Page images
PDF
EPUB

536

ABORTION-NATURAL CAUSES.

CRIMINAL ABORTION.

CHAPTER XLVI.

ABORTION FROM NATURAL CAUSES.-CRIMINAL CAUSES.-MECHANICAL MEANS.-MEDICINAL SUBSTANCES. SIGNS OF ABORTION.-SPECIFIC ABORTIVES.- LOCAL APPLICATIONS.FEIGNED ABORTION.-MEANING OF THE WORD "NOXIOUS" AS APPLIED TO DRUGS.-ON INDUCING PREMATURE LABOR.-PROOF OF PREGNANCY NOT NECESSARY.-ABORTION OF MONSTERS.-MOLES AND HYDATIDS.

By abortion is commonly understood, in medicine, the expulsion of the contents of the womb before the sixth month of gestation. If the expulsion takes place between the sixth and ninth months, the woman is said to have a premature labor. The law makes no distinction of this kind, but the term "abortion" is applied to the expulsion of the foetus at any period of pregnancy before the term of gestation is completed; and in this sense it is synonymous with the popular term miscarriage. Criminal abortion is incorrectly thought to be rarely attempted before the third month; it is now very common to perform it before the second month, because then a woman begins for the first time to acquire a certainty of her pregnancy. The causes of abortion may be either natural or violent. The latter only fall under the cognizance of the law; but a medical witness should be well acquainted with the causes which are called natural, in contradistinction to others which depend on the application of violence. These natural causes are sometimes very obscure, and the real cause is thus often overlooked. They are so frequent, that according to Whitehead's observation-of 2000 pregnancies, one in seven terminated in abortion. These causes are commonly ascribable to peculiarities in the female system, to the presence of uterine or other diseases, or to some shock sustained by a woman during pregnancy. Any diseases which strongly affect the womb or general system of a woman may give rise to abortion. An attack of smallpox has been known to produce it; and it has been suggested by Acton that the presence of constitutional syphilis in the father is not only a cause of infection in the offspring, but of repeated abortions in the woman. (Lond. Med. Gaz., vol. xxxvi. p. 164; Ramsbotham's Obst. Med., p. 655.) These facts deserve attention, when it is proved that a woman has really aborted, and an attempt is unjustly made to fix an alleged act of criminality on another. For further information on the numerous natural and accidental causes which may give rise to abortion, the reader may consult the work of Whitehead (On Abortion and Sterility, p. 252); and, for the effects of undue lactation and diseases of the placenta in causing abortion, the Med. Times and Gaz., 1852, ii. p. 580, and 1853, i. p. 302. In considering the operations of these causes, it is proper to bear in mind that, during pregnancy, the womb is subject to a natural periodical excitement corresponding to what would have been the menstrual periods dating from the last cessation. Hence comparatively trivial causes operating at these periods may lead to

[blocks in formation]

an expulsion of the fœtus. Salomon has reported two cases in which premature delivery followed the mercurialization of the system. (Lond. Med. Gaz., vol. xxxvi. p. 658.)

The violent causes of abortion may be of an accidental or criminal nature. In general the distinction will not be difficult: the kind of violence and the adequacy of the alleged cause to produce abortion will be apparent from the evidence. In reference to criminal cases, the causes may be referred either, first to the use of mechanical means; or second, of irritating medicinal substances acting upon the womb or bowels. They operate with greater certainty in proportion as the pregnancy is advanced.

Mechanical Means.-Among the mechanical causes may be mentioned— severe exercise, the violent agitation of the body, as by riding or driving over a rough pavement, in which case no marks of violence would be apparent. Any physical shock sustained by the body may operate indirectly on the womb. Violent pressure or blows on the abdomen are sometimes resorted to; but in these cases the marks of violence will be commonly perceptible. Instruments have been devised for the purpose of piercing the membranes, destroying the child, and thereby leading to its expulsion. It cannot be denied that cases have occurred which show that the crime is frequently perpetrated by persons who basely derive a profit from the practice; and for one case that comes to light probably many are effectually concealed. In the evidence given on four trials within a recent period the cases presented no feature of novelty or interest. Instruments were employed, and drugs in large doses were proved to have been also administered.

