Allowing the fact of the occurrence of an abortion to be proved or
granted, it becomes necessary to discover its cause, whether accidental,
natural, or intentional. Of this it will be found that the proofs are
both positive and negative; drawn from the history of the case and from
personal examination of the patient and the fœtus. The value of each of
these elements is increased in proportion as it is compared with the
other; but “this I wish most especially to have noted, that WHEREVER
THERE IS A MISCARRIAGE, THERE IS ALWAYS PRESENT SOME ACTUAL, PERCEPTIBLE,
AND OFTEN TANGIBLE CAUSE.”[115]
The story of the patient may be to one effect, and that of other parties
involved, to a very different one; if the first is corroborated by the
second, it may again, as has already been remarked, present or not the
likelihood of truth. If the habit of aborting at a certain period has
existed, which of course cannot be alleged in a first pregnancy, if
the patient has had sudden fright or grief, or is known to have been
accidentally injured, the chances are to be considered in her favor, in
the absence of proof to the contrary. The converse of this statement,
however, must not be considered as always and necessarily true. Women
have time and again suffered shipwreck, undergone torture, been thrown
from a height, and otherwise severely injured, and yet have escaped
miscarriage; while, on the other hand, they may repeatedly have aborted
before, and yet passing safely their usually critical point, may without
trouble go on to the full period. In still other cases there may exist
local disease, pelvic or uterine, which, if left alone, would of itself
occasion miscarriage.
The character of the abortion is not without its value, whether occurring
suddenly and without apparent cause, or preceded by maternal disease or
the signs of fœtal death.
Examination of the mother, though proof that she has herself been
injured is not necessary to establish the crime, may reveal local wounds
and mutilations; or their absence, which, however, by no means goes
to prove that violence may not have been inflicted; and, on the other
hand, as in a case lately reported by the writer to the Boston Society
for Medical Observation, traces of former violence in instrumental or
other labors may remain, and to such an extent as to give to the touch
every character of a recent and criminal interference.[116] The fœtus
may show pre-existing and natural disease sufficient to account for
the effect apparent, or may present the signs of direct and intentional
interference. Recent scars of venesection on the arms and feet, and of
leech-bites, especially on the upper and inner parts of the thighs, are
suspicious in a patient who has aborted, unless they were evidently
required by the state of her previous health. If signs of irritant
injections into the vagina are present, they are ground for more than
suspicion.
The instrument, where used, with which the operation has been performed,
may sometimes be identified; though this is almost impossible unless
by confession or direct testimony. The weapons resorted to by the
unprofessional are various; knitting kneedles, pen handles, skewers,
goose quills, pieces of whale-bone, and even curtain rods, are among the
number. The finger alone, except where the uterus is prolapsed or can
be depressed, and the os is very soft and patulous, is seldom if ever
sufficient for the deed. If a physician be accused, it is important to
notice with what instrument the crime is said to have been performed, if
before witnesses, and whether it was introduced openly or under pretence
of a digital examination.
The sensations of the patient at the time, are also in different cases
unlike each other. In some instances nothing unusual is observed, in
others a prick or probing, but in most an acute and tearing uterine pain,
often followed by syncope or an hysterical attack. Slight but immediate
hemorrhage generally occurs, save in professional cases, increased by
compelled exercise, prolonged baths or ergot.
The time ensuing before the expulsion of the fœtus is an element not to
be lost sight of. In 34 cases reported by Orfila, the minimum observed
was 13½ hours, the maximum 6 days; in 36 cases by Tardieu, the minimum
was 5 hours, the maximum 11 days. Of these last cases, however, 29 were
within 4 days.
It cannot be alleged in excuse that the sex of the child, so fatal in
advanced pregnancy, has any influence in producing early abortion. In 293
premature still-births reported by Collins,[117] 146 were male and 147
female, bearing the proportion of 100 to 100. Nor can the plea of Drs.
Gordon Smith, Good, Paris, and Copeland, that as a fœtus born before the
seventh month has a slender chance of surviving, its murder should be
viewed with leniency,[118] be allowed. Such arguments, that the perils
and dangers to which the fœtus is naturally subjected should lessen the
criminality of attempts at its destruction, are without foundation, and
when advanced by physicians are utterly unworthy the profession.