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SYSTEMATIC 




ABORTION: 



EDWIN M. HALE, M.D., 

PKOFESSOR OF MATERIA MEDICA AND THERAPEUTICS IN HAHNEMANN MEDICAL COLLEGE : 
ETC., ETC. 



CHICAGO. 

C. S. HALSEY, 147 Clark Street. 

1866. 



X S-^. X9' 



Entered according to Act of Congress, in the year 1S66, 

By C. S. HALSEY, 

in the Clerk's Office of the District Court, for the Northern District of Illinois. 



^^^7 




FEB 26 1923 



Church, Goodman and Donnelley, Pbinteks, 51 and 53 LaSalle Street, Chicago. 



VOLUME 

IS 

INSCRIBED 

TO 

A. E. SMALL, A.M., M.D., 

OP CHICAGO : 



A MOST EXCELLENT PHYSICIAN, 

ONE OF THE BEST OF MEN, 

AND TEUEST OP FRIENDS. 



. PREFACE. 



In the Eighth Volume of the North Atnerican Journal of Homoeopathy 
(1860), an article appeared bearing the title, ''Abortion: its Pre- 
vention and Treatment," in which the writer ventured to call the 
attention of his professional colleagues to medicines not heretofore 
used by members of the Homoeopathic school, and which he believed 
to be of considerable value as remedial agents for the removal of 
certain abnormal conditions of the organs of generation, which are 
likely to cause an arrest of development, or premature expulsion of 
the product of conception. The interest that this article aroused 
in the professional mind was such that the writer felt justified in 
enlarging and amending the original paper. It was then issued by 
the present publisher, in a pamphlet of twenty-two pages, entitled 
" The Homoeopathic Treatment of Ahortion,'" etc. 

This small brochure was prefixed by a Prefatory Letter from Dr. 
R. Ludlam, in which he kindly commended it to the notice of 
Homoeopathic physicians. 

That edition of the monograph having been exhausted, the writer 
engaged in a more thorough and systematic study of the subject. 
Five years having elapsed since the appearance of the original 
paper, he had gained increased practical experience upon the 
subject. He has, therefore, attempted to embody these results 
in the Treatise herewith presented to the general medical profes- 
sion, and especially to physicians of the Homceopathic school. 

He sincerely hopes this volume will form a useful addition to 
our medical literature. 

Chicago, April 2, 1866. 



CONTENTS. 



PAGE 

Introduction xiii 

PART I.— STATISTICS OF ABORTION. 

Of Foreign Countries .'. 19 

.Of New York City 20 

Of Boston 22 

Of Chicago 23 

As to the period at which Abortion occurs 25 

Of Criminal Abortion 27 

PART II.— ETIOLOGY OF ABORTION. 

Tabular View of the Causes op Abortion 33 

Sec. I. — Predisposing Causes. 

Plethora 85 

Anasmia or Chlorosis 35 

Scrofula 36 

Return of Menstrual Crisis 36 

Zymotic Diseases: 

Syphilis 37 

Mercurialization 38 

Variola 38 

Asiatic Cholera 39 

Yellow Fever 39 

Sec. II. — Local Causes. 

Abnormal Condition of the Ovum and its Appendages 39 

Moles ■ 40 

Hydatids 41 

Fatty deterioration of the Chorion and Placenta 42 

Congestion of the Placenta 43 

Inflammation of the " 43 

Placenta Previa 44 

Sec. III. — Centric Causes. 

Emotional 45 

Physical 45 

Medicinal 46 



Vlll. CONTENTS. 

■ PAGE 

Galvanism 48 

Cerebro-Spinal -Meningitis 49 

Sec. IV. — Concentric Causes. 

Parotidean 55 

Thyroidean 56 

Mammary 56 

Gastric 56 

Dental 57 

Eenal 57 

Vesical 57 

Eectal 57 

Vaginal 58 

Ovarian 58 

Uterine 59 

Sec. V. — Functional Diseases of the Uterus. 

Congestion 61 

Leucorrhcea , 62 

" Cervical or Mucous ' 64 

" " Sequelae 65 

" Vaginal or Epithelial , 67 

Gonorrhcea 69 

Sec. VI.- — Organic Diseases of the Uterus and Cervix. 

Ulceration of tKe Cervix 71 

Simple Granulating Ulcer 73 

Varicose " .■ 76 

Fissured " 77 

Follicular " 79 

Phagaedenic ■ '' 80 

Corroding " 80 

Cancerous " 80 

Syphilitic " 80 

Sec VII. 

Induration of the Cervix Uteri '.,...... 82 

Displacements of the Uterus 84 

Anteversion 84 

Prolapsus 84 

Eetroversion 84 

Death of Embryo 87 

Coitus 87 

Instrumental Irritation 88 

Ovarian 89 

" Irritation 89 

*' Congestion 90 

" Inflammation 90 



CONTENTS. ' IX. 

Sec. VIII. 

PAGE 

Medicinal Causes " 90 



PART III.— GENERATION : 

Symptoms, Diagnosis, Pathology. Mechanism and Pkognosis of 

Abortion. 

Sec. I. — Generation. 

To date of Placental Attachments , 115 

" Viability 117 

" Delivery 118 

Dimensions and Weight of the Foetus at the different periods 

of Uterine Life 119 

Sec. II. — Symptoms of Abortion. 

Premonitory 123 

Actual 124 

Chills 124 

Pain 125 

Hsemorrhage 127 

Fever 130 

Complications 131 

Discharges 131 

Subsequent 131 

Sec. III. — Diagnosis of Abortion. 

Metritis 134 

Peritonitis 135 

Dysmenorrhoea 135 

Dysentery 135 

Congestion of Uterus 136 

Hydrorrhcea ' 137 

Haemorrhage 138 

Retention in Utero of the Ovum and Appendages 140 

Sec. IV. — Pathology and Mechanism of Abortion. 

Process of Abortion ■ 142 

After Conception 1 43 

" twenty days to the third month 143 

At sixth month 146 

Sec. V. — Prognosis of Abortion. 

When favorable 148 

" unfavorable 149 

Natural abortions 150 

Immediate consequences 151 

Remote " ; ■. 151 



X. - CONTENTS. 

PAET lY.— TREATMENT OF ABORTION. 
Sec. I. — Preventive Treatment, 

PAGE 

Of Plethora 155 

Anaemia or Chlorosis 159 

Scrofula 162 

Return of Menstrual Crisis 162 

Of Zymotic Diseases: 

Syphilis 163 

Mercurialization 164 

Variola' 164 

Scarlatina 166 

Diphtheria 168 

Cholera -. 170 

Sec- II. — Of Local or Organic Diseases. 

Malformation of the Ovum 171 

" " Membranes 171 

Placenta Previa 172 

Organic Disease of Placenta 173 

Fatty Degeneration 173 

Hydatid " 173 

Calcareous " ■ 175 

Molar " 175 

Sec. III. — Of Reflex Causes. 

Centric ' 176 

Emotion, Fright, etc 176 

Blows, Injuries, etc 177 

Medicinal 178 

Concentric 178 

Parotidean Irritation : 178 

Thyroidal 179 

Mammary 179 

Dental 180 

Gastric 182 

Rectal 183 

Vesical 186 

Vaginal 187 

Hysterical 189 

Epilepsy 189 

Falls, Jumping, Blows, etc 189 

Sec. IV. — Of Functional Diseases op the Uterus. 

Congestion 191 

Inflammation 192 

Leucorrhcea 192 

Cervical : 192 



CONTENTS. XI. 

PAGE 

Vaginal 194 

Gonorrhoea 197 

Sec. V. — Of Ulceration of the Os and Ceryix Uteri. 

Simple Granulating Ulcer 204 

Varicose " 204 

Fissured " 205 

Follicular " 206 

Phagedenic " 206 

Syphilitic " 208 

Eesume 209 

Diphtheria 209 

Ovarian Diseases i ,,, . 211 

Sec. VI. — Of Uterine Displacements. 

Prolapsus 213 

Anteversion 214 

Eetroversion 214 

Sec. VII. — Eemedial Treatment. 

Medicinal 217 

Mechanical 224 

Sec. VIII. 

Conduct of the Physician 234 

Sec. IX. 

Examination oiF the Patient i 237 

Sec. X. 
Management of Labor 240 

Sec. XL — Sequels of Abortion. 

Post-partum Treatment 248 

Postural 248 

Dietetic 251 

Medicinal , 252 

Of Pelvic Cellulitis ' 253 

Hypertrophy of the Uterus 253 

Fistula 253 

Inflammation of the Uterus 253 

Puerperal Metritis 254 

"■ Peritonitis 254 

Phlebitis 254 

Dropsy 254 

Paralysis 254 

Mental Aberrations ' 254 

Chronic Menorrhagia 255 

Mechanical Treatment 256 

Of Prolapsus 256 

Eetroversion ! 256 



Xn. CONTENTS. 

PAET v.— OBSTETEIC ABOKTION. 
Sec. I. — Obsteteic Abortion. 

PAGE 

Necessity of Premature Labor 263 

Methods employed — Stillette 2*71 

Sponge-tent 271 

■ Caoutchouc Bags 271 

Tampon 272 

Colpeurynteur 273 

Water-douche 273 

Ergot 275 

Cupping-glasses 275 

Galvanism 277 

Sec. II. — F(ETAL Abortion. 

Methods employed 280 

Flexible Bougie 281 

Catheter 281 

Sec. III. — Embryonic Abortion. 

Methods employed 284 

Flexible Catheter 284 

Uterine Sound • 287 

Injections 288 

Abortion Forceps 288 

Sec. IV. — Ovular Abortion. 

What it. is 290 

Utopian Theories 291 

Duty of the Physician 292 

Different methods 293 

Theory of Impregnation . 295 

Character of Spermatozoa 299 

Prophylaxis of Conception—agents employed 303 

Tabular View of Uterine Contents and Synopsis of Treatment 309 

PAET VI.— JUEISPEUDENCE OF ABOETION. 
Sec. I. — Criminal Abortion. 

A Lecture by A. E. Small, M.D 313 

Charles Woodhouse, M.D 320 

Laws of the European Countries 321 

different States 323 

General Index , . 339 



INTRODUCTION. 



The term Abobtion, is derived from the Latin word aborto, whicli 
means literally — to hring forth hefore the time. This broad defini- 
tion allows of no restriction, aside from the one given in the literal 
rendering. The premature expulsion of the contents of the gravid 
uterus at any date prior to the end of the ninth month, or the 
normal expiration of pregnancy, is an abortion. In this work, the 
term has therefore been used in its broadest sense ; but, as will 
be seen, I have divided the period of pregnancy into three natural 
divisions, based on the condition of the placenta and the fcetus. 
Four kinds of abortion are treated of, namely: (1) Ovul-ar, when 
the ovum is lost before it is impregnated. (2) Embryonic, when 
the impregnated ovum is expelled before the placenta has formed 
its uterine attachment. (3) Fcetal, when the expulsion occurs 
after the last date, and before the viability of the child ; and (4) 
when the child is born capable of living, or viable, but before the 
end of a normal pregnancy. 

This is not an arbitrary plan, because it is founded on natural 
changes and certain periods, which are well recognized in physio- 
logical science. Such an arrangement greatly facilitates a study 
of the subject in a methodical manner. 

Hitherto no complete and systematic treatise on Abortion has 
appeared in the literature of any school of medicine. 

The Allopathic branch of the profession, in which we would 
naturally look for a worb on this subject, possesses but one volume, 
which treats of it in a monographic manner. 

Dr. Whitehead's work on "Abortion and Sterility" was pub- 



XIV. INTEODUCTIOlSr. 

lished in 1854. "While it is a valuable work of reference on certain 
points, it is lacking in systematic completeness. It contains some 
suggestive statistics, and an excellent elucidation of many of the 
causes of abortion, with their Allopathic treatment ; but beyond 
this, the author does not extend the work. No mention is made 
of the intermediate and remedial treatment of the accident itself, 
or of its numerous and important sequelae. 

The obstetrical works of Churchill, Ramsbotham, Tyler Sm_ith, 
Simpson, Cazeaux, Hodge, Meigs, Bennett, Bedford, Gardner and 
others (Allopathic); King, Scudder, and Beach, (Eclectic); and 
Jahr, Leadam, Pulte, Loomis, Small, Marcy, Ludlam and others 
(Homoeopathic); all contain much in relation to this subject. 

I have drawn freely from all these authorities, selecting the 
practical and useful, and rejecting all that was irrelevant. Of all 
medical writers, Cazeaux seems to me to have treated the subject 
of abortion in the most systematic manner. 

The various periodicals of our school have been examined for 
clinical experience relating to the treatment of this accident. 
Considerable practical information on this point has been commu- 
nicated to me by my professional friends. I am especially under 
many obligations to Dr. R. Ludlam, Professor of Obstetrics and 
Diseases of Women and Children in Hahnemann Medical College, 
for his kind assistance while in the preparation of this work, and 
also for the use of his large obstetrical library, containing many 
rare and valuable volumes. 

I am obliged to state, however, that on many points of import- 
ance relating to the treatment and induction of abortion I have had 
to rely almost wholly upon my own experience, and to ascertain 
the most practical and useful facts by careful experiment and 
patient investigation. 

Abortion has grown to be a subject of such importance to the 
medical man, that its consideration should no longer be confined to 
the works devoted to obstetrics and diseases of women, wherein it 
can but be treated of in a manner not sufficiently complete to sat- 
isfy the student or investigating practitioner. 



IlfTEODUCTION. XV. 

It must strike every observant and thinking physician that the 
day for large treatises, on such broad subjects as "Practice," 
"Materia Medica," "Surgery," "Obstetrics and Diseases of Wo- 
men," has gone by. No medical writer can do justice to the range 
of subjects naturally included in any one of the above titles, if he 
is confined to one or even two volumes. Nothing short of an ency- 
clopoedia of one of the above subjects would satisfy the require- 
ments of the age, and as an encyclopoedia is made up of separate 
monographs, it will greatly enhance the value of medical literature 
if a series of exhaustive monographs appear which shall do away 
with the necessity for such ponderous works. Moreover, the accu- 
mulations of such valuable material relating to any one subject 
pertaining to practical medicine has become so extensive, and 
withal so scattered through the books, journals and other periodi- 
cals, that it is the duty of the medical writer to collect the material 
together, and put it in such a form as to be most available to the 
student or practitioner. 

To this end the writer of this volume has directed his labors. 
He does not claim to present much original matter, although his 
observations and experience have enabled him to increase somewhat 
the common stock of information relative to the etiology and treat- 
ment of the accident. 

He has drawn freely from all the standard medical works of the 
day, and from all sources which seemed to him reliable. Medical 
facts are common property, and it is not necessary to give further 
credit to authors and observers, than is given in J;he pages wherein 
mention is made of the sources of information. 

This work is intended in no respect for public circulation, and 
the author would be sorry to think it should ever be perused by 
the prurient and immoral. 

In order to render the work as complete as possible, it has been 
necessary to mention the various methods to be made use of for the 
induction of abortion for legitimate purposes. If this information 
shall be abused, and used for unlawful purposes, the blame must 
rest where it really belongs. 



XVI. INTEODUCTIOlSr. 

If I have not given minute indications for tlie use of each remeclf 
mentioned in the follovying pages, it is because of the impossibility 
of so doing in a work of this kind, without swelling it to an inordi- 
nate size. The symptoms of, and special indications for, the use of 
each medicine can be found in the several works on Materia Medica, 
belonging to the HomcBopathic school. 

I believe that no physician in whose hands this work may fall, 
will consider the volume a superfluous addition to our literature. 



PART I. 



STATISTICS OF ABOETION. 




!^EB 26 1923 



STATISTICS OF ABORTIOK 

It will be apj)ropriate, before we enter upon tlie 
consideration of the causes, pathology, treatment, etc., 
of Abortion, that we shall make ourselves acquainted 
with the statistics having a direct bearing upon the 
subject. 

The first question which presents itself — Zs Abortion 
constantly increasing f — is so important that we shall 
present the statistics in as complete a manner as is con- 
sistent with' the plan of this work. 

The following statistics are taken from an elaborate 
work* by Horatio B. Storer, M. D., of Boston. 'Wri- 
ting of the frequency of abortion in our own country, 
he says : 

" Statistics in this country are yet so imperfect that 
we are necessitated to a process of deduction. ^- * * 
If we find that in another country living births are 
steadily lessening in proportion to the population and 
to its increase — that natural and preventive causes are 
insufiicient to account for this — while the proportion 
of still births and of known abortions is constantly 
increasing, and these last bear an evident yet increasing 
ratio to the still-births ; that in this country the de- 
crease of living births, and the increase of still-births, 
are in much greater ratio to the population, and the 
proportion of premature births is constantly increasing; 
and that these relations are constantly and yearly more 
marked, we are justified in supposing that abortions are 

* Criminal Abortion in America. 



20 HALE Olf ABOETIOl^r. 

at least as freqaent witli us, and probably more so. 
In* many countries of Europe it lias been ascertained 
that the ' fecundity' of the population, or the rate of 
' its annual increase is rapidly diminishing. 

" In Sweden it has lessened by a fifth ; in Prussia, 
by a fourth ; in Denmark and England, by a third, and 
in Russia, Spain, Germany and France, by a half, in a 
single eentury I 

" In four departments of France, among which are 
two of the. most thriving of Normandy, the deatbs ac- 
tually exceed the births ! 

" Again, as might have been expected, we find that 
the proportion of still-births, in which we must include 
abortions, as has hitherto been done, however improp- 
erly, in all extensive statistics, is enormous, and is 
steadily increasing ; and while the proportion of still- 
births to the whole number is greatly increasing in 
Paris, as is the number of known abortions. * * At 
the Morgue, which represents but a very small fraction 
of the foetal mortality of Paris, and in this matter 
almost entirely crime, there were deposited during the 
eighteen years preceding 1855, a total of 1115 foetuses, 
of which 423 were at the full term, and 692 were less 
than nine months, and of these last, 519, or five-sixths, 
were not over six months, a large proportion of them 
showing decided marks of criminal abortion. 

" We now turn to our own country, to which the city 
of Ne^w York holds much the same relation that Paris 
holds to France. 

" Since 1805, when returns were first made to the 
Registry of New York, the number, proportionate as 
well as actual of foetal deaths, has steadily and rapidly 
increased. With a population, at that time, (1805) of 
76,770, the number of still and premature births was 
47; in 1849, with a population at 450,000, the number 
had swelled to 1320." 

In brief, while the ratio of foetal deaths to the popu- 
lation was, in 1805, 1 to 1633.40, in 1849 it was 1 to 
340.90 ; and wh.en we consider that a large proportion 



still-birth. 


RaiJo. 


349 


1 to 37.6 


633 


1 to 26.3 


1,818 


1 to 19.1 


3,7M 


1 to 15.8 


21,702 


1 to 13.3 


1,942 


1 to 11.1 



STATISTICS OF ABORTIOK", 21 

of tlie reported premature births must always "be from, 
criminal causes ; and that though almost all the still- 
births at the full time, even from infanticide, are ne- 
cessarily registered, but a small proportion of the 
abortions and miscarriages occurring are ever reported 
to the proper authorities, it will be apparent that at 
the present moment the abortion statistics of New York 
are far above those of 1849. This the following table 
will show, as well as the fact that the ratio is steadily 
increasing : 

Total mortality. 

1804 to 1809 - - - 13,128 

1809 to 1815 - - - 14,011 

1815 to 1825 - - • 34,798 

1825 to 1835 - - - 59,347 

1835 to 1855 - - - 289,786 

1856 - - - 21,658 

" The frequency of abortions and premature births 
reported from the pi'actice of physicians, and thus to a 
certain extent, but not entirely, likely to be of natural 
or accidental origin, is as follows : 

"In 41,699 cases registered by Collins, Beatty, La 
Chapelle, Churchill, and others, there were .530 abor- 
tions and miscarriao;es. Here all the abortions were 
known: their proportion was 1 to 78.5. 

"In New York, from 1854 to 1857, there were 48,- 
323 births at the full time reported, and 1,196 prema- 
ture. Here all the abortions were not known, probably 
but a very small fraction of them : the proportion was 
1 in 40.4. In the seventeen years from 1838 to 1855 
there were reported 17,237 still-births at the full time^ 
and 2,710 still prematurely; the last bearing the pro- 
portion of 1 to 6.3. In the nine years from 1838 to 
1847, there were 632 premature still-births, and 6,445 
still at the full time : a yearly average of 1 in 10.2. In 
the eight years from 1848 to 1855, there were 2,078 
premature still-births, and 10,792 still at the full time : 
an average of 1 in 5; while in 1856 there were 387 
still prematurely and 1,556 at the full time, or 1 in 4.02. 



22 HALE ON ABOETIOlSr.' 

" From these figures tliere can be drawn but one 
conclusion — that criminal abortion prevails to an enor- 
mous extent in New York, and that it is steadily and 
rapidly increasing. ' We cannot refer,' was well said 
by a former Inspector of that city,'^' ' such a hecatomb 
of human offspring to natural causes.' " 

The same statistics also shew that the reported ecwlij 
abortions, of which the greater number of course escape 
registry, bear the ratio to the living births of 1 in 40, 
while elsewhere they are only 1 in '78.5 : and finally, 
that early abortions, bearing the proportion to the still- 
births at the full time of 1 in 10.2 in 1846, had increased 
to 1 in 4.2 in 1856. 

Almost doubling, therefore, as does New York, the 
worst of those fearful ratios of foetal mortality existing 
in Europe, it is not strange that our metropolis has 
been held up, even by a Parisian, to the execration of 
the world : " On le voit (I'avortement)," says Tardieu, 
" en Amerique, dans une grande cite comme New York, 
constituer une Industrie veritable et non poursuivie." 

" In this description of New York," says Dr. Storer, 
" we have that of the country." 

" In Boston, which for morals is supposed to compare 
favorably with any city of its size in the Union, un- 
doubtedly more than a hundred still-births yearly escape 
being ^^ecorded ; a large proportion of which, no doubt, 
results from criminal abortion." 

In the State of Massachusetts it appears that during 
the fourteen years and eight months preceding 1855, 
there were recorded 4570 still-births, and 11,716 pre- 
mature births and abortions, the ratio being one abor- 
tion to three still-births ; or, in other words, it would 
appear from the statistics quoted, that the comparative 
frequency of abortions in Massachusetts is thwteen times 

*Eeport of 1849. 



STATISTICS OF AB0ETI01S-. 23 

as great as in tlie worst statistics of tlie city of New 
York ! 

It must not be forgotten that while nearly every 
still-birth at the full time is necessarily recorded, there 
must be but very few registrations of the premature 
births and abortions actually occurring. Few persons 
could have believed possible the existence of such 
frightful statistics. They should call the attention of 
the whole medical and legal world toward some plan to 
arrest such awful destruction of embryo human life. 

In the great city of Chicago no registration of the 
births has ever been made ; nor do the physicians make 
any returns relating to the still-births, miscarriages, etc. 
This is much to be regretted on many accounts. It 
does not do credit to the municipal authorities, to the 
influential citizens, nor to those physicians of the domi- 
nant school, who are supposed to have influence with 
those in power. It is alleged as an apology for this 
omission of a civil daty, that the State legislators have 
never passed, a law of Registration of Births, etc. ; but 
this is no valid excuse, when it is in the power of the 
city authorities to pass an ordinance which would an- 
swer every purpose of such a law. 

To the above statistics of the frequency and increase 
of abortions, I will add those of Dr. Whitehead,* who 
aiSserts that " the number of pregnancies which each 
woman experiences, during the existence of her procre- 
ative aptitude, is about twelve , or one in every twenty 
months. This includes abortions, false conceptions, 
premature deliveries, and all having an unsuccessful 
issue, the average amount of which will be rather more 
than one and a half for each individual ; or it may be 

* Ou Abortion and Sterility, page 198. 



24 HALE ON ABOETION. 

stated, as a general rule, ttat every seventh 'pregnancy 
has a premature termination. These conclusions have 
been drawn from the subjoined facts. 

"Two thousand niarried women in a state of preg- 
nancy, admitted for treatment at the Manchester Lying- 
in Hospital, during parts of the years 1845 and 1846, 
were interrogated in rotation respecting their existing 
condition and previous history. Their average age at 
the time of inquiry was a small fraction below thirty 
years. The sum of their pregnancies already termi- 
nated was 8681, or 4.38 for each, of which rather less 
than one in seven had terminated abortively. But as 
abortion occurs somewhat more frequently during the 
latter than in the first half of the child-bearing period, 
the real average will consequently be rather more than 
one in seven. Of the individuals submitted to inquiry, 
1253 had not then suffered abortion. The average age 
of these was 28.62 years ; the sum of their pregnancies 
was 3906, or 3.11 for each person. The remaining 747 
had already aborted once at least, and some oftener. 
Their average age was 32.08 years. The sum of their 
pregnancies was 5775, or 6.37 ; that of their abortions 
1222, or 1.63 for each person. From the preceding 
statements it appears that more that thirty-seven out of 
every hundred mothers, experience abortion before they 
attain the age of thirty years." 

Dr. Whitehead's observations do not accord with the 
popular idea, that early, especially first pregnancies, 
have more frequently a premature termination than 
those which come after. He is inclined to believe that 
the third and fourth, a*nd subsequent pregnancies, and 
one or two of the last — namely, those which occur near 
the termination of the fruitful period — are most com- 
monly unsuccessful. 



STATISTICS OF ABOETION. 25 

At what period of pregnancy does ahortion mo8t fre- 
quently occur? 

The following table, copied from Whitehead, throws 
some light on this question. It will be noted that the 
abortions here referred to, were those which were sup- 
posed to occur from diseased conditions of the mother 
or foetus. Hereafter the subject of criminal abortions 
will be referred to. Aboetioist (which term is here used 
in its most extensive signification) may occur at any 
period of utero-gestation. It will be seen that it is 
much more common at some stages of the process than 
at others, and is attended with different degrees of 
danger, according to the circumstances under which it 
occurs, the nature of the exciting cause being the most 
important. When it takes place before the end of the 
sixth month, it is invariably fatal to the offspring, either 
before birth, or in a short time after ; and at any period 
before the completion of the process, it is . more or less 
injurious to its well-being. Instances are on record, 
however, of children born during the early part of the 
seventh month, having lived in the enjoyment of toler- 
able health and constitutional vigor to a mature age. 

" Abortion is at all times fraught with danger to the 
mother, and sometimes attended with fatal consequences. 
I give in the following table the respective periods of 
602 cases of abortion, which have occurred under my 
own immediate observation. It may be noticed that 
each figure in the first column embraces a period of 
four weeks, extending from a fortnight before to the 
same length of time after the month indicated ; and as 
abortions happening earlier than the seventh week of 
uterine life are so frequently and so nearly simulated, 
both in married and unmarried females, by certain ute- 
rine discharges, the result of disordered menstruation,- 



26 



HALE ON ABOETION". 



events said to have taken place at tMs early period, 
except those wherein the escape of an ovum was un- 
doubtedly found, have not been included in the report." 

TABLE 

Showing the Period of Pregnancy at which Abortion 
occurred in 602 cases, the relative number of Still- 
born and Living Children, and the number living at 
the end of a month after birth. 



Period of pregnancy at which abortion 
occurred. 


Number of 

births at each 

period. 


Number still 
born. 


Number liv- 
ing at birth 


Nuniber liv- 
ing at end 
of a month 


2 months . . ." 


35 

2Y5 

147 

30 

32 

55 

28 


24 

38 
23 


8 
17 

5 





3 " 


, 


4 " 





5 " 





6 " 





7 " 


3 


8 " 


1 






Total 


602 


85 


30 


4 



"The foetus of six months' growth is generally consid- 
ered viable. Of the eight indicated in the table, as 
having been born alive, when born at this period, seven 
perished within six hours after birth, and one only 
attained to the age of ten days. Of the seventeen born 
alive at seven months, the majority lived over several 
days' and a few to the end of the third and fourth 
week. Three still survive, the youngest of whom is 
now aged nineteen months." 

Whitehead does not mention the possibility or proba- 
bility of an abortion occurring at the f/rst month, or 
even at the third week of pregnancy. Yet it must be 
admitted by those who have investigated the causes of 
abortion, that it is by no means improbable, and very 
possible, for the abortions which occur at that early 
period to outnumber those of any other month. 



STATISTICS OF ABOETIOJST. 27 

If any disease of the uterus or contiguous organs^ or 
any constitutional irritation sufficient to cause abortion 
exists, such causes a/re more likely to induce abortions at 
the FIRST month than at any other period. 

Let us consider tlie matter logically. Intimately 
connected with tlie subject above treated of, is that of 
criminal abortion, and the period of pregnancy at which 
it generally occurs. 

From Dr. Storer's work we learn that "It was Orfila's 
opinion that criminal abortion was most frequent in the 
first two months of pregnancy. This would naturally 
have been supposed to be the case, as then some doubt 
always might obtain regarding its existence, and the 
excuse that the measures resorted to were for the pur- 
pose of preventing ill effects from an abnormal men- 
strual suppression, would be more available. Devergie, 
on the other hand, was inclined to put the limits of 
greater frequency at from three months to four and a 
half; while Briand and Chandler thought the crime 
more common in the third month than the fifth, and 
in the last month much more frequent than even in the 
first or second. Tardieu also came to a similar conclu- 
sion. He ascertained that of 34 cases investigated by 
himself, 25 were in from the third to the sixth month, 
mostly in the third ; 5 in the first two months ; 4 in 
the second and eighth ; or that the cases in the third 
month, or shortly after, were five times as numerous as 
at either an earlier or a later period, and nearly three 
times as numerous as in both combined. Upon exam- 
ining the register of the Morgue, we find its statistics 
strikingly corroborative of this deduction. We have 
already seen that from 1837 to 1854 there had been 



28 HALE ON ABORTION". 

deposited at the Morgue 692 foetuses of less than nine 
months. Of these 

23 were from the first to the second month ; 



79 




second " 


third 




108 




third " 


fourth 




158 




fourth " 


fifth 




150 




fifth " 


sixth 




97 




sixth " 


seventh 




48 




seventh" 


eighth 




29 




eighth " 


ninth 





" It has been stated that 519, or five-sixths of them 
all, were not over six months ; and it now appears that 
on a scale twenty times larger than that given by Tar- 
dieu from his own experience, nearly two-thirds of the 
foetal deaths induced by abortion were in from the third •: 
to the sixth month of pregnancy, the three periods 
included giving a much larger proportion than any 
others, and the last two of them being nearly identical. 
The extreme paucity shown by the above table in the 
first and ninth months, and the decrease in the seventh 
and eighth from those preceding, are worthy of remark. 
It is probable that the sudden increase may be attribut- 
able to mental reaction after the first shock occasioned 
by the absolute certainty of pregnancy, is past ; and 
the subsequent decrease to the fact that in many at- 
tempted criminal abortions, during the latter months, 
children are born alive, the mother's courage then prov- 
ing iusufiicient for infanticide, and its greater and more 
probable punishment." 

My observation has shown me that criminal abortions 
are very frequent in the fourth week after conception. 
Many women, who are habitually regldar to a day, are 
in the habit of using some drug or instrument if the 
menses delay a few days, and they have reason to sup- 
pose conception has taken place. They allege that they 



STATISTICS OF ABOETIOIS^. 29 

know by certain sensations that conception lias occnrrecl, 
as early as tlie third or fourth week. This habit is 
more frequent than has been supposed, as any physician 
will ascertain who seeks to investigate the matter. 

In order to make complete the statistics of abortion, 
we should be able to present tables representing the 
average mortality of women who suffer that accident, 
both from criminal and other causes. " The results of 
abortion from natural causes," says Dr. Store r, " as 
obstetric disease, separate or in common, of mother, 
foetus or membranes, or from a morbid habit consequent 
on its repetition, are much more than those following 
the average of labors at the full period. If the abortion 
be from accident, from external violence, mental shock, 
great constitutional disturbance from disease or poison, 
or even necessarily induced by the skillful physician in 
early pregnancy, the risks are worse. But if, taking 
into account the patient's constitution, her previous 
health, and the period of gestation, the abortion had 
been criminal, then the risks are infinitely increased." 
In 34 cases of criminal abortion reported by Tardieu, 
where the history was known, 22 were followed as a 
consequence by death, and only 12 were not. In 15 
cases ^" necessarily induced by physicians, not one was 
fatal. 

These meagre statistics are all I have been able to 
obtain relative to the consequences of abortion, to the 
mother. While I admit that the risks of a fatal result from 
criminal abortion brought about by other than skillful 
physicians, or even from diseased condition, are great, I 
cannot believe the result of abortion "necessarily in- 
duced by skillful physicians," is as fatal as Dr. Storer 



Annals de Hygiene, 1856, p. 141. 



30 HALE OlS" ABORTIO]^. 

asserts. My observation and experience in tliis matter 
have been quite extensive, and I have been led to the 
conclusion that, if the operation is skillfully performed, 
the fatal results need not exceed one in a thousand. 

I have not been able to find an}^ statistics relative to 
the proportionate frequency of the various diseased con- 
ditions which result from abortion ; but the information 
which I have received from my colleagues, and the 
various writers on diseases of women, as well as my own 
observations, lead me to place the consequences of abor- 
tion and their relative frequenc}^ in the following order : 

1. Ulceration, erosion and congestion of the os uteri. 

2. Premature and profuse menses. 

3. Retroflexion and retroversion of the uterus. 

4. Prolapsus uteri. 

5. Ovarian disease. 

6. Pelvic cellulitis. 

The statistics relating to the causes of abortion, as 
well as those having reference to the various other 
matters connected with the subject, will be found under 
the appropriate chapters. 



PART II. 



CAUSES OF ABORTION. 



CAUSES OF ABORTION. 



The following; Classification of tlie causes of Abortion 
is based upon the one used by Prof. Ludlam in bis 
Lecture before the class of Hahnemann Medical Col- 
lege. The additions made by myself will be denoted 
by the initial H. 

I. Constitutional or Predisponent. 



Plethora. 

Ansemia or Chlorosis. 
The Scrofulous Diathesis. 
Return of Menstrual Crisis. 
{a) Syphilis. 

(b) Mercurialization. 

(c) Variola. 

(d) Scarlatina. 

(e) Diphtheria. 
{/) Cholera. (H.) 



1. 

2. 
3. 
4. 



f- Zymotic 
' Diseases. 



II. Local or Organic. 



1. 

2. 



Malformation of ovum. 

" of membrane. 



{a) Mal-location of (Placenta Previa.) 
(h) Organic Disease of 
Placental (c) Detachment of 

id) Fatty Degeneration of 
Ahnormalities. (e) Calcareous " of 
/) Hydatids. (H.) 
g) Moles. (H.) 

III. Rejlex {Exciting.) 

(a) Emotional — as Fright, Anger, Grief, etc. 
1 ri -,,/ -^ J (^) Dii'ect blows upon the brain or spinal cord. 
1. Leiitnc. < ^^^ Medrcinal. (H.) 

(d) Cerebro Spinal Meningitis. 



34 



HALE ON ABORTION". 



2. Concentric. 



(H.) 
(H.) 
(H.) 

(H.) 



also Renal. (H.) 
(H.) 



(a) Parotidean Irritation. 

{h) Thyroideal 

(c) Thoracic 

{d) Mammary 

ie) Dental 

(/) Gastric 

{g) Rectal 

(A) Vesical 

(^') Vaginal 

{j) Hysterical 

{k) Epilepsy. 

(T) Falls, jumping, blows, etc. 

{m) Functional and Organic Diseases of the 

Uterus. (H.) 
{n) Functional and Organic Diseases of the 

Ovaries. (H.) 
(o) Displacements of the Ovaries. 
{p) Death of Embryo. 
{q) Genital (Coitus.) 
(r) " (Instrumental.) 



