Part 3

The results of abortion from natural causes, as obstetric disease, separate or in common, of mother, fœtus, or membranes, or from a morbid habit consequent on its repetition, are much worse 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 skilful 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 has been criminal, these risks are infinitely increased. Those who escape them are few.

In thirty-four cases of criminal abortion reported by Tardieu, where the history was known, twenty-two were followed, as a consequence, by death, and only twelve were not. In fifteen cases necessarily induced by physicians, not one was fatal.

It is a mistake to suppose, with Devergie, that death must be immediate, and owing only to the causes just mentioned. The rapidity of death, even where directly the consequence, greatly varies; though generally taking place almost at once if there be hemorrhage, it may be delayed even for hours where there has been great laceration of the uterus, its surrounding tissues, and even of the intestines; if metro-peritonitis ensue, the patient may survive for from one to four days, even, indeed, to seven and ten. But there are other fatal cases, where on autopsy there is revealed no appreciable lesion, death, the penalty of unwarrantably interfering with nature, being occasioned by syncope, by excess of pain, or by moral shock from the thought of the crime.

That abortions, even when criminally induced, may sometimes be safely borne by the system, is of little avail to disprove the evidence of numberless cases to the contrary. We have instanced death. Pelvic cellulitis, on the other hand, fistulæ, vesical, uterine, or between the organs alluded to; adhesions of the os or vagina, rendering liable subsequent rupture of the womb, during labor or from retained menses, or, in the latter case, discharge of the secretion through a Fallopian tube, and consequent peritonitis; diseases and degenerations, inflammatory or malignant, of both uterus and ovary; of this long and fearful list, each, too frequently incurable, may be the direct and evident consequence, to one patient or another, of an intentional and unjustifiable abortion.

We have seen that, in some instances, the thought of the crime, coming upon the mind at a time when the physical system is weak and prostrated, is sufficient to occasion death. The same tremendous idea, so laden with the consciousness of guilt against God, humanity, and even mere natural instinct, is undoubtedly able, where not affecting life, to produce insanity. This it may do either by its first and sudden occurrence to the mind, or, subsequently, by those long and unavailing regrets, that remorse, if conscience exist, is sure to bring. Were we wrong in considering death the preferable alternative?[13]

To the above remarks it might truthfully be added, that not only is the fœtus endangered by the attempt at abortion, and the mother's health, but that the stamp of disease thus impressed is very apt to be perceived upon any children she may subsequently bear. Not only do women become sterile in consequence of a miscarriage, and then, longing for offspring, find themselves permanently incapacitated for conception, but, in other cases, impregnation, or rather the attachment of the ovum to the uterus, being but imperfectly effected, or the mother's system being so insidiously undermined, the children that are subsequently brought forth are unhealthy, deformed, or diseased. This matter of conception and gestation, after a miscarriage, has of late been made the subject of special study, and there is little doubt that from this, as the primal origin, arises much of the nervous, mental, and organic derangement and deficiency that, occurring in children, cuts short or embitters their lives.

It may be alleged by those who, sceptical or not sceptical as to these conclusions, have reason, nevertheless, to desire to throw discredit upon them, that the weekly or annual bills of mortality, the mortuary statistics, do not show such direct influence from the crime of abortion as I have claimed exists.

On the other hand, it must not be forgotten that in these cases there is always present every reason for concealment. In the earlier months of pregnancy it is very difficult to prove, in the living subject, that pregnancy has occurred. Such a conclusion being arrived at, before the sound of the fœtal heart can be heard, for this is the only sign that is positively certain, by merely circumstantial and probable evidence, which becomes of weight only as it is accumulated and found corroborative. In the dead subject, the victim of an abortion in the earlier months, the case is often equally obscure, or at least doubtful, unless the product of conception has not yet escaped, or, having been thrown off, has been detected or preserved. When found, it of course proves pregnancy, whether the parent be living or dead; that is, in the former instance, if its discharge can be traced directly to the woman in question, and to no other, and correlative circumstances may show that an abortion has occurred; but this may have been accidental and guiltless. Where the act has been committed by an accomplice, the proofs of such commission and of the intent, though this is generally implied by the act itself, are by no means always forthcoming. Where the abortion has been induced by the woman herself, as is now so frequently the case, certainty upon the point becomes far more difficult. The only positive evidence by which to judge of the real frequency of the crime is _confession_, and it is from the confessions of many hundreds of women, in all classes of society, married and unmarried, rich and poor, otherwise good, bad, or indifferent, that physicians have obtained their knowledge of the true frequency of the crime.

