UTERUS. Congestion 191 Inflammation 192 Leucorrhrea 192 Cervical ., .192 CONTENTS. XI. PAGE Vaginal 194 Gonorrhoea 197 SEC. V. OF ULCERATION OF THE Os AND CERVIX UTERI. Simple Granulating Ulcer 204 Varicose " 204 Fissured " : 205 Follicular 206 Phagsedenic " 206 Syphilitic " 208 Resume 1 209 Diphtheria 209 Ovarian Diseases 211 SEC. VI. OF UTERINE DISPLACEMENTS. Prolapsus 213 Anteversion 214 Retroversion . 214 SEC. VII. REMEDIAL TREATMENT. Medicinal 217 Mechanical 224 SEC. VIII. CONDUCT OF THE PHYSICIAN 234 SEC. IX. EXAMINATION OF THE PATIENT 237 SEC. X. MANAGEMENT OF LABOR 240 SEC. XI. SEQUELA OF ABORTION. Post-partum Treatment 248 Postural 248 Dietetic 251 Medicinal 252 Of Pelvic Cellulitis 253 Hypertrophy of the Uterus 253 Fistula 253 Inflammation of the Uterus 253 Puerperal Metritis 254 " Peritonitis 254 Phlebitis 254 Dropsy 254 Paralysis 254 Mental Aberrations 254 Chronic Menorrhagia 255 Mechanical Treatment 256 Of Prolapsus 256 Retroversion.. , . 256 Xll. CONTENTS. PART V. OBSTETRIC ABORTION. SEC. I. OBSTETRIC ABORTION. PAGE Necessity of Premature Labor 263 Methods employed Stillette 271 Sponge-tent 271 Caoutchouc Bags 271 Tampon 272 Colpeurynteur 273 "Water-douche 273 Ergot 275 Cupping-glasses 275 Galvanism 277 SEC. II. F(ETAL ABORTION*. Methods employed 280 Flexible Bougie 281 Catheter 281 SEC. III. EMBRYONIC ABORTION. Methods employed 284 Flexible Catheter 284 Uterine Sound 287 Injections 288 Abortion Forceps 288 SEC. IV. OVTILAR ABORTION. What it is 290 Utopian Theories 291 Duty of the Physician 292 Different methods 293 Theory of Impregnation . 295 Character of Spermatozoa 299 Prophylaxis of Conception agents employed 303 Tabular View of Uterine Contents and Synopsis of Treatment 309 PART VI. JURISPRUDENCE OF ABORTION. SEC. I. CRIMINAL ABORTION. A Lecture by A. E. Small, M.D 313 " Charles Woodhouse, M.D 320 Laws of the European Countries 321 " different States 323 GENERAL INDEX . . . 339 USTTEODTJCTION. THE term ABORTION, is derived from the Latin word aborto, which means literally to bring forth before the time: This broad defini- tion allows of no restriction, aside from the one given in the literal rendering. The premature expulsion of the contents of the gravid uterus at any date prior to the end of the ninth month, or the normal expiration of pregnancy, is an abortion. In this work, the term has therefore been used in its broadest sense ; but, as will be seen, I have divided the period of pregnancy into three natural divisions, based on the condition of the placenta and the foatus. Four kinds of abortion are treated of, namely: (1) OVTJLAR, when the ovum is lost before it is impregnated. (2) EMBRYONIC, when the impregnated ovum is expelled before the placenta has formed its uterine attachment. (3) FCETAL, when the expulsion occurs after the last date, and before the viability of the. child; and (4) when the child is born capable of living, or viable, but before the end of a' normal pregnancy. This is not an arbitrary plan, because it is founded on natural changes and certain periods, which are well recognized in physio- logical science. Such an arrangement greatly facilitates a study of the subject in a methodical manner. Hitherto no complete and systematic treatise on Abortion has appeared in the literature of any school of medicine. The Allopathic branch of the profession, in which we would naturally look for a work on this subject, possesses but one volume, which treats of it in a monographic manner. Dr. Whitehead's work on "Abortion and Sterility" was pub- XIV. INTRODUCTION. lished in 1854. "While it is a valuable work of reference on certain points, it is lacking in systematic completeness. It contains some suggestive statistics, and an excellent elucidation of many of the causes of abortion, with their Allopathic treatment ; but beyond this, the author does not extend the work. No mention is made of the intermediate and remedial treatment of the accident itself, or of its numerous and important sequelae. The obstetrical works of Churchill, Ramsbotham, Tyler Smith, Simpson, Cazeaux, Hodge, Meigs, Bennett, Bedford, Gardner and others (Allopathic); King, Scudder, and Beach, (Eclectic); and Jahr, Leadam, Pulte, Loomis, Small, Marcy, Ludlam and others (Homoaopathic); all contain much in relation to this subject. I have drawn freely from all these authorities, selecting the practical and useful, and rejecting all that was irrelevant. Of all medical writers, Cazeaux seems to me to have treated the subject of abortion in the most systematic manner. The various periodicals of our school have been examined for clinical experience relating to the treatment of this accident. Considerable practical information on this point has been commu- nicated to me by my professional friends. I am especially under many obligations to Dr. R. Ludlam, Professor of Obstetrics and Diseases of Women and Children in Hahnemann Medical College, for his kind assistance while in the preparation of this work, and also for the use of his large obstetrical library, containing many rare and valuable volumes. I am obliged to state, however, that on many points of import- ance relating to the treatment and induction of abortion I have had to rely almost wholly upon my own experience, and to ascertain the most practical and useful facts by careful experiment and patient investigation. Abortion has grown to be a subject of such importance to the medical man, that its consideration should no longer be confined to the works devoted to obstetrics and diseases of women, wherein it can but be treated of in a manner not sufficiently complete to sat- isfy the student or investigating practitioner. INTRODUCTION. XV. It must strike every observant aud thinking physician that the day for large treatises, on such broad subjects as "Practice," " Materia Medica," "Surgery," "Obstetrics and Diseases of Wo- men," has gone by. No medical writer can do justice to the range of subjects naturally included in any one of the above titles, if he is confined to one or even two volumes. Nothing short of an ency- clopredia of one of the above subjects would satisfy the require- ments of the age, and as an encyclopaedia is made up of separate monographs, it will greatly enhance the value of medical literature if a series of exhaustive monographs appear which shall do away with the necessity for such ponderous works. Moreover, the accu- mulations of such valuable material relating to any one subject pertaining to practical medicine has become so extensive, and withal so scattered through the books, journals and other periodi- cals, that it is the duty of the medical writer to collect the material together, and put it in such a form as to be most available to the student or practitioner. To this end the writer of this volume has directed his labors. He does not claim to present much original matter, although his observations and experience have enabled him to increase somewhat the common stock of information relative to the etiology and treat- ment of the accident. He has drawn freely from all the standard medical works of the day, and from all sources which seemed to him reliable. Medical facts are common property, and it is not necessary to give further credit to authors and observers, than is given in the pages wherein mention is made of the sources of information. This work is intended in no respect for public circulation, and the author would be sorry to think it should ever be perused by the prurient and immoral. In order to render the work as complete as possible, it has been necessary to mention the various methods to be made use of for the induction of abortion for legitimate purposes. If this information shall be abused, and used for unlawful purposes, the blame must rest where it really belongs. XVI. INTRODUCTION. If I have not given minute indications for the use of each remedy mentioned in the following pages, it is because of the impossibility of so doing in a work of this kind, without swelling it to an inordi- nate size. The symptoms of, and special indications for, the use of each medicine can be found in the several works on Materia Medica, belonging to the Homoeopathic school. I believe that no physician in whose hands this work may fall, will consider the volume a superfluous addition to our literature. PART I. STATISTICS OF ABORTION. STATISTICS OF ABORTION. IT will be appropriate, before we enter upon the consideration of the causes, pathology, treatment, etc., of Abortion, that we shall make ourselves acquainted with the statistics having a direct bearing upon the subject. The first question which presents itself Is Abortion constantly increasing? is so important that we shall present the statistics in as complete a manner as is con- sistent with the plan of this work. The following statistics are taken from an elaborate work* by Horatio B. Storer, M. D., of Boston. Wri- ting of the frequency of abortion in our own country, he says : "Statistics in this country are yet so imperfect that we are necessitated to a process of deduction. * * * If we find that in another country living births are steadily lessening in proportion to the population and to its increase that natural and preventive causes are insufficient to account for this while the proportion of still births and of known abortions is constantly increasing, and these last bear an evident yet increasing ratio to the still-births ; that in this country the de- crease of living births, and the increase of still-births, are in much greater ratio to the population, and the proportion of premature births is constantly increasing ; and that these relations are constantly and yearly more marked, we are justified in supposing that abortions are * Criminal Abortion in America. 20 HALE ON ABOETION. at least as frequent with us, and probably more so. In many countries of Europe it has been ascertained that the ' fecundity' of the population, or the rate of its annual increase is rapidly diminishing. " In Sweden it has lessened by a fifth ; in Prussia, by a fourth ; in Denmark and England, by a third, and in Russia, Spain, Germany and France, by a half, in a single c&ntwry ! " In four departments of France, among which are two of the most thriving of Normandy, the deaths ac- tually exceed the births ! " Again, as might have been expected, we find that the proportion of still-births, in which we must include abortions, as has hitherto been done, however improp- erly, in all extensive statistics, is enormous, and is steadily increasing ; and while the proportion of still-, births to the whole number is greatly increasing in Paris, as is the number of known abortions. * * At the Morgue, which represents but a very small fraction of the foetal mortality of Paris, and in this matter almost entirely crime, there were deposited during the eighteen years preceding 1855, a total of 1115 foetuses, of which 423 were at the full term, and 692 were less than nine months, and of these last, 519, or five-sixths, were not over six months, a large proportion of them showing decided marks of criminal abortion. " We now turn to our own country, to which the city of New York holds much the same relation that Paris holds to France. " Since 1805, when returns were first made to the Registry of New York, the number, proportionate as well as actual of foetal deaths, has steadily and rapidly increased. With a population, at that time, (1805) of 76,770, the number of still and premature births was 47; in 1849, with a population at 450,000, the number had swelled to 1320." In brief, while the ratio of fcetal deaths to the popu- lation was, in 1805, 1 to 1633.40, in 1849 it was 1 to 340.90 ; and when we consider that a large proportion STATISTICS OF ABORTION. 21 of the reported premature births must always be from criminal causes ; and that though almost all the still- births at the full time, even from infanticide, are ne- cessarily registered, but a small proportion of the abortions and miscarriages occurring are ever reported to the proper authorities, it will be apparent that at the present moment the abortion statistics of New York are far above those of 1849. This the following table will show, as well as the fact that the ratio is steadily increasing : Total mortality. Still -birth. Ratio. 1804 to 1809 - - - 13,128 349 I to 37.6 1809 to 1815 - - - 14,011 533 1 to 26.3 1815 to 1825- - - 34,798 1,818 1 to 19.1 1825 to 1835 - - - 59,347 3,744 1 to 15.8 1835 to 1855 - - - 289,786 21,702 1 to 13.3 1856 - - - 21,658 1,942 1 to 11.1 " The frequency of abortions and premature births reported from the practice of physicians, and thus to a certain extent, but not entirely, likely to be of natural or accidental origin, is as follows : "In 4 1,699 cases registered by Collins, Beatty, La Chapelle, Churchill, and others, there were .530 abor- tions and miscarriages. Here all the abortions were known : their proportion was 1 to 78.5. "In New York, from 1854 to 1857, there were 48,- 323 births at the full time reported, and 1,196 prema- ture. Here all the abortions were not known, probably but a very small fraction of them : the proportion was 1 in 40.4. In the seventeen years from 1838 to 1855 there were reported 17,237 still-births at the full time, and 2,710 still prematurely; the last bearing the pro- portion of 1 to 6.3. In the nine years from 1838 to 1847, there were 632 premature still-births, and 6,445 still at the full time : a yearly average of 1 in 10.2. In the eight years from 1848 to 1855, there were 2,078 premature still-births, and 10,792 still at the full time : an average of 1 in 5 ; while in 1856 there were 387 still prematurely and 1,556 at the full time, or 1 in 4.02. 22 HALE ON ABORTION. "From these figures there can be drawn but one conclusion that criminal a*bortion prevails to an enor- mous extent in New York, and that it is steadily ami rapidly increasing. * We cannot refer/ was well said by a former Inspector of that city,* ' such a hecatomb of human offspring to natural causes.' " The same statistics also shew that the reported i-arlij abortions, of which the greater number of course escape registry, bear the ratio to the living births of 1 in 40, while elsewhere they are only 1 in 78.5 : and finally, that early abortions, bearing the proportion to the still- births at the full time of 1 in 10.2 in 1846, had increased to 1 in 4.2 in 1856. Almost doubling, therefore, as does New York, the worst of those fearful ratios of foetal mortality existing in Europe, it is not strange that our metropolis has been held up, even by a Parisian, to the execration of the world : " On le voit (1'avorternent)," says Tardieu, " en Amerique, dans une grande cite comme New York, constituer une industrie veritable et non poursuivie." " In this description of New York," says Dr. Storer, " we have that of the country." " In Boston, which for morals is supposed to compare favorably with any city of its size in the Union, un- doubtedly more than a hundred still-births yearly escape being recorded ; a large proportion of which, no doubt, results from criminal abortion." In the State of Massachusetts it appears that during the fourteen years and eight months preceding' 1855, there were recorded 4570 still-births, and 11,716 pre- mature births and abortions, the ratio being one abor- tion to three still-births ; or, in other words, it would appear from the statistics quoted, that the comparative frequency of abortions in Massachusetts is thirteen times Report of 1849. STATISTICS OF ABOKTION. 23 as great as in the worst statistics of tlie city of New York ! It must not be forgotten that while nearly every still-birth at the full time is necessarily recorded, there must be but very few registrations of the premature births and abortions actually occurring. Few persons could have believed possible the existence of such frightful statistics. They should call the attention of the whole medical and legal world toward some plan to arrest such awful destruction of embryo human life. In the great city of Chicago no registration of the births has ever been made ; nor do the physicians make any returns relating to the still-births, miscarriages, etc. This is much to be regretted on many accounts. It does not do credit to the municipal authorities, to the influential citizens, nor to those physicians of the domi- nant school, who are supposed to have influence with those in power. It is alleged as an apology for this omission of a civil duty, that the State legislators have never passed a law of Registration of Births, etc. ; but this is no valid excuse, when it is in the power of the city authorities to pass an ordinance which would an- swer every purpose of such a law. To the above statistics of the frequency and increase of abortions, I will add those of Dr. Whitehead,* who asserts that " the number of pregnancies which each woman experiences, during the existence of herprocre- ative aptitude, is about twelve , or one in every twenty months. This includes abortions, false conceptions, premature deliveries, and all having an 'unsuccessful issue, the average amount of which will be rather more than one and a half for each individual ; or it may be * On Abortion and Sterility, page 198. 24 HALE ON ABORTION. stated, as a general rule, that every seventh pregnancy has a premature termination. These conclusions have been drawn from the subjoined facts. " Two thousand married women in a state of preg- nancy, admitted for treatment at the Manchester Lying- in Hospital, during parts of the years 1845 and 1846, were interrogated in rotation respecting their existing condition and previous history. Their average age at the time of inquiry was a small fraction below thirty years. The sum of their pregnancies already termi- nated was 8681, or 4.38 for each, of which rather less than one in seven had terminated abortively. But as abortion occurs somewhat more frequently during the latter than in the first half of the child-bearing period, the real average will consequently be rather more than one in seven. Of the individuals submitted to inquiry, 1253 had not then suffered abortion. The average age of these was 28.62 years ; the sum of their pregnancies was 3906, or 3.11 for each person. The remaining 747 had already aborted once at least, and some oftener. Their average age was 32.08 years. The sum of their pregnancies was 5775, or 6. 37; that of their abortions 1222, or 1.63 for each person. From the preceding statements it appears that more that thirty-seven out of every hundred mothers, experience abortion before they attain the age of thirty years." Dr. Whitehead's observations do not accord with the popular idea, that early, especially first pregnancies, have more frequently a premature termination than those which come after. He is inclined to believe that the third and fourth, and subsequent pregnancies, and one or two of the last namely, those which occur near the termination of the fruitful period are most com- monly unsuccessful. STATISTICS OF ABORTION. 25 At what period of pi^egnancy does abolition most fre- quently occur f The following table, copied from Whitehead, throws some light on this question. It will be noted that the abortions here referred to, were those which were sup- posed to occur from diseased conditions of the mother or foetus. Hereafter the subject of criminal abortions will be referred to. ABORTION (which term is here used in its most extensive signification) may occur at any period of utero-gestation. It will be seen that it is much more common at some stages of the process than at others, and is attended with different degrees of danger, according to the circumstances under which it occurs, the nature of the exciting cause being the most important. When it takes place before the end of the sixth month, it is invariably fatal to the offspring, either before birth, or in a short time after ; and at any period before the completion of the process, it is more or less injurious to its well-being. Instances are on record, hpwever, of children born during the early part of the seventh month, having lived in the enjoyment of toler- able health and constitutional vigor to a mature age. " Abortion is at all times fraught with danger to the mother, and sometimes attended with fatal consequences. I give in the following table the respective periods of 602 cases of abortion, which have occurred under my own immediate observation. It may be noticed that each figure in the first column embraces a period of four weeks, extending from a fortnight before to the same length of time after the month indicated ; and as abortions happening earlier than the seventh week of uterine life are so frequently and so nearly simulated, both in married and unmarried females, by certain ute- rine discharges, the result of disordered menstruation, 26 HALE ON ABORTION. events said to have taken place at this early period, except those wherein the escape of an ovum was un- doubtedly found, have not been included in the report." TABLE Showing the Period of Pregnancy at which Abortion occurred in 602 cases, the relative number of Still- born and giving Children, and the number living at the end of a month after birth. Period of pregnancy at which abortion occurred. Number of births at each period. Number still born. Number liv- ing at birth Number liv- ing at end of a month 2 months 35 275 147 30 32 55 28 24 38 23 8 17 5 3 1 3 " 4 " 5 " 6 " 7 8 " Total 602 85 30 4 "The foetus of six months' growth is generally consid- ered viable. Of the eight indicated in the table, as having been born alive, when born at this period, seven perished within six hours after' birth, and one only attained to the age of ten days. Of the seventeen born alive at seven months, the majority lived over several days, and a few to the end of the third and fourth week. Three still survive, the youngest of whom is now aged nineteen months." Whitehead does not mention the possibility or proba- bility of an abortion occurring at the forst month, or even at the third week of pregnancy. Yet it must be admitted by those who have investigated the causes of abortion, that it is by no means improbable, and very possible, for the abortions which occur at that early period to outnumber those of any other month. STATISTICS OF ABORTION". 27 If any disease of the uterus or contiguous organs, or any constitutional irritation sufficient to cause abortion exists, such causes are more likely to induce abortions at the FIKST month than at any other period. Let us consider the matter logically.. Intimately connected with the subject above treated of, is that of criminal abortion, and the period of pregnancy at which it generally occurs. From Dr. Storer's work we' learn that " It was Orfila's opinion that criminal abortion was most frequent in the first two months of pregnancy. This would naturally have been supposed to be the case, as then some doubt always might obtain regarding its existence, and the excuse that the measures resorted to were for the pur- pose of preventing ill effects from an abnormal men- strual suppression, would be more available. Devergie, on the other hand, was inclined to put the limits of greater frequency at from three months to four and a half; while Briarid and Chandler thought the crime more common in the third month than the fifth, and in the last month much more frequent than even in the first or second. Tardieu also came to a similar conclu- sion. He ascertained that of 34 cases investigated by himself, 25 were in from the third to the sixth month, mostly in the third ; 5 in the first two months ; 4 in the second and eighth ; or that the cases in the third month, or shortly after, were five times as numerous as at either an earlier or a later period, and nearly three times as numerous as in both combined. Upon exam- ining the register of the Morgue, we find its statistics strikingly corroborative of this deduction. We have already seen that from 1837 to 1854 there had been 28 HALE ON ABORTION. deposited at the Morgue 692 fcetuses of less than nine months. Of these 23 were from the first to the second month ; 79 " second " third " 108 " third " fourth " 158 " fourth " fifth " 150 " fifth " sixth 97 " sixth '" seventh " 48 " seventh" eighth " 29 " eighth " ninth " " It has been stated that 519, or five-sixths of them all, were not over six months ; and it now appears that on a scale twenty times larger than that given by Tar- dieu from his own experience, nearly two-thirds of the foetal deaths induced by abortion were in from the third to the sixth month of pregnancy, the three periods included giving a much larger proportion than any others, and the last two of them being nearly identical. The extreme paucity shown by the above table in the first and ninth months, and the decrease in the seventh and eighth from those preceding, are worthy of remark. It is probable that the sudden increase may be attribut- able to mental reaction after the first shock occasioned by the absolute certainty of pregnancy, is past ; and the subsequent decrease to the fact that in many at- tempted criminal abortions, during the latter months, children are born alive, the mother's courage then prov- ing insufficient for infanticide, and its greater and more probable punishment." My observation has shown me that criminal abortions are very frequent in the fourth week after conception. Many women, who are habitually regular to a day, are in the habit of using some drug or instrument if the menses delay a few days, and they have reason to sup- pose conception has taken place. They allege that they STATISTICS OF ABORTION. 29 know by certain sensations that conception lias occurred, as early as the third or fourth week. This habit is more frequent than has been supposed, as any physician will ascertain who seeks to investigate the matter. In order to make complete the statistics of abortion, we should be able to present tables representing the average mortality of women who suffer that accident, both from criminal and other causes. " The results of abortion from natural causes," says Dr. Store r, " as obstetric disease, separate or in common, of mother, foetus or membranes, or from a morbid habit consequent on its repetition, are much more than those following the average of labors at the full period. If the abortion be from accident, from external violence, mental shock, * great constitutional disturbance from disease or poison, or even necessarily induced by the skillful physician in early pregnancy, the risks are worse. But if, taking into account the patient's constitution, her previous health, and the period of gestation, the abortion had been criminal, then the risks are infinitely increased." In 34 cases of criminal abortion reported by Tardieu, where the history was known, 22 were followed as a consequence by death, and only 12 were not. In 15 cases* necessarily induced by physicians, not one was fatal. These meagre statistics are all I have been able to obtain relative to the consequences of abortion, to the mother. While I admit that the risks of a fatal result from criminal abortion brought about by other than skillful physicians, or even from diseased condition, are great, I cannot believe the result of abortion " necessarily in- duced by skillful physicians," is as fatal as Dr. Storer * Annals de Hygiene, 185(5, p. 147. 30 HALE ON ABORTION. asserts. My observation and experience in this matter have been quite extensive, and I have been led to the conclusion that, if the operation is skillfully performed, the fatal results need not exceed one in a thousand. I have not been able to find any statistics relative* to the proportionate frequency of the various diseased con- ditions which result from abortion ; but the information which I have received from my colleagues, and the various writers on diseases of women, as well as my own observations, lead me to place the consequences of abor- tion and their relative frequency in the following order : 1. Ulceration, erosion and congestion of the os uteri. 2. Premature and profuse menses. 3. Retroflexion and retroversion of the uterus. 4. Prolapsus uteri. 5. Ovarian disease. 6. Pelvic cellulitis. The statistics relating to the causes of abortion, as well as those having reference to the various other matters connected with the subject, will be found under the appropriate chapters. PART II. CAUSES OF ABORTION. CAUSES OF ABORTION. The following Classification of the causes of Abortion is based upon the one used by Prof. Ludlam in his Lecture before the class of Hahnemann Medical Col- lege. The additions made by myself will be denoted by the initial H. /. Constitutional or Predisponent. 1. Plethora. 2. Anaemia or Chlorosis. 3. The Scrofulous Diathesis. 4. Return of Menstrual Crisis. (a) Syphilis. (b} Mercurialization. r Zymotic O. TV Diseases. (c) Variola. (d) Scarlatina. (e) Diphtheria. (/) Cholera, (H.) II. Local or Organic. 1. Malformation of ovum. 2. of membrane. (a) Mai-location of (Placenta Previa.) Organic Disease of 3. Placental Abnormalities. (c) Detachment of (d) Fatty Degeneration of (e) Calcareous " of (/) Hydatids. (H.) (g) Moles. (H.) III. Reflex (Exciting.] (a) Emotional as Fright, Anger, Grief, etc. (b) Direct blows upon the brain or spinal cord. (c} Medicinal. (H.) (d) Cerebro Spinal Meningitis. 3 84 HALE ON ABORTION. 2. Concentric. < (a) Parotidean Irritation. (H.) (6) Thyroideal " (H.) (ft Thoracic " (H.) (d) Mammary " (e) Dental " (H.) (/) Gastric " (g) Rectal " (h) Vesical " also Renal. (H.) (f) Vaginal " (H.) (j) Hysterical " (k) Epilepsy. (I) Falls, jumping, blows, etc. (m) Functional and Organic Diseases of the Uterus. (H.) (n) Functional and Organic Diseases of the Ovaries. (H.) (o) Displacements of the Ovaries. (p) Death of Embryo. (q) Genital (Coitus.) (r) " (Instrumental.) MEDICINAL. Emmenagogues or Oxytoxics. The following list of medicinal agents is necessarily imperfect, but I have placed therein the drugs which may, under certain circumstances, cause abortion. The list is not complete, as there are many medicines not named which have been supposed to cause that accident. Apis mellifica. Actsea alba. Aloes. Asarum europeum. " canadense. Asclepias syriaca. " incarnata. Aletris farinosa. Baptisia tinctoria. Borax. Bovista. Cantharis. Caulophyllum. Cimicifuga. Decodon verticillatus. Gossipium herbaceum. Ilex opaca. Mercurius. Podophyllum. Quinise sulphas. Ruta graveolens Sabina. Secale Cornutum. Sanguinaria. Terebinth. Tanacetum vulgaris. Ustilago madis. SECTION I. PEEDISPOSING CAUSES. Plethora. The first predisposing cause of Abortion mentioned in the foregoing table is Pletliwa ; but it is oftener a cause of sterility, and will be again alluded to under that head. Obesity may cause abortion in several ways. The deposition of fat in the abdomen and pelvis will have the same effect as a tumor in those localities. In some cases of adiposis the action of the heart is mani- festly impeded, and sometimes entirely arrested, by the deposition of fat in and around it. The same result may obtain in regard to the uterus, and prevent its expansion beyond a certain point, at which abortion would inevitably occur. Dr. Gardner also suggests that the .deposit may " press down the uterus, pressing it into the pelvic strait, sometimes producing eversiou, or so that the os uteri presses upon the sacrum, where by mere friction its surface becomes abraded, and pro- fuse leucorrhoea ensues." Not only this, but prolapsus and retroversion may be thus caused. Ancemia or Chlorosis. Frequent abortions may cause anaemia; and this condition may in turn predispose to repeated abortions, 36 HALE ON ABORTION. the uterus not having sufficient "tone," or vitality, to retain the product of conception. Chlorotic women are as liable to abortion as those who are anaemic, and from the same cause, namely a lack of vitality in the uterus, and a blood so impoverished that it is incapable of nourishing the foatus. Scrofula. 4 The scrofulous diathesis, by its influence upon the vital powers of the system, causing laxity of tissue, defi- cient nervous force, and depriving the blood of its nor- mal constituents, is a powerful predisponent cause of loss of the ovum at any and all periods of gestation. Return of the Menstrual Crisis. This, as a cause of abortion, especially in the first months, has not been sufficiently appreciated. I have stated in the introduction to this work, that I consider it proper to define "Abortion," as the premature death and expulsion of the ovum at any time after conception, or before the ejid of the ninth month. I have also mentioned, in another place, the frequency, of abortions in the first month. The older accouchers paid much attention to the loss of the ovum shortly after impregnation. Married women who passed over a monthly period by a few days and then menstruated profusely were believed to have lost the ovum. This was called an effluxion, if it occurred before the tenth day, " because," as Smollie observes, "the embryo and secundines are not yet formed, and nothing but the liquid conception, or geni- tura, is dislodged. Tyler Smith thinks such cases are not uncommon, and the ovum is unobserved, not from CAUSES OF ABORTION. 3V its liquid condition, but because it is so little above the size of the unimpregnated ovum, as not to be visible in the discharges. An ovum of fourteen days has been described by Velpeau, and its size did not exceed three- eighths of an inch in diameter. In the expulsion of an ovum of an earlier date than this, the symptoms hardly differ from those of profuse menstruation. In cases of dysmenorrho3a especially the pseudo-membranous va- riety, and in cases of profuse menstruation (habitual) this loss of the ovum may frequently occur at a very early period. It has often 'been a matter of wonder to me that the uterus should so frequently resist the influ- ence of a menstrual nisus, when abnormal in its charac- ter, or that a diseased uterus could so often bear the recurrence of the crisis when normal, without being irritated to such an extent as to throw off the impreg- nated ovum at such periods. (See Ovarian Irritation.) ZYMOTIC DISEASES. Syphilis. Independent of the power which this blood-poison possesses of causing diseases of the. uterus as ulcera- tion, etc., which will be mentioned in another place- syphilis seems to exercise a blighting power over the product of conception, in such a manner that it is liable to die in utero, of the same poison, and be expelled as a foreign body, at any period of pregnancy, or the membranes may become diseased from the pernicious influence of the malady : in both cases the disease may be transmitted by either or both parents : by the mother through the circulation, and by the father through the spermatozoa. Writing of this disease, as a cause of sterility, Dr. 38 HALE OX ABORTION. Gardner says : " In my opinion it is more often a cause of early abortion from an imperfect development of the ovum, than a cause of sterility, as it is difficult to decide whether the woman was ever impregnated or not. The menses are retained a few days over the usual period ; there is finally a somewhat profuse discharge, accom- panied by more pain than usual, and the passage of what are considered clots, but in them lies concealed the semi-developed ovum." Mercurihlization. Mercury, in its various forms, may not only be an immediate cause of abortion, as in the cases of large doses of calomel, elsewhere alluded to, but the system inay.be so saturated with the poison that the blood and tissues are deprived, by its baleful influence, of the normal vitality necessary to carry on the process of gestation. The effects of this drug upon the organism are not unlike those of syphilis. It has long been re- marked that women whose systems have been saturated with mercurial preparations were very liable to abor- tions, and this without any organic disease being dis- covered in the organs of generation. Variola, etc. Abortion may occur from the intense febrile orgasm, or from the congestive complications which take place during these disorders. All the exantliematous fevers predispose the system to take on such irritative con- ditions as may bring about miscarriage during or after their accession. The foetus in utero has been known to be attacked with the variola, and be expelled either before or after its death. CAUSES OF ABORTION. 39 According to Cazeaux, " confluent small-pox nearly always occasions abortion, and this is almost uniformly followed by the death of the mother." Asiatic Cholera and Yellow Fever are powerful zymotic poisons, and, like other diseases of this character, effect the foetus through the medium of the circulation. Dr. Pulte* states that during the cholera epidemic of 1848 abortions were very frequent, and were apparently caused by the imponderable poison pervading the at- mosphere at that time. The same phenomena has been noticed during the prevalence of yellow fever in the large cities of the South. Dr. Bouchut, in a quite recent work, mentions his observation of fifty-two cases of cholera in pregnant women, twenty-five of whom aborted in consequence of the disease. SECTION II. LOCAL CAUSES. Abnormal conditions of the Ovum and its Appendages. Dr. Whitehead says these are " so constantly associ- ated with disease of the maternal organs as to lead to the suspicion that the mischief, in a great majority if not in all instances, originates in the latter." In my own practice, such complication has been almost invari- ably found in those cases wherein I have had an oppor- tunity of making the necessary examination. * Homoeopathic Domestic Physician, 477. 40 HALE ON ABORTION. The fcetus is liable to many diseases winch may tend to its death, such as inflammation and dropsy of its venous cavities, dropsy of anmion, disease of the liver or kidneys, tubercular diseases, syphilis, and even small pox ; diseases of the umbilical cord, knots upon the cord ; strangulation, by the twisting of the cord about the neck of the child. I have seen cases in which the cord was twisted three and four times around the neck. Probably the diseased ovum excites the uterus to con- traction before the actual death of the ovum has occurred. In many cases of criminal abortion the injury done to the child by instruments, etc., is the real cause of the abortion. The membranes may not be ruptured or separated. The impregnated ova may degenerate into moles, hydatids, or " bligMed ova" Genuine moles are to be distinguished from certain O fibrinous masses which are sometimes expelled from the uterus. These are called spurious moles, and a close examination will show their real character. Those moles which are the result of impregnation are of vari- ous kinds, consisting of different forms of degeneration of the membranes of the ovum. We can readily dis- tinguish the varieties of moles depending on the carne- ous or fleshy, the hydatigenous, and the fatty, and other degenerations of the membranes. None of these cases can occur without conception. Many authors believed that fleshy moles might occur in nuns, and others presumed to be virgins, without the occurrence of intercourse. Percy believed that hydatids were in- dependent animals, and that their production was com- patible with the purest chastity. Dennison thought they sometimes originated in the uterus as independent CAUSES OF ABORTION. 41 formations, and Sir Charles Clarke was pf opinion that uterine hydatids might exist apart from pregnancy. Madam Boivin and several other writers are in favor of the belief that this form of degenerated ovum may be retained for many months, or even years, after the ordinary date of labor. Tyler Smith is not aware that any case of this kind has been observed. I have known two cases in my own practice where a hydatid mass was not expelled until the twelfth month after the last appearance of the menses. Those who wish to investi- gate the nature of moles and hydatids can consult Tyler Smith* In the carneous moles there is an arrest of the usual symptoms of pregnancy, and the patient remains out of health. The ovum from the time of its death becomes to a great extent a foreign body, and is a source of irritation to the system generally. No increase of size takes place, so that at the fourth or fifth month the uterus may not be larger than it should be in the fifth or sixth week of normal pregnancy. The complexion is muddy and the breath fetid, with loss of appetite and digestion. Hemorrhage frequently occurs, but not very profuse. The hydatid mole causes symptoms more strongly marked. The increase in size is often enormously rapid, so that at the fifth or sixth month the abdomen is as it should be at the end of pregnancy. The shape of the uterus is often quite different from that existing during natural pregnancy. There is absence of all foetal move- ments and the sounds of the fcetal heart. After three or four months' suspension of the catamenia, there oc- curs a copious discharge of water and blood, resembling * Lectures on Obstetrics. 42 HALE ON ABORTION. red currant juic. This occurs irregularly and in vari- able quantities. The watery discharge is accompanied by pain, and appears to be caused by the breaking down of numbers of the larger hydatids. In a suspected case the discharges should be carefully examined, and of course the detection of a single hydatid renders the diagnosis certain. Excessive flooding often occurs, at frequent intervals, accompanied with discharges of masses of hydatids. The general health suffers pro- foundly, resulting in anaemia, dropsy, and even paral- ysis. Fatty Deterioration of the Chorion and Placenta. We are indebted to Dr. Kobert Barnes for our know- ledge of this frequent cause of abortion. This form of degeneration may affect the secundines at any time between the early weeks of pregnancy and the termina- tion of gestation. Fatty degeneration may exist in the placenta as a post mortem change ; that is, it may occur in utero after the death of the foetus. It may happen also as the result of the transformation of effused fibrin in inflammatory disease of the placenta, or of a clot of blood in hemorrhagic effusion. Lastly, it may consist of the metamorphosis of portions of the maternal and foatal structures of the placenta during the life of the foetus. The latter pathological phenomenon is that which is of the chiefest importance in relation to abor- tion. In a placenta affected with fatty degeneration, the lobes of the placenta are altered in appearance, some of them being of yellow fatty color, brittle and exsanguine, the rest presenting their ordinary characters. Exam- ined more minutely, the tufts are found to be glistening, hard and tallowy, and not expanding when placed CAUSES OF ABORTION. 