MEDICINAL. 



Emmenagogues or Oxytoxics. 

The following list of medicinal agents is necessarily 
imperfect, but I liave placed therein the drugs which 
may, under certain circumstances, cause- abortion. The 
list is not complete, as there are many medicines not 
named which have been supposed to cause that accident. 



Apis mellifica. 

Actgea alba. 

Aloes. 

Asarum europeum. 

" canadense. 
Asclepias syriaca. 

" incarnata. 
Aletris farinosa. 
Baptisia tinctoria. 



Borax. 

Bovista. 
Cantharis. 
Caulophyllum. 
Cimicifuga. 
Decodon verticillatus. 
Gossipium herbaceum. 
Ilex opaca. 
Mercurius. 



Podophyllum. 

Quinise sulphas. 

Buta graveolens 

Sabina. 

Secale Cornutum. 

Sanguinaria. 

Terebinth. 

Tanacetum vulgaris. 

Ustilago madis. 



SECTION I. 



PEEDISPOSING CAUSES. 

Pletliora. 

The first predisposing cause of Abortion mentioned 
in the foregoing table is Pletliora ; but it is oftener a 
cause of sterility, and will be again alluded to under 
that head. Obesity may cause abortion in several ways. 
The deposition of fat in the abdomen and pelvis will 
have the same effect as a tumor in those localities. In 
some cases of adiposis the action of the heart is mani- 
festly impeded, and sometimes entirely arrested, by the 
deposition of fat in and around it. • The same result 
may obtain in regard to the uterus, and prevent its 
expansion heyond a certain pointy at which abortion 
would inevitably occur. Dr. Gardner also suggests 
that the deposit may " press down the uterus, pressing 
it into the pelvic strait, sometimes producing eversion, 
or so that the os uteri presses upon the sacrum, where 
by mere friction its surface becomes abraded, and pro- 
fuse leucorrhoea ensues." Not only this, but prolapsus 
and retroversion may be thus caused. 

Ancemia or Chlorosis. 

Frequent abortions may cause anaemia; and this 
condition may in turn predispose to repeated abortions, 



36 HALE OK ABOKTIOZ^-. 



the uterus not liaving sufficient "tone," or vitality, to 
retain the product of conception. Chlorotic women are 
as liable to abortion as those who are anaemic, and from 
the same cause, namely — a lack of vitality in the uterus, 
and a blood so impoverished that it is incapable of 
nourishing the foetus. 

SGrofida. 

The scrofulous diathesis^ by its influence upon the 
Adtal powers of the system, causing laxity of tissue, defi- 
cient nervous force, and depriving the blood of its nor- 
mal constituents, is a powerful predisponent cause of 
loss of the ovum at any and all periods of gestation. 

Metwrn of the Menstrual Crisis. 

This, as a cause of abortion, especially in the first 
months, has not been sufficiently appreciated. I have 
stated in the introduction to this work, that I consider 
it proper to define "Abortion," as the premature death 
and expulsion of the ovum at any time after conceptions 
or before the end of the ninth month. I have also 
mentioned, in another place; the frequency of abortions 
in t}\Q first month. 

The older accouchers paid much att*ention to the loss 
of the ovum shortly after impregnation. Married 
women who passed over a monthly period by a few 
days and then menstruated profasely were believed to 
have lost the ovum. This was called an effluxion, if it 
occurred before the tenth day, " because," as SmoUie 
observes, "the embr3^o and secundiues are not yet 
formed, and nothing but the liquid conception, or geni- 
tura, is dislodged. Tyler Smith thinks such cases are 
not uncommon, and the ovum is unobserved, not from 



CAUSES OF ABOKTION. 37 

its liquid condition, but because it is so little above the 
size of the unimpreguated ovum, as not to be visible in 
the discharges. An ovum of fourteen dsijs has been 
described by Velpeau, and its size did not exceed threp- 
eighths of an inch in diameter. In the expulsion of an 
ovum of an earlier date than this, the symptoms hardly 
differ from those of profuse menstruation. In cases of 
dysmenorrhoea — especially the pseudo-membranous va- 
riety, and in cases of profuse menstruation (habitual) — 
this loss of the ovum may frequently occur at a very 
early period. It has often been a matter of wonder to 
me that the uterus should so frequently resist the influ- 
ence of a menstrual nisus, when abnormal in its charac- 
ter, or that a diseased uterus could so often bear the 
recurrence of the crisis when normal^ without being 
irritated to such an extent as to throw off the impreg- 
nated ovum at such periods. (See Ovarian Irritation.) 

ZYMOTIC DISEASES. 

Syphilis. 

Independent of the power which this blood-poison 
possesses of causing diseases of the uterus — as ulcera- 
tion, etc., which, will be mentioned in another place — 
syphilis seems to exercise a blighting power over the 
product of conception, in such a manner that it is liable 
to die in utero, of the same poison, and be expelled as 
a foreign body, at any period of pregnancy, or the 
membranes may become diseased from the pernicious 
influence of the malady : in both cases the disease may 
be transmitted by either or both parents : by the 
mother through the circulation, and by the father 
through the spermatozoa. 

Writing of this disease, as a cause of sterility, Dr. 



38 HALE ON ABORTION. 

Gardner says : "In my opinion it is more often a cause 
of early abortion from an imperfect development of tlie 
ovum, than a cause of sterility, as it is difficult to decide 
whether the woman was ever impregnated or not. The 
menses are retained a few days over the usual period ; 
there is finally a somewhat profuse discharge, accom- 
panied by more pain than usual, and the passage of 
wha,t are considered clots, but in them lies concealed 
the semi-developed ovum." 

Mereui'ialization. 

Mercury, in its various forms, may not only be an 
immediate cause of abortion, as in the cases of large 
doses of calomel, elsewhere alluded to, but the system 
may be so saturated with the poison that the blood and 
tissues are deprived, by its baleful influence, of the 
normal vitality necessary to carry on the process of 
gestation. The effects of this drug upon the organism 
are not unlike those of syphilis. It has long been re- 
marked that women whose systems have been saturated 
with mercurial preparations were very liable to abor- 
tions, and this without any organic disease being dis- 
covered in the organs of generation. 

Variola^ etc. 

Abortion may occur from the intense febrile orgasm, 
or from the congestive complications which take place 
during these disorders. All the exanthematous fevers 
predispose the system to take on such irritative con- 
ditions as may bring about miscarriage during or after 
their accession. The foetus in utero has been known 
to be attacked with the variola, and be expelled either 
before or after its death. 



CAUSES OF ABORTIOlSr. 39 

According to Cazeaux, " confluent small-pox nearly, 
always occasions abortion, and this is almost uniformly 
followed by tlie death of the mother." 

Asiatic Cholera and Yellow Fever 

are powerful zymotic poisons, and, like other diseases 
of this character, effect the foetus through the medium 
of the circulation. 

Dr. Pulte'^ states that during the cholera epidemic of 
1848 abortions were very frequent, and were apparently 
caused by the imponderable poison pervading the at- 
mosphere at that time. The same phenomena has been 
noticed during the prevalence of yellow fever in the 
large cities of the South. 

Dr. Bouchut, in a quite recent work, mentions his 
observation of fifty-two cases of cholera in pregnant 
women, twenty-five of whom aborted in consequence of 
the disease. 



SECTION II. 

LOCAL CAUSES. 

Abnormal conditions of the Ovum and its A])jpendages. 

Dr. Whitehead says these are " so constantly associ- 
ated with disease of the maternal organs as to lead to 
the suspicion that the mischief, in a great majority if 
not in all instances, originates in the latter." In my 
own practice, such complication has been almost invari- 
ably found in those cases wherein I have had an oppor- 
tunity of making the necessary examination. 

* Homoeopathic Domestic Physician, 477. 



40 HALE ON ABORTION. 

The fcettis is liable to many diseases wliich may tend 
to its death, such as inflammation and dropsy of its 
venous cavities, dropsy of amnion, disease of the liver 
or kidneys, tubercular diseases, syphilis, and even small 
pox ; diseases of the umbilical cord, knots upon the 
cord ; strangulation, by the twisting of the cord about 
the neck of the child. I have seen cases in which the 
cord was twisted three and four times around the neck. 
Probably the diseased ovum excites the uterus to con- 
traction before the actual death of the ovum has 
occurred. 

In many cases of criminal abortion the injury done 
to the child by instruments, etc., is the real cause of 
the abortion. The membranes may not be ruptured or 
separated. 

The impregnated ova may degenerate into moles, 
hydatids, or " blighted ovaP 

Genuine 'moles are to be distinguished from certain 
fibrinous masses which are sometimes expelled from the 
uterus. These are called spurious moles, and a close 
examination will show their real character. Those 
moles which are the result of impregnation are of vari- 
ous kinds, consisting of different forms of degeneration 
of the membranes of the ovum. We can readily dis- 
tinguish the varieties of moles depending on the carne- 
ous or fleshy, the hydatigenous, and the fatty, and 
other degenerations of the membranes. None of these 
cases can occur without conception. Many authors 
believed that fleshy moles might occur in nuns, and 
others presumed to be virgins, without the occurrence 
of intercourse. Percy believed that hydatids were in- 
dependent animals, and that their production was com- 
patible with the purest chastity. Deunison thought 
they sometimes originated in the uterus as independent 



CAUSES OF ABORTION. 41 

formations, and Sir Charles Clarke was of opinion tliat 
uterine hydatids might exist apart from pregnancy. 
Madam Boivin and several other writers are in favor 
of the belief that this form of degenerated ovum may 
be retained for many months, or even years, after the 
ordinary date of labor. Tyler Smith is not aware that 
any case of this kind has been observed. I have known 
two cases in my own practice where a hydatid mass was 
not expelled until the twelfth month after the last 
appearance of the menses. Those who wish to investi- 
gate the nature of moles and hydatids can consult Tyler 
Smith. ^"■ 

In the ca/tmeous moles there is an arrest of the usual 
symptoms of pregnancy, and the patient remains out of 
health. The ovum from the time of its death becomes 
to a great extent a foreign body, and is a source of 
irritation to the system generally. No increase of size 
takes place, so that at the fourth or fifth month the 
uterus may not be larger than it should be in the fifth 
or sixth week of normal pregnancy. The complexion 
is muddy and the breath fetid, with loss of appetite and 
digestion. Hemorrhage frequently occurs, but not very 
profuse. 

The hydatid mole causes symptoms more strongly 
marked. The increase in size is often enormously rapid, 
so that at the fifth or sixth month the abdomen is as 
it should be at the end of pregnancy. The shape of the 
uterus is often quite different from that existing during 
natural pregnancy. There is absence of all foetal move- 
ments and the sounds of the foetal heart. After three 
or four months' suspension of the catamenia, there oc- 
curs a copious discharge of water and bloody resembling ' 

* Lectures on Obstetrics. 



42 HALE ON ABOETION. 

red currant juice. This occurs irregularly and in vari- 
able quantities. The watery discharge is accompanied 
by pain, and appears to be caused by the breaking 
down of numbers of the larger hydatids. In a suspected 
case the discharges should be carefully examined, and 
of course the detection of a single hydatid renders the 
diagnosis certain. Excessive flooding often occurs, at 
frequent intervals, accompanied with discharges of 
masses of hydatids. The general health suffers pro- 
foundly, resulting in anaemia, dropsy, and even paral- 
ysis. 

Fatty Deterioration of the CJiorion and Placenta. 

We are indebted to Dr. Robert Barnes for our know- 
ledge of this frequent cause of abortion. This form of 
degeneration may affect the secundines at any time 
between the early weeks of pregnancy and the termina- 
tion of gestation. Fatty degeneration may exist in the 
placenta as a post mortem change ; that is, it may occur 
in utero after the death of the foetus. It may happen 
also as the result of the transformation of effused fibrin 
in inflammatory disease of the placenta, or of a clot of 
blood in hemorrhagic effusion. Lastly, it may consist 
of the metamorphosis of portions of the maternal and 
foetal structures of the placenta during the life of the 
foetus. The latter pathological phenomenon is that 
which is of the chiefest importance in relation to abor- 
tion. 

In a placenta affected with fatty degeneration, the 
lobes of the placenta are altered in appearance, some of 
them being of yellow fatty color, brittle and exsanguine, 
the rest presenting their ordinary characters. Exam- 
ined more minutely, the tufts are found to be glistening, 
hard and tallowy, and not expanding when placed 



CAUSES OF ABORTIOK". 43 

under water, as is tlie case with villi of healthy pla- 
centse. The microscopical investigations of Dr. Hassall, 
show that the villi are studded with spherules and drop- 
lets of fatty matter and oil. The fatty material is found 
principally in the cells of the villi, and in the coats of 
its blood vessels, which vessels do not carry red globules 
when the degeneration exists to any extent. Dr. Barnes 
considers constitutional syphilis a frequent cause of this 
disease. Fatty degeneration causes abortion by destroy- 
ing the vitality of the ovum ;' or owing to the friable 
condition of the placenta, partial separation may occur ; 
or the partially degenerated blood vessels may burst 
and lead to placental apoplexy. For a full description 
of this disease of the placenta and chorion, see Tyler 
Smith's Lectures on Obstetrics, page 185. 

Congestion of the Placenta 

Leads to what is termed apoplectic effusion. Blood 
may be poured out either on the foetal or external sur- 
face of the placenta. It may produce abortion in sev- 
eral ways. The loss of blood may deprive the foetus 
of life ; or the effusion may excite the separation of the 
ovum, and cause uterine contractions. In some cases 
the effused blood coagulates, its fluid portions are re- 
moved, and a fibrous mass remains without doing any 
great injury. 

. Infiammation of the Placenta (Placentitis). 

In this disease effusion of lymph may occur, or the 
disease may pass on to hepatization, suppuration, or 
gangrene. Sometimes, when the inflammation affects 
the internal surface of the placenta, adhesions form 
between the placenta and the external surface of the 



44 HALE OF ABOETION. 

ovum. In this way tlie placenta lias been found adher- 
ent to the forehead or body of the foetus. According 
to Professor Simpson, who wrote an elaborate memoir 
on this subject, the synvptoms are obscure, consisting of 
pain in the uterus, near the site of the placenta, pains 
in the back and thighs, and general fever. Tyler 
Smith did not find, on stethoscopic examination, any 
modification of the uterine sounds in cases of suspected 
placentitis. The causes of placentitis are not very 
obvious, beyond mechanical injuries, and the great 
afiiux of blood to the organ which occurs during preg- 
nancy. Congestion and inflammation of the placenta 
are probably both common causes of abortion. 

The placenta is liable to other diseases, as calcareous 
degeneration, tubercular deposits, and atrophy or hyper- 
trophy. Sometimes, after the death of the foetus, the 
placenta is still nourished, imperfectly, but still suffi- 
ciently to insure its retention, together with the dead 
ovum, for a considerable time. 

Placenta Previa 

May be the cause of abortion at any period of preg- 
nancy. Of 378 cases mentioned by Whitehead, eight 
were from this cause. When the placenta is implanted 
on the OS uteris abortion is inevitable, and this almost 
invariably takes .place before the fifth month. When 
only a small portion of it extends over the orifice, ges- 
tation may proceed to the seventh or eighth month, or 
even to the full period, without producing any great 
amount of danger to the process ; but always, under 
such circumstances, separation takes place to some ex- 
tent as the cervix expands, although premature expul- 



CAUSES OF ABORTION". 45 

sion is not an inevitable consequence. Whitehead 
mentions a case of implantation of placenta on the os 
uteri, and its partial separation, attended with hemorr- 
hage before quickening, which he treated with favor- 
able results. 



SECTION III. 



EEFJLEX CAUSES. 



The centric causes of abortion are those which origi- 
nate in the nervous centres, the brain or spinal cord, 
and act upon the uterus in a direct manner. They may 
be divided into Emotional, Physical, and Medicinal. 

Emotional. — Fright, anger, joy, grief, and other men- 
tal influences, have been known to cause such disturb- 
ance in the organism, as to be a direct cause of the 
expulsion of the foetus. Many cases are on record 
where the death of the foetus has resulted from the per- 
turbing effects of emotional shocks. Women have 
aborted immediately after hearing of the death of a 
beloved husband; or the gnawing canker of grief, 
shame, and remorse, has led to loss of the foetus ; and 
martyred women have aborted at the stake. 

Physical. — Under this head we may enumerate direct 
blows upon the brain, or spinal cord, or intense conges- 
tion or paralysis of those organs. Some interesting 
experiments have been made, which have a bearing 
upon the centric causes of abortion. M. Serres divided 
the spinal cord in animals, after the commencement of 
parturition, and the process was arrested. In other ex- 



46 . HALE ON ABORTIO]Sr. 

periments lie excited abortion in animals by irritating 
the spinal marrow in tlie lumbar region. M. Bracliet 
divided the cord in guinea pigs, between the twelfth 
and thirteenth dorsal vertebrse, after the commencement 
of labor, and everything but feeble contractions of the 
uterus was arrested, the animals dying in a few days 
undelivered. M. Segales made a section of the cord 
high up, without influencing the uterus, but the organ 
was paralyzed when the division was practiced low 
down. Cases are detailed by the above authors as oc- 
curring in the human subject, in which, in paralysis 
depending upon disease high up in the spinal marrow, 
uterine action was not interfered with ; but was dimin- 
ished or suspended altogether in cases of paraplegia — 
the result of injury or disease, low down in the cord. 
Dr. Simpson has lately made some experiments which 
go to negative the above. In his experiments, parturi- 
tion is said to have occurred, notwithstanding the des- 
truction of the lower portion of the spinal marrow. If 
such are Dr. Simpson's results, they will not prove the 
independence of the uterus of reflex action, since, from 
the connections of the greater and lesser splanchic 
nerves and the thoracic, abdominal and pelvic j^lexuses 
and ganglia, it is quite possible that the uterus may 
receive spinal fibres from the upper portion of the 
spinal marrow. The latter conditions may be caused 
by disease (idiopathic) or influences which we may 
term 

Medicinal. — Certain medicines undoubtedly cause 
abortion by their direct efifect upon the brain or spinal 
cord. Those which produce congestive conditions are 
Quinine., Strychnine, and Ergot. 

Quinine.^ according to Dr. Gardner, and several other 
observers, has been known to cause abortion, and they 



CAUSES OF ABORTION. 47 

caution the practitioner against its use during preg- 
nancy. The specific action of this drug upon the 
nervous centres is admitted by nearly all toxicologists. 
Dr. Brown-Sequard saj^s it causes engorgement of the 
vessels of the brain and spinal cord. While engaged 
in an extensive practice, in a locality noted for malari- 
ous diseases, I found that abortions were frequent 
among the patients of my allopathic colleagues, who 
gave quinine in massive doses (5, 10, or 15 grains). 
The accident was supposed to be induced by the dis- 
eases for which it was administered. No such results 
occurred in my practice, although the cases under my 
care were as severe as any under' allopathic treatment. 
Only a small portion of my patients were treated with 
quinine^ and those to whom I was obliged to prescribe 
it took it in small doses, not exceeding one grain every 
two or three hours. I am fully satisfied that/the mis- 
carriages alluded to are caused by the quinine^ and not 
by the chill or febrile paroxysm. 

Stryclinine has caused abortion. The tetanic spasms 
which occur in cases of poisoning by this drug seem 
detrimental to the life of the foetus or the integrity of 
the uterine tissues. It causes congestion of the spinal 
cord and its membranes. The foetus may not be ex- 
pelled while the woman is under the influence of the 
poison, for in a frog, rendered tetanic by strycJmia^ the 
ova was not expelled during the tetanoid symptoms, 
but some days afterward, when the spasms had nearly 
disappeared. 

Ergot. — This agent has been supposed by some to 
act upon the uterus through the cord. Tyler Smith 
says : " The ergot of rye passes into the blood, and 
affects the spinal centre, being specially directed to the 
lower part of the spinal marrow, and to that part of it 



48 HALE ON ABOllTION. 

in relation to the uterus." Others contend that it acts 
through the circulation directly upon the uterine tissues. 
Brown-Sequard, however, classes it among the medi- 
cines which cause congestion of the vessels of the 
spinal cord. 

Carhonic acid^ savin^ aloes^ alcoliol^ hiborate of soda, 
and ipecacuanha, are supposed by Tyler Smith"^' and 
some others to act in a similar manner. This can, how- 
ever, hardly be said of all the above agents. Ipecac 
acts upon the gastric nerves ; carbonic acid, alcohol, 
and perhaps borax, may act through the cord, but 
aloes and savin appear to me to act in quite a different 
manner. The former seem to act by irritating the 
rectum, the latter as an irritant to the uterus through 
the medium of the blood, and rank with tanacetum^ 
turpentine, uva ursi, cantharis, etc. If these medicines, 
however, are given in massive doses, they may act 
through both media. 

There are other medicinal agents which may act as 
centric causes of abortion, namely, gelseminum, caulo- 
phyllum, cimicifuga, cannabis indica, and, perhaps, 
gossi/pium. Gelseminum probably causes abortion by 
j)aralyzing the lower portion of the spinal cord. When 
given in large quantities during parturition, it arrests 
that process. In small doses it facilitates labor, and 
increases the contractions of the uterus. The other 
remedies mentioned probably cause miscarriage by 
irritating the whole or a portion of the cord. 

Galvanism may be applied so as to act as a centric 
cause of abortion. 

The state of the circulation affects the spinal centre 
in a very distinct manner. Want or excess of blood, or 
materies morbi in the circulation, act as a direct 

* Lectures on Obstetrics, p. 264. 



CAUSES OF ABOETION. 49 

stimuli to the spinal centre, and in this way may induce 
abortion or premature labor. Certain diseases may act 
as predisponents, or exciting causes of abortion, by the 
influence which they exert directly upon the spinal 
centre. Among these diseases may be mentioned, 
cerebro-spinal-meningitis, myelitis, diphtheria, scarla- 
tina, etc., examples of which will be mentioned in 
their appropriate places. 

CEREBROSPIN'AL-MEJSriE'GITIS, OE SpOTTED FeVEE. I 

find, on examining the reported cases of this disease, 
that it almost invariably causes abortion in those preg- 
nant women who are its victims. This is what we might 
expect from a malady which strikes with fearful force 
the great nerve centres. 

Dr. Black* reports a case of a woman aged thirty-one, 
mother of five children, and in the fourth month of her 
sixth pregnancy, of good constitution, who was taken 
with a prolonged chill, severe aching over the whole body, 
and ^parturient pains. On the afternoon of the same 
day had second chill, not so severe as first, succeeded 
by very high fever, and an increase of pains. During 
the night she aborted. The foetus appea/red natural, the 
secundines passing without difficulty or hoemorrhager 
This woman succumbed to the allopathic treatment on 
the tenth day. 

Several cases have come under my observation, and 
to my knowledge, where this disease caused abortion. 
One peculiarity marks all the cases, namely, the abor- 
tion occurs shortly after the onset of the attack. I 
have been struck with the close similarity between the 
chill (rigor) and general symptoms of pain, prostration? 

* American Journal of Medical Science, No. 98, p. 345. 

4 




50 HALE ON ABOETION. 

etc., wMdi attend tlie onset of both spotted fever and 
-most cases of abortion. 



SECTION ly. 

CONCENTRIC OE EEFLEX-SPINAL CAUSES OF ABOETION. 

V 

It will be well, before we enter into tlie considera- 
tion of tlie special concentric causes of abortion, if tlie 
physician or student refreshes his memory concerning 
the sympathetic relations of the uterus with other por- 
tions of the body, and the manner in which such rela- 
tions are kept up. The uterus is in relation with the 
cerebral, spinal and ganglionic divisions of the nervous 
system, and possesses properties derived from each of 
these sources of motor power. The uterus is withdrawn 
from the direct influence of volition. The will has no 
direct power either to contract or dilate this organ. 
Labor may take place when cerebral paralysis exists — 
the will being entirely in abeyance, or abolished — as 
when under the influence of Glilorofov'm^ ether ^ or gelse- 
minum. But though not exerting any direct influence, 
volition may affect the uterus indirectly. (The direct 
influences — as emotions of various kinds — have been 
considered.) The efforts at "bearing down" during labor 
serve as an illustration of indirect cerebral influence; 
the abdominal muscles in this case stimulate the uterine 
by pressure. Since the brilliant discovery of the spinal 
system by Dr. Marshal Hall, that form of uterine action 
depending upon the spinal marrow now admits of clear 
comprehension, and is understood by all well-read phy- 
sicians. 




Explanation op Plate. — 1. Posterior or sensory roots of spinal nerves. 
2. Anterior or motor ditto. 3. Fallopian tubes. 4. Fundus of the uterus. 
5. Cervix uteri. 6. External os uteri. The arrows indicate the course of the 
afferent and efferent currents. 



CAUSES OF ABORTIOlSr, 53 

The Ibest resume of tlie modus o]?erandi of this action, 
next to that of Dr. Tyler Smith,* is the clear elucida- 
tion by Dr. K. Ludlam,f in a valuable paper on the 
" Reflex Sympathies of the Uterus." From that paper 
I quote the following paragraphs, illustrated with the 
diagram kindly supplied to me by the author : 

" The spinal nervous filaments supplied to the uterus 
are of two kinds — the motor and the sensory, or those 
which arise from the anterior and posterior columns of 
the medulla spinalis. The chief physiological peculi- 
arity of these filaments is, that in case of the arteries 
and veins, their currents set in different directions — one 
toward, and the other out from, the central organ of 
the system. The sensory impression is that of general 
sensibility, and is afferent in its course — from the sur- 
face of the organ to which its filaments are. distributed, 
and no matter how remotely it may be situated, to the 
spinal or cerebral centre. The motor impulse, or that 
which supplies the force that causes muscular contrac- 
tion, is efferent in its course — from the cord or brain, 
or both, to the muscular tissue, upon which the motor 
nervous filaments are distributed. 

" When you are told that every organ, and indeed 
every one of the bodily tissues, is supplied with, and is 
under the dominion of, the nerves, you will at once 
infer that the sensory and motor filaments must neces- 
sarily communicate with each other. This occurs either 
in the gray matter of the spinal cord, which is called its 
ganglion, or in that of the brain, where it forms the cen- 
tral ganglia. It is only necessary that the force or im- 
pression propagated to the sensitive filaments of the 
afferent nerves shall be conveyed to the gray or vesicu- 
lar matter of the brain or the cord, when it is acted upon 
by some of their ganglia, modified and returned to the 
organ through the out-going conductor, the efferent or 
motor nerve. 

* Lectures on Obstetrics, Page 263. 

f North American Journal of Homceopathy, Vol. 13, Page 2. 



54 HALE 0]Sr ABOETIOlSr. 

" Here is the whole philosophy of reflex action. Every 
organ is connected with and under the control of a mass 
of gray neurine, wliicli anatomists call a ganglion, no 
matter whether that collection of nerve vesicles be 
found in the brain, the spinal cord, or in the ganglia 
of the great sympathetic. Sensitive impressions tele- 
graphed to, modified by, and returned from these va- 
rious centres to the same or any oth&i^ organ or organs, 
furnish all the detail of reflex action." 

Our space will not permit an explanation of the 
physiological or healthy relations of the uterus to the 
cerebro-spinal system. Its pathological relations, how- 
ever, come within the limits of our special subject. In 
order to be systematic we should classify these morbid 
relations under three heads, namely : 

1. When the sensory current is reflected upon the 
womb, and causes various modifications of its healthy 
sensibility. 

2. When the motor current is reflected upon the 
womb, causing abnormal or normal mobility. 

3. When both currents are reflected in a way to 
modify the healthy vascularity, of that organ. 

From the first we ma)^ have hysteralgia, dysme- 
norrhoea, "nterine colics," super-sensitiveness of the 
uterus, etc. 

From the second.^ uterine cramps, spasms, contractions, 
dilation and rigidity of the cervix, etc. 

From the third^ congestion, inflammation, and their 
sequelae of leucorrhoea, ulceration, etc. 

This treatise is, however, not intended to be sufli- 
ciently extensive for any attempt at such a complete 
classification of the causes of abortion. I shall, there- 
fore, classify them under two heads. 

1. Those irritations which, originating in the tissues, 
or within the cavity of the uterus, cause abnormal 



CAUSES OF ABOETIOlSr. 55 

influences to be reflected back upon itself, with suffi- 
cient force to cause abortion. 

2. Those irritations wbidi originate in otlieT organs 
and are reflected upon the uterus, so as to cause the 
expulsion and death of the foetus. 

riEST CLASS. 

Parotidean. — In Brcdtliioaite^ s Retrospect ^ Part xx. 
page 201, a case of abortion is mentioned, which seemed 
to have been caused by a metastasis of mumps. The 
patient was a lady aged twenty-five, who was attacked 
with cynanche-parotidea when advanced just beyond 
the third month of her third pregnancy. She had gone 
her full time in her previous pregnancies. After a day 
or two of vaginal discharge, uterine pains and haemor- 
rhage came on suddenly in the night and a foetus was 
discharged. The haemorrhage continuing, ergot was 
given, and fifteen hours after the birth of the foetus the 
placenta was removed. 

Dr. Salter, who reports the case, remarks, that we 
have abundant experience to show that the parotid 
glands, when diseased, have a relation to the testicles 
in the male and mammae in the female. The mammary 
glands have a well-known symj)athetic relation to the 
ovaries : and thus it may readily be supposed that in 
mumps an irritation may be communicated to the ute- 
rine system. On the other hand, the mammary glands 
may be affected, in metastasis of mumjos, through the 
ovaries. It is difficult to decide which organ is prima- 
rily affected by the reflex influence originating in the 
parotids ; but the analogy between the testes and the 
ovaries, and the sympathy of the breasts with the ova- 
ries, go rather to support the hypothesis that the latter 
organs first receive the metastatic irritation. 



56 HALE ON ABOETIOIT. 

Dr. Bedford and Scanzoni both make use of tMs 
reflex influence : the latter has founded upon it a 
method of inducing premature labor by irritation of 
the mammae. 

Thyroideal. — Cases are on record, and some have 
come under my own observation, where abortion was 
apparently caused by the application of iodine to an 
enlarged thyroid gland. All irritations of this gland 
should be avoided during pregnancy. I believe I was 
the first to call attention to the sympathetic relation of 
this gland to the reproductive organs, in a paper on 
that subject written several years since. ^" Subsequent 
investigations appear to substantiate my views on that 
subject. 

Mamma/ry. — Tyler Smith states that he has seen 
abortion caused by irritation of the mammary nerves. 
Instances of this are when abortions occur from pro- 
longed lactation during pregnancy. That it is not 
mere weakness or exhaustion in some of these cases is 
proved by the fact that the mammary secretion may 
cease upon the occurrence of impregnation, but that a 
plentiful supply of milk returns after the recurrence of 
abortion. Blisters or sinapisms, or even hot fomenta- 
tions to the breasts, may irritate the pregnant uterus. 
It is well known that contractions of the womb are 
excited, after labor, from irritation of the mammae. 

Gastric. — Although it is surprising what an amount 
of nausea and vomiting the uterus will bear without 
being excited to expel its contents, yet there are many 
cases recorded in which abortion has been apparently 
brought on by excessive vomiting during pregnancy. 
I have known abortion to be caused by the excessive 

* North. American Journal of Homoeopathy, Vol. 12, page 316. 



CAUSES OF ABOETIOW. 57 

vomiting induced by lobelia. It is true that in some 
cases the mechanical irritation may be the main cause, 
but there are many in which it undoubtedly occurs as 
a reflex pathological phenomenon. 

Dental. — Irritation of the trifacial nerves may pro- 
duce abortion. This happens sometimes from the irri- 
tation of cutting the wisdom teeth, the extraction of a 
decayed tooth, or the irritation of a constant odon- 
talgia. It is advised by many of the older obstetric 
writers to avoid the extraction of teeth in a pregnant 
woman. 

JRenal. — Acute nephritis, the passage of calculi, or 
irritation of the kidneys in albuminuria, are said to be 
sometime causes of abortion. 

Vesical. — Cystitis — idiopathic, or from the poison- 
ous" action of drugs— may be a cause of abortion. Tur- 
])entine^ cantharis^ and other medicines, may induce such 
irritation of the bladder as to bring on miscarriage ; 
so, also, the presence of stone in the bladder. 
, Hectal. — The production of abortion by the irritation 
of the rectal nerves is a well-recognized occurrence. It 
may happen from hoemorrhoidal inflammation, the irri- 
tation of ascarides, the action of violent purgatives, 
diarrhoea, dysentery, or the opposite condition of exces- 
sive constipation, stimulating enemata, etc. Whitehead, 
under the head of " Functional Impediments of the 
Bowels," mentions many instances of abortion from 
the irritation of retained foecal matter. He says : 
" The symptoms are distension and tenderness of the 
abdomen, commonly attributed by the patients to flatu- 
lence, of which they are constantly endeavoring to re- 
lieve themselves by eructation. The abdomen is some- 
times as large, under these circumstances, in the middle, 
as it should be at the end of pregnancy. There is a 



58 HALE ON ABOETIOlSr. 

constant inclination to relieve the bowels, the evacua- 
tions, which, are thin and scanty, being accompanied by 
violent straining eiforts. This action is not long in 
being extended to the uterus, which becomes affected 
with pains of an intermittent and expulsive character, 
creating the belief that abortion is about to happen. 
The real cause of these disturbances is accumulation of 
foeces in the third turn of the colon, accompanied with 
flatulent distension of that portion of the bowel immedi- 
ately above the seat of obstruction. This cause of 
abortion does not generally occur before the fourth 
month, for not until that time does the womb attain 
sufficient size to act as an impediment to the passage of 
foecal matter through the rectum. The haemorrhage in 
this description of cases is apt to be profuse, and 
restrained with difficulty." Foecal accumulations may 
also cause abortion, by producing that displacement of 
the uterus known as retroversion, a condition treated of 
in another place. Aloes^ podophyllmn^ Qnercury, and 
their analogues, may cause abortion by the rectal irri- 
tation they produce. 

Va-giyial. — Acute vaginitis, gonorrhoeal or idiopathic, 
will sometimes cause abortion. Mechanical irritation 
of the vagina, by plugging, coition, or ill-fitting pessa- 
ries, or irritating injections, may have the same effect. 
Vaginismus, a painful spasmodic affection, which has 
attracted much attention of late, is not only a frequent 
cause of sterility, but of abortion. Dr. Helmuth* has 
given us a vivid example of this condition, in a recent 
article. The induction of abortion by means of the 
coljpev/rynter will be considered in another place. 

Ovm^ian. — Any irritation or excitement of the ovaries 
is reflected upon the uterus, mammae, or thyroid gland. 

* See Western Homoeopathic Observer, Vol. 1. 



CAUSES OF ABOETION. 59 

In tlie unimpregnated state, tlie uterus generally re- 
ceives the reflex ovarian influence ; wlien it occurs 
during pregnancy it is an abnormal phenomenon, 
and is liable to cause miscarriage. If this influence 
is received by the mammae or thyroid, the nterus is 
left to go on with its normal development. In many 
instances the simple occurrence of the menstrual nidus 
has been sufficient to cause abortion. This is one form 
of that disease called " habitual abortion." The uterus 
must first be in a debilitated, irritable condition, in 
order to be seriously affected by this influence. The 
ovarian irritation may be perfectly normal all the time, 
or it may be abnormal, consequent on diseased condi- 
tions, or the toxical effects of drugs. Thus if canthar- 
ides, camahis indica, apis met, or similarly acting drugs, 
be given in pathogenetic doses, they may set up an 
irritation in the ovaries which shall be reflected upon 
the uterus with such force as to cause it to take on 
diastaltic action. Certain diseases of the ovaries have 
the same effect, namely — inflammation, congestion, 
suppuration, etc. Those diseases which can act as di- 
rect or mechanical ii'ritants to the uterus, are enlarge- 
ments, from cystic and other growth, dropsy, etc. 