The confidential relations in which the physician stands to his patient; the understanding that nothing can wring from him her disclosures, save the direct commands of the law, so unlikely in any given case to become cognizant of its existence, elicits from a woman in almost every instance, especially if she believes herself in peril of death, a frank statement of the means by which she has been brought low; for it is evident that upon such knowledge must depend the measures of relief to which the physician may resort. Could the test of confession be always applied, as is, however, manifestly impossible, so many women die during or in consequence of an abortion, without the attendance of a physician and without making any sign, it would be found that many of the cases now reported upon our bills of mortality as deaths from hemorrhage, from menorrhagia, from dysentery, from peritonitis, from inflammation of the bowels or of the womb, from obscure tumor, or from uterine cancer, would be found in reality to be deaths from intentional abortion. At first sight, it would seem impossible that such grossly erroneous opinions as the above could be rendered; but their likelihood is readily perceived when it is recollected how often, when the best medical skill has been secured, attending circumstances are such as to excite little or no suspicion of the true state of the case, and a physical examination of the patient is therefore neglected. Women are still allowed to die of ovarian or of other tumors that might be easily and successfully removed, and, in default of a proper examination, are sometimes mistakenly pronounced instances of disease of the liver or of ordinary abdominal dropsy, and as such are buried. If such and similar errors can occur in chronic cases, where time and opportunity have permitted the most thorough examination and study, still more likely are they to take place during the hurry and anxieties of an acute and alarming attack, where the conscience and shame of the patient are alike interested in causing or keeping up a deception.

It will have been seen, then, not merely that an induced abortion may be attended with great immediate danger to the mother, but that in reality it is very often fatal, either from the so-called shock to her system, or from hemorrhage, or from immediately ensuing peritonitis.

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2. Should the woman survive these immediate consequences, no matter how excellently she may have seemed to rally, she is by no means safe as to her subsequent health. There are a host of diseases, some of them very dangerous, to which she is directly liable.

The product of conception is not always entirely gotten rid of. If a fragment remains, no matter how trifling in size, it may serve as the channel of the most severe and constant hemorrhagic discharge. Of this, examples are by no means infrequent; the flux lasting at times for very many months, and, if the cause is not finally detected and removed, hurrying the patient to her grave.

The product of conception is sometimes retained entire, after its detachment from the uterine walls has been supposed wholly effected. It may be carried for many years, always acting as a foreign body; at times occasioning extreme irritation, shown perhaps only by distant and otherwise inexplicable symptoms, or it may lie dormant for a time without apparent trouble--finally making itself known by some sudden explosion of disease, whether by purulent absorption and general pyæmia; by ulceration and discharge of fœtal debris, through the intestines, bladder, or even abdominal integuments; or, by metritic inflammation, followed by sympathetic or consequent fatal peritonitis.

The patient, after an abortion, is very liable to one or another of the forms of uterine displacement, which are now known to lie at the foundation of so very large a proportion of the lame backs, formerly supposed consequent on spinal irritation; of the painfully neuralgic breasts, so often suggestive of incipient cancer; of the disabled limbs, pronounced affected with sciatica, cramps, or even paralysis; of the impatient bladders, from whose irritability or incontinence the kidneys are supposed diseased; of the obscure abdominal aches and pains, which unjustly condemn so many a liver and so many an ovary; of the constipation from mere mechanical pressure, which is so often thought to argue stoppage from stricture or other organic disease; of the severe and intractable headaches that, resisting all and every form of direct or constitutional treatment, are supposed to indicate an incurable affection of the brain; of the easily deranged stomachs, that are so suggestive of ulceration or of malignant degeneration; of the general hypochondria and despondency, that of the most gentle, even almost angelic, dispositions make the shrew and virago, and of the purest and most innocent produce, in her own conceit, the worst of sinners, even at times effecting suicide. Who that has suffered will think this picture overdrawn? Who that has practised will not recognize in displacements, the key by which these riddles may be solved?

