The abortion may perhaps be known to have taken place by confession or
witness; in either case requiring no further demonstration. Instances are
not rare, however, where suspicion merely may exist, and the fact must be
proved by collateral testimony; and this in two cases, where the woman is
still alive, and where she is dead.
The general history of the case, even if pregnancy and delivery be
equally denied, may throw some light on its true nature. This as given,
no matter how affected by the evidence of interested or implicated
witnesses, may be probable or improbable; as in an instance related by
Burns,[111] where her sudden lessening in bulk was ascribed by a patient
to a night’s profuse sweating, of course an impossible result. But, on
the other hand, care is necessary lest from its rarity of occurrence or
its improbability, the reality should be disbelieved. Cases are on record
where innocent women, suffering from retention of menses or from ovarian
disease, and suddenly relieved by a critical and spontaneous discharge,
have on suspicion of abortion lost character and even their lives. If
the statements contradict each other, this fact of itself may reveal the
truth.
There are at times difficulties in proving delivery at the full period
of pregnancy, as is well known. The earlier in gestation, if the patient
survive, the more these difficulties are enhanced. The occurrence of
normal labor cannot be discovered with any certainty by a personal
examination after eight days have elapsed,[112] those of an early
abortion not even after only one or two.[113] The signs of delivery that
are well marked at the full period, the general symptoms then obtaining,
the size of the uterus, ascertained by the hand and sound, lacerations of
the perineum and cervix, the lochia, the state of the breasts, abdomen,
vagina, and vulva, all of little value except in conjunction with each
other, are proportionately less defined as we go back, until near the
commencement of pregnancy it becomes impossible to distinguish the
abortion from severe hemorrhage or from menorrhagia, unless by detecting
the impregnated ovum.
If the patient is dead, and too long time have not elapsed since the
supposed occurrence, decision is often more easy; many facts in the
case being generally known, and concealment being less possible. If
the ovum, but partially detached, be still retained, the fact is
self-evident; if it has been discharged, and concealed or lost, there
will still be present the recent corpus luteum and other well-known
signs, in proportion to the period of the pregnancy. Allowance, in this
latter respect, must be made for the possibility of partial uterine
contraction after death, as is sometimes known to occur at the full
period;[114] the writer has seen it to a marked degree some time previous
to the expiration of pregnancy, at a Cæsarean section after death from
laryngitis, occurring in the Edinburgh Maternity Hospital.