SECOISTD CLASS. 

Uterine. — This class includes the following, namely : 

{a) Diseases of the uterus, functional and organic. 

{U) Disj^lacements of the uterus. 

(c) Death of the foetus. 

The uterus is endowed with what is termed peristaltic 
action — a peculiar vermicular motion or contraction, 
which is called by Tyler Smith, "ganglionic motor 
action." "When any part of a muscular organ, sup- 
plied in whole or in part by the ganglionic system of 



60 HALE ON ABORTION. 

nerves, is irritated, the contraction which ensues gene- 
rally spreads in a vermicular manner to a distance from 
the point of irritation, and continues for some time 
after the exciting cause is removed. The uterus is 
eminently endowed with the peristaltic form of con- 
traction. When one point of the uterus is stimulated, 
through the abdominal parietes, or by the introduction 
of the hand into the uterus, the contraction excited 
extends to the whole organ." Dr. Smith has seen this 
action occur after death, in animals, and he asserts that 
the uterus seems capable of expelling the foetus hy 'peri- 
staltic action alone. In cases of paraplegia from disease 
of the lower part of the spinal marrow, or in animals 
reduced to the same state by experiment, the peristaltic 
action is the chief power remaining in the uterus. In 
such cases delivery has been effected in an imperfect 
manner by the peristaltic action of the uterus or by the 
application of galvanism to the organ. It is not stated, 
however, how much of the spinal marrow must be des- 
troyed before the reflex ordisastaltic action of the uterus 
ceases. It is not probable that this peristaltic action 
can exist to any extent, unconnected with the reflex 
spinal influence. In cases of labor and abortion, the 
two forms of action exist in combination. The motor 
nerves of the uterus are in relation with the mammary, 
pubic, rectal, pneumogastric, ovarian, vaginal, and the 
nerves of the os and cervix uteri, as incident excitor 
nerves. There can be no doubt that in an organ thus 
subject to reflex action, its own nerves are excitors, and 
that in all contractions of the uterus excited by irrita- 
tion of its external surface, or of the os and cervix, by 
disease or otherwise, the uterine actions are both reflex 
and peristaltic. It is indeed a question if any pure 
spinal fibres reach or proceed from the uterus unmixed 



CAUSES OF ABOETION. 61 

witli fibres from the ganglionic. Any pathological 
condition of the uterus, which is capable of exciting 
these reflex-spinal and ganglionic-motor actions, may be 
a cause of abortion at any period of pregnancy. 

Functional diseases of the uterus, are those in which 
no change in structure has yet appeared, although the 
condition existing may lead to such lesion. The older 
writers laid much stress on the opposite states, which 
they termed rigidity and laxity of the muscular tissue 
of the womb. We cannot dispute the fact that such a 
condition may exist as idiopathic affections, i. e., de- 
pending upon the same general state of muscular fibre. 
But it may obtain from purely local causes, namely : an 
exhausting discharge from the mucous tissues of the 
organ itself — as functional leucorrhoea. But as leucor- 
7'Jioea may be functional, and also dependent on organic 
changes in the uterine tissues, we will proceed to con- 
sider that disease, as it is the connecting link between 
the two classes of uterine diseases. 



SECTION y. 

FUNCTIONAL DISEASES OF THE UTERUS. 

Congestion of tlie Uteri7ie Circulation. — According to 
Whitehead this appears to prevail as the immediate 
cause of abortion in one out of every twenty-five cases. 
He believes the average is even greater. Those in 
whom the venous capillary function is naturally below 
par, indicating predisposition to local congestion, are 
most frequently the subjects of it. The symptoms which 



62 HALE ON ABORTIOlNr. 

usually manifest themselves after the period of quick- 
ening, from tlie end of tlie fourtli to the eighth month 
of pregnancy, are — immoderate and painful distension of 
the abdomen, generally attributed by the patient to 
the accumulation of wind in the bowels ; a pulsative 
movement extending over the whole cavity ; sense of 
weight and bearing down; intermittent pains in the 
loins, like those of labor, and occasionally escape of 
blood from the vagina. There is also distension of the 
pubic, spermatic, hasmorrhoidal, and all the pelvic 
veins, and sometimes those of the lower extremities. 
On examination^ the vagina is found hot and turgid, 
and the cervix uteri tumid and varicose. When this 
state is allowed to exist for a length of time, local phle- 
bitis may take place, resulting in varicose ulceration of 
the cervix ; or the inflammation may extend through 
the entire organ, and eventually to the uterine perito- 
neum, ending in eJBPasion, etc. 

LeucorrJioea. 

p The frequency of leucorrhoea during pregnancy, and 
the many unpleasant symptoms to which it gives rise, 
should lead us to study more closely the connection 
between that disorder and abortion. 

The valuable monograph of Dr. Tyler Smith on 
Leucorrhoea leaves but little to be desired relative to 
the true pathology of the abnormal discharges which 
go under that name. The limits of this work will not 
permit me to give more than a cursory glance at the 
divisions of leucorrhoea; our main purpose is to con- 
sider the influence it has on the causes of utero-gestation. 
But the treatment of this disease will in time be so inti- 
mately connected with a true understanding of the 
nature and locality of the discharge, that we cannot for- 



CAUSES OF ABOETIOISr. 63 

bear giving some general idea of the classification of 
tlie varieties of tliis malady. 

" All pathology has its basis in physiology. The 
demonstration of two very differently organized sm^faces 
in the vagina, and in the canal of the cervix uteri, with 
the existence of two very distinct forms of secretion, 
naturally lead us to the consideration of two principal 
forms of leucorrhoea. But at this point it may be well 
to revert for a moment to the special difference which 
exists between the vagina and the cervical canal. The 
lining membrane of the vagina approaches in organiza- 
tion to the skin ; it is covered by a thick layer of scaly 
epithelium ; it contains in the greater part of its surface 
few, if any, mucous follicles or glands ; its secretion is 
acid^ consisting entirely of plasma and epithelium, and 
the chief object of tiie secretion is the lubrication of the 
surface upon w^hich it is formed. 

" On the other hand, the lining of the canal of the 
cervix, is a true mucous membrane : it is covered in 
great part by cylinder epithelium ; it abounds with 
immense numbers of mucous follicles, having a special 
arrangement ; it pours forth a true mucous secretion, 
alkaline in character, and consisting of mucous corpus- 
cles and plasma, with little or no epithelium, and this 
secretion has special uses to perform in the unimpreg- 
nated state, and in pregnancy, and parturition."^^ 

We here have presented the anatomico-physiological 
character of the vagina, and canal of the cervix uteri. 
So long as the secretions from these surfaces remain 
within physiological limits, no disease is present : but 
the moment these secretions become ahnormal in quan- 
tity or quality^ the result is Leucorrhoea. 

Leucorrhoea admits of the same divisions as set forth 
in the above quotation. The jwst and most important 
is the Mucous variety, consisting chiefly of mucus-cor- 

* Tyler Smith on Leucorrlicea. 



64 HALE ON ABOETION. 

puscles and plasma, and secreted cMefly by tlie follicu- 
lar canal of tlie cervix. The second is the Epithelial 
variety, in whicli the discharge is vaginal, or is secreted 
by the vaginal portion of the os and cervix, and con- 
sists, for the most part, of scaly epithelium and its debris. 

These two varieties may, of course, exist in various 
degrees of combination. Sometimes the one and some- 
times the other preponderates, or is the original affec- 
tion. The old division of uterine leucorrhoea, as arising 
from the cavity of the fundus^ is now obsolete — such, 
discharge rarely occurs. In certain cases of menor- 
rhagia,^the periodical sanguineous discharge is converted 
into a constant colored discharge, in which may appear 
some mucus, but hardly enough, to constitute a leu- 
corrhoea. • 

Cervical or Mucous Leucorrhoea. — This most com- 
mon form of leucorrhoea is, when simple and uncompli- 
cated, the result of a morbid activity of the glandular 
cervix. Instead of the discharge of the plug of mucus 
at the catamenial period; a constant discharge is set up. 
The glandular portion of the canal of the cervix is the 
cliief source of the discharge ; it is a special secretion, 
elaborated by those glands. 

In recent cases of cervical leucorrhoea, when tbe dis- 
order consists merely of a hyper-secretion of the mucous 
follicles, without any manifest lesion of structure, the 
cervical discharge is found (on examination with the 
speculum) hanging at the os uteri, or adhering to its 
vaginal portion, and is almost always viscid and trans- 
parent. It may be drawn out in long tenacious threads 
of the utmost clearness, unless in course of pregnancy, 
or abnormal state of the vagina, when it is rendered 
opaque by the acid vaginal mucus. This string of 
mucus sometimes extends tlie whole length of the 



CAUSES OF ABORTIOIS'. 65 

vagina, and even extends from that passage. This 
secretion is always cdhaline^ in contradistinction to the 
vaginal secretions which are acid. 

In severe or chronic cases of this form of lencorrhcea, 
the alkaline cervical mucus is mixed with pus and 
blood, owing to the irritable and more deeply diseased 
condition of the glands of the canal of the cervix. In 
some cases, the exudation of blood from the canal of 
the cervix is so constant that it is apt to be mistaken 
for menorrhagia. In other cases of cervical lencorrhcea 
the secretion is so profuse and watery that the traces 
of viscidity are nearly lost. Instead of the mucus and 
plasma, a watery serum is poured out in large quan- 
tities. 

The quantity of mucus or serum lost in cases of cer- 
vical leucorrhoea is often so considerable as to prove a 
serious drain to the constitution, and set up functional 
or more serious disorders in different parts of the body. 
The serous secretion in particular is often a source of 
great debility. Patients suffering from either of the 
above forms may become hectic from purulent secre- 
tion and absorption, or rendered anaemic from the loss 
of blood. The symptoms arising from cervical leucorr- 
hoea are numerous and changeable, dependent on the 
amount of local irritation, functional derangement of 
other organs, or the loss of tone in the muscular or 
nervous system. 

Sequelce o'f Cervical Leucorrlioea. — It is well known 
by the reading men of the medical profession that 
writers on uterine pathology are divide into antagon- 
istic schools, namely, (1) those who, under the leader- 
ship of Bennet, believe nearly all abnormal discharges 
from the uterus are the result of inflammation and 
ulceration, and (2) those who adopt the theory of Tyler 



66 HALE ON ABOPwTION. 

Smith, that tlie ulceration is the result of abnormal 
discharges from the cervical canal and its glandular 
apparatus. 

When these conditions occur as actual sequelse of 
cervical leucorrhoea, the following is their order of 
appearance. I quote from Dr. Tyler Smith. 

" Bj observing cases of mucous or cervical leucorr- 
hoea, under e\evy variety of circumstances, we may 
obtain a tolerably correct knowledge of the different 
stages of the disease, and we may learn the order in 
which its sequelae makes its appearance w^hen it is 
allowed to run its course unchecked for a considerable 
time. In the first place there is simply an increase of 
the secretion of the cervical mucus. Instead of the 
formation of the plug after each monthly period, there 
is a constant escape of thick mucus from the os uteri. 
But in this phase of the disorder there is little constitu- 
tional or local disturbance. The size of the os and 
cervix is not increased, and the surface of tbe os 
remains quite natural, both as regards volume and 
color. After a time the os uteri gapes ; there is relax- 
ation of th.e cervix, the upper part of the vagina loses 
its tone, and some amount of prolapsus generally occurs. 
With this the ring of superficial redness slowly passes 
on to the destruction of epithelium ; then the loss of 
the villi takes place, and the formation of the granular 
surface upon their base occurs. The whole of the os 
and cervix now becomes swollen and turgid, induration 
commences, and fibrinous deposit in the substance of 
the cervix frequently takes place. The sensibility of 
the different portions of the utero- vaginal canal varies 
greatly in different cases. In some the abraded or 
hypertrophied os uteri is exquisitely tender, while in 
others its sensibility is little, if at all, increased. In 
some cases of leucorrhoea, in which abrasion occurs, the 
whole of the os uteri and the cervix hangs into the 
vagina, completely denuded of its integumentary cover- 



CAUSES OF ABOETIOIf, 67 

ing, but tliere is no great enlargement of tlie parts. 
In others there is considerable hypertrophy without 
any destruction of epithelium or loss of surface." 

All the conditions above mentioned as being caused 
by ceTvical leucorrhoea may arise from other causes. 
Dr. Benuet insists that they arise from inflammation of 
the cervix. 

It is of considerable importance to the practical 
physician whether these conditions are primary or 
secondary effects : the selection of the remedy depends 
considerably upon the theory adopted. The contro- 
versy is yet undecided, and probably will not be until 
personal asperity and prejudice is laid aside, and all 
seek conscientiously for truth. As in nearly all other 
controversies, neither party has all the truth on his 
side. I am inclined to the belief that either leucor- 
rhoea or inflammation may be the primary affection. 
An inflammation of the cervix, or an ulcer thereon, 
may cause cervical leucorrhoea, and vice versa. The 
best we can do, in the present state of our knowledge, 
is to judge from the history of the case, and a careful 
examination with the speculum, which has the priority. 
Vagi7ial or E^itlielial Leucorrhoea. — This discharge 
has its origin in the muco-cutaneous lining of the vagina 
and the portion of this membrane reflected on the ex- 
ternal surface of the cervix to the margin of the os 
uteri. In strictly vaginal leucorrhoea there may be no 
discharge whatever issuing from the canal of the cervix, 
and in some cases the secretion of the cervix seems 
almost suspended, the os uteri appearing drier than 
natural, and no mucus being visible between the labia 
uteri. In others the cervical glands are excited by the 
condition of the vagina, and secrete copiously a mixed 
epithelial and mucous leucorrhoea, from the union of 



68 HALE ON ABORTION. 

the two kinds of discharge-. The discharge in vaginal 
leucorrhoea may arise, chiefly, either from the lower part 
of the vaginal membrane or from that part which is 
reflected upon the cervix, but in severe cases the whole 
surface of the vagina is involved. In simple acute 
cases of vaginal leucorrh(«a the discharge is epithelial, 
made up of imperfect and perfect scales. In severe 
and chronic csises^pus is mixed with the epithelial mat- 
ter ; for the villi become affected and the pus is formed 
upon the sub epithelial or villous surface. In some 
cases portions of the vaginal surface may be so abraded 
that blood globules escape and mix with the other con- 
stituents of the vaginal discharge. In one form of 
vaginal leucorrhoea but little fluid discharge appears, 
but the vao-inal walls are coated over with a white 
membrane, which may be detached in large shreds or 
pieces, composed of epithelium in which the parchment- 
like arrangement of the scales is perfectly preserved. 
These laniinge frequently have upon them marks of the 
rugse of the vagina, and their under surfaces are rough 
from the indentations of the vaginal papillae. This 
may be termed a memhrcmous form of leucorrhoea, and 
occurs oftenest in cases of pregnancy. The vagina may 
be attacked with the diphtheritic poison, and secrete 
a membrane having that character. In some cases of 
vaginal leucorrhoea, the irritation is intense and annoy 
ing, assuming the form of jyruritus vulvce. This latter 
symptom is, however, oftener caused by an aphthous- 
inflammation of the lining membrane of the vagina and 
vulva. I have known cases in which abortion appeared 
to be caused by this symptom alone, the severe reflex 
irritation being sufficient to set up expulsive action in 
the uterus. 



CAUSES OF AB0ETI0T7. by 

The frequency of leucorrlioea during pregnancy has 
been alluded to. Whitehead found, in 2,000 cases 1,116 
in which leucorrhoea was present. Out of the 2,000 
cases, 747 had abortions, and of this latter number, 
only 172 cases of abortion could be assigned to specified 
causes — leaving 575 cases out of 1,116 having leucor- 
rhoea. This is a large percentage — larger than we ever 
meet in general practice. In many of these cases, per- 
haps a majority, the discharge was probably due to 
ulceration, 

Gonorrhosa. 

This should not be overlooked when we are consid- 
ering the causes of abortion. The uterus is more com- 
monly affected by the gonorrhoeal poison than has been 
supposed. Whitehead asserts that this disease more 
commonly affects the uterus than the vagina. This opin- 
ion is at variance with what has usually been taught. 
That writer contends that the gonorrhoeal virus, from 
physiological causes, is liable to be carried immediately 
to the highest paii; of the canal, and forcibly projected 
upon the lowest extremity of the uterus, which organ 
also, at this juncture, is in a state eminently calculated 
speedily to absorb it ; besides, the normal secretion of 
the vagina possesses properties which are capable, to a 
certain extent, of destroying or materially modifying 
the virulency of the poison, and of thus protecting the 
vaoinal surface from its immediate influence. The 
urethral orifice, however, does not seem to be provided 
with this protection to any degree, and is therefore 
much more susceptible to the action of specific inocula- 
tion. In nine unimpregnated women affected with 
gonorrhoea, seven had inflammation, with abrasion of 
the OS uteri, and in the remaining two, the upper 
vaginal surface and urethra were affected. 



70 HALE ON ABOETION. 

Gonorrlioea first affects tlie uterus by causing super- 
ficial inflammation of the lips of the os and the com- 
mencement of the internal cervix. The inflammation 
seems to affect principally the small mucous follicles 
with which the surface is closely studded. " A small 
red patch is first perceived ; sometimes there are two 
or three isolated spots which extend and soon run to- 
gether, forming one patch, of variable size in different 
cases and in different stages of the complaint, and 
generally of irregular shape. On removing the thick 
secretion with .which this is covered, the surface appears 
to consist of minute granules, equally dispersed over 
every part of it ; the abrasion is bounded by a margin 
not very distinctly defined, running imperceptibly into 
the erysipelatous redness which surrounds the sore ; 
this extends to some distance upon the cervix, the 
whole of which is more or less tumid^ but not painful 
to the touch." In plethoric women the symptoms are 
often very violent, the inflammation being severe, and 
the ulceration of an irritable character, throwing off 
large quantities of pus and often causing much fever. 

If the infection be contracted during pregnancy, 
abortion is liable to take place during the acute stage 
of the complaint from the intense uterine irritation. If 
the disease existed previous to gestation, it may have 
caused chronic endo-ateritis, or an ulcerated condition 
of the cervix, both of which conditions are quite serious, 
and are likely to be cause of abortion at any period of 
pregnancy. 

It is Whitehead's opinion that gonorrhoeal affections 
in women are rarely cured ; that they are frequently 
the cause of induration, fissured ulcer, and chronic in- 
flammation of the deeper seated tissues. 



CAUSES OF ABOETION. 71 



SECTION VI. 

ORGANIC DISEASES OF THE UTERUS ATTO CERVIX. 

TJlceraticm of the Cervix. — Whitehead refers to a 
table containing the records of 400 cases of abortion 
and threatened abortion, " In all which, disease of the 
uterus was an accompanying condition, and for which 
no other cause could be assigned for the disturbance 
complained of, the average occurrence of the superficial 
granulating ulcer, or of diffuse inflammation of the 
cervix, amounted to 26 in every hundred. In the 
majority of these, the event happened between the mid- 
dle of the sixth and the middle of the ninth month. 
In some, however, the symptoms commenced earlier." 

This would seem to indicate that ulceration of the 
cervix was better tolerated in the earlier, than in the 
later months of pregnancy. In several cases, recorded 
by Bennet,* the abortions, or threatened abortions, 
occurred as often in the first, as in the last three months 
of gestation. 

Ulceration of the cervix may be considered as one 
of the chief causes of abortion. Bennet thus sums up 
his experience in the matter ; 

"Abortion is often occasioned by inflammatory ulcer- 
ation of the cervix, and likewise often occasions it. In 
the latter case, abortion occurs accidentally, under the 
influence of some of its generally recognized causes, 
and leaves behind a morbid state of the cervix and its 
cavity. Local disease of this nature may follow an 

* Diseases of the Uterus. 



T9, 



HALE OlS; ABOETION. 



abortion of tlie simplest kind, one from which the 
patient rallies in a few days, although it is more gene- 
rally the result of those that are accompanied by inflam- 
matory and hsemorrhagic symptoms. Ulcerative disease 
of the cervix, when once established, from whatever 
cause, is itself a frequent cause of abortion. When 
abortion is the result of the actual existence of the 
inflammatory disease, it may be produced in various 
ways. The vitality of the womb may be so modified 
in the earlier stage of pregnane}^, by the existence of 
the disease, that the foetal germ dies, in which case it 
is expelled along with the membranes, or it is partly 
or entirely absorbed, the membranes continuing to 
enlarge for some months, and being eventually expelled 
under the form of a mole, or false conception ; or the 
pregnancy may advance to a farther period, until the 
third or fourth month, when the womb becoming too 
irritable, or being unalDle to develop itself, or the foetus 
dying, the membranes separate, flooding ensues, and 
the contents of the uterus are expelled. At a later 
stage still, when the muscular structure of the womb is 
more fully developed, the presence of inflammation at 
its mouth may bring on strong reflex action, and occa- 
sion premature confinement, independently of aii}^ dis- 
ease of the child or of its membrane. • 

" Abortions, no doubt, frequently occur under the 
influence of accidental causes alone, and of constitutional 
cachexia, such as scrofula and syphilis, without there 
being any local disease of the cervix. It may, however, 
be laid clown as a rule, that a great majority of abor- 
tions which are ]3receded or followed by morbid symp- 
toms, and of those which occur spontaneously, without 
any evident cause, and in the absence of uterine tumor 
or constitutional cachexise, are occasioned by inflamma- 
tory disease of the cervix. It may also be considered 
as all but certain, that inflammatory and ulcerative dis- 
ease of the cervix exists when abortions quickly suc- 
ceed one another, and when a female does not seem 
able to carry the product of impregnation to the full 
time." 



CAUSES OF ABORTION. 73 

According to the same author, " inflammatory ulcer 
ation, during the pregnant state, is by no means neces- 
sarily followed by abortion." Gestation may go on till 
full time, when no remedial treatment is resorted to ; 
or the ulceration may be treated by local applications, 
and cured, without interfering with the course of preg- 
nancy. 

Bennet also says that " instrumental examination of 
females [women ?] laboring under inflammatory ulcera- 
tion of the cervix, during pregnancy, is unattended 
with any risk, either to the mother or to the foetus, and 
it is absolutely necessary, in order not only to fully 
recognize the disease, but also to treat it." 

This statement I have often verified in practice. The 
speculum should be generally resorted to in cases of 
threatened abortion. 

" The simple granulating ulcer ^1'' says Whitehead, 
" may be confined to one labium only, the other being 
perfectly normal. More frequently, however, it impli- 
cates both at the same time, extending to some distance 
up the external cervix, and passing more or less wdthin 
the orifice, which often appears to be the part most 
severely affected. The whole cervix is in a state of 
hypertrophy, and considerably softened, with the excep- 
tion of the inflamed crust upon which the ulcer is situ- 
ated. 

" Upon tactile examination, the whole lower part of 
the uterus is found to be altered in form : the lips are 
elongated and flabby, and the orifice open. The ulcer 
presents a flattened, velvety surface, with a raised cord- 
like external boundary, which the practiced touch will 
be able to de ect without difiS.culty. When viewed 
through the speculum, the whole cervix — unless it be 
unusually large — will readily fall within the upper 
aperture of the instrument. The diseased surface, when 



74 HALE ON ABOETION. 

both labia are implicated, appears irregularly circular, 
about the size of a shilling — larger or smaller — of a 
bright red color, and covered over with a coating of 
muco-pus : this being removed by a piece of lint, to 
"U^hich a portion of ropy mucus often adheres, derived 
from the central orifice, the granulations are brought 
palpably to view. * '''" '^ The granulating ulcer is 
most commonly observed in women of the sanguino- 
lymphatic temperament, lax fibre, and feeble circulating 
powers. When met with in primapara, the first indi- 
cations of its existence are noticed before the period of 
quickening, often as early as the second or third month. 
It may exist for years, and during several pregnancies, 
without causing abortion." (See plate.) 

West'^ describes ulceration of the cervix in a different 
manner : 

" They are for the most part mere superficial abra- 
sions of the epithelium investing the lips of the os uteri, 
whose abraded surface is of a vivid red color, and finely 
granular. In other cases, in which the absence of epi- 
thelium is less complete, the surface seems beset by a 
number of minute, superficial, aphthous ulcerations, be- 
tween which the tissue appears healthy, or slightly 
redder than natural. The ulcerations of the os uteri 
seldom or never present an excavated appearance with 
raised edges, as ulcers of other parts often do, but either 
their surface is smooth, or it projects a little beyond the 
surface of the surrounding tissue. They are usually, 
but not constantly, of greater extent on the posterior, 
than on the anterior lip, are sometimes confined to the 
former, but very rarely indeed limited to the latter. 
They appear to commence at the inner margin of the 
OS uteri, whence they extend outward, and sometimes, 
though by no means invariably, the short extent of the 
canal of the cervix uteri w^hich can be brought into 
view by the speculum, appears denuded of its epithe- 
lium." 

* Diseases of Women, page 97. 



CAUSES OF ABOETIOlSr. 75 

Otber writers vary as much in their description 'of 
ulceration of tlie os and cervix, as Beunet says, " with- 
out necessity or advantage." 

"Writing of this lesion the same writer says : 

" An ulceration occupying the cervix uteri may pre- 
sent the various modifications which suppurating sur- 
faces oifer in any other part of the body, from the 
minute granulations of a slight abrasion, to the livid 
vegetations of an unhealthy sore ; but these modifica- 
tions of the ulceration require, in reality, no division or 
classification." 

The student who would acquaint himself with the 
various local and constitutional syinptoms caused by 
these ulcerations, may refer to such works as West, 
Meigs, Scanzoni, Simpson, and particularly Bennet. 

To the Allopathic school, who attack all ulcerations 
of the cervix uteri with caustics or constitutional reme- 
dies — tonics and alteratives — the division of ulceration 
into different forms and species, may be of no practical 
use or benefit ; but to the homoeopathician, these classi- 
fications, or minute descriptions, may be of great value 
in the selection of the specific remedy, especially when 
our Materia Medica shall be perfected, particularly the 
pathological symptoms thereof. 

After consulting all the more recent writers who des- 
cribe ulceration of the cervix uteri, and from the results 
of my own limited observation, I know no better man- 
ner in which to classify these lesions than the one 
adopted by Whitehead — namely : 

8u2oerficial erosion^ Fissured ulceration^ 

Vm'icose ulceration^ Follicular ulceration. 

Bennet inadvertently sanctions this arrangement, for 
he mentions — " Abrasion, or Excoriation " — " Ulcera- 
tion, with Fungous Granulations" — and " Varicose con- 



76 HALE OIT ABOETION". 

dition" of the parts — " Aphthae, or Ulcerated Mucous 
Follicles" — and even a condition when " The lips of 
the OS uteri are very much hypertrophied and indur- 
ated ''^' ^' separated by a deep fissure, and the ulcer- 
ated surface, which is situated deeply hetwee7i them, can 
only be discovered with the eye, on their being sepa- 
rated by a bivalve speculum." 

We will noAv examine the peculiar characteristics of 
the different forms of ulceration : the simple erosion^ or 
grariulating ulcer, has already been described. 

Varicose Ulcer. — This variety, according to White- 
head, is liable to cause abortion in the latter two or 
three months of pregnancy. It prevails in about six 
or eight cases out of every hundred, and is often difii- 
cult of cure before delivery. It is generally met with 
in women of the bilious temperament and hard fibre, 
who have been subject to piles and profuse menstrual 
discharges, and to derangement of the biliary organs. 
The premonitory condition of the parts consists in a 
hardened and hypertrophied state of the cervix, which 
is traversed in various directions by a number of tortu- 
ous dark colored trunks, about the thickness of a probe, 
or goose quill, raised upon the surrounding surface. 
Larger and more prominent points are here and there 
noticed, indicating the situation of inosculation of one 
branch with another ; and generally, at one of these 
points, the ulcel^ative process is set up, which soon ex- 
tends through the coats of the vessel, and hsemori'hage 
follows immediately. The ulcer, which is not long 
after in being developed, presents an uneven livid aspect, 
with irregular margins, near which a few tortuous ves- 
sels may be seen ramifying: it now secretes a quantity 
of pus, and often has small dark clots of blood or fibrin, 
the size of a pin's head, lying loose upon the surface. 



CAUSES OF ABORTION". 77 

It usually occupies but one 'ahium, the anterior more 
frequently, but often tbe wla-i; circumference of the 
cervix is im|)licatecL Sometiwe.-:. i he inflammation ex- 
tends to the body of the iiierus, . . n,ji uvuie phlebitis, 
and thus acquires a serious imj)->>"^;nicL. Tiit- .. :!Vpt(mts 
indicating the existence of varicose iL.t-.cition (.lining 
pregnancy, are bearing-down pains oi ai intermittent 
character, similar to those of the first stage of labor, 
aching of the loins and along the thighs, irritable blad- 
der, with inability to retain the urine the usual length 
of time, disorded digestion, sickness and headache, lan- 
guor, and a vaginal discharge of a white glairy mucus 
at first, which becomes brown, then bloody, and finally 
purulent. Bennet says this form of ulceration is gener- 
ally attended with fangous granulations, large, livid, 
and bleeding at the slightest touch. Whitehead says 
it causes induration of the cervix, and often degenerates 
into the 

Fissured Ulcer. — This form of uterine disease, ac- 
cording to Whitehead, is perhaps equally prevalent 
with the superficial variety, and is much more difficult 
of cure, on account of the extent to which the subjacent 
textures are implicated. It is found to exist in twenty 
to twenty-four out of every hundred cases of abortion, 
not resulting from accidental causes. It is always 
accompanied by a degree of inflammatory induration 
which extends more or less deeply on each side of the 
fissure ; this is readily detected by the touch, the cir- 
cumference of the orifice being uneven and lobulated. 
There may be one or more fissures, the intervening 
spaces being healthy or inflamed, excoriated, and in a 
state of erosion, or superficial ulceration. The fissures 
are often deep, and extend to a considerable distance 
in an upward direction. 



78 HALE OjST ABOETIOlSr. 

The discharge^ whicli is seldom so abundant as in tlie 
form of disease first described, lias a decidedly purulent 
character, being alkalescent, of a yellow or greenish, 
yellow color, sometimes brown or ichorous, and not un- 
frequently mixed with blood. This variety of ulcera- 
tion is considered the most intractable — existing for 
years. Whitehead thinks it one of the most frequent 
causes of " habitual abortion." Whether this accident 
occurs habitually at the third, sixth, or any other period, 
is owing to the extent of the parts affected by the 
ulceration, and Dr. A. K. Gardner"''* adopts this view, 
and mentions many cases in proof. The cUscharge be- 
gins to be mixed with blood as soon as the expansion 
of tbe uterus extends itself as far as the diseased parts, 
the slightest irritation being sufficient to induce hsem- 
orrliage. The careful introduction of the speculum, or 
digital examination, will cause bleeding. Haemorrhage 
from fissured ulcer often gives rise to the so-called 
"menstruation during pregnancy," the habitual con- 
gestion during the usual menstrual period being suffi- 
cient to cause bleeding from the ulcerated surface. 
Regarding this phenomena, Dr. Whitehead thus writes : 
" The evidence now producedf appears sufficient to 
establish, as a general rule — to which I am not as yet 
acquainted with an exception — that the blood discharged 
in cases of alleged menstruation during pregnancy is 
furnished, not by the lining membrane of the uterus, 
nor by any healthy secreting surfaces — except some- 
times tlie inferior part of the inner cervix — but by the 
lower extremity of the uterus, external to its cavity, or 
by the contiguous vaginal reflexion being in a state of 
suppurative inflammation. The fact is always demon- 
strable by the aid of the speculum." 

* See cases in "Abortion and Sterility," p. 181. 
f " Gardner on Sterility." 



CAUSES OF ABOETION. 79 

"The s i/mpto?ns mdicating tlie presence of the disease 
in question, are — severe aching of the loins and sacrum, 
tenesmus, irritable bladder, with frequent desire to void 
urine, violent pain of the lower part of the abdomen, 
often confined to one side, at a point a little above the 
groin, corresponding to the situation of the round liga- 
ment, and following the course of the inguineo cutane- 
ous and external pudic nerves." 

follicular Jllceration. — This form of disease of 
the cervix is said to be an inflammation and ulceration 
of the Nabothean follicles. It occasionally accompa- 
nies other morbid conditions of the cervix, but is most 
frequently met with in a distinct form. Whitehead 
doubts whether it is a primar}^ affection. Upon exami- 
nation^ the part appears to be studded with a number 
of raised circular spots, having the dimensions of small 
peas, covered with a white crust, the surrounding sur- 
face being of a reddish hue. This w^hite pellicle is 
easily removed by means of lint, exposing a surface of 
the same form and size, slightly elevated, and appear- 
ing as if composed of extremely minute granules. The 
parts are not painful to the touch. These spots are 
sometimes numerous, as many as fifteen or twenty 
being visible, but often only* one or two are seen. 
Owing probably to specific causes they sometimes be- 
come very prominent, and assume a warty appeai'ance. 

According to Bennet — who will not admit of any 
classification of inflammatory ulceration — this follicular 
ulceration is to be considered the same as any other 
arising from that cause ; but he admits that " sometimes 
we find, in the vicinity of the os uteri, several small 
ulcerated patches, isolated one from the other, but near 
to it. These multiple ulcerations, which are rare, are 

* See cases in " Abortion and Sterility," p. 181. 



80 nALE oisr ABOETioisr. 

evidently formed, in tlie first instance, by apJithw., or 
ulcerated mucous follicles." 

I have under treatment, at tlie time of this writing, 
a case of follicular ulceration of the cervix, associated 
with hypertrophy of the uterus, and consequent retro- 
version. The patient had an abortion four months 
since, caused undoubtedly by these conditions. When 
this variety of ulceration occurs in cachectic habits, 
or in women advanced in life, these follicles are liable 
to inflame and suppurate in considerable numbers, leav- 
ing circular cavities, which give to the parts a worm- 
eaten appearance : or the suppurative action may ex- 
tend, until several of the orifices coalesce, forming a 
deep, irregular shaped excavation, with callous, over- 
hanging margins, constituting what some writers have 
described as the " corroding, or phagsedenic ulcer." 
Induration and oedema of the cervix is a common con- 
comitant of this aggravated form of follicular ulceration. 

Pliagcedenic^ Corrodiiig ^ Cancerous Ulceration. — Under 
the above names have been described various forms of 
ulceration of the cervix, of a malignant character, char- 
acterized by a tendency to sloughing, with extension of 
ulceration to the body of the uterus, and a discharge, 
nearly always of a foetid, corrosive, and otherwise un- 
healthy character. These forms of ulceration generally 
lead to organic changes, such as hypertrophy, indura- 
tion, tumors, etc., which will be treated of hereafter. 
[,i Syphilitic Ulceration. — There can be no doubt that 
the syphilitic ulcer is a frequent cause of abortion. It 
was not until recently that its importance as such was 
suspected. In treating the abandoned classes in great 
cities, and even those in higher positions, the physician 
w411 do well to be on the look-out for this disease, when 
he is searching for the cause of abortion. 



CAUSES OF ABORTIOlSr. 81 

The primary venereal sore is very rarely seen attack- 
ing the lower part of tlie uterus. Tlie virus is not 
likely to be carried up so high, except in occasional 
cases. It is chiefly secondm'y syphilis which aifects the 
uterus. It may have its origin in three different ways, 
according to Whitehead. 