Their mode of causation is plain. After an abortion, just as after labor at the full term, the womb is more weighty than natural--its walls thicker and heavier than usual, alike by the excess of blood they contain, and by the increased deposition of muscular fibre. After childbed, it has been shown that this increase is normally lessened by certain physiological processes attending the natural completion of that function. After an abortion, these processes are absent or are but imperfectly performed. It is notorious that during the slight increase of weight from simple congestion that occurs at the regular monthly periods, women are very liable to displacement on any effort, extreme or slight, whether riding on horseback, gently lifting, or even straining at stool; during or after an abortion, the risk is very greatly increased.

With equal justice could I refer to the chances of trouble that otherwise accompany the premature ending of pregnancy. In many instances, I have now been summoned to attend, and frequently to operate upon, the consequences of local uterine or vaginal inflammation or of laceration, for both of these results may ensue where the womb has not been prepared to evacuate itself by the normal closure of pregnancy--and this, whether or not instruments may have been employed. Adhesions of varying situation and extent are not uncommon as the result of an abortion. They may be slight, and merely tilt or draw the womb to one side, giving rise only to severe local or distant neuralgias, and rendering the occurrence of a subsequent pregnancy somewhat dangerous; they may be more decided, and as bridles or septa partially close the canal of the vagina, rendering menstruation and conjugal intercourse alike difficult and painful; they may be so complete as entirely to obliterate the mouth of the womb or of the external passage, in these instances preventing the escape of the menses, and rendering an operation necessary to avoid a rupture that might perhaps be fatal. Should it be the outer entrance that is occluded, the woman is of course entirely shut off from her husband's embrace; an effect that, however grateful to many an invalid, her shame would hardly be willing to accept as the consequence of disease.

These that I have mentioned are but a tithe of the pathological effects daily revealed to physicians, as in consequence of an intentional abortion. They are, however, sufficient for our purpose.

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3. But not only is a woman in peril both as to life and health, alike at the time of an abortion and for months or years subsequently. She may seem to herself and to others successfully to have escaped these dangers, and yet when she has reached the critical turn of life, succumb.

At this eventful period, when the fountains of youth dry up, and the scanty circulation is turned from its accustomed channel, the woman ceases from the periodical discharges, which in health and with care are the secret of her beauty, her attractions, her charms. At its occurrence not merely is a change produced in the system generally, but the womb, no longer required, becomes atrophied and dwindles into insignificance. It may have had impressed upon it, years and years back, the stamp of derangement, till now not rendered effective; for, as in other portions of the body, a part once weakened may retain itself in tolerably good condition until some accident or other change develops or awakens the seed of disease. Thus it is that an ancient hypertrophy, or a chronic irritation, may become scirrhous and degenerate into undoubted carcinoma, or chronic menorrhagia or uterine leucorrhœa become intractable hemorrhage, or a latent fibroid deposit develop into an irrepressible, and, perhaps, irremediable tumor.

Little the comfort for a woman to have had her own way against the dictates of her conscience, the advice, perhaps, of her physician, if to the dangers she must directly incur, she must add the looking forward through all the rest of her life to possible disease, invalidism or death as the direct consequence of her folly; no wonder if she should consider prevention better than such cure as this, and yet the prevention of pregnancy, by whatever means it may be sought, by cold vaginal injections, or by incomplete or impeded sexual intercourse, is alike destructive to sensual enjoyment and to the woman's health; her only safeguard is either to restrict approach to a portion of the menstrual interval, or to refrain from it altogether.

Not merely are certain of the measures to which I have alluded detrimental to the health of the woman, they are so to both parties engaged, and it is to their frequent employment, freely confessed as this is to the physician, that much of the ill health of the community, both of men and women is to be attributed. Though they may seem sanctioned by the rites of marriage, they are in some respects worse for the physical health, I might almost say for the moral health likewise, than illicit intercourse or even prostitution, for they bring both parties down to all the evils and dangers, mental and physical, of self-abuse.

V.--_The Frequency of Forced Abortions, even among the Married._

All are familiar with the fact, to be perceived everywhere upon the most casual scrutiny, that the standard size of families is not on the average what used to be seen; in other words, that instances of an excess over three or four children are not nearly as common as we know was the case a generation or two back. No one supposes that men or women have, as a whole, so deteriorated in procreative ability as this might otherwise seem to imply.

There can be but one solution to the problem, either that pregnancies are very generally prevented, or that, occurring, they are prematurely cut short. We have seen that countless confessions prove that this surmise is true.

