Page images
PDF
EPUB

a more direct physical impression upon the uterus, as in cases where the patient leaps or steps suddenly down from a height, or lifts a weight, stretches her arms above her head, or is exposed to any sudden jar or more protracted jolting. Though many cases of abortion are attributed to such a cause, it is always to be borne in mind that in some of these, at least, that supposed cause would not have led to the disaster unless there had already existed a predisposition in some morbid condition of the uterus or its contents.

Amongst the local causes we find, first, and most frequently, diseased conditions of the deciduæ. Commonly in these cases the patient had previously been the subject of chronic endometritis; though occasionally cases are met with where there have been no marked symptoms previously, and the generative process may affect either the vera, or reflexa, or serotina separately or simultaneously. Second in frequency, under this head, we have the abortions due to displacements of the uterus, these being commonly either descents or retroversions. Thirdly, neoplasms of the uterus, such as cancers or fibroid

tumors, sometimes permit the occurrence of conception, but prevent gestation running to its natural term. Fourthly, the presence of tumors in the neighboring organs, or inflammatory adhesions among them, may prevent the uterus from attaining its full growth, and compel it to early evacuation of its contents."

Mr. Chitty says: "Miscarriage is the expulsion of the ovum or embryo from the uterus within the first six weeks after conception. Between that time and the expiration of the sixth month of gestation, when the child may possibly live, it is termed abortion. But the criminal act of destroying the foetus at any time before birth is termed in law miscarriage: " Chit. Med. Jur. 410. The expulsion of the foetus at a period of uterogestation so early that it has not acquired the power of sustaining an independent life is now generally termed abortion: Bouv. L. Dic., Abortion.

Again, it has been observed that abortion signifies the expulsion of the contents of the pregnant uterus before the seventh month of gestation: Quain's Dic. of Med. (8th Am. ed.) 5.

In a recent case in Kentucky it was held that criminal abortion could not be committed, in the

absence of statutes to the contrary, unless the woman was quick with child: Mitchell v. Com., 78 Ky. 204; 39 Am. Rep. 227; 10 Cent. L. J. 338. And in New York it has been held that the willful killing of an unborn child is not manslaughter, except it is made so by statute: Evans v. People, 49 N. Y. 86.

§ 74. Maternal causes of abortion.

Abortion or miscarriage may be natural and innocent, or it may be artificial and criminal, depending upon the cause or the circumstances of the case. Again, abortion may be distinguished into two varieties: 1. Miscarriage, or the expulsion of an ovum or of a non-viable child; or, 2. Premature labor, or the expulsion of a viable child: See Verrier's Obstetrics (1st Am. from the 4th French ed.), 167; Dr. Barnes' Obstet. Operations (Eng. ed.), 385 et seq.

The maternal causes of abortion have been classified as follows:

1. Poisons circulating in the mother's blood, as fevers, syphilis, various gasses, lead, copper, etc.; or the products of morbid action, as jaundice, albuminuria, carbonic acid from asphyxia and in the moribund.

2. Diseases degrading the mother's blood, as amæmia, obstinate vomiting, over-lactation.

3. Diseases disturbing the circulation dynamically, as liver, heart, and lung disease.

4. Causes acting through the nervous system, as chorea, mental shock, diversion or exhaustion of nerve force, as from obstinate vomiting.

5. Local disease-uterine, as fibroid tumors, inflammation, hypertrophy, etc., of the uterine mucous membrane; mechanical anomalies, retroversion, pressure of tumors external to the uterus, etc.

6. Climatic abortion.

7. Abortion artificially induced.

§ 75. Foetal causes of abortion.

The foetal causes of abortion are as follows:

1. Diseases of the membranes of the ovum, as fatty degeneration, hydratiform degeneration, inflammation, congestion, apoplexy, fibrous deposits.

2. Diseases of the embryo itself, as malformation, inflammation of the serous membrane, diseases of the nervous system; diseases of the kidney, liver, etc.; mechanical, as from torsion of the cord or funis.

The causes of abortion are often complicated; in other words, they may be partly maternal and partly foetal. And it is often difficult to discover the primary cause; and it may be further observed that abortion has a great tendency to become a habit: Dr. Barnes' Obstetric Operations (1st ed.), 385; Tidy's Leg. Med. (Am. ed.) 97.

§ 76. Natural and innocent causes of abortion.

Abortion may be naturally and innocently caused, or artificially and criminally produced. Natural and innocent abortion or miscarriage may arise from a nervous and irritable temperament, disease, malformation of the pelvis, immoderate venereal indulgence, a habit of miscarriage, plethora, great debility, or from disease in the ovum or in the membranes.

§ 77. Artificial and innocent abortion; premature labor. The laws of England, it seems, do not recognize the induction of premature labor by the medical practitioner; but English judges have always held that medical men are morally justified in inducing premature labor, provided the object

« PreviousContinue »