(1) As an imperfectly cured primary affection, which 
was originally a genuine chancre in the external geni- 
tals. 

(2) As a result of virulent inoculation upon the 
lower part of the uterus. 

(3) As a consequence of secondary inoculation. The 
possibility of transference of venereal taint under this 
form, is still a matter of dispute. 

The constitutional symptoms denoting the presence 
of secondary syphilis are, pallor of the countenance, 
languor, precarious appetite, loss of rest, hectic fever- 
ishness, lumbar and hypogastric pains, disordered secre- 
tions, and the appearance of the disorder in the off- 
spring. 

The local symptoms, enumerated in the order of their 
frequency, are, (1) JEndo-cervicitis^ or inflammation of 
the lining membrane of the cervix uteri, with inflam- 
mation, excoriation, or ulceration of the labia around 
the uterine orifice. This appearance was noticed in 19 
out of 28 cases. 

(2) A mottled OT patcliy appearance of the cervix, 
consisting of a number of dark red spots of irregular 
shape, surrounded by lighter colored portions : they 
sometimes appeared highly irritable and excoriated, 
but not aphthous ; the w^hole cervix was generally en- 
larged and slightly indurated and in most cases there 
were evidences of endo-cervicitis. 

(3) A])litli(B of the cervix, occurring in 8 out of 28 
6 



82 HALE ON ABOETIOlSr. 

cases ; the patcheSj wbicli appeared perfectly wMte, of 
a circular or oblong shape, situated upon a dark red 
base, were easily detached by the aid of lint, and left 
a bright red surface of similar form and dimensions, 
having, in some instances, a very minutely granular 
aspect. These were associated with hypertrophy of 
the cervix and endo-cervicitis. 

(4) Warts were witnessed in 3 out of 28 cases, twice 
on the cervix and once on the walls of the vagina. They 
were witnessed in many other cases. 

The sypMlitic ulceration of the cervix cannot be 
diagnosed from that of a non-venereal character, except 
by an actual knowledge of the presence of the specific 
poison in the system of the patient. There is nothing 
in the appearance of the ulcer or erosion which can 
show itself to be syphilitic. When we see warts, or 
the mottled appearance mentioned by Whitehead, we 
may justly have our suspicions. 

Syphilis may act as a predisposing cause. (See that 
chapter.) 



SECTION VII. 

Induration of tlie Cervix Uteri. — This may be a pri- 
mary or idiopathic affection. Whitehead met with 
severe cases of chronic induration during pregnancy, in 
only two of which treatment was effectual in averting 
abortion. All these persons had aborted ; three of 
them, including the two just mentioned, he had at- 
tended in the preceding instances, in all of which the 
same form of disease at that time existed, and in the 



CAUSES OF ABOETION". 83 

remaining four, it is probable, had. long before existed. 
The sum of tlieir abortions was 19 ; the average age of 
the patients 31 years. 

This form of disease is usually met with as a chronic 
affection, the result of previous deep-seated inflamma- 
tion, a species of prolonged metritis. The enlargement 
and induration may involve the whole neck, or may be 
confined to the anterior or posterior lip alone. In 
either case it may depend on inflammatory action, or 
upon some general cachexia. In the latter case the in- 
duration may be accompanied with hypertrophy due 
to fibrinous deposit, or infiltration of serum into the 
tissue of the cervix. The last named condition is 
termed oedema of the cervix. On examination^ one or 
both labia of the cervix will present the appearance of 
a hard conical substance, sufficiently large, generally, 
to occupy the whole orifice of an average-sized glass 
speculum. If the anterior lip alone is affected, the os 
is situated behind, and high up, and is with difiiculty 
brought into view. " When both labia are diseased 
they present a neutral appearance, very much resemb- 
ling the top of the piece representing the bishop, in 
games of chess." Their opposing surfaces are often 
inflamed, excoriated or granular, and the fissures at 
their base ulcerated, and exuding pus. 

This form of disease usually occasions abortion be- 
fore the fifth month, although it may occur consider- 
ably later. 

The symptoms of induration, hypertrophy, or oedema, 
are quite characteristic. A painful sense of constriction 
around the pelvis and hips is almost constantly present ; 
a dull, fixed, aching pain of one or both ovarian regions, 
irritability of the bladder and rectum, pain in the re- 
gion of the sciatic nerves, a highly excited state of the 



84 HALE OK ABOETIOlSr. 

whole nervous system, lassitude, indigestion, etc. Ha- 
bitual abortion may be tlie result of this diseased con- 
dition of the cervix. 

Displacements of the Uterus. 

The various malpositions of the womb may act as 
causes of abortion. 

jinteversion, although of rare occurrence, may so 
irritate the bladder as to set up sufficient reflex action 
to result in expulsion of the ovum. 

Prolctpsus is a more frequent cause of abortion. 
This displacement generally occurs previous to preg- 
nancy, as a result of congestion of the uterus, or indu- 
ration, witli hypertrophy of the cervix, and often from 
mere muscular atony. In either case the uterus will 
be found, on examination, low down in the vagina, the 
lips of the cervix resting on the perineal floor, and the 
body of the fundus within easy reach with the finger. 

Until the end of the third month this condition is 
not generally provocative of any tendency to abortion, 
but about this time the uterus increases in size, and 
unless it rises above the promontory of the sacrum it 
becomes impacted in the pelvis. Any impediment to 
the proper expansion of the uterus will prove an excit- 
ing cause of abortion. In prolapsus and retroversion 
this impediment exists, unless the uterus rises out of 
the pelvic cavity. 

Hetroversion. — This is the most formidable displace- 
ment to which the gravid uterus is liable, and one 
which is more likely to cause abortion than any other. 
Eetroversion during pregnancy was first fully described 
by William Hunter, and Denman. This affection 
occurs in its mosf decided form at about the third or 



CAUSES OF ABOETION. 85 

fourth month, when the uterus is entirely within the 
pelvis, and when it is of such large size that any alter- 
ation from its natural position occasions great incon- 
venience to the neighboring organs. 

Retroversion during pregnancy may be sudden in its 
occurrence ; or it may have existed from the period of 
conception. In the former case it may be caused by 
unusual exertions, as lifting, jumping, reaching ; or 
from such accidents as falling, jolting ; or from diseases 
in which tenesmus occurs, as dysentery, etc. ; also from 
distension of the bladder. In the latter case the retro- 
version had either existed previous to conception, or 
occurred during the first weeks of gestation. For a full 
description of the symptoms and causes of these dis- 
placements the reader is referred to my Monograph on 
that subject.* 

Retroversion occurring during pregnancy is usually 
described as arising from excessive distension of the 
bladder, through neglect, reserve, or restraint on the 
part of the 2:)atient. It is believed that the full blad- 
der, rising in the abdomen, drags the neck of the uterus 
upwards, while the distended organ presses the fundus 
uteri backward. The displaced uterus, by the pressure 
it exerts upon the neck of the bladder, in turn increases 
the distension of this viscus, and the retro verted uterus 
at length becomes fixed across the pelvis, the fundus 
lying in the hollow of the sacrum, and the os being tilted 
against the pubes, so as, in the worst cases, to render 
the evacuation of the rectum difficult, and that of the 
bladder impossible. Recent retroversion may undoubt. 
edly be caused in this manner ; but there are doubtless 
many cases in which retroversion has existed previous 
to pregnancy, and no inconvenience is felt from it until 
* " Retroflexion and Retroversion of the Uterus." 



86 HALE ON ABOETION. 

such time as tlie uterus, from its size, presses upon the 
bladder and rectum to sucli a degree tliat tlie displace- 
ment is looked upon as sudden. In both cases abortion 
may occur from the irritation set up in the surrounding 
organs, and in the uterus itself, or from the utter impos- 
sibility of any further enlargement of the uterus. 

The symptoms of retroversion, when the uterus is of 
such dimensions as to exert mechanical pressure upon 
the antero-posterior axis of the pelvis, are, in the iirst 
instance, partial or complete retention of the urine, 
pain in the pelvic region, and a sense of pressure on 
the rectum, giving rise to a constant desire for defe- 
cation, even when the bowels are empty. Should these 
symptoms pass unrelieved, the bladder becomes some- 
times enormously distended, and even ruptured me- 
chanically, or the coats inflame and ulcerate, allowing 
the urine to escape into the peritoneal cavity, and 
the patient sinks or dies of peritonitis. If the uterus 
cannot be replaced, and the water is occasionally and 
with difficulty drawn off, the bladder gradually enlarges 
and elongates, and its mucous membrane becomes dis- 
eased ; muco-purulent, ammoniacal and bloody urine is 
passed, and the kidneys may become diseased by the 
effects of the backward pressure of the urine. The 
structures between the bladder and the uterus may 
become inflamed, and the patient be destroyed by irri- 
tative fever. In some cases all these mischiefs are 
arrested or modified by spontaneous abortion. In others 
the displacement continues to the fifth or sixth month, 
without destroying the patient, and it has been known 
to go on to the full term without causing a fatal result. 
These cases are however very rare, and the occurrence 
of abortion is less to be dreaded, than a continuance 
of the displacement. ;; 



CAUSES OF ABOETIOTiT. 87 

Death of Embryo^ from any cause, will result in an 
abortion. The presence of a foreign body in tlie ute- 
rus will, in the majority of cases, cause the uterus to 
exert its expulsive action. There are, however, many 
cases in which the foetus and its envelopes have passed 
off in a fluid, disorganized state ; and cases are on record 
even where the embryo after its death was undoubt- 
edly absorbed. In another class of cases, the dead 
embryo itself, or the placenta, is left to become a mole 
or hydatid mass. 

Coitus^ when indulged in to excess, or even its mod- 
erate indulgence in women whose reproductive organs 
are irritable from disease, may be a cause of abortion. 
This may occur at any period of pregnancy, but espe- 
cially at or about the usual menstrual periods. Coition 
causes abortion by exciting, from the mechanical irrita- 
tion it induces, the reflex influences which preside over 
the uterus. If the os or cervix is diseased, the irrita- 
tion excites the peristaltic action of the uterus ; if not, 
it is probably the diastaltic action which is aroused. 

Many cases of habitual abortion will be found to be 
due to this cause alone, and if abstinence from inter- 
course be strictly enforced, either wholly or at the men- 
strual periods, the usual abortions will be prevented. 

As a rule, sexual intercourse should not be indulged 
in at all, or very rarely, during the period of pregnancy. 
That it is physiologically unnatural every physician 
will admit. The general aversion to the act manifested 
by women during that period, as also the fact that the 
animal creation rarely, if ever, cohabit during gestation, 
should teach us that it is improper. Whether sexual 
connection should be prohibited or not, will depend 
upon the judgment of the physician. 



88 HALE ON ABOETION. 

Instrumental Irritation. — Tlie use of instruments, 
wliether for criminal or surgical purposes, is a very 
frequent and powerful cause of abortion at any stage 
of pregnancy. Criminal abortion is rarely brought 
about by the administration of drugs ; it is generally 
induced by some instrument which has for its object 
the puncturing or separation of the membranes, the 
death of the foetus, or the irritation of the os uteri, by 
which means the uterus is made to expel the product 
of conception prematurely. The same may be said 
when abortion or premature labor is induced by the 
physician, in a legitimate manner — i. e. to insure the 
safety of- the mother or child, or both. Instruments 
have sometimes to be used during pregnancy, for pur- 
poses foreign to the accident above named, such as 
replacing a retroverted uterus, or in cases of extreme 
prolapsus, although such instances are rare. But there 
are cases on record where a retroverted uterus became 
so impacted that, other means failing, it was considered 
justifiable and necessary to use the uterine sound. In 
such cases it would seem that abortion would be the 
inevitable result ; but I believe the operation might be 
performed in the early months, and the foetus and 
membranes remain intact. My opinion is based on 
several instances which have come under my own 
observation, where a sound was introduced into the 
uterine ca\7ity, and turned several times round, with no 
other effect than slight pain and haemorrhage — ^preg- 
nancy not being interrupted, but terminating naturally. 

Pessaries have been introduced for the purpose of 
supporting a prolapsed uterus during pregnancy. The 
presence of such a foreign body in the vagina, may, by 
exciting the reflex action, cause an expulsion of the 
ovum ; yet pessaries have been worn for several 



CAUSES OF ABOETION. 89 

months by pregnant women, without sucli a result. 

As a general rule, the use of all instruments, intro- 
duced into the uterus or vagina, should be dispensed 
with, if possible, during utero-gestation, as well as all 
surgical operations on these organs, or on contiguous 
organs or tissues. Instances are not wanting, however, 
where women have borne the most severe operations, 
even on neighboring organs, without interfering with 
the normal advance of pregnancy. 

Dr. Whitehead gives the treatment, by caustics, of 
several cases of ulceration of the os, during pregnancy, 
which treatment was successful, not only in curing the 
diseased condition, but of preventing an habitual abor- 
tion due to the ulceration. 

No positive rule can be laid down as regards the use 
of such remedial measures, as the irritability of the 
uterus varies greatly in different individuals. 

Ovainan. — The functional disorders which may 
prove exciting causes of abortion are sirn'ple irritation^ 
from perverted physiological influences : Congestion 
and Injlammation. 

During pregnancy, the ovaries should be in a dor- 
mant condition. Their functional activity is supposed 
to be suspended, because there is no use for the ovum, 
even if it were formed and extruded. In some instances 
the process of ovulation may go on during pregnancy, 
at the usual menstrual periods. We know the same 
process cloes often occur during lactation ; but it is 
believed that in both cases it is an unnatural proceed- 
ing, and that it arises from some abnormal irritation of 
the ovaries. When this process occurs during preg- 
nancy, the consequent aiEux of blood, or nervous force, 
to the uterus, is often quite sufficient to induce abortion. 
We believe that this is the chief cause of that form of 



90 HALE ON ABORTIOlSr. 

habitual abortion, wHcli occurs within four weeks after 
conception, but about which so little has been written 
or known. 

Congestion and infiammation of the ovaries may 
cause abortion by the severe reflex irritation which the 
diseased process originates. The organic diseases liable 
to cause abortion are, ovarian tumors, dropsy and cystic 
enlargement. 



SECTION VIII, 

JIEDICINAL CAUSES OF ABORTION. 

A list of the medicines which have been known to 
cause abortion at various periods of pregnancy ; toge- 
ther with others which have been supposed to be detri- 
mental to the life of the foetus, has been given on a 
previous page of this work. 

In order that we may arrive at some definite conclu- 
sion as to the real influence of the drugs named, it will 
be proper for us to consider them separately. 

It is manifestly impossible for us to classify the medi- 
cinal causes, as we have classified other morbific influ- 
ences, for in the present stage of our knowledge of the. 
pathological action of medicines, we cannot decide with 
absolute certainty whether secale or cimicifuga., etc., 
cause abortion by their action on the spinal cord (cen- 
tric), or upon the uterus directly (concentric). We 
cannot decide whether a medicine causes diastaltic or 
peristaltic action chiefly ; nor can we say positively that 
aloes induces abortion by irritation of the rectum alone, 
or terehintli by its action upon the urinary organs. 



CAUSES OF ABOETION. 91 

But as all metliods of classification must liave a 
beoiuninD', the following; classes mav be made, and their 
imperfections rectified at some future day, when greater 
pathogenetic or pathological progress shall have been 
made in our school. 

Medicines which act as PEEDispoisrEivrT causes. — 
Belladonna, calcarea carh., carho veg., china, cha'mo- 
milla, chenopodium, ferru/m, hyosciamus, lachesis, lyco- 
podiuni, mercury, nux vomica, 'platinum, podophyllum, 
Pulsatilla, plumhumj, sepia, silicea, sulphur, zinc, and 
many others, which have the power of causing a dys- 
crasia in the system, or a cachectic state of the body. 

Medicines which act as centric causes. — Secale corn., 
cimicifuga, caulophyUum, gelseminum, quinine, cannabis 
ind., nux vomica, ignatia, strychnia, are the principal 
medicinal agents at present known to the profession. 

Medicines which act as concentric causes. — All, or 
nearly all the medicines in the list may act in this man- 
ner ; but upon various organs, and thence to the uterus 
by reflex action. Thus, aloes, podophyllum, mercury, 
and others are said to act on the rectum^ cantharis, 
cannabis sat., turpentine, sabina (.^) upon the urinary 
organs ; and apis met. npon the ovaries. 

A medicine may act, however, both as a reflex and 
concentric cause of abortion at the same time. 

Special analysis of the principal medicinal agents 
capable of causing abortion : 

Apis f}iellifica. 

This poison is stated to have produced " miscarriages 
in the second, third, and fourth months." Dr. Humph- 
reys asserts, that he has in several instances known it 
to produce miscarriages when given for various maladies 



92 HALE ON ABOETIOJSr. 

during pregnancy. This is said to be corroborated by 
other physicians. I have, however, known it to be 
administered with this intent by several physicians, but 
with no such result as above stated ; and upon wide in- 
quiry, I cannot obtain any reliable testimony relating 
to its oxytoxic powers. That abortion may occur while 
the patient was suffering from the poisonous effects of 
bee-stings, I do not doubt; but I beg leave to be sceptical 
as to the power of the 3rd and 6th dilutions, or even 
the 1st trituration, in causing that accident. If apis 
causes abortion when taken internally, it probably does 
so by its irritant action on the ovaries. 

Actoea alba. 

This is a near analogue of the actoea racemosa {Cinn- 
icifuga^. It is called " white cohosh," in contradistinc- 
tion to the latter, which is known as the "black cohosh." 
The country people allege that it causes abortion in the 
early months, and physicians have used it with success 
in suppressed menstruation. 

Aloes. 

The action of aloes^ when given in large doses, in 
cases of amenorrhcea, is well known to every physician. 
It increases the menses, causes menorrhagia, congestion 
of the uterus, and abortion. This it is supposed to do, 
by causing an abnormal engorgement of the blood-ves- 
sels of the pelvic viscera. If it causes abortion, there 
is much coincident irritation of the rectum, tenesmus, 
haemorrhoids, dysenteric symptoms, etc. 

Asarum. 

Asarum Euroyeum. — As early as the sixteenth cen- 
tury its abortion-power was spoken of by Hieronymus 



CAirSES OF ABOETIOE". 93 

Trajus. According to Berclitolcl, it is regarded in 
Bohemia as one of tlie most active and popular abortion- 
remedies. Dierbacli places it witli sahina, among the 
uterine remedies. It is used in England to cause mis- 
carriage, and Hoffman cautions women who are preg- 
nant, against its use. It seems to be an analogue of 
Pulsatilla^' an acrid, emetic, purgative medicine, irritat- 
ing all the mucous surfaces. 

Asarwn Oanadense. — This is a plant indigenous to 
-the United States, known as " Avild ginger," etc. Dr. 
Scudder says he was informed many years since that 
the root was used by the Indians as a " parturient, and 
also as an abortive." It was said to be used frequently 
by white women to prevent conception, and also to 
cause abortion. From these reports Scudder was in- 
duced to try it in amenorrhoea. In his hands it has 
acted well in restoring the menses. 

Asclepias. 

The Asclepias Inca/rnata was noticed in the North 
A7neriGan Journal of Hommopathy^ by Dr. Fowler, as 
being capable of causing abortion in small doses — viz., 
two or three drops twice a day ; but the experiments of 
Dr. A. C. Jones, of Philadelphia, together with my own, 
entirely disprove this statement. 

The Asclejnas Syriaca, appears to possess a decided 
action upon the uterus, as its effects when given in large 
doses in a case of dropsy, reported in " New Homoeo- 
pathic Provings," page 63, seem to prove. 

Aletris farinosa. 

This plant is said to have caused abortion with ver- 
tigo, headache, vomiting, and narcotic effects. Popular 
testimony ascribes to it the power of causing abortion 



94 HALE ON ABORTION. 

in tlie early months; but we have no positive medical 
testimony to that effect. Professor Tally says very 
truly, that certain medicines are in successful use by 
the people for the induction of abortion, long before 
such uses become known and recognised by the medical 
profession. 

Baptisia tinctoria. 

This very depressing drug has been known to cause 
abortion. A strong decoction of the root, taken warm, 
at about the period of the menses, will produce such 
extreme relaxation as to result in miscarriage. Dr. Coe 
says, "It should not be used during the period of utero- 
gestation, as it is capable of producing abortion, for 
which purpose we have known it to be used by quacks 
and empirics. The danger to the general health is 
very great, when used in sufficient quantities to produce 
this result." 

Borax. 

This is a very ancient drug ; known by the older 
physicians to be an " echolic^'' or producer of abortion, 
as well as capable of stimulating the inert uterus in 
cases of lingering labor. For the latter effect Kopp 
advises four to six grains every fifteen minutes, and says 
" it will arouse the expulsive action of the uterus, and 
terminate the delivery." Sunderlin testifies from his 
personal experience that it is useful in " difiicult and 
irregular labors." Dr. Golding Bird says, "In women, 
this drug cannot be used with impunity, as it certainly 
exerts a stimulant action on the uterus, and I have seen 
it, in two instances, produce abortion^ Premature 
labor has been caused by horax^ 30 grains, three times 



OAITSES OF ABOSTION". 95 

a day, for 16 days. Tlie labor was natural, and the 
child born alive. 

"In doses of 10 grains, repeated three or four times 
a day, it has produced abortion, attended with pains 
all over the system, and excessive debility of the joints, 
Avhich remained for several months, in a greater or less 
degree. | On this account its administration to pregnant 
females is improper."* 

Bovista. 

This fungus is placed by Prof. Tully, in his class 
echolica,, upon the authority of " a distinguished phy- 
sician," (name not given) who '' informed him that if 
collected before the interior became a powder, it was 
both a narcotic and ecbolic. 

Hartlaub and Trinks give us a proving of hovista, 
which would seem to substantiate the above statement. 
It certainly has some specific action on the genital 
organs. AVe find some notable symptoms in the patho- 
genesis, among which are, " menses too early by eight 
or nine days, and more profuse / discharge of blood 
het'iueen the catamenia ; bearing-down towards the sex- 
ual organs ; leucorrhoea^ etc." 

It seems that this remedy has been too much neg- 
lected by our profession; or those who have tried it 
may have been disappointed in it. This may arise 
from the fungus from which the preparation was made 
having been collected when too late. We are told that 
the smoke or odor of the dry powder will act as an 
anaesthetic when inhaled; but the ecbolic property may 
exist solely in the green or ripe fungus, before it changes 
to a powder. Jahr's Pharmacopoeia directs it to be col- 

* King's Obstetrics, p. 714. 



96 HALE OJSr ABOETION". 

lected in the montlis of August and September. This 
is too indefinite. Experiments should be instituted to 
test its properties, and the most eligible method of 
preparation. 

Cantliarides. 

This violent poison has been used for the criminal 
purpose of producing abortion, although its action on 
the uterus is uncertain and indirect. In cases where 
this effect has been produced, it was accompanied by 
intense inflammation of the urinary organs, swelling 
and heat of the generative organs, and violent general 
disturbance of the system. It has caused abortion 
when given to animals. 

In the pathogenesis of Hartlaub and Trinks, it is said 
to " promote fecundity, expel moles, dead foetuses and 
the placenta " — a rather sweeping declaration, and one 
quite unwarranted by the facts. A poison so uncertain 
in its action cannot be used with any advantage, in 
large or small doses, in such cases. 

No more power as an " abortivant " can be claimed 
for cantliarides^ than for any of its analogues — apis^ 
cannabis^ erigeron, copavia and Mrpentine — except that 
it is the most powerful irritant. In fact tmyentine seems 
more capable of causing abortion than any other. The 
cannahis indica is lately being used as a partus-accele- 
ratur, and in persons predisposed to abortion, might 
excite that accident, as might any medicine, in large 
doses, which specifically affects the uterus. 

Caulopliyllwn. 

This medicine has a peculiarly specific action on 
muscular tissue generally, and that of the uterus in 
particular. While secah causes spasmodic diastaltic 



CAUSES OF AB0RTI01S-. 97 

action, this drug seems to originate or call up the peri- 
staltic motion of the uterus. It has been used since 
the settlement of this country, by the whites, and by 
the aborigines before them, as a partus-acceleratur. 
In very large quantities it has caused abortion, with 
strong expulsive eiforts, but with no alarming or 
disagreeable symptoms of the general organism. But 
it requires such an inordinately large quantity of this 
agent to effect miscarriage, that it is not often used 
for that purpose. I have known one ounce of the 
tincture taken with no apparent effect, and a pint of 
strong decoction with like result. In fact, it often 
acts just the opposite of what is desired. I have 
known it resorted to by women, and even physicians, 
to hasten an impending abortion, with no other effect 
than to dissipate the pains, and other symptoms, and 
arresting the abnormal process. In these instances, 
one drachm doses of the tincture, and one grain doses of 
the alkaloid, were repeated every hour. The same may 
be said of many medicines of this class — aletris fci/r.^ 
asdepias syr.^ cimicifuga^ — t\LQj prevent abortion, even 
in massive doses. This should teach us, that although 
minute doses may suffice, we should not be afraid to 
resort to material doses, when sanctioned by clinical 
experience. 

, Cimicifuga racemosa. 

That this powerful medicine will cause abortion at 
nearly all periods of pregnancy, the abundance of tes- 
timony, in and out of the profession, does not leave us 
in doubt. We do not mean by this to imply that the 
hlachcoliosli will invariahly cause expulsion of the foetus, 
for, like all other ecbolic remedies, it requires a consti- 
tution susceptible to its influence, in order to have its 
1 



98 HALE ON ABOETIOW. 

action developed. In tlie old American "Herbals" we 
are told that this root was used by tlie Indians to facil- 
itate labor, and also by their women to produce miscar- 
riage. Prof. Tully, one of tlie most extensive observers, 
has known it to produce abortion, and had great confi- 
dence in its power as a partus-acceleratur. He thinks 
all the actcBCB possess the same power. 

Since tke publication of the work on JSfeiv Remedies^ 
I have received several letters from correspondents, 
good medical observers, who assert that tkey know the 
decoction of the roots, or tke active principle (^nacrotiii) 
will, in doses of four or six grains, cause abortion in 
some women, at any period of gestation. I have been 
cognizant of several instances in wkicli women liave 
induced miscarriage with, the root, and also wkere 
physicians had administered the 'inacrotin with, tkat 
result. 

The symptoms accompanying abortion caused by 
cimicif'uga^ are generally these : severe headache, as if 
tke top of the head would be pushed off, or the eyes 
pressed out ; stiffness of the whole body, witk torpor, 
heaviness, and stiffness of the extremities, intermitting 
labor-like pains in the uterus, with pain in back and 
thighs, coldness and shivering, palpitation of the heart, 
neuralgic pains in limbs, contractions of the tendons, 
lowness of spirits. 

If enormous doses are given, convulsions and serious 
injury to the system might ensue, as tlie remedy acts 
specifically on the spinal cord and brain ; yet I cannot 
find any record of the drug having proved fatal. 

The extensive experience which is being gained by 
our school, in the use of this remedy, proves that it is 
of great value in the treatment of many of the diseases 
of women, especially those occurring during the partu- 



CAUSES OF ABOETION. 99 

rient state. It relieves tlie mauy pains and disagreeable 
sensations felt during gestation, prevents miscarriage, 
conducts accidental abortion safely, if inevitable'; and 
it also controls false pains in the latter months, and 
facilitates labor, if tedious and unnatural. 

Decodon verticiUatus. 

This plant, known to botanists as lythrum verticilla- 
tum^ and by the common people as sivain,]) loosestrife^ 
or swamp-willow-herb, has the i^eputation of causing 
abortion in brute animals. 

"If a great amount of testimony," says TuUy,"^" "will 
decide anything in medicine, decodon is ecbolic for 
certain brute animals. This effect is said to be most 
frequently produced upon ewes, next upon cow^s, and 
sometimes upon mares. Any amount of testimony to 
this effect may be obtained from intelligent farmers, 
and even much from w^ell educated physicians, who are 
either farmers themselves, or whose practice is in an 
agricultural region and almost wholly among farmers." 

Tully thinks if this plant can cause abortion upon 
brute animals, it may produce the same effect upon 
women. Yet he is not aware that it has been verified. 
He instituted some experiments wdth it on the cat and 
dog, but with no definite result. He quotes Lindlay, 
who says " it is said to destroy the young of cattle 
heavy with calf." 

Kingf says "it is said to cause abortion in mares 
and cows browsing it in winter, and may, perhaps, exert 
a medicinal influence on the female uterus " (uterus of 
women). 

Culpepper (an old English writer) says it will "stay 
profuse courses in women." 

* Materia Medica, Vol. 2, page 1369. f Dispensatory. 



100 HALE ON ABOETION. 

The decodon may prove a valuable remedy wlien its 
powers are investigated and better known. 

Gossipium Herhaceum. 

I know of no agent used in medicine about wkicli 
there is so mucli variance of opinion, as to its action on 
the uterus especially, as the cotton root. In my work 
on New Remedies* will be found the statements of Dr. 
Bouchelle, of New Orleans, and Dr. I. H. Shaw, of Ten- 
nessee, both of whom write enthusiastically of its powers 
as a uterine-motor stimulant, and mention as reliable, 
statements of its capabilities in causing abortion. Dr. 
King merely sums up the statements of other writers 
as to its alleged virtue, but gives no experience of his 
own. Dr. Coe's statements are of less value. Drs. Jones 
and Scudder believe it is emmenagogue, but "not abor- 
tional or parturiant in the slightest degree." Dr. Hol- 
comb has no confidence in its pritudeal virtues. The 
writer has used it many hundred times and in all doses, 
but never saw it bring back the menses or cause abor- 
tion. Dr. Tully had no positive experience with it, 
but quotes Drs. Frost, Cabell, and Prof. Metlauer, as 
physicians who have tested it, and proved it to act 
powerfully on the uterus. Since the article in "New 
Provings" was written I have received a large amount 
of testimony, both for and against its asserted action 
on the uterus. Time only can clear up these conflict- 
ing statements. It may be that the usual preparations 
are inert, and only the green fresh root should he used. 

Ilex Opaca. 

The American Holly is mentioned by Prof. Tully as 
having the reputation of being a powerful "ecbolic." 

* New Provings, page 317. 



CAUSES OF ABORTION. 101 

It is an evergreen tree, from 20 to 40 feet in "height, 
and is found growing tlironghout tlie United States, 
from Maine to Louisiana, but is especially abundant in 
tlie district of Abbeville, S. C. Dr. Tully states that 
he was informed by several physicians of that region 
that it had a " high popular reputation as an ecbolic, it 
being considered capable of producing abortion or mis- 
carriage at any stage of pregnancy." A strong infusion 
or decoction of the leaves is to be drank freely. Its use 
seems to be confined to the negroes. Dr. Tully could 
not ascertain that one educated physician had ever 
made a trial of it in a single case ; yet he was told that 
no intelligent physician doubted its efficacy in that 
direction. 

I cannot find in any work on materia medica or ther- 
apeutics any mention of the ilex^ as a medicine speci- 
fically affecting the uterus. It has never been used in 
Homoeopathic practice that I am aware of. It is to be 
hoped that some intelligent and investigating physician 
will test its pathogenetic powers, and add it to the list 
of our curative agents. 

Mercurius. 

Ever since the introduction of this deleterious drug, 
instances have not been wanting of its prejudicial effects 
upon the foetus in utero. The older physicians observed 
that large doses of calomel administered to pregnant 
women, were frequently followed by abortion. 

Stille* mentions that the inhabitants of districts 
where ores of imercury are smelted are seriously affected 
by its influence. " The annual mortality is more than 
1 in 40. Premature hirtJis and abortions are very com- 

* Materia Medica and Therapeutics. 



102 HALE ON ABOETION. 

monP Dr. Lizi had an extensive observation of female 
operatives exposed to mercurial vapors. "Marriages 
among tliem were vastly more productive of abortions^ 
stillbirths, and feeble cJiild/i^en which seldom arrive at 
maturity, than among women engaged in other occu- 
pations." Dr. Colson, who wrote of the action of mer- 
cury on the uterus, says — " In not a few instances has 
it occasioned menorrhagoea or amennorrhoea^ and in 
pregnant females miscarriager More recent writers 
mention the fact that calomel frequently causes abortion. 
I was once informed by an Allopathic physician whose 
practice lay in a rather disreputable direction, that he 
knew of no surer producer of abortion than a massive 
dose of calomel — its hydro-cathartic efPect was generally 
followed by expulsion of the foetus. A woman once 
informed me that she usually arrested her pregnancies 
by a large dose of calomel at a menstrual period. 

Podophyllum peltatum. 

This active drastic cathartic has been known to cause 
abortion. I have been informed that the podophyllin 
is often administered for that purpose by certain dis- 
reputable Eclectic physicians. It probably acts in a 
similar manner to aloes^ calomel^ and other medicines 
which highly irritate the lower intestines, and by sym- 
pathy the organs of the pelvis. In large doses it is 
frequently and often successfully used in amenorrhoea, 
yet I cannot believe it has any such specific influence 
over the uterus as caidopliyllum and some others. 
When threatened abortion is attended with piles, dys- 
entery, prolapsus ani, bilious diarrhoeas or extreme 
uterine prolapsus, this medicine will be indicated as a 
curative agent. 



CAUSES OF ABOETIOJSr. 103 

• Quinice SulpJias. 

lu anotlier portion of tliis volume will be found some 
mention of quinine. In the massive doses (30 to 40 
grains) used in Allopathic practice, it has probably 
caused abortion, when given for the cure of malarious 
fevers. Dr. Petitjean afhrms that he has so frequently- 
seen abortion produced during the exhibition of quinine 
in intermittent fever, that he has ceased to prescribe it 
for pregnant women.'"' Dr. A. K. Gardner asserts that 
the administration of quinine to pregnant women is 
hazardous, and likely to cause premature labor. f 

These statements are opposed by Kodriques and 
Henry, who attribute the abortion to the disorder of 
the general health, and the " mechanism of the par- 
oxysm" during malarial fevers. Dr. Rich, of Georgia, 
attributes to it the suspension of contractions of the 
uterus threatening abortion under similar circumstances. 
By some physicians it has been alleged to render uterine 
contractions more active during labor, and as a means 
of overcoming rigidity of the os uteri. 

Quinine is Homoeopathic to many of the symptoms 
of abortion and its consequences, and will be found a 
useful remedy, especially in malarious districts. 

Ruta graveolens. 

This is a very old medicine, used by Hippocrates and 
other ancient physicians for a variety of diseases, among 
which was menorrhagia. Hippocrates, however, says 
it " excites the menstrual flow, and destroys the foetus 
in utero." M. Helie, in 1838, published three cases of 
attempts to produce abortion by this plant, in one of 

* Lancet, 4th, 1847. 
f Tyler Smitli's Lectures on Obstetrics, by Gardner, 



104 HALE ON ABOETIOK. 

wliicli a decoction of tlie fresli sliced root, in the second 
a decoction of tlie leaves, and in tlie third, the expressed 
juice of the leaves was taken. The effects were, in one 
case, violent pain in the stomach, and vomiting, or 
rather efforts at vomiting, with rejection of a small 
quantity of blood. In all of the cases the nervous sys- 
tem was prominently deranged ; there was great pros- 
stration, with confusion of the mind ; cloudiness of the 
vision with feebleness of pulse ; cold extremities, and 
twitching of the limbs. All of the females, who were 
in the foui'th or ilfth month of pregnancy, aborted and 
recovered. Hahnemann records the effects of ruta thus : 
"Metrorrhagia? Miscarriage? Sterility?" It woul'd 
seem that he doubted its power of causing abortion : a 
doubt which other observers do not share. Stille says 
it is emmenagogue, and " not only like ergot acts upon 
the gravid uterus, but it stimulates the unimpregnated 
organ also." M. Bean recommends it, associated with 
savin^ in uterine licemorrli'age after abortion, and men- 
orrliagia from general debility. 