Mechanical means are undoubtedly more effectual in producing abortion than mechanical substances; yet when the attempt is made by ignorant persons the woman often dies from inflammation of the womb or peritoneum or other serious after-consequences. A case was tried some years since in which the evidence showed that the prisoner had attempted to produce abortion in the deceased, by thrusting wooden skewers into the substance of the womb. Inflammation and gangrene took place, and the woman died. The prisoner was convicted of murder. (For similar cases, see Lond. Med. Gaz., vol. xxxvi. p. 102; xlv. p. 693.) This kind of injury to the womb generally, but not always, implies the interference of some other person in the perpetration of the crime. Mechanical means often leave marks of violence on the womb, as well as on the body of the child. If the mother should die an inspection will at once settle the point. (Ann. d'Hyg, 1834, t. 1, p. 191; 1838, t. 1, p. 425; 1839, t. 2, p. 109.) An important case of this kind was the subject of a criminal trial in Scotland in 1858. (Case of Reid, Lond. Med. Gaz., Dec. 11, 1858.) The womb near its mouth presented two openings in its substance, described as punctured wounds by the medical witnesses for the prosecution who made the examination, and as the openings of torn blood vessels by others who were called for the defence. There was also a rupture of one ovary. The prisoner was convicted, and the medical man who was supposed to have been the principal agent in the crime committed suicide. The case is chiefly important in showing that any apparent mechanical injury to the womb should be minutely examined at the time of inspection, so that no doubt of the cause may afterwards be entertained by any present. If, in a case of this kind, the mother should survive and the child be expelled, then marks of violence may be found on its body. These marks may not be sufficient to account for its death; but this is not here the question. If it can be proved that they have not resulted from accidental causes

538

MECHANICAL MEANS-INSTRUMENTS.

during gestation or subsequently to delivery, then their presence may furnish strong corroborative evidence of the actual means by which abortion was attempted. It is said that abortion has been in some instances accomplished by frequent bleeding from the arm. This effect may follow as a result of shock produced by the sudden loss of a large quan tity of blood. An examination of the veins of the arms would show whether any such attempt had been made.

There can be no doubt that of all the exciting causes of abortion the most effectual, and that which most certainly brings on the expulsive action of the womb, is the destruction of the ovum or embryo. If by accident or design the ovular membrane should become ruptured, gestation is arrested, and abortion necessarily ensues. At any period of preg nancy, therefore, a puncture through the membranes will sooner or later occasion the evacuation of the womb. (Ramsbotham's Obst. Med., p. 655.) This author remarks that the performance of the operation demands a most accurate knowledge of the anatomy of the ovum and the maternal structures, as well as of the state of development which the neck of the womb assumes at different periods of pregnancy. In medical practice, for the induction of premature labor the membranes are ruptured either by the use of a catheter or by an instrument of this shape, but including a blade like a tonsil-lancet. Unless the inner membrane or amnion be opened, gestation may still proceed, and abortion will not take place. When all the membranes are completely penetrated and the waters are discharged, uterine action is invariably induced, but the time which elapses from the performance of the operation to the commencement of labor is subject to great variation. Ramsbotham states that he has known the womb begin to act in ten hours after the rupture, but in another case a week elapsed before its action commenced. As a rule, uterine action is in general fully established in from fifty to sixty hours. In Reg. v. Sharpe (Notts Lent Ass., 1873), the prisoner, who was a charwoman, but said by profession to be an abortion-monger, was convicted of this crime. It was proved that she ruptured the membranes with an ivory crochet-needle, and three days afterwards the woman was delivered of a stillborn child. Another woman, proved to be an accessory to the act, was sentenced to fifteen months' imprisonment. (Lancet, 1873, i. p. 422.) It must not be supposed, however, that, where a criminal intention exists, a long period is required for removing the contents of the womb. In a criminal attempt by a medical practitioner, in which the woman would be a consenting party to the act, the removal of the embryo or fœtus might be effected in a much shorter period of time than in those cases of obstetric practice in which there was no desire to expose the woman to the slightest risk, and premature labor was openly induced. At any rate, the time for the completion of abortion could not be measured by cases in which the womb has been left to undergo spontaneous contraction after the membranes had been punctured, and the waters had escaped. There would, however, be great danger to a woman in the necessary manipulations required. The reader will find reports by Tardieu (Ann. d'Hyg., 1855, t. 1, p. 406) of numerous cases of abortion as a result of mechanical means applied to the womb; and some good practical remarks by the same writer on the mode in which these inquiries should be conducted, in the Ann. d'Hyg., 1856, t. 1, p. 141. On the mechanical means for procuring abortion and the results, see a paper by Lex. (Vierteljahrsschr. für Gerichtl. Med., 1866, 1, p. 253.)

