(4.) must be delayed as long as is consistent with the child’s safety.
5. Its means must be those which are most efficient, and safest for the
child.
We have already stated that the induction of abortion before the seventh
month, undertaken for the child’s sake, must be generally useless;
and therefore, as attended with some degree of danger to the mother,
generally unjustifiable. As the profession are nearly united on this
point, its further discussion is here unnecessary.
We have asserted that the cases where prematurely induced labor is
required for the child, are comparatively rare. We now add that while in
some respects they are more frequent, in others they are less so than is
generally supposed. To necessitate it, there must be disease or deformity
on the part of the mother, or disease on the part of the fœtus or its
appendages.
It is most frequently performed to avoid the alternative of craniotomy,
the necessity of which, unless extreme, can manifestly only be known
with certainty, before the expiration of pregnancy, from the experience
of past labors. But here too much caution cannot be exercised; the rules
of the books and of accepted authorities are not to be blindly followed.
Craniotomy at the full time is still too frequently performed:
Where it has been suggested by the character of a previous labor,
children are often, or might be, born living;
Where it seems indicated by direct exploration, as ruled even by recent
writers, children are sometimes, or might be, born living;
Where it was formerly thought absolutely essential, the progress of
obstetric science has now rendered it often unnecessary.
It is proper that we consider these points, for they bear directly on the
question at issue concerning criminal abortion.
It is known that the sex of children exercises an appreciable influence
upon the result of labors at the full time, as regards the possibility
of their passing alive, unaided or at all, through the pelvis, and as
regards the length of the labor, which also progressively endangers the
life of the mother and their own; the average female fœtus, in cases at
all difficult, having the advantage over the male by its inferiority in
size, especially important in the cranial diameters. It is unnecessary
for us to do more than refer to the facts by which these assumptions
are proved.[138] Where, therefore, craniotomy has been found necessary
in a former labor, the child then being male, in another labor a female
fœtus may often pass uninjured. However this argument may be lessened
in value by the impossibility of previously ascertaining the sex, it is
strengthened in the doctrine of chances, by the number of the labor and
the sex of the former children; and by the fact that first labors are
generally most difficult, whatever the sex of the child.
Furthermore, cases will suggest themselves to most practitioners of
experience, in which from difference in the character of the labor or
without apparent reason, children are born living at the full time,
males, of large size, and presenting by the vertex, where craniotomy
had previously, perhaps repeatedly, been performed. An instance of
this has occurred to the writer, where the patient had been advised to
early abortions from alleged physical incapacity of ever bearing living
children; he delivered her, without difficulty, of a large-sized and
living boy, at the full time.
Again, it may happen that in labor at the full period, craniotomy may
seem decidedly indicated and advisable, but for one reason or another
may not be performed, and yet the child, unaided, be born living. The
writer’s experience furnishes him with two illustrations of this class:
one of them occurred in 1851, the patient his own, Drs. S. sen., and
C., in consultation; the other was seen at Edinburgh, in 1854, in the
practice of his friend, Dr. G. W. In both cases, permission was refused
to operative procedures, the patients being Catholic, and the physicians
unable conscientiously to pronounce the fœtus already dead, while the
possibility of intra-uterine baptism was not recollected; in both
instances the children were born living, and without instrumental aid.
In other cases, where from deformity previously diagnosticated,
craniotomy is pronounced necessary if the patient should go her full
time, she may do so, the labor be unassisted, and the child yet escape
with its life. I instance a remarkable case for some time under my
own charge at the Boston Lying-in Hospital, delivered by one of my
colleagues, Dr. Dupee, and subsequently reported by Dr. Read.[139] The
pelvis was here equably contracted, and to a great degree, but from some
difference of opinion, partly as regarded the justifiability of premature
labor as compared with craniotomy, the patient was allowed to go her
full time. Both mother and child did well.
Finally, by turning, the use of the long forceps and of anæsthesia,
children are now constantly saved, where formerly craniotomy and their
consequent destruction would have been absolutely indicated. These
processes, with the introduction of each of which as an alternative a
single name is imperishably connected, are now successfully employed by
very many of the profession;[140] they have each of them saved to the
writer the disagreeable necessity of fœtal destruction. Where, however,
one life is thus preserved, there are still multitudes unnecessarily,
and, therefore, unjustifiably, sacrificed.
The comparative frequency of craniotomy in the different countries of
Europe is in this connection worth noticing.