Sdbina. 

The Juniperus Sabina is a native evergreen shrub of 
Southern Europe, and is cultivated as an exotic in gar- 
dens in this country. The Juniperus proGumhens, a 
species having very similar, if not identical, properties, 
is found growing on the shores of our north-western 
lakes. I have met with it in the interior of Michigan, 
and also on the sand-dunes which cover the southern 
shore of Lake Michio-an. It has been found on the 
shores of Lake Huron. It throws out its branches very 
close to the ground, spreading in large circles, generally 
quite horizontal, but often growing upward at a slight 
angle of perhaps 10 or 20 degrees. This indigenous 



OAIJSES OF ABOETIOlSr. 106 

variety sTiould be proven, in order to test its compara- 
tive effects. 

Dioscorides was tlie first to describe tlie qualities of 
savin. Among other things, he says, " An infusion of 
them in wine causes bloody urine, and applied as a 
fomentation to the belly of pregnant women, they pro- 
duce abortion^ Galen says it " Excites the menses 
more powerfully than any other agent, provokes bloody 
urine, destroys the life of the foetus, and causes its exp.il- 
sionr " But," says Stille, " it was most celebrated for 
its emmenagogue properties, which were habitually 
invoked for the criminal purpose of destroying the pro- 
duct of conception." This belief of the power of savin 
to cause abortion has been perpetuated to this day, and 
it is now frequently resorted to for that criminal pur- 
pose, notwithstanding the almost certainly fatal conse- 
quences resulting from its administration in doses 
sufiicient to cause the destruction and expulsion of the 
foetus. The annals of medical jurisprudence abound in 
cases of fatal poisoning by savin taken to produce mis- 
carriage. It is much more employed than is commonly 
imagined for criminal purposes, but fortunately in such 
doses as fail of their purpose, and only produce instead 
vomiting and purging. It generally produces inflam- 
mation of the intestines and urinary organs, and some- 
times congestion of the brain. A case is reported by 
Mohrenheim of a pregnant female who took an infusion 
of savin to produce abortion. It caused incessant vom- 
iting, and some days afterwards excruciating pains, 
abortion, flooding, and death. Rupture of the gall- 
bladder was found on examination of the body, and an 
effusion of bile into the abdominal cavity, with perito- 
nitis. Many other cases might be quoted. Hahnemann 
records several of an interesting character, by which he 



106 HALE ON ABOETIOlSr. 

was led to recommend its use in cases of abortion. In 
most cases enteritis-mucosa, and peritonitis were de- 
tected after death. Tully says, " The active principle 
of sabina has exactly the same composition as oil of 
turpentine^ if it is not identically the same in all res- 
pects." It is a curious fact, apparently confirmatory of 
this statement, that the external application of both 
savin and turpentine to the abdomen of pregnant 
women, will often cause abortion. Both agents seem 
to have a similar effect on the intestines, urinary organs, 
skin, and general organism. 

Sabina^ in poisonous doses, acts most powerfully upon 
plethoric women, whose menses are habitually profuse. 
In such constitutions it would be more apt to provoke 
an abortion, than in persons of spare habit, even if they 
menstruated profusely. 

Secale cornutum. 

Although ergot has been used as a uterine motor 
stimulant since the year 1096, yet its modus operandi^ 
as well as its general and local action, seems far from 
being understood. 

It seems quite settled, however, that it will cause 
intermittent contraction of the uterus at full term. That 
it is capable of causing abortion seems to be generally 
doubted. Says Stille : " If we examine the influence 
of ergot upon the gj'avid uterus in the earlier stages 
of pregnancy, and before quickening, when it is most 
likely to be resorted to with criminal intentions, we 
shall find that in proportion as we recede from the 
period at which the spontaneous action of the womh he- 
gins^ ergot fails to exhibit its peculiar influenced M. 
Dargan, in his report to the Academy of Medicine, 
says : " We do not believe that, independently of labor, 



CAUSES OF ABOETION. 107 

of direct manipulation, or of some otlier external in- 
fluence, tliat ergot^ of itself, can excite uterine contrac- 
tions during the first half of pregnancy." Stille re- 
marks that this is probably the opinion of physicians 
who have had the best opportunities of studying the 
subject. It is, however, to be recollected — ^he says — 
that the distension of the uterus at this period is a 
normal condition, and it does not follow that an equal 
or even a less degree of enlargement should not have 
a different result when it depends upon morbid causes. 
This is the case in menorrhagia. It was so in a singu- 
lar accident reported by Dr. Taylor, of New York. A 
female who was not pregnant had some leeches applied 
to the neck of the uterus to relieve engorgement of that 
organ. One of them found its way into the cavity of 
the uterus, where it occasioned bearing-down pain and 
a bloody discharge. Ergot was administered, and a 
clot expelled holding in its centre a dead leech. Ac- 
cording to Dr. Ker, an enlarged and prolapsed uterus 
contracted under the use of ergot so that it could be 
placed in situ. If we examine the annals of criminal 
abortion, we find that enormous doses of ergot have 
been taken, sometimes with fatal effect upon the mother, 
and often to the production of serious disease, without 
causing the expulsion or death of the foetus. In other 
cases the life of the foetus was destroyed, but it was not 
expelled. Two very interesting cases of poisoning by 
ergot are published in the " Transactions of the New 
York State Homeopathic Society, vol. ii.," in one of 
which 160 grains oi ergot were taken, causing a serious 
illness, but without " any pains or signs of labor," and 
pregnancy went on uninterrupted. In the other case, 
reported by Dr. Hill, half an ounce of ergot was taken 
to produce miscarriage, by a woman who was evidently 



108 HALE ON ABORTION. 

not pregnant, but affected with uterine Lsemorrliage 
due to irritation of the uterus. In this there were 
"pains of an expuldve character in the uterus" the 
first day, and continued "pain in the vulva" nearly 
ev.ery day until she died. I have known it to cause 
expulsive pains in passive menorrhagia. 

Effects of ergot upon gravid anwials. — It is important 
that we should study this point. Stille says, "The in- 
fluence of ergot upon the gravid uterus in animals is 
not uniform. In some cases it seems to have been 
purely negative, in others to have destroyed the pro- 
duct of conception without producing its expulsion, 
and in still others — and these are the most numerous 
— to have caused abortion. Bonjean gave ergot to a 
female guinea pig during the early stages of gestation ; 
abortion was not occasioned, nor, indeed, any symptom 
whatever. The experiments of Wright were to this 
effect. He mixed ergot with the food of a pregnant 
rabbit ; no tendency to abortion was excited, and in 
due time six healthy young ones were born. The ani- 
mal, still kept upon the same food, was again impreg- 
nated. She looked drowsy and moped, the fur grew 
erect and rough, gestation was protracted beyond its 
usual term, and three young ones were born, two of 
which were dead, and the third survived but a few 
hours. The same experimenter, after many trials of 
ergot upon pregnant bitches, concluded that it did not 
act as a parturifacient in them, although it sometimes 
appeared to injure or destroy the product of concep- 
tion.* 

On the other hand, according to Diez, it produced 
abortion in bitches and sows, without harm to the 
mother or the young, when the dose was moderate, but 



CAUSES OF ABORTION. 109 

large doses destroyed both, and excited inflammation 
of the womb. 

Dr. Oslen gave ergot to a sow, a cow^ and a cat^ be- 
fore the completion of pregnancy, and in each case pro- 
duced abortion. In 1841 an epidemic of abortion 
among cows occurred in France, which was traced to the 
ergotted state of the rye and other graminse in the district. 

The most of the above cases of abortion in animals 
undoubtedly occurred during the last half of preg- 
nancy. The same effect would have been produced in 
women under similar circumstances. After the study, 
observation, and experience the writer has bestowed 
upon ergot^ his belief is that it is capable of causing 
abortion in animals and women, in the early months of 
gestation, in those constitutions which are susceptible 
to its action. I do not believe, however, that it excites 
contractions and expulsive pains until U destroys the 
life of the foetus. When this occurs the enlargement 
of the uterus becomes an abnormal condition, because 
it contains a foreign body, which is a source of irrita- 
tion of itself In this condition of the uterus the ergot 
will act, and cause expulsive pains and contraction. In 
the last months of pregnancy it may induce premature 
labor, but the child is generally still-born, so that the 
exceptions to the above rule are very few. 

It may be said of ergot that it is a dangerous and 
uncertain medicine, when used to cause abortion, and 
should never be resorted to for that purpose, 

Sanguinaria canadensis. 

This medicine is one possessing active and varied 
properties, and is capable of exercising a strong eifect 
upon the uterus — whether direct or not cannot yet be 
satisfactorily decided. 



110 HALE ON ABORTIOlSr. 

Rafinesque cautions against its use during pregnancy, 
as it acts very powerfully on the uterus, and causes 
abortion., and recommends its employment in amenor- 
rhoea. Tally says it is sometimes emmenagogue, and 
has been known to produce uterine hoemorrhage. 

Many eclectic practitioners assert that they liave 
used it successfully in amenorrhoea and infrequent men- 
struation. They state that a sure sign of its remedial 
action is the presence of " pains in the small of the 
back, extending down the thighs." These would 
probably be the symptoms in abortion caused by 
blood-root : there would also be other important symp- 
toms — as vertigo, pain in the head, narcosis, vomiting, 
burning pains in the stomach, etc."^ 

Terebinth. 

The oil of turpentine is one of the most active and 
powerful of that group of medicines which aifect the 
urino-genital organs. The apparent starting-point of 
its action seems to be in the urinary apparatus, but 
it produces profound aberrations in the nervous and 
vascular systems. Persons exposed to the vapors of 
turpentine ex23erience its general effects, such as nausea, 
vertigo, impaired vision, pain in the back and loins, 
strangury, bloody urine, insomnia, malaise and an 
eczematous eruption. Women, in addition, are often 
affected with menorrliagia or dysmenorrhcea. [Eminent 
Allopathic authorities claim for it great curative pow- 
ers — which it really has — in all haemorrhages, especially 
those from the uterus .^] Stillef says it arrests hsemor- 
rhage after parturition by exciting contractions of the 
uterus, as it is known to do, as well as by its styptic 

* See New Homoeopathic Provings : Art. Sanguinaria. 
f Materia Medica : Art. Tereb. 



CAUSES OF ABOETIOIsr. Ill 

(homoeopatliic) powers. Turpentine when taken inter- 
nally has been known to cause aboetion and premature 
labor ^ accompanied or not by the above-mentioned local 
and general symptoms. A patient who applied to me 
for the cure of sterility, informed me that she had 
caused abortion several times in the early months upon 
her own person, by simply rubbing the hypogastric 
region with the spirits of turpentine. Several years 
had elapsed since she had been pregnant ; her menses 
were too profuse and frequent. By this it would seem 
to cause both abortion and sterility. 

Tanacetum vulgaris. 

This' common plant has been perhaps more frequently 
resorted to for the purpose of inducing criminal abor- 
tion, than almost any other agent. The oil of tansy is 
the preparation usually selected for this purpose. The 
many cases of death arising from the use of this power- 
ful poison do not seem to deter the vicious or unfortu- 
nate from its use. 

In overdoses, the oil causes unconsciousness, flushed 
cheeks, dilated pupils ; hurried, stertorous respiration, 
strong spasms, full and frequent pulse, repeated con- 
vulsions ; then failing pulse and death. In a case of 
attempted abortion, by a decoction of the herb, there 
occurred delirium, slow and laborious respiration, con- 
tracted pupils, dusky countenance, fixed features, and 
cool skin. Subsequently the muscles of deglutition 
and all the voluntary muscles became paralyzed, and 
death with gradual retardation of the heart's action, 
took place in 26 hours after the poison was taken. It 
would appear that the operation of the tincture or de- 
coction of tansy was not the same as its essential oil. 
Both preparations have undoubtedly been used success- " 



112 HALE ON ABORTIOTf. 

fully as abortivants, without fatal or serious results ; 
but its administration in large quantities is generally 
dangerous. In the February number of the North 
American Journal of Homoeopathy (1865) will be 
found a resume of all that is known concerning the 
pathogenetic and curative effects of tanacetum. 

Ustilago madis. 

This ustilago is a parasitic mushroom, which occurs 
on maize (Indian corn) as ergot does on rye. In a cow. 
house where cows were fed on Indian corn infested with 
this parasite, eleven of their number aborted in eight 
days. After their food was changed, none of the others 
aborted. The better to be convinced of the poisonous 
nature of these mushrooms, the author, after having 
dried and pulverized them, administered six drachms 
to two bitch dogs with young, which soon caused them 
to abort.'^" 

Lindlay says : — " Its action on the uterus is as pow- 
erful as the ergot of rye, and perhaps more." Accord- 
ing to Roulin — " Its use (long protracted, of course) is 
attended with shedding of the hair, both of man and 
beast, and sometimes even of the teeth. Mules fed on 
it lose their hoofs, ^ndi fowls lay eggs without any shells.'''' 

Tully in his mention of this fungus adds — " It is 
doubtless by its abortifacient power that it causes the 
eggs of fowls to be extruded before there has been time 
for a shell to be formed. By what power does it cause 
the shedding of the hair of man and brute animals and 
the casting off of the hoofs of mules long fed upon it?" 
It would seem to be capable of great curative powers. 

* Anal. Med. Vetr. Beige, and Rep. de Ph. 



PAET III. 



GENERATION : 

SYMPTOMS, DIAGNOSIS, PATHOLOGY, MECHANISM, 
AND PROGNOSIS OF ABORTION. 



GEFEEATION". 115 



SECTION I. 

GEISTEEATION. 

The Physiology of Generation is so intimately con- 
nected with the subject of Abortion, that it would be 
improper to omit some mention of that process, when 
conducted normally. 

Generation^ in its broadest sense, is that function of 
the female generative organs which dates from the suc- 
cessful impregnation of the ovum to the period of its 
birth. It includes the several processes of contact of the 
ovum with the fertilizing semen of the male, its passage 
through the Fallopian tube into the uterus, certain 
textural changes in the uterus in advance, and in con- 
sequence of its reception and developement, and its 
final passage and parturition. 

I propose to treat of Generation as including three 
distinct stages, namely, 

(1) From tlie arrival of tlie impregnated ovum in the 
uterine cavity until the placental attachments an^e 'per- 
fected^ or the period of quickening. 

The ovule has its origin in the ovary, and when 
it has attained its full maturity, the vesicle in which it 
is enclosed becomes the seat of an excitation, which 
finally results in a rupture of the walls of the vesicle, 
and the extrusion of the ovule. This maturation, and 
escape of the ovule, generally occurs at or about the 
menstrual periods. After its escape, the ovum engages 
in the Fallopian tube, the enlarged extremity of which has 



116 HALE ON ABOETIOlSr. 

been applied to tlie ovary. It has been supposed that 
the above processes occur from the stimulus of coition, 
or erotic excitement, as well as from the excitation con- 
sequent on the menstrual crisis ; but it is doubtful if 
the former uniformly causes such results. 

The ovum passes through the Fallopian tube, but the 
time necessary for this passage is not with any certainty 
known. In the human subject, says Cazeaux, no one 
case has ever proved its existence in the womb prior to 
the twelfth day. But this cannot be accepted as any 
decision of the question. 

When the ovum enters the cavity of the uterus, if it 
has been fecundated by the spermatic fluid in its pas- 
sage, it attaches itself to some portion of the hypertro- 
phied mucous membrane, generally near the fundus, at 
which portion the placenta is afterwards attached. 

It is here necessary to make some mention of the 
decidua. It is now argued that at each menstrual 
period the uterine mucous membrane is exfoliated, 
thrown off, and a new one formed in its place. It is 
this membrane, greatly hypertrophied, that we find in 
membraneous dysmenorrhoea. It is now well estab- 
lished that the decidua is nothing more than the hyper- 
trophied mucous membrane. Whilst the evolution of 
the ovarian vesicle is going on in the ovary, the vascu- 
larity of the uterine mucous membrane is greatly in- 
creased, and the highly congested vessels are discover- 
able beneath the epithelium. This state of turgescence, 
however diminishes during the last days of the mens- 
trual epoch, and disappears almost entirely sometime 
after the catamenia has ceased. But if the ovule, 
before leaving the ovarian vesicle, or during its passage 
through the tube, receive the vivifying influence of the 
spermatic fluid, the fecundation will maintain and in- 



GEISTEEATIOK. llf 

crease tlie abnormal excitement of the genital organs, 
and then, instead of subsiding, the uterine mucous mem- 
brane becomes still more turgescent, of a deeper violet 
color, and the folds and wrinkles increase so as to more 
than line the cavity of the uterus. It is in one of these 
folds that the ovum is enclosed, after the lapse of a period 
as yet unascertained, and this fold of hypertrophied 
mucous membrane which remains in the uterus, when 
united, forms the deciclua rejiexa of authors. The ovum 
is also enveloped in its own proper membranes — the 
amnion and chorion. 

From the date of conception and lodgment of the 
ovum in the uterine cavity, until about the fourteenth 
week (three and a half months), its nutrition is car- 
ried on by means of imbibition, or absorption through 
the membranes that surround it. Up to this period 
the placenta is not attached to the uterus^ and the con- 
nection between the mother and child is established 
by means of the allantois. The fact that before 
the fourteenth week of gestation the placenta is not 
attached to the uterus should be kept in mind, as it will 
have considerable bearing on the pathology and treat- 
ment of abortion. This period is also that known 
to writers as the period of " quickening," or a time 
when the foetus is connected with the maternal circula- 
tion through the placental vessels. In a medico-legal 
point of view, this is an important date, as by some 
jurists it is considered a date after which the induction 
ofabortion is considered a criminal offence, unless some 
point of medical expediency demanded it. 

(2) The second stage extends from the date of the 
attachment of the placenta to the uterus^ until the period 
when the foetus is capable of a sepa/rate existejice. 



118 HALE ON ABOETION". 

The beginning and end of this period, however, can 
■not be said to have any fixed limits. It is supposed 
by some that the period of " quickening" corresponds 
with the attachment of the placenta. To a certain 
extent this may be true, as both generally occur about 
the sixteenth week. 

Tli6age at which a foetus is viable may be said to be 
about the end of the seventh month. Cases occur in 
which children born at an earlier time than this sur- 
vive, but these are rare exceptions. (Dr. J. W. Francis 
reports a foetus born with membranes intact in the 
twenty-third week of pregnancy that lived to matu- 
rity.) Even at the seventh month they are kept alive 
with difiiculty. The state of the heart as regards 
development, the feebleness with which the foetus sucks 
before this time, the ready failure of animal heat, and 
the inability to bear the movements necessary to nurs- 
ing and cleansing, render it almost impossible to rear 
the foetus born at an earlier period. 

(3) The tliird stage of utero-gestation reaches from 
the viability of the foetus until the end of pregnancy. 

This, however, like the period of viability, is a variable 
period. According to those authorities who consider 
the last day of the last menstruation the proper date to 
reckon from, the termination of pregnancy varies from 
the thirty-seventh to the forty-third week. Dr. Reid, 
whose elaborate calculations appeared in the Lancet, 
gives the terminations of 500 pregnancies, which ranged 
from the thirty-seventh to the forty-fifth week. Dr. 
Reid also calculated from "a single coitus" in 43 cases, 
all of them resting upon testimony as credible as can 
be obtained in such cases. These ranged from 260 to 



GENERATION. 119 

300 days, giving the average duration of gestation at 
about 275 days. Nine months is supposed to be the 
average duration of human pregnancy, but the time 
undoubtedly varies from eight and a half to ten months. 

Dimensions and loeigJit of the foetus at the different 
feriods of uterine life. 

A treatise on Abortion would be incomplete if it did 
not contain some practical information on this subject. 
In a purely medical, and especially a medico-legal 
point of view, this is of manifest importance. 

At the time when the embryo first begins to be 
distinct, that is, about the third lueeh^ it is oblong, 
swollen in the middle, obtuse at one extremity, though 
drawn to a blunt point at the other, and straight, or 
nearly so, being somewhat curved forward. It is 
therefore vermiform in shape, of a grayish white color, 
semi-opaque, almost without consistence, and gelatin- 
ous, varying from tivo to four lines in lengthy and 
'Weighing one or two grains. At this period the only 
trace of the head is a small tubercle separated from the 
rest of the body by a notch, but no rudiments of ex- 
tremities are observed, nor is there a cord at first. 

At \\iQ fifth weelc the embryo becomes more consis- 
tent ; the head is large in proportion to the body ; the 
rudimenta,ry eyes are indicated by two black spots 
turned toward the sides ; it is nearly two-thirds of an 
inch long., and weighs about fifteen grains. 

At the sixth week., the bronchial fissures disappeai', 
leaving only a slight cicatrix, and its size and weight 
are somewhat increased. 

At the seventh weeh^ the first centres of ossification 
appear. The intestine still extends for a considerable 



120 HALE ON AEORTION. 

distance along tlie umbilical cord. At this time the 
embryo is nearly an inch in length. 

At two months, the forearm and hand can be distin- 
guished, but it is not supplied with fingers. The cord 
has not yet assumed a spiral arrangement ; it is four or 
five lines in length, and is inserted near the lowest 
point of the abdomen. It is very difficult at this period 
to distinguish between the sexes, owing to the extreme 
length of the clitoris. The embryo is from one and a 
half to two inches long^ and weighs from th/t^ee to five 
d/}'aGhms, ■ 

At ten weehs^ the embryo is from one and a half to 
two and a half inches in lengthy and weighs an ounce 
or an ounce and a half The cord is longer than the 
embryo, and begins to assume the spiral arrangement, 
but its base always contains a portion of intestine. 
The fingers are distinct, but not the toes. At the end 
of the third month, the embryo weighs three to four 
ounces, and measures f^oTufive to six inches. The cord 
contains no intestine ; the nails begin to appear, the 
sex is distinct, the eyeball is seen through the lids, the 
forehead and nose are clearly traced, and the lips well 
marked and not turned outward. 

At i\iQ fourth month, the embryo takes the name of 
foetus. The body is six or eight inches in length, and 
weighs from seven to eight ounces. The face still 
remains but little developed ; the eyes, nostrils, and 
mouth are closed ; the skin has a rosy color, and begins 
to be covered with down, and the muscles now produce 
sensible motion. " A foetus born at this period," says 
Cazeaux,* "might live for several hours. Whilst I was 
Interne at the Hotel Dieu, I received one that had 

* Cazeaux's Midwifery, page 208. 



GENEEATIOIf. 121 

scarcely readied the fourtli month. It lived, however, 
from half-past seven to half-past eleven o'clock." 

At five months^ the length of body is eight to 
ten inches^ and it weighs from eight to eleven ounces. 
The skin is more consistent ; the pupils cannot be 
distinguished. 

At six montlis^ the hair is longer and thicker, the 
nails are solid, but the eyes are still closed. The length 
is eleven to twelve and a half inohes^ and the vjeight 
about one pound (avoir.) 

At seven months^ the eyelids are partly open, and 
the testicles begin to descend into the scrotum. The 
foetus acquires a length of twelve and a half to fourteen 
inches. 

At eight months^ it is only sixteen or eighteen inches 
long, and yet weighs four to five ^pounds., because the 
foetus seems, at this period, to grow rather io. thickness 
than in length. The scrotum generally contains one 
testicle, usually that on the left side. The skin is 
very red, and covered with long down. The lower 
jaw is now as long as the upper one. 

Finally, at term., the foetus is about nineteen to twenty- 
three inches long^ and weighs from six to seven pounds. 
Cazeaux thinks the weight and length of children at 
birth have been wonderfully exaggerated, in which he 
is probably correct. 



122 HALE ON ABOETION. 



SECTION II. 



SYMPTOMS OF ABORTION. 



The symptoms of an al)ortion may be divided into 
three classes, namely: 

1. The Premonitoey. 

2. The Actual. 

3. The Subsequent. 

Eacli of these classes, or divisions, constitutes a differ- 
ent stage of the miscarriage. 

The PREMONITORY symp'toms constitute the first stage 
of the abortivant process, namely — the stage of irrita- 
tion^ or that condition of the uterus lohich exists up to 
the time of the rupture or separation of the membranes 
or placenta. 

The ACTUAL symptoms constitutes the time which inter- 
venes from the sepaTation of the memhranes^ etc., until 
the expulsion of the fmtus and placenta. 

The SUBSEQUENT symptoms are those which follow 
and marh the conditions which are hiown as the sequelae 
of abortion. 

It is important that the above divisions be borne in 
mind, as it leads to a methodical study of the subject, 
and has an important bearing upon the treatment. 

The symptoms of the premonitory stage may be said 
to include all those symptoms which belong to the 
causes heretofore mentioned ; but more strictly consid- 
ered, are those which occur for a few days or weeks 
previous to the commencement of the second stage. 



SYMPTOMS OF ABORTION. 123 

The premonitions of an abortion may be present for a 
long time, or only for a few liours. This depends upon 
the natm'e of the causes ; for if the cause be an ulcer 
on the cervix, the symptoms may appear at every 
monthly period, and may not result in actual expulsion 
of the foetus if proper remedial means are used ; or, 
should the cause be a fall, concussion, or instrumental, 
the premonitory symptoms may be few, or entirely 
wanting. 

The prodromes of an abortion generally appear in 
the following order : 

1. Pain. — This may consist merely of an aching in 
the back (sacrum) or hypogastrium, and extending 
down the thighs ; or it may be acute, and described as 
griping, lancinating, darting or stitching ; but what- 
ever the character of the pain may -be, it is generally 
confined to the above localities. 

2. Sensations^ which are not pains, but consist of a 
feeling of v)eight^ pressing-doion^ or- soreness, in the hy- 
pogastrium and in the pelvis. These sensations may 
co-exist with the ^9«m, or may be present without the 
pains above mentioned. 

3. General symptoms. — There is almost always a 
general uneasiness, nervousness, languor, and depression 
of spirits, accompanied or not with some acceleration 
of pulse, flushed face, and cold extremities. At the 
same time the symptoms which are usually attendant 
on pregnancy remain. 

4. Hmmorrliage, generally a slight discharge, which 
may continue days, and even weeks, before the second 
stage begins. 

But so soon as the membranes are broken, by acci- 
dent, or punctured by artificial means ; or the mem- 
branes or placenta become separated from the walls of 



124 HALE ON ABOETIO]^. 

tlie uterus ; or tlie foetus dies from any cause ; then we 
have a train of symptoms in addition to the prodromic, 
namely : 

1. Chills. — My observation and experience goes to 
show that the chill, or i^igor, whether preceded or not 
by pains and sensations, is the most reliable symptom 
of a rupture or separation of the membranes. The 
foetus may die, and remain for some time in the uterus 
before it excites irritation sufficient to arouse the ex- 
pulsive action of that organ. Meanwhile the placenta 
may be said to live, and even perform its functions, as 
in certain cases when the blighted or dead ovum is 
changed to a mole. 

In other cases we may be made aware of the death 
of the embryo by certain symptoms generally obscure ; 
but until the woman has a chill, or chilly sensations, 
we may consider separation of the membranes as not 
having occurred. This cMU greatly varies in intensity 
and duration. Sometimes it consists of a vague sensa- 
tion of internal chilliness or coldness, and may last for 
days, and may be mistaken for the first stage of an 
influenza or a fibrile attack ; at other times and in 
other patients, it may assume the form of rigors, in 
which the woman will shiver and shake, as during a 
paroxysm of ague. I have seen instances, even, where 
the attack could have been easily mistaken for a " con- 
gestive chill," so excessive was the prostration and the 
general coldness. 

There is a class of cases in which rigors may appear 
unattended by any sensations of coldness. These are 
called, by old nurses, " nervous chills." The woman 
will shiver, her teeth will " chatter," and she will ap- 
pear to suffer from great chilliness ; but will tell you 
she "is not cold." This form of "rio^or" is usuallv met 



SYMPTOMS OF ABORTION. 125 

with in cases of parturition at full time, and is supposed 
to indicate a relaxation of the cvrcular myscles of the 
ce7'mx, or of any sphincter muscle. I am inclined to 
view this as a correct explanation. In one instance in 
which I noticed this rigor without coldness, the embryo 
was expelled in the unbroken membranes, together with 
the placenta. In this case, the time which intervened 
between the separation of the membranes, and the ex- 
pulsion of the whole, was too short for the appearance 
of a chill. 

2. Pain. — As in the prodromic stage, the pains may 
be aching, cutting or griping, but they are generally 
attended with another kind known as "labor-pains." A 
woman may feel a pressing-down sensation in the pelvis 
during the premonitory stage, but that sensation is 
quite different from the one under consideration. A 
labor-pain is a bearing-down sensation accompanied y<[\\h 
pain: this pain regularly intermits, or remits, which is 
rarely the case with the premonitory sensation alluded 
to. Some authors claim that it is possible to arrest the 
progress of an abortion in the second stage. I think 
it hardly possible, as I have never known such an arrest 
to take place after the occurrence of intermittent, labor 
like pain, coming on after a chill. From the above, it 
will be noticed, that I consider the second stage of 
abortion to be marked by two prominent symptoms, 
namely : the chill., and the labor-pain. There is another 
prominent symptom of the second stage. I allude to 
the painful sensation of sorenes-% tenderness, or sensi- 
tiveness of the hypogastric region, and sometimes the 
whole abdomen. This is often so severe as to lead to 
the belief of the presence of peritoneal inflammation, 
which, however, rarely occurs in such cases: or more 
correctly to the occurrence of metritis, which is oftea- 



126 HALE OF ABOETION. 

present to a certain extent. This sensation is not 
always due to inflammation or congestion ; but is of- 
tener neuralgic in its nature, having its seat in the 
abdominal muscles, or even in the uterus, which is only 
a hollow muscle. But as this symptom sometimes at- 
tends the prodromes, and as the abortion is often pre- 
vented after its occurrence, it cannot be considered as 
belonging exclusively to the second stage. 

Pains may exist in other portions of the body, as 
the back, thighs, hypochondria and head. The pain 
in the head is particularly to be noted : it is often in- 
tense, and aifects principally the top of the head, and 
the eyes, and is described as a painful pressure from 
wdthin outwards (a pain quite similar to that caused 
by cimicifuga or macrotin). This pain in the head, as 
well as the nausea and vomiting which sometimes oc- 
cur, is due to reflex iriitation. Sensations of numbness, 
lameness, and cramps of the upper and lower extremi- 
ties, sometimes appear, and are due to the same cause. 

A common symptom of the second stage is a sensa- 
tion as if the back (sacrum) was dislocated, or as some 
patients express it, "as if they had no hach in one place," 
alluding to the sacral region. It is during this stage 
that we sometimes find considerable febrile excitement, 
occurring generally subsequent to the chills. This fever 
may come on in irregular paroxysms, and be followed 
by perspiration, and so nearly simulate certain forms 
of ague, that the careless practitioner is often misled as 
to its real significance. Together with the appearance 
of the above symptoms, we generally notice a disap- 
pearance of the usual symptoms of pregnancy, or those 
which the patient has usually been troubled with, if 
she has borne children. The morniDg nausea and 
vomiting subsides; the "longings" cease, and the en- 
larged breasts become soft and flabby. 



SYMPTOMS OF ABORTION". 127 

Hmmorrhage. — This is almost invariably attendant 
on the second stage. There are, however, some few 
exceptions to the rule, as in the case mentioned above, 
of the expulsion of the unbroken membranes. In this 
instance absolutely no haemorrhage occurred, as I was 
informed by the nurse, who stated that only the slight- 
est stain of blood appeared upon the napkins used. 
HcBmorrhage rarely occurs to any great extent before the 
expulsion of tliefcetus: it is from this occurrence, up to 
the final expulsion of the placenta, that flowing is most 
to be feared. I believe that no instance of fatal, or even 
dangerous haemorrhage can be cited as having occurred 
previous to the expulsion of the foetus. It is rarely the 
case that the placenta is expelled at the same time with 
the foetus, or shortly thereafter ; while the cont]=ary ob- 
tains in delivery at full time. I have often thought that 
the expulsion of the foetus ought to mark an interme- 
diate stage, between the second and the third. Many 
hours or days, and even weeks, may elapse between the 
expulsion of the foetus and the placenta. Meanwhile 
the patient generally loses considerable blood, which 
may flow uninteruptedly, or the flooding may occur at 
longer or shorter intervals. The chills, which marked 
the onset of this stage, may occur frequently, at irregu- 
lar intervals, or if the patient resides in a locality where 
malaria abounds, the paroxysms may occur regularly, 
and assume all the characteristics of an idiopathic inter- 
mittent. It is not strange, perhaps, that intelligent 
physicians have treated such cases as pure agues, and 
overlooked the intra-uterine cause. Anti-periodics^ or 
quinine^ while they will break the regular recurrence of 
the paroxysms, will not cause them to subside entirely, 
nor will any medicine arrest them until it first causes 
the expulsion of the retained placenta. 



128 HALE ON AUOETION. 

The placenta is frequently retained in the uterus until 
putrefaction takes place, in which case it is"not expelled, 
in the usual acceptation of the term, but passes away in 
a dissolved or disintegrated state. In such, cases the 
discharges from the uterus have a peculiar and persist- 
ent foetor, unlike anything else — a foetor which the 
physician who has ever inhaled it will never forget. 
The odor of the discharge from uterine cancer bears 
some relation to it ; but there is a marked difference, 
which the experienced practitioner can detect. It is 
peculiar to both discharges, that it is almost impossible 
for several days to eradicate entirely the disagreeable 
foetor from the hand which has been used in making a 
necessary examination. The best preventive of such a 
disagreeable contamination is to annoint the hand thor- 
oughly with fresh lard, previous to the examination. 
The lard absorbs the odor, and retains it, in the same 
manner as it absorbs the delicate and costly perfumes 
of flowers, which are placed between layers of purified 
lard, in order to preserve volatile odors, and transmit 
them to pure alcohol. 

The decaying placenta may be weeks in passing 
away, or it may be expelled by the irritated uterus 
before this process is completed. In this case the 
mass expelled has a spongy, worm-eaten appearance, 
and exhales an intolerable effluvia. 

In some instances the placenta is neither expelled or 
discharged in putrefactive solution, but in some man- 
ner keeps up a connection with the uterus, and con- 
tinues to enlarge, becoming in the end a hydatid or 
molar mass. 

There are even cases where the after-birth has 
remained in the uterus a long time, having no connec- 
tion with that organ, remaining about the size it had 



SYMPTOMS OF ABOETION. ' 129 

attained wlien tlie foetus was expelled, yet undergoing 
no change of a putrefactive character, and finally being 
thrown off with or without haemorrhage. One such case 
came under my own observation. A woman aborted 
in the third menstrual period from conception. The 
foetus was expelled, considerable hasmorrhage followed, 
and it was supposed the placenta had been thrown off. 
Ergot was given to arrest the flooding ; nothing fur- 
ther occurred for a month, when violent haemorrhage 
occurred, and again two weeks after. At this time I 
was consulted. Caulophyllin^ 1-1 0th, in doses of two 
grains every two hours, arrested the flooding, and 
under its use for twenty-four hours, the unchanged pla- 
centa was expelled. No foetus was present at the time 
nor afterwards. It is supposed that in these instances, 
putrefaction is prevented by the closure of the cervix 
so tightly as to be hermetically sealed. 