In the treatise to which we have already alluded, its author has shown by a series of unanswerable deductions, based on material gathered from many sources both at home and abroad, that forced abortions in America are of very frequent occurrence, and that this frequency is rapidly increasing, not in the cities alone, but in the country districts, where there is less excuse on the ground of excessive expenditures, the claims of fashionable life, or an overcrowding of the population. It was proved, for instance, that in one State that was named, one of the wealthiest in the Union, the natural increase of the population, or the excess of the births over the deaths, has of late years been wholly by those of recent foreign origin. This was the state of things existing in 1850; three years later it was evident that the births in that commonwealth, with the usual increase, had resulted in favor of foreign parents in an increased ratio. In other words, it is found that, in so far as depends upon the American and native element, and in the absence of the existing immigration from abroad, the population of our older States, even allowing for the loss by emigration, is stationary or decreasing.

The strange and otherwise unaccountable phenomenon to which we are now referring, appears to have been first elucidated in a memoir, upon the decrease of the rate of increase of population now obtaining in Europe and America, read by the same author in 1858 to the American Academy of Arts and Sciences, as a contribution to the science of political economy. That paper, with all its mass of evidence, that as yet there seems to have been no attempt to controvert, we find embodied in the treatise to which I have referred, and which will prove of absorbing interest to even the casual reader.

Thus it is seen that abortion is a crime not merely against the life of the child and the health of its mother, and against good morals, but that it strikes a blow at the very foundation of society itself.

One of the strange and unexpected results at which the author we have so often referred to has arrived, but which he has both proved to a demonstration and satisfactorily explained, is that abortions are infinitely more frequent among Protestant women than among Catholic; a fact, however, that becomes less unaccountable in view of the known size, comparatively so great, of the families of the latter--in the Irish, for instance--the point being that the different frequency of the abortions depends not upon a difference in social position or in fecundity, but in the religion. We should suppose _à priori_ that the Protestant, especially if of New England and Puritan stock, would be much the safer against all such assaults of the world, the flesh, and the devil. The following is the concise and convincing solution of the paradox that has been given:--

"It is not, of course, intended to imply that Protestantism, as such, in any way encourages, or, indeed, permits the practice of inducing abortion; its tenets are uncompromisingly hostile to all crime. So great, however, is the popular ignorance regarding this offence, that an abstract morality is here comparatively powerless; and there can be no doubt that the Romish ordinance, flanked on the one hand by the confessional, and by denouncement and excommunication on the other, has saved to the world thousands of infant lives."[14]

There is another surprising result that must strike every candid observer whose position gives him extended and frequent observation of women, and of late years the study and treatment of their special diseases has become so recognized that there are many physicians thus rendered competent to judge; it is this, but a second one of the many very frightful characteristics of induced abortion, that the act is proportionately much more common in the married than in the unmarried basing the calculation upon an equal number of pregnancies in each case.

This fact also may be easily accounted for. Abortion is undoubtedly more common in the earlier than in the later months of pregnancy, because the sensible signs of fœtal vitality are then less permanently present, and the conscience is then better able to persuade itself that the child may possibly be without life, or the alarm wholly a false one. It is less common with first than with subsequent children, though instances of its occurrence with the former are certainly not rare. A woman who has never been pregnant does not, as a general rule, conceive as readily as one who has already been impregnated before, perhaps partly from the fact that intercourse, under certain circumstances, is more likely to be excessive in such cases, at times producing acute or subacute inflammation of the cervix uteri, and consequent sterility, as is so constantly observed in prostitutes, very many of whom, upon ceasing their trade, after accumulating a little property, as in France, or upon being sent to out-lying colonies, as in England, and becoming married, at once fall pregnant.

The unmarried woman, if _enceinte_, has not the opportunity of lying by for a few days' sickness, without exciting suspicion, that the married can easily seize for themselves. She is often not so conversant with the early symptoms of gestation, and is more prone to wait until its existence has been rendered certain by the sensation of quickening, in the hope, doubtless, not unfrequently, that this certainty may persuade her paramour to marriage, instead of deciding him against it, as is so often the case. It may be allowed, I think, that infanticide, the murder of a child after its birth, or its exposure to the vicissitudes and perils of chance, is more common among the unmarried, but that destruction of the fœtus in utero, the rather prevails where the rites of law and religion would seem to have extended to that fœtus every possible safeguard.

In the latest of the papers upon the subject of abortion, to which we have already alluded, there is furnished additional evidence as to the frequency of induced miscarriage.