43 under water, as is the case with villi of healthy pla- centae. The microscopical investigations of Dr. Hassall, show that the villi are studded with spherules and drop- lets of fatty matter and oil. The fatty material is found principally in the cells of the villi, and in the coats of its blood vessels, which vessels do not carry red globules when the degeneration exists to any extent. Dr. Barnes considers constitutional syphilis a frequent cause of this disease. Fatty degeneration causes abortion by destroy- ing the vitality of the ovum ; or owing to the friable condition of the placenta, partial separation may occur ; or the partially degenerated blood vessels may burst and lead to placental apoplexy. For a full description of this disease of the placenta and chorion, see Tyler Smith's Lectures on Obstetrics, page 185. Congestion of the Placenta Leads to what is termed apoplectic effusion. Blood may be poured out either on the foetal or external sur- face of the placenta. It may produce abortion in sev- eral ways. The loss of blood may deprive the foetus of life ; or the effusion may excite the separation of the ovum, and cause uterine contractions. In some cases the effused blood coagulates, its fluid portions are re- moved, and a fibrous mass remains without doing any great injury. Inflammation of the Placenta (Placentitis) . In this disease effusion of lymph may occur, or the disease may pass on to hepatization, suppuration, or gangrene. Sometimes,- when the inflammation affects the internal surface of the placenta, adhesions form between the placenta and the external surface of the 44 HALE ON ABORTION. ovum. In this way the placenta lias been found adher- ent to the forehead or body of the foetus. According to Professor Simpson, who wrote an elaborate memoir on this subject, the symptoms are obscure, consisting of pain in the uterus, near the site of the placenta, pains in the back and thighs, and general fever. Tyler Smith did not find, on stethoscopic examination, any modification of the uterine sounds in cases of suspected placentitis. The causes of placentitis are not very obvious, beyond mechanical injuries, and the great afflux of blood to the organ which occurs during preg- nancy. Congestion and inflammation of the placenta are probably both common causes of abortion. The placenta is liable to other diseases, as calcareous degeneration, tubercular deposits, and atrophy or hyper- trophy. Sometimes, after the death of the foatus, the placenta is still nourished, imperfectly, but still suffi- ciently to insure its retention, together with the dead ovum, for a considerable time. Placenta Previa May be the cause of abortion at any period of preg- nancy. Of 378 cases mentioned by Whitehead, eight were from this cause. When the placenta is implanted on the os uteri, abortion is inevitable, and this almost invariably takes place before the fifth month. When only a small portion of it extends over the orifice, ges- tation may proceed to the seventh or eighth month, or even to the full period, without producing any great amount of danger to the process ; but always, under such circumstances, separation takes place to some ex- tent as the cervix expands, although premature expul- CAUSES OF ABORTION. 45 sion is not an inevitable consequence. Whitehead mentions a case of implantation of placenta on the os uteri, and its partial separation, attended with hemorr- hage before quickening, which he treated with favor- ' able results. SECTION III. REFLEX CAUSES. The centmc causes of abortion are those which origi- nate in the nervous centres, the brain or spinal cord, and act upon the uterus in a direct manner. They may be divided into Emotional, Physical, and Medicinal. Emotional. Fright, anger, joy, grief, and other men- tal influences, have been known to cause such disturb- ance in the organism, as to be a direct cause of the expulsion of the foetus. Many cases are on record where the death of the foetus has resulted from the per- turbing effects of emotional shocks. Women have aborted immediately after hearing of the death of a beloved husband; or the gnawing canker of grief, shame, and remorse, has led to loss of the foetus ; and martyred women have aborted at the stake. Physical. Under this head we may enumerate direct blows upon the brain, or spinal cord, or intense conges- tion or paralysis of those organs. Some interesting experiments have been made, which have a bearing upon the centric causes of abortion. M. Serres divided the spinal cord in animals, after the commencement of parturition, and the process was arrested. In other ex- 46 HALE ON ABORTION. periments he excited abortion in animals by irritating the spinal marrow in the lumbar region. M. Brachet divided the cord in guinea pigs, between the twelfth and thirteenth dorsal vertebra, after the commencement of labor, and everything but feeble contractions of the uterus was arrested, the animals dying in a few days undelivered. M. Segales made a section of the cord high up, without influencing the uterus, but the organ was paralyzed when the division was practiced low down. Cases are detailed by the above authors as oc- curring in the human subject, in which, in paralysis depending upon disease high up in the spinal marrow, uterine action was not interfered with ; but was dimin- ished or suspended altogether in cases of paraplegia the result of injury or disease, low down in the cord. Dr. Simpson has lately made some experiments which go to negative the above. In his experiments, parturi- tion is said to have occurred, notwithstanding the des- truction of the lower portion of the spinal marrow. If such are Dr. Simpson's results, they will not prove the independence of the uterus of reflex action, since, from the connections of the greater and lesser splanchic nerves and the thoracic, abdominal and pelvic plexuses and ganglia, it is quite possible that the uterus may receive spinal fibres from the upper portion of the spinal marrow. The latter conditions may be caused by disease (idiopathic) or influences which we may term Medicinal. Certain medicines* undoubtedly cause abortion by their direct effect upon the brain or spinal cord. Those which produce congestive conditions are Quinine, Sti'ychnine, and Ergot. Quinine, according to Dr. Gardner, and several other observers, has been known to cause abortion, and they CAUSES OF ABOKTION. 47 caution the practitioner against its use during preg- nancy. The specific action of this drug upon the nervous centres is admitted by nearly all toxicologists. Dr. Brown-Seojuard says it causes engorgement of the vessels of the brain and spinal cord. While engaged in an extensive practice, in a locality noted for malari- ous diseases, I found that abortions were frequent among the patients of my allopathic colleagues, who gave quinine in massive doses (5, 10, or 15 grains). The accident was supposed to be induced by the dis- eases for which it was administered. No such results occurred in my practice, although the cases under my care were as severe as any under allopathic treatment. Only a small portion of my patients were treated with quinine, and those to whom I was obliged to prescribe it took it in small doses, not exceeding one grain every two or three hours. I am fully satisfied that the mis- carriages alluded to are caused' by the quinine, and not by the chill or febrile paroxysm. Strychnine has caused abortion. The tetanic spasms which occur in cases of poisoning by this drug seem detrimental to the life of the foetus or the integrity of the uterine tissues. It causes congestion of the spinal cord and its membranes. The foetus may not be ex- pelled while the woman is under the influence of the poison, for in a frog, rendered tetanic by strychnia, the ova was not expelled during the tetanoid symptoms, but some days afterward, when the spasms had nearly disappeared. Ergot. This agent has been supposed by some to act upon the uterus through the cord. Tyler Smith says : " The ergot of rye passes into the blood, and affects the spinal centre, being specially directed to the lower part of the spinal marrow, and to that part of it 48 HALE ON ABORTION. in relation to the uterus." Others contend that it acts through the circulation directly upon the uterine tissues. Brown-Sequard, however, classes it among the medi- cines which cause congestion of the vessels of the spinal cord. Carbonic acid, savin, aloes, alcohol, biborate of soda, and ipecacuanha, are supposed by Tyler Smith* and some others to act in a similar manner. This can, how- ever, hardly be said of all the above agents. Ipecac acts upon the gastric nerves ; carbonic acid., alcohol, and perhaps borax, may act through the cord, but aloes and savin appear to me to act in quite a different manner. The former seem to act by irritating the rectum, the latter as an irritant to the uterus through the medium of the blood, and rank with tanacetum, turpentine, uva ursi, cantharis, etc. If these medicines, however, are given in massive doses, they may act through both media. There are other medicinal agents which may act as centric causes of abortion, namely, gelseminum, caulo- phyllam, cimicifuga, cannabis indica, and, perhaps, gossipium. Gelsemijvum probably causes abortion by paralyzing the lower portion of the spinal cord. When given in large quantities during parturition, it arrests that process. In small doses it facilitates labor, and increases the contractions of the uterus. The other remedies mentioned probably cause miscarriage by irritating the whole or a portion of the cord. GALVANISM: may be applied so as to act as a centric cause of abortion. The state of the circulation affects the spinal centre in a very distinct manner. Want or excess of blood, or materies morbi in the circulation, act as a direct * Lectures on Obstetrics, p. 264. CAUSES OF ABORTION. 49 stimuli to the spinal centre, and in this way may induce abortion or premature labor. Certain diseases may act as predisponents, or exciting causes of abortion, by the influence which they exert directly upon the spinal centre. Among these diseases may be mentioned, cerebro-spinal-meningitis, myelitis, diphtheria, scarla- tina, etc., examples of which will be mentioned in their appropriate places. CEREBRO SPINAL-MENINGITIS, OR SPOTTED FEVER. I find, on examining the reported cases of this disease, that it almost invariably causes abortion in those preg- nant women who are its victims. This is what we might expect from a malady which strikes with fearful force the great nerve centres. Dr. Black* reports a case of a woman aged thirty-one, mother of five children, and in the fourth month of her sixth pregnancy, of good constitution, who was taken with a prolonged chill, severe aching over the whole body, and parturient pains. On the afternoon of the same day had second chill, not so severe as first, succeeded by very high fever, and an increase of pains. During the niglit sJie aborted. The fcetus appeared natural, the secundines passing, without difficulty or haemorrhage.' 1 ' 1 This woman succumbed to the allopathic treatment on the tenth day. Several cases have come under my observation, and to my knowledge, where this disease caused abortion. One peculiarity marks all the cases, namely, the abor- tion occurs shortly after the onset of the attack. I have been struck with the close similarity between the chill (rigor) and general symptoms of pain, prostration, * American Journal of Medical Science, No. 98, p. 345, 4 50 HALE ON ABORTION. etc., which attend the onset of both spotted fever and most cases of abortion. SECTION IV. CONCENTRIC OR REFLEX-SPINAL CAUSES OF ABORTION. It will be well, before we enter into the considera- tion of the special concentric causes of abortion, if the physician or student refreshes his memory concerning the sympathetic relations of the uterus with other por- tions of the body, and the manner in which such rela- tions are' kept up. The uterus is in relation with the cerebral, spinal and ganglionic divisions of the nervous system, and possesses properties derived from each of these sources of motor power. The uterus is withdrawn from the direct influence of volition. The will has no direct power either to contract or dilate this organ. Labor may take place when cerebral paralysis exists the will being entirely in abeyance, or abolished as when under the influence of chloroform, ether, or gelse- minitm. But though not exerting any direct influence, volition may affect' the uterus indirectly. (The direct influences as emotions of various kinds have been considered.) The efforts at " bearing down" during labor serve as an illustration of indirect cerebral influence; the abdominal muscles in this case stimulate the uterine by pressure. Since the brilliant discovery of the spinal system by Dr. Marshal Hall, that form of uterine action depending upon the spinal marrow now admits of clear comprehension, and is understood by all well-read phy- sicians. EXPLANATION OF PLATE. 1. Posterior or sensory roots of spinal nerves. 2. Anterior or motor ditto. 3. Fallopian tubes. 4. Fundus of the uterus. 6. Cervix uteri. 6. External os uteri. The arrows indicate the course of the afferent and efferent currents. CAUSES OF ABORTION. 53 The best resume of the modus operandi of this action, next to that of Dr. Tyler Smith,* is the clear elucida- tion by Dr. K. Ludlam,f in a valuable paper on the " Reflex Sympathies of the Uterus." From that paper I quote the following paragraphs, illustrated with the diagram kindly supplied to me by the author : " The spinal nervous filaments supplied to the uterus are of two kinds the motor and the sensory, or those which arise from the anterior and posterior columns of the medulla spinalis. The chief physiological peculi- arity of these filaments is, that in case of the arteries and veins, their currents set in different directions one toward, and the other out from, the central organ of the system. The sensory impression is that of general sensibility, and is afferent in its course from the sur- face of the organ to which its filaments are distributed, and no matter how remotely it may be situated, to the spinal or cerebral centre. The motor impulse, or that which supplies the force that causes muscular contrac- tion, is efferent in its course from the cord or brain, or both, to the muscular tissue, upon which the motor nervous filaments are distributed. " When you are told that every organ, and indeed every one of the bodily tissues, is supplied with, and is under the dominion of, the nerves, you will at once infer that the sensory and motor filaments must neces- sarily communicate with each other. This occurs either in the gray matter of the spinal cord, which is called its ganglion, or in that of the brain, where it forms the cen- tral ganglia. It is only necessary that the force or im- pression propagated to the sensitive filaments of the afferent nerves shall be conveyed to the 'gray or vesicu- lar matter of the brain or the cord, when it is acted upon by some of their ganglia, modified and returned to the organ through the out-going conductor, the efferent or motor nerve. * Lectures on Obstetrics, Page 263. f North American Journal of Homoeopathy, Vol. 13, Page 2. 54 HALE ON ABORTION. " Here is the whole philosophy of reflex action* Every organ is connected with and under the control of a mass of gray neurine, which anatomists call a ganglion, no matter whether that collection of nerve vesicles be found in the brain, the spinal cord, or in the ganglia of the great sympathetic. Sensitive impressions tele- graphed to, modified by, and returned from these va- rious centres to the same or any other organ or organs, furnish all the detail of reflex action." Our space will not permit an explanation of the physiological or healthy relations of the uterus to the cerebro-spinal system. Its pathological relations, how- ever, come within the limits of our special subject. In order to be systematic we should classify these morbid relations under three heads, namely : 1. When the sensory current is reflected upon the womb, and causes various modifications of its healthy sensibility. 2. When the motor current is reflected upon the womb, causing abnormal or normal mobility. 3. When both currents are reflected in a way to modify the healthy vascularify of that organ. From the jwst we may have hysteralgia, dysme- norrhoea, "uterine colics," super-sensitiveness of the uterus, etc. From the second, uterine cramps, spasms, contractions, dilation and rigidity of the cervix, etc. From the third, congestion, inflammation, and their sequelae of leucorrhoaa, ulceration, etc. This treatise is, however, not intended to be suffi- ciently extensive for any attempt at such a complete classification of the causes of abortion. I shall, there- fore, classify them under two heads. 1. Those irritations which, originating in the tissues, or within the cavity of the uterus, cause abnormal CAUSES OF ABORTION. 55 influences to be reflected back upon itself, with suffi- cient force to cause abortion. 2. Those irritations which originate in other organs and are reflected upon the uterus, so as to cause the expulsion and death of the foetus. FIRST CLASS. Parotidean. In Braithwaitd s Retrospect, Part xx. page 201, a case of abortion is mentioned, which seemed to have been caused by a metastasis of mumps. The patient was a lady aged twenty-five, who was attacked with cynanche-parotidea when advanced just beyond the third month of her third pregnancy. She had gone her full time in her previous pregnancies. After a day or two of vaginal discharge, uterine pains and haemor- rhage came on suddenly in the night and a foetus was discharged. The hsemorrhage continuing, ergot was given, and fifteen hours after the birth of the foetus the placenta was removed. Dr. Salter, who reports the case, remarks, that we have abundant experience to show that the parotid glands, when diseased, have a relation to the testicles in the male and mammae in the female. The mammary glands have a well-known sympathetic relation to the ovaries : and thus it may readily be supposed that in mumps an irritation may be communicated to the ute- rine system. On the other hand, the mammary glands may be affected, in metastasis of mumps, through the ovaries. It is difficult to decide which organ is prima- rily affected by the reflex influence originating in the parotids ; but the analogy between the testes and the ovaries, and the sympathy of the breasts with the ova- ries, go rather to support the hypothesis that the latter organs firt receive the metastatic irritation. 56 HALE ON ABORTION. Dr. Bedford and Scanzoni both make use of this reflex influence : the latter has founded upon it a method of inducing premature labor by irritation of the mammae. Thyroideal. Cases are on record, and some have come under my own observation, where abortion was apparently caused by the application of iodine to an enlarged thyroid gland. All irritations of this gland should be avoided during pregnancy. I believe I was the first to call attention to the sympathetic relation of this gland to the reproductive organs, in a paper on that subject written several years since.* Subsequent investigations appear to substantiate my views on that subject. Mammary. : Tyler Smith states that he has seen abortion caused by irritation of the mammary nerves. Instances of this are when abortions occur from pro- longed lactation during pregnancy. That it is not mere weakness or exhaustion in some of these cases is proved by the fact that the mammary secretion may cease upon the occurrence of impregnation, but that a plentiful supply of milk returns after the recurrence of abortion. Blisters or sinapisms, or even hot fomenta- tions to the breasts, may irritate the pregnant uterus. It is well known that contractions of the womb are excited, after labor, from irritation of the mammae. Gasti*ic. Although it is surprising what an amount of nausea and vomiting the uterus will bear without being excited to expel its contents, yet there are many cases recorded in which abortion has been apparently brought on by excessive vomiting during pregnancy. 'I have known abortion to be caused by the excessive * North American Journal of Homoeopathy, Vol. 12, page 375. CAUSES OF ABORTION. 57" vomiting induced by lobelia. It is true that in some cases the mechanical irritation may be the main cause, but there are many in which it undoubtedly occurs as a reflex pathological phenomenon. Dental. Irritation of the trifacial nerves may pro- duce abortion. This happens sometimes from the irri- tation of cutting the wisdom teeth, the extraction of a decayed tooth, or the irritation of a constant odon- talgia. It is advised by many of the older obstetric writers to avoid the extraction of teeth in a pregnant woman. Renal. A cute nephritis, the passage of calculi, or irritation of the kidneys in albuminuria, are said to be sometime causes of abortion. Vesical. Cystitis idiopathic, or from the poison- ous action of drugs may be a cause of abortion. Tur- pentine, canthariS) and other medicines, may induce such irritation of tjie bladder as to bring on miscarriage ; so, also, the presence of stone in the bladder. Rectal. The production of abortion by the irritation of the rectal nerves is a well-recognized occurrence. It may happen from hoemorrhoidal inflammation, the irri- tation of ascarides, the action of violent purgatives, diarrhoea, dysentery, or the opposite condition of exces- sive constipation, stimulating enemata, etc. Whitehead, under the head of " Functional Impediments of the Bowels," mentions many instances of abortion from the irritation of retained foecal matter. He says : " The symptoms are distension and tenderness of the abdomen, commonly attributed by the patients to flatu-* lence, of which they are constantly endeavoring to re- lieve themselves by eructation. The abdomen is some- times as large, under these circumstances, in the middle, as it should be at the end of pregnancy. There is a 58 HALE ON ABORTION. constant inclination to relieve the bowels, the evacua- tions, which are thin and scanty, being accompanied by violent straining efforts. This action is not long in being extended to the uterus, which becomes affected with pains of an intermittent and expulsive character, creating the belief that abortion is about to happen. The real cause of these disturbances is accumulation of fceces in the third turn of the colon, accompanied with flatulent distension of that portion of the bowel immedi- ately above the seat of obstruction. This cause of abortion does not generally occur before the fourth month, for not until that time does the womb attain sufficient size to act as an impediment to the passage of foecal matter through the rectum. The haemorrhage in this description of cases is apt to be profuse, and restrained with difficulty." Frecal accumulations may also cause abortion, by producing that displacement of the uterus known as retroversion, a condition treated of in another place. Aloes, podophyllum, mercury, and their analogues, may cause abortion by the rectal irri- tation they produce. Vaginal. Acute vaginitis, gonorrhoeal or idiopathic, will sometimes cause abortion. Mechanical irritation of the vagina, by plugging, coition, or ill-fitting pessa- ries, or irritating injections, may have the same effect. Vaginismus, a painful spasmodic affection, which has attracted much attention of late, is not only a frequent cause of sterility, but of abortion. Dr. Helnmth* has given us a vivid example of this condition, in a recent .article. The induction of abortion by means of the colpeurynter will be considered in another place. Ovarian. Any irritation or excitement of the ovaries is reflected upon the uterus, mamma}, or thyroid gland. *See Western Homoeopathic Observer, Vol. 1. CAUSES OF ABOKTION. 59 In the unimpregnated state, the uterus generally re- ceives the reflex ovarian influendl ; when it occurs during pregnancy it is an abnormal phenomenon, and is liable to cause miscarriage. If this influence is received by the mammae or thyroid, the uterus is left to go on with its normal development. In many instances the simple occurrence of the menstrual nidus has been sufficient to cause abortion. This is one form of that disease called " habitual abortion." The uterus must first be in a debilitated, irritable condition, in order to be seriously affected by this influence. The ovarian irritation may be perfectly normal all the time, or it may be abnormal, consequent on diseased condi- tions, or the toxical effects of drugs. Thus if canthar- ides, camabis indica, apis mel, or similarly acting drugs, be given in pathogenetic doses, they may set up an irritation in the ovaries which shall be reflected upon the uterus with such force as to cause it to take on diastaltic action. Certain diseases of the ovaries have the same effect, namely inflammation, congestion, suppuration, etc. Those diseases which can act as di- rect or mechanical irritants to the uterus, are enlarge- ments, from cystic and other growth, dropsy, etc. SECOND CLASS. ' Uterine. This class includes the following, namely : (a) Diseases of the uterus, functional and organic. (&) Displacements of the uterus. (c) Death of the foetus. The uterus is endowed with what is termed peristaltic action a peculiar vermicular motion or contraction, which is called by Tyler Smith, "ganglionic motor action." "When any part of a muscular organ, sup- plied in whole or in part by the ganglionic system of 60 HALE ON ABORTION. nerves, is irritated, the contraction which ensues gene- rally spreads in a vermicular manner to a distance from the point of irritation, and continues for some time after the exciting cause is removed. The uterus is eminently endowed with the peristaltic form of con- traction. When one point of the uterus is stimulated, through the abdominal parietes, or by the introduction of the hand into the uterus, the' contraction excited extends to the whole organ." Dr. Smith has seen this action occur after death, in animals, and he asserts that the uterus seems capable of expelling the foetus by peri- staltic action alone. In cases of paraplegia from disease of the lower part of the spinal marrow, or in animals reduced to the same state by experiment, the peristaltic action is the chief power remaining in the uterus. In such cases delivery has been effected in an imperfect manner by the peristaltic action of the uterus or by the application of galvanism to the organ. It is not stated, however, how much of the spinal marrow must be des- troyed before the reflex ordisastaltic action of the uterus ceases. .It is not probable that this peristaltic action can exist to any extent, unconnected with the reflex spinal influence. In cases of labor and abortion, the two forms of action exist in combination. The motor nerves of the uterus are in relation with the mammary, pubic, rectal, pneumogastric, ovarian, vaginal, and the nerves of the os and cervix uteri, as incident excitor nerves. There can be no doubt that in an organ thus subject to reflex action, its own nerves are excitors, and that in all- contractions of the uterus excited by irrita- tion of its external surface, or of the os and cervix, by disease or otherwise, the uterine actions are both reflex and peristaltic. It is indeed a question if any pure spinal fibres reach or proceed from the uterus unmixed CAUSES OF ABORTION. 61 with fibres from the ganglionic. Any pathological condition of the uterus, which is capable of exciting these reflex-spinal and ganglionic-motor actions, may be a cause of abortion at any period of pregnancy. Functional diseases of the uterus, are those in which no change in structure has yet appeared, although fhe condition existing may lead to such lesion. The older writers laid much stress on the opposite states, which they termed rigidity and laxity of the muscular tissue of the womb. We cannot dispute the fact that such a condition may exist as idiopathic affections, i. e., de- pending upon the same general state of muscular fibre. But it may obtain from purely local causes, namely: an exhausting discharge from the mucous tissues of the organ itself as functional leucorrhoea. But as leucor- rhcea may be functional, and also dependent on organic changes in the uterine tissues, we will proceed to con- sider that disease, as it is the connecting link between the two classes of uterine diseases. SECTION V. FUNCTIONAL DISEASES OF THE UTERUS. Congestion of the Uterine Circulation. According to Whitehead this appears to prevail as the immediate cause of abortion in one out of every twenty-five cases. He believes the average is even greater. Those in whom the venous capillary function is naturally below par, indicating predisposition to local congestion, are most frequently the subjects of it. The symptoms which 62 HALE ON ABORTION. . usually manifest themselves after the period of quick- ening, from the end of the fourth to the eighth month of pregnancy, are immoderate and painful distension of the abdomen, generally attributed by the patient to the accumulation of Wind in the bowels ; a pulsative movement extending over the whole cavity ; sense of weight and bearing down ; intermittent pains in the loins, like those of labor, and occasionally escape of blood from the vagina. There is also distension of the pubic, spermatic, hsemorrhoidal, and all the pelvic veins, and sometimes those of the lower extremities. On examination, the vagina is found hot and turgid, and the cervix uteri tumid and varicose. When this state is allowed to exist for a length of time, local phle- bitis may take place, resulting in varicose ulceration of the cervix ; or the inflammation may extend through the entire organ, and eventually to the uterine perito- neum, ending in effusion, etc. Leucorrluw. ! The frequency of leucorrhoea during pregnancy, and the many unpleasant symptoms to which it gives rise, should lead us to study more closely the connection between that disorder and abortion. The valuable monograph of Dr. Tyler Smith on Leucorrhoea leaves but little to be desired relative to the true pathology of the abnormal discharges which go under that name. The limits of this work will not permit me to give more than a cursory glance at the divisions of leucorrhoea; our main purpose is to con- sider the influence it has on the causes of utero-gestation. But the treatment of this disease will in time be so inti- mately connected with a true understanding of the nature and locality of the discharge, that we cannot for- CAUSES OF ABOETION. 63 bear giving some general idea of the classification of the varieties of this malady. "All pathology has its basis in physiology. The demonstration of two very differently organized surfaces in the vagina, and in the canal of the cervix uteri, with the existence of two very distinct forms of secretion, naturally lead us to the consideration of two principal forms of leucorrhcea. But at this point it may be well to revert for a moment to the special difference which exists between the vagina and the cervical canal. The lining membrane of the vagina approaches in organiza- tion to the skin ; it is covered by a thick layer of scaly epithelium ; it contains in the greater part of its surface few, if any, mucous follicles or glands ; its secretion is acid, consisting entirely of plasma and epithelium, and the chief object of the secretion is the lubrication of the surface upon which it is formed. " On the other hand, the lining of the canal of the cervix, is a true mucous membrane : it is covered in great part by cylinder epithelium ; it abounds with immense numbers of mucous follicles, having a special arrangement ; it pours forth a true mucous secretion, alkaline in character, and consisting of mucous corpus- cles and plasma, with little or no epithelium, and this secretion has special uses to perform in the unimpreg- nated state, and in pregnancy, and parturition."* We here have presented the anatomico-physiological character of the vagina, and canal of the cervix uteri. So long as the secretions from these surfaces remain within physiological limits, no disease is present : but the moment these secretions become abnormal in quan- tity or quality, the result is Leucorrhoea. Leucorrhoea admits of the same divisions as set forth in the above quotation. The first and most important is the Mucous variety, consisting chiefly of mucus-cor- * Tyler Smith on Leucorrhoea. 64 HALE ON ABORTION. puscles and plasma, and secreted chiefly by the follicu- lar canal of the cervix. The second is the Epithelial variety, in which the discharge is vaginal, or is secreted by the vaginal portion of the os and cervix, and con- sistSj for the most part, of scaly epithelium and its debris. These two varieties may, of course, exist in various degrees of combination. Sometimes the one and some- times the other preponderates,- or is the original affec- tion. The old division of uterine leucorrhoea, as arising from the cavity of the fundus, is now obsolete such discharge rarely occurs. In certain cases of inenor- rhagia/the periodical sanguineous discharge is converted into a constant colored discharge, in which may appear some mucus, but hardly enough to constitute a leu- corrhoea. Cervical or Mucous Leucoi^rhoea. This most com- mon form of leucorrhcea is, when simple and uncompli- cated, the result of a morbid activity of the glandular cervix. Instead of the discharge of the plug of mucus at the catamenial period, a constant discharge is set up. The glandular portion of the canal of the cervix is the chief source of the discharge ; it is a special secretion, elaborated by those glands. In recent cases of cervical leucorrhcea, when the dis- order consists merely of a hyper-secretion of the mucous follicles, without any manifest lesion of structure, the cervical discharge is found (on examination with the speculum) hanging at the os uteri, or adhering to its vaginal portion, and is almost always viscid and trans- parent. It may be drawn out in long tenacious threads of the utmost clearness, unless in course of pregnancy, or abnormal state of the vagina, when it is rendered opaque by the acid vaginal mucus. This string of mucus sometimes extends the whole length of the CAUSES OF ABORTION. 65 vagina, and even extends from that passage. This secretion is always alkaline, in contradistinction to the vaginal secretions which are acid. In severe or chronic cases of this form of leucorrhoea, the alkaline cervical niucus is mixed with pus and blood, owing to the irritable and more deeply diseased condition of the glands of the canal of the cervix. In some cases, the exudation of blood from the canal of the cervix is so constant that it is. apt to be mistaken for rnenorrhagia. In other cases of cervical leucorrhoea the- secretion is so profuse and watery that the traces of viscidity are nearly lost. Instead of the mucus and plasma, a watery serum is poured out in large quan- tities. The quantity of mucus or serum lost in cases of cer- vical leucorrhoea is often so considerable as to prove a serious drain to the constitution, and set up functional or more serious disorders in different parts of the body. The serous secretion in particular is often a source of great debility. Patients suffering from either of the above forms may become hectic from purulent secre- tion and absorption, or rendered anaemic from the loss of blood. The symptoms arising from cervical leucorr- hcea are numerous and changeable, dependent on the amount of local irritation, functional derangement of other organs, or the loss of tone in the muscular or nervous system. Sequelae of Cervical Leucorrhoea. It is well known by the reading men of the medical profession, that writers on uterine pathology are divide into antagon- istic schools, namely, (1) those who, under the leader- ship of Bennet, believe nearly all abnormal discharges from the uterus are the result of inflammation and ulceration, and (2) those who adopt the theory of Tyler 5 66 HALE ON ABORTION. Smith, that the ulceration is the result of abnormal discharges from the cervical canal and its glandular apparatus. When these conditions occur as actual sequelae of cervical leucorrhoea, the following is their order of appearance. I quote from Dr. Tyler Smith. " By observing cases of mucous or cervical leucorr- hcea, under every variety of circumstances, we may obtain a tolerably correct knowledge of the different stages of the disease, and we may learn the order in which its sequelae makes its appearance when it is allowed to run its course unchecked for a considerable time. In the first place there is simply an increase of the secretion of the cervical mucus. Instead of the formation of the plug after each monthly period, there is a constant escape of thick mucus from the os uteri. But in this phase of the disorder there is little constitu- tional or local disturbance. The size of the os and cervix is not increased, and the surface of the os remains quite natural, both as regards volume and color. After a time the os uteri gapes ; there is relax- ation of the cervix, the upper part of the vagina loses its tone, and some amount of prolapsus generally occurs. With this the ring of superficial redness slowly passes on to the destruction of epithelium ; then the loss of the villi takes place, and the formation of the granular surface upon their base occurs. The whole of the os and cervix now becomes swollen and turgid, induration commences, and fibrinous deposit in the substance of the cervix frequently takes place. The sensibility of the different portions of the utero-vaginal canal varies greatly in different cases. In some the abraded or hypertrophied os uteri is exquisitely tender, while iii others its sensibility is little, if at all, increased. In some cases of leucorrhoea, in which abrasion occurs, the whole of the os uteri and the cervix hangs into the vagina, completely denuded of its integumentary cover- CAUSES OF ABOETION. 67 ing, but there is no great enlargement of the parts. In others there is considerable hypertrophy without any destruction of epithelium or loss of surface." All the conditions above mentioned as being caused by cervical leucorrhoea may arise from other causes. Dr. Bennet insists that they arise from inflammation of the cervix. It is of considerable importance to the practical physician whether these conditions are primary or secondary effects : the selection of the remedy depends considerably upon the theory adopted. The contro- versy is yet undecided, and probably will not be until personal asperity and prejudice is laid aside, and all seek conscientiously for truth. As in nearly all other controversies, neither party has all the truth on his side. I am inclined to the belief that- either leucor- rhoea or inflammation may be the primary affection. An inflammation of the cervix, or an ulcer thereon, may cause cervical leucorrhoea, and. vice versa. The best we can do, in the present state of our knowledge, is to judge from the history of the case, and a careful examination with the speculum, which has the priority. Vaginal or Epithelial Leucorrhoea. This discharge has its origin in the muco-cutaneous lining of the vagina and the portion of this membrane reflected on the ex- ternal surface of the cervix to the margin of the os uteri. In strictly vaginal leucorrhoea there may be no discharge whatever issuing from the canal of the cervix, and in some cases the secretion of the cervix seems almost suspended, the os uteri appearing drier than natural, and no mucus being visible between the labia uteri. In others the cervical glands are excited by the condition of the vagina, and secrete copiously a mixed epithelial and mucous leucorrhoea, from the union of 68 HALE ON ABORTION. the two kinds of discharge. The discharge in vaginal leucorrhoea may arise, chiefly, either from the lower part of the vaginal membrane or from that part which is reflected upon the cervix, but in severe cases the whole surface of the vagina is involved. In simple acute cases of vaginal leueorrtaea the discharge is epithelial, made up of imperfect and perfect scales. In severe and chronic cases, pun is mixed with the epithelial mat- ter ; for the villi become affected and the pus is formed upon the sub epithelial or villous surface. In some cases portions of the vaginal surface may be so abraded that blood globules escape and mix with the other con- stituents of the vaginal discharge. In one form of vaginal leucorrhcea but little fluid discharge appears, but the vaginal walls are coated over with a white membrane, which may be detached in large shreds or pieces, composed of epithelium in which the parchment- like arrangement of the scales is perfectly preserved. These laminae frequently have upon them marks of the rugae of the vagina, and their under surfaces are rough from the indentations of the vaginal papillae. This may be termed a membranous form of leucorrhcea, and occurs oftenest in cases of pregnancy. The vagina may be attacked with the diphtheritic poison, and secrete a membrane having that character. In some cases of vaginal leucorrhoaa, the irritation is intense and annoy ing, assuming the form of pruritus vulvce. This latter symptom is, however, oftener caused by an aphthous- inflammation of the lining membrane of the vagina and vulva. I have known cases in which abortion appeared to be caused by this symptom alone, the severe reflex irritation being sufficient to set up expulsive action in the uterus. CAUSES OP ABORTION. 69 The frequency of leucorrhcea during pregnancy has been alluded to. Whitehead found, in 2,000 cases 1,116 in which leucorrhoea was present. Out of the 2,000 cases, 747 had abortions, and of this latter number, only 172 cases of abortion could be assigned to specified causes leaving 575 cases out of 1,116 "having leucor- rhoea. This is a large percentage larger than we ever meet in general practice. In many of these cases, per- haps a majority, the discharge was probably due to ulceration. Gonorrhoea. This should not be overlooked when we are consid- ering the causes of abortion. The uterus is more com- monly affected by the gonorrhoeal poison than has been supposed. Whitehead asserts that this disease more commonly affects the uterus than the vagina. This opin- ion is at variance with what has usually been taught. That writer contends that the gonorrhoeal virus, from physiological causes, is liable to be carried immediately to the highest part of the canal, and forcibly projected upon the lowest extremity of the uterus, which organ also, at this juncture, is in a state eminently calculated speedily to absorb it ; besides, the* normal secretion of the vagina possesses properties which are capable, to a certain extent, of destroying or materially modifying the virulency of the poison, and of thus protecting the vaginal surface from its immediate influence. The urethral orifice, however, does not seem to be provided with this protection to any degree, and is therefore much more susceptible to the action of specific inocula- tion. In nine unimpregnated women affected with gonorrhoea, seven had inflammation, with abrasion of the os uteri, and in the remaining two, the upper vaginal surface and urethra were affected. 