CHAPTER XIII

FŒTICIDE, OR CRIMINAL ABORTION

[“_Every woman, being with child, who, with intent to procure her own miscarriage, shall unlawfully administer to herself any poison or other noxious thing, or shall unlawfully use any instrument, or other means whatsoever, with the like intent: and whosoever, with intent to procure the miscarriage of any woman, whether she be or be not with child, shall unlawfully administer to her, or cause to be taken by her, any poison or other noxious thing, or shall unlawfully use any instrument, or other means whatsoever, with the like intent, shall be guilty of felony, and being convicted thereof shall be liable, at the discretion of the Court, to be kept in penal servitude for life, or for any term not less than five years, or to be imprisoned for any term not exceeding two years, with or without hard labour, and with or without solitary confinement._”--Statute 24 and 25 Vict. c. 100, sec. 58.]

The 59th section of the same Statute also takes into consideration the unlawfully supplying or procuring any poison, or other noxious thing, or instrument, or thing whatsoever for a woman, for the purpose of inducing abortion. The person so doing shall be guilty of a misdemeanour, and be kept in penal servitude for a term of five years, or be imprisoned for any term not exceeding two years, with or without hard labour.

It will be seen from the passages above quoted that there is no distinction between a woman _quick_ or not _quick_ with child. “The offence is to procure the miscarriage of _any woman, whether she be or be not with child_” (R. _v._ Goodhall, 1 Din. 187; 2 C. & K. 293). But although the law does not regard “quickening” in cases of abortion, yet the fact of having “quickened” may be pleaded as a bar to immediate capital punishment.

[Illustration: Fig. 23.--Abortion at fourth week.

(Glaister.)]

It has been decided in Scotland that drugging or operating to procure abortion is criminal, though unsuccessful, but it is not certain whether the woman alone can be charged with taking drugs to procure abortion. Both in England and in Scotland, to make the procuring of abortion criminal, “there must be felonious intent,” for it may be necessary to cause abortion. It must be borne in mind that the law allows no discretionary power on the part of medical practitioners who, to save the life of the mother, may deem it advisable to induce premature delivery. This being the case, no medical man should attempt to induce premature labour without the consent of the relatives of the woman, and the sanction of a medical colleague after consultation. This precaution is the more necessary as several medical men have been prosecuted, an event which would not have taken place had the precaution above suggested been observed. A medical man should also be very careful never to give any medicine “to bring on the courses” if he has the slightest suspicion of pregnancy, even as a “placebo” to satisfy an importunate patient, for should abortion be otherwise procured, his really harmless medicine may be accused with the result, and a grave suspicion be raised against him, to say the least.

The term _abortion_ is understood in _medicine_ to mean the expulsion of the contents of the fœcundated uterus before the sixth month of pregnancy, that is, before the child is considered viable. After this period it is said to be a premature labour.

_In law_, however, no distinction is made and the expulsion of the contents of the uterus at _any_ period before the full time of pregnancy is considered an _abortion_; in popular language, a _miscarriage_.

[Illustration: Fig. 24.--Abortion between sixth and eighth week.

(Glaister.)]

[Illustration: Fig. 25.--Abortion at tenth week.

(Glaister.)]

Abortion, when not produced by criminal means, generally occurs at or a little before the _third month_ of utero-gestation, and then usually in first pregnancies, or during the latter part of the period of child-bearing. It is also more frequent among the rich than among the poor. Of the two thousand cases of pregnant women examined by Dr. Whitehead of Manchester, the sum of whose pregnancies was 8681, or 4.38 for each, rather less than 1 in 7 had aborted.

When abortion is criminally induced, it generally takes place between the _fourth and fifth months_, that is, about the time the woman becomes certain of her condition.

The Causes of Abortion are--

1. Natural or Accidental.--(_a_) Maternal--belonging to the mother; (_b_) Fœtal--belonging to the ovum.

2. Violent.--(_a_) Mechanical; (_b_) Medicinal.

1. Natural or Accidental

(_a_) =Maternal.=--Among the maternal causes may be mentioned excessive lactation; any irritation of the rectum or bladder; loss of blood, which, by increasing the amount of carbonic acid in the blood, acts as an excitant to the spinal cord; excessive irritability and excitability of the uterus, &c. Certain states of the system conduce to abortion--albuminuria, syphilis, certain fevers, scarlet fever, smallpox, &c. Abortion may become habitual in some women. Great joy or sudden sorrow have not infrequently been the cause of abortion. The tendency to abortion is greatest at the menstrual periods, that is, at the time when, had not the woman become pregnant, menstruation would have taken place. Slight causes acting at these times are very liable to produce abortion.

