CRIMINAL .ABORTION.—In all civilized countries most severe punishment is inflicted upon criminal abortionists; in most of them the penalties are increased if the crime is committed by professional persons, such as medical men, midwives, and druggists. Notwithstanding this, criminal abortion is extremely frequent, principally in large cities.
It is generally between the second and fifth month of pregnancy that abortion is artificially produced.
Criminal abortion is performed by means of drugs and by local and sur gical intervention. A large number of drugs were, until recently, thought to possess active ecbolic properties, but a more elaborate study of the question has shown that no drug has a special action upon the uterus for expelling the prod uct of conception.
Criminal abortion is sometimes brought on by using lead. Four cases in which it was definitely determined that lead was taken for this purpose, and in which a diagnosis was made by discovering a blue line on the gums. Fourteen similar instances known of, sonic of which were personally seen, others having occurred in the practices of colleagues. As a rule, the diagnosis in these eases was at first acute gastri tis, renal colic, tubal inflammation, and similar conditions. In many cases the patients misrepresented matters abso lutely, and there was not the least sug gestion in their story of the actual cause of their condition. Schwarzwaeller (Berliner klin. Woch., Feb. 18, 1901).
The only fact to be admitted in a medico-legal point of view is that some drugs may cause abortion in predisposed women, but more by the general dis turbance of the system than by any spe cific action on the womb. The strong cathartics (scammony, jalap, etc.), given in large doses, may be classed in this category. Caustic acids are also active in the same sense.
Examination of 72 women on whom criminal abortion had been performed. In 1 case death resulted from nervous shock.
In 5 other eases, during or shortly after the injection, faintness, dizziness, and vomiting occurred, lasting several hours and disappearing without leaving any trace. In nine-tenths of the cases there was no special disturbance. Abor tion usually resulted in the course of a day, sometimes in six or eight hours. In only 4 of 5 cases was fever present or the patients obliged to remain in bed for several days. In 25 cases, however, there was evident endometritis, which propor tion would show sonic relation to the operation. It was strange that no septic troubles arose, as no special care was taken either of the syringe or the solu tion used. Vibert (Jour. de MCA, Feb. 26, '93).
Case of criminal abortion by the use of a tupelo tent in which the latter had been forced through the uterine walls. The tent was found lying transversely in Douglas's cal-dc-sac. Supravaginal hys
terectomy performed, on account of the septic condition of the pelvic cavity. The perforation, beginning at the inter nal os, extended obliquely upward and the tent had been forced through the serous coat just below the left horn of the uterus. W. Easterly Ashton (Med. Bull., July, '97).
Opinion recorded as to liability of person who consents to have abortion performed upon her: The judge, when summing up in the Collins trial. decided that "the woman who subunits herself to an unlawful operation is guilty of felony just as much as the agent she employs." Editorial (Ga. Jour. of Med. and Slug., Sept., '9S).
Death may ensue without the produc tion of traumatism, during the intra uterine use of instruments, probably through the intermediary of the sympa thetic system.
Case of sudden death during attempted abortion while introducing the nozzle of a syringe into the os uteri. Judicial in quiry. No uterine abnormality found, although the cervix was soft and patu lous. Death seemed to be due simply to syncope from a stimulus arising in the uterus. It was a phenomenon of inhibi tion. Syncope has been observed after passage of the sound. De in Touche (Sem. Gynee., June 23, '96).
In performing an autopsy upon a woman who is supposed to have at tempted abortion search sbould be made for the embryo or pieces of it, or for the placenta. if the uterus is empty, the thickness of its walls must be measured, and the insertion of the placenta sought, as this can be recognized up to the tenth day after the expulsion of the embryo. This is possible even later, if the uterus is kept in 90-per-eent. alcohol. The ex amination of the ovaries is of only rel ative importance, as no positive signs exist there. Stains of meconium, if found, will prove the abortion. If all instrument has been used to cause abor tion, traces of the damage done by it will be seen. This is especially true when the uterus has been perforated. Brouardel (Jour. des Pratieiens, Jan. 12, 1901).
Six hundred and ninety-eight cases of abortion witnessed. supposed to be spoil taneons. Four of the women died: that is, 0.57 per cent. During the same period forty-four eases of criminal abortion were treated: the mortality was 56.8 per cent.: that is, only nine teen women recovered. In the presence of a complete or incomplete abortion, clue unmistakably to mechanical meas ures, or even when such abortive meas ures are suspected, and in absence of any complication, early evacuation of the uterus is required. If septic acci dents have already developed, evacua tion is still more urgent, and general measures are also indicated. Maygrier (L'Obstetrique, July 4, 1902).