It is obvious that this mode of perpetrating abortion is only likely to succeed in the hands of persons who have a complete anatomical knowl

USE OF MEDICINAL SUBSTANCES.

539 edge of the parts. The death of the woman will convert the crime into murder if instruments are introduced into her body by persons who are ignorant of anatomy. In Reg. v. Heap (Liverpool Lent Ass., 1875), it was proved that the prisoner had caused abortion by the use of instruments. The man procured abortion and brought about the death of the woman by driving a weaver's spindle into the womb, the fundus of which was completely transfixed and a fatal peritonitis induced. On an inspection, two sharply-punctured wounds were found in the womb, and to these death was attributed. The prisoner, although not intending to destroy life, was convicted of murder. A midwife was convicted of a similar crime. (Reg. v. Cartledge, Manchester Wint. Ass., 1877.) The evidence showed that the prisoner had introduced an instrument for the purpose of procuring abortion. Inflammation followed, and the woman died in three days from peritonitis and gangrene.

A method much resorted to in the metropolis is to rupture the membranes by the insertion of a piece of whalebone or wire into the mouth of the womb till blood appears. Pills of oil of savin, sulphate of iron, and aloes, are then freely given to aid in the expulsion of the ovum. A miscarriage is frequently brought about by the mere insertion of a male catheter or bougie between the membranes and the wall of the womb. Other means, such as tents and Barnes's bags, are also resorted to. The editor met in his practice with the case of a married woman on whom an unqualified medical man had successfully operated ten times. The same woman had also abortion successfully induced on her by a female abortionist. (Reg. v. Sprowle, C. C. C., Oct. 1884.)

It is to be regretted that members of the medical profession have on several occasions misused their professional knowledge and have exposed themselves to prosecutions for this crime. Sometimes it is probable the charge has been raised falsely or through misapprehension on the part of the woman; at others, the evidence has left it very clear that the charge was well founded. Of late years medical men have rather freely used the speculum. When this instrument has been improperly or unnecessarily used on a pregnant woman, a charge of attempted abortion by instruments may be easily raised against a medical practitioner. A trial took place (Reg. v. Griffin and Venn, Exeter Lent Ass., 1854) in which it was charged that the accused Venn (a surgeon) had feloniously used an instrument with the intent to procure a miscarriage of a woman. According to the evidence, Venn had on several occasions passed a round polished instrument into her body, once in a coppice and at another time in a field. The defence was that the surgeon had merely used a speculum to ascertain whether the girl was pregnant in order to know how to prescribe for her; and that it was absurd to suppose that he had ever intended to procure abortion, for this had not followed, and it might have been easily produced by him at any period of pregnancy, if he had wished it. On this evidence the prisoners were acquitted. Admitting the statements of the girl and the prisoner to be correct, it may be remarked that medical practitioners, in the lawful exercise of their profession, do not commonly use a speculum in open fields or coppices to determine whether a woman is pregnant or not; and it is a well-known fact that a speculum is not necessarily required for determining the question of pregnancy.