(_b_) =Fœtal.=--The death of the ovum, or a diseased condition of its uterine coverings, or of the placenta, probably of an inflammatory nature.

2. Violent

(_a_) =Mechanical.=--Under this head may be mentioned the passage of certain instruments into the cavity of the womb, and the rupture by violence of the membranes which surround the fœtus; also the injection of fluids into the uterus. A medical man practising in Yorkshire informed Husband that so great was the dread of large families, that he knew of several ladies who, if they went a day over their monthly period, passed a catheter into the uterus, with the desired result. “It was wonderful,” he added, “how clever they were.” In India a twig of the _Euphorbium nivulia_, anointed with assafœtida, is used for the same purpose. “The fœtus is never delivered alive, but there is said to be no great danger to the woman” (Chevers). Women may use hairpins, knitting-needles, and the idea is to pass the instrument “until blood comes,” which is accepted as a sign that abortion will be sure to follow. In some cases it is by no means easy to procure abortion, and women have been known to undergo a considerable amount of violence without abortion taking place. In some women, however, on the other hand, the slightest violence--such, for instance, as slipping from a step or low chair--will cause them to abort.

(_b_) =Medicinal.=--Certain drugs, among which may be mentioned ergot, savin, pennyroyal, rue, tansy, saffron, perchloride of iron, diachylon which contains lead, and others, have been used for the induction of abortion. In India unripe pineapple has a great reputation as an abortive (_Medical Jurisprudence for India_, Chevers). It is scarcely necessary to mention each drug individually, but it must be remembered that there is _not one single internal medicament_ of which it can be consistently with experience asserted that, even when an abortion has followed its use, it must have produced this abortion, and that cause and effect are in such a case “indirect and necessary connection.” All the so-called abortives are most uncertain in their action, and their use is attended with considerable risk to the woman. In the case of diachylon profound lead poisoning may be the result. Be this as it may, they are more frequently used to induce abortion than mechanical procedure, from the fact that the latter requires some amount of anatomical knowledge and manipulative skill.

The dangers of abortion from any cause are hæmorrhage, sepsis, and peritonitis. In mechanical interference, especially where proper precautions have not been taken to prevent them, sepsis and peritonitis from local injury and perforation are prone to occur.

A medical man may be required to--(1) Examine into the nature and characters of the substances expelled from the womb; (2) Examine the woman stated to have aborted.

1. =Examination of the Substances expelled from the Womb.=--The substances expelled from the womb often become the subject of judicial inquiry, and the medical man may be required to give his opinion as to their probable nature.

Dr. Gallard has called attention to the following:

1. During the last six months of pregnancy, abortion, even when it occurs spontaneously, goes through the two stages as at full time, _i.e._ the expulsion of the products of conception is, as a rule, preceded by rupture of the membranes, followed after a time by the expulsion of the placenta.

2. In the first three months this order of things is absent, for it is the rule to see the fœtus expelled entire _en bloc_ without rupture of the membranes.

3. If, then, we find during the first three months of pregnancy the products of an abortion in which the membranes have been ruptured and the embryo expelled alone, we must look for a pathological cause for this infraction of a general rule; and if no disease of the embryo or of the mother is found, we are justified in attributing the abortion to mechanical means used directly against the products of conception. Charpentier has shown that this rupture of the membranes is not an absolute proof of criminal abortion; but in eighteen cases of spontaneous abortion M. Leblond only found rupture of the membranes in one, and in this the membranes presented an abnormal friability.

The questions may be asked--(1) Is it a fœtus?--(2) Is it a mole? If so, is a mole also a fœtus?--(3) Is it merely the coats of the uterus, and unconnected with pregnancy?

1. _Is it a Fœtus?_--The development of the fœtus is given on pp. 35, 36 _et seq._

2. _Is it a Mole?_--This question gives rise to another: Is a mole a fœtus? To this the answer must be in the affirmative. Moles, being the diseased appendages of the fœtus, vary in character, and have been described by obstetrical writers under the following heads: (_a_) Hydatiginous; (_b_) Carneous; (_c_) Fatty Moles.

(_a_) _Hydatiginous Moles_ are a result of a diseased condition of the villi of the chorion. The villi become dropsical, and hang in masses like a bunch of grapes. (_b_) _Carneous Moles._--These are the result of hæmorrhage into the chorion. The blood becomes organised, and a fleshy mass is formed, to which in some cases a withered fœtus is attached. (_c_) _Fatty Moles._--Death of the fœtus and fatty degeneration of the placenta, or fatty degeneration of the placenta and death of the fœtus, produces this variety of mole. A withered fœtus with a mass of fatty placenta are expelled.