We may here inquire why the placenta is so often 
persistently retained. But one explanation is usually 
given, namely, that the uterus, before the fourth month, 
is quite undeveloped, and its muscular structure incap- 
able of originating or maintaining contractile or expul- 
sive action. That this is often the cause of the non- 
expulsion of the placenta is not to be disputed, but 
that it is always the cause of its retention is certainly 
not the case. Those who have attended many cases of 
abortion, if they are at all observant, must have noticed 
how frequently the uterus is, in such instances, more or 
less retroverted. It has seemed to me that this disloca- 
tion occurs in two-fifths of all cases of abortion before 
the fourth month. In such a malposition the cervix is 
flexed, and even bent at nearly a right angle, suflS- 
ciently so as to nearly or entirely close the canal of the 
cervix ; and no amount of effort can expel the placenta 
9 



130 HALE OlSr ABOETION". 

until the uterus is placed in proper position. Ante- 
version of the uterus will have the same effect, but as 
this occurs more rarely, it is not of as much importance. 
I have met with but three cases of this latter form of dis. 
location occurring during the progress of an abortion. 
The uterine sound was here efficient in effecting the 
change of position, and dislodging the retained pla- 
centa. 

A woman who has aborted may suppose she has got 
rid of the whole contents of the uterus, and her phy- 
sician may be of the same opinion, unless he has had 
considerable experience and is a close observer. There 
may be a slight discharge, bloody or not, or there may 
be none at all. This condition of uterine quiescence 
may continue for days, and even weeks, when suddenly 
after walking, stooping, lifting, or some unusual exer- 
tion, uterine pains, with or without hsemorrhage, may 
set in, and a retained placenta be thrown off. 

If the patient only has pains while lying on her face ^ 
we may generally consider that retroversion exists. 
This I have observed in several instances, and upon 
examination, I found that the uterus changed to a 
natural position when the woman lay upon her face, 
and dropped into the hollow of the sacrum when she 
turned upon her back. 

After the expulsion or discharge of the placenta and 
membranes, if no coagula are present, the chills and 
fever generally cease, but there is, however, a kind of 
irritative fever, which may occur before or after this 
period. It is probably due to the presence of a sub- 
stance undergoing putrefaction in the uterine cavity, 
and the absorption of morbid matter into the circula- 
tion. This fever, although zymotic in its character, is 
not, like puerperal fever, due to any specific contagion, 



SYMPTOMS OF A30ETI0N. 131 

nor is it propagated from one woman to another, i. e., 
my experience does not lead me to suppose that any- 
such contagion is to be apprehended. I have often 
gone direct from the room of a patient from whom I 
had just extracted a putrid retained placenta, to at- 
tend a woman in labor, using no more than usual 
means of cleanliness, yet I never had a case of puer- 
peral fever in my practice under such circumstances. 

This putrefactive, or irritative fever, is usually at- 
tended with all the symptoms of a typhoid, namely : 
the heat of the skin, quick, irritable pulse, dry tongue, 
stupor, or coma-vigil, and even diarrhoea. But it is a 
notable fact, that if at any period of the fever the 
uterus gets rid of its morbid contents, the unfavorable 
symptoms disappear with surprising rapidity, showing 
that the condition of the blood is not due to any fer- 
menting poison working in that fluid, but from the 
absorption of a poison, only. 

The complications which may ensue during this 
fever, are inflammation of the uterus, phlebitis, ovaritis, 
pelvic cellulitis, and occasionally cystitis ; but as these 
more usually occur as sequelae of abortion, they will be 
considered under that head. 

The discharges from the uterus before all the morbid 
material is thrown off, are often irritating and excori- 
ating in the extreme, causing in their passage outward 
superficial erosion, and even ulceration of the os uteri, 
vagina, and vulva. I have now described the symp- 
toms of abortion, in various degrees of severity, from 
the first premonitus to the entire expulsion of all the 
products of conception. The subsequent symptoms re- 
main to be considered. 

*The sequelae of abortion are many and important, 
comparing in gravity with those of an unnatural labor. 



132 HALE ON ABOETION. 

It is the opinion of some authors that serious conse- 
quences are oftener the result of abortion than of pre- 
mature labor, but this statement is hardly warranted 
by the facts. If abortion is properly treated, the 
sequelae are very few and unimportant. It is only 
when this accident is improperly treated, or left to the 
unaided powers of life, that serious results occur. The 
most common sequelae are metritis, ovaritis (acute and 
chronic), induration and ulceration of cervix and os 
uteri, leucorrhcea, prolapsus, retroversion, chronic me- 
trorrhagia, and anaemia. To these may be added the 
occasional occurrence of mastitis, peritonitis, and puer- 
peral mania. 

The symptoms of the above diseases are supposed to 
be familiar to every practical physician, and are to be 
found in every work on diseases of women. We will 
therefore omit to enumerate them in this place. In re- 
lation, however, to mastitis, it may be said that the 
mammae rarely become engorged and filled with milk 
before the third month ; but after that time it is no 
uncommon occurrence to have all the symptoms appear 
which usually accompany the secretion of milk at 
full time, and even of the occurrence of mammary 
abscess. 



DIAGNOSIS OF ABOETION. 133 



SECTION III. 



DIAGNOSIS OF ABOETION. 



Feom the numerous and characteristic symptoms just 
given, tlie diagnosis of abortion ouglit to be very 
easy; but unfortunately, tbese signs are not very 
clearly marked until the abortion is inevitable, and 
consequently when it is a matter of indifference to the 
patient whether the physician makes out a clear diag- 
nosis or not. It is therefore during the premonitory 
stage, that we should endeavor to recognize the true 
nature of the disease, for then only can our art succeed 
in arresting its progress. 

The diagnosis of abortion involves the solution of 
three questions : 

(1) Is the woman pregnant ? If she is, 

(2) Are the symptoms those of a commencing abor- 
tion, or do they arise from other diseases ? 

(3) Is the abortion inevitable ? 

Is tJis woman 'pregnant ? This first question is quite 
readily solved after the fourth month of gestation, 
though before that period it is almost always unanswer- 
able. All physicians of experience are aware of the 
difficulties which involve it. A woman in good health 
may cease to menstruate for several months ; she will 
show nearly all the natural signs of pregnancy. At 
the third or fourth month she may have signs of uterine 
congestion or irritation, lasting for several days, fol- 
lowed by a slight flow of blood. Is it a return of the 
interrupted menses or an approaching abortion % The 



134 HALE ON ABOETION. 

physician should try to satisfy himself, if possible, of 
the actual existence of pregnancy (see " Conduct of 
Physician"), but if this cannot be done, he must rely 
upon the symptoms present. 

If hoBinorrhage occurs, we must distinguish it from 
those rare cases of " menstruation during pregnancy," 
so-called. This is supposed to be an exudation of blood 
from an ulcerated os or diseased cervical canal, or from 
the lower segment of the uterus, not occupied by the 
deciduous membrane. To distinguish it from this ab- 
normal form of menstruation, we must ascertain if the 
symptom has occurred every month since the symptoms 
of pregnancy set in, and also the duration of each 
previous haemorrhage. If such has occurred, and this 
subsides like them, it is plain it cannot be an impend- 
ing abortion, unless such haemorrhage proceed from 
placenta previa^ as is sometimes the case. 

Little or nothing can be inferred from the form and 
size of the clot^ whether it has proceeded from an un- 
impregnated womb or not; but all clots should be 
examined, by carefully picking them in pieces under 
clean water, and if the abortion has occurred after the 
third week, the embryo may be discovered. 

Cazeaux gives certain rules, laid down by Holl, how 
to distinguish a clot in the cervix uteri from the head 
of the foetus, but our space will not permit their inser- 
tion. 

(1) Metritis may occur idiopathically during preg- 
nancy, when it is pretty sure to cause abortion. If it 
occur from medicinal or mechanical causes, and for the 
purpose of causing criminal abortion, the consequences 
are very grave. 

To distinguish an impending abortion from inflam- 
mation of the uterus (unimpregnated), we must con- 



DIAGNOSIS OF ABOETIOlSr. 135 

sider the character of tlie pain, which in the latter is 
not intermitting, nor is there any hgernorrhage. A me- 
tritis may be followed by a foetid grumous discharge, 
but it lacks the peculiar foetor of a decaying decidua 
or placenta. Finally, the history of the case, and the 
absence of the usual symptoms of pregnancy. 

(2) Peritonitis may occur without causing abortion. 
The first symptoms of this disease, however, may be mis- 
taken for symptoms of abortion, particularly the ab- 
dominal tenderness, the chills, and the tympanites. But 
the absence of intermitting uterine pain, the condition 
of the OS and cervix, and the absence of haemorrhage, 
will enable us to form a correct diagnosis. As in me- 
tritis, we may have both a peritonitis and an abortion 
existing at the same time. 

(3) Dysinenorrlioea has many symptoms which very 
closely resemble those of abortion, so nearly, indeed, 
that it is almost impossible to form a satisfactory diag- 
nosis between that disease and an abortion before the 
tenth week of gestation. 

The shreds and skinny substances discharged in 
membraneous dysmenorrhoea, may not contain any dis- 
coverable foetus or placenta. But if, as I believe to be 
often the case, abortion occurs in the third or fourth 
week after conception, the embryo is so small as to 
elude a very close search. In fact the deciduous mem- 
branes expelled in dysmenorrhoea and early abortion 
are said by recent investigators to be identical, and 
sometimes their expulsion is attended with all the 
symptoms of abortion. It may be said, therefore, that 
there are many cases which come under the care of the 
physician, where it is impossible to give a decided 
opinion one way or the other. 

(4) Dysentery. The pains which accompany dysen- 



136 HALE ON ABOETION. 

tery, and are located in the hypogastrium and sacrum, 
extending in some cases down the thighs, the tenes- 
mus, and desire to bear down with the abdominal 
muscles, so nearly simulate the symptoms of an abor- 
tion, that the latter has often been prescribed for, as 
dysentery, especially if a diarrhoea has been present 
with the abortion, — a not uncommon occurrence. But 
no careful and observing practitioner will ever be guilty 
of such carelessness. 

When pregnancy exists, may the symptoms be attri- 
buted to simple congestion, or should they be regarded 
as the first tokens of a threatened abortion ? Although 
it is very difficult to decide this question within the 
first three or four months, or at the beginning of the 
accident, its solution is happily of little importance, as 
regards the treatment, the measures indicated for simple 
congestion being equally applicable as preventives of 
of miscarriage. 

" When symptoms, which in all appearance were due 
to simple congestion, have yielded to proper treatment, 
the physician is often required to answer a question 
whose rigorous solution is always impossible — namely : 
the abdominal and lumbar pain being allayed, and all 
the other alarming symptoms removed, is the patient 
therefore out of danger of miscarriage ? In the majority 
of cases we can tell nothing about it, for it is impossible 
to know whether the congestion has been arrested in 
time to prevent a rupture of blood-vessels, and an 
effusion between the placenta and uterus, or whether 
the separation of the placenta is extensive enough to 
have destroyed the foetus immediately : even supposing 
the child to be still living, we cannot ascertain the 
degree of separation of the placenta, nor foresee the 
effect which a partial destruction of its maternal attach- 
ment may have upon the foetus. Very frequently, 
indeed, the latter, by being cut off from a considerable 



DIAGNOSIS OF ABORTION. 137 

part of its means of respiration, is placed in the condi- 
tion of an adult, whose lungs are in great measure des- 
troyed, and whose respiration and nutrition being 
insufficient, gradually wastes away. As the child often 
does not perish until after the lapse of eight days, two 
weeks, and frequently not until the next menstrual 
period, this, too, without the appearance of any new 
symptoms to explain the unlooked for death, the 
physician, therefore, cannot be too reserved in his 
diagnosis, as regards the possible consequence of such 
accidents."* 

But if the abortion has really begun, can we hope to 
arrest the symptoms ? Severe pains, their constant 
direction from the umbilicus towards the occyx ; the 
previous duration of the discharge, and the amount of 
blood already lost ; softening and dilatation of almost 
the entire neck, and even of the internal orifice, and 
projection of the membrane during contraction, all in- 
dicate a very unfavorable prognosis. It is said by some 
authorities, that these symptoms should not destroy all 
hope, but I have never known abortion arrested after 
it has reached this stage. It is even stated that rupture 
of the membranes, and discharge of the amniotic fluid, 
does not render abortion inevitable. But this assertion 
is simply absurd ; for such a condition not resulting in 
death, and expulsion of the embryo or foetus, is impos- 
sible. In the cases alluded to by Desameaux, there 
was certainly a mistake in reference to the true origin 
of the water lost by the patient. 

Hydrorrhoea^ resulting in discharge of water from the 
uterus, has undoubtedly been mistaken for rupture of 
the ovum. Cazeaux relates a case where the occurrence 
took place at three and a half and four and a half 
months ; the pregnancy terminated naturally. 

* Cazeaux's Midwifery, 



138 HALE ON ABOETIOlSr. 

Hcemorrhage may occur without an al)ortion Ibeing 
inevitable, for it may arise from an ulcerated os, a dis- 
eased cervix, or even a slight separation of the placenta. 
The amount of discharge is more important than its 
duration. A slight haemorrhage may continue for 
several days or weeks, since it may originate in the 
rupture of a few vessels. I have known it to last six 
weeks or two months without compromising the preg- 
nancy. But if a large amount of blood is lost in a 
very short time, the placenta must be separated to a 
considerable extent, and abortion must necessarily 
ensue. 

Abortion is really inevitable only when the foetus 
has ceased to live, when the membranes have been 
broken, or when the separation of the placenta, and 
the rupture of the utero-placental vessels, are so exten- 
sive that the remaining utero-placental attachments are 
unequal to the support of the foetal respiration. It is 
impossible to ascertain in the early months whether the 
foetus is living or dead. The sudden cessation of the 
vomitings, salivation, swelling of the breasts, and other 
sympathetic functional disorders of pregnancy, are pretty 
sure proof of the death of the foetus. The continuance 
of these symptoms, even after the occurrence of leu- 
corrhoea and other disturbances, is certainly favorable. 

There is a particular form of the neck of the womb, 
which Cazeaux says is only met with when abortion 
has taken place. " When the patient has been for a 
short time only pregnant, we know that it is always 
easy to distinguish the neck of the uterus from the 
body ; in the great majority of cases we may even feel 
the angle which separates them. Now when the con- 
tractions have lasted for a certain length of time, they 
have gradually dilated the internal orifice, the cavity 



DIAGNOSIS OF ABORTION. 139 

of the neck Las become confounded with tliat of the 
body, and when the finger in the vagina is passed over 
the entire lower segment of the uterus, the neck can no 
longer be distinguished from it ; a well-defined limit 
between them is no more to be detected, and all that 
belongs to the neck of the womb has the shape of a 
pear, the larger part being continuous with the body 
of that organ, and the lower extremity corresponding 
with the external orifice. Whenever I have met with 
this condition of things, abortion has taken place."* 

After the fourth month of pregnancy the diagnosis 
is much more certain, there is greater haemorrhage, and 
dilation of the os is more easily detected, and the death 
of the foetus can be verified in a positive manner. The 
following are the signs of this occurrence, (a) The 
abdomen diminishes instead of increases in volume ; 
(h) the breasts shrink away ; (c) the woman has drag- 
ging sensations about her loins, an unusual weight in 
the hypogastrium, as of an inert body which falls 
toward the side on which she lies from the mere law of 
gravity ; (d) the movements of the infant cease to be 
perceptible, (e) Lastly, the most valuable evidence is 
that furnished by auscultation, for an impossibility of 
hearing the sounds of the foetal heart after the fifth 
month is an almost certain sign of the child's death ; 
indeed it is the only sign, for all the others may be 
absent, and yet the foetus be living. Unfortunately, 
the pulsations of the heart are not generally percepti- 
ble before the fourth month of pregnancy. 

We may, in most cases, be able to diagnose the ex- 
istence of an abortion during its progress, and directly 
after the accident ; but we are often called upon to treat 

* Cazeaux does not mean to imply that that the foetus and membranes 
have been expelled, but that their expulsionis inevitable. 



140 HALE ON ABOETION". 

• * 

the sequelse of abortion, and, were we not closely ob- 
servant of, and acquainted with, the symptoms occur- 
ring from retention of decidual debris, or a placental 
mass, we might treat the patient for some other malady. 

Retention in Utero of tJie Ovum^ Placenta^ Decidual 
Membrane J or parts of either. 

It is well known to the profession, that the whole or 
portions of the product of conception may be retained 
in the womb, after the vitality of the ovum has ceased. 
In such cases, a putrid discharge generally occurs, which 
is sometimes attended with danger to life, and which 
generally disappears after a longer or shorter time. 

We are often called to cases presenting the following 
array of symptoms : The woman is much prostrated, 
anaemic, with sometimes an icterode hue of the skin ; 
she is very languid, hysterical and depressed in spirits; 
she may be confined to her bed, or tries to be up and 
attend to her domestic duties : in the former case there 
is continual haemorrhage, or a constant sanious discharge, 
having an abominably foetid odor ; or in the latter case 
the haemorrhage occurs occasionally, at irregular inter- 
vals, coming on suddenly, with or without pain. We 
sometimes find the symptoms very severe: with the 
prostration there will be loss of appetite, tumid or ten- 
der abdomen, frequent small and sharp pulse ; hot and 
parched state of the skin of the hands and feet, hectic 
fever and night sweats. The discharge is extremely 
foetid, and there are frequent haemorrhages, brought on 
by the slightest exertion. 

After examining a case of this character, the phy- 
sician will be likely to pronounce that an abortion has 
occurred, and the ovum, placenta, membranes, one or 



DIAGNOSIS OF ABOETION. 141 

all, Lave been retained, and are undergoing putrefac- 
tion. But this would not always be a correct diag- 
nosis. There are other causes of the above] symptoms, 
all or in part, namely : retention of the lochia, of leu- 
corrhoeal or purulent discharges, detached polypi, can- 
cer of vagina or uterus, extra-uterine pregnancy, disin- 
tegrating fibrous tumor, abscess of the genital organs 
or pelvis, and thrombus or hoematocele of the same 
parts. These causes do not invariably produce all the 
above symptoms, or any of them, but they all fre- 
quently do so. .^ The same may be said of tents, pessaries, 
or any substance introduced from without, which will 
decompose, or lead to retention of matters that readily 
undergo putrefaction. The art of distinguishing the 
retention of the ovum and its appendages from the 
above, is one which can only be learnt by close study 
and much experience. The scope of this work will 
not permit a further reference or an extensive differ- 
ential diagnosis. The physician must judge from the 
history of the case. He should first satisfy himself 
whether pregnancy previously existed; other matters 
should follow after. 

There are other consequences of imperfect abortion 
which differ from the above symptoms, in that an early 
ovum, or a part of it, may be retained for months, 
without causing any discharge having a noticeable 
foetor, or indeed any discharge at all. These cases are 
the most difficult of diagnosis ; there may be no special 
symptom to distinguish the illness from an ordinary 
uterine ailment ; even an examination by the touch or 
speculum will fail to help us. A case is reported by 
Dr. Duncan where the ovum was retained seven months, 
with the " absolute absence of any foetor." She suf- 
fered during that time from " weight in uterine region, 



142 HALE ON ABORTION. 

slight bearing down, occasional irritability of the blad- 
der, irregular action of the bowels, occasional disorder of 
the stomach, and even sickness, hrownish lencorrhoea, 
bright bloody discharges, often profuse, never absent 
above a week. At seven months a sponge tent was 
inserted into the cervix, and the next day the ovnm 
was found in the vagina. It was a placental mass an 
inch and a half broad, and above half an inch thick. 
On opening the bag of membranes, a few drops of dirty 
brownish fluid escaped ; no remains of an embryo or 
cord was discoverable, and the ovum perhaps never 
contained any, being addle from the beginning."* 



SECTION IV. 

PATHOLOGY AND MECHANISM OF ABOETION. 

" This is a subject," says Dr. Duncan, " which is little 
understood." He probably alludes to the changes 
which take place in the uterus, embryo, placenta, decid- 
ual membranes, etc., during t]iQ process of abortion^ and 
not to the causes of the abortion. The latter are 
pretty well understood ; not completely, however, for 
there are many predisponent and exciting causes which 
are probably yet unknown. 

The pathological changes which go on in the uterus 
and its contents, during an abortion, varies with the 
stages of utero-gestation. Abortion, when it occurs 
very early in pregnancy (before the twentieth day, 
during which time M. Guillemot calls it ovular abor- 

* Edinburgli Medical Journal, January 1863, p. 589. 



PATHOLOar AND MECHATSTISM OF ABOETION. 143 

tion), is generally owing to certain obstacles wliicli 
prevent the permanent attacliment of the ovum to the 
nterine walls. In cases where conception has occurred 
just before a menstrual period, the motor act of expul- 
sion is probably limited to the Fallopian tubes, the 
ovum being carried out of the uterus with the men- 
strual discharge. 

When conception has occurred just cffter a period, 
the ovum may be dislodged by some mechanical action, 
or motor irritation, affecting the uterus, in which case 
it would fall into or near the cervix, and after undergo- 
ing disintegration, pass off w^ith a leucorrhoeal dis- 
charge. 

After twenty days, and until the third month, or 
fourteenth week (embryonic abortion), after the decid- 
ual membrane is fully developed, and before the pla- 
centa has formed its uterine attachments, the great 
vascularity of the uterine mucous membranes renders 
the effusion of blood between the decidua and uterine 
walls an easy occurrence. This extravasation may 
arise from simple congestion, from rupture of a vessel, 
or from separation of the membranes by instrumental 
means ; but from whatever cause it arises, the blood 
collects and spreads in all directions, separating the 
decidua from its connections, and causing contractions 
in the uterus, which generally end in the expulsion of 
its contents. 

In cases occurring in this stage, the canal of the 
cervix and the os uteri have to be dilated before the 
ovum can pass, and this process of dilatation occupies a 
considerable time, and frequently causes much suffering. 
The most favorable way in which an early abortion can 
occur, is when the detachment of the entire ovum takes 
place before the act of expulsion occurs. The perfect 



144 HALE ON ABOETION. 

ovum is tlien expelled at once, and the uterus contracts 
without much haemorrhage. In other cases the mem- 
branes are ruptured, and the small foetus comes out 
alone or enveloped in the amnion, or the membranes 
may be discharged piecemeal, leaving the ovum to 
escape afterward. As a general rule, the membranes 
remain after the expulsion of the embryo, and the 
earlier the abortion, the longer the placenta or mem- 
branes have a tendency to remain. This is probably 
owing to the extended adhesion of the ovum to the in- 
ternal superficies of the uterus, and the feeble power of 
the uterus to contract on its contents. Sometimes the 
membranes of an early ovum will remain for weeks, 
but in such circumstances there is not the same tend- 
ency to decomposition and its dangers, as there is in a 
case of placenta after the sixth month. 

I have observed, in reading some reports of cases of 
abortion before the third month, the remark that " the 
placenta was adherent." Such a condition cannot exist 
prior to that date, for the reason mentioned above, that 
until that time the placenta does not form its attach- 
ments to the uterine walls. 

Although the contractile power of the uterus at this 
date is comparatively feeble, yet it is sometimes quite 
notable. This contractile power has been greatly 
underrated. Dr. Simpson has seen the uterus contract, 
when unimpregnated, upon the uterine sound. The 
virgin uterus contracts violently during dysmenorrhoea, 
and with labor-like pains expels the abnormal decidua 
("false membranes"). I have known the uterus to 
contract forcibly, during an abortion, before three 
months, and the pains were very like those of labor. 
This contractile power of the uterus, even at an early 



PATHOLOGY AND MECHANISM OF ABORTION. 145 

date, may be taken advantage of when we are striving 
to cause expulsion of tlie placenta. 

Tlie appearance of the masses discharged in early- 
abortion, is described with excellent minuteness by Dr. 
Meyer.'"' He says: 

" When these masses do not prove to be mere coagula, 
they present the following appearances : " In form they 
resemble internal coatings of the uterus, the fundus and 
cervix being quite discernable. The external appear- 
ance of the mass is that of a coagulum of blood with a 
more or less smooth surface ; and this it is found to be 
on cutting into it, until we arrive at about its middle, 
when we come upon a cavity having smooth walls, more 
or less collapsed. Upon nearer examination, this cavity 
is found to be lined with two membranes, the chorion 
and amnion. An affixed funis is always found, and 
near its attachment, the umbilical vesicle, and fre- 
quently the ductus cw^Aa^o-mesariacus. The free ex- 
tremity of the fanis has all the appearance of being 
torn. These various appearances fix the age of the 
fcetus at about t'^vo mo7iths; but no foetus is to be found, 
or even the fragments of one." 

The conclusion usually come to, that no foetus has 
been present, was regarded by Dr. Meyer as inadmissi- 
ble, and he therefore instituted a more exact investiga- 
tion into these cases. He accordingly found in all of 
them a rent, extending through the membranes, usually 
at the place which corresponded to the orifice of the 
uterus, and this rent led into a canal of greater or less 
length, amidst the external coagulum. So constantly 
is the funis directed towards thi-: ^ent, tb it in one case 
where the placenta ^'Z.<r> implanted luore towards the 
orifice of the uterus, and a I'^ige rent had occurred at 
the fundus of the ovnid, the funis passed directly up- 

Henle's Zeitschrift, Band, X. p. 283. 
10 



146 HALE ON ABOETIO]Sr. 

wards. It is evident, then, tliat tlie foetus escapes 
througli the rupture of the membranes, and the follow- 
ing seems to be the proximate cause of its doing so. 
Abortions of this kind are complicated with considera- 
able haemorrhage, and the blood effused between the 
walls of the uterus and the ovum, whether in the fluid 
state or as a coagulum, when acted upon by the uterine 
contraction, compresses and bursts the ovum. The 
membranes collapse, and the funis becomes fixed in the 
position it assumes on the exit of the foetus through the 
rupture. So small an object as the foetus becoming 
mixed with the coagula is easily overlooked. 

Dr. Duncan writes, in his paper " On some of the 
Results of Imperfect Deliverance in Abortion :"^* 

" In abortion it sometimes happens that the entire 
double layer of decidua is discharged with the ovum ; 
in this case the abortion may be truly called complete. 
It also sometimes happens that the ovum alone is dis- 
charged, unaccompanied by any decidual structures ; 
and in such cases the incomplete abortion is followed, 
after a few hours, or even a day or two, by the expul- 
sion of the remaining decidual masses. Occasionally 
no such decidual masses are discharged as masses, and 
yet recovery is undisturbed ; and in cases of this kind 
the persistent decidual membrane must either disin- 
tegrate rapidly, and come away imperceptibly in the 
discharges, or, maintaining its uterine connections, the 
membranes may slowly exfoliate, and atrophy in like 
manner as it does after ordinary menstruation. But it 
also, though rarely, happens that the decidual masses 
are retained for many weeks undecomposed (perhaps 
adherent to the uterus), and then become separated, 
putrify, and cause foetid discharges, until they are ex- 
pelled." 

In abortions occurring from the time of the maternal 
attachment of the placenta until the viability of the 

* Braithwaite, Part 47, page 234. 



PATHOLOGY AND MECHANISM OF ABOETION. 147 

foetus (the sixth montli), the mecJianism resembles more 
closely the pains and motor action of a natural partu- 
rition, and the tendency, as regards the expulsion of 
the ovum, is to imitate labor at full time. The patho- 
logical changes are the same as in abortion, occurring 
'during the first stage of gestation, with this additional 
feature, that the extravasation may occur between the 
placenta and uterine parietes, as a result of intense con- 
gestion (placental apoplexy), mechanical separation by 
instruments, or strong contractions of the womb. When 
this occurs the membranes are also separated by the 
out-pouring blood, and the uterus thereby irritated 
until its motor actions are aroused ; the cervix uteri is 
slowly dilated, the membranes ruptured (if intact be- 
fore), and the foetus expelled, to be followed at a longer 
or shorter interval by the membranes and placenta. 
As gestation advances the cervix uteri becomes devel- 
oped, the difficulty of passing through the cervix be- 
comes diminished, while that of passing the pelvis is 
increased. When the ovum is small, the contractions 
of the uterus are chiefly or solely concerned in its ex- 
pulsion ; but when it is large enough to ^distend the 
vagina, the abdominal and respiratory efforts are called 
into play. From the sixth to the ninth month the 
pathology and mechanism are nearly the same, but 
more closely simulate natural labor. 



148 HALE ON ABOETIOK. 



SECTION V. 



PROGNOSIS OF ABORTION. 



Unless the abortion has been caused bj violent 
means ; or the use of instruments in the hands of the 
the patient, or an unskillful or reckless physician ; or 
from serious organic disease, which has previously pros- 
trated the vital powers — the prognosis of an abortion 
may generally he considered as favorable. 

An important element constituting a favorable prog- 
nosis, is the rational and scientific treatment of this 
accident. An abortion may begin in a favorable man- 
ner ; the uterus may do all that is demanded of it for 
the purpose of expelling the embryo; but the treat- 
ment adopted may, by deranging the functions of other 
organs, or arresting the natural efforts of the uterus, 
render the result of the case decidedly unfavorable. 
On the other hand, a case may commence with the 
most alarming symptoms ; the uterus may fail to put 
forth any proper efforts ; yet the skillful physician, by 
using the medicinal and instrumental means appropriate 
to the case, may conduct it to a safe and rapid termina- 
tion. 

The period at which an abortion occurs influences the 
prognosis. Some authorities, among them Desamor- 
eaux, assert that it is more serious for the patient in 
the last stages of gestation. This is not always the 
case. I am inclined to agree with Cazeaux, that " It 
hardly constitutes an indisposition during the first and 
even second month, but in the third or fourth, the ex- 



PEOGNOSIS OF ABOETION. 149 

pulsion of tlie foetus demands a certain dilatation of the 
OS uteri, and tolerably energetic contractions, for the 
neck and body of the uterus have not yet undergone 
the modifications necessary to such an effort, and the 
delivery of the after-birth often presents difficulties less 
frequently met with at a more advanced stage of gesta- 
tion ; whence I conclude that an abortion is then more 
grave and painful to the patient, as also more dangerous, 
than in the fifth or sixth month." 

Tyler Smith states, that " In abortion the danger 
from haemorrhage is before the expulsion of the ovum : 
in labor at full term, it occurs after delivery." The 
reasons for this opinion have been given when treating 
of the Pathology of Abortion. 

As I have before stated, dangers rarely occur in 
abortion before the sixth month, after the placenta is 
expelled or has been removed. 

A favorable prognosis may be given in all cases when 
the foetus and placenta has been expelled with but 
little haemorrhage at or after the occurrence, or when 
the placenta has been removed before severe haemorr- 
hage has occurred, or even if the secundines cannot be 
removed but pass off in putrefactive solution unat- 
tended with a low grade of fever. 

It is unfavorable when, in cases of criminal abortion, 
such violence has been used as to cause serious inflam- 
mation of the uterus, etc., or injuries to that organ or 
contiguous structures. The uterus has been lacerated or 
perforated by sharp instruments, and death has resulted 
from internal haemorrhage or peritonitis ; sharp probes 
have been forced through the bladder, or into the cul- 
de-sac between the rectum and vagina, causing serious 
and sometime fatal results. Caustic or acid fluids have 
been injected into the womb and caused death by me^ 



150 HALE ON ABOETION. 

tritis; or if the substances injected passed througli tlie 
Fallopian tubes, fatal peritonitis has ensued. Finally, 
the internal administration of such poisons as ergot^ 
sahina^ and turpentine^ have caused such intense uterine 
inflammation, and constitutional disturbance, as to 
destroy life. 

The instances above enumerated are usually those 
which result from criminal ignorance or recklessness, 
and the injurious causes have their origin in the first 
stages of abortion. There is, however, another class of 
cases, which might perhaps be termed natural abortions, 
as they are due to some disorder of the body. In all 
these cases an unfavorable prognosis can only be feared 
in the event of two morbid conditions having obtained, 
viz: 

(1) The retention of the placenta with flooding. 

(2) Its putrefactive absorption. 

In cases of the retention of the placenta, if it be not 
removed, severe, protracted, and dangerous flooding 
may ensue ; death may then occur of sheer exhaustion 
from loss of blood unless the placenta is removed. 

In other cases of retention, it is not the flooding 
only that is to be dreaded, but the absorption of fluids 
in a state of putrefaction. In quite a large experience, 
however, I have never lost a patient from either cause ; 
in fact, I have never lost a patient from abortion or 
any of its consequences. Cases, however, do occur, of 
death from flooding, or irritative fever, as also from 
some of the sequelae of this accident. 

Two cases will illustrate how a little medicinal or 
instrumental interference may change the most unfa- 
vorable case into one of only moderate danger, and 
insure final recovery. I was once called to see a woman 
said to be dying. Three allopathic physicians had at- 



PEOGlSrOSIS OF ABOETIOW. 151 

tended her for six weeks, and diagnosed " inflammation 
of tlie womb with gangrene." She appeared nearly in 
a/rticulo Tnortis ; pulse scarcely perceptible, face hip- 
pocratic, skin cold and covered with a clammy sweat. 
The discharge per vaginum was most intolerably offen- 
sive. I got a hasty history of the case, but sufficient 
to satisfy me that an abortion had occurred about eight 
weeks previously. OMna^ in thirty-drop doses, was 
alternated half hourly with the same quantity of the 
wine of ergot. Brandy and food were given freely. In 
six hours a horribly offensive placental mass was ex- 
pelled. The patient made a rapid recovery. The 
other case was a nearly similar one, except that death 
was imminent from profuse flooding, which the tampon 
or medicines had been powerless to arrest. The blunt 
hook was introduced, and the placenta removed ; haem- 
orrhage ceased immediately, and the woman had a 
favorable convalescence. 

We have considered the immediate prognosis, and it 
will be noticed that we do not coincide with the old 
proposition which has been advocated since the time of 
Hippocrates, viz., that the prognosis is more grave 
than that of labor at full time. But the remote conse- 
quences are undoubtedly more disastrous in the former 
case. Thus the acute diseases which attack lying-in 
women are more frequent after labor, whilst the chronic 
disorders of the genital organs which appear in ad- 
vanced age, are more common in females who have 
often aborted than in those who have been delivered 
at term. Again, it is highly important to notice the 
unfavorable influence which one abortion has on subse- 
quent pregnancies, for whenever a woman has had a 
miscarriage she is more predisposed than others to a 



152 HALE ON ABOETION. ^ 

similar accident, and hence great precautions should 
always be taken to prevent it. 

"The prognosis," says Cazeaux, "as regards the 
foetus^ is always fatal." This author, however, limits 
abortion to the period preceding the time of viability 
fixed by law, namely, the end of the sixth month. 
He admits that cases are reported of children born 
prior to this period which have lived; but these 
examples, he says, even if they were authentic, are too 
rare to invalidate his general proposition. 



PART IV. 

TREATMENT OF ABORTION. 



TREATMENT OF ABOETION". 155 



SECTION I. 

TEEATMENT OF ABOETION. 

[ The treatment "of abortion may be divided into 

1. Peeventive. 

2. Remedial. 

a. Mechanical, 
h. Medicinal. 

3. Post-Paetum. 

a. Postural, 
h. Dietetic. 
c. Medicinal. 

This excellent division is the one adopted by my col- 
league, Dr. Ludlam, in his Lectures on Obstetrics, and 
I have appropriated it as the most methodical and 
scientific which has come under my observation. 

I. Peeventive. 

The preventive treatment of abortion consists mani- 
festly in the remedial measures adopted for the removal 
of those diseases which have been enumerated as being 
the causes which have a tendency to result in the death 
of the ovum; the separation of the membranes and 
the expulsion of all the products of conception. 

(1.) Constitutional or JPredisponent. 