70 HALE ON ABORTION. Gonorrhoea first affects the uterus by causing super- ficial inflammation of the lips of the os and the com- mencement of the internal cervix. The inflammation seems to affect principally the small mucous follicles with which the surface is closely studded. " A small red patch is first perceived ; sometimes there are two or three isolated spots which extend and soon run to- gether, forming one patch, of variable size in different cases and in different stages of the complaint, and generally of irregular shape. On removing the thick secretion with which this is covered, the surface appears to consist of minute granules, equally dispersed over every part of it ; the abrasion is bounded by a margin not very distinctly defined, running imperceptibly into the erysipelatous redness which surrounds the sore ; this extends to some distance upon the cervix, the whole of which is more or less tumid, but not painful to the touch." In plethoric women the symptoms are often very violent, the inflammation being severe, and the ulceration of an irritable character, throwing off large quantities of pus and often causing much fever. If the infection be contracted during pregnancy, abortion is liable to take place during the acute stage of the complaint from the intense uterine irritation. If the disease existed previous to gestation, it may have caused chronic endo-uteritis, or an ulcerated condition of the cervix, both of which conditions are quite serious, and are likely to be cause of abortion at any period of pregnancy. It is Whitehead's opinion that gonorrhoeal affections in women are rarely cured ; that they are frequently the cause of induration, fissured ulcer, and chronic in- flammation of the deeper seated tissues. CAUSES OF ABORTION. SECTION VI. ORGANIC DISEASES OF THE UTERUS AND CERVIX. Ulceration of the Cervix. Whitehead refers to a table containing the records of 400 cases of abortion and threatened abortion, " In all which, disease of the uterus was an accompanying condition, and for which no other cause could be assigned for the disturbance complained of, the average occurrence of the superficial granulating ulcer, or of diffuse inflammation of the cervix, amounted to 26 in every hundred. In the majority of these, the event happened between the mid- dle of the sixth and the middle of the ninth month. In some, however, the symptoms commenced earlier." This would seem to indicate that ulceration of the cervix was better tolerated in the earlier, than in the later months of pregnancy. In several cases, recorded by Bennet,* the abortions, or threatened abortions, occurred as often in the first, as in the last three months of gestation. Ulceration of the cervix may be considered as one of the chief causes of abortion. Bennet thus sums up his experience in the matter : "Abortion is often occasioned by inflammatory ulcer- ation of the cervix, and likewise often occasions it. Jn the latter case, abortion occurs accidentally, under the influence of some of its generally recognized causes, and leaves behind a morbid state of the cervix and its cavity. Local disease of this nature may follow an * Diseases of the Uterus. 72 HALE ON ABORTION. abortion of the simplest kind, one from which the patient rallies in a few days, although it is more gene- rally the result of those that are accompanied by inflam- matory and hseniorrhagic symptoms. Ulcerative disease of the cervix, when once established, from whatever cause, is itself a frequent cause of abortion. When abortion is the result of the actual existence of the inflammatory disease, it may be produced in various ways. The vitality of the womb may be so modified in the earlier stage of pregnancy, by the existence of the disease, that the foetal germ dies, in which case it is expelled along with the membranes, or it is partly or entirely absorbed, the membranes 'continuing to enlarge for some months, and being eventually expelled under the form of a mole, or false conception ; or the pregnancy may advance to a farther period, until the third or fourth month, when the womb becoming too irritable, or being unable to develop itself, or the foetus dying, the membranes separate, flooding ensues, and the contents of the uterus are expelled. At a later stage still, when the muscular structure of the womb is more fully developed, the presence of inflammation at its mouth may bring on strong reflex action, and occa- sion premature confinement, independently of any dis- ease of the child or of its membrane. " Abortions, no doubt, frequently occur under the influence of accidental causes alone, and of constitutional cachexia, such as scrofula and syphilis, without there being any local disease of the cervix. It may, however, be laid down as a rule, that a great majority of abor- tions which are preceded or followed by morbid symp- toms, and of those which occur spontaneously, without any evident cause, and in the absence of uterine tumor 01^ constitutional cachexise, are occasioned by inflamma- tory disease of the cervix. It may also be considered as all but certain, that inflammatory and ulcerative dis- ease of the cervix exists when abortions quickly suc- ceed one another, and when a female does not seem able to carry the product of impregnation to the full time." CAUSES OF ABOKTION. 73 According to the same author, " inflammatory ulcer ation, during the pregnant state, is by no means neces- sarily followed by abortion." Gestation may go on till full time, wHen no remedial treatment is resorted to ; or the ulceration may be treated by local applications, and cured, without interfering with the course of preg- nancy. Bennet also says that " instrumental examination of females [women ?] laboring under inflammatory ulcera- tion of the cervix, during pregnancy, is unattended with any risk, either to the mother or to the foetus, and it is absolutely necessary, in order not only to fully recognize the disease, but also to treat it." This statement I have often verified in practice. The speculum should be generally resorted to in cases of threatened abortion. " The simple granulating ulcer" says Whitehead, " may be confined to one labium only, the other being perfectly normal. More frequently, however, it impli- cates both at the same time, extending to some distance up the external cervix, and passing more or less within the orifice, which often appears to be the part most severely affected. The whole cervix is in a state of hypertrophy, and considerably softened, with the excep- tion of the inflamed crust upon which the ulcer is situ- ated. " Upon tactile examination, the whole lower part of the uterus is found to be altered in form : the lips are elongated and flabby v and the orifice open. The ulcer presents a flattened, velvety surface, with a raised cord- like external boundary, which the practiced touch will be able to detect without difficulty. When viewed through the SPECULUM, the whole cervix unless it be & * unusually large will readily fall within the upper aperture of the instrument. The diseased surface, when 74 HALE ON ABOETION. both labia are implicated, appears irregularly circular, about the size of a shilling larger or smaller of a bright red color, and covered over with a coating of muco-pus : this being removed by a piece of lint, to which a portion of ropy mucus often adheres, derived from the central orifice, the granulations are brought palpably to view. The granulating ulcer is most commonly observed in women of the sanguino- lymphatic temperament, lax fibre, and feeble circulating powers. When met with in primapara, the first indi- cations of its existence are noticed before the period of quickening, often as early as the second or third month. It may exist for years, and during several pregnancies, without causing abortion." (See plate.) West* describes ulceration of the cervix in a different manner : " They are for the most part mere superficial abra- sions of the epithelium investing the lips of the os uteri, whose abraded surface is of a vivid red color, and finely granular. In other cases, in which the absence of epi- thelium is less complete, the surface seems beset by a number of minute, superficial, aphthous ulcerations, be- tween which the tissue appears healthy, or slightly redder than natural. The ulcerations of the os uteri seldom or never present an excavated appearance with raised edges, as ulcers of other parts often do, but either their surface is smooth, or it projects a little beyond the surface of the surrounding tissue. They are usually, but not constantly, of greater extent on the posterior, than on the anterior lip, are sometimes confined to the former, but very rarely indeed limited to the latter. They appear to commence at the inner margin of the os uteri, whence they extend oufward, and sometimes, though by no means invariably, the short extent of the MI in 1 of the cervix uteri which can be brought into view by the speculum, appears denuded of its epithe- lium. 1 ' * Diseases of "Women, page 97. CAUSES OF ABOETION. 75 Other writers vary as much in their description of nlceration of the os and cervix, as Bennet says, " with- out necessity or advantage." Writing of this lesion the same writer says : " An ulceration occupying the cervix uteri may pre- sent the various modifications which suppurating sur- faces offer in any other part of the body, from the minute granulations of a slight abrasion, to the livid vegetations of an unhealthy sore ; but these modifica- tions of the ulceration require, in reality, no division or classification." The student who would acquaint himself with the various local and constitutional symptoms caused by these ulcerations, may refer to such works as West, Meigs, Scanzoni, Simpson, and particularly Bennet. To the Allopathic school, who attack all ulcerations of the cervix uteri with caustics or constitutional reme- dies tonics and alteratives the division of ulceration into different forms and species, may be of- no practical use or benefit ; but to the homoeopathician, these classi- fications, or minute descriptions, may be of great value in the selection of the specific remedy, especially when our Materia Medica shall be perfected, particularly the pathological symptoms thereof. After consulting all the more recent writers who des- cribe ulceration of the cervix uteri, and from the results of my own limited observation, I know no better man- ner in which to classify these lesions than the one adopted by Whitehead namely : Superficial erosion, Fissured ulceration, Va/ricose ulceration, Follicular ulceration. Bennet inadvertently sanctions this arrangement, for he mentions" Abrasion, or Excoriation " " Ulcera- tion, with Fungous Granulations" and " Varicose con- 76 HALE ON ABORTION. dition" of the parts " Aphthae, or Ulcerated Mucous Follicles" and even a condition when "The lips of the os uteri are very much hypertrophied and indur- ated * * separated by a deep fissure, and the ulcer- ated surface, which is situated deeply between them, can only be discovered with the eye, on their being sepa- rated by a bivalve speculum." We will now examine the peculiar characteristics of the different forms of ulceration : the simple erosion, or granulating ulcer, has already been described. Varicose Ulcer. This variety, .according to White- head, is liable to cause abortion in the latter two or three months of pregnancy. It prevails in about six or eight cases. out of every hundred, and is often diffi- cult of cure before delivery: It is generally met with in women of the bilious temperament and hard fibre, who have been subject to piles and profuse menstrual discharges, and to derangement of the biliary organs. The premonitory condition of the parts consists in a hardened and hypertrophied state of the cervix, which is traversed in various directions by a number of tortu- ous dark colored trunks, about the thickness of a probe, or goose quill, raised upon the surrounding surface. Larger and more prominent points are here and there noticed, indicating the situation of inosculation of one branch with another ; and generally, at one of these points, the ulcerative process is set np, which soon ex- tends through the coats of the vessel, and haemorrhage follows immediately. The ulcer, which is not long after in being developed, presents an uneven livid aspect, with irregular margins, near which a few tortuous ves- sels may be seen ramifying: it now secretes a quantity of pus, and often has small dark clots of blood or fibrin, the size of a pin's head, lying loose upon the surface. CAUSES OF ABOKTION. V7 It usually occupies but one labium, the anterior more frequently, but often the whole circumference of the cervix is implicated. Sometimes the inflammation ex- tends to the body of the uterus, as an acute phlebitis, and thus acquires a serious importance. The symptoms indicating the existence of varicose ulceration during pregnancy, are bearing-down pains of an intermittent character, similar to those of the first stage of labor, aching of the loins and along the thighs, irritable blad- der, with inability to retain the urine the usual length of time, disorded digestion, sickness and headache, lan- guor, and a vaginal discharge of a white glairy mucus at first, which becomes brown, then bloody, and finally purulent. Bennet says this form of ulceration is gener- ally attended with fungous granulations, large, livid, and bleeding at the slightest touch. Whitehead says it causes induration of the cervix, and often degenerates into the Fissured Ulcei\ This form of uterine disease, ac- cording to Whitehead, is perhaps equally prevalent with the superficial variety, and is much more difficult of cure, on account of the extent to which the subjacent textures are implicated. It is found to exist in twenty to twenty-four out of every hundred cases of abortion, not resulting from accidental causes. It is always accompanied by a degree of inflammatory induration which extends more or less deeply on each side of the fissure ; this is readily detected by the touch, the cir- cumference of the orifice being uneven and lobulated. There may be one or more fissures, the intervening spaces being healthy or inflamed, excoriated, and in a state of erosion, or superficial ulceration. The fissures are often deep, and extend to a considerable distance in an upward direction. 78 HALE ON ABORTION. The oKsehargt) which is seldom so abundant as in the form of disease first described, has a decidedly purulent character, being alkalescent, of a yellow or greenish yellow color, sometimes brown or ichorous, and not un- frequently mixed with blood. This variety of ulcera- tion is considered the most intractable existing for years. Whitehead thinks it one of the most frequent causes of " habitual abortion." Whether this accident occurs habitually at the third, sixth, or any other period, is owing to the extent of the parts affected by the ulceration, and Dr. A. K. Gardner* adopts this view, and mentions many cases in proof. The discliarge be- gins to be mixed with blood as soon as the expansion of the uterus extends itself as far as the diseased parts, the slightest irritation being sufficient to induce haem- orrhage. The careful introduction of the speculum, or digital examination, will cause bleeding. Haemorrhage from fissured ulcer often gives rise to the so-called "menstruation during pregnancy," the habitual con- gestion during the usual menstrual period being suffi- cient to cause bleeding from the ulcerated surface. Regarding this phenomena, Dr. Whitehead thus writes: " The evidence now producedf appears sufficient to establish, as a general rule to which I am not as yet acquainted with an exception that the blood discharged in cases of alleged menstruation during pregnancy is furnished, not by the lining membrane of the uterus, nor by any healthy secreting surfaces except some- times the inferior part of the inner cervix but by the lower extremity of the uterus, external to its cavity, or by the contiguous vaginal reflexion being in a state of xHjijmrtitii'? inflammation. The fact is always demon- strable by the aid of the speculum." * See cases in "Abortion and Sterility," p. 181. f " Gardner on Sterility.'' CAUSES OF ABOKTION. 79 "The symptoms indicating the presence of the disease in question, are severe aching of the loins and sacrum, tenesmus, irritable bladder, with frequent desire to void urine, violent pain of the lower part of the abdomen, often confined to one side, at a point a little above the groin, corresponding to the situation of the round liga- ment, and following the course of the inguineo cutane- ous and external pudic nerves." Follicular Ulceration. This form of disease of the cervix is said to be an inflammation and ulceration of the Nabothean follicles. It occasionally accompa- nies other morbid conditions of the cervix, but is most frequently met with in a distinct form. Whitehead doubts whether it is a primary affection. Upon exami- nation, the part appears to be studded with a number of raised circular spots, having the dimensions of small peas, covered with a white crust, the surrounding sur- face being of a reddish hue. This white pellicle is easily removed by means of lint, exposing a surface of the same form and size, slightly elevated, and appear- ing as if composed of extremely minute granules. The parts are not painful to the touch. These spots are sometimes numerous, as many as fifteen or twenty being visible, but often only* one or two are seen. Owing probably to specific causes they sometimes be- come very promin%nt, and assume a warty appearance. According to Bennet who will not admit of any classification of inflammatory ulceration this follicular ulceration is to be considered the same as any other arising from that cause ; but he admits that " sometimes we find, in the vicinity of the os uteri, several small ulcerated patches, isolated one from the other, but near to it. These multiple ulcerations, which are rare, are * See cases in " Abortion and Sterility," p. 181. 80 HALE ON ABORTION". evidently formed, in the first instance, by aphtha, or ulcerated mucous follicles." I have under treatment, at the time of this writing, a case of follicular ulceration of the cervix, associated with hypertrophy of the uterus, and consequent retro- version. The patient had an abortion four months since, caused undoubtedly by these conditions. When this variety of ulceration occurs in cachectic habits, or in women advanced in life, these follicles are liable to inflame and suppurate in considerable numbers, leav- ing circular cavities, which give to the parts a worm- eaten appearance : or the suppurative action may ex- tend, until several of the orifices coalesce, forming a deep, irregular shaped excavation, with callous, over- hanging margins, constituting what some writers have described as the " corroding, or phagsedenic ulcer." Induration and oadema of the cervix is a common con- comitant of this aggravated form of follicular ulceration. Phagcedenic, Corroding, Cancerous Ulceration. Under the above names have been described various forms of ulceration of the cervix, of a malignant character, char- acterized by a tendency to sloughing, with extension of ulceration to the body of the uterus, and a discharge, nearly always of a foetid, corrosive, and otherwise un- healthy character. These forms of laceration generally lead to organic changes, such as hypertrophy, indura- tion, tumors, etc., which will be treated of hereafter. ; i Syphilitic Ulceration. There can be no doubt that the syphilitic ulcer is a frequent cause of abortion. It was not until recently that its importance as such was suspected. In treating the abandoned classes in gr^at cities, and even those in higher positions, the physician will do well to be on the look-out for this disease, when he is searching for the cause of abortion. CAUSES OF ABOKTION. 81 The primary venereal sore is very rarely seen attack- ing the lower part of the uterus. The virus is not likely to be carried up so high, except in occasional cases. It is chiefly secondary syphilis which affects the uterus. It may have its origin in three different ways, according to Whitehead. (1) As an imperfectly cured primary affection, which was originally a genuine chancre in the external geni- tals. (2) As a result of virulent inoculation upon the lower part of the uterus. (3) As a consequence of secondary inoculation. The possibility of transference of venereal taint under this form, is still a matter of dispute. The constitutional symptoms denoting the presence of secondary syphilis are, pallor of the countenance, languor, precarious appetite, loss of rest, hectic fever- ishness, lumbar and hypogastric pains, disordered secre- tions, and the appearance of the disorder in the off- spring. The local symptoms, enumerated in the order of their frequency, are, (1) ^Endo-cervicitis^ or inflammation of the lining membrane of the cervix uteri, with inflam- mation, excoriation, or ulceration of the labia around the uterine orifice. This appearance was noticed in 19 out of 28 cases. (2) A mottled or patchy appearance of the cervix, consisting of a number of dark red spots of irregular shape, surrounded by lighter colored portions : they sometimes appeared highly irritable and excoriated, but not aphthous ; the whole cervix was generally en- larged and slightly indurated and in most cases there were evidences of endo-cervicitis. (3) AphtJiGB of the cervix, occurring in 8 out of 28 6 82 HALE ON ABORTION. cases ; the patches, which appeared perfectly white, of a circular or oblong shape, situated upon a dark red base, were easily detached by the aid of lint, and left a bright red surface of similar form and dimensions, having, in some instances, a very minutely granular aspect. These were associated with hypertrophy of the cervix and endo-cervicitis. (4) Warts were witnessed in 3 out of 28 cases, twice on the cervix and once on the walls of the vagina. They were witnessed in many other cases. The syphilitic ulceration of the cervix cannot be diagnosed from that of a non-venereal character, except by an actual knowledge of the presence of the specific poison in the system of the patient. There is nothing in the appearance of the ulcer or erosion which can show itself to be syphilitic. When we see warts, or the mottled appearance mentioned by Whitehead, we may justly have our suspicions. Syphilis may act as a predisposing cause. (See that chapter.) SECTION VII. Induration of the Cervix Uteri. This may be a pri- mary or idiopathic affection. Whitehead met with severe cases of chronic induration during pregnancy, in only two of which treatment was effectual in averting abortion. All these persons had aborted ; three of them, including the two just mentioned, he had at- tended in the preceding instances, in all of which the same form of disease at that time existed, and in the CAUSES OP ABOETION. 83 remaining four, it is probable, had long before existed. The sum of their abortions was 19 ; the average age of the patients 31 years. This form of disease is usually met with as a chronic affection, the result of previous deep-seated inflamma- tion, a species of prolonged naetritis. The enlargement and induration may involve the whole neck, or may be confined to the anterior or posterior lip alone. In either case it may depend on inflammatory action, or upon some general cachexia. In the latter case the in- duration may be accompanied with hypertrophy due to fibrinous deposit, or infiltration of serum into the tissue of the cervix. The last named condition is termed cedema of the cervix. On examination, one or both labia of the cervix will present the appearance of a hard conical substance, sufficiently large, generally, to occupy the whole orifice of an average-sized glass speculum. If the anterior lip alone is affected, the os is situated behind, and high up, and is Avith difficulty brought into view. " When both labia are diseased they present a neutral appearance, very much resemb- ling the top of the piece representing the bishop, in games of chess." Their opposing surfaces are often inflamed, excoriated or granular, and the fissures at their base ulcerated, and exuding pus. This form of disease usually occasions abortion be- fore the fifth month, although it may occur consider- ably later. The symptoms of induration, hypertrophy, or cedema,, are quite characteristic. A painful sense of constriction around the pelvis and hips is almost constantly present ; a dull, fixed, aching pain of one or both ovarian regions, irritability of the bladder and rectum, pain in the re- gion of the sciatic nerves, a highly excited state of the 84 HALE ON ABORTION. whole nervous system, lassitude, indigestion, etc. Ha- bitual abortion may be the result of this diseased con- dition of the cervix. Displacements of the Uterus. The various malpositions of the womb may act as causes of abortion. Anteversion, although of rare occurrence, may so irritate the bladder as to set up sufficient reflex action to result in expulsion of the ovum. Prolapsus is a more frequent cause of abortion. This displacement generally occurs previous to preg- nancy, as a result of congestion of the uterus, or indu- ration, with hypertrophy of the cervix, and often from mere muscular atony. In either case the uterus will be found, on examination, low down in the vagina, the lips of the cervix resting on the perineal floor, and the body of the fundus within easy reach with the finger. Until the end of the third month this condition is not generally provocative of any tendency to abortion, but about this time the uterus increases in size, and unless it rises above the promontory of the sacrum it becomes impacted in the pelvis. Any impediment to the proper expansion of the uterus will prove an excit- ing cause of abortion. In prolapsus and retroversion this impediment exists, unless the uterus rises out of the pelvic cavity. Retroversion. This is the most formidable displace- ment to which the gravid uterus is liable, and one which is more likely to cause abortion than any other. Retroversion during pregnancy was first fully described by William Hunter, and Denman. This affection occurs in its most decided form at about the third or CAUSES OF ABORTION. 85 fourth month, when the uterus is entirely within the pelvis, and when it is of such large size that any alter- ation from its natural position occasions great incon- venience to the neighboring organs. Retroversion during pregnancy may be sudd&ri in its occurrence ; or it may have existed from the period of conception. In the former case it may be caused by unusual exertions, as lifting, jumping, reaching; or from such accidents as falling, jolting ; or from diseases in which tenesmus occurs, as dysentery, etc. ; also from distension of the bladder. In the latter case the retro- version had either existed previous to conception, or occurred during the first weeks of gestation. For a full description of the symptoms and causes of these dis- placements the reader is referred to my Monograph on that subject.* Retroversion occurring during pregnancy is usually described as arising from excessive distension of the bladder, through neglect, reserve, or restraint on the part of the patient. It is believed that the full blad- der, rising in the abdomen, drags the neck of the uterus upwards, while the distended organ presses the fundus uteri backward. The displaced uterus, by the pressure it exerts upon the neck of the bladder, in turn increases the distension of this viscus, and the retro verted uterus at length becomes fixed across the pelvis, the fundus lying in the hollow of the sacrum, and the os being tilted against the pubes, so as, in the worst cases, to render the evacuation of the rectum difficult, and that of the bladder impossible. Recent retro version may undoubt. edly be caused in this manner ; but there are doubtless many cases in which retroversion has existed previous to pregnancy, and no inconvenience is felt from it until * " Retroflexion and Retroversion of the Uterus." ITALE ON ABORTION. such time as the uterus, from its size, presses upon the bladder and rectum to such a degree that the displace- ment is looked upon as sudden. In both cases abortion may occur from the irritation set up in the surrounding organs, and in the uterus itself, or from the utter impos- sibility of any further enlargement of the uterus. The symptoms of retroversion, when the uterus is of such dimensions as to exert mechanical pressure upon the antero-posterior axis of the pelvis, are, in the first instance, partial or complete retention of the urine, pain in the pelvic region, and a sense of pressure on the rectum, giving rise to a constant desire for defe- cation, even when the bowels are empty. Should these symptoms pass unrelieved, the bladder becomes some- times enormously distended, and even ruptured me- chanically, or the coats inflame and ulcerate, allowing the urine to escape into the peritoneal cavity, and the patient sinks or dies of peritonitis. If the uterus cannot be replaced, and the water is occasionally and with difficulty drawn off, the bladder gradually enlarges and elongates, and its mucous membrane becomes dis- eased ; muco-purulent, ammoniacal and bloody urine is passed, and the kidneys may become diseased by the effects of the backward pressure of the urine. The structures between the bladder and the uterus may become inflamed, and the patient be destroyed by irri- tative fever. In some cases all these mischiefs are arrested or modified by spontaneous abortion. In others the displacement continues to the fifth or sixth month, without destroying the patient, and it has been known to go on to the full term without causing a fatal result. These cases are however very rare, and the occurrence of abortion is less to be dreaded, than a continuance of the displacement, j CAUSES OF ABORTION. 87 Death of Embryo, from any cause, will result in an abortion. The presence of a foreign body in the ute- rus will, in the majority of cases, cause the uterus to exert its expulsive action. There are, however, many cases in which the foetus and its envelopes have passed off in a fluid, disorganized state ; and cases are on record even where the embryo after its death was undoubt- edly absorbed. In another class of cases, the dead embryo itself, or the placenta, is left to become a mole or hydatid mass. Coitus, when indulged in to excess, or even its mod- erate indulgence in women whose reproductive organs are irritable from disease, may be a cause of abortion. This may occur at any period of pregnancy, but espe- cially at or about the usual menstrual periods. Coition causes abortion by exciting, from the mechanical irrita- tion it induces, the reflex influences which preside over the uterus. If the os or cervix is diseased, the irrita- tion excites the peristaltic action of the uterus ; if not, it is probably the diastaltic action which is aroused. Many cases of habitual abortion will be found to be due to this cause alone, and if abstinence from inter- course be strictly enforced, either wholly or at the men- strual periods, the usual abortions will be prevented. As a rule, sexual intercourse should not be indulged in at all, or very rarely, during the period of pregnancy. That it is physiologically unnatural every physician will admit. The general aversion to the act manifested by women during that period, as also the fact that the animal creation rarely, if ever, cohabit during gestation, should teach us that it is improper. Whether sexual connection should be prohibited or not, will depend upon the judgment of the physician. 88 HALE ON ABORTION. Instrumental Irritation. The use of instruments, whether for criminal or surgical purposes, is a very frequent and powerful cause of abortion at any stage of pregnancy. Criminal abortion is rarely brought about by the administration of drugs ; it is generally induced by some instrument which has for its object the puncturing or separation of the membranes, the death of the ftetus, or the irritation of the os uteri, by which means the uterus is made to expel the product of conception prematurely. The same may be said when abortion or premature labor is induced by the physician, in a legitimate manner i. e. to insure the safety of the mother or child, or both. Instruments have sometimes to be used during pregnancy, for pur- poses foreign to the accident above named, such as replacing a retroverted uterus, or in cases of extreme prolapsus, although such instances are rare. But there are cases on record where a retroverted uterus became so impacted that, other means failing, it was considered justifiable and necessary to use the uterine sound. In such cases it would seem that abortion would be the inevitable result ; but I believe the operation might be performed in the early months, and the foetus and membranes remain intact. My opinion is based on several instances which have come under my own observation, where a sound was introduced into the uterine cavity, and turned several times round, with no other effect than slight pain and haemorrhage preg- nancy not being interrupted, but terminating naturally. Pessaries have been introduced for the purpose of supporting a prolapsed uterus during pregnancy. The presence of such a foreign body in the vagina, may, by exciting the reflex action, cause an expulsion of the ovum ; yet pessaries have been worn for several CAUSES OF ABOETION. 89 months by pregnant women, without such a result. As a general rule, the use of all instruments, intro- duced into the uterus or vagina, should be dispensed with, if possible, during utero-gestation, as well as all surgical operations on these organs, or on contiguous organs or tissues. Instances are not wanting, however, where women have borne the most severe operations, even on neighboring organs, without interfering with the normal advance of pregnancy. Dr. Whitehead gives the treatment, by caustics, of several cases of ulceration of the os, during pregnancy, which treatment was successful, not only in curing the diseased condition, but of preventing an habitual abor- tion due to the ulceration. No positive rule can be laid down as regards the use of such remedial measures, as the irritability of the uterus varies greatly in different individuals. Ovarian. The functional disorders which may prove exciting causes of abortion are simple irritation, from perverted physiological influences : Congestion and Inflammation. During pregnancy, the ovaries should be in a dor- mant condition. Their functional activity is supposed to be suspended, because there is no use for the ovum, even if it were formed and extruded. In some instances the process of ovulation may go on during pregnancy, at the usual menstrual periods. We know the same process does often occur during lactation ; but it is believed that in both cases it is an unnatural proceed- ing, and that it arises from some abnormal irritation of the ovaries. When this process occurs during preg- nancy, the consequent afflux of blood, or nervous force, to the uterus, is often quite sufficient to induce abortion. We believe that this is the chief cause of that form of 90 HALE ON ABORTION. habitual abortion, which occurs within four weeks after conception, but about which so little has been written or known. Congestion and inflammation of the ovaries may cause abortion by the severe reflex irritation which the diseased process originates. The organic diseases liable to cause abortion are, ovarian tumors, dropsy and cystic enlargement. SECTION VIII. MEDICINAL CAUSES OF ABOETION. A list of the medicines which have been known to cause abortion at various periods of pregnancy ; toge- ther with others which have been supposed to be detri- mental to the life of the fcetus, has been given on a previous page of this work. In order that we may arrive at some definite conclu- sion as to the real influence of the drugs named, it will be proper for us to consider them separately. It is manifestly impossible for us to classify the medi- cinal causes, as we have classified other morbific influ- ences, for in the present stage of our knowledge of the pathological action of medicines, we cannot decide with absolute certainty whether secale or cimicifuga^ etc., cause abortion by their action on the spinal cord (cen- tric), or upon the uterus directly (concentric). We cannot decide whether a medicine causes diastaltic or peristaltic action chiefly ; nor cajj we say positively that aloes induces abortion by irritation of the rectum alone, or terebinth by its action upon the urinary organs. CAUSES OF ABORTION. 91 But as all methods of classification must have a beginning, the following classes may be made, and their imperfections rectified at some future day, when greater pathogenetic or pathological progress shall have been made in our school. Medicines whwh act as PREDISPONENT causes. Belladonna, calcarea carb., carlo veg., china, chamo- milla, clienopodium, ferrum, hyosciamus, lacliesis, lyco- podium, mercury, nux vomica, platinum, podophyllum, pulsatilla, plumbum, sepia, silicea, sulphur, zinc, and many others, which have the power of causing a dys- crasia in the system, or a cachectic state of the body. Medicines which act as CENTRIC causes. Secale corn., cimicifuga, caulophyllum, gelseminum, quinine, cannabia ind., nux vomica, ignatia, strychnia, are the principal medicinal agents at present known to the profession. Medicines which act as CONCENTRIC causes. All, or nearly all the medicines in the list may act in this man- ner ; but upon various organs, and thence to the uterus by reflex action. Thus, aloes, podophyllum, mercury, and others are said to act on the rectum; cantJiaris, cannabis sat., turpentine, sabina (f) upon the urinary organs ; and apis mel. upon the ovaries. A medicine may act, however, both as a reflex and concentric cause of abortion at the same time. Special analysis of the principal medicinal agents capable of causing abortion : Apis mellifica. -L /X cannabis, erigeron, copavia and turpentine except that it is the most powerful irritant. In fact turpentine seems more capable of earning abortion than any other. The cannabis indica is lately being used as a partus-accele- ratur, and in persons predisposed to abortion, might excite that accident, as might any medicine, in large doses, which specifically affects the uterus. Caulophyttum. This medicine has a peculiarly specific action on muscular tissue generally, and that of the uterus in particular. While secale causes spasmodic CAUSES OF ABORTION. 97 action, this drug seems to originate or call up the peri- staltic motion of the uterus. It has been used since the settlement of this country, by the whites, and by the aborigines before them, as a partus-acceleratur. In very large quantities it has caused abortion, with strong expulsive efforts, but with no alarming or disagreeable symptoms of the general organism. But it requires such an inordinately large quantity of this agent to effect miscarriage, that it is not often used for that purpose. I have known one ounce of the tincture taken with no apparent effect, and a pint of strong decoction with like result. In fact, it often acts just the opposite of what is desired. I have known it resorted to by women, and even physicians, to hasten an impending abortion, with no other effect than to dissipate the pains, and other symptoms, and arresting the abnormal process. In these instances, one drachm doses of the tincture, and one grain doses of the alkaloid, were repeated every hour. The same may be said of many medicines of this class aletris far., asclepias syr., cimicifuga, they prevent abortion, even in massive doses. This should teach us, that although minute closes may suffice, we should not be afraid to resort to material doses, when sanctioned by clinical experience. Cimicifuga racemosa. That this powerful medicine will cause abortion at nearly all periods of pregnancy, the abundance of tes- timony, in and out of the profession, does not leave us in doubt. We do not mean by this to imply that the black-coliosh will invariably cause expulsion of the foetus, for, like all other ecbolic remedies, it requires a consti- tution susceptible to its influence, in order to have its 98 HALE ON ABORTION. action developed. In the old American "Herbals" we are told that this root was used by the Indians to facil- itate labor, and also by their women to produce miscar- riage. Prof. Tully, one of the most extensive observers, has known it to produce abortion, and had great confi- dence in its power as a partus-acceleratnr. He thinks all the actcece possess the same power. Since the publication of the work on New Itemed it*, I have received several letters from correspondents, good medical observers, who assert that they know the decoction of the roots, or the active principle (macrotin^ will, in doses of four or six grains, cause abortion in some women, at any period of gestation. I have been cognizant of several instances in which women have induced miscarriage with the root, and also where physicians had administered the macrotin with that result. The symptoms accompanying abortion caused by cimicifuga, are generally these : severe headache, as if the top of the head would be pushed oif, or the eyes pressed out ; stiffness of the whole body, with torpor, heaviness, and stiffness of the extremities, intermitting labor-like pains in the uterus, with pain in back and thighs, coldness and shivering, palpitation of the heart, neuralgic pains in limbs, contractions of the tendons, lowness of spirits. If enormous doses are given, convulsions and serious injury to the system might ensue, as the remedy acts specifically on the spinal cord and brain ; yet I cannot find any record of the drug having proved fatal. The extensive experience which is being gained by our school, in the use of this remedy, proves that it is of great value in the treatment of many of the diseases of women, especially those occurring during the partu- CAUSES. OF ABORTION. 99 rient state. It relieves the many pains and disagreeable sensations felt during gestation, prevents miscarriage, conducts accidental abortion safely, if inevitable ; and it also controls false pains in the latter months, and facilitates labor, if tedious and unnatural. Decodon verticittatm. This plant, known to botanists as lyihrum verticilla- tum, and by the common people as swamp loosestrife, or swamp-willow-herb, has the reputation of causing abortion in brute animals. "If a great amount of testimony," says Tully,* "will decide anything in medicine, decodon is ecbolic for certain brute animals. This effect is said to be most frequently produced upon ewes,- next upon cows, and sometimes upon mares. Any amount of testimony to this effect may be obtained from intelligent farmers, and even much from well educated physicians, who are either farmers themselves, or whose practice is in an agricultural region and almost wholly among farmers." T nlly thinks if this plant can cause abortion upon brute animals, it may produce the same effect upon women. Yet he is not aware that it has been verified. He instituted some experiments with it on the cat and dog, but with no definite result. He quotes Lindlay, who says " it is said to destroy the young of cattle heavy with calf." Kingf says "it is said to cause abortion in mares and cows browsing it in winter, and may, perhaps, exert a medicinal influence on the female uterus " (uterus of women). Culpepper (an old English writer) says it will "stay profuse courses in women." * Materia Medica, Vol. 2, page 1369. f Dispensatory. 