3. _Is it merely the Coats of the Uterus, and unconnected with Pregnancy?_--Fleshy masses may be expelled from the womb, which may not be the result of sexual intercourse. The description just given of true moles will, it is hoped, assist in forming a correct diagnosis. Considerable care will be required, for the honour of the woman accused depends upon the opinion given as to the nature of the substances submitted for examination. It must also not be forgotten that moles may be retained for many months in the uterus and be then expelled. The knowledge of this fact may rebut an accusation of infidelity against a wife. Polypi may be discharged from the womb; the presence of a pedicle will point to their true character. All substances expelled from the uterus should be carefully washed in water, and all clots removed. The examination of the woman may also help in the formation of the diagnosis. The absence of the signs of defloration or of recent delivery will be in her favour.

2. =Examination of a Woman stated to have aborted.=--This subject may be divided under two heads--(1) Has the woman been recently delivered? (2) What were the means used to procure the abortion?

It is by no means easy to answer the question whether an alleged abortion has really taken place or not. The signs of recent delivery are in most cases absent, for the woman can better hide her condition during the earlier than during the later months of utero-gestation; consequently suspicion may not have been aroused against her for some weeks or months after the event. The history of the case, with other attendant circumstances--milk in the breasts, change in the colour of the areola round the nipples, severe flooding, absence of the hymen, injuries to the os uteri, transverse condition of the os uteri in contradistinction to its circular form after delivery, &c.--will, in most cases, assist in forming a correct diagnosis; but it must be again repeated that few of the signs applicable to delivery at the full time are here available.

In all doubtful cases--

1. Examine into the general and present state of the health of the woman.

2. Find out if there are any reasons which would occasion a pretext to use drugs which are not usually given to women during pregnancy.

3. Learn if menstruation is regular and easy, or if the woman is in the habitual use of emmenagogues, for, if so accustomed, she may have used them ignorant of pregnancy.

4. If a woman ascribes her abortion to a fall, to an accident, or to violence used against her, carefully examine into the nature of these.

5. Examine into the general causes of abortion, and also inspect the expelled substances.

Where death is supposed to have followed the use of abortives, the alimentary canal must be examined for the signs of the action of irritants, or the presence of disease in the internal organs; but when death has resulted from an attempt to procure abortion by instrumental means, the neck of the womb is most frequently found covered by a number of small more or less irregular wounds, which may penetrate into the womb or lose themselves in the walls of the organ. Their course is indicated by infiltration, or a small extravasation of coagulated blood, the exact condition of which must, if possible, be ascertained, so as to decide when the wound was inflicted.

The examiner must not forget that the wounds may extend to the fundus of the uterus, and in this case the autopsy shows that a blunt instrument, as a catheter or uterine sound, introduced through the os uteri into the retroverted uterus, glides by its own weight into the rent. The seat of the tear leads one to think that pregnancy was not far advanced when the attempt was made, and in fact the accident most frequently occurs in cases of suspected pregnancy. It must be remembered that the uterus is often punctured by the injudicious use of the uterine sound, but without any immediate dangerous symptoms. Wounds in the walls of the vagina indicate the use of instruments by an inexperienced hand; in the fundus of the uterus, to one at least accustomed to the introduction of instruments. Spontaneous rupture of the uterus is impossible during the early periods of pregnancy, just when the attempts at abortion are usually made. Rupture due to external violence is, as a rule, accompanied with outward signs of the violence used.

In all cases a careful examination of the structure of the uterus should be made. An examination of the ovaries for _false_ or _true corpora lutea_ should be made. The opinions on the character and differences of these bodies are so discordant as to destroy all confidence in their value as proof of conception or the reverse.

Taylor says: “The discovery of the _ovum_ in the uterus _in process of development_ could alone, in the present state of our knowledge, warrant an affirmative opinion on this point in a Court of Law, and this I believe to be the safest view at present of this much-contested question. On the other hand, the absence of a corpus luteum from the ovary would not in all cases warrant an opinion that conception had not taken place.”

Examine carefully for local sepsis and signs of inflammation of the uterus and its surrounding structures.

Recapitulation

In Medicine, Abortion occurs before the sixth month of pregnancy--premature labour after that period.

In Law, Abortion may take place any time before the full period of utero-gestation.

Abortion may be due to--

1. _Natural or Unavoidable Causes._ (_a_) Maternal.   (_b_) Fœtal. 2. _Violence, with Criminal Intent._ (_a_) Mechanical. (_b_) Medicinal.

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