Plethora. — If this condition is caused by an excess of 
nutritive material taken into and assimilated by the 



156 HALE ON ABOETION. 

organism, tlie proper treatment would seem to be tlie 
adoption by the patient of that diet wMch would most 
effectually cut off the supply of tissue-making material. 
It is the opinion of the best physiologists of the present 
day that the ingestion of starchy or saccharine matter 
directly tends to cause corpulence. It matters not 
whether starch or sugar be taken into the stomach as 
such, or whether they are generated in the stomach 
from other substances which contain the elements of 
starch or sugar. It is proper, however, that we should 
distinguish plethora from corpulence or adiposis. The 
former may consist in an excess of blood alone, or it 
may be associated with the latter. Adiposis, it is well 
known, may and does often exist when there is no real 
sanguineous plethora, in which case the food is improp- 
erly digested, leaving the fatty particles to be absorbed 
and deposited in the tissues (muscles, etc.), sometimes 
to the entire destruction of their integrity. In true 
sanguineous plethora, a low diet, or the prohibition of 
meat^ soups, pastry, and certain vegetables, as beans, 
peas, etc., also such beverages as tea, coffee, brandy and 
other liquors, should be insisted upon. If the plethora 
be associated with adiposis, all carbonaceous articles of 
food, sugar, starch, etc., and malt liquors, should be 
strictly prohibited. If it is found difficult to subject 
the patient to these restrictions at her home, it will 
hasten the removal of the plethora if we place the 
patient in a water-cure establishment, or subject her to its 
processes under the care of an experienced nurse, whose 
duty it should be to regulate the diet as well as apply 
the proper baths, etc. The Turkish vapor bath has 
some reputation in England for the removal of pleth- 
oric conditions. 

There are certain medicines which have a dynamic 



TEEATMENT OF ABORTIOI?'. 157 

inflaence over the circulation of blood to the extent of 
retarding the nutrition of the body. Dr. Rogers, of 
Michigan, asserts that the •veratrum viride, in doses of 
five or ten drops of the first dilution several times 
daily, will tend to the arrest of the plethoric condition. 
If this should prove to be a fact, then we may presume 
that aconite, gelseminum and others of its analogues 
may have the same effect. It is supposed by some 
authorities that excessive water-drinking will have the 
result to diminish the amount of plethora, by acting as 
a diluent of the blood, but the value of this theory is 
more than doubtful. 

In true corpulence, or adiposis, a somewhat different 
treatment is required. It consists principally in the 
withdrawal from the food of all starchy and saccharine 
substances, obliging the patient to live almost wliolly 
upon meat. The advantages of this plan of treatment, 
with its successful results, is best set forth in a pamph- 
let by a Mr. AVilliam Banting, of England,^* who, from 
being excessively corpulent, weighing 202 lbs, after 
living on the the following diet for one year, found his 
weight reduced' 46 lbs, and his "girth" around the 
waist twelve and a half inches. 

"For breakfast I take four or five ounces of beef, 
mutton, kidneys, broiled fish, bacon, or cold meat of 
any kind except pork, a large cup of tea (without milk 
or sugar), a little biscuit or one ounce of dry toast. 

"For dinner five or six ounces of any fish except 
salmon, any meat except pork, any vegetable except 
potato, one ounce of dry toast, fruit out of a pudding, 
any kind of poultry or game, and two or three glasses 
of good sherry, claret, or madeira — champagne, port or 
beer, forbidden. 

* " Letter on Corpulence." New York, 1864 (fourth edition). 



158 HALE OIT ABOETION. 

" For tea two or three ounces of fruit, a rusk or two, 
and a cup of tea without milk or sugar. 

"For supper three or four ounces of meat or fish, 
similar to dinner, with a glass or two of claret. 

"For night-cap, if required, a tumbler of grog (gin, 
whiskey, or brandy without sugar), or a glass or two 
of claret or sherry." 

It seems almost incredible that a man could actually 
get lean upon such a substantial, even luxurious, diet. 
Yet there is not wanting the testimony of other corpu- 
lent patients who have adopted this method, that it is 
quite effectual for the purpose, the mere abstraction of 
starch and sugar arresting the accumulation of adipose 
matter. Mr. Banting had previously tried "sea-air and 
bathing, much walking exercise, taken gallons of 
physic and liquor potassae, riding on horseback, " lived 
upon sixpence a day, and earned it," if bodily labor be 
so construed, yet the evil still increased. 

There are some medicinal measures which may be 
tried if the above diet does not succeed. Liquor 
potasscB has been useful in the removal of adiposis. 
This it is supposed to do by saponifying the fatty por- 
tions of the food before it has time to be absorbed. 
The dose is twenty to thirty drops, taken about two 
hours after meals. Iodine^ iodide of potassium^ and 
some other drugs, are alleged to have removed adiposis, 
but they are poisons, and should not be used. Acetic 
acid, when taken in the form of vinegar, is well known 
to cause a great decrease in size in fat persons, but in 
doing so it is likely to deteriorate the blood to a serious 
degree. 

Quite lately a species of sea-weed known as th^fucus 
vesciculosus has been highly recommended for the pur- 
pose of decreasing corpulence. It probably contains, 
in common with other sea- weeds, iodine in large pro- 
portion. 



TEEATMENT OF ABOETION. 159 

There is a condition of general anasm^ca which is 
often mistaken for plethora or adiposis, but may be dis- 
tinguished by a careful examination. It may be allied 
to that condition known as leucocythsemia. This con- 
dition calls for such remedies as potass, tart, etferrum, j\ 
in grain doses, aided by apis mel., apocynum cann.j 
eupatoriwn pur.^ cliina^ and helonias. 

Aricemia^ or Chlorosis. — These conditions should not 
be considered identical. The former generally proceeds 
from direct loss of blood, of or some of the vital fluids 
formed from the blood, to such an extent as to diminish 
the amount of the circulating fluid. The latter is 
generally a condition in which the quality of the blood 
is deteriorated, and is caused by deficient assimilation 
or depraved nutrition. The origin of the malady may 
exist in the digestive organs or nervous system. 

It is therefore evident that the same treatment is not 
appropriate for both conditions. It has been, and still 
is to a certain extent, the opprobrium of the old school 
of medicine, that they prescribe ferruginous remedies 
indiscriminately in both diseases. The result is that 
only a portion of those who are thus treated are bene- 
fitted by the medicines used. 

In uncomplicated anoemia iron is rarely indicated. 
It is only when the deficiency of blood is attended with 
a lack of certain vital constituents that this mineral 
should be used. For true anaemia the appropriate 
remedies are cJiina^ helonias^ aletris^ Jiydrastis. If 
chlorotic symptoms are associated with the ansemia, 
then it will be found beneficial to alternate with one of 
the above, ferrum met. or some of its preparations — I 
usually prefer the pyrophosphate of iron — or we may 
use such compound preparations as have been sanc- 
tioned by experience, whose constituents we find to be, 



160 HALE ON ABOETION. 

by their pafhogeneses, indicated in the case. Of this 
class of medicines, the citrates of iron and quinia^ 
elixir of harlc and iron^ and some others, may be given 
with the best results. In true clilorosis, the most 
useful remedies are those which directly modify the 
digestive and nutritive functions, and increase the tone 
of the nervous system. 

The medicines may be divided into three classes : 
(a) Ferrum met,^ or some one of its various prepara 
tions. It has been observed by nearly all practical 
physicians that iron^ in its pure state, while it would 
restore some cases in a very short time, failed to 
improve the condition of others. But when used com- 
bined with some acid (as the ^hos'phoric) or an alkali 
(as, potasli)^ it would act as a prompt remedial agent. 
The reason of this can best be understood by the 
Homceopathist, who finds that cases not amenable to 
iron alone, but which improved under i^^on srndi plios- 
pJioric acid (£l^ phosphate of iron), presented symptoms 
which were not covered by the pathogenesis of either 
remedy singly, but by both completely. It is possible, 
even probable, that the alternation of the two medi- 
cines would effect the same curative result ; but if, 
when given in combination, they cure promptly, we 
should not object to the form of administration. 

Q)) Phosphoric^ Nitric^ or Mwiatic Acids. — Of these 
the phosphoric acid stands the highest in the estimation 
of the new school, probably because of its intimate 
relation to the nervous system. Here again, as with 
ferrum met., we meet with cases wherein the acids alone 
will fail to effect a cure, but if we associate with the 
acid indicated, an alkali, or some other remedy which is 
also indicated, we speedily remove the disease. As 
examples of this rule, we often treat cases for which 



TREATMENT OF ABOETION. 161 

pJiosplioric acid and calcarea are tjbe appropriate reme- 
dies. In such instances it does not matter whether we 
give \}i\Q ])liospliate or the liypopJiosphite of lime^ a cura- 
tive result follows, because a diseased organism will 
appropriate to itself the proper curative agents, no 
matter in what form or chemical combination it is 
administered. I have found the hali liypoplios.^ manga- 
num Jiypophos.^ and natrum hypophos.., to be very useful 
in certain cases of chlorosis. Natrum muriaticum is an 
excellent remedy in this condition. Allopathic autho- 
rities speak of it as a powerful haematogen, in some 
cases nearly equal to iron. 

(6) Nux vomica^ Igyiatia^ Strychnia. — When chlo- 
rosis depends upon spinal exhaustion, or a want of tone 
in the nervous system, then this class of remedies are 
the only ones which will effect satisfactory improve- 
ment. Dr. Muller* reports many cases of chlorosis 
cured with ignatia^ when all other means had failed. 
The citrate of iron and stryclmia., or strychnia alone, 
has been found very effectual for the cure of chlorosis. 
The former preparation is a favorite one with me. In 
many cases of chorea, hysteria, and chlorosis, dependent 
upon spinal exhaustion, it has effected in my hands the 
most rapid and surprising cures. 

Jahrf gives a long list of medicines indicated in 
chlorosis, of which the following are the most useful : 
Calcarea., cocculus., ferrum, nitric acid, conium^, pulsa- 
tilla.1 sulphur., china., platina., sepia and sulphur, to 
which I will add manganese, helonias, cimicifuga, sene- 
cio gracilis and aletris. 

In that analogous disorder known as leucocythemia, 
a somewhat different class of remedies are indicated, 

* North American Journal of Homoeopathy, vol. vi. p. 166. 
f Diseases of Women. 
11 



162 HALE ON ABOETION. 

namely, ferrum iodatum^ ferrura arseniosum, and Jielo- 
nias dioica (also plumhicm) . 

I hardly need add, that appropriate food, proper 
exercise, bathing, pure air, and healthful surroundings, 
together with the removal of all known causes of the 
complaint, whether mental or physical, are as import- 
ant as the most carefully selected medicinal agents. 

The Scrofulous Diathesis. — In those cases where we 
are convinced that the local disorders which threaten 
the life of the foetus, or tend to arrest the progress of 
gestation, are due to scrofulosis, we must combat the 
diathesis with remedies adapted to each case, and at 
the same time prescribe such palliative remedies or 
topical applications as are indicated. A careful study 
of Hahnemann's chronic diseases is essential to the 
proper treatment of these cases. The remedies which 
are evidently appropriate, are those whose local effects 
upon the uterus, as well as their general symptoms, cor- 
respond most to the cases under treatment. The most 
prominent of these are the well-known anti-psorics — 
Arse7iicum^ calcarea^ coriium^ hepar sulph., iodine, ly co- 
podium, mercmmis, silicea, sulphur, to which may be 
added other medicines equally efficient but less used — 
Aurum mur., bromine, cistus canad., graphites, Jcreo- 
sote, lachesis, sepia; or, hromide of potash, bromide of 
iron, iodide of potash, iodide of ii^on, iodide of arsenic, 
iodide of sulphur, iodide of mercu/ry, chloride of plati- 
num, oleunn jecoris aselli, chimaphilla, iris versicolor, 
Phytolacca, rumex crispus, stillingia sylvatica. 

Return of Menstrual Crisis. — When, from previous 
habitual dysmenoiThcea, menorrhagia, or any undue 
tendency of blood to the uterus, or from any weakness 
or irritability of that organ, the menstrual nidus 
threatens to be so great as to threaten the continuance 



TEEATMENT OF ABOETION. 163 

of pregnancy, such remedies should be selected as seem 
appropriate to each particular case, and should be ad- 
ministered during the m^^-menstrual as well as the 
menstrual period. The medicines which will be most 
generally useful are — Aletris farinosa^ asclej>ias syriaca^ 
belladonna, cimicifuga^ caulophyllum, calcarea, gos- 
sipium, helonias, ignatia, platinum, Pulsatilla, sanguin- 
aria, secale, sahina, sepia, trillvum, senecio gracilis, 
tanacetum ,' or some one of the medicines mentioned 
as being capable of causing abortion. 

But medicines alone are not caj)able of preventing 
the unnatural return of the menstrual nidus, unless we 
direct the woman to avoid undue exercise or warm 
baths, stimulant articles of food or beverages, coition, 
or any mental emotion of an unusual character, also 
any other influence which the physician with his know- 
ledge of the idiosyncrases of his patient, shall consider 
inappropriate to her condition. 

Zymotic Diseases. — In a work of this character and 
scope, the particular treatment of this class of maladies 
cannot be entered into. A mere mention is all that 
can be given to each disease. 

(a) Syphilis. — For the speciflc treatment of this dis- 
order the reader is referred to those works which treat 
of venereal affections, among which may be mentioned 
" Gollmann on Diseases of Sexual, Organs," " Yeldham 
on Venereal Diseases," together with, the papers on 
that subject to be found in our journals^ etc. The best 
works of the dominant school may be consulted, the 
most scientific and rational of which is " Bumstead on 
Venereal." 

There are certain remedies, however, which are not 
mentioned by any of the above authorities, but which 
have been found useful in the treatment of syphilis: 
they are, 



164 HALE ON ABOETION". 

Corydcdis foimiosa^ chloride of platina^ iris versi- 
color^ pJiytolaoca dec.^ and styllingia syl. In my own 
practice these last-mentioned medicines liave been pre- 
scribed with signal advantage, when the preparations 
of mercmy, so much relied upon, were useless or nearly 
so. In addition to the above the hiniodide of mercury 
and iodide of potash have been the most effectual prepa- 
rations, which I have used in the treatment of syphilis. 

(5) Mercurialization. — In the treatment of this form 
of drug poisoning, we must bring to bear upon the 
organism two forces : namely, the chemical and dy- 
namic. These may be used singly or combined. It is 
well known to scientific medical men, that iodide of 
potassium actually enters into chemical combination 
with mercury, in the body- — holds it in solution, — in 
which state it is carried out of the system through the 
various emunctories. For such purpose — it is needless 
to add — the drug must be administered in naaterial 
quantities, or we shall fail to get any but its dynamic 
effects, which alone are not sufficient to eradicate the 
malady. Chlorate of potash and hepar sulphuris have 
a somewhat similar effect, but not to the same degree. 
If we wish to obtain a dynamic antidotal effect, or to 
remove certain local affections caused by mercury, we 
shall find most useful the remedies mentioned above, also, 
aurum met., and mwiaticum, platinum chlor. phyto- 
laca, podophyllum, nitric acid, iodine, mezereum, sulphur, 
.styllingia, iris versicolor la^hesis. 

In some instances it would be well to advise the pa- 
tient to drink certain mineral waters, etc., abounding 
in sulphur, iodine, and other well-known antidotes to 
j:he effects of mercury. 

(p) Va/riola. — The therapeutics of small-pox are so 



TEEATMENT OF ABORTION. 165 

well set forth in our standard works on Practice,* that 
no extended treatment will be given here. 

My colleagues, with whom I have compared notes rela- 
tive to the treatment of this disease, give, as the results 
of their experience, that aconite^ gelseminum^ or cimici- 
fuga^^ are the most valuable in the first stage of the 
malady; and in the second, tartar emetio or vo/riolin. 

My experience in small -pox has been limited. Two 
of my cases, however, were of the most severe character, 
(confluent) occurred in pregnant women, but they made 
a good recovery without any threatening of abortion. 
They were treated with aconite, helladonna, varioUn and 
tartar emetic. 

It is my impression that when abortions are reported 
to have occurred during an attack of variola, it is as 
often due to the harsh medication, as to the disease. 
At the same time it cannot be doubted that appro- 
priate remedies may, by mitigating -the violence of the 
attack, prevent the occurrence of miscarriage. Of these 
remedies none promise to be more efficient than cimici- 
fuga (or cimicifugin^ Having a specific influence over 
the uterine-motor functions, it prevents the access of 
spasmodic or irritable conditions, which might other- 
wise obtain. 

In relation to the extraordinary claims set forth for 
thuja, no positive testimony has ever aj)peared wliich 
in the least substantiated those claims. Those who are 
practically acquainted with the progress of a varioloid/, 
know very well that at a certain period of the dise.ase, 
the eruption, which appeared to be ripening, all at once 
is arrested, as it would seem from some powerful influ- 
ence. The pustules suddenly "abort," a rapid recovery 
ensues and no pitting occurs. This peculiar crisis never 

* Marcy and Hunt's Practice. f New Provings, page 106. 



166 HALE ON ABOETION. 

occurs in variola^ — i. e., in persons who liave never been 
vaccinated. Now, in those cases in which thuja^ 400th, 
is alleged to have been given with such splendid results, 
no mention is made whether they were variola or vario- 
loid. This omission makes the testimony very unsatis- 
factory, if not entirely unreliable. 

The same objections would hold good against the 
claims of the new remedy, sarracenia^ were it not for 
the fact that this has been extensively tested in cases 
which were undoubtedly true variola. Sarracenia is 
strongly opposed by those who are sceptical of its 
powers. Since the publication of the first article treat- 
ing of that plant,* in our literature, the testimony which 
has appeared, from public and private sources, relative 
to its prompt efficacy in arresting the course of the 
worst forms of variola, would place it at the head of all 
known remedies for that virulent malady. 

Br. Wilkinson, of England, in a recent work,f sets 
up extraordinary claims for the curative virtues of 
veratrum viride and liydrastis in this disease; but the 
same objections may be properly urged against the 
alleged value of those medicines. In the first, or febrile 
stage, the veratrum v. will undoubtedly alleviate the 
intense orgasm of the circulation, and in that way 
might prevent abortion. I do not think the claims set 
up for the hydn^astis will ever be substantiated by posi- 
tive experience. J 

{cT) Scarlatina. — No physician who has witnessed cases 
of malignant, or even severe scarlatina, can doubt its 
influence for evil over the pregnant uterus and its con- 
tents. Although the cases are rare where scarlatina 
maligna occurs as late in life as the usual child-bearing 

* " New Provings," page 384. 

\ " Small-pox — its preventive treatment," etc. London. 

X Medical Investigatof, January, 1865. 



TREATMENT OF ABORTION. 16? 

period, yet instances have occurred of abortion from 
that cause. When this result is to be feared, the most 
useful remedies are evidently helladonna^ apis ineUifica^ 
haptisia^ and terehintliina. 

Several eminent physicians, among them Dr. Nanki- 
vel, of Penzance, and Dr. Blair, of this country, strongly 
recommend the apis mel. as a valuable remedy in ma- 
lignant, as well as simple scarlatina. These recom- 
mendations are based upon successful clinical experience 
with this remedy. By reference to a former page it will 
be seen that apis has been alleged to cause abortion. 
This, together with its well-known action upon the 
kidneys, uterus, ovaries, etc., should commend it to us 
as an important remedial agent in cases of scarlatina 
where abortion threatens. 

Belladonna^ when the abortion threatens from arte- 
rial congestion, or spinal paralysis ; apis^ when the 
phlegmonous inflammation extends to the uterus, and 
the nervous centres are irritated ; haptisia^ when a pro- 
found typhoid and septic condition threatens; and 
turpentine, when the intestinal or urinary tract is the 
chief seat of the excessive irritation. Other analogous 
remedies — as cimicifuga, sabina, caulophyllum or gel- 
serninum may be made use of, as auxiliary remedial 
agents. 

In this disease, as in all others, of which mention will 
be made, while we should select the remedy in accord- 
ance with the law of similia, namely, — to correspond 
with all the symptoms and conditions of the patient, — 
we may select as an alternate remedy, another medicine 
which has a special affinity for the uterus, or, rather, 
has some decided influence in the production of abor- 
tion, while it is not Homoeopathic to the ensemble of the 
disease under treatment. 



168 HALE ON ABOETION. 

Diplitlieria. — The treatment of this malady* lias been 
so fully set forth in the excellent lectures and mono- 
graphsf of my western colleagues, that I will only add 
thereto such practical suggestions as are the results of 
my own experience. 

The internal or constitutional remedies upon which 
I place most reliance are haptisia^ 7)iercwius^ hijodatus^ 
Phytolacca^ and hall hiclwomatum. 

The topical remedies (which also act upon the gene- 
ral system), are clilorate of potash^ liydrastis canadensis^ 
findi per-manganate of potash. I think the latter medi- 
cine was first used in diphtheria by myself. My first 
experience with it was in ulcers of an irritable char- 
acter that had baffled other I'emedies both general and 
local. They healed kindly under a local aj)plication 
of the solution, and a consideration of the constituents 
of the agent led me to use it in diphtheria. I was 
struck with the prompt curative results obtained. No 
medicine with which I am acquainted so soon removes 
the exudation, luhich does not return. In this it has a 
great advantage over all others, for it is well known 
that the pseudo-membrane will return again and again 
under ordinary treatment with the applications in gen- 
eral use. Neither does the exudation extend — at least 
such has been my experience. 

A glance at the chemical character of the remedy 
will explain its curative action. 

" It may be made by mixing equal parts of very 
finely pulverized deutoxide of manganese and chlorate of 
potassa., with rather more than equal parts of caustic 
potassa^X 

* Lectures on Diphtheria, by Professor Ludlam. 
f Treatise on Diphtheria, by Professor Helmuth. 
X Parrish' s Practical Pharmacy, p. 525. 



TEEATMEI^T OF ABOETION. 169 

We note tliat it contains chlcyrine^ wliicli is antagon- 
istic to all zymotic poisons and septic conditions. 
Chlorate of potash and muriatio acid have been found 
the most useful remedies in diphtheria by physicians 
of the new and old schools of medicine. In the Tcali 
per-manganatum we have not only these, but also raan- 
ganese^ which, next to ferrum^ is the most active and 
powerful hsematogen known. Not only this, but it has 
a sustaining and tonic influence on the nervous system 
possessed by but few medicines. The kali per-man- 
ganatvmi acts not only as a disinfectant, and tonic, but 
as a caustic^ and one, too, which causes little or no pain, 
no corrosion nor irritation. It may be applied in two 
ways, namely, (a)*in strong solution with a camel's hair 
brush, and (5) in weak solution as a wash or gargle. 

The maximum strength of the former preparation is 
ten grains to one ounce of distilled or pure rain water ; 
of the latter, one drachm of the strong solution to one 
pint of pure rain water. No alcohol should be brought 
in contact with the drug, as a few drops will precipi- 
tate and render useless a large quantity of the solution. 

The fauces should be thoroughly exposed, and all 
portions invaded by the exudation painted over with 
the strong solution ; this should be done twice or three 
times daily, and the weak solution should be used as a 
gargle every three. or four hours. None need be given 
internally in addition, as a sufficient quantity will get 
into the circulation to have its constitutional effect. It 
must be understood that I consider this medicine to 
act Homoeopathically, but at the same time it may be 
said to act chemically, as will be shown in some future 
essay on this drug.* 

* Two severe cases of diphtheria, treated mainly with the hali per-man- 
ganatum, will illustrate its efficiency : 

{a) A young man who had been ill with fever for ten days; on the third 



170 HALE ON ABORTION. l 

If I have somewliat stepped aside from my strict task, 
namely, the treatment of diphtheria in adult and preg- 
nant women, my only apology is, that those remedies 
which have the greatest mastery over the disease at 
any age, will give iis the greatest aid in the cases under 
consideration. 

If premonitions of abortion appear during the course 
of a diphtheritic attack, we can appropriately alternate 
certain remedies, namely, sahina, caulophyllum, or 
ci'micifuga^ etc., with those which we are using for the 
original malady. The remedies mentioned will not 
retard the cure — in fact may assist our treatment, by 
their specific action upon the diphtheria itself, as well 
as upon the uterus. 

Cholera. — The Homoeopathic treatment of the differ- 
ent varieties of this disease, whether sporadic, as cholera 
morbus ; or epidemic, as cholera Asiatica, will be found 
in the various text-books of our school, but especially 
in that admirable monograph* by a late lamented 
Homceopathician, Dr. B. F. Joslin, sen. 

day I saw Mm ; his fauces covered with a membrane, pearly at the edges, 
yellowish in the centre ; breath very offensive ; much debility ; pains as if 
beaten all over ; prognosis unfavorable. The weak solution was used every 
three hours, and mere. Mjod., 3rd, used alternately. In thirty-six hours all 
the membrane had disappeared ; strength increasing ; breath not offensive ; 
discharged on third day of treatment. 

(6) A child aged five years ; two sisters had died of diphtheria within a 
week ; tonsils coated with false membrane ; breath offensive ; very weak ; 
croupy cough, etc. Used the strong and weak tincture, alternate with 
Phytolacca, 1st. Cured in three days. 

* Epidemic Cholera, 1853. 



TEEATMENT OF ABOETIOJST. l7l 



SECTION II. 

(2) Local oe Oeganic. 

(1) Malformation of the Ovum. 

(2) Malformation of the Memhranes. 

As it is apparent that no remedial measures can pre- 
vent or remove any malformation of tlie ovum* or mem- 
branes, if we liave a suspicion that such an abnormality 
exists, our only method of preventing abortion from 
Such causes, is to prescribe such remedies as will tend 
to prevent the uterus from taking on an irritable con- 
dition, or, if such condition has already obtained, to 
remove it. In this way we may, if it is considered de- 
sirable, conduct the pregnancy to a termination at full 
time. It is doubtful, however, if such a termination 
is to be desired, for there are no dictates of humanity 
which . can make it a moral duty for us to favor the 
birth of a monster, or deformed child, rather than its 
premature expulsion, unless the safety of the mother 
is to be gained by the former result. The medicines 
best adapted to bring about the uterine sedation men- 
tioned above, are belladonna^ atropine, cimicifuga, 
caulophyllum, secale, sabina, tanacetum, etc. 

Placental abnormalities. — (a) Mal-location of placenta 
(placenta previa), (5) detachment of placenta. Obvi- 
ously, no remedy can prevent the placenta from locat- 

* Croserio {vide Obstetrics) intimates that the administration, to the mother, 
of such remedies as sulphur, culcarea, and other anti-psorics, in the 30th 
dilution, will remove diseased conditions of the oyum. (!) 



172 HALE OlS" ABOETION. 

* 

ing over the os uteri, or any otlier portion of tlie 
surface of the uterus. But there are remedies which, 
after the mal-location has resulted in conditions and 
symptoms which tend to bring about an abortion, may 
so modify the condition, and hold the symptoms in 
abeyance, as to conduct the pregnancy to a favorable 
issue for both mother and child. If, when detachment 
occurs as the result of, or from falls, blows, or instru- 
mental interference, haemorrhage occurs, the patient is 
confined to her bed, kept cool and perfectly quiet, and 
such medicines administered as arnica^ hamamehis^ 
Jiypericum^ ruta^ etc., or any other remedy which seems 
specially Homoeopathic to the symptoms, we may be 
gratified by seeing the haemorrhage arrested, and with 
it the pain and other symptoms subside, and the patient 
ultimately recover. But such a favorable result is not 
usual. Generally, with the haemorrhage, other symp- 
toms, as chills, labor-like pains, etc., appear, which indi- 
cate that the blood is separating the membranes from 
the uterine walls. After this occurs, no remedial agent 
can arrest the abortion. Our sole effort should be to 
conduct it to a safe termination. 

In cases of jylacenta previa^ frequent haemorrhages 
may occur, as the uterus expands and enlarges. These 
haemorrhages will often subside spontaneously, at other 
times the loss of blood goes on until checked by appro- 
priate remedies. In this form of haemorrhage the blood 
escapes directly into the vagina, and does not permeate 
between the membranes and the uterus, hence the dan- 
ger of an abortion is not as great. 

The most efficient remedies to arrest the bleeding 
are efi'igeron^ ereclithites^ mmica^ hamamelis^ aconite^ mil- 
lefolium, secede^ sulpli. acid^ t/t'illimn^ etc., administered 
internally. Topically, we may use with advantage 



TEEATMENT OF ABOETION. l73 

pieces of lint or cotton saturated witli a solution of any 
of the above remedies, especially erigeron^ hcmiamelis^ 
and arnica. Cold water will sometimes arrest the 
bleeding, when applied to the os uteri. Care should 
be taken not to use too much lint, as it might act as a 
tampon, and cause the blood to' collect and flow back, 
separating the membrane in the process, thus causing 
the very accident we are trying to avoid. We should 
also be careful not to irritate the vagina by unneces- 
sary or harsh inanual efforts, or we may set up sufficient 
reflex action to excite uterine contractions. The ex- 
ternal application of cold water to the abdomen should 
be avoided, as it tends to the same result. 

OEGANIC DISEASE OF PLACENTA. 

(a) Fatty Degeneration, (b) Calcareous Degeneration. 
(<?) Hydatid Degeneration, (d) Molar Degeneration. 

In the present state of our therapeutical knowledge, 
we know of no remedy or remedies which could prevent 
the occurrence of the above organic changes. These 
diseases of the placenta probably have their origin in 
some djT-scrasia pervading the blood of the mother. 
This dyscrasia is generally the psoric or the syphilitic. 

The science of diagnostics has not reached that point 
where we can decide if either of the above changes have 
taken place in the placenta. It is true we may safely 
predict the existence of a hydatid mass in the uterus, 
if individual hydatid vesicles have been discharged 
per vaginum; but we cannot safely give an opinion as 
to the existence of a mole, until the uterus has expelled 
it. If a woman has had conceptions which have re- 
sulted in such organic diseases, as was proved by the 
expulsion of the degenerated mass, we may fear the 



174 HALE o:N" ABOETION-. 

occurrence of similar changes in the placenta, as a re- 
sult of subsequent conceptions, especially if the symp- 
toms of the pregnancy are peculiar and unnatural. 

The treatment of organic diseases of the placenta ; or 
rather the 'preventive treatment of abortion from such 
causes, is manifestly obscure. 

Dr. Tyler Smith says — " When the foetus is threat- 
ened with death because the placenta cannot perform 
its nutritive and respiratory functions, we may, through 
the mother, act upon the placenta, and assist in the 
performance of its functions.""^ Dr. Power prescribed 
the inhalation of air containing an increased quantity 
of oxygen^ or the use of medicines containing a large 
proportion of oxygen in a loose state of combination, as 
nitric acid^ in cases where the child has been lost re- 
peatedly in the latter months of pregnancy. Dr. Simp- 
son states that he has found chlorate of potash useful in 
cases where the foetal respiration is imperfect. " In the 
prevention of abortion from fatty degeneration of the 
placenta," Dr. Smith says,f "the strength of the mother 
should be supported in every way. The chlorate of 
potash^ nitric acid, mild preparations oiiron, and, above 
all, fresh air, should be recommended. The treatment 
of fatty placenta should be the same as fatty heart, or 
fatty degeneration of any other organ." 

The Homceopatlvic treatment of fatty or calcareous 
degeneration is yet uncertain. We know of no medi- 
cines which cause these organic changes. 

If we suppose, from the patient's previous history, 
and the present symptoms, that the placenta is under- 
going degeneration, we may administer medicines for 
the purpose of acting through the maternal circulation 
upon the diseased organ. 

* Lecture3 on Obstetrics, page 201. f Ibid. 



TEEATMENT 01' ABOETION. 175 

The anti-psorics may be consulted, for in tliat class 
we sliall be most likely to find the appropriate remedy. 

For fatty degeneration, such remedies as ha/i^yta car- 
honica, thuja, hali hromatuin or nitric acid, may be 
used. 

For calcareous degeneration, we can suggest no spe- 
cific remedy; nor for the hydatid or molar; the general 
symptoms of the patient must be our guide in the selec- 
tion of the medicines. 

If we become satisfied that these organic changes 
have taken place, it seems evident to me that our duty 
should be to rid the woman of them as soon as possible. 
To this end, we may separate the degenerated mass 
from the uterine walls by the careful use of the sound 
or flexible catheter, or by the injection of tepid water ; 
and in case of hydatids we may break down the accu- 
mulation and separate the mass from the uterus by the 
same means. Dr. Bedford relates the case of a woman 
in extreme danger from loss of blood, in which he suc- 
cessfully broke down the hydatids with a female cath- 
eter. Dr. Tyler Smith says the hydatids are sometimes 
expelled with difficulty, and he once saw a case in which 
the uterus had been ruptured by the violence of its 
contractions in expelling an hydatid mole. 

Several cases of hydatids successfully treated have 
appeared in our periodicals ; one by Dr. Comstock,* 
and another by the writer.f 

The after treatment is the same as in cases of actual 
foetal abortion. 

* Medical Investigator, vol. ii., p. 10. 

f American Magazine of Homoeopathy, vol. 1. 



176 HALE ON ABOETIOIT. 



SECTION III. 

Keflex (exciting). 

1. Centkic. 

(a) Emotions of Fright^ Anger, Grief, etc. 

We find in our repertories the following remedies 
recommended for tlie consequences of tlie above men- 
tioned emotions. I have placed those in italics which 
are most likely to be useful in abortion excited by such 
causes. 

Angee. — Aconite, bryonia, cTiamomilla, colocynth, 
nux vomica, platina, staphisagria. 

Feight. — Aconite, helladonna, gelseminum, hyoscia- 
mus, ignatict, lacJiesis, opium, pulsatilla, sambucus, vera- 
trum. 

Geief. — Ignatia, phosphoric acid, hellebore. 

Joy. — Coffee, Scutellaria, cannabis indica. 

Most of the above medicines are recommended 
from general indications, and no true Homoeopath- 
ician would prescribe any one of them unless the gene- 
ral symptoms corresponded with those present in the 
attack. If any other medicine in our extensive Materia 
Medica seems particularly indicated, no attention 
should be paid to the emotional cause, which should 
not be deemed important except in the absence of 
characteristic symptoms. 

A case in which this latter condition obtained, once 



TREATMENT OF ABOETION. 177 

came under my care. In tlie absence of any guiding 
symptom of importance, j9A(98/:>A6>r2'(? acid and ignatia 
were prescribed and prevented tlie abortion. Disap- 
pointed love was the cause of the threatening symptom. 

(J) Direct hloios upon the brain or spinal cord. 

The remedies most appropriate to meet the effects of 
concussion of. nerve substance, are arnica, coniuni, cimL 
cifuga, cicuta, gelseminum, liypericmn, unercury, mix 
vomica, opium, quinine, rJius tox, and sidpliuric acid. 

It is needless to give the special indications for each 
of the above remedies. The specific curative power of 
arnica is well known to all practical physicians ; it 
should be used freely externally upon the portion 
which has received the injury, and at the same time 
administered internally; conium is indicated more par- 
ticularly for the chronic effects of concussion. Oimi- 
cifuga will often be found very useful, especially after 
concussions, when, with the uterine pain, severe cepha- 
lagia is present (also quinine). Gelseminum is often 
useful when a condition of general paralysis of the 
voluntary muscles, with loss of sense, and blindness 
occurs. 

Hypericum is said by some physicians, who have 
tested its virtues, to be more useful in injuries to nerv- 
ous tissues than any other medicine. 

Ignatia and nux vomica when tetanic symptoms are 
feared. 

Opium, when we find sopor, or coma, and symptoms 
similar to apoplexy. 

Sulphuric acid, when the |only^notable~symptom is 
sudden and excessive uterine haemorrhage. 

12 



178 HALE ON ABORTION. 

(c) Medicinal^ namely — Quinine, JVux vomica, Gel- 
semhium, Cimicifuga, Secale, Apis (f) and others. 

