THE INDUCTION OF MISCARRIAGE.
The induction of artificial labor in case of pelvic deformity naturally led to the thought of the induction of miscarriage in cases of extreme pelvic contraction. It was also in England, in 1768, that W. Cooper, Barlow and Hull counselled miscarriage in place of the Ciesarean section. From 1774 on, the induction of labor and of miscarriage rapidly spread throughout Germany, Holland and Italy. France alone rejected both procedures, and although, in 1831, Stoltz practised the induction of pre mature labor, it was not till 1842 that P. Dubois, publicly at the Clinic, induced miscarriage in a case of contracted pelvis. The method was ac cepted by Cazeaux, Lenoir, and others, but still was rejected by many, and to-day the induction of miscarriage is accepted in principle, although its two most decided opponents, Stoltz and Villeneuve, of Marseilles, re ject it in case of contracted pelvis, where they prefer the Ciesarean section, and authorize it in other instances, such as uncontrollable vomiting.
To-day the question is definitively settled, and, as Devilliers justly says, "although, with us, civil and religious law does not make any distinction between criminal and medical miscarriage, yet the magistrates, on weighing the facts of an induced miscarriage, cannot, in justice, apply the penalties of the law. This is why the physician should never act except under the advice of experienced counsel. Still, if at the moment of sacrificing the foetus, hand stops from conscientious motives, he may smother these, for both the sacred text and the college at Rome have given an affirmative answer to the question." As we have stated above, the principle of induced miscarriage is ad mitted to-day, and authorities only differ in regard to the indications, some deeming it justifiable when the mother's life is in danger from the fact of pregnancy, or of its complications, but excluding carefully pelvic deformity where they advise the Caesarean section; others include con traotions of the pelvis.
As for us, in accord with our teachers, we admit not only that we may, but also that we ought to induce miscarriage: 1. Whenever pelvic
contraction is considerable, that is to say, below 2.34 inches; when the infant cannot be delivered by the forceps, and when embryotomy is so difficult as to compromise the life of the mother. 2. Whenever during pregnancy, either from this fact alone, or from intercurrent disease, the life of the mother is in danger, and the interruption of pregnancy would seem to deliver her from danger. In a word, between the foetal and the maternal existence we would never hesitate.
Miscarriage should be induced: 1. In case of extreme pelvic deformity, under 2.34 inches. 2. Where the pelvis is obstructed by tumors which can neither now, nor later, be removed or pushed out of the way. 3. In uncontrollable vomiting. 4. In uterine retroversion. 5. In hemor rhages, profuse, and endangering, either immediately or from recurrence, the life of the mother. 6. In every case where the life of the mother is endangered, (hydramnios, ascites, circulatory or pulmonary affections, etc.) We will examine each of these indications separately.
Extreme Pelvic Deformity.—The opponents of the method, in these in stances, base their views on the results obtained from cephalotripsy and the Caesarean section, in particular the latter. It suffices to glance at statistics to see how disastrous these operations are for the mother and the infant, cephalotripsy necessarily killing the fcetus even as does mis carriage, and the Cfesarean section giving less satisfactory results than is ordinarily supposed.
As regards cephalotripsy, De Soyre, in his thesis, gives the following figures: Gu(niot cites the following figures, which formally contradict one an other: 77 cases—mothers saved, 47; mothers dead, 30. 69 cases— mother saved, 5; mothers dead, 64.
Finally, as De Soyre says, we must take into account the infantile mor tality after the Caesarean section. From Joulin's table, borrowed from Churchill, West, Kayser and Constantin, of 1,050 operations, 352 chil dren were dead, 35.5 per cent.