Medicinal Substances. Emmenagogues. Ecbolics.-These are frequently resorted to for inducing criminal abortion; but they rarely answer the intended purpose, and, when abortion follows, it is often at the expense of the life of the woman. Mineral poisons have been ignorantly employed for this nefarious object, and often with a fatal result. Among

540

USE OF MEDICINAL SUBSTANCES.

these substances may be mentioned arsenic, corrosive sublimate, bichromate of potassium (Vierteljahrsschr. für Gerichtl. Med., 1862, 2, p. 113), sulphate of copper, copperas or sulphate of iron, perchloride of iron, and other irritants Metallic mercury, which is generally reputed to be innocent, has been given for the purpose of procuring abortion. In a case recorded by Gibb (Lancet, 1873, i. p. 339), it produced no effect on the womb, but caused some severe nervous symptoms, which would justify the application of the term "noxious" to this substance.

Solutions of perchloride of iron (steel drops) have frequently caused severe symptoms, and seriously injured health without producing abor tion. In a case in which the author's evidence was required (Reg. v. Rumble, Lincoln Sum. Ass., 1863), it was proved that this compound of iron had been given in large doses daily to a pregnant woman for the purpose of exciting abortion. It had not this effect, but it had seriously injured the health of the woman. The prisoner also gave to her cantharides in pill. The defence was that these were proper medicines for the treatment of amenorrhoea, under which, it was alleged, she was laboring. The large doses administered, and the secrecy with which the medicines were supplied, proved that they had been given unlawfully and with criminal intent; and the chemist who supplied them, knowing the purpose for which they were required, was convicted. In 1878, a chemist pleaded guilty, on the analysis of the editor, of administering large doses of tincture of iron and aloes to a woman with the view of procuring abortion. The method failed, and the woman was afterwards operated on by a qualified medical man, with fatal result. (Reg. v. Darley and Moon, Lewes Sum. Ass., 1878.)

Arsenic, corrosive sublimate, and other mercurial compounds may cause death without in any way exciting the womb to expel its contents. In July, 1845, a woman who had passed the fifth month of her pregnancy, took a large dose of arsenic, as it was alleged, for the purpose of abortion. She died in less than seven hours, having suffered during that time from severe vomiting and purging; yet abortion did not take place. Such powerful poisons as strychnine have failed to effect it. A girl, æt. 17, who was pregnant, swallowed the contents of a packet of Battle's verminkiller. The usual symptoms followed, with tetanic spasms and opisthotonos. She recovered, and went her full time without aborting.

Drugs, such as croton-oil, elaterium, gamboge, colocynth, hellebore, and other drastic purgatives, have been used with criminal intent without causing abortion. Aloes and two of its compounds-hiera picra, a mixture of aloes and canella bark, and Pilacotia (pilulæ coccia), sometimes called "pill cochia," a mixture of aloes and colocynth-are much used as purgatives among the poor. In large or repeated doses they are supposed to have the power of exciting the womb, and are secretly employed for the purpose of abortion. Although not poisons in the strict sense of the word, it may be observed of these drugs, and of all purgatives which cause much straining, or specially affect the rectum, that they may readily bring on abortion in the advanced stages of pregnancy, while they fail in the earlier stages. The herbs which have acquired a popular repute as abortives, in the form of powdered leaves, infusion, or decoction, are very numerous. Some are innocent such as pennyroyal, broom, and fern; others are pernicious-such as white and black hellebore, yew, and laburnum. A decoction of broom simply acts as a diuretic

The medicinal substances above described, if they have any effect, exert an indirect action on the womb by producing a shock to the general sys tem. But there is another class of bodies which are considered to act on

« PreviousContinue »