If we know, or liave reason to suspect, tliat the im- 
pending abortion we are called wpon to avert has been 
excited by any of the above medicines which act 
through the nervous centres, we must, if called in sea- 
son, attempt to empty the stomach of the poison. If it 
has already entered the circulation, we must use those 
general and special antidotes which are at our com- 
mand. 

The best known antidotes against the immediate 
effects of quinine are — Morphine, arnica, cimicifuga, 
ipecac, pulsatilla, and veratrum viride. 

Nux vomica (^Strychnia). — Administer gelsem,inum 
in appreciable doses, and place the patient under the 
anaesthetic influence of chloroform until the spasmodic 
(tetanic) symptoms cease. 

Gelseminum. — Give stimulants, brandy, whiskey, and 
ammonia, with nux vomica, or arnica. 

Cimicifuga. — The antidotes of the hlach cohosh are 
atropine, opium, and secale, in minute quantities. 

Secale. — For the effects of ergot on the uterus, I have 
found caulophyllin and atropine excellent antidotes. 

Apis mel. — Ammonia, in stimulant doses, is the best 
medicine to ward of the bad effects of the bee-poison 
upon the nervous centres. 

II. CoisrcENTEic. 

(a) Parotidean Irritation. 

By referring to a former page of this work, it will 
be seen that in one case at least parotitis was a cause 
of abortion. To prevent such a result from metastasis 
of mumps, we should prescribe about the same remedies 



TEEATMENT OF ABOETIOIS". 1T9 

as in case of threatened ovaritis or orchitis from the 
same disease, namely, apis mel., belladonna, 'pulsatUla^ 
or mercury. The two in Italics are probably the most 
useful, and would be indicated in the metastasis re- 
ferred to. 

Q)) Thyroidal. — If the reflex irritation which has 
located in this gland has been diverted from it to the 
uterus, directly or through the mammae or ovaries, the 
remedies to be mentioned hereafter will be indicated. 
The treatment of goitre with external applications of 
iodine., mere. hinAod.. or hromine., should be suspended 
during pregnancy, and small doses of these remedies 
used instead. These minute doses, while they do not 
divert the irritation, act as a sedative or palliative to 
it, and really prevent such irritation from impinging 
upon the uterus. If uterine pain, etc., has already set 
in, we must select the remedy in accordance with the 
general principles of our school of medicine. This 
latter observation will apply to all the following causes, 
and need not be hereafter repeated. 

(c) Mammary. — If abortion or premature labor 
threatens from prolonged lactation, the child should be 
immediately taken from the breast, and lotions of bella- 
donna^ aconite^ or camphor^ applied to the glands, to 
arrest the secretion of milk and subdue the existing 
irritation. If the cause be mammary abscess, the same 
lotions should be applied, also phytolacca^ which is an 
admirable remedy in this affection. At the same time 
belladonna., apis, phosphorus., or phytolacca., should be 
administered internally. If these agents do not bring 
about speedy resolution, and suppuration is inevitable, 
place the patient (if she is nervous and sensitive) under 
the influence of chloroform, and open the abscess, after 
which apply soothing applications, such as calendula^ or 



180 HALE ON ABORTIOIT. 

poppy leaves^ or lotions of aconite^ calendula^ or liamO' 
melis. Tlie pathogenesis of cimicifuga seems to inti- 
mate that it may be useful in abortion from mammary 
irritation. 

Scanzoni causes premature labor by applying dry 
cups to the mammae. Dr. Bedford admits that abor- 
tion may be caused by irritating these glands ; yet we 
are told by some late medical writers that habitual 
abortion or sterility may be prevented by applying a 
child to the breast during the period when the usual 
menstrual crisis returns ! 

We are even advised by certain obstetric authorities 
to apply the child early to the breast, in order to avert 
a metritis, uterine congestion after confinement, or 
puerperal fever. 

It would seem by the above that mammary irritation 
acts both as a cause and as a preventive of abortion and 
uterine irritation. 

Would it not be proper and useful then, in cases of 
threatened miscarriage, to apply mildly irritating sub- 
stances to the mammae ? Weak sinapisms of unustard^ 
capsicum, or arnica, a dry cup to each breast, or even 
a warm emollient poultice, might divert the irritation 
from the uterus to these organs, and thus avert the loss 
of the embryo, or a premature labor. 

(d) Dental. — If we have to treat a merely functional 
disorder of the trifacial nerves, or any nerve branches 
which supply the teeth, the remedies will be mainly, 
aconite, helladonna, atropine, cJiina, quinia, valeriomate 
of zhiG, GOGcionella, gelseminum, arsenicum, spigelia, and 
Pulsatilla. 

If the affection is organic, namely, carious teeth, the 
remedies most likely to palliate the pain and reflex 
irritation, when given internally are mercurius, nit/ric 



TREATMENT OF ABOETIOJST. 181 

acid, antimony^ Tcali liyd.^ ^lios]}horu8^ manganese^ or 
those above mentioned. 

The repertories decree that for " odontalgia" in preg- 
nant women, we should give helladonna^ calcarea^ man- 
ganese^ nux moschata^ nux vomica, pidsatiUa, se/pia, etc. 

We are cautioned against the extraction of carious 
teeth during pregnancy. But in many cases the irri- 
tation caused is so intense, and so intractable to medi- 
cinal treatment, that it is better to risk the operation. 
By the aid of chloroform, however, we can generally 
extract the tooth and avoid the risk of abortion from 
the irritation attendant on the operation. If it should 
be objected to, or feared, we may resort to topical, 
palliative measures, such as cotton wet with aconite, 
gelseminum, or opium, and applied to the exposed 
nerve ; or we may use Icreosote in the same manner. I 
have often used with permanent benefit a plugging 
composed of aconite, chloroform, and copal, which 
formed a solid, imj)ervious, and lasting compound.* 

The usual operation of filling, plugging, etc, of the 
dentist, need not be deferred, unless we have special 
reasons for so doing. 

Odontalgia is often accompanied by inflammation of 
the buccal cavjty, stomatitis, gingivitis, and other 
diseases of the mouth, nearly all of which will subside 
under the specific curative action of clilorate of potash, 
used in the form of a lotion.f 

Ulcerative affections of the teeth demand the same 
remedies advised for pain in carious teeth, and in addi- 
tion, hepan" sulph. and phytolacca. It is better to ex- 
tract the tooth than to allow the abscess, if deep, to go 

* 5 Aconite tincture, 3j f ? Chlorate of potash, grs. x. 

Chloroform, 3j Water, §4 

Gum copal, grs. x. 



182 HALE ON ABOETION. 

on to suppuration with the intense suffering wMcli some- 
times accompanies it. 

(e) Gastric. — The variety of gastric irritation which 
usually causes abortion, is obstinate and excessive vom- 
iting. This may begin at or before the sixth week, 
and continue until the period of confinement. It is not 
only often obstinate, but intense and painful, and even 
accompanied with severe gastric irritation, simulating 
acute gastritis, or ulceration. I have seen patients, 
victims to this disorder, who became debilitated and 
emaciated to the last degree from the inability to retain 
the least food or beverage upon the stomach. The 
vomiting, in such cases, was accompanied by the most 
distressing pyrosis, burning pain in the stomach, and 
spasmodic, empty retching, or with the ejection of 
bloody, grumous matters, and even pure blood. But 
it is a strange fact, that even in these cases of extreme 
severity, pregnancy will sometimes go on uninfluenced, 
and confinement occur at its proper period. In other 
instances, however, less severe, and even quite mild, 
abortion will occur, apparently from no other cause 
than the efforts at vomiting. 

Tyler Smith says — " Women who have undertaken 
sea- voyages during pregnancy, have died from the com- 
bined effects of sea-sickness and the vomiting of preg- 
nancy. '''" * In the worst cases, women who are not 
relieved, or who do not abort, perish slowly from starv- 
ation, or they die from the rupture of a blood-vessel, 
convulsions, or exhaustion, after violent and continued 
fits of vomiting." It is in these severe cases that it is 
proper and humane to arrest the suffering of the patient 
by inducing an abortion by artificial means ; but of this 
we shall speak further on. 

This affection, which, at first sympathetic, or reflex, 



TEEATMENT OF ABORTION. 183 

often becomes a local disease, is quite amenable to 
Homoeopathic treatment. In the simplest form, namely : 
morning vomiting — a dose of nux vomica or podopJiyl- 
lumj in the evening, with ipecac or cimicifuga in the 
morning before rising, will often palliate, if not cor- 
rect the symptoms. When the vomiting occurs after 
meals, and the food is ejected, — pulsatilla, nux vomica^ 
iris V. or ferrwm. If the vomiting occurs at all pe- 
riods, and is aroused by the least food and drink — 
arsenicum^ euphorhia cor.^ veratrum alh.^ or viride, hreo- 
sote^ sanguinaria and oxalate of cerium are useful. Of 
these, c(/rsenicum and sanguinaria are indicated, if there is 
great thirst and burning pain in the stomach, vomiting 
of bloody mucus, etc. ; veratrum and arsenicum^ if the 
prostration is excessive : hreosote has been found almost 
specific, by the old school, in many severe cases — in 
minute doses, it has been found useful by physicians of 
the Homoeopathic school. The oxalate of cerium^ first 
recommended by Professor Simpson, I have prescribed 
with great benefit in the first decimal trituration in 
some very severe and obstinate cases. 

Other remedies have occasionally been used with suc- 
cess when ordinary remedies fail. Among them are — 
tincture of aconite^ in drop doses ; colomho and ivild 
cherry^ in infusion ; chloroform^ five or ten drops in a 
spoonful of mucilage ; nitrate of bismuth^ when the 
acidity and epigastric pressure is excessive ; salicine^ 
helonias and nitric acid^ " if the stomach be in an atonic 
condition." 

(/) Rectal. — The rectal causes of abortion — namely, 
dysentery, haemorrhoids, etc., have been described. 

The remedies which have been found most useful in 
dysentery are — aloes^ aconite, haptisia^ colocynth, ipecac^ 
iris versicolor, mercurius^ nux vomica, podopliyllurn. 



184 HALE ON ABOETIOIir. 

Those in Italics would be most applicable in cases 
when abortion was threatening, in consequence of the 
sympathetic or reflex irritation. If no one of the above 
remedies covered the ensemble of the symptoms, some 
other remedy not capable of causing dysentery may be 
alternated with the one selected out of the above list. 
Thus, aconite and caulophyllum^ or colocynth and aletris 
could be alternated. The symptoms of sahina^ however, 
cover nearly the whole ground, for that medicine not 
only causes abortion, with inflammation of the urinary 
organs, but. it has enteritis and dysentery, bloody stools, 
etc., among its pathogenetic effects. Asarum euro- 
pemn^ which causes abortion, has been found very use- 
ful in acute dysentery. The same is true of turpentine. 
These last remedies should not be forgotten when we 
are called to treat this disease in pregnant women. 

The topical treatment of dysentery during pregnancy 
should not be omitted. By applying some medicine 
locally to the rectum, and causing a sedation of its 
nerves, we shall also calm the irritated nerves of the 
uterus. The remedies best calculated to subserve this 
end are — aconite^ gelseminum^ hamamelis^ opiuin, mor- 
pJiine^ atropin. These medicines may be added to 
mucilaginous preparations, starch-water or pure water, 
in proper proportions,'"^ and thrown into the rectum, 
where it should remain. I am confident that I have in 
one instance prevented abortion by the use of an enema 
of ten drops of gelseminum to one ounce of starch-water ; 
and in another prevented a premature labor by the use of 
half a grain of crude tnorpliine in two ounces of pure 
water. In each case the severe labor-like pains ceased in 

* Aconite, Gelseminum, _o_, 10 drops to one ounce of water. 
Opium Tine, _o_ (Laudanum) 20 drops to one ounce of water. 
Hamamelis, _o_, 1 drachm to one ounce of water. 
Morphine, 1-lOth, Atropin, 2d, two or three grains to one ounce. 



TEEATMEISTT OF ABOETION. 185 

half an liour after tlie enema was given. In some cases 
a suppository of one grain of pure opmm, introduced 
into the rectum, will have a prompt effect in calming 
the tenesmus and labor-like pains. 

In case the uterine irritation proceed from hemor- 
rJioidal inflammation, the following remedies will be 
found applicable : 

Aconite^ aloes^ belladonna, cesculus Jiijp., coUinsonia, 
Jiamamelis, iris versicolor, mercurius, nitric acid, nux 
vomica, podophyllum, sulphur, turpentine. 

In this disease, as in dysentery, local applications 
should not be neglected. Lotions or cerates* of atro- 
pine, hamamelis, or opium, may be applied to the in- 
flamed and protruded tumors, and the patient advised 
to assume and maintain the recumbent position, until 
the local and reflex irritation has subsided. 

Fissure of the anus, one of the most painful and in- 
tractable local affections with which we have to deal, 
has been known to cause abortion. The reflex disturb- 
ance which this apparently insignificant lesion can pro- 
duce, is quite astonishing. The remedies Homoeopathic 
to this, are ignatia, nit/i^ic acid, plumbum, arsenicum, 
sulphur, etc. The most notable cures have been made 
with nitric acid, 30th, and ignatia, 30th. I have, how- 
ever, cured two severe cases — one in a pregnant woman, 
with nit/ric acid and ignatia (at the 3rd dilution). An 
enema of nitric acid was used at the same time with 
the internal treatment. (Ten drops of nitric acid 
[dilute acid] was added to four ounces of water.) 

Diarrhoea. — That variety capable of causing miscar 
riage, will be best met by such remedies as arsenicum, 

* Cerate of Atropine, 1 grain to 1 ounce, 
" Opium, 10 grains to 1 ounce, 

" Hamamelis, 1 drachm to 1 ounce. 



186 HALE OlSr ABOETION. 

eupliorhia cor., ipecac, iris versicolor, mercurius, podo- 
phyllum, cuprum, Pulsatilla, sulphuric acid, veratrum 
album, and veratrum viride. 

Constipation, or "functional impediment of the 
bowels," slionld be relieved by tlie most prompt 
and efficient measures. In order to effect this, pur- 
gatives should never be resorted to, for they will 
only intensify the difficulty, and aggregate the ten- 
dency to uterine irritation. The diet of the patient 
should be made as laxative as possible. The free use 
of fruits, corn bread, cracked wheat, berries (particu- 
larly whortleberries) should be urged, and one of the 
following remedies prescribed, namely, arsenicum, hry- 
onia, collinsonia^ mercurius, nux vomica, plumbum, pla- 
tina, lycopodium, and sulphur. 

The persevering use of enemas are particularly re- 
commended. They may be composed of pure water, 
or water holding in solution common salt, ox-gall, soap, 
or molasses — in quantities not sufficient to be stimulat- 
ing. Decided benefit has resulted from enemas medi- 
cated with small quantities of nux vomica, or some 
other medicine Homoeopathic to the local condition 
of the intestines. If violent purgatives are the cause 
of the symptoms of abortion we are called to treat, 
they are to be met by the same means advised for the 
relief of a dysentery or diarrhoea. 

{g) Vesical. — ;The causes of abortion which emanate 
from the urinary organs are not unimportant, and any un- 
usual irritation of the bladder or urethra, during preg- 
nancy, should be met with prompt remedial treatment. 
The kidneys are not so powerful to originate reflex 
irritation as the other portions of the urinary tract. 

Acute cystitis calls for cannabis, cantharis, apis, aco- 
nite, senecio aureus, mercurius, pulsatilla, and turpen- 



TEEATMENT OF ABORTION". 187 

tine (European physicians estimate higUy the curative 
powers oi ^areira hrava^ and hucJiu, in this affection). 

Chronic cystitis demands copaiva^ chimapMlla^ erig- 
eron^ erechthites cubeba^ thuja^ turpentine^ eupatorium 
purpureum^ and hydrastis. 

Nephritis, and urethritis, acute and chronic, demand 
the same remedies. For special indications, refer to 
" Materia Medica," " New Remedies," etc. The free 
use of diluent and mucilaginous drinks should not be 
omitted, as they greatly aid the action of specific reme- 
dies. Among the most useful of these semi-mediciual 
agents, are ulmus fulva (slippeiy elm), galium apa/i'- 
ine (cleavers), Althasce off. (marsh mallows). These 
should be prepared in simple infusion with cold 
or warm water, and drank ad lihitum, or in given 
quantities (as a wine-glassful), at given intervals, alter- 
nately with the medicinal remedies. 

(Ji) Vaginal. — The causes of abortion originating 
in the vagina, are acute and chronic inflammation, 
malignant disease, and granular vaginitis. 

Acute vaginitis, occurring during pregnancy, is an 
important disease. West has known it to extend to 
the uterus, producing metritis. The swelling, heat, 
pain, and irritation, have been known to form an excit- 
ing cause of miscarriage. When attended with pru- 
ritus of the vulva, it is a most distressing affection, pro- 
ducing intense irritability of the nervous system. This 
latter symptom generally attends an aphthous con- 
dition of the vulva and vagina. The disagreeable itch- 
ing is felt not only in the vulva, but in the internal 
organs. 

The treatment of vaginitis (simple acute) consists in 
the internal administration of cantharis, cannabis, mer- 
curius, Pulsatilla, thuja, sabina, and such auxiliary 



188 HALE ON ABOETION. 

measures as cool Mp baths, emollient and sootMng ene- 
mata. Tlie injections whicli I have found most useful 
are infusions of flaxseed, poppy-leaves, calendula flowers, 
and slippery elm. There are other forms of vaginitis 
which require different medicines. In the erysipe- 
latous, or erythematous variety, when the inflammation 
extends to the cellular tissue, with extensive swelling, 
and even suppuration, it will be necessary to give 
helladonna^ apis^ coccionella^ mercurius^ collinsonia^ can- 
tliaris^ and aconite. 

Gra7iuldr vaginitis requires mefGurm^^ phytolacca, 
sdbina^ and cantharis. 

Vesicular Y2igimi\?> — rlius tox^ commoclaiMa^ petroleum^ 
cantharis^ croton tig.^ and dulcamara,' and the pustular 
variety — tartar emetic^ and sahina. The gonorrJioeal 
has been mentioned under that head, and the clironic 
under " Leucorrhoea." 

\iprwritus attends either of the above varieties, some 
one of the above medicines will be indicated, especially 
cantJiaris., sahina^ collinsonia^ or platina^ but topical ap- 
plications cannot safely be dispensed with. For the relief 
of this distressing symptom we have not found anything 
so useful as the " lotion of horax and morpJiia!!'"^ applied 
to the vulva, or used as a vaginal injection — one ounce 
every six hours. Dr. Westf says, " nothing relieves the 
pruritus which accompanies the decline of vaginitis more 
than goulard water and Jiydrocyanic hcid., in the pro- 
portion of two drachms of the latter to eight ounces of 
the former." These applications might, with some 
reason, be objected to, if the disease occurred in the 
unimpregnated state ; but when we wish to alleviate 

* Sodse Sub-boracis 3 ix, f Diseases of Females, p. 480. 

Morphia Sulph., gr. viii., 
Aqua Rosge § x. 



TEEATMENT OF ABOETION. 189 

promptly a symptom likely to result in serious conse- 
quences, we must not adhere too strictly to purely 
Homoeopathic remedies, given internally. Other appli- 
cations may be found useful, such as aconite-water, 
ewpat. arom., 7iamameli% cliloroform-vapor. 

Yaginismus is most successfully treated by the ad- 
ministration of gelseminum^ belladonna^ atro'pin^ Tvyosci- 
amus, ignatia^ or platinum. This symptom is gener- 
ally found in hysterical women, and the remedies used 
for that condition will be useful. Injections of water, 
medicated with one of the above remedies, will aid the 
cure, or a soft cerate, in which they are incorporated in 
proper proportion,* is sometimes still better. If the 
vaginal irritation has been mechanical, remove the 
source of irritation, and use mucilaginous injections, or 
enemas of aconite^ liamamelis^ opium or arnica^ in the 
proportion of one drachm to one pint of water. 

Hysterical. — This condition of the system may 
be kept in abeyance, and the attacks warded off or 
palliated by the use of aconite, gelseminum, atropine, 
ignatia, platinum, cimicifuga, caulopJiyllum, nux mos. 
chata, ambergris, zincum val.^ Scutellaria, or cypripe- 
dium, also the use of remedies calculated to remove the 
pathological state upon which the hysterical irritation 
depends. 

Epilepsy, though generally incurable, may be pal- 
liated by atropine, hyosciamus, belladonna, stramonium, 
zincum pJios., and many other remedies mentioned in 
our Materia Medica and late Journals.f 

Falls, Jumping, Blows, etc. — These accidents, when 

* Gelseminum (tine.) 3 i to § i 
Belladonna (ext.) 3 i to | i 

Atropin, gr.i to | i. 

f North American Journal of Homoeopathy, vol. 12, p. 261. 



190 HALE OlSr ABOETIOlSr. 

acting as concentric causes of abortion, require about 
the same remedies as when acting centrically. 

If the patient receive a blow, or has a fall, and the 
injury is followed by any pain or soreness in the uterine 
region, or. flow of blood from the vagina, she should be 
required to assume the recumbent position, and enjoined 
to keep very quiet. At the same time we should pre- 
scribe arnica^ rJius fox^ hamamelis^ sulphi(/)^iG acid, cin- 
namon, erigeron, or caulopliyTlum, as the nature of the 
case and symptoms demand. Allopathic physicians 
place much reliance, in cases of impending abortion 
from injuries, upon the free use of morpMrie. They 
prescribe a " full dose," from one-eighth to half a grain, 
or more, if the nervous excitement is great. This treat, 
ment is not more at variance with strict Homoeopathic 
practice, than is the administration of morphine after 
fractures or severe surgical operations. It deadens sen- 
sation, relieves pain and excitement, paralyzes the mo- 
tor actions of the womb, and places the system in such 
a condition (in splints, if the phrase is allowed), that 
the injury is powerless to excite the amount of reflex 
irritation necessary to cause abx)rtion. I have never 
resorted to morphine but in one instance, and the 
patient escaped a miscarriage ; in all others, I have 
relied upon other remedies, with varying success. 



TEEATMENT OF ABOETIOISr. 191 



SECTION IV. 

rUNCTIO]M"AL DISEASES OF THE UTERUS. 

Congestion of the Uterus. — The treatment of this 
condition will depend on the nature of the congestion, 
whether acute or chronic. The remedies recommended 
in the Repertories for " congestion of blood to the ute- 
rus" are 

Belladonna, hryonia, ohina, crocus, hepar sulpJi., mer- 
curms, mix vomica, platina, sabina, secale, sulphur. 

Of these, helladonna, crocus, sabina and secale, are 
the most likely to be indicated in abortion from this 
cause. 

But there are other remedies equally important in 
the treatment of congestion and its consequences. It 
should be borne in mind that any remedy capable of 
causing abortion, will cause congestion of the uterus. 
We have, therefore, a large number of remedies from 
which to choose. 

For acute congestion the following are the most effi- 
cient — veratrum viride, sahina, belladonna, cimicifuga, 
secale, caulophyllum, tanacetum, aletris, mitchella and 
terebinth. 

For chronic congestion — china, sepia, platina, secale, 
sulphur, trillium, nux vomica, helonias, murex, ferrwm 
and calcarea. 

In peculiar cases, sabina, cimicifuga, aletris, tanace- 
tum and terebinth, may be Homoeopathic in chronic 
(passive) engorgements of the womb, by virtue of their 
secondary action. 



192 HALE ON ABORTION. 

Engorgement^ Indiwation or Hypertrophy of the neck 
of the womh^ like congestion of the body of tliat organ, 
may be acute or clironic. In cases of simple engorge- 
ment^ witliout ulceration, abrasion, or cedema, we shall 
find the following remedies, aided by enemas of cool 
aconite-water, or calendula- water quite sufficient for its 
removal — belladonna^ cimicifuga^ mitchella^ platina^ 
sahina and aquaphohin. 

In induration or clironic inflammation, we shall find 
most useful — sepia^ murex^ platina^ mercwius iod.^ Tcali 
hrom.^ hali hydriod^ conium^ china ^ sulphwr^ helonias^ 
stillingia^ and many others. 

For oedematous engorgement, or hypertrophy, the 
the most appropriate remedies are — arsenicum^ conium^ 
apis mel. arnica sepia^ iodine^ china^ helonias^ etc. 

The internal treatment of the last two conditions of 
the cervix, may be materially assisted by the topical 
use of the same medicines, but especially arnica^ iodine^ 
conium^ hromlde of potash and china. These may be 
used, largely diluted, as enemas, or in some cases the 
stronger preparations may be applied to the cervix, by 
means of a soft brush. 

Leucorrhoea. — The treatment of this affection depends 
so much on the character of the discharge, the patholo- 
gical condition to which it owes its origin, and the 
symptoms with which it is attended, that it is absolutely 
necessary the physician should consult his Materia 
Medica, or some elaborate work like Jahr on Diseases of 
"Women. It would not be proper, in a work like this, 
to enter fully into the special indications of each rem- 
edy. The best that can be done is to designate those 
remedies which will be found most useful in the varie- 
'ties of the disorder. 

In mucous or cervical leucorrhoea, or that variety 



TKEATMEISTT OF ABOETION. 193 

wliich is secreted by tlie mucous follicles of the cervix 
uteri, the most appropriate remedies are — 

In acute cases — Pulsatilla, senecio gracilis, sabina, 
inercurius, hovista, cantharis, podopJiylluiii, dulcama/ra, 
senega, Jcali liyd. 

In clironic cases — pulsatilla, stannum, sulphur, 
Gonium, sepia, copaiva, mnerc. iod., Jcali hromatum, pliy- 
tolacca, trillium, thuja, calcarea carh. 

In cases when the discharge has produced abortion 
or erosion of the os uteri — nitric acid, mere, cor., mere, 
iod., Icali liyd., Icali hrom, a/rsenicmn, lacliesis, p>hospJio- 
ris, sabina. (See Ulceration of Os Uteri.) 

Where there is anaemia or debility — china, lielonias, 
ferrum, manganese, hydrastis, aletris, phosphoric acid, 
and the hypophosphites. 

In cases of chronic cervical leucorrhoea, it is useful 
and proper to use topical applications. Any remedy 
Homceopathic to the disorder may be applied locally to 
the canal of the cervix, by means of a syringe of pecu- 
liar shape, and with the result of hastening the cure. 
Those caustic substances which act Homoeopathically 
upon diseased surfaces may be applied in the above 
manner, or by means of a brush, or even in substance. 
Of these the most useful are a/rgentum nit., Jcali per- 
manganatum, and nitric acid. The topical treatment 
here advised is not to be used during, but previous to 
pregnancy. 

The treatment of a leucorrhoea should be conducted 
upon the same general principles as an acute coryza, 
or catarrh of the air passages, or profuse secretion from 
glandular or mucous surfaces. It will be , noticed by 
the careful student of Materia Medica, that any remedy 
capable of causing a peculiar mucous discharge from 
the nose, is capable of causing a similar, or even iden- 
13 



194 HALE ON ABOETIOI^. 

tical discharge from the bronchia, bladder, intestines, 
and cervical canal of the uterus. If the discharge from 
the nose be acrid and corrosive, the discharge from the 
cervix will have the same irritating quality : if tena- 
cious in the larynx, it will be tenacious elsewhere ; if 
green, yellow, or white in one place, it will have the 
same color elsewhere. The idea of any remedy causing 
specifically a mucous discharge from one surface, and 
not from any other, is absurd and unphilosophical. If 
the physician will examine any complete pathogenesis^ 
he will be- convinced of the truth of this assertion. 
Medicines have a specific affinity for tissues, not organs. 
This is a great truth, and one of immense importance 
in practice, and a valuable guide to our study of the 
science of Therapeutics. 

Vaginal or IHpithelial Leucorrhma. — Owing to the 
total absence of a microscopical examination of the 
leucorrhoeal discharges, occurring during a proving of 
our medicines, we cannot designate the remedies indi- 
cated for a strictly epithelial discharge ; nor can we 
designate with any more certainty the proper remedies 
for a purulent leucorrhoea, although Jahr indicates coo- 
cuius, mercurius, saMna, cMna, sepia, copaiva, and 
nitric acid. I do not suppose cocculus or china capa- 
ble of causing a purulent discharge from any tissue. It 
is not in the nature of the medicine ; and I suspect if 
the original provings were examined, they would be 
found faulty in that respect. It is probable that china, 
by its Homoeopathicity to extreme debility, will cure 
purulent discharges, for it is now known that anaemia 
will cause a mucous discharge to become purulent, and 
a removal of the debility will cause the pus to disap- 
pear. Cocaidus acts principally upon the nervous cen- 
ters, and it is difficult to imagine how it can cure a pur- 
ulent discharge. 



TEEATMENT OF ABOETION. 195 

For epithelial leucorrlioea I would tJieoretically desig- 
nate — dulcamara^ horax^ hovista^ caharea^ pulsatilla^ 
sulphur, hall hyd.^ mere, iod.^ senecio, cannabis^ copaiva, 
cuhehsj euphrasia and sticta. 

For tlie different varieties of vaginal leucorrlioea, I 
would refer the reader to Jahr,* who gives minutely the 
symptomology of each remedy likely to be useful in 
leucorrhoea generally. 

When it arises from simple, acute catarrhal vaginitis, 
dulcaniira, Pulsatilla^ kali hyd., sticta^ senecio gracilis 
or mei'G. iod. will generally remove it. 

If from aphthous inflammation, horax, caulophylliim^ 
sulphur and muriatic add will be found most useful. 
On a previous page this form of vaginitis and its pecu- 
liar discharge has been mentioned, also the distressing 
pruritus to which it sometimes gives rise, and that it is 
apt to occur during pregnancy, and be a cause of 
abortion. The two remedies having greatest control on 
this variety of the disease happen to be very different 
in constitutiou. One is a vegetable, the other a mine- 
ral substance, yet both exercise a similar effect upon the 
organs of generation, as mentioned in the " Medicinal 
Causes of Abortion." Both cause labor-like pains, 
and are capable, under certain circumstances, of causing 
abortion and premature labor. Both are Homoeopathic 
to, and curative in, aphthae of any mucous surface. It 
follows that no remedies are likely to be so useful in 
threatened abortion from aphthae and pruritis, as horax 
and caidophyllum. 

Sulphur^ and even sulphuric acid^ according to Hart- 
man,f are both useful in aphthao, but more against the 
constitutional diathesis, than the immediate attack and 
its consequences. 

* Diseases of Women. f Diseases of the Children. 



196 HALE OK ABOETIOir. 

Muriatic add., says Teste, is the specific remedy for 
tliat form of aphthae, termed by the French writers 
muguet^ and which may sometimes attack the vagina, 
especially in very low, atonic states of the system. 

The local application of horax has been mentioned 
mider "Pruritus." Caulopliyllimi may be used as an 
injection — the tincture in water. SulpJiwous acid is 
promptly curative in the form of enema, when there 
exists in the vaginal discharge the fungi peculiar to 
some aphthous diseases.* 

If the whole vaginal surface has become involved, 
and by means of the speculum we discern that the 
epithelium has nearly or wholly disappeared, leaving 
the villi exposed, the villous coat abraded and bathed 
in pus, or if we have to judge of the leucorrhoea wholly 
from the discharge, and we find it composed of pus, 
mixed with blood globules, we may assume the con- 
dition present as the one above described. 

In such cases, the appropriate remedies are nitric 
Ojdd^ sabina^ sepia^ calca/rea^ copaiva^ terehintJi., trillium^ 
mercwius^ arsenicum^ etc. 

It is utterly impossible for us, in the present con- 
dition of our Materia Medica, to construct a reliable 
repertory. Jahr mentions many remedies for " bloody" 
leucorrhoea, many of which are also mentioned under 
the head of "flesh-colored" and "reddish discharges." 
But how are we to decide whether the blood-globules 
come from the abraded cervix or vagina, or the interior 
of the uterus ; whether it was really a bloody leucor- 
rhcea, or a simple mucous leucorrhoea, mixed with the 
blood of a uterine haemorrhage? The appropriate 
local treatment of this form of vaginal leucorrhoea with 
.abrasion, consists of injections of calendula^ Jiamamelis., 

* West on Diseases of Children. 



TEEATMENT OF ABORTION. 197 

trillium^ horax^ sanguina/ria^ podophyllum ^' or nitric acid, 
per-manganafe of potash, hichromate of potash, ox nitrate 
of silver. Those first mentioned being mildest, may be 
tried first. In many cases they prove effectual. The 
proportion best adapted to the purpose is a watery 
infusion,* but the mother tincture can be used in the 
same proportion. The latter, unless largely dil- 
uted, cannot be used with safety during pregnancy. 
They are not as efficient when used weak, unless the 
case be a recent one. The nitric cccid enema may be 
prepared ten or twenty drops to the pint ; the per-man- 
ganate of potash, ten grains to the pint ; the hichromate 
one or two grains to the pint, of water ; the argentum 
nit/ratis, in the same proportion. In non-pregnant 
women, and long standing cases, stronger proportions 
can be used. 

Gonorrhoea. — If this disorder has been contracted 
previous to the pregnancy, and its results — namely, ulcer- 
ation, induration, and endo-metritis, are disposed to act 
as exciting causes of abortion, the treatment to be 
adopted should be the same as laid down for those 
affections. 

If, however, the gonorrhoeal infection occurs during 
pregnancy, an abortion may be caused by the congestion, 
irritation, and sympathetic fever which accompanies 
the outset of the disease. In such cases, the woman 
should be ordered to keep as much as possible the 
recumbent posture, use cooling and mucilaginous bever- 
ages, such as flax-seed, marsh mallows, or ulmus fulva, 
and one of the following medicines be prescribed ; aconite, 
gelseminum, or veratrum mride, if the fever assumes a 
high grade, with local congestion ; cannabis, cantharis, 
or senecio aweus, if the febrile irritation is accompanied 

* One drachm of the crude material to one pint of water. 



198 HALE ON ABOETIOlSr. 

witli mucli local pain and irritation ; sabina^ terebinth^ 
and Pulsatilla., if the irritation seems likely to bring on 
uterine pain and flooding. If this first stage passes 
over, and the second, or that mentioned on a previous 
page — namely, an inflamed and abraded surface or patch 
on the OS uteri — obtains, the same treatment as that 
advised for " granular ulcer" should be adopted. 



SECTION V. 

ULCEEATION OF THE OS AND CEEVIX UTEEI. ' 

The tlierapeutiGS of ulceration of the os and cervix 
uteri cannot be considered at all settled. Those reme- 
dial agents which are appropriate in this disease, are 
those which are Homoeopathic to the pathological con- 
dition^ as well CCS to the symptoms present. Those 
who still assert that this disease can be diagnosed and 
treated from the symptoms alone, should ponder 
well over the statement of Professor Simpson, a state- 
ment concurred in by all the best and most practical 
observers of both schools of medicine — namely : " There 
can be no doubt of the fact, that there seems to be no 
organ in which there is a less strict relation observable 
between the intensity and character of the existing 
pathological disease, and the intensity and character of 
the accompanying symptoms, or between the exact 
nature of the structural lesions that are present, and 
the exact combination and succession of functional 
derangements to which they give rise." Dr. Madden* 

* Uterine Diseases, p. 19. 



TRBATMEI*rT OF ABORTIOjST. 199 

says : " In tliis disease I bave met witli the greatest 
possible variety in the symptoms complained of, when 
a physical examination revealed the greatest possible 
correspondence between the pathological conditions of 
the various cases. I have found enlargement and ulcer- 
ation of the cervix uteri in a case examined for another 
purpose, and when there was no detectable aberration 
from robust health. I