100 HALE ON ABORTION. The decodvn may prove a valuable remedy when its powers are investigated and better known. Gossipium Herlaceum. I know of no agent used in medicine about which there is so much variance of opinion, as to its action on the uterus especially, as the cotton root. In my work on New Remedies* will be found the statements of Dr. Bouchelle, of New Orleans, and Dr. I. H. Shaw, of Ten- nessee, both of whom write enthusiastically of its powers as a uterine-motor stimulant, and mention as reliable, statements of its capabilities in causing abortion. Dr. King merely sums up the statements of other writers as to its alleged virtue, bat gives no experience of his own. Dr. Coe's statements are of less value. Drs. Jones and Scudder believe it is emmenagogue, but "not abor- tional or parturiant in the slightest degree." Dr. Hoi- comb has no confidence in its pritudeal virtues. The writer has used it many hundred times and in all doses, but never saw it bring back the menses or cause abor- tion. Dr. Tully had no positive experience with it, but quotes Drs. Frost, Cabell, and Prof. Metlauer, as physicians who have tested it, and proved it to act powerfully on the uterus. Since the article in "New Provings" was written I have received a large amount of testimony, both for and against its asserted action on the uterus. Time only can clear up these conflict- ing statements. It may be that the usual preparations are inert, and only the green, fresh root should be used. Hex Opaca. The American Holly is mentioned by Prof. Tully as having the reputation of being a powerful "ecbolic." * New Provings, page 217. CAUSES OF ABORTION. 101 It is an evergreen tree, from 20 to 40 feet in height, and is found growing throughout the United States, from Maine to Louisiana, but is especially abundant in the district of Abbeville, S. C. Dr. Tully states that he was informed by several physicians of that region that it had a " high popular reputation as an ecbolic, it being considered capable of producing abortion or mis- carriage at any stage of pregnancy." A strong infusion or decoction of the leaves is to be drank freely. Its use seems to be confined to the negroes. Dr. Tully could not ascertain that one educated physician had ever made a trial of it in a single case ; yet he was told that no intelligent "physician doubted its efficacy in that direction. I cannot find in any work on materia medica or ther- apeutics any mention of the ilex, as a medicine speci- fically affecting the uterus. It has never been used in Homoeopathic practice that I am aware of. It is to be hoped that some intelligent and investigating physician will test its pathogenetic powers, and add it to the list of our curative agents. Mercurius. Ever since the introduction of this deleterious drug, instances have not been wanting of its prejudicial effects upon the foetus in utero. The older physicians observed that large doses of calomel administered to pregnant women, were frequently followed by abortion. Stille* mentions that the inhabitants of districts where ores of mercury are smelted are seriously affected by its influence. " The annual mortality is more than 1 in 40. Premature birtlis and abortions are very com- * Materia Medica and Therapeutics. 102 HALE ON ABORTION. mon" Dr. Lizi had an extensive observation of female operatives exposed to mercurial vapors. "Marriages among them were vastly more productive of abortions, stillbirths, and feeble children which seldom arrive at maturity, than among women engaged in other occu- pations." Dr. Colson, who wrote of the action of mer- c '//// on the uterus, says " In not a few instances has it occasioned menorrhagoaa or amennorrhcea, and in pregnant females jniscariiage" More recent writers mention the fact that calomel frequently causes abortion. I was once informed by an Allopathic physician whose practice lay in a rather disreputable direction, that he knew of no surer producer of abortion* than a massive dose of calomel its hydro-cathartic effect was generally followed by expulsion of the foetus. A woman once informed me that she usually arrested her pregnancies by a large dose of calomel at a menstrual period. This active drastic cathartic has been known to cause abortion. I have been informed that the podophyllin is often administered for that purpose by certain dis- reputable Eclectic physicians. It probably acts in a similar manner to aloes, calomel, and other medicines which highly irritate the lower intestines, and by sym- pathy the organs of the pelvis. In large doses it is frequently and often successfully used in amenorrhcea, yet I cannot believe it has any such specific influence over the uterus as caulopJtyllum and some others. When threatened abortion is attended with piles, dys- v. prolapsus ani, bilious diarrhoeas 'or extreme H- prolapsus, this medicine will be indicated as a rive u v L r 'iit. CAUSES OF ABORTION. 103 QuinicB Sulphas. In another portion of this volume will be found some mention of quinine. In the massive doses (30 to 40 grains) used in Allopathic practice, it has probably caused abortion, when given for the cure of malarious fevers. Dr. Petitjean affirms that he has so frequently seen abortion produced during the exhibition of quinine in intermittent fever, that he has ceased to prescribe it for pregnant women.* Dr. A. K. Gardner asserts that the administration of quinine to pregnant women is hazardous, and likely to cause premature labor. f These statements are opposed by Rodriques and Henry, who attribute the abortion to the disorder of the general health, and the "mechanism of the par- oxysm" during malarial fevers. Dr. Rich, of Georgia, attributes to it the suspension of contractions of the uterus threatening abortion under similar circumstances. By some physicians it has been alleged to render uterine contractions more active during labor, and as a means of overcoming rigidity of the os uteri. Quinine is Homoeopathic to many of the symptoms of abortion and its consequences, and will be found a useful remedy, especially in malarious districts. Ruta graveolens. This is a very old medicine, used by Hippocrates and other ancient physicians for a variety of diseases, among which was menorrhagia. Hippocrates, however, says it " excites the menstrual flow, and destroys the foetus in utero." M. Helie, in 1838, published three cases of attempts to produce abortion by this plant, in one of * Lancet, 4th, 1847. f Tyler Smith's Lectures on Obstetrics, by Gardner. 104 HALE ON ABORTION. which a decoction of the fresh sliced root, in the second a decoction of the leaves, and in the third, the expressed juice of the leaves was taken. The effects were, in one case, violent pain in the stomach, and vomiting, or rather efforts at vomiting, with rejection of a small quantity of blood. In all of the cases the nervous sys- tem was prominently deranged ; there was great pros- stration, with confusion of the mind ; cloudiness of the vision with feebleness of pulse ; cold extremities, and twitching of the limbs. All of the females, who were in the fourth or fifth month of pregnancy, aborted and recovered. Hahnemann records the effects of ruta thus: " Metrorrhagia ? Miscarriage ? Sterility ?" It would seem that he doubted its power of causing abortion : a doubt which other observers do not share. Stille says it is emmenagogue, and " not only like ergot acts upon the gravid uterus, but it stimulates the unimpregnated organ also." M. Bean recommends it, associated with savin, in uterine Itcemorrliage after abortion, and men- orrhagia from general debility. Sabina. The Juniperus Sabina is a native evergreen shrub of Southern Europe, and is cultivated as an exotic in gar- dens in this country. The Juniperus procumbens, a species having very similar, if not identical, properties, is found growing on the shores of our north-western lakes. I have met with it in the interior of Michigan, O ' and also on the sand-dunes which cover the southern shore of Lake Michigan. It has been found on the shores of Lake Huron. It throws out its branches very close to the ground, spreading in large circles, generally quite horizontal, but often growing upward at a slight angle of perhaps 10 or 20 degrees. This indigenous 4 CAUSES OF ABOKTION. 105 variety should be proven, in order to test its compara- tive effects. Dioscorides was the first to describe the qualities of savin. Among other things, he says, " An infusion of them in wine causes bloody urine, and applied as a fomentation to the belly of pregnant women, they pro- duce abortion" Galen says it " Excites the menses more powerfully than any other agent, provokes bloody urine, destroys the life of the foetus, and causes its expul- sion" " But," says Stille, " it was most celebrated for its emmenagogue properties, which were habitually invoked for the criminal purpose of destroying the pro- duct of conception." This belief of the power of savin to cause abortion has been perpetuated to this day, and it is now frequently resorted to for that criminal pur- pose, notwithstanding the almost certainly fatal conse- quences resulting from its administration in doses sufficient to cause the destruction and expulsion of the foetus. The annals of medical jurisprudence abound in cases of fatal poisoning by savin taken to produce mis- carriage. It is much more employed than is commonly imagined for criminal purposes, but fortunately in such doses as fail of their purpose, and only produce instead vomiting and purging. It generally produces inflam- mation of the intestines and urinary organs, and some- times congestion of the brain. A case is reported by Mohreuheim of a pregnant female who took an infusion of savin to produce abortion. It caused incessant vom- iting, and some days afterwards excruciating pains, abortion, flooding, and death. Rupture of the gall- bladder was found on examination of the body, and an effusion of bile into the abdominal cavity, with perito- nitis. Many other cases might be quoted. Hahnemann records several of an interesting character, by which he 106 HALE ON ABORTION. was led to recommend its use in cases of abortion. In most cases enteritis-mucosa, and peritonitis were de- tected after death. Tally says, " The active principle of sabina has exactly the same composition as oil of turpentine, if it is not identically the same in all res- pects." It is a carious fact, apparently confirmatory of this statement, that the external application of both savin and turpentine to the abdomen of pregnant women, will often cause abortion. Both agents seem to have a similar effect on the intestines, urinary organs, .skin, and general organism. Sabina, in poisonous doses, acts most powerfully upon plethoric women, whose menses are habitually profuse. In such constitutions it would be more apt to provoke an abortion, than in persons of spare habit, even if they menstruated profusely. Secale cornutum. Although ergot has been, used as a uterine motor stimulant since the year 1096, yet its modus operandi, as well as its general and local action, seems far from being understood. It seems quite settled, however, that it will cause inteiwittent contraction of the uterus at full term. That it is capable of causing abortion seems to be generally doubted. Says Stille : " If we examine the influence of ergot upon the gravid uterus in the earlier stages of pregnancy, and before quickening, when it is most likely to be resorted to with criminal intentions, we shall find that in proportion as we recede from tlie period at which the spontaneous action of tlie womb be- gins, ergot fails to exhibit its peculiar influence." M. Dargan, in his report to the Academy of Medicine, says : " We do not believe that, independently of labor, CAUSES OF ABOETION. 107 of direct manipulation, or of some other external in- fluence, that ergot, of itself, can excite uterine contrac- tions during the first half of pregnancy." Stille re- marks that this is probably the opinion of physicians who have had the best opportunities of studying the subject. It is, however, to be recollected he says that the distension of the uterus at this period is a normal condition, and it does not follow that an equal or even a less degree of enlargement should not have a different result when it depends upon morbid causes. This is the case in menorrhagia. It was so in a singu- lar accident reported by Dr. Taylor, of New York. A female who was not pregnant had some leeches applied to the neck of the uterus to relieve engorgement of that organ. One of them found its way into the cavity of the uterus^ where it occasioned bearing-down pain and a bloody discharge. Ergot was administered, and a clot expelled holding in its centre a dead leech. Ac- cording to Dr. Ker, an enlarged and prolapsed uterus contracted under the use of ergot so that it could be placed in situ. If we examine the annals of criminal abortion, we find that enormous doses of ergot have been taken, sometimes with fatal effect upon the mother, and often to the production of serious disease, without causing the expulsion or death of the foetus. In other cases the life of the foetus was destroyed, but it was not expelled. Two very interesting cases of poisoning by ergot are published in the " Transactions of the New York State Homeopathic Society, vol. ii.," in one of which 160 grains of ergot were taken, causing a serious illness, but without " any pains or signs of labor," and pregnancy went on uninterrupted. In the other case, reported by Dr. Hill, half an ounce of ergot was taken to produce miscarriage, by a woman who was evidently 108 HALE ON ABORTION. not pregnant, but affected with uterine haemorrhage due to irritation of the uterus. In this there were "pains of an expulsive character in the uterus" the first day, and continued " pain in the vulva" nearly every day until she died. I have known it to cause expulsive pains in passive menorrhagia. , Effects of ergot upon gravid animals. It is important that we should study this point. Stille says, "The in- fluence of ergot upon the gravid uterus in animals is not uniform. In some cases it seems to have been purely negative, in others to have destroyed the pro- duct of conception without producing its expulsion, and in still others and these are the most numerous to have caused abortion. Bonjean gave ergot to a female guinea pig during the early stages of gestation ; abortion was not occasioned, nor, indeed, any symptom whatever. The experiments of Wright were to this effect. He mixed ergot with the food of a pregnant rabbit; no tendency to abortion was excited, and in due time six healthy young ones were born. The ani- mal, still kept upon the same food, was again impreg- nated. She looked drowsy and moped, the fur grew erect and rough, gestation was protracted beyond its usual term, and three young ones were born, two of which were dead, and the third survived but a few hours. The same experimenter, after many trials of ergot upon pregnant bitches, concluded that it did not act as a parturifacient in them, although it sometimes appeared to injure or destroy the product of concep- tion. On the other hand, according to Diez, it produced abortion in bitches and sows, without harm to the mother or the young, when the dose was moderate, but CAUSES OF ABORTION. 109 large doses destroyed both, and excited inflammation of the womb. Dr. Oslen gave ergot to a sow, a cow, and a cat, be- fore the completion of pregnancy, and in each case pro- duced abortion. In 1841 an epidemic of abortion among cows occurred in France, which was traced to the ergotted state of the rye and other graminse in the district. The most of the above cases of abortion in animals undoubtedly occurred during the last half of preg- nancy. The same effect would have been produced in women under similar circumstances. After the study, observation, and experience the writer has bestowed upon ergot, his belief is that it is capable of causing abortion in animals and women, in the early months of gestation, in those constitutions which are susceptible to its action. I do not believe, however, that it excites contractions and expulsive pains until it destroys the life of the foetus. When this occurs the enlargement of the uterus becomes an abnormal condition, because it contains a foreign body, which is a source of irrita- tion of itself. In this condition of the uterus the ergot will act, and cause expulsive pains and contraction. In the last months of pregnancy it may induce premature labor, but the child is generally still-born, so that the exceptions to the above rule are very few. It may be said of ergot that it is a dangerous and uncertain medicine, when used to cause abortion, and should never be resorted to for that purpose. Sanguinaria canadensis. This medicine is one possessing active and varied properties, and is capable of exercising a strong effect upon the uterus whether direct or not cannot yet be satisfactorily decided. HO HALE ON ABORTION. Rafinesque cautions against its use during pregnancy, as it acts very powerfully on the uterus, and causes fihui't'nm, and recommends its employment in amenor- rhrea. Tully says it is sometimes emmenagogue, and has been known to produce uterine hoemorrhage. Many eclectic practitioners assert that they have used it successfully in amenorrhoea and infrequent men- struation. They state that a sure sign of its remedial action is the presence of " pains in the small of the back, extending down the thighs." These would probably be the symptoms in abortion caused by blood-root : there would also be other important symp- toms as vertigo, pain in the head, narcosis, vomiting, burning pains in the stomach, etc.* Terebinth. The oil of turpentine is one of the most active and powerful of that group of medicines which affect the uri no-genital organs. The apparent starting-point of its action seems to be in the urinary apparatus, but it produces profound aberrations in the nervous and vascular systems. Persons exposed to the vapors of turpentine experience its general effects, such as nausea, vertigo, impaired vision, pain in the back and loins, strangury, bloody urine, insomnia, malaise and an eczematous eruption. Women, in addition, are often affected with menorrJiagia or dysmenorrhoea. [Eminent Allopathic authorities claim for it great curative pow- ers which it really has in all haemorrhages, especially those from the uterns /] Stillef says it arrests haemor- rhage after parturition by exciting contractions of the uterus, as it is known to do, as well as by its styptic * See New Homoeopathic Provings : Art. Sanguinaria. f Materia Medica : Art. Tereb. CAUSES OF ABORTION. Ill (homoeopathic) powers. Turpentine when taken inter- nally has been known to cause ABORTION and premature labor, accompanied or not by the above-mentioned local and general symptoms. A- patient who applied to me for the cure of sterility, informed me that she had caused abortion several times in the early months upon her own person, by simply rubbing the hypogastric region with the spirits of turpentine. Several years had elapsed since she had been pregnant ; her menses were too profuse and frequent. By this it would seem to cause both abortion and sterility. Tanacetum vulyaris. This common plant has been perhaps more frequently resorted to for the purpose of inducing criminal abor- tion, than almost any other agent. The oil of tansy is the preparation usually selected for this purpose. The many cases of death arising from the use of this power- ful poison do not seem to deter the vicious or unfortu- nate from its use. In overdoses, the oil causes unconsciousness, flushed cheeks, dilated pupils ; hurried, stertorous respiration, strong spasms, full and frequent pulse, repeated con- vulsions ; then failing pulse and death. In a case of attempted abortion, by a decoction of the herb, there occurred delirium, slow and laborious respiration, con- tracted pupils, dusky countenance, fixed features, and cool skin. Subsequently the muscles of deglutition and all the voluntary muscles became paralyzed, and death with gradual retardation of the heart's action, took place in 26 hours after the poison was taken. It would appear that the operation of the tincture or de- coction of tansy was not the same as its essential oil. Both preparations have undoubtedly been used success- 112 HALE ON ABORTION. fully as abortivants, without fatal or serious results ; but its administration in large quantities is generally dangerous. In the February number of the North American Journal of Homoeopathy (1865) will be found a resumS of all that is known concerning the pathogenetic and curative effects of tanacetum. Ustilago madis. This wtttago is a parasitic mushroom, which occurs on maize (Indian corn) as ergot does on rye. In a cow. house where cows were fed on Indian corn infested with this parasite, eleven of their number aborted .in eight days. After their food was changed, none of the others aborted. The better to be convinced of the poisonous nature of these mushrooms, the author, after having dried and pulverized them, administered six drachms to two bitch dogs with young, which soon caused them to abort.* Lindlay says : " Its action on the uterus is as pow- erful as the ergot of rye, and perhaps more." Accord- ing to Roulin " Its use (long protracted, of course) is attended with shedding of the hair, both of man and beast, and sometimes even of the teeth. Mules fed on it lose their hoofs, and fowls lay eggs without any slidls" Tully in his mention of this fungus adds " It is doubtless by its abortifacient power that it causes the eggs of fowls to be extruded before there has been time for a shell to be formed. By what power does it cause the shedding of the hair of man and brute animals and the casting off of the hoofs of mules long fed upon it?" It would seem to be capable of great curative powers. * Anal. Med. Vetr. Beige, and Rep. de Ph. PART III. GENERATION : SYMPTOMS, DIAGNOSIS, PATHOLOGY, MECHANISM, AND PROGNOSIS OF ABORTION. GENERATION. 115 SECTION I. GENERATION. The Physiology of Generation is so intimately con- nected with the subject of Abortion, that it would be improper to omit some mention of that process, when conducted normally. Generation, in its broadest sense, is that function of the female generative organs which dates from the suc- cessful impregnation of the ovum to the period of its birth. It includes the several processes of contact of the ovum with the fertilizing semen of the male, its passage through the Fallopian tube into the uterus, certain textural changes in the uterus in advance, and in con- sequence of its reception and developement, and its final passage and parturition. I propose to treat of Generation as including three distinct stages, namely, (1) From the arrival of the impregnated ovum in the uterine cavity until the placental attachments are per- fected, or the period of quickening. The ovule has its origin in the ovary, and when it has attained its full maturity, the vesicle in which it is enclosed becomes the seat of an excitation, which finally results in a rupture of the walls of the vesicle, and the extrusion of the ovule. This maturation, and escape of the ovule, generally occurs at or about the menstrual periods. After its escape, the ovum engages in the Fallopian tube, the enlarged extremity of which has 116 HALE ON ABORTION. been applied to the ovary. It has been supposed that the above processes occur from the stimulus of coition, or erotic excitement, as well as from the excitation con- sequent on the menstrual crisis ; but it is doubtful if the former uniformly causes such results. The ovum passes through the Fallopian tube, but the time necessary for this passage is not with any certainty known. In the human subject, says Cazeaux, no one case has ever proved its existence in the womb prior to the twelfth day. But this cannot be accepted as any decision of the question. "When the ovum enters the cavity of the uterus, if it has been fecundated by the spermatic fluid in its pas- sage, it attaches itself to some portion of the hypertro- phied mucous membrane^generally near the fundus, at which portion the placenta is afterwards attached. It is here necessary to make some mention of the decidua. It is now argued that at each menstrual period the uterine mucous membrane is exfoliated, thrown off, and a new one formed in its place. It is this membrane, greatly hypertrophied, that we find in membraneous dysmenorrhoea. It is now well estab- lished that the decidua is nothing more than the hyper- trophied mucous membrane. Whilst the evolution of the ovarian vesicle is going on in the ovary, the vascu- larity of the uterine mucous membrane is greatly in- creased, and the highly congested vessels are discover- able beneath the epithelium. This state of turgescence, however diminishes during the last days of the mens- trual epoch, and disappears almost entirely sometime after the' catamenia has ceased. But if the ovule, before leaving the ovarian vesicle, or during its passage through the tube, receive the vivifying influence of the spermatic fluid, the fecundation will maintain and in- GENERATION. 117 crease the abnormal excitement of the genital organs, and then, instead of subsiding, the uterine mucous mem- brane becomes still more turgescent, of a deeper violet color, and the folds and wrinkles increase so as to more than line the cavity of the uterus. It is in one of these folds that the ovum is enclosed, after the lapse of a period as yet unascertained, and this fold of hypertrophied mucous membrane which remains in the uterus, when united, forms the decidua reflexa of authors. The ovum is also enveloped in its own proper membranes the amnion and chorion. From the date of conception and lodgment of the ovum in the uterine cavity, until about the fourteenth week (three and a half months), its nutrition is car- ried on by means of imbibition, or absorption through the membranes that surround it. Up to this period tJie placenta is not attached to tJie uterus, and the con- nection between the mother and child is established by means of the allantois. The fact that before the fourteenth week of gestation the placenta is not attacked to the uterus should be kept in mind, as it will have considerable bearing on the pathology and treat- ment of abortion. This period ' is also that known to writers as the period of " quickening," or a time when the foetus is connected with the maternal circula- tion through the placental vessels. In a medico-legal point of view, this is an important date, as by some jurists it is considered a date after which the induction of abortion is considered a criminal offence, unless some point of medical expediency demanded it. (2) The second stage extends from the date of the attachment of the placenta to the uterus, until the period when the foetus -is capable of a separate existence. 118 HALE ON ABORTION. The beginning and end of this period, however, can not be said to have any fixed limits. It is supposed by some that the period of " quickening" corresponds with the attachment of the placenta. To a certain extent this may be true, as both generally occur about the sixteenth week. The age at which a foetus is viable may be said to be about the end of the seventh month. Cases occur in which children born at an earlier time than this sur- vive, but these are rare exceptions. (Dr. J. W. Francis reports a foetus born with membranes intact in the twenty-third week of pregnancy that lived to matu- rity.) Even at the seventh month they are kept alive with difficulty. The state of the heart as regards development, the feebleness with which the foetus sucks before this time, the ready failure of animal heat, and the inability to bear the movements necessary to nurs- ing and cleansing, render it almost impossible to rear the foetus born at an earlier period. (3) The third stage of utero-gestation reaches from the viMUty of the fcetus until the end of pregnancy. This, however, like the period of viability, is a variable period. According to those authorities who consider the last day of the last menstruation the proper date to reckon from, the termination of pregnancy varies from the thirty-seventh to the forty-third week. Dr. Reid, whose elaborate calculations appeared in the Lancet, gives the terminations of 500 pregnancies, which ranged from the thirty-seventh to the forty-fifth week. Dr. Reid also calculated from "a single coitus" in 43 cases, all of them resting upon testimony as credible as can be obtained in such cases. These ranged from 260 to GENEE ATION. 119 300 days, giving the average duration of gestation at about 275 days. Nine months is supposed to be the average duration of human pregnancy, but the time undoubtedly varies from eight and a half to ten months. Dimensions and weight of the foetus at the different periods of uterine life. A treatise on Abortion would be incomplete if it did not contain some practical information on this subject. In a purely medical, and especially a medico-legal point of view, this is of manifest importance. At the time when the embryo first begins to be distinct, that is, about the third week, it is oblong, swollen in the middle, obtuse at one extremity, though drawn to a blunt point at the other, and straight, or nearly so, being somewhat curved forward. It is therefore vermiform in shape, of a grayish white color, semi-opaque, almost without consistence, and gelatin- ous, varying from two to four lines in length, and weighing one or two grains. At this period the only trace of the head is a small tubercle separated from the rest of the body by a notch, but no rudiments of ex- tremities are observed, nor is there a cord at first. At the fifth week the embryo becomes more consis- tent ; the head is large in proportion to the body ; the rudimentary eyes are indicated by two black spots turned toward the sides ; it is nearly two-thirds of an inch long, and weighs about fifteen grains. At the sixth week, the bronchial fissures disappear, leaving only a slight cicatrix, and its size and weight are somewhat increased. At the seventh week, the first centres of ossification appear. The intestine still extends for a considerable 120 HALE ON ABORTION. along the umbilical cord. At this time the t-nibryo is nearly an inch m length. At two months, the forearm and hand can be distin- guished, but it is not supplied with fingers. The cord has not yet assumed a spiral arrangement ; it is four or five lines in length, and is inserted near the lowest point of the abdomen. It is very difficult at this period to distinguish between the sexes, owing to the extreme length of the clitoris. The embryo is from one and a half to two inches long, and weighs from three to five drachms. At ten weeks, the embryo is from one and a half to two and a half inches in length, and weighs an ounce or an ounce and a half. The cord is longer than the embryo, and begins to assume the spiral arrangement, but its base always contains a portion of intestine. The fingers are distinct, but not the toes. At the end of the third month, the embryo weighs three to four ounces, and measures firomjffto to six inches. The cord contains no intestine ; the nails begin to appear, the sex is distinct, the eyeball is seen through the lids, the forehead and nose are clearly traced, and the lips well marked and not turned outward. At ihefowth month, the embryo takes the name of foetus. The body is six or eigM inches in length, and weighs from seven to eigM ounces. The face still remains but little developed; the eyes, nostrils, and mouth are closed ; the skin has a rosy color, and begins to be covered with down, and the muscles now produce sensible motion. " A foetus born at this period," says Cazeaux,* " might live for several hours. Whilst I was Interne at the Hotel Dieu, I received one that had * Cazeaux's Midwifery, page 208. GENERATION. 121 scarcely reached the fourth month. It lived, however, from half-past seven to half-past eleven o'clock." At five months, the length of body is eight to ten inches, and it weighs from eight to -eleven ounces. The skin is more consistent ; the pupils cannot be distinguished. At six montJis, the hair is longer and thicker, the nails are solid, but the eyes are still closed. The length is eleven to twelve and a half inches, and the weight about one pound (avoir.) At seven months, the eyelids are -partly open, and the testicles begin to descend into the scrotum. The foetus acquires a length of twelve and a half to fourteen inches. At eight months, it is only sixteen or eighteen inches long, and yet weighs four to five pounds, because the foetus seems, at this period, to grow rather in thickness than in length. The scrotum generally contains one testicle, usually that on the left side. The skin is very red, and covered with long down. The lower jaw is now as long as the upper one. Finally, at term, the foetus is about nineteen to twenty- three inches long, and weighs from six to seven pounds. Cazeaux thinks the weight and length of children at birth have been wonderfully exaggerated, in which he is probably correct. 122 HALE ON ABORTION. SECTION II. SYMPTOMS OF ABORTION. The symptoms of an abortion may be divided into three classes, namely: 1. The PREMONITORY. 2. The ACTUAL. 3. The SUBSEQUENT. Each of these classes, or divisions, constitutes a differ- ent stage of the miscarriage. The PREMONITORY symptoms constitute the first stage of the abortivant process, namely the stage of irrita- tion, or that condition of tlie uterus which exists up to tlie time of tlie rupture or separation of the membranes or placenta. The ACTUAL symptoms constitutes the time which inter- venes from the separation of tlie membranes, etc., until the expulsion of thtfcetus and placenta. The SUBSEQUENT symptoms are those which follow and mark the conditions which are lenown as tlie sequelw of aJtortion. It is important that the above divisions be borne in mind, as it leads to a methodical study of the subject, and has an important bearing upon the treatment. The symptoms of the premonitory stage may be said to include all those symptoms which belong to the causes heretofore mentioned ; but more strictly consid- ered, are those which occur for a few days or weeks previous to the commencement of the second stage. SYMPTOMS OF ABORTION". 123 The premonitions of an abortion may be present for a long time, or only for a few hours. This depends upon the nature of the causes; for if the cause be an ulcer on the cervix, the symptoms may appear at every monthly period, and may not result in actual expulsion of the foetus if proper remedial means are used ; or, should the cause be a fall, concussion, or instrumental, the premonitory symptoms may be few, or entirely wanting. The prodromes of an abortion generally appear in the following order: 1. Pain. This may consist merely of an aching in the back (sacrum) or hypogastrium, and extending down the thighs ; or it may be acute, and described as griping, lancinating, darting or stitching ; but what- ever the character of the pain may be, it is generally confined to the above localities. 2. Sensations, which are not pains, but consist of a feeling of weight, pressing-down, or soreness, in the hy- pogastriuin and in the pelvis. These sensations may co-exist with the pain, or may be present without the pains above mentioned. 3. General symptoms. There is almost always a general uneasiness, nervousness, languor, and depression of spirits, accompanied or not with some acceleration of pulse, flushed face, and cold extremities. At the same time the symptoms which are usually attendant on pregnancy remain. 4. Il&morrliage, generally a slight discharge, which may continue days, and even weeks, before the second stage begins. But so soon as the membranes are broken, by acci- dent, or punctured by artificial means ; or the mem- branes or placenta become separated from the walls of 124 HALE OX ABORTION. the uterus ; or the foetus dies from any cause ; then we have a train of symptoms in addition to the prodromic, namely : 1. Chilh. My observation and experience goes to show that the chill, or rigor, whether preceded or not by pains and sensations, is the most reliable symptom of a rupture or separation of the membranes. The foetus may die, and remain for some time in the uterus before it excites irritation sufficient to arouse the ex- pulsive action of that organ. Meanwhile the placenta may be said to live, and even perform its functions, as in certain cases when the blighted or dead ovum is changed to a mole. In other cases we may be made aware of the death of the embryo by certain symptoms generally obscure ; but until the woman has a chill, or chilly sensations, we may consider separation of the membranes as not having occurred. This chill greatly varies in intensity and duration. ' Sometimes it consists of a vague sensa- tion of internal chilliness or coldness, and may last for days, and may be mistaken for the first stage of an influenza or a fibrile attack ; at other times and in other patients, it may assume the form of rigors, in which the woman will shiver and shake, as during a paroxysm of ague. I have seen instances, even, where the attack could have been easily mistaken for a " con- gestive chill," so excessive was the prostration and the general coMn,-^. There is a class of cases in which rigors may appear unattended by any sensations of coldness. These are called, by old nurses, " nervous chills." The woman will shiver, her teeth will " chatter," and she will ap- pear to suffer from great chilliness ; but will tell you she "is not cold." This form of "rigor" is usually met SYMPTOMS OF ABORTION. 125 with in cases of parturition at full time, and is supposed to indicate a relaxation of the circular mmcles of tJie cervix, or of any sphincter muscle. I am inclined to view this as a correct explanation. In one instance in which I noticed this rigor without coldness, the embryo was expelled in the unbroken membranes, together with the placenta. In this case, the time which intervened between the separation of the membranes, and the ex- pulsion of the whole, was too short for the appearance of a chill. 2. Pain. As in the prodromic stage, the pains may be aching, cutting or griping, but they are generally attended with another kind known as "labor-pains." A woman may feel a pressing-down sensation in the pelvis during the premonitory stage, but that sensation is quite different from the one under consideration. A labor-pain is a bearing-down sensation accompanied with pain : this pain regularly intermits, or remits, which is rarely the case with the premonitory sensation alluded to. Some authors claim that it is possible to arrest the progress of an abortion in the second stage. I think it hardly possible, as I have never known such an arrest to take place after the occurrence of intermittent, labor like pain, coming on after a chill. From the above, it will be noticed, that I consider the second stage of abortion to be marked by two prominent symptoms, namely : the chill, and the labor-pain. There is another prominent symptom of the second stage. I allude to the painful sensation of soreness, tenderness, or sensi- tiveness of the hypogastric region, and sometimes the whole abdomen. This is often so severe as to lead to the belief of the presence of peritoneal inflammation, which, however, rarely occurs in such cases: or more correctly to the occurrence of nietritis, which is often HALE ON ABORTION. present to a certain extent. This sensation is not always due to inflammation or congestion; but is of- tener neuralgic in its nature, having its seat in the abdominal muscles, or even in the uterus, which is only a hollow muscle. But as this symptom sometimes at- tends the prodromes, and as the abortion is often pre- vented after its occurrence, it cannot be considered as belonging exclusively to the second stage. Pains may exist in other portions of the body, as the back, thighs, hypochondria and head. The pain in the head is particularly to be noted : it is often in- tense, and aifects principally the top of the head, and the eyes, and is described as a painful pressure from within outwards (a pain quite similar to that caused by dmicifuga or macrotin). This pain in the head, as well as the nausea and vomiting which sometimes oc- cur, is due to reflex irritation. Sensations of numbness, lameness, and cramps of the upper and lower extremi- ties, sometimes appear, and are due to the same cause. A common symptom of the second stage is a sensa- tion as if the back (sacrum) was dislocated, or as some patients express it, "as if they had no lack in one place," alluding to the sacral region. It is during this stage that we sometimes find considerable febrile excitement, occurring generally subsequent to the chills. This fever may come on in irregular paroxysms, and be followed by perspiration, and so nearly simulate certain forms of ague, that the careless practitioner is often misled as to its real significance. Together with the appearance of the above symptoms, we generally notice a disap- pearance of the usual symptoms of pregnancy, or those which the patient has usually been troubled with, if she has borne children. The morning nausea and vomiting subsides; the "longings" cease, and the en- larged breasts become soft and flabby. SYIVIPTOMS OF ABOKTION. 127 Hcemorrliage. This is almost invariably attendant on the second stage. There are, however, some few exceptions to the rule, as in the case mentioned above, of the expulsion of the unbroken membranes. In this instance absolutely no haemorrhage occurred, as I was informed by the nurse, who stated that only the slight- est stain of blood appeared upon the napkins used. Hwmorrliage rarely occurs to any great extent before the expulsion of thefcetus: it is from this occurrence, up to the final expulsion of the placenta, that flowing is most to be feared. J[ believe that no instance of fatal, or even dangerous haemorrhage can be cited as having occurred previous to the expulsion of the foetus. It is rarely the case that the placenta is expelled at the same time with the foetus, or shortly thereafter ; while the contrary ob- tains in delivery at full time. I have often thought that the expulsion of the foetus ought to mark an interme- diate stage, between the second and the third. Many hours or days, and even weeks, may elapse between the expulsion of the foetus and the placenta. Meanwhile the patient generally loses considerable blood, which may flow uninteruptedly, or the flooding may occur at longer or shorter intervals. The chills, which marked the onset of this stage, may occur frequently, at irregu- lar intervals, or if the patient resides in a locality where malaria abounds, the paroxysms may occur regularly, and assume all the characteristics of an idiopathic inter- mittent. It is not strange, perhaps, that intelligent physicians have treated such cases as pure agues, and overlooked the intra-uterine cause. Anti-periodics, or quinine, while they will break the regular recurrence of the paroxysms, will not cause them to subside entirely, nor will any medicine arrest them until it first causes the expulsion of the retained placenta. 128 HALE ON ABORTION. The placenta is frequently retained in the uterus until putrefaction takes place, in which case it is[not expelled, in the usual acceptation of the term, but passes away in a dissolved or disintegrated state. In such cases the discharges from the uterus have a peculiar and persist- ent fcetor, unlike anything else a fcetor which the physician who has ever inhaled it will never forget. The odor of the discharge from uterine cancer bears some relation to it ; but there is a marked difference, which the experienced practitioner can detect. It is peculiar to both discharges, that it is almost impossible for several days to eradicate entirely the disagreeable foetor from the hand which has been used in making a necessary examination. The best preventive of such a disagreeable contamination is to annoint the hand thor- oughly with fresh lard, previous to the examination. The lard absorbs the odor, and retains it, in the same manner as it absorbs the delicate and costly perfumes of flowers, which are placed between layers of purified lard, in order to preserve volatile odors, and transmit them to pure alcohol. The decaying placenta may be weeks in passing away, or it may be expelled by the irritated uterus before this process is completed. In this case the mass expelled has a spongy, worm-eaten appearance, and exhales an intolerable effluvia. In some instances the placenta is neither expelled or discharged in putrefactive solution, but in some man- ner keeps up a connection with the Uterus, and con- tinues to enlarge, becoming in the end a hydatid or molar mass. There are even cases where the after-birth has remained in the uterus a long time, having no connec- tion with that organ, remaining about the size it had SYMPTOMS OP ABORTION. 129 attained when the foetus was expelled, yet undergoing no change of a putrefactive character, and finally being thrown off with or without haemorrhage. One such case came under my own observation. A woman aborted in the third menstrual period from conception. The foetus was expelled, considerable haemorrhage followed, and it was supposed the placenta had been thrown off. Ergot was given to arrest the flooding ; nothing fur- ther occurred for a month, when violent haemorrhage occurred, and again two weeks after. At this time I was consulted. Caulophyllin, l-10th, in doses of two grains every two hours, arrested the flooding, and under its use for twenty-four hours, the unchanged pla- centa was expelled. No foetus was present at the time nor afterwards. It is supposed that in these instances, putrefaction is prevented by the closure of the cervix so tightly as to be hermetically sealed. We may here inquire why the placenta is so often persistently retained. But one explanation is usually given, namely, that the uterus, before the fourth month, is quite undeveloped, and its muscular structure incap- able of originating or maintaining contractile or expul- sive action. That this is often the cause of the non- expulsion of the placenta is not to be disputed, but that it is always the cause of its retention is certainly not the case. Those who have attended many cases of abortion, if they are at all observant, must have noticed how frequently the uterus is, in such instances, more or less retroverted. It has seemed to me that this disloca- tion occurs in two-fifths of all cases of abortion before the fourth month. In such a malposition the cervix is flexed, and even bent at nearly a right angle, suffi- ciently so as to nearly or entirely close the canal of the cervix ; and no amount of effort can expel the placenta 9 130 HALE ON ABORTION. until the uterus is placed in proper position. Ante- version of the uterus will have the same effect, but as this occurs more rarely, it is not of as much importance. I have met with but three cases of this latter form of dis- location occurring during the progress of an 'abortion. The uterine sound was here efficient in effecting the change of position, and dislodging the retained pla- centa. A woman who has aborted may suppose she has got rid of the whole contents of the uterus, and her phy- sician may be of the same opinion, unless he has had considerable experience and is a close observer. There may be a slight discharge, bloody or not, or there may be none at all. This condition of uterine quiescence may continue for days, and even weeks, when suddenly after walking, stooping, lifting, or some unusual exer- tion, uterine pains, with or without haemorrhage, may set in, and a retained placenta be thrown off. If the patient only has pains while lying on her fac'e, we may generally consider that retroversion exists. This I have observed in several instances, and upon examination, I found that the uterus changed to a 7 O natural position when the woman lay upon her face, and dropped into the hollow of the sacrum when she turned upon her back. After the expulsion or discharge of the placenta and membranes, if no coagula are present, the chills and fever generally cease, but there is, however, a kind of irritative fever, which may occur before or after this period. It is probably due to the presence of a sub- stance undergoing putrefaction in the uterine cavity, and the absorption of morbid matter into the circula- tion. This fever, although zymotic in its character, is not, like puerperal fever, due to any specific contagion, SYMPTOMS OF ABORTION. 131 nor is it propagated from one woman to another, i. e., my experience does not lead me to suppose that any such contagion is to be apprehended. I have often gone direct from the room of a patient from whom I had just extracted a putrid retained placenta, to at- tend a woman in labor, using no more than usual means of cleanliness, yet I never had a case of puer- peral fever in my practice under such circumstances. This putrefactive, or irritative fever, is usually at- tended with all the symptoms of a typhoid, namely : the heat of the skin, quick, irritable pulse, dry tongue, stupor, or coma-vigil, and even diarrhoea. But it is a notable fact, that if at any period of the fever the uterus gets rid of its morbid contents, the unfavorable symptoms disappear with surprising rapidity, showing that the condition of the blood is not due to any fer- menting poison working in that fluid, but from the absorption of a poison, only. The complications which may ensue during this fever, are inflammation of the uterus, phlebitis, ovaritis, pelvic cellulitis, and occasionally cystitis ; but as these more usually occur as sequelae of abortion, they will be considered under that head. The discharges from the uterus before all the morbid material is thrown off, are often irritating and. excori- ating in the extreme, causing in their passage outward superficial erosion, and even ulceration of the os uteri, vagina, and vulva. I have now described the symp- toms of abortion, in various degrees of severity, from the first premonitus to the entire expulsion of all the products of conception. The subsequent symptoms re- main to be considered. The sequelae of abortion are many and important, comparing in gravity with those of an unnatural labor. 132 HALE ON ABORTION. It is the opinion of some authors that serious conse- quences are oftener the result of abortion than of pre- mature labor, but this statement is hardly warranted by the facts. If abortion is properly treated, the sequelae are very few and unimportant. It is only when this accident is improperly treated, or left to the unaided powers of life, that serious results occur. The most common sequelae are metritis, ovaritis (acute and chronic), induration and ulceration of cervix and os uteri, leucorrhoea, prolapsus, retro version, chronic me- trorrhagia, and anaemia. To these may be added the occasional occurrence of mastitis, peritonitis, and puer- peral mania. The symptoms of the above diseases are supposed to be familiar to every practical physician, and are to be found in every work on diseases of women. We will therefore omit to enumerate them in this place. In re- lation, however, to mastitis, it may be said that the mammae rarely become engorged and filled with milk before the third month ; but after that time it is no uncommon occurrence to have all the symptoms appear which usually accompany the secretion of milk at full time, and even of the occurrence of mammary abscess. DIAGNOSIS OF ABORTION. 133 SECTION III. i DIAGNOSIS OF ABOETION. FEOM the numerous and characteristic symptoms just given, the diagnosis of abortion ought to be very easy; but unfortunately, these signs are not very clearly marked until the abortion is inevitable, and consequently when it is a matter of indifference to the patient whether the physician makes out a clear diag- nosis or not. It is therefore during the premonitory stage, that we should endeavor to recognize the true nature of the disease, for then only can our art succeed in arresting its progress. The diagnosis of abortion involves the solution of three questions : (1) Is the woman pregnant ? If she is, (2) Are the symptoms those of a commencing abor- tion, or do they arise from other diseases ? (3) Is the abortion inevitable ? Is the woman pregnant f This first question is quite readily solved after the fourth month of gestation, though before that period it is almost always unanswer- able. All physicians of experience are aware of the difficulties which involve it. A woman in good health may cease to menstruate for several months ; she will show nearly all the natural signs of pregnancy. At the third or fourth month she may have signs of uterine congestion or irritation, lasting for several days, fol- lowed by a slight flow of blood. Is it a return of the interrupted menses or an approaching abortion ? The 134 HALE ON ABORTION. physician should try to satisfy himself, if possible, of the actual existence of pregnancy (see " Conduct of Physician"), but if this cannot be done, he must rely upon the symptoms present. If haemorrhage occurs, we must distinguish it from those rare cases of " menstruation during pregnancy," so-called. This is supposed to be an exudation of blood from an ulcerated os or diseased cervical canal, or from the lower segment of the uterus, not occupied by the deciduous membrane. To distinguish it from this ab- normal form of menstruation, we must ascertain if the symptom has occurred every month since the symptoms of pregnancy set in, and also the duration of each previous haemorrhage. If such has occurred, and this subsides like them, it is plain it cannot be an impend- ing abortion, unless such haemorrhage proceed from placenta previa, as is sometimes the case. Little or nothing can be inferred from the form and size of the clot, whether it has proceeded from an un- irapregnated womb or not; but all clots should be examined, by carefully picking them in pieces under clean water, and if the abortion has occurred after the third week, the embryo may be discovered. Cazeaux gives certain rules, laid down by Holl, how to distinguish a clot in the cervix uteri from the head of the foetus, but our space will not permit their inser- tion. (1) Metritis may occur idiopathically during preg- nancy, when it is pretty sure to cause abortion. If it occur from medicinal or mechanical causes, and for the purpose of causing criminal abortion, the consequences are very grave. To distinguish an impending abortion from inflam- mation of the uterus (unimpreguated), we must con- DIAGNOSIS OF ABORTION. 135 sider the character of the pain, which in the latter is not intermitting, nor is there any haemorrhage. A me- tritis may be followed by a foetid grumous discharge, but it lacks the peculiar foetor of a decaying decidua or placenta. Finally, the history of the case, and the absence of the usual symptoms of pregnancy. (2) Peritonitis may occur without causing abortion. The first symptoms of this disease, however, may be mis- taken for symptoms of abortion, particularly the ab- dominal tenderness, the chills, and the tympanites. But the absence of intermitting uterine pain, the condition of the os and cervix, and the absence of haemorrhage, will enable us to form a correct diagnosis. As in ine- tritis, we may have both a peritonitis and an abortion existing at the same time. (3) Dysinenwrhcea has many symptoms which very closely resemble those of abortion, so nearly, indeed, that it is almost impossible to form a satisfactory diag- nosis between that disease and an abortion before the tenth week of gestation. The shreds and skinny substances discharged in membraneous dysmenorrhoea, may not contain any dis- coverable foetus or placenta. But if, as I believe to be often the case, abortion occurs in the third or fourth week after conception, the embryo is so small as to elude a very close search. In fact the deciduous mem- branes expelled in dysmeuorrhcea and early abortion are said by recent investigators to be identical, and sometimes their expulsion is attended with all the symptoms of abortion. It may be said, therefore, that there are many cases which come under the care of the physician, where it is impossible to give a decided opinion one way or the other. (4) Dysentery. The pains which accompany dysen- 136 HALE ON ABORTION. tery, and are located in the hypogastrium and sacrum, extending in some cases down the thighs, the tenes- mus, and desire to bear down with the abdominal muscles, so nearly simulate the symptoms of an abor- tion, that the latter has often been prescribed for, as dysentery, especially if a diarrhoea has been present with the abortion. a not uncommon occurrence. But no careful and observing practitioner will ever be guilty of such carelessness. When pregnancy exists, may the symptoms be attri- buted to simple congestion, or should they be regarded as the first tokens of a threatened abortion ? Although it is very difficult to decide this question within the first three or four months, or at the beginning of the accident, its solution is happily of little importance, as regards the treatment, the measures indicated for simple congestion being equally applicable as preventives of of miscarriage. ' .' -. " When symptoms, which in all appearance were due to simple congestion, have yielded to proper treatment, the physician is often required to answer a question whose rigorous solution is always impossible namely : the abdominal and lumbar pain being allayed, and all the other alarming symptoms removed, is the patient therefore out of danger of miscarriage ? In the majority of cases we can tell nothing about it, for it is impossible to know whether the congestion has been arrested in time to prevent a rupture of blood-vessels, and an effusion between the placenta and uterus, or whether the separation of the placenta is extensive enough to have destroyed the foetus immediately : even supposing the child to be still living, we cannot ascertain the degree of separation of the placenta, nor foresee the effect which a partial destruction of its maternal attach- ment may have upon the foetus. Very frequently, indeed, the latter, by being cut off from a considerable DIAGNOSIS OF ABORTION. 137 part of its means of respiration, is placed in the condi- tion of an adult, whose lungs are in great measure des- troyed, and whose respiration and nutrition being insufficient, gradually wastes away. As the child often does not perish until after the lapse of eight days, two weeks, and frequently not until the next menstrual period, this, too, without the appearance of any new symptoms to explain the unlocked for death, the physician, therefore, cannot be too reserved in his diagnosis, as regards the possible consequence of such accidents."* But if the abortion has really begun, can we hope to arrest the symptoms ? Severe pains, their constant direction from the umbilicus towards the occyx ; the previous duration of the discharge, and the amount of blood already lost ; softening and dilatation of almost the entire neck, and even of the internal orifice, and projection of the membrane during contraction, all in- dicate a very unfavorable prognosis. It is said by some authorities, that these symptoms should not destroy all hope, but I have never known abortion arrested after it has reached this stage. It is even stated that rupture of the membranes, and discharge of the amniotic fluid, does not render abortion inevitable. But this assertion is simply absurd ; for such a condition not resulting in death, and expulsion of the embryo or foetus, is impos- sible. In the cases alluded to by Desameaux, there was certainly a mistake in reference to the true origin of the water lost by the patient. Hydrorrhcea, resulting in discharge of water from the uterus, has undoubtedly been mistaken for rupture of. the ovum. Cazeaux relates a case where the occurrence took place at three and a half and four and a half months ; the pregnancy terminated naturally. * Cazeaux's Midwifery. i 138 HALE ON ABORTION. llinwrrhage may occur without an abortion being inevitable, for it may arise from an ulcerated os, a dis- eased cervix, or even a slight separation of the placenta. The amount of discharge is more important than its duration. A slight haemorrhage may continue for several days or weeks, since it may originate in the rupture of a few vessels. I have known it to last six weeks or two months without compromisirg the preg- nancy. But if a large amount of blood is lost in a very short time, the placenta must be separated to a considerable extent, and abortion must necessarily ensue. Abortion is really inevitable only when the foetus has ceased to live, when the membranes have been broken, or when the separation of the placenta, and the rupture of the utero-placental vessels, are so exten- sive that the remaining utero-placental attachments are unequal to the support of the foetal respiration. It is impossible to ascertain in the early months whether the foetus is living or dead. The sudden cessation of the O vomitings, salivation, swelling of the breasts, and other sympathetic functional disorders of pregnancy, are pretty sure proof of the death of the foetus. The continuance of these symptoms, even after the occurrence of leu- corrhoea and other disturbances, is certainly favorable. There is a particular form of the neck of the womb, which Cazeaux says is only met with when abortion has taken place. " When the patient has been for a short time only pregnant, we know that it is always easy to distinguish the neck of the uterus from the body ; in the great majority of cases we may even feel the angle which separates them. Now when the con- tractions have lasted for a certain length of time, they have gradually dilated the internal orifice, the cavity DIAGNOSIS OF ABORTION. 139 of the neck has become confounded with that of the body, and when the finger in the vagina is passed over the entire lower segment of the uterus, the neck can no longer be distinguished from it ; a well-defined limit between them is no more to be detected, and all that belongs to the neck of the womb has the shape of a pear, the larger part being continuous with the body of that organ, and the lower extremity corresponding with the external orifice. Whenever I have met with this condition of things, abortion has taken place."* After the fourth month of pregnancy the diagnosis is much more certain, there is greater haemorrhage, and dilation of the os is more easily detected, and the death of the foetus can be verified in a positive manner. The following are the signs of this occurrence, (a) The abdomen diminishes instead of increases in volume ; () the breasts shrink away ; (y Kluge is another plan frequently adopted. It acts both as an irritant and a mechanical dilator, thus bringing on labor by causing reflex action, and opening the os and cervix by its ex- pansion. It is used in the following manner : Warm emollient injections are used ; then the conical prepared sponge is carried up to the uterine orifice by means of a pair of long curved forceps (intra-uterine forceps) and is made to enter the canal of the cervix, where it is kept in place by means of a tampon of pieces of cloth, or a sponge. If pains are not established in twenty- four hours, use another and larger tent. Sometimes the plan of M. Meissner is combined with Kluge's with good results. Small caoutchouc bags have been recommended by Dr. Barnes, of England, and used very successfully, in- stead of the sponge tent. They are introduced into the canal of the cervix, and filled with water. For full particulars relative to this method, reference is made to the articles on that method. " This instrument," says Dr. Barnes, " is of a fiddle- shape, having, when distended, a narrower cylindrical central portion, dilating at either end into a bulging or mushroom-like expansion. The object of this is to pre- vent the bag from slipping forward into the uterus, or backward into the vagina. The bag is prolonged into a long narrow tube with a stop-cock at the end, to keep HALE ON ABORTION. in the water when injected. The injecting medium is the ordinary Higginson's syringe (or ^ Essex') an in- strument which should always be carried in the obstet- ric trosseau, as it is useful for many other purposes. Three bags of different sizes are sufficient as a series/ To facilitate the introduction of the flaccid bag into the n-rvix uteri, a small pouch is attached outside to receive the end of the uterine sound, which, guided by the finger of the left hand applied to the os uteri, sei-ves to push the bag into the cervical canal." Dr. Barnes claims that by the use of these bags, pre- mature labor may be induced at a predetermined hour. The operation is entirely within the control of the operator. The vagina is first dilated by the use of the colpeurynteur ; then the smallest or medium bag (" dilator") is introduced into the cervix, care being taken that the terminal bulging part shall pass through the os uteri internum, while the inferior bulging end emerges in the vagina. When water is thrown in, the dilator is thus secured by its shape in situ, and the eccentric pressure bears upon the whole cervical ca,nal, and especially upon the two points of greatest resist- ance the os externum and internum. This stage ought not, as a mle, to occupy less than three or four hours. If the smallest or medium-sized dilator does not expand the cervix sufficiently, the largest size must be used. If, when full dilation occurs, pains do not set in, a portion of the liquor amnii may be drawn off, and the uterus compelled to collapse. A portion of the liquor should be left in to facilitate turning, if that should become necessary. Caulopliyllin, or ergot may be used after full dilation and puncturing of the membranes, if the uterus seems to be in a condition of inertia. The tampon, used as recommended for uterine haem- orrhage, has been resorted to. It should be large OBSTETRIC ABORTION. 273 enough to expand the upper portion of the vagina, to such an extent as to excite reflex irritation. This plan is, however, painful, and slow in its operation, and is Adopted by but few. The colpe-uryntewr is often used to induce premature labor. The instrument is a simple bag of vulcanized india-rubber, which is to be introduced into the vagina, and then dilated with air, warm or cold water, as may be deemed expedient. After being more or less fully expanded (and it may be advisable at first to grad- ually inflate it, and increase, as the pressure is less and less inconvenient) the aperture is closed by a stop-cock, and the bag allowed to remain in the vagina. A full description of the instrument and its use was given in the treatment of retroversion. The meaning of the Greek words from which this instrument is derived, is vagina-dilator, and expresses the idea of the effect it produces, dilating the vagina, and even pulling open the os uteri, and by its forcible pressure exciting, by sympathy the action of the uterus. The water douche was introduced into practice by the late Professor Kiwisch, of Wurzburg. Tyler Smith, Cazeaux and others, prefer this method above all others, especially when the life of. the child is an object. If a stream of hot or cold water be directed against, or, still better, within the os uteri, at intervals of three or four hours, for the space of ten minutes or a quarter of an hour at each application, labor is certainly and speedily brought on. The water may be made by means of a syphon and reservoir, to descend upon the uterus from a height, or it may be forced into or against the os by a common injecting apparatus which is capa- ble of throwing a continuous stream, like the Essex syringe heretofore described. 18 074 HALE ON ABORTION. Kiwisch explained the modus operandi of the douche on the supposition that it caused swelling of the parts by imbibition of fluid, and separation of decidua from the uterus. Probably the reflex and peristaltic actions of the uterus are also excited. Tyler Smith found the douche more efficacious, when warm and cold water were injected alternately, than when either warm or cold was applied alone. The great advantages of the douche are, that the premature labor excited is more dertain, and imitates to a greater degree natural parturi- tion ; also it never injures the genital organs, the mem- branes of the ovum, or the foetus. Separation of the memfjranes from the os and cervix uteri, by the catheter, bougie, or sound, is highly recommended by Professor Simpson, who is high authority in obstetric matters. The instrument is oiled and cautiously insinuated between the membranes and the uterine surface, and with short, gentle move- ments from side to side, carried up towards the fundus of the womb. Care should be taken that the placental vessels are not ruptured. An ordinary flexible bougie, introduced a considerable distance between the mem- branes and uterus, and allowed to remain, will cause premature labor. This plan has been improved upon by an eminent obstetrician, who introduces a flexible English catheter, by means of a wire of sufficient size inside, nearly up to the fundus uteri. The wire is then withdrawn, and a quantity of warm olive oil injected into the uterus, through the catheter by means of a syringe. Glycerine or milk will answer the purpose as well as oil. Another physician uses a flattened female catheter, to which is attached a common injecting syringe, and after its in- troduction between the membranes and the uterine OBSTETRIC ABORTION. 275 wall, a quart of tepid water is injected, slowly, so as to act by gradually separating the membranes. A syringe, having a very long, slightly flexible tube of hard rubber twelve or fifteen inches in length, would be preferable, as there would be no necessity for the introduction of the catheter. Two openings in the end of the tube, at its sides, would be better than the usual orifice in the end. The amount of fluid thrown up at once should not exceed two or three ounces. Its ope- ration is to separate the membranes over a large surface, and at the same time excite the reflex and peristaltic actions of the uterus. INTRA-UTERINE SYRINGE. The administration of &rgol is recommended by Dr. Ramsbotham, but, as it seems to us, upon insuf- ficient grounds. The majority of obstetricians are opposed to its use, and those who have investigated the action of this drug are the least inclined to use it. If medicines are tried, there are others much safer and more efficient. Oaulophyllm has in several instances brought on premature labor in the eighth month ; the same is asserted of Cimicifugin. In order to be effectual, these drugs must be used in large doses two grains of the former, or one of the latter, repeated every hour or two. The application of cupping glasses to the mammce, is advised by Scanzoni. Sucking-pumps made of caout- chouc, were applied in one case for two hours, seven times during three days. After the third application 276 HALE ON ABORTION. the cervix uteri wag shortened ; after the sixth severe labor pains came on, and after the seventh the child was born.* Separation of the membranes by the introduction of at- \ Jieric air, or gas, has, I believe, been recommended for the purpose of inducing premature labor. I cannot recommend this plan, as I believe it to be decidedly unsafe, and the most dangerous of all methods, not excepting the stiletted canula. Dr. Hitchcockf reports a case which shows conclusively that by this method air may be forced into the uterine sinuses and cause death by entering the circulation. The case occurred in Kalaniazoo county, Michigan, and happened during an attempt to cause abortion. u The operator, through an instrument introduced into the womb, or at least into the vagina, blew air with his mouth, when immediately the woman screamed, struck at the operator, fainted, and was found a minute or two afterwards blue in the face and insensible, the muscles about the arms and neck having a trembling motion." The case presented an entire correspondence with the symptoms described as occurring in cases where death is known to have occurred from the acci- dental entrance of air into the circulation during sur-. gical operations. The post-mortem appearances observed were also altogether consistent with the theory of death from the introduction of air into the circulation ; namely, extreme congestion of the lungs, entire absence of blood from the left, and nearly so from the right cavities of the heart ; the escape of air from the uterus the instant its walls were incised ; the marble whiteness of the ex- tremities, and the unusual paleness of the brain and its membranes. * Braithwaite, Part XXVIII., page 263. f Trans. Amer. Med. Association, 1865. OBSTETRIC ABORTION. 277 Galvanism. The employment of galvanism or electro-magnetism was first suggested by Huder in 1803, for the purpose of bringing on uterine contractions, after all other means failed. This is accomplished by placing one pole of the battery on either side of the uterus, continuing the application of the current for half an hour or an hour each time, and renewing it once or twice daily ; the ordinary magneto-electric apparatus in use is the best form, as repeated shocks prove more effectual and certain in stimulating the uterus to contractions than a continued current. In applying the poles, it wall be proper to attach to the discs a sponge moistened with water, or salt and water, or pieces of thin flannel likewise moistened may be placed between the discs and the abdomen. Some apply one pole to the neck of the uterus, and the other to the spine or abdomen immediately above the fundus. Dr. Radford says that " galvanism not only originates the temporary contractions of the uterus, but also pro- duces such a lasting impression on that organ that pains continue to occur until the labor is terminated. It produces severe pains in the loins, and great bearing down efforts, followed by dilation of the os, and expul- sive pains. Dr. King says, " I have employed this agent in a few cases, and with invariable success, though the number and intensity of the applications had necessarily to be varied in each." In cases of premature labor, the foetus does not appear to be injured by the application of galvanism. Cases of still-birth seldom occur from its use, while in the majority of cases where ergot is used the child is born dead. Dr. Kadford writes, " Galvanism is especially ad van- 278 HALE ON ABORTION. tageous as a general stimulant in all those cases in which the vital powers are extremely depressed from loss of blood. Its beneficial effects are to be observed in the change of countenance, restoring an animated expression ; in its influence on the heart and arteries ; in changing the character of respiration ; and its warm- ing influence upon the general surface. I have several times Observed, in cases in which other powerful stim- ulants have failed to produce any beneficial results, the most decided advantages accrue from its application." This recommendation would lead us to use this agent in the prostration and chill which sometimes ushers in an abortion. In such cases the abortion is inevitable ; and galvanism would be productive of great benefit both by bringing on healthy reaction and aiding the uterus in expelling its contents. Galvanism will cause embryonic and foetal abortion, as well as premature labor. I have made use of it in several cases. In one it caused an easy abortion in the fourth month (this was a case of dangerous vomiting) ; in another it acted satisfactorily in the eighth week of pregnancy. In a case where it was decided necessary to terminate the pregnancy, it was used but on.ce, and for five minutes only. Pains immediately set in, accom- panied by some haemorrhage. The abortion would undoubtedly have proceeded to a termination, had not the woman, under the idea of hastening the labor, drank a " hot gin sling." Strange to say, this stimulant im- mediately arrested the abortivant process, the pain and haemorrhage ceased, and did not return. (Was it by virtue of the juniper (salina) contained in it ? ) Four weeks were suffered to elapse, when the abortion was brought on by the use of the catheter. Dr. Robert Barnes, Lecturer on Midwifery to the OBSTETRIC ABORTION. 2*9 Royal Free Hospital Medical College, England, once wrote a paper on the Use of Galvanism in Obstetrics. It is worthy of attentive perusal, as it enters fully into a consideration of the action of this a^ent. O The article was published in Braithwaite's Retro- spect, Part xxix., pages 259 268, and is copied by Dr. King, in his Obstetrics, pages 669 681. SECTION II. FCETAL ABORTION. Postal abortion consists in the expulsion of the pro- duct of conception during the second stage of pregnancy, viz., from" the date of the connection of the placenta with the uterus, to the date of viability of the child. The induction of abortion during this stage may be resorted to for the same reasons given above, where it is not deemed pnident to wait until the child is viable. The same obstructions, existing to a greater degree, will make it proper to cause the expulsion of the fcetus before the seventh month. In these cases, the life of the mother is to be considered beyond all other con- siderations. The same means may be used, and will be found equally efficient as those adopted during the last three months of pregnancy. The same precautions, having in view the non-injury to the placental vessels, are to be adopted, because it is better to have the placenta detached by the contractions of the uterus, than by any instrument. By so doing much hEemorrhage is avoided, which might become dangerous before the uterus could HALE OX ABORTION. iade to expel the secundines. As before noticed, the haemorrhage before the sixth month, generally occurs before the expulsion of the placenta, whereas, in premature labor, it is afterward*. For the safe and speedy induction of foetal abortion, I ] nvfer, as mentioned under premature labor, the use of the flexible bougie or catJieter, or the injection of bland fluids /"/'/< tn the membranes and the uterus. A com- bination of the two operations is probably the best that can be adopted. My favorite method is to intro- duce a smooth flexible catheter or bougie (having one or two orifices in the sides of its extremity) by means of a wire stiff enough to act as a conductor. It should be introduced carefully, so as to gently insinuate it between the membranes and the uterus. I especially recommend the operator not to puncture the mem- branes, for according to all experience, this accident should be avoided during the whole period of preg- nancy. When the instrument has been carried up nearly to the fundus of the uterus, on its posterior surface, the wire is withdrawn, and one or two ounces of warm milk, glycerine, olive oil, or water, is to be injected by means of any syringe which will throw a continuous stream. The modus operand* is plain. The fluid permeates between the membranes and the uterus, separating them throughout the whole FLEXIBLE BOUGIE OR CATHETER. or a large portion of their extent. It may even sepa- rate the placenta during the fourth or fifth month. At OBSTETRIC ABORTION. 281 the same time the presence of the fluid causes uterine contractions of a forcible character, which generally ends in the expulsion of the fcetus and secundines, with little or no haemorrhage. The chitt, or rigor, previ- ously mentioned among the symptoms of abortion, is a sure indication that the operation has been successful and efficient. It sometimes happens that it is difficult, and even impossible, to inject any fluid into the uterus through the catheter or bougie, owing, probably, to the com- pression of the instrument by the contraction of the cervix uteri, or the whole organ. To avoid this diffi- culty, I have frequently made use of a hard rubber syringe, holding two ounces, and having a tube about eight to ten inches in length, and about one-fourth or one-sixth of an inch in diameter, with a very smoothly rounded point. (See cut on page 275). The only instrument of this character now sold, has its tube straight. But before it can be used for the purpose here recommended, it must be bent to the requisite curve. The extent of this curve will depend on the position and size of the uterus, and the period of pregnancy. The tact and judgment of the phy- sician must be the guide in this matter. To prepare the tube so that it can be bent to the requisite curve, it is only necessary to plunge it into boiling water for a minute, when it will become quite ductile, and may be made to assume any curve desired. When the tube has been introduced into the uterus as directed for the bougie the piston is to be slowly pushed down, so as to force the fluid gently out, and effect a gradual separation of the membranes. In filling the syringe, previous to its introduction, care should be taken to exclude all air, as the presence 282 . HALE ON ABORTION. of air in the uterus is neither safe or desirable. The woman should remain in the recumbent position for half an hour or more after the operation, or until the occurrence of the rigors. For obvious reasons, the best time for the operation is in the evening after the patient has retired for the night. It is advisable that the bladder and rectum be emptied of their contents ; the latter by enema, if any foecal matter has accumu- lated there. It is taught by some medical writers that it is haz- ardous to inject fluids into the uterus. Whatever danger there may be in the uninipregnated state from fluids passing through the Fallopian tubes into the peritoneal cavity, thereby causing inflammation, this objection is not valid in the condition under consider- ation, for during pregnancy those tubes are undoubtedly plugged up with tenacious mucus, which would effectu- ally prevent the passage of any fluid. This simple and effective method is far preferable to puncturing the membranes, which nearly always results in a tedious labor ; or the douche, which is altogether complicated and slow of operation ; or the administra- tion of drugs, which is always uncertain, and generally injurious. No other method yet known is at all com- parable with it, and in my opinion none other should be adopted by the conscientious physician who seeks in all cases the good of his patient above all else. OBSTETRIC ABORTION. 283 SECTION III. EMBRYOOTC ABORTION. The induction of abortion during the three months following conception, is sometimes necessary and justir fiable. If the pregnancy is not to be allowed to go on until such time as the child is viable, it is absurd to wait any time after the physician has decided on the necessity of the operation, as every day's delay renders it more liable to be productive of injury to the woman. The following question was put to Dr. Hunter, in 1768, by "W. Cooper, and was shortly after decided in the affirmative by most English practitioners : " When a woman, three or four months pregnant, has so contracted a pelvis as to preclude all hope of a possible expulsion or extraction of a viable foetus, may we think of inducing abortion 2" One of the latest obstetric writers Cazeaux declares the accoucher is warranted in producing abor- tion, whenever a woman who is five or six months pregnant, at most, shall have less than two and a half inches in the smallest diameter of the pelvis. I can not see the propriety of waiting until the woman is so far advanced. If the physician is cognizant of the pelvic deformity, and also of the -cominencement of pregnancy, he should induce the abortion at the earliest possible moment consistent with the patient's state of health. He should, of course, be sure the woman is pregnant, before any operation is performed ; but it is my opinion that he had better err in this respect, than allow a pregnancy to go on till a late HALE ON ABORTION. date. For the introduction of the sound or bougie, or the injection, of fluids, if carefully done is not produc- tive of injury, and may even bring back the menses, if that was the only obstruction. The .indications for producing an abortion during the first third of preg- nancy, may be thus summed up : Extreme contraction of the pelvis; voluminous, immoveable, and non- operable tumors of the excavation ; extreme dropsy of the amnion; irreducible displacements of the womb; haemorrhages which have resisted the employment of the most rational measures ; eclampsia, mania, chorea, and obstinate, dangerous vomiting. If any of these indications obtain, the sooner after conception the embryo is destroyed, the better for the health and safety of the patient. Method of Operating. Nearly all the methods men- tioned above, except the injection of fluids, are inoper- ative when used during the first stage of gestation. They may induce the abortion, but only after a tedious trial, and nearly always to the injury of the uterus. I allude to the sponge-tent, ergot, douche, puncture of the membrane, electricity, and colpeurysis. The most efficient methods are : (1) The introduction of the bougie. (2) The injection of fluids. (3) The forceps. (4) The uterine sound. The bougie or flex'Me catheter is an effective instru- ment for terminating pregnancy before the end of the third month. If introduced into the uterus without rupturing the membranes, it will bring on labor with expulsion of the ovum entire, with the decidua. Before the fourth month, so close is that tissue to the uterus, that it is a matter of doubt whether a bougie or any other instrument can be insinuated between the two adherent surfaces. The instrument must then pass OBSTETRIC ABORTION. 285 through the orifice at the cervix, and between the membranes of the ovum and the decidua. It is best not to use sufficient force to rupture the delicate mem- branes of the ovum, so delicate that I imagine they are destroyed in a large majority of the cases where instru- ments are used in the early months, especially during the first eight weeks. To use the bougie successfully, select a smooth one, about one quarter of an inch in diameter, with a curved wire of sufficient size to render it a good conductor (the wires generally found in bougies and catheters are too small for this purpose.) Have the woman lie on her back, near the side of the bed, with the knees drawn up and the hips slightly elevated. First ascertain by the touch the position of the os uteri, its condition, etc. Moisten the instrument with oil or glycerine, and pass its point along the palmar surface of the index finger of the right hand, the end of which should rest upon the lower lip of the os uteri. Insinuate the instrument into the cervix, and push it gently upward towards the uterine cavity until it meets with some obstruction. These obstructions are generally the lacunae or folds of the mucous lining of the neck. Care should be taken not to lacerate these folds by any forcible measures, as such injuries lead to chronic inflammations of the cer- vical canal. By the use of tact, patience, and gentle efforts, the instrument will after a time pass suddenly into the uterine cavity. In some cases of primapara, the introduction of any instrument through the cervical canal is a matter of much difficulty. The most careful physician and practical amateur may fail after efforts lasting a quarter of an hour. Sometimes when we are about to give up our efforts, the bougie will glide into the cavity with the utmost ease and readiness. Any 286 HALE ON ABORTION. one who will take the trouble to examine the minute anatomy of the cervical canal, and note the small size of the inner orifice of the canal, and the numerous lacunae or crypts of the enlarged middle portion, will under- stand the reason of the difficulty. When the bougie shall have entered the cavity of the uterus, it should be slowly pushed upwards until it seems to meet with an obstruction to its funther pro- gress. Here all efforts to introduce it further should cease, else we may rupture the membranes of the ovum. Now, with the finger and thumb of the right hand, hold the bougie firmly in its place, and with the other hand slowly withdraw the wire, not directly down- wards, but with a circular movement, outward and upward, so that the cwve of the wire will follow the axis of the pelvis. By so doing we avoid any unneces- sary irritation of the interior of the uterus, or a rupture of the membranes. After the wire has been withdrawn, coil the end of the bougie until it can be placed in the vagina, resting on the perineum, or if it is not flexible enough to be easily coiled, the protruding end may be cut off. At any rate, leave the instrument in the womb, until hemorrhage or labor pains set in, when it may be removed. To keep it in situ until such an occasion, no aid is needed if the woman remains in bed ; but if she is to sit up or walk, a bandage should be worn. The time which intervenes between the introduction of the instrument (if it be retained) and the occurrence of pains, etc., varies from six to twenty-four hours, rarely exceeding the latter. It is very rare that haemor- rhage occurs during a foetal abortion caused by the proper use of the bougie. I do not approve of the plan adopted by some obste- OBSTETEIC ABOKTION. 287 tricians, of rotating the bougie when in the womb, and then withdrawing it. Not only is injury done thereby, but the induction of abortion by such a method is very uncertain. This leads us to the considera- tion of The Uterine Sound. Professor Simpson makes use of this instrument for the induction of abortion in the early months of pregnancy. The silver male catheter has been substituted for it in some instances. Professor Simpson directs that after its introduction it is to be turned three or four times round, and then withdrawn. That this method will prove effectual in a majority of cases, I do not doubt ; in fact, my observations lead me to believe it will generally destroy the embryo. But Simpson admits that the operation is not always imme- diately effectual, and states that he has been obliged to repeat it several times in some cases, before the uterus would take on expulsive action, or before he was satis- fied the embryo was destroyed. There are many other objections to the use of the sound, especially in the third month of gestation. If not used with great care, the interior of the uterus will be abraded or other- wise injured by its forcible rotation. Next to the bougie, however, it is the best and most certain method of causing abortion now known. Its introduction is effected in the same manner as that of the bougie. UTERINE SOUND. HALE ON ABORTION. The injection of fluids, &s described under Premature Li\ may be resorted to when the above means are not at hand, or when it is deemed advisable not to use them. The introduction of the curved tube should be conducted as described above. Not more than one ounce of liquid should be injected at once. When the syringe is used, a sensation of faintness, or actual syn- cope sometimes occurs immediately after the operation. The ri^ or occurs sooner than when other instruments o are used. The Forceps. This instrument is similar to a variety of "bullet forceps," used in military surgery for the seizure and extraction of foreign substances in the tissues. It consists of four " claws," which are sheathed in a tube during its introduction, and are made to protrude and open when in the interior of the uterus. The instru- ment is pushed upward to the fundus uteri, to the posi- tion the ovum is supposed to occupy, when the "claws" are closed upon the embryo, if reached, and the whole forcibly extracted. This instrument is the one most generally employed by those villains who disgrace the medical profession and humanity by practising the vile trade of producing criminal abortion. The instrument may, however, be used by the honorable physician for legitimate purposes. It may be used when the other instruments mentioned are not obtainable, or proper ; or for the purpose of removing a retained placenta or membranes, or any residual mass. ABORTION FORCEPS. OBSTETRIC ABOETION. 289 Various other instruments have been used by physi- cians and abortionists. The stiletted catheter was once in general use. There are several varieties of this in- strument, but all upon the general plan of a sheathed needle or lancet, which can be protruded when intro- duced into the uterus, and having for their aim the rupture of the membrane of the ovum. Besides the mechanical measures above enumerated, for the purpose of inducing abortion in the first stage of pregnancy, the medicinal means may not pass unno- ticed. When premature labor or foetal abortion is induced by medicines, they set up uterine contractions, and thereby dislodge and expel the uterine contents. But owing to the non-development of the muscular tissue of the womb in the earlier months, such effectual contractions can rarely, if ever, be aroused. Medicines, therefore, which cause abortion during the first three months, must cause it by simulating the menstrual process namely, uterine congestion and haemorrhage, with the exfoliation of the decidua. Now, nearly all the medicines mentioned under " Medicinal Causes of Abortion," are capable, under certain circumstances, of causing so much congestion, as to set up a pseudo-menstrual nidus, and the conse- quent arrest of gestation. If, however, the uterus is in a healthy condition, I do not think such medicines, unless taken in massive and dangerous doses, are ever capable of such effects ; but when the uterus is diseased, and has been " irritable," then almost any one of them, if administered at or near the usual menstrual periods, will be very apt to cause such ainux of blood as to lead to the destruction of the product of conception. 19 _",<> HALE ON ABORTION. SECTION IV. OVULAR ABORTION. Another variety of abortion might be considered under the title of Ovular. This might be defined as the destruction of the ovum at any time after it leaves the Graafian vesicle, and be- fore it has been impregnated by the seminal fluid. In other words, any measures which are adopted to prevent the impregnation of the ovum, must result in ite destruction. If, from good and sufficient causes, it is considered best that the fruit of conception should not be allowed to go on to the end of utero-gestation, would it not be better, in a medico-legal, as well as in a moral point of view, to arrest or prevent conception itself ? If premature labor is to be avoided in all cases, and only resorted to to save the life of the mother or child, or both ; if it is preferable to allow the mother to run the risk of her life, and suffer from dangerous dis- eases ; if fcetal and embryonic abortion is only to be resorted to in the most dangerous cases, and avoided because morally and legally it is a crime, equal to, if not identical with, murder ; if so many grave obstacles are in the way, inducing us to avoid any of these opera- tions, would it not be better, in all cases, for the phy- sician to advise that ovular abwtion be allowed ? By adopting this plan to prevent the occurrence of gesta- tion, no crime is committed, and there is no risk of human life. I admit that this is not feasible in a large OVULAR ABORTION. 291 proportion of the cases. Physicians are rarely consulted until after pregnancy is well advanced, and often not until the period of confinement itself. But after the physician has attended one confinement where the life of the child had to be sacrificed to save the mother, it is his duty to inform his patient of the danger of a future pregnancy, and advise and instruct her as to the best possible manner of preventing the occurrence of that state. All perfect theories are probably Utopian. A theory which should regulate and define the laws which relate to marriage is so Utopian that it may never be real- ized. If it were possible to regulate this matter by absolute law, the following rules would have to be car- ried into effect : (a) No woman should marry until it was decided by a competent physician that no physical deformity existed which would incapacitate her from bearing a living, average sized child, at full time. (b) After a woman has had one labor, attended with great danger to herself, and involving the death of the child, it should be rendered obligatory upon the parents to prevent the occurrence of future conceptions. If these two rules were adopted by all civilized nations, it would narrow down the necessity for the induction of Abortion to a very small number of cases of difficult and dangerous labor. Even in the present condition of society, much might be done if physicians would do their duty, and they were upheld by public opinion and public confidence. The fault is both with the physician and people. Phy- sicians are not honest and frank enough with their patients : they do not give them the proper advice and instruction in the premises. We read of women pass- J'.i2 HALE ON ABORTION. ing through a succession of pregnancies, ending in each case with craniotomy or Caesarian section, and every time under the care of the same family physician ! Did the physician do his duty in these cases ? Did he instruct the parents how to prevent a conception which was fraught with such dangerous results? Why do not family physicians protest against allowing young women to marry, whom they know, or believe, are not in normal physical condition to bear children ? The people are, perhaps, more to blame than physicians, in this matter. This arises from the general ignorance which prevails on all subjects pertaining to the physi- ology of generation. This ignorance is almost absolute, for not one layman in a thousand, even if he is other- wise well-read and intelligent, has a correct knowledge of this function. In fact, the most ridiculous and absurd notions are held by the people, and, I regret to say, by many physicians, in relation to the passage of the ovum, the manner of its impregnation, and the nature of the seminal fluid. Books which teach the latest discovered facts relat- ing to generation are kept out of the hands of the young, and virtually out of the hands of the public, by the very nature of the technical language in which they Are written. Every man and woman, before entering into marriage, should be conversant, in some way or other, with all the positive facts concerning the genera- tive process. That I may not be blamed for asserting that physi- cians, even, are ignorant of facts, I will quote from a work by a distinguished author, who is considered an authority by the profession. Speaking of impotency, he says : OVULAR ABORTION. 293 " Eacjulation is weak and precipitate, so that the seminal fluid cannot be thrown into the cavity of the uterus * * it is not sufficient, in order to fecundate, simply to spread the fluid Over the vagina : it must be projected with sufficient force through the orifice of the uterine neck."* This assertion is at variance with all the well-known facts relating to impregnation. A fraction of a drop of the seminal fluid upon the vaginal mucous membrane is sufficient to result in impregnation, if the proper time is selected for the experiment. Not only is the author's knowledge of physiology deficient, but his ana- tomical knowledge is in a worse condition. The uter- O ine neck is scarcely ever sufficiently open to permit of the seminal fluid being thrown in by ejaculation. It does not open during coition, and need not be open in the manner implied by Lallemand. It may be, and is generally, closed, but not impervious. Nothing short of actual occlusion can prevent the spermatozoa from insinuating themselves into the uterine cavity. The majority of the people entertain an idea similar to Lal- lemand' s, and think they take due precaution, when in fact no real precaution is taken to prevent impregnation. Ovular Abortion, may be allowed by adopting certain regulations concerning the act of coition. First, by regulating the time of its occurrence. In all except about six per cent, of cases, according to M. Rociborski, coition will not result in impregnation, if not performed until ten days after the cessation of the menses, nor within four days previous to, or during their occurrence. Coitus immediately after or during menstruation, has often been advised as a cure for ster- ility, and frequently with success. Among the Jews, * Lallemand on Spermatorrhoea. 294 HALE ON ABOKTION. women are not allowed sexual intercourse until twelve days after menstruation ; yet the women of that race are noted for their fertility. This is accounted for on the supposition that impregnation took place just pre- vious to menstruation. When conception occurs at this time, the catamenia sometimes appear, and are some- times absent ; if they appear their duration is generally less than usual.* I am inclined to think that the rates of six or seven per cent, are too small. Some women will conceive at any period between the menses, even when only the slightest particle of seminal fluid is brought in contact with the vaginal surface. The rule above mentioned, relating to the avoidance of coition at certain times cannot be considered as reli- able in all instances. It is based on the theory, which in the majority of cases seems supported by facts, that the ovum is extruded from the generative passages be- fore the twelfth day after, and does not appear therein before the fourth day previous to the menstrual period. When the experiment has been tried, and found to be reliable, the rule may be adopted to prevent concep- tion, but there is some risk in trying the experiment. Some women are in the habit, acting probably under the advice of physicians, of taking some powerful emmenagogue just previous to the usual menstrual period. Such drugs may act in two ways namely, by causing the already impregnated ovum to be ex- pelled with the unnatural menstrual flow, or increas- ing the amount and force of a natural flow (menorrha- gia) which will wash away the unimpregnated ovum in a shorter time than usual. Second, by regulating the manner of its performance. * Carpenter, Physiology, page 361. OVULAR ABOKTIOX. 295 We Lave seen that under certain circumstances, in a large proportion of cases, Ovular Abortion will occur if coition is not indulged in. o We will now consider the second method of inducing ovular abortion; namely, by preventing the seminal fluid from coming in contact with the ovum in the geni- tal passage. This can only be done by placing some mechanical and impervious impediment in such a manner as will prevent the seminal fluid from escaping into the genital passages. As the ovum must be impregnated in the uterus, Fal- lopian tubes, or ovaria, if any obstacle is so placed as to prevent the passage of the spermatozoa through the neck into the cavity of the uterus, impregnation will not take place. As the cervical canal cannot be closed by any mechanical contrivance, we must turn to other means to prevent the entrance of the vivifying animal- cules. Dr. Casanova, in a work more ingenious than reli- / O able,* gives, in a chapter on the " Prophylaxis of Con- ception," the following as a preventive of impregnation : " The possibility of rendering fecundity ineffectual by artificial means, is founded in the fact that if an appro- priate foreign body be interposed between the sexual organs of the male and those of the female, sub coitu, fecundation will not take place, because the body will stand as a bar or impediment to the absorption of the aura spermatica emitted against it in the act of copu- lation." Dr. Casanova illustrates this phenomena by allusion to the discovery of Sir H. Davy, that a wire-gauze lamp prevents the flame within from reaching and * Contributions to Physiology and Medical Jurisprudence, page 96. 296 HALE ON ABORTION. exploding the explosive gas without. He goes on to say that if a small piece of sponge, or any analogous substance, be placed within the vaginal canal, sub coitu, it will produce the same effect as the wire-gauze : i. e., it will represent the intermediary agent which will interrupt the aura seminalis from being absorbed from within, thus rendering fecundation impossible." Although he says, " I have tried the experiment therapeutically more than once, and found the pheno- mena to correspond, and to be in perfect harmony with truth," we are obliged to deny the truth of his theory, and the reliability of his experiments. There are doubtless cases where this evidently ineffectual means would prevent impregnation, for there are cases where even the slightest precautions are sufficient. In refuta- tion of his assertion, I will state that I have known of many instances where the plan he describes a plan not new in this country was carefully and thoroughly tried, and in not one of these instances was it sufficiently effectual to be reliable. The reason is easily explainable by the fact that only an infinitesimal quantity of the seminal fluid is requisite for the purpose of impregnation. When we remember that the mucous membrane of the vagina is thrown into rugae or folds, which are more decided immediately after coition, it will be seen that a consid- erable quantity of the seminal fluid will be caught in these folds, and retained there after the sponge has been withdrawn, for it is impossible for a sponge, unless it be of great size to sweep out all the anirnalculse. For this reason also, all those contrivances which have for their object the removal of the semen with a sponge or other similar material, are unreliable in most cases. Dr. Casanova does not believe that impregnation is OVULAR ABORTION. 297 caused by the actual contact of the spermatozoa with the ovum, but by the absorption of what he terms the " aura seminalis" a kind of imponderable force. Even if this were true and the theory is utterly untenable it would be so much the worse for his plan, for it is evident that no material substance of a porous nature will prevent the absorption of an imponderable aura. I have been shown an india-rubber ball used for the purpose of preventing impregnation. It was directed to introduce it into the vagina, and place it against the os uteri, and allow it to remain six or twelve hours after coition. This plan, however, afforded no protec- tion from the influence of the semen, for conception took place in spite of it, and for very obvious reasons, namely : the spermatozoa will live several days in the secretions of the vagina. Leewenhock and other ob- servers have discovered them in a living condition in the uterus and Fallopian tubes, seven and eight days after connection. Of what use, then, is such a contriv- ance ? I have known conception to take place notwith- standing coitus was performed w r hile a large inflated rubber pessary was in the vagina, apparently complete- ly filling up that canal. A study of the nature of the spermatozoa will convince any one that they are capa- ble of insinuating themselves between any such sub- stance and the vaginal wall. There is but one contrivance that is sufficiently relia- ble to be mentioned and recommended, and one which is absolutely reliable so long as it remains intact, name- ly : a covering made to be worn by the male, of sufficient size to cover the whole of the penis. It should be made of firm, elastic india-rubber, or good gold-beater's skin. The first named material is to be preferred when a good quality is used. They are for sale under the 298 HALE ON ABORTION. name of "condom" by every druggist, and in all phar- macies, and the trade in them is considered legitimate. In selecting them, care must be taken that the material is firm, and contains no small orifices, and will resist the pressure of the air. Some will easily tear when air is forced into them. These are unfit for use, as are those from which the air escapes in minute quantities, with a very low, whistling sound, almost imperceptible to the ear. These pin-holes, as they may be called, are still large enough to permit the passage of a minute quan- tity of the fluid containing spermatozoa. After each connection, the " covering " should be examined care- fully, to see that no rent nas occurred during the act, and if such is found to be the case, injections will have to be used, as directed below. Some of these " cover- ings " are quite durable, and if proper care is taken of them, by cleaning, keeping them dry and inflated, and not alloVing them to become adherent to the box where they are placed, they may be used many times, and re- main uninjured and impervious. When it is known that spermatozoa remain in the urethra for many hours after coition, or until free urina- tion occurs,* it will be obvious to all that no second entrance of the penis into the vagina will be safe, unless protected by the covering, or after urination has taken place. Ignorance of the fact has led to the occurrence of impregnation, where the parties were very much astonished at the result. I will not notice at any length the plan of compress- ing the urethra so as to prevent the semen from escap- ing during the orgasm, and until the withdrawal has been effected, for such a plan would be productive of * Lallemand on Spermatorrhoea, p. 262. OVULAR ABORTION. 299 the most serious consequences, and result in organic dis- ease of the male organ of generation. I hardly need allude to the absurd doctrine taught by Dr. Casanova, that unless the woman participates, or enjoys the copulative act, conception will not take place. His foolish arguments to explain away the facts which disprove this theory, are unworthy the slightest notice from men of intelligence and science. It mat- ters not what the condition of the woman is, whether insensible, indifferent, or absolutely frigid, if the ovum is in the genital passages, and the semen comes in con- tact with it, impregnation will take place. We now come to the third and last method of caus- ing or permitting Ovular Abortion, namely : the des- truction of the spermatozoa. In order to treat this subject in a proper manner, we must make some inquiries into the nature of these pecu- liar organisms, upon which depend the fertilizing qual- ities of the seminal fluid. Notwithstanding the denial, by Casanova and a few other writers, that the spermatozoa are independent or- ganisms, or veritable animalcules, it is needless, in the present day, to enter into any lengthy refutation of the views of such authorities. Dr. Casanova says they are not animalcules, " though they possess that optical illusion, a sort of, but not an independent animal life that is, a life of motion, only, caused by the effects of light." (!) Such an absurd and incoherent assertion is too ridiculous to receive serious notice, and would not be noticed at all in this place, were it not that it is desired to convey to the reader a truthful idea of the nature and importance of these or- ganisms. I am aware that Dr. Carpenter writes that the spermatozoa " have no more claim to a distinct ani- 300 HALE ON ABORTION. inal character than have the ciliated epithelia of mu- cous membrane, which likewise continue in movement when separated from the body. They appear to be nothing else than cell-germs, furnished with a peculiar power of movement, by means of which they are ena- bled to make their way into the situation where they may be received, cheiished and developed." These as- sertions are as untenable as that of Dr. Casanova. I will here mention a few facts in relation to the nature and qualities of the spermatozoa, sufficient to disprove all the above statements. (a) Leewenhock, Gerber, Valentin*, Dujardin, Wag- ner, and other eminent microscopists, all testify to hav- ing discovered traces of organization in spermatozoa. Commenting on this, Hassall properly observes f that " the determination of the fact that the spermatozoa are possessed of even the smallest amount of organization, would involve their classification in the animal kingdom." (&) The motions of the spermatozoa are proof of their animal nature. Hassall says, " All the spermato- zoa contained in a drop of semen which has undergone dilution will not start into motion at once ; many of them will remain for a time perfectly motionless, and then suddenly, as it were by an act of volition, begin to move themselves in all directions." Speaking of their " mode of progression," the same writer says, " The motions of the spermatozoa are effected principally by means of the tail, which is moved alternately from side to side, and during the progression, the head is always in advance." It is stated that the spermatozoa of differ- ent animals move in a different manner, because they differ very much in their form and structure. This " The spermatozoa of the bear have a mouth, anua and stomach, or a convoluted intestine. (Sec illustration in Muller's Embryology, p. 1475). f Microscopic Anatomy, vol. 1, p. 225. OVULAE ABOKTION. 301 would not be the case if they were "nothing more than ciliated epithelium." Hassall also states that " in the varied motions exe- cuted by the spermatozoa, they exhibit all the charac- ters of volition ; thus they move sometimes quickly, at others slowly, alter their course, stop altogether for a time, and again resume their eccentric movements. These movements it is impossible to explain by refer- ence to any hygroscopic properties which may be inhe- rent in the spermatozoa, they appear to be so purely voluntary." Dr. Morris Wilson* says the spermatozoa when mov- ing through a fluid, " turn readily out of the way of any obstructions, but they have not the backward motion of vibriones." (Would ciliated epithelium avoid obstructions?) (c) The spermatozoa are influenced by the poisons, or chemical agents, in the same manner as animal organ- isms. While they " retain their locomotive powers for a very long time in fluids of a bland character for ex- ample, in blood, milk, mucus and pus, on the contrary, in reagents of an opposite character, and in those pos- sessed of poisonous properties, they soon cease to move ; thus in saliva and urine, unless these fluids be very much diluted, their motions are soon destroyed, and immediately cease in the acids and alkalies, iodine, strychnine and the watery solution of opium."f The narcotic poisons do not arrest the motions of ciliated epithelium. Lehman J says " the motion of the spermatozoa is de- stroyed by the solution of opium and strychnine ; the tail then generally remains extended." (Is not the ani- * "Diseases of the Vesiculse Seininales," in Lalleraand's Spermatorrhoea, p. 346. f Hassall's Microscopic Anatomy. f Physiological Chemistry, p. 70. 302 HALE ON ABORTION. malcule rendered tetanic by the poison?) Hassall thinks, the result of the application of these poi- sons, furnishes an additional argument in favor of the unimnlity of the spermatozoa, and one which it would be difficult, if not impossible, satisfactorily to contro- vert. Dalton* makes the bold assertion that the spermato- zoa cannot properly be considered as animals. He says their motions are " precisely analogous " to that of cili- ated epithelium. He further says that they are organic forms, produced in the testicles, and forming a part of their tissues, just as the eggs, which are produced in the ovaries, are a part of those organs. Draperf says, " it has never yet been established that anything answering to a true structural arrangement exists, and, upon the whole, it may be concluded that the appear- ances which have been by some supposed to indicate organization, are, in reality, only an optical illusion." Notwithstanding the assertions of these high author- ities, we must remember that the later discoveries with the microscope have overturned a great many just as bold assertions of the earlier physiologists. It will be more in accordance with true scientific modes of thought, not to assert of the spermatozoa a want of organization, because we cannot discover and demonstrate it, but to await the results of more minute investigations. Not only is it necessary to impregnation that the seminal fluid should contain these animalcules, but they must be perfectly organized, and alive. Wagner found that in the semen of hybrids the sper- matozoa were altogether wanting, or occurred in small numbers, and were ill-formed and ill-conditioned. It is * Human Physiology, p. 542. f Human Physiology, p. 519. OVULAE ABOETION. 303 a well-known fact that hybrids are incapable of bear- ing offspring. In men suffering from impotence, the seminal fluid is found destitute of spermatozoa, or if present, they seem to be either lifeless or of feeble vitality. It is generally believed that the introduction of semen into the uterus, the spermatozoa of which were dead, would not result in impregnation. M. M. Pro- vost and Dumas, who filtered the seminal fluid, found that the fluid portion, which passed through the filter, would not vivify the eggs (of a frog), while the more solid part, consisting of the spermatozoa, produced im- pregnation. The apparently contradictory experiment of Spallanzini does not controvert this, for it is not ab- solutely known that the spermatozoa of frogs die in thirty-five hours after being placed in water at a tem- perature of seventeen to nineteen degrees, or even in fifty -five hours in water three degrees above zero, while it is known that the spermatozoa of fishes will live sev- eral days and retain their power of impregnation. Moreover, in all cold-blooded animals, cold does not have that destructive effect that it does on the warm- blooded. From all the above,* it is evident that three proposi- tions may be laid down : I. That impregnation may occur, it is necessary that the semen contain living, perfectly organized spermato- zoa, and that these animalcules must come in contact with the ovum while in the living condition. II. That any agent which is capable, when brought in contact with the ''spermatozoa, of destroying their life, will prevent their power of impregnation. III. That if they are wholly washed out of the 304 HALE ON ABORTION. vagina and cervical canal immediately after coition, impregnation cannot take place. It follows, therefore, that to cause Ovular Abortion, by other than rules relating to the time of the act of coition, or the mechanical prevention of the contact of the spermatozoa with the ovum, the results of the second and third proposition must be obtained. To destroy the life of the spermatozoa while in the vagina, some substance inimical to their vitality must be thrown into that passage in such a manner as to come in contact with them, when holding the seminal fluid in solution. We must first ascertain the substances which, when thus brought in contact with the spermatozoa, will destroy their vitality and power of impregnation. Among the most prominent of these agents are, cold water, watery solution of opium, spirits of wine, salts, acukj alkalies, astringents, strychnine, and probably all narcotics and other poisons. Gelseminum, arnica, aco- nite, and other medicines, are among the latter. Has- sall says the spermatozoa are devoid of life in persons who have died from the poisonous effects of prussic acid. Under certain conditions, any one of the above men- tioned agents might be resorted to for the purpose of causing de vital ization of the spermatozoa, in order to insure ovular abortion. The selection of the agent would depend on the health of the woman, and the local diseases to which she was subject. The physician of the parties should be the judge of this matter. Cold water should generally have the preference in the majority of cases. By reference to a previous para- graph it will be seen that cold water causes motion OVULAR ABORTION. 305 to cease in human spermatozoa rolls them up and destroys their power of impregnating the ovum. Opium would hardly be admissible except under peculiar circumstances. The Same may be said of spirits of wine and strychnine. The latter, however, may be used cautiously, when there is great relaxation of the vaginal muscles, with prolapsus. I have known vaginal injections of a solution of strychnine, (one grain to one quart of water) to cure a most obstinate case of chronic prolapsus from atony of the muscular tissues. One drachm of the tincture of nux vomica in the same amount of water has been equally effectual. Either preparation, in cold water, if injected immediately after coition, would doubtless result in the destruction of the animalcules. A solution of common salt is quite popular as an enema for the prevention of conception. It is used at about the strength of ordinary sea-water. I have been informed by many of my patients who have used this agent, that it cured, in a short time, a profuse and long lasting Ieucorrho3a, and was quite effectual for the origi- nal purpose. The acids, even when used quite dilute, have the effect of destroying the motions of the spermatozoa. Acetic acid, or vinegar, largely diluted with water, is used to a considerable extent. Sulphuric acid has been recommended, and cases have come under my observa- ... tion where this was habitually resorted to. The water used as an enema is rendered slightly acid by it, not sufficiently so to cause any smarting of the mucous surface. A very popular and effectual mixture for vaginal enema is made of sulphuric acid and alum* * 5 Acid. Sulph. dil. 3j- Aluinen, 3j. Aqua, Iqt. 20 306 HALE ON ABORTION. Nitric and mwiatic acids might be beneficial in certain diseased conditions of the vagina and os uteri, and per- fectly safe as well as reliable for the purposes desired. The alkalies might be advised or permitted in cer- tain cases. It is said by Donne that when the secretion from the uterus is too alkaline, and that of the vagina too acid, they destroy the life of the spermatozoa and thereby induce sterility. Astringents have always enjoyed the most extensive popularity. They are resorted to by women in all parts of the world, under the instinctive idea that they contract the mouth of the womb, and prevent the en- trance of the seminal fluid. If this was the extent of the action of astringents, their use would be of no value ; in fact, they are of but little value unless used in such quantities as to destroy the life of all the animalcules. Alum is the most commonly used; sulphate of zinc ranks next in popularity. Tannin, and vegetable sub- stances containing that substance namely, geranium, oak-bark, etc., have all been used with success. Aconite, gelseminum, belladonna, arnica, and ham- amelis, might each be recommended for the purpose of preventing impregnation. Each would destroy the spermatozoa, and in inflammatory or congested condi- tions of the os, cervix, and vagina, would prove curative by their local action. Injections of any medicinal solution, or even of very cold water, no matter how destructive they may be to the spermatozoa, will prove useless unless they are used in a proper manner. It will not suffice to use them in small quantities, or hurriedly. Neither will it do to wait longer than two or three minutes after coition. The spermatozoa are very active when mixed with healthy vaginal mucus ; and, in women who have borne OVULAK ABORTION. 307 children, or in whom the cervical canal is patent, the animalcules enter the os uteri by their own volition in an incredibly short time. They also become lodged in the folds of the vaginal mucous membrane, where they remain unharmed for hours or days if the enema is not most thoroughly used. The injection, to be effectual for the prevention of impregnation by destroying the spermatozoa, must be used immediately after coition ; it must be thrown in with considerable force, and in a large quantity, in order to reach the animalcules which may be lodged in the mouth of the womb, or the rugse of the vagina. The ordinary vaginal syringe, holding but a few ounces, is not a proper instrument, unless it is very large, and is used six or eight times. The orifices of all vaginal syringes are generally too small, and should be enlarged. The most appropriate instrument is the Essex syringe with an extra large tube. Not less than one pint of water should be used, and if one or two quarts is thrown up, the danger of impregnation is materially lessened in proportion. The third proposition implies the use of /ion-medicated fluids thrown into the vaginal canal for the purpose of washing away all the animalcules lodged therein during coition. For this purpose fluids might be used which were not inimical to the life of the spermatozoa, namely, warm water, milk, etc., and if a sufficient quantity was used would probably be effectual. There would be danger, however, that the bland character of these fluids would preserve the life of a few of the animalcules, and thus allow impregnation to take place. Cold waiter is the most generally useful fluid to be used as an enema. It should be used immediately after .".MS HALE ON ABORTION. coition, and in quantity not less than one quart. The temperature need not be lower than 42, and should not be higher than 60. An Essex syringe, throwing a continuous stream, should be used, and the water should be directed to all parts of the vagina, particu- larly the upper portion, around the cervix uteri. The best position for the woman to assume is the sitting- posture, on the side of a stool or any low seat, in such a position that the water when thrown up will gravitate downward and outward. None of the fluid should be allowed to remain in the vagina. This last method is preferable to all the others, as a general one. No risk of injury is incurred. I have never known but one instance, where cool vaginal injec- tions could not be borne, and in this it only caused a a temporary spasmodic and painful action of the uterus. There is but one condition in which it would prove ineffectual ; namely, when the uterus lies so low in the pelvis, and the cervical canal so ope^ as to permit the entrance of the seminal fluid into 7 the uterine cavity during the act of coition. In this state of the organ, impregnation could hardly be prevented, as it is not always safe to inject fluids into the cavity of an unim- pregnated uterus. TABULAR VIEW. 309 The following TABLE icitt give at a glance the condition of the uterine contents, and the treatment to be adopted, during the THREE great periods of utero-gestation. From conception to end of third month. From end of third month to I From end of sixth month to end of sixth. full term. Placenta oped. not devel- Decidual membrane adherent to the uterus. Placenta developed and; Placenta developed and attached to uterus. attached to uterus. Decidual membrane Decidual membrane non-adherent. non-adherent. Contractile power of| Contractile power of! Uterus capable of forc- the uterus too feeble to! uterus capable, in some'ible expulsive contrac- expel embryo, etc., or instances, of expelling tions. arrest haemorrhage. placenta and embryo. Haemorrhage before ex- Haemorrhage before ex- Haemorrhage after ex- pulsion of after-birth. pulsion of after-birth. pulsion of after-birth. REMEDIES FOB HAEM- REMEDIES FOB H.EM- REMEDIES FOR HAEM- ORRHAGE. Sabina, erig- OBRHAGE. Sabina, cro- ORRHAGE. Secale, caulo- eron, tanacetum, arnica, cus, erigeron, erechthites, phyUin, macrotin, erig- hamamelis, trillium, cin- secale, cinnamon, ice, and eron, ice, cold and hot namon, ice, cold water, cold or hot water, gal- water, galvanism (tam- hot water, tampon, sulph. vanism tampon. pon never). Pressure on acid. uterus, or manipulations with the hand. REMOVAL OFDECIDTJA. REMOVAL OF AFTER- REMOVAL OF AFTER- Blunt hooks forceps BIBTH. Secale, dry cup- BIRTH. Forceps, blunt injections. ping, galvanism, pulsa- hook, secale, caulophyttin, tilla, caulophyUin, macro- macrotin, gossypium, gal- tin, gossypium, reflex irri- vanism, dry cupping, tation by tampon, etc.; uterine irritation by cold blunt hook, forceps. water or the hands (tam- pon never). PART VI. JURISPRUDENCE OF ABORTION. SECTION I. The consideration of the Jurisprudence of Abortion, includes the moral and legal bearings of both obstetric and criminal abortion. I cannot commence this portion of the work in a more appropriate manner than by quoting entire a Lec- ture delivered by my venerable friend and colleague, who lately occupied the chair of Medical Jurisprudence in Hahnemann Medical College. CRIMINAL ABORTION: A LECTURE BEFORE THE CLASS OF HAHNEMANN MEDICAL COLLEGE, DECEMBER, 1864. BY PROF. A. E. SMALL. Next to the crime of infanticide is that of criminal abortion. It matters not by whom committed, whether by the mother herself or some interested friend, nurse or physician. The procuring of abor- tion, under all circumstances, is a direct violation of the laws of the physical constitution, and almost always a violation of that holy commandment, " Thou shalt not kill." Before we proceed to discuss the nature of this crime in the light of reason, and in reference to what legislation there has been upon the subject, it is proper to test its heinousness in the light of the moral law, which regards the willful killing of a human being, at any stage of its existence, as nothing short of murder. When we consider the fact that foetal life is human life, distinct from that of the mother's, and dependent upon an organization as distinct from that of the mother's as if it were entirely liberated from its resting place in her womb, we cannot avoid the conclusion that the destruction of such a being would be the destruction of a human life, and that he or she who had an agency in perpetrating the deed would, in the eye of the moral law, be guilty of murder. In order to gain a better understanding of the bearings of the subject, abortion in the abstract must be considered. To begin with a proper definition it is a violent and premature expulsion of the product of conception, independently of its age, viability and normal formation. In the investigation of the subject 314 HALE ON ABORTION. as a crime, all cases of abortion that result from natural causes, or the result of accident, or justified by the rules of medicine, whether to save the life of the mother or her child, will be set aside. We shall confine our discourse to such cases only where the attempt at premature expulsion of the product of conception is artificially unnecessarily and intentionally made, and without which they would not otherwise have occurred. The laws of the land do not recognize that unnecessary abortion per se is a crime, inasmuch as the act is not directed against the life of the mother, and because, too, she is generally a party to the action performed, and when no manifest injury or loss of life hap- pens to the mother, it is regarded a mere misdemeanor ; or, if other- wise, the law does not take cognizance of the act as a capital offense. Able authorities upon the subject have pointed out the inconsist- ency of the law as contemplating the crime as directed against the mother, and not against the fetus, when in fact no criminal intent against the mother can be affirmed, but against the foetus. The act, when unnecessarily performed, manifestly seems to have been undertaken from one of two reasons either to prevent the pro- duct of conception from receiving life ; or if living,- to destroy it. - "We shall produce evidence to show that the former cannot be the case, and, consequently, that the latter is the sole intent when the act is committed. To constitute a crime, a malicious or wicked attempt is supposed to exist, and as the intent in attempting to produce abortion is against the product of conception, and not against the mother, we cannot but regard this assumption of the law as erroneous ; tending rather to increase the frequent repetition of the crime instead of exerting a wholesome influence against it. For unless the woman die in consequence of the attempt, it is declared, in every state of pregnancy, a mere misdemeanor ; or where injury is done the mother, not necessarily fatal to her life, the crime may be considered a felony, and punishable by fine or temporary imprisonment. The mag- nitude of the crime against the second human victim being entirely overlooked. We shall, for the present, omit the further consideration of the subject as treated both in common and statutory law, our purpose being to show that abortion is primarily a crime of the most heinous character, directed with malicious intent against human embryotic and festal life, and in pursuing this course we shall attempt to show the fallacy of the arguments urged by interested parties in extenua- tion of the offense. Excepting all accidental and necessary cases of abortion, it must be evident that abortions must be intentional, and must be occa- sioned by the " malice aforethought " of the law. It has been stated that the malicious intention, unless otherwise shown, is not directed against the mother, but against the product of her womb. Hence the whole criminality of the offense turns on this one fact JURISPRUDENCE OF ABOETION. 315 the real nature of the fetus in utero. If the foetus be a lifeless ex- cretion, however soon it might have received life, the offense would have been of minor consequence. " If the fcetus be already, and from the very outset, a living human being, and existing independently of its mother, though draw- ing its substance from her, its destruction, in every stage of preg- nancy, is MURDER. Every act of procuring abortion," rules Judge Kihg, of Philadelphia, " contrary to the usual interpretation of the law, is murder, whether the person perpetrating such act intended to kill the woman, or merely feloniously to destroy the fruit of her womb." In Dr. Storer's contributions to Obstetric 'Jurisprudence maybe found a complete reply to the plea of ignorance of the nature of the crime, which is often urged in extenuation. He says : '' Ignorance of the law is held no excuse. The plea of ignorance of guilt could hardly better prevail, where its existence is implied by common sense, by analogy, and by all natural instinct, binding even on brutes. * * * Common sense would lead us to the conclusion that the fcetus is, from the very outset, a living and dis- tinct being. It is alike absurd to suppose identity of bodies and independence of life, or independence of bodies and identity of life ; the mother and the child within her, in abstract existence, must be entirely identical from conception to birth, or entirely distinct. Allowing, then, as must be done, that the ovum does not originate in the uterus ; that for a time, however slight, during its passage through the Fallopian tube, its connection with the mother is wholly broken ; that its subsequent history is one merely of development, its attachment merely for nutrition and shelter it is not rational to suppose that its total independence, thus once established, becomes again merged into total identity, however temporary ; or that life depending on nine months' growth, or on birth, because confess- edly existing long before the latter period since quickening at least, a time varying widely as to limits, dates from any other period than conception." "Another argument is furnished us, but differing. The fcetus, previous to quickening, must exist in one of two states, either death or life. The former cannot take place, nor can it ever exist except as a finality. If its signs do not at once manifest them- selves, as is generally the case, and the fcetus is retained in utero, it must either become magnified or disintegrated it can never be- come vivified. If, therefore, death has not taken place, and we can conceive no other state of the fcetus save one, that namely, life, must exist from the beginning." " These reasons are strengthened by the reasonings from analogy. The utter loss of direct influence by the female bird upon its off- spring from the time the egg has left her, and the marked effect originally of the male. The independence in body, in movement and in life, of young marsupial mammals, almost from the very moment of their conception, identical analogically with the intra-uterine 316 HALE ON ABORTION. state of other embryos nourishment by teat merely replacing that by placenta at an earlier period ; the same in birds, shown by move incuts in their egg, on cold emersion before the end of incubation. The permanence of low vitality or of impaired or distorted nervous force, arising from early arrest or error of development, and neces- sarily contemporaneous with it, are all instances in point." " The human instinct, unaided by reason, invariably leads to the protection of embryonic and foetal life. It is said that reason sup- plants this instinct which is enjoyed in common by the brutes. But this may be doubted, inasmuch as the absence of reason in idiots and insane persons does not impair the maternal instinct. What- ever ideas the human mind, by reasoning, may have forced itself to believe or entertain, let the slightest proof of the existence of foetal life be alleged, and maternal instinct at once makes itself known." Thus far, incidental proof concerning the commencement of foetal life, and consequently the manifest guilt of unjustifiable abortion, becomes apparent. If there exists any doubt of the vitality of the contents of the womb in early pregnancy, none whatever can be cherished after the period of quickening. This period, which betokens the existence of a living fcetus in the womb of the mother, declares emphatically that there is an intra- uterine life that may be destroyed by violent hands ; that this posi- tive evidence becomes revealed to the mother by unmistakable sen- sations, is universally admitted ; and this accounts for the fact of abortions being much more rare after this period than previous. But singular as it may seem, quickening is often absent through- out pregnancy, and other evidences are relied on to establish the fact. These cases are confessedly exceptions to the rule. In most cases of pregnancy it does occur, but varying very greatly in point of time. In the same woman, in successive seasons of pregnancy, the period of quickening, reckoning from conception, has varied from fifteen to thirty days. In the .greater number, the period occurs from the one hundred and twentieth to the one hundred and thirtieth day after conception. But from infra-uterine causes, this period may be lengthened to one hundred and forty, or even one hundred and fifty days, and yet, from facts which cannot be disputed, the foetus is living. "We have witnessed premature births in several instances where the mother was in doubt of her situation till the hour of parturition arrived. Only a few weeks ago, a lady who had been married two years or more applied for counsel in reference to her health, stated that she had not menstruated for seven months, that her form had changed but little, and that at no time had she been conscious of any sensation that would lead her to suppose that she had been car- rying in her womb a living child. At the same time, her feet were swollen, which, in connection with other signs of anasarca, led her to believe that she was the victim of disease not dependent on preg- nancy. Scarcely a week, however, elapsed, before there was ocu- lar demonstration of the incorrectness of her conclusions ; the hour of parturition arrived, and she gave birth to a livinf child. JURISPRUDENCE OF ABORTION. 317 In premature births, where quickening has not occurred, we have the most positive evidence of early independent and vital existence. These births sometimes occur previous to the time when quickening may be looked for, and in some instances by the ear there is conclu- sive evidence to be gained of the existence of a living being in utero, when no quickening has taken place. It will be conceded, then, that the period of manifest quickening is by no reasonable conclusion to be regarded the commencement of foetal life. The period set by some of the old writers was the third day after conception, and this is quite as reasonable, and yet neither is to be accredited as true. In order to arrive at the conclusion that embryotic life exists from the commencement to the end of pregnancy, it is not necessary to set up the claim of sentience and will, as some writers have done. For while perfection of endowment does not exist with the embryo, its independent life can be conceded, with prophetic endowments for future development, in the womb and after birth, of all the attributes of human perfection. We must concede this, if any- thing, for how can the embryo merge into the foetus without a per- fectly independent excito-motory system, distinct from that of the mother? If we admit this, we are brought directly to the conclu- sion, that the existence of a distinct and independent nervous cen- tre must be as self-acting and living as that of the mother. If we have succeeded in proving the existence of foetal life, be- fore quickening has taken or can take place, even though but the be- ginning of undeveloped faculties, the inalienable rights of a human being are implied, and this should compel us to believe that unneces- sary abortion is a crime. This once established, we are struck with a full sense of human degradation ; mothers imbruing their hands in their infants' blood ; fathers equally guilty, counseling and procuring the commission of the crime ; nurses who lend themselves to the infamy ; mem- bers of the medical profession, made wicked by their wholesale murders, out-IIeroding Herod eclipsing in criminality the pirate upon the seas, the midnight robber or highwayman ; wretches who make this kind of murder a trade ; who go forth with falsehood and lies, in defiance of the mandates of the Almighty; public com- placency that nurses the crime, or palliates it, or with insulting claims of legal assumption that it is a mere misdemeanor to go forth as a destroying angel to prey upon human life. Who can uphold or defend so common a violation of all just law, human and divine ? Who can justify such assault upon all instinct and reason? Let those answer who would seek, if they could, some reasonable excuse for this waywardness. That criminal abortion is carried on to a great extent in our country, is indeed probable, and that it is carried on apparently by those having high claims to respectability, we also admit, and fur- ther, we admit the plausibility of the motives that frequently lead to the act ; and these are of sufficient importance to enter concisely 318 HALE OX ABORTION. into our discussion. Does not the motive give moral quality to the ac t? some may inquire. "We have already said that necessary and justifiable abortions, in accordance with the rules of medicine, are >.. in, -times demanded. The lives of human beings are, under more cir.-umstan<-(>< than a few, sacrificed to prevent greater evils. But far be it from us to .offer any palliation for the crime of murder. \Vli.-M a woman, a wife, either with or without the consent of her husband, applies to an abortionist for the purpose of ridding herself of tin- product of conception, she will always make a show of rea- son for the act, by attempting to show a necessity for it. She may set up the claim of being unable to have the responsibility of child- ren : that she cannot educate them or keep them fed and clothed, or above degradation ; that her own health will not permit it ; that the period of gestation subjects her to confinement and keeps her from society, and she might as well be dead as alive. We have known some physicians to listen to an appeal like this, and yield to the dic- tates of a blind sympathy, especially when a generous fee was forth- coming to more effectually close their minds against all sense of moral obligation, and plant themselves upon the flimsy reasoning of such women, and while prostrate before mammon would write a prescrip- tion for some powerful deobstruent. But. they lend countenance to crime by such acts, and become particeps criminis in a murderous transaction. Such a woman's reasonings are as baseless as a fabric upon the sand. She has a husband to father her offspring, a Heavenly Father to protect her on the voyage of life, and in all probability an angel sent for her future comfort; and would any but a God- forsaken father and mother, and a God-forsaken physician, ever enter into a conspiracy to destroy human life upon such flimsy grounds? Thou- sands of cases of this kind are constantly occurring in the large cities and towns of our country, to enrich such female wretches as Mads. Restell, Beaumont and others, who levy imposing taxes in order to support them in the crime. By all that is human, all that is noble and grand in the attributes of true manhood, and by every consideration that relates to time and eternity, every honorable phy- sician should set his face .against this practice, and hold it UP as murder, in public and private. Let him scorn to sympathize with the barbarity, and feel that fees taken for such agency would pro- duce an uncomfortable sensation about his neck, and bind him as firm as fate to perdition. But it may be urged that illegitimate pregnancy is a different matter, and that every right-minded physician should be ready to save the reputation of a great many victims of this sort from utter ruin, and their families from disgrace. A mere glance at the crime of abortion, without considering its heinous nature, might cause the unwary physician to fall into temptation. A young" lady of pre- vioug good reputation has fallen. Will it raise her from degrada- tion to make a violent assault upon the intra-uterine life that is the fruit of her imprudence, or, in other words, would any physician JURISPRUDENCE OF ABORTION. 319 feel hinjself worthy of saying his prayers at night, after he had lent his hand to commit a deliberate murder to save the' reputation of an already disgraced young woman ? What good would he accomplish by the act ? Experience proves that the fallen one seldom recovers, and her seducer is made no better, and the physician made more in- famous than either. Such, nevertheless, should command our sympathy, and we should do all we can to promote their temporal, physical and moral well- being. And we can do much in that direction, if we regard first of all our duty to God and our obligation to obey all just laws, both human and divine. It will be proper to guard the reputation as far as we can, and by all possible means consistent with divine and human laws. But God forbid that we should do evil that good may come. I cordially and sincerely subscribe to most of the views above set forth, so far as relates to the destruc- tion of the ovum, without good and sufficient cause. I differ, however, with some of my professional brethren, in relation to the propriety of inducing abortion or pre- mature labor when certain diseases and conditions exist. I hold that in no instance should the life, or even health of the mother be sacrificed to save that of an im- pregnated ovum, before the date of its " viability." The dogma that the embryo, before that date, is of the same importance as after, is yet debatable. I can not, therefore, look upon the destruction of the ovum before that period as murder. If we were to carry the criminality of the deed back to the period of impregna- tion, we may as well carry it back to the period of ovulation, and believe with the ancient Hindoos, that the voluntary loss of an unirnpregnated ovum was a criminal act. According to Robertson, early marriages in India were obligatory, in consequence of an ancient theory of generation, much resembling the latest modern ovarian theory. It was taught that if an unmarried girl has the menstrual secretion in her father's house, he incurs a guilt equal to the destruction of the foetus ; 320 HALE ON ABORTION. for the girl is capable of conceiving, and should be allowed to conceive ; menstruation being the loss of an ovum, which is equivalent to the loss of a foetus. According to the laws of the Shastras, females must be given in marriage before the occurrence of mens- truation ; and, should consummation of the marriage ' O not take place until after this event, the marriage is a sin. These ancient doctrines are -not to be treated with indifference. The ovum, is the receptacle or vehicle of the human soul. If the receptacle is voluntarily allowed to be discharged unimpregnated, it certainly is a crimi- nal offence in a certain degree, for the existence of a human being is prevented. On the contrary, lawgivers or physiologists have no right to establish any date, anterior to viability, after which the unnecessary induction of abortion is a crimi- nal offence. In relation to this subject, I herewith present a paper on the subject of Criminal Abortion, prepared by my colleague, Dr. Charles Woodhouse, the present incum- bent of the chair of Medical Jurisprudence and Insanity in Hahnemann Medical College. CRIMINAL ABORTION ITS JURISPRUDENCE. In our remarks on this branch of our subject, it is a matter of regret that the laws of our country in relation to it, are far from being all that the interests of society demand. But it is the duty of the medical man, and especially the medical author, to do what he can to correct these mistakes, and supply their deficiencies. It is in this conviction that we consider, in this place, this momentous subject. In medicine, we understand by abortion the expulsion of the foetus before the sixth month of gestation. If this expulsion takes JUKISPKUDEXCE OF ABORTION. 321 place between the sixth and ninth month, this, in medical parlance, is termed miscarriage, or premature labor. The popular word for both is miscarriage. And the law does not make the distinction made by medical men. In many instances the law, unfortunately, recognizes the popular falsehood, that a woman may be at a cer- tain point of time, " not quick with child," and in the next instant " quick with child," and this event is supposed always to take place several months after conception. It is needless to say, that no sound physiologist can give the least sanction to this error ; an error fruitful in sin and crime,- however venerable for age. Law- makers, as well as people, need enlightenment on this matter. Those who believe that at a certain period, say the fourth month after conception, the fcetus for the the first moment begins to live, will agree that it is no moral wrong to remove it before that time, and justify themselves for this crime on this false ground. But a little reflection must satisfy the reason, that the fcetus from the beginning must exist in one of two states, life or death. If dead from the beginning of gestation, that death is a, finality. The mother has no power to give life to a dead fcetus within her. If the fcetus is alive at the fourth or fifth month, or in any period of utero-gesta- tion, it must have been alive from the beginning. Unless the word " quickening," in connection with this subject, can be so used as to guard against error, it had better not be used at all. It is to be hoped that, at all events, the absurd distinction of "quick and not quick with child," will soon be banished from the legal codes of all civilized lands. And inasmuch as the laws, in many States, do not, (to use the language of Storer), "recognize the true nature of the crime of abortion, draw unwarrantable distinctions, allow many criminals to escape, neglect to establish a standard of justification, and in many respects are at variance with equity and justice," every true physician should aim to perfect, as far as his influence may go, codes for courts, and ideas for the people, until the Divine command, " Thou shalt not kill." shall be understood to apply alike to the taking away of all human life, fcetal or otherwise. We will now give a brief view of some of the laws of different countries and States, on abortion : ENGLAND. In this country the absurd distinction of " quick and not quick " is now done away with. "Within the reign of the pres- ent Queen the following law has been enacted : " Whosoever, with the intent to procure the miscarriage of any woman, shall unlaw- fully administer to her, or cause to be taken by her, any poison 01 21 HALE ON ABORTION. other noxious thing, or shall unlawfully use any instrument, or othf r means whatsoever, with the like intent, shall be guilty of felony, and being convicted thereof, shall be liable at the discretion of the court, to be transported beyond the seas for the term of hi? or her natural life, or for any term not less than fifteen years, or to 1)0 imprisoned for any term not exceeding three years." It will be seen at a glance, that this law makes no exception in respect to medical men, who may adopt, for any purpose or with any motive, this practice. It would doubtless be essential for him to show, in case of prosecution for this offence, that his motives were as good as those of the surgeon's in amputating a badly diseased limb, to ave himself from the penalties of the law. The English law is clearly against the practice, by any body. SCOTLAND. Mr. Allison, a late writer on Scottish law, states it thus : ' If a person gives a potion to a woman to procure abortion, and she die in consequence, this will be murder in the person giving it, if the potion was of that powerful kind which evidently puts the woman's life at hazard." Further, "Administering drugs to procure abortion is an offence at common law, and that equally whether the desired effect be produced or not." In 1806 and 1823, persons who used instruments for this purpose, were sentenced to transportation for this offence. However it may be in actual practice, the Scotch law, as given by Allison, makes no exception in behalf of medical men. Like the law of England, it shows some advance in a right direction, by discarding the phrase, "quick and not quick," etc. FBAXCE. The Code of Napoleon declares that every person who. by means of ointments, beverages, medicines, acts of violence, or by other means, shall procure the untimely delivery of a pregnant woman, although with her consent, shall be sentenced to confine- ment." The mother procuring abortion on herself is similarly pun- ished, under the same code. And it also provides that "Physicians, surgeons, apothecaries, and other officers of health, who shall pre- scribe or administer such means of abortion, shall, if miscarriage ensue, be sentenced to hard labor for a limited time." AUSTRIA. The criminal code of this country, established in 1787, by Joseph II., decrees that a woman with child, using means to procure abortion, is to be imprisoned not less than fifteen years, nor more than thirty, and condemned to the public works. If married, the punishment is still greater. Even advising abortion is severely punished, and where the accomplice is the father of the infant, the punishment is increased. JURISPRUDENCE OF ABORTION. 323 GERMANY. Deck gives the following summary of the laws of Germany : If produced within thirty weeks from the time of con- ception, the woman or her aiders are imprisoned from two to six years. The punishment when committed in the last month of pregnancy, is imprisonment from eight to ten years. ITALY. The laws punish the woman who makes the attempt only, to confinement from six months to a year ; if she is successful in the attempt, she is confined from one to five years. If the father of the foetus is a party to the crime, his punishment is still greater. The party attempting abortion against the will of the mother is punished with four to ten years' severe imprisonment ; and if the life of the mother is endangered, or her health impaired, the impris- onment is five to ten years. STATE OF NEW YORK. The laws of this State, on abortion, are now embraced in three sections, one of which provides that for the willful commission of this crime, by medicine or instrument, the offender shall be imprisoned in the county jail not less than three months, nor over one year. This section omits the distinction of i( quick and not quick." Another section provides for punishing the offence, committed on a woman quick with child, with intent to destroy the child, unless necessary to save the life of the mother. Otherwise than for this purpose, if either child or mother die in consequence, the offence is manslaughter in the second degree, and the punishment is State prison, for not over seven nor less than four years. A further section provides that the willful killing of an unborn quick child, by an injury to its mother, which would be murder if it resulted in her death, is manslaughter in the first degree, and the penalty is State prison for not less than seven years. This great State has for its motto " Excelsior," and doubtless may for many good reasons still use it ; but it needs to follow in the wake of England and Scotland, and younger sister States, in discarding from its laws on abortion the pernicious and absurd phrase, " quick and not quick," etc. STATE OF CONNECTICUT. Here this absurd distinction of "quick and not quick," still remains, but the crime may be punished by State prison for life. STATE OF OHIO. In the laws of this State, the same absurd dis- tinction is kept up as in New York and Connecticut, but there is a provision justifying the physician in saving the life of the mother, even at the expense of that of the fcetus. 324 HALE ON ABORTION. STATE or MASSACHUSETTS. In 1845, this State adopted a law, discarding the distinction of "quick," etc., and providing that abor- tion, by whatsoever means produced, if the woman die, shall be pun- ished by imprisonment for not less than five years, nor more than twenty. If the woman do not die, the offence is a misdemeanor, and the punishment not over seven years, nor less than one, and by a fine of not over $2,000. STATE OF MISSOUBI. The penalty for this crime here is impris- onment not over seven years, and a fine not over $3,000. STATE OF VIRGINIA. This offence is here punished by confine- ment in the penitentiary not less than one nor over four years. In all these named States, provisions are made for exempting from punishment any physician, or other person, where the act is done in good faith, with intent to preserve the life of either mother or child. (See Beck. Med. Jurisprudence, Vol. I., page 584). STATE OF ILLINOIS. In the laws of this State, the absurd dis- tinction alluded to is not retained. The punishment is confine- ment in the penitentiary not over three years, and a fine not over $1,000. STATE OF IOWA. From the year 1851 to 1858 there were in this State, strange to say, no laws punishing the procurement of abor- tion. Prior to the year 1851, the "willful killing of an unborn quick child, by drugs or violence," was punished as manslaughter. But for this omission of duty and once legal recognition of the false distinction of "quick and not quick," etc., Iowa has nobly atoned by giving a very good law (a model for some other States) on this subject. It reads as follows : " That every person who shall will- fully administer to any pregnant woman any medicine^ drug, sub- stance or thing whatever, with the intent thereby to procure the miscarriage of any such woman, unless the same shall be necessary to preserve the life of such woman, shall, upon conviction thereof, be punished by imprisonment in the county jail for a term not exceeding one year, and be fined in the sum not exceeding one thousand dollars." STATE OF CALIFOBNIA. The law 'against abortion in California, says The Medical and Surgical Reporter, is exceedingly stringent. It declares that the person on whom an abortion is practised shall be held as guilty as the. abortionist. The object of this feature of the law is to relieve the physician of vexatious lawsuits, to which he is sometimes subject by the attempt of certain wicked females to fasten upon him criminal abortion, when he has not even been applied to at JURISPRUDENCE OF ABORTION. 325 all in the matter. A case of this kind is said to have occurred in. San Francisco, and illustrates the necessity of the law in that State, even though the cases which may occur under it may be rare. Procuring abortion is justly regarded as a crime of great magnitude, and the laws of all the States, so far as we are informed, inflict upon the perpetrator of it a heavy penalty ; and the law is right. Its penalties are none too severe ; indeed hardly enough so, to prevent its occasional, if not frequent violation. These citations of some of the laws on abortion, are sufficient to show how this crime is viewed in different States and countries, and also to call attention to such improvements in them as the facts in physiology and the authority of the divine law shall suggest and require. The laws should in no case create or perpetuate the dis- tinction of " quick and not quick with child," as it is repudiated by right reason and sound physiology. The fact should also be pressed upon the attention of law-makers that a pregnant woman may, her- self, be mistaken as to whether quickening has taken place or not, and that she may bear a living child without having been ever con- scious of quickening having ever taken place in her case at all. The laws should leave no loop-holes for the escape of the offender, who knows the nature and enormity of the crime he or she commits. One State, for instance, could be cited, where the laws are perhaps sufficiently severe against the crime of abortion, when produced by drugs, but, singularly enough, says nothing against its production by instruments. The moralist has a duty to do in the premises, and all books on abortion should be deemed exceedingly faulty, which do not bear testimony against this evil, and help to aid its suppression. [Dr. Woodhouse has obtained, with much difficulty, the existing laws relating o abortion in the States above mentioned. In the other States of the Union we cannot ascertain what change, if any, has been made in their laws relating to criminal abortion, since the date of the work on that subject by Dr. Storer.] Dr. Storer, writing in I860,* gives the following as the laws of the various States : " In the following States Rhode Island, New Jersey, Pennsyl- vania, Delaware, Maryland, North Carolina, South Carolina, Geor- gia, Florida, Kentucky, Tennessee, Iowa,f and the District of Columbia, there appear to exist no statutes against abortion, and * Criminal Abortion, p. 75. f Iowa has since passed a very good law. HALE ON ABORTION. the crime can only be reached at common law and by the rulings of the courts." So far the instances in this country of an absence of special stat- utes. Where such exist, they may be variously classified. Reserv- ing for a little all other considerations, we find them at once falling in to. four great divisions. 1. Those acknowledging the crime only after quickening has occurred : Connecticut, Minnesota, Mississippi, Oregon. Arkansas, II. Those acknowledging the crime throughout pregnancy, but supposing its guilt to vary with the period to which this has ad- vanced : Maine, Ohio, New Hampshire, Michigan, New York, Washington. III. Those acknowledging the crime throughout pregnancy, un- mitigated ; but still requiring proof of the existence of this state : Vermont, Missouri, Massachusetts, Alabama, Illinois, Louisiana, Wisconsin, Texas, Virginia, California. Kansas, IV. That, like the present English statute, requiring no such proof, and punishing also the attempt, even though pregnancy do not exist : Indiana. Briefly to recapitulate these groups : Maine, Class II. New Hampshire, " II. Vermont, " III. Massachusetts, " III. Rhode Island, no statute. Connecticut, Class I. New York, " H. New Jersey, none. Pennsylvania, none. Delaware, none. Maryland, none. District of Columbia, none. Virginia, Class III. North Carolina, none. South Carolina, none. Georgia, none. Florida, none. Alabama, Class III. Mississippi, Louisiana, I. " III. Texas, " III. Ohio, Class II. Indiana, " IV. Illinois, " III. Michigan, " II. Kentucky, none. Tennessee, none. Missouri, Class III. Arkansas, I. Wisconsin, " III. Iowa, none. Minnesota, Class I. California, " III. Oregon, I. JURISPRUDENCE OF ABORTION. 327 MISSISSIPPI. " The willful killing of an unborn quick child, by any injury to the mother of such child, which would be murder if it resulted in the death of the mother, shall be deemed manslaughter. " Every person who shall administer to any woman pregnant with a quick child, any medicine, drug, or substance whatever, or shall use or employ any instrument or other means, with intent thereby to destroy such child, unless the same shall have been necessary to preserve the life of such mother, or shall have been advised by a physician to be necessary for such purpose, shall be deemed guilty of manslaughter."* Punishment, by fine not less than one thou- sand dollars, or imprisonment in the county jail for not more than one year, or in the penitentiary for not less than two years. ARKANSAS. " The willful killing of an unborn quick child, by any injury to the mother of such child, which would be murder if it resulted in the death of such mother, shall be adjudged manslaughter. " Every person who shall administer to any woman pregnant with a quick child, any medicine, drug, or substance whatever, or shall employ any instrument or other means, with intent thereby to destroy such child, and thereby shall cause its death, unless the same shall be necessary to preserve the life of the mother, or shall have been advised by a regular physician to be necessary for such purpose, shall be deemed guilty of manslaughter."! MINNESOTA. The willful killing of an unborn infant child, by any injury to the mother of such ehild, which would be murder if it resulted in the death of such mother, shall be deemed manslaughter in the first degree. ; ' Every person who shall administer to any woman pregnant with a quick child, any medicine, drug, or substance whatever, or shall use or employ any instrument or other means, with intent thereby to destroy such child, unless the same shall have been necessary to preserve the life of such mother, or shall have been advised by two physicians to be necessary for such purpose, shall, in case the death of such child or of such mother be thereby produced, be deemed guilty of manslaughter in the second degree. "J Punishment for first degree, imprisonment in the territorial prison for not less than seven years ; and for second degree, not more than seven years nor less than four. MAIXE. Whoever administers to any woman pregnant with child, whether such child is quick or not, any medicine, drug, or other sub- stance, or uses any instrument or other means, unless the same were done as necessary for the preservation of the mother's life, shall be punished, if done with intent to destroy such child, and thereby it was destroyed before birth, by imprisonment not more than five years, or by fine not exceeding one thousand dollars ; if done with intent to procure the miscarriage of such woman, by imprisonment * Revised Code of Mississippi, 1857, chap. 64, p. 601. Digest of Statutes of Arkansas, 1848, chap. 51, p. 325. Revised Statutes of Minnesota, 1851, chap. 100, p. 493. 328 HALE ON ABORTION. ) than one year, and by fine not exceeding one thousand dollars.'* Xr.w HAMPSHIRE. "Every person who shall willfully administer . proirnant woman any medicine, drug, substance or thing what- 11 use or employ any instrument or means whatever, with thereby to procure the miscarriage of any such woman, unless the same shall have been necessary to preserve the life of such woman, or shall have been advised by two physicians to be necessary for that purpose, shall, upon conviction, be punished by imprison- ment in the county jail not more than one year, or by a fine not exceeding one thousand dollars, or by both such fine and imprison- ment, at thefliscretiou of the court. " Every person who shall administer to any woman pregnant with a quick child, any medicine, drug, or substance whatever, with in- tent thereby to destroy such child, unless the same shall have been necessary to preserve the life of such woman, or shall have been advised by two physicians to be necessary for such purpose, shall, upon conviction, be punished by fine not exceeding one thousand dollars, and by confinement to hard labor not less than one year nor more than ten years. Any person who shall cause the death of any pregnant woman, in the perpetration or attempt to perpetrate either of the crimes mi'iitioned in the two preceding sections, or in consequence of the perpetration or the attempt to perpetrate either of said crimes, shall be taken and deemed to be guilty of murder in the second degree, and be punished accordingly. "Any woman who shall voluntarily submit to the violation of the provisions of this act (this and the three preceding sections!) upon herself, shall be punished by imprisonment in the county jail not exceeding one year, or by fine not exceeding one thousand dollars, or by both said fine and imprisonment, at the discretion of the court. "J OHIO. "Any physician, or other person, who shall willfully ad- minister to any pregnant woman, any medicine, drug, substance, or tiling whatever, or shall use any instrument, or other means what- ever, with intent thereby to procure the miscarriage of any such woman, unless the same shall have been necessary to preserve the life of such woman, or shall have been advised by two physicians to be necessary for that purpose, shall, upon conviction, be punished by imprisonment in the county jail not more than one year, or by fiiu- not exceeding five hundred dollars, or by both such fine and imprisonment. Any physician, or other person, who shall administer to any woman, pregnant with a quick child, any medicine, drug, or sub- stance whatever, or shall use or employ any instrument, or other * Revised Statutes of Maine, 1857, chap. 124, p. 685. + The above should evidently read, "the first two sections," to be possible. : Compiled Statutes of New Hampshire, 1853, chap. 227, p. 543. JUEISPEUDENCE OF ABOKTION. 329 means, with intent thereby to destroy such child, unless the same shall have been necessary to preserve the life of such mother, or shall have been advised by two physicians to be necessary for such purpose, shall, in case of the death of such child or mother, in con- sequence thereof, be deemed guilty of a high misdemeanor, and upon conviction thereof, shall be imprisoned in the penitentiary not more than seven years, nor less than one year."* MICHIGAN. " The willful killing of an unborn quick child, by any injury to the mother of such child, which would be murder if it resulted in the death of such mother, shall be deemed manslaughter. "Every person who shall administer to any woman pregnant with a quick child, any medicine, drug, or substance whatever, or shall use or employ any instrument, or other means, with intent thereby v to destroy such child, unless the same shall have been- necessary to preserve the life of such mother, or shall have been advised by two physicians to be necessary for such purpose, shall, in case the death of such child or of such mother be thereby produced, be deemed guilty of manslaughter. " Every person who shall willfully administer to any pregnant woman, any medicine, drug, substance, or thing whatever, or shall employ any instrument, or other means whatever, with intent there- by to procure the miscarriage of any such woman, unless the same shall have been necessary to preserve the life of such woman, or shall have been advised by two physicians to be necessary for that purpose, shall, upon conviction, be punished by imprisonment in a county jail not more than one year, or by a fine not exceeding five hundred dollars, or by both such fine and imprisonment."! VERMONT. " Whoever maliciously or without lawful justifica- tion, with intent to cause and procure the miscarriage of a woman, then pregnant with child, shall administer to her, prescribe for her, or advise or direct her to take or swallow any poison, drug, medi- cine, or noxious thing, or shall cause or procure her, with like intent, to take or swallow any poison, drug, medicine, or noxious thing ; and whoever maliciously and without lawful justification, shall use any instrument, or means whatever, with the like intent, and every person with the like intent, knowingly aiding and assisting such offenders, shall be deemed guilty of felony, if the woman die in con- sequence thereof, and shall be imprisoned in the State prison not more than ten years, nor less than five years ; and if the woman does not die in consequence thereof, such offenders shall be deemed guilty of a misdemeanor, and shall be punished by imprisonment in the State prison not exceeding three years, nor less than one year, and pay a fine not exceeding two hundred dollars."]; WISCONSIN. " Every person who shall administer to any preg- nant woman, or prescribe for any such woman, or advise or procure * Revised Statutes of Ohio, 1854, chap. 162, p. 296. f Compiled Laws of Michigan, 1857, vol. ii. chap. 180, p. 1509. The statute of the Territory of WASHINGTON is very similar to those above. \ Compiled Statutes of Vermont, 1850, chap. 108, p. 560. 330 HALE ON ABORTION. any such woman to take any medicine, drag, or substance, or thing whatever, or shall use or employ any instrument, or other means whatever, or advise or procure the same to be used, with intent thereby to procure the miscarriage of any such woman, shall, upon conviction, be punished by imprisonment .in a county jail, not more than one year nor less than three months, or by fine not exceeding fivi' hundred dollars, or by both fine and imprisonment, at the dis- cretion of the court. "Every woman who shall take any medicine, drug, substance, or thing whatever, or who shall use or employ any instrument, or shall submit to any operation, or other means whatever, with intent to procure a miscarriage, shall, upon conviction, be punished by impris- onment in a county jail not more than six months, nor less than one month, or by .a fine not exceeding three hundred dollars, or by both fine and imprisonment, at the discretion of the court."* ALABAMA. "Any person who willfully administers to any preg- nant woman, any drug or substance, or uses and employs any instru- ment or other means to procure her miscarriage, unless the same is necessary to preserve her life, and done for that purpose, must, on conviction, be fined not more than five hundred dollars, and impris- oned not less than three nor more than twelve months. "f LOUISIANA. "Whoever shall feloniously administer, or cause to be administered, any drug, potion, or any other thing, to any woman, for the purpose of procuring a premature delivery, and whoever shall administer, or cause to be administered, to any woman pregnant w'ith child, any drug, potion, or any other thing, for the purpose of pro- curing abortion, or a premature delivery, shall be imprisoned at hard labor for not less than one, nor more than ten years. "J TEXAS. " If any person shall designedly administer to a pregnant woman, with her consent, any drug or medicine, or shall use toward her any violence, or any means whatever, externally or internally applied, and shall thereby procure an abortion, he shall be punished by confinement in the penitentiary not less than two nor more than five years ; if it be done without her consent, the punishment shall be doubled. "Any person who furnishes the means for procuring an abortion, knowing the purpose intended, is guilty as an accomplice. "If the means used shall fail to produce an abortion, the offender is nevertheless guilty of an attempt to procure abortion, provided it be shown that such means were calculated to produce that result, and shall receive one-half the punishment prescribed. f the death of the mother is occasioned by an abortion so pro- duced, or by an attempt to effect the same, it is murder. * Revised Statutes of Wisconsin, 1858, chap. 169, sect. 58. It will be I that the second section of the above statute differs from the first, in requiring the proof of pregnancy. f Code of Alabama, 1852, sect. 3230, p. 582. vised Statutes of Louisiana, 1856, p. 138. By its wording, this statute might be forced into the next division. JURISPRUDENCE OF ABORTION. 331 "If any person shall, during the parturition of the mother, destroy the vitality or life of a child, which child would otherwise have been Lorn alive, he shall be punished by confinement in the penitentiary for life, or any period not less than five years, at the discretion of the jury.* "Nothing contained in this chapter shall be deemed to apply to the case of an abortion procured, or attempted to be procured, by medical advice for the purpose of saving the life of the mother. "f INDIANA. " Every person who shall willfully administer to any pregnant woman, or to any woman whom he supposes to be pregnant, anything whatever, or shall employ any means with intent thereby to procure the miscarriage of such woman, unless the same is neces- sary to preserve her life, shall be punished by imprisonment in the Bounty jail not exceeding twelve months^and be fined not exceeding five hundred dollars. "J KAXSAS. " Every physician or other person who shall willfully administer to any pregnant woman, any medicine, .drug, or substance whatever, or shall use or employ any instrument or means whatso- ever, with intent thereby to procure abortion, or the miscarriage of any such woman, unless the same shall have been necessary to pre- serve the life of such woman, or shall have been advised by a physi- cian to be necessary for that purpose, shall, upon conviction, be adjudged guilty of a misdemeanor, and punished by imprisonment in a county jail not exceeding one year, or by fine not exceeding five hundred dollars, or by both such fine and imprisonment." || After commenting on the imperfections of the laws of the States relating to criminal abortion, Dr. Storer makes the following just remarks : " If our previous assumptions of the actual character of criminal abortion be granted, and we believe that they have been proved to a demonstration, it must follow from the subsequent remarks that the common law, both in theory and in practice, is insufficient to control the crime ; that in many States of this Union the statutory laws do not recognize its true nature ; that they draw unwarrantable dis- tinctions of guilt ; that they are not sufficiently comprehensive, directly allowing many criminals to escape, permitting unconsum- mated attempts, and improperly discriminating between the meas- ures employed ; that they require proofs often unnecessary or impos- sible to afford ; that they neglect to establish a standard of justifi- * I insert this clause not merely for its relation to the points we are now considering, but for its important bearing on the broad question of infanticide during labor; concerning which it stands in bold and direct antagonism to all the rulings of the common law in this country and abroad. In other respects also, though not faultless, the Texas statute is rationally and admir- ably drawn. t Penal Code of Texas, 1857, p. 103. i Revised Statutes of Indiana, 1852, p. 437. J Statutes of Kansas, 1855, chap. 48, p. 243. 332 HALE ON ABORTION. cation, and thereby sanction many clear instances of the crime ; that by a system of punishments wholly incommensurate with those inflicted for all other offences whatsoever, they thus encourage instead of prevent its increase; and that in many respects they are at variance, not merely with equity and abstract justice, but with the fundamental principles of law itself. " ' It is to be hoped,' has forcibly been written, ' that the period is not far remote, when laws so cruel in their effects, so inconsistent with the progress of knowledge and civilization, and so revolting to the feelings and claims of humanity, will be swept from our statutes.'* " In a similar trust, it now behooves us to consider whether, and in what manner, the difficulties in the way of generally suppressing the crime of abortion can Ije overcome. * CAN IT BE AT ALL CONTROLLED BY LAW? " To this important question I do not hesitate to give an unqualified answer in the affirmative. The fact that criminal abortion is not controlled by law anywhere, cannot be entertained as a valid argu- ment to the contrary of this assertion ; for it is equally the fact, as we have seen, that laws against abortion do not as yet exist, which are in all respects just, sufficient, and not to be evaded. ' It is evident that in aiming to suppress this crime, the law should provide not merely for its punishment, but indirectly as well as directly, and so far as possible, for its prevention. The punishment of a crime cannot be just, if the laws have not endeavored to prevent that crime by the best means which times and circumstances would allow.f and this is to be accomplished by a twofold process by rendering on the one hand its detection more probable, and on the other its punishment more certain. As indirect though important measures for the former of these ends, we have already mentioned laws for registration,^ and against * LEE, note to Guy's Principles of Forensic Medicine, p. 134. f BECCARI, Crimes and Punishments, 104. f "An efficient and practical remedy for the prevention of this crime would be a law requiring the causes of death to be certified by the physician in attendance, or where there has been no physician, by one called in for the purpose. In this way the cause of death, both in infants and mothers, could be traced to attempts to procure abortion. In three cases which occurred in Boston in 1855, the death was reported by friends to be owing to natural causes, and in each it was subsequently ascertained that the patient died in consequence of injuries received in procuring abortion. It is probable that such cases are by no means rare ; and if the cause of death were known, an immediate investigation might lead to the detection of the guilty party ." (Boston Med. and Surg. Journal, Dec. 1857, p. 365.) [NOTE. There is no law of the State of Illinois against the concealment of births, and, we believe, none against secret burials. In this city (Chicago) there is also no ordinance against the concealment of births ; and although there is an ordinance providing for the registration of deaths, and against secret burials, yet, owing to the culpable neglect of the city authorities, the JUEISPETTDENCE OF ABOETION. 333 concealment of births and secret burials. As a single proof of their possible influence in this respect, out of many that might be adduced, we instance the fact that in Paris the number of premature foetuses deposited at the Morgue, during the nine years from 1846 to 1854, inclusive, was found to exceed by more than two-thirds that of the full decade just preceding, from 1836 to 1845.* To render this dif- ference more apparent, we have compiled the following table : Age of Foetuses deposited. Ten years : Nine years : 1836 to 1845. 1846 to 1854. From 2 to 3 months 21 58 " 3 to 4 " 35 73 " 4 to 5 " 56 102 " 5 to 6 " 69 82 Total 181 315 " Part of this advance, it is true, is attributable to the increase in the population of Paris, and in the prevalence of criminal abortion ; but in great measure it is clearly owing to the enforcement of a more rigid .law against secret burials. The above remarks' are strikingly corroborated by the fact that of trials for the crime and we must not forget that these bear but a small ratio to the whole number of cases preliminarily investigated! there were in France, during the latter of these periods, fully four times the number occurring from 1836 to 1845. " The establishment of foundling hospitals, by the State govern- ments, has been urged as a preventive of the crime, and, on the other hand, fears have been expressed lest the same means should increase it. For ourselves, however, and from some experience in law is almost a dead letter. Not only do the undertakers neglect to report many cases of burial, but they are unwarrantably permitted to report to the health officer on the causes of death ! In consequence the reports of that officer are a standing disgrace to any civilized community, on account of the gross ignorance which they expose. Not only this, but they undoubtedly hide a vast amount of crime, behind their unmeaning and unscientific terms. We will take as an example, the yearly record of the city mortality for 1865. The whole number of deaths for that year were 3,659. Of this number the following are set down as the causes of death : Congestion (!!) 90 Cramps (!!!!) 183 What was the matter with these 183 persons, who died of "cramps?" and the 90 who died of " congestion ? " Is it not disgraceful that such returns are permitted in a civilized city ? How many of these deaths were really from criminal causes ? How many resulted from criminal abortion ? This is only known to the All-seeing JSye, and the guilty ones. Tltere were also 132 still-born infants buried in 1865. Did all these die natural deaths? Does any one suppose that this small number includes all the still-born of this great city? HALE.] * Register of the Morgue. f From 1846 to 1850, 188 cases of criminal abortion were discovered in Paris, but, for want of proof, only 22 of them were sent to trial. (Comptes Mendus Ann. de la Justice Criminelle.) 334 HALE ON ABORTION. such cases, we believe that these fears are groundless, and that with equal justice might they be entertained of every large charity having for its end the improvement, sanitary or otherwise, of the masses of society. " We have quoted a statute existing in Massachusetts, though practically unenforced, against one great agent in the increase of abortion, an abuse pf its license by the public press. Were such laws to become general, and to be faithfully executed, and were it also made penal to sell any drug, popularly known as emmenagogue, except as advised by physicians, just as the sale of direct poisons is, or should be, controlled by law, the present system of openly advertising by abortionists, would undoubtedly be brought to a close. "In no matter is it of more importance than in cases of suspected criminal abortion that coroners should be intelligent and well edu- cated medical men ; and we could wish that this point might have received especial attention from Dr. Semmes, in his late admirable report to the American Medical Association.* In the sudden excite- ment of an inquest, the guilty are more likely than at a later period to be off their guard, and evidence may often be elicited at this time. which, at the subsequent trial, it would be impossible to obtain. There can be no question of the importance of this point ; the coro- ner should be skilled in all that pertains to obstetric jurisprudence ; and if similar knowledge were generally possessed by other officers of justice, attorney, juror, and judge, a far greater number of con- victions, under a proper law, would be secured. " As regards the more direct statutes, we have already considered their important points. -;''* " ' In order to render laws effectually preventive,' as has wisely been said, ' they should be consistently framed, and based on justice. 'f In accordance with this truly axiomatic doctrine, and with various rulings of the courts, already quoted, no proof should be demanded which is not necessitated by the actual character of the crime. We have seen that neither in intent nor in fact is this an attempt against the person or life of the mother. If she die in consequence, the offender is already amenable for it as homicide ; in the absence of any special statute, at common law. The crime both in intent and in fact, is against the life of the child. " The attempt being proved, it is unnecessary that it should have been consummated, not merely the completion of a crime bringing its punishment, but also certain overt acts with intent to the per- petration ; nor is it requisite that any injury, specific or general, should have been inflicted upon the person of the mother. " The offence being of equal guilt throughout pregnancy, proof of quickening, the incident, not the inception of vitality, indicating neither the commencement of a new stage of existence, nor an * Report on the Medico-legal Duties of Coroner. 1857. f RAUKOKD, British Record of Obstetric Medicine, vol. i. p. 55. JURISPRUDENCE OF ABORTION. 335 advance from one stage to another,* and, therefore, an element without the slightest intrinsic value, should not be required. " The crime of abortion should be considered to include, as it does, in the absolute fact of moral guilt, all cases of attempted or intention- ally effected destruction and miscarriage of the product of impreg- nation ; and this, whether it be living or dead, normal or abnormal, which last expression equally comprehends instances of moles, hydatids, extra-uterine conception, acephalous, anencephalous, and other monsters. " Proof should not, as now, be required of intent to destroy the child. f This should be considered shown by the intent to produce miscarriage, in .the absence of lawful justification therefor; the act in all stages of pregnancy being attended with great danger to the child, and, in much more than a moiety of the period, necessarily fatal to it. " The attempt being considered criminal, it follows that proof of pregnancy is not necessary, and that conviction should be had though it were proved that pregnancy did not exist,| even that the woman on whom the abortion was attempted, however unlikely, was still a virgin. || " No discrimination should be made as to the means criminally employed, and no escape thus afforded to the guilty ; as we have seen still obtaining in Great Britain and many of our own States. " The mother, almost always "an accessory before the fact," or the principal, should not, as now, be allowed almost perfect im- punity. There is no valid reason for such exemption ; there is every reason against it. The woman is covered by the laws of most continental nations of Europe France, Austria, Germany, Bava- ria, and Italy, and by many of them her punishment, if married, is greatly increased. ^Similar severity is also exercised in these countries against the father of the foetus, if he, too, is implicated in the crime. " To allow that abortion is extenuated in the unmarried, it has been said, will 'to the moral and political philosopher appear to have exalted the sense of shame into the principle of virtue, and to have mistaken the great end of penal law, which is not vengeance, but the prevention of crime. Law, which is the guardian and bulwark of the public weal, must maintain a steady and even rigid watch over the general tendencies of human actions. " But, on the other hand, the measure of punishment should be proportionate, as nearly as possible, to the temptation to offend, and to the kind and degree of evil produced by the offence. "^[ " We have seen the increase in moral guilt, and of opportunity for commission and for escape, in the case of nurses, midwives, and * \VHARTOX, Criminal Law, 540. f Smith vs. The State, 33 MAINE, (3 RED.) 48. \ Rex vs. Phillips ; Regina vs. Goodall ; Regina vs. Heynes, etc. | TAYLOR, Medical Jurisprudence, p. 386. PERCIVAL, Medical Ethics, p. 84. 1 Ibid, p. 85. 336 HALE ON ABORTION. other classes of persons, who, from their profession, are brought more directly into contact with pregnant women. By the penal code of Napoleon the First, remarkable in so many respects for the wisdom of its provisions, an increase of punishjnent was enacted for abortion criminally induced or advised by physicians, surgeons, or other officers of health, including midwives, or by druggists ;* their guilt being enhanced by their greater opportunities and knowledge. <; Punishments for the crime of abortion should not, as is now generally the case, be so framed as to render the statute, in fact, if not in name, simply nugatory. Were the murder of adults to be made answerable by merely a year or two in prison, far more con- victions than at present would undoubtedly be secured ; but it is certain that the instances of the crime would be fearfully increased. We have reason to believe that it is precisely thus with the case in hand. " A standard of justification for the instances of necessary abor- tion should be fixed by law. If perfection in this respect be impos- sible, let the nearest approach be made to it that can. Since my remarks upon the relative rights of the mother and fetus, to the chance of life in doubtful cases, were published in a former paper of the present series, I have received from Dr. Rattermann, late of Tubingen, an essay, written by himself, in which this question is discussed at length, and the repetition of abortion upon the same individual, in the early months of pregnancy, is defended. I have carefully considered the several arguments advanced by the gentle- man, and am compelled to adhere to the views I have already expressed. "In presenting a report upon the matter, in 1857, by direction of the Suffolk District Medical Society of Massachusetts, the writer offered the draft of a law, prepared after much thought and consul- tation, with legal as well as with medical men, and embodying the suggestions made above. This was intended for the consideration of the Legislature of the State, in the hope that it might be of aid toward a modification of the present defective law. " Having seen no reason to change the opinion then avowed, but on the contrary, receiving constant confirmation of their truth, I now present the essential portions of that draft, acknowledging most willingly that its wording may, perhaps, with safety, be simplified and condensed ; but contending, in all sincerity and earnestness of purpose, that its general tenor is what justice and humanity alike, and imperatively, demand at the hands of society. " ' Whoever, with intent to cause and procure the miscarriage of a woman, shall sell, give, or administer to her, prescribe for her, or advise, or direct, or cause, or procure her to take any medicine, or drug, or substance whatever, or shall use, or employ," or advise any instrument, or other means whatever, with the like intent, unless the same shall have been necessary to preserve the life of such * Loc. cit., article 317. JURISPRUDENCE OF ABORTION. 337 woman, or of her unborn child, and shall have been so pronounced (in consultation) by two competent physicians ; and any person, with the like intent, knowingly aiding and assisting such offender or offenders, shall be deemed guilty of felony,' etc. etc. ; ' and if such offence shall have been committed by a physician, or surgeon, or person claiming to be such, or by a midwife, nurse, or druggist, such punishment may be increased at the discretion of the court. " ' Every woman who shall solicit, purchase or obtain of any per- son, or in any other way procure, or receive, any medicine, drug, or substance whatever, and shall take the same, or shall submit to any operation or other means whatever, or shall commit any operation or violence upon herself, with intent thereby to procure a miscarriage, unless the same shall have been by two competent physicians (in consultation) pronounced necessary to preserve her own life, or that of her unborn child, shall be deemed guilty,' etc. etc. ; ' and if said offender be a married woman, the punishment may be increased at the discretion of the court.' " It was also advised that the encouragement of criminal abortion, by publication, lecture or otherwise, or by the advertisement, sale, or circulation of such publication, should be made penal, and that the present well-worded statute against the personal advertisements of abortionists, and their nostrums, should be rigorously enforced. " To the words now quoted were added, and they are still applica- ble, the following : " ' We have aimed at a statute, which, while it better defined this atrocious crime, and covered the usual grounds of escape from con- viction, established also the proper standard of competence in all medical questions involving issues of life and death. "We believe that it would be the means of preventing much of the present awful waste of human life. But enforce such a law, and the profession would never allow its then high place in the community to be un- worthily degraded ; nor, as now, would those be permitted, unchal- lenged, to remain in fellowship, who were generally believed guilty, or suspected even of this crime.'* * Report to Suffolk District Med. Society, May, 1857, p. 12. 22 GENERAL INDEX. Abortion, statistics of, 19 " causes of, 31 " treatment of, 153 " of animals, 108 " forceps, 288 " vectis, 245 Actual symptoms of abort'n, 124 Actea alba, a cause of " 92 Acids in treatment of anaemia, 160 Acetic acid as a preventive of conception, 305 Aconite in treatment of abor- tion, 220 Aconite as a preventive of con- ception, 306 Adhesion, treatment of, 253 Aloes, a cause of abortion, 92 Aletris farinosa a cause of abor- tion, 93 Aletris farinosa in treatment of abortion, 222 Alum as a preventive of con- ception, 305 Alkalies as a preventive of con- ception, 305 Alabama, laws of, on abort'n, 330 Anaemia, a cause of abortion, 35 " treatment of, 154 Anteversion, a cause of abor- tion, 84 Anteversion, treatment of, 214 Appearance on examination of cervix uteri, 83 Apis mellifica, a cause of abor- tion, 91 Arnica in treatment of abor- tion, 218 Asarum europeum, a cause of abortion, 92 Asarum canadense, a cause of abortion, 93 Asclepias incarnata, a cause of abortion, 93 Asclepias sjriaca, a cause of abortion, 93 Astringents as preventives of conception, 306 Atrophy of placenta, a cause of abortion, 44 Baptisia tinctoria, a cause of abortion, 94 Belladonna in treatment of abor- tion, 220 Belladonna as a preventive of conception, 306 Blows, Treatment of, 189 Blunt hook, 229 Borax, a cause of abortion, 94 Bovista, a " " 95 Calcareous degeneration of pla- centa, a cause of abortion, 44 Calcareous degeneration of pla- centa, treatment of, 175 California, laws of, on abortion, 324 Caoutchouc bags, 271 Can abortion be controlled by law, 332 340 GENERAL INDEX. Case of retroversion of the ute- rus, 257 Causes of abortion, 33 Cancerous ulcer, a cause of abor- tion, 80 Cantharis, a cause of abortion, 96 Caulophyllin, a cause ofab'n, 96 " in treatment of abor- tion, 220 Cerebro-spinal meningitis, a cause of abortion, 49 Centric causes of abortion, 45 " causes, treatment of, 176 Cervical leucorrhoea, a cause of abortion, 44 Chancre simplex, treatment of, 208 Cholera as a cause of abortion, 39 Cholera, treatment of, 170 Chlorosis, treatment of, 159 Cimicifuga racemosa, a cause of abortion, 97 Cimicifuga racemosa in treat- ment of abortion, 220 Cinnamon in treatment of haem- orrhage, 221 Classification of States according to Jaws, 326 Cold water in treatment of ab- ortion, 226 Common salt as a preventive of conception, 305 Complications occurring with abortion, 131 Congestion of the placenta, a cause of abortion, 43 Congestion of the uterus, a cause of abortion, 61 Congestion of the uterus, treat- ment of, 191 Congestion of the ovaries, a cause of abortion, 90 .Concentric causes of abortion, 49 Concentric causes, treatment of, 178 Coitus as a cause of abortion, 87 Corroding ulcer, a cause of abor- tion, 80 Corpulence, treatment of, 157 Constipation, treatment of, 186 Colpeurynteur in treatment of abortion, 226 Colpeurynteur to produce abor- tion, 273 Condom, description and use of, 298 Concealment of births and deaths, 332 Conduct of physicians when call- ed to case of abortion, 234 Connecticut, laws of, on abor- tion, 323 Criminal abortion considered, 313 " " is it increasing, 18 " '.' its jurisprudence, 320 Cystitis, treatment of, 186 Danger from use of stillette, 270 Date of viability of foetus, 117 Death of the embryo, a cause of abortion, 87 Decidua, character of, 116 Decodon verticillatus, a cause of abortion, 99 Definition of abortion, 36 Dental causes of abortion, 56 " treatment of, 180 Diagnosis of abortion, 133 " " after fourth month, 139 Diarrhoea, treatment of, 185 Diameters of child's head, 265 " pelvis, 266 Dimensions of fcetus at different periods, 119 Dietetic treatm't of abortion, 251 Direct blows upon brain, treat- ment of, 177 Diphtheria, treatment of, 168 Discharges after abortion, 131 Displacements of the uterus, a cause of abortion, 84 Douche, in treatment of abor- tion, 273 Dropsy of the ovaries, a cause of abortion, 90 GENERAL INDEX. 341 Dropsy of the ovaries, treatment of, 254 Dry cupping in treatment of abortion, 233 Draft of abortion law, by Doctor Storer, 336 Duty of physician concerning prevention of conception, 291 Dysmenorrhoea, diagnosis of, 135 Dysentery " 135 " treatment of, 183 Embryonic abortion, 283 Emotional causes of abortion, 45 " treatment of, 176 Engorgement of the cervix uteri, 192 England, laws of, on abortion, 321 Epilepsy, treatment of, 189 Ergot, as a cause of abortion, 47 Essex syringe, 203 Exanthematous fevers causing abortion, 38 Falls, treatment of, 189 Fatty deterioration of chorion and placenta, a cause of abor- tion, 41 Fatty deterioration of chorion and placenta, treatment of, 1 74 Fecundity in European countries, 20 Foetus, when so named, 121 " date of viability of, 117 " weight and length of, at different periods, 119 Foetal abortion, when necessary, ' 279 Ferrum in Anaemia, 160 Fevers, yellow, 39 " exanthematous, 38 Fissured ulcer, a cause of abor- tion, 77 Fissured ulcer, treatment of, 205 Fissure of the anus, 185 Fistulas, treatment of, 253 First stage of labor, management of, 244 Flexible bougie, manipulations with, 280 Flexible catheter, manipulations with, 284 Follicular ulcer, a cause of abor- tion, 79 Follicular ulcer, treatment of, 206 Forceps, long, 231 " ' short, 231 French laws on abortion, 322 Frequency of " 22 Fucus vesiculosis in corpulence, 158 Functional diseases of uterus, causes of abortion, 61 Functional diseases of uterus, treatment of, 191 Galvanism, a cause of abortion, 48 " in treatm't of " 233 11 to induce " 277 Gastric irritation, a cause of ab- ortion, 56 Gastric irritation, treatm't of, 182 Gelseminum in treatment of ab- ortion, 221 Gelseminum to prevent concep- tion, 306 Generation, 115 Germany, laws of, on abortion, 322 Gonorrhoea, a cause of ; < 69 " treatment of, 197 Granular vaginitis, treatment of, 188 Habitual abortion, 59 Haemorrhage, diagnosis from ab- ortion, 137 Haemorrhage, after sixth month, treatment of, 239 342 GENERAL INDEX. Haemorrhoids, treatment of, 185 Hot water in treatment of abor- tion, 227 How to use stillette, 269 " destroy spermatozoa, 299 " render laws efficient, 334 Hydatids, a cause of abortion, 41 " treatment of, 175 Hydrorrhoea, diagnosis from ab- ortion, 137 Hypertrophy of placenta, a cause of abortion, 44 Hypertrophy of the uterus, treat- ment of, 253 Hypertrophy of cervix, symp- toms of, 183 Hypertrophy of cervix, treat- ment of, 192 Hysteria, treatment of, 189 Ice in treatment of abortion, 226 Illinois, laws of, on " 324 Ilex opaca, a cause of " 100 Impregnation, 293 Indiana, laws of, on " 331 Induration of the cervix, a cause of abortion, 82 Indurated chancre, treatment of, 208 Inflammation of placenta, a cause of abortion, 43 Inflammation of ovaries, a cause of abortion, 90 Inflammation of mammae, treat- ment of, 253 Injections, 288 " when to use, 307 Instrumental irritation, a cause of abortion, 88 Intra uterine syringe, 275 Iowa, laws of, on abortion, 324 Irregularity of os uteri, treat- ment of, 200 Italy, laws of, on abortion, 323 Jewish customs, 294 Jumping, treatment of injuries from, 189 Jurisprudence of abortion, 320 Kansas, laws of, on abortion, 331 Laudanum in treatment of abor- tion, 222 Laws of the Shastras on abortion, 320 Laws of foreign countries on ab- ortion, 321 Laws of different States on abor- tion, 323 Lecture on criminal abortion- Prof. A. E, Small, 313 Lecture on jurisprudence of abor tion Prof.C.Woodhouse, 320 Length of foetus at three to seven weeks, 119 Length of foetus at two to five months, 120 Length of foetus at six months to full term, 121 Leucorrhoea, a cause of abortion, 62 Leucorrhcea, cervical, a cause of abortion, 64 Leucorrhcea, vaginal, a cause of abortion, 67 Leucorrhcea, treatment of, 192 Leucorrhoea, cervical, treatment of, 192 Leucorrhcea, vaginal, treatment of, 194 Leucorrhcea, sequelae, treatment of, 65 Local causes of abortion, 39 " diseases, treatment of, 171 " syphilis, symptoms of, 81 Louisiana, laws of, on abortion, 330 Maine, laws of, on abortion, 327 Malformation of the ovum, 172 GENERAL INDEX. 343 Malformation of the membranes, 172 Mammary irritation, a cause of abortion, 56 Mammary irritation, treatment of, 179 Management of labor, 241 . Manner of coition to prevent conception, 294 . Manchester Lying-in Hospital, statistics of, 23 Massachusetts, statistics of, on abortion, 22 Massachusetts, laws of on abor- tion, 324 Means employed to destroy sper- matozoa, 304 Mechanical abortion, pathology of, 142 Mechanical obstruction, 265 " treatment of sequelae of abortion, 256 Medicinal causes of abortion, 46 " " treatment of, 178 " treatm'tofabort'n, 217 " " in the third . stage, 252 Medicines acting as predispo- nents to abortion, 91 Medicines acting as centric causes of abortion, 91 Medicines acting as concentric causes of abortion, 91 Membranes, how separated from uterus, 274 Membranes, how separated by air, 276 Menstrual crisis, a cause of abor- tion, 36 Menstrual crisis, treatm't of, 162 Mental aberrations, treatment of, 254 Menorrhagia, chronic, treatment of, 255 Mercurialization, a cause of ab- ortion, 38 Mercurialization, treatm't of, 164 Mercury, a cause of abort'n, 101 Methods of inducing premature labor, 269 Methods of inducing embryonic abortion, 284 Methods of using syringe, 308 Metritis, diagnosis from abortion, 134 Metritis, treatment of, 200 " puerperal, treatment of, 254 Missouri, laws of, on abort'n, 324 Minnesota, laws of, on " 327 Michigan, laws of, on " 329 Moles as causes of abortion, 40 " treatment of, 175 Muriatic acid, to destroy sperm- atozoa, 306 Neuralgia of ovaries, treatment of, 312 New Hampshire, laws of, on ab- ortion, 328 New York, laws of, for abortion, 323 New York, statistics of abor'n, 20 a it tl from 1804 to 1862, 21 New York, ratio in, 21 Nitric acid, to prevent concep- tion, 306 Non-medical fluids, use of, 307" Nux vomica, to prevent concep- tion, 305 Obstetric abortion, 263 Obesity, a cause of abortion, 35 Occurrence of abortion, tabular view, 26 Ohio, laws on abortion, 323 Opium, to prevent concept'n, 305 Organic diseases of uterus, a cause of abortion, 71 Organic diseases of placenta, treatment of, 173 Ovarian causes of abortion : Irritation, 35 344 GENERAL INDEX. Congestion, 58 Inflammation, 90 Tumors, 90 Dropsy, 90 Ovarian diseases, treatm't of, 211 irritation, " tumors, Ovaritis, Ovaralgia, Ovular abortion, Ovum, 115 211 212 212 212 290 when necessary, 290 Paris, statistics of. on abort'n, 20 Pathology of " 142 Parotidean irritation, a cause of abortion, 55 Parotidean irritation, treatment of, 178 Paralysis, treatment of, 256 Patient, examination of, 237 " position of, 243 Pelvic diameters, 266 " cellulitis, treatm't of, 253 Peritonitis, diagnosis from abor- tion, 135 Period of pregnancy at Avhich ab- ortion is most frequent, 25 Period of occurrence of abortion, tabular view, 26 Period of abortion, tabular view, 309 Pessaries, a cause of abortion, 88 " ring, 259 Podophyllum, a Cjause of abort'n, 102 Position of patient during injec- tions, 308 Postural treatm't of abort'n, 248 Post partum " " 248 Phagsedenic ulcer, a cause of ab- ortion, 80 Phagtedenic ulcer, treatment of, 206 Phlebitis, treatment of, 254 Physician's duty when applied to to produce abortion. 318 Physical causes of abortion, 45 Physiology of generation, 115 Plethora, a cause of abortion, 35 " treatment of, 155 Placental causes of abortion : Fatty degeneration, 42 Congestion, 43 Inflammation, 43 Calcareous degeneration, 44 Tubercular deposits, 44 Atrophy, 44 Hypertrophy, 44 Previa. 44 Placental fatty degeneration, treatment of, 174 Placental calcareous degenera- tion, treatment of, 175 Placenta previa, treatment of, 172 " retention of, 140 Predisposing causes of abortion, 35 " treatment of, 155 Pregnancy, signs of, 133 Premature labor, 263 " when necessary, 264 Premonitory symptoms of abor- tion, 133 Preventive treatment of abor- tion, 155 Principal medicines as causes of abortion, 91 Prognosis of abortion, 148 " when favorable, 148 " " unfavorable, 150 Prolapsus, a cause of abortion, 84 " treatment of, 213 " mechanical treatment of, 256 Puerperal Peritonitis, treatment of, 254 Puerperal Metritis, treatment of, 254 Pulsatilla in treatment of abor- tion, 222 Quinine, a cause of abortion, 46 GENEKAL INDEX. 345 Quinine sulphas, a cause of ab- ortion, 103 Ratio of abortion in N. York, 21 Rectal irritation, a cause of ab- ortion, 57 Rectal irritation, treatm't of, 183 Reflex causes of abortion, 44 " " treatment of, 176 Regulation of coition, 294 " " Jewish custom, 294 Register at the Morgue, 333 Remote consequences of abortion, 151 Remedial treatment of abortion, 217 Renal causes of abortion, 57 Results of abortion, 28 Resume of treatment, 209 Retention of ovum, a cause of abortion, 140 Return of menses, a cause of ab- ortion, 36 Return of menses, treatment of, 162 Retroversion, a cause of abortion, 84 treatment of, 214 " mechanical treat- ment of, 256 Rules for use of blunt hook, 228 Ruta graveolens, a cause of ab- ortion, 103 Ruta graveolens, treatment of, 221 Sabina, a cause of abortion, 104 " in treatment of " 221 Sanguinaria, a cause of ab'n, 109 Sarracenia purp., 166 Scarlatina, treatment of, 166 Scotland, laws of, on abort'n, 322 Scrofulous diathesis, a cause of abortion, 36 Scrofulous diathesis, treatment of, 162 Secale corn., a cause of ab'n. 106 " " in treatm't of " 221 Separation of membranes from uterus, 274 Separation of membranes from uterus by air, 276 Sequelae of leucorrhoea. a cause of abortion, 65 Sequelae of abortion, 131 " " 248 Shastras, laws of, on abort'n. 320 Simple irritation of ovaries, a cause of abortion, 89 Simple granulating ulcer, treat- ment of, 204 Softening of the uterus, 200 Sponge tent, 271 " in treatment of abor'n, 225 Spermatozoa, character of. 298 " how destroyed, 299 Spirits of wine, to prevent con- ception, 305 Stage of pregnancy, first, 244 " " " sequelae of, 249 Stage of pregnancy, second, 246 11 " " sequela? of, 249 Stage of pregnancy, third, 247 " " " sequela? of, 250 Statistics of abortion, 19 in foreign countries, 20 in New York, 20 in Boston, 22 iu Massachusetts. 22 in Chicago, 22 Manchester Lying-in Hos- pital, 24 at the Morgue, 28 States, laws of, on abortion. 323 which have no laws on ab- ortion, 325 which acknowledge the crime after quickening, 32G 346 GENERAL INDEX. which acknowledge the crime, but require proof of pregnancy, 326 which punish an attempt at abortion, 326 Stillette, description of, 270 " death by, 270 Strychnine, a cause of ab'n, 47 " to prevent concept'n, 305 Sucking pumps, to induce abor- tion, 275 Sulphate of zinc, to prevent con- ception, 306 Sulphuric acid, in abortion, 223 " " to prevent con- ception, 305 Swelling of cervix, 200 Syringe, Essex, as a means to prevent conception, 307 Symptoms of induration, 83 " retroversion, 86 " abortion, 122 Syphilis, a cause of abortion, 37 " sterility, treatment of, 163 38 ulcerat'n, a cause of ab'n, 80 " treatment of, 208 constitu'al, cause of ab'n-, 81 local, " " 81 Table showing frequency of ab- ortion, 26 Tabular view of the three great periods of utero-gestation, 309 Tampon, its use in abortion, 224 Tanacetum vulgans, a cause of abortion. 111 Terebinth, a cause of abort'n,110 Texas, laws of, on " 330 Third stage of pregnancy, abor- tion at, 247 Third stage of pregnancy, abor- tion at, sequelae, 250 Thyroidal causes of abortion, 56 " treatment of, 1 79 Treatment of abortion, 155 Tubercular deposits in placenta, a cause of abortion, 44 Ulceration of the cervix, a cause of abortion, 71 Ulceration of the cervix, treat- ment of, 198 Ulcer, varicose, cause of ab'n, 76 " treatment of,- 204 fissural, a cause of ab'n, 77 " treatment of, 205 follicular, a cause of ab'n, 79 " treatment of, 206 corroding, a cause of ab'n, 80 calcareous, <( " 80 syphilitic, " 81 " treatment of, 208 Unnecessary abortion, murder, 313 Uterine causes of abortion, 59 " displacements, treatment of, 212 Utopian theories, 291 Uterine sound, 289 Use of speculum, a cause of abor- tion, 73 Ustilago niadis, a cause of abor- tion, 112 Vaginitis, a cause of abort'n. 58 " treatment of, 187 " vesicular, " 188 " granular " 188 Vaginal irritation, " 187 " leucorrhcea, " 194 " a cause of abortion, 67 Vaginismus, a cause of abor'n. 50 " treatment of, 189 Variola, " 164 " a cause of abortion, 38 Variation of period of quicken- ing, 316 GENERAL INDEX. 347 Vesical irritation, a cause of abortion, 57 Vesical irritat'n, treatm't of, 186 Vermont, laws of, on abort'n, 329 Virginia, " " 324 Vomiting, a cause of abort'n, 266 "Weight of fcetus, at three to seven weeks, 119 "Weight of fcetus, at two to five months, 120 Weight of fcetus, at six months to full term, 121 Wisconsin, laws of, on ab'n, 329 Yellow fever, a cause of ab'n, 39 Zymotic diseases, a cause of abortion, 37 C. 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Holcombe . . 20 THE UNITED STATES MEDICAL AND SURGICAL JOURNAL. A Quarterly Magazine of Homoeopathic Practice and Medi- cal Science in general. Per annum, in advance 3 00 THE MEDICAL INVESTIGATOR. A Monthly Journal of Homoeo- pathy and general Medical Intelligence. Per annum, in advance 2 00 " HOME PAPERS." A Family Magazine, devoted to the Phy- sical, Social and Moral Interests of the People. Monthly, per annum, in advance 1 50 MEDICAL HINTS FOR THE PEOPLE. A Pamphlet containing much useful information concerning the Preservation of Health and Cure of Disease finely printed on heavy paper. Price, free by mail 25 University of California SOUTHERN REGIONAL LIBRARY FACILITY 305 De Neve Drive - Parking Lot 17 Box 951388 LOS ANGELES, CALIFORNIA 90095-1388 Return this material to the library from which it was borrowed. A "ii" mil IIIH 000 499 493 31970008352343 J. R. W0.225 Hl6ls 1866 Hale: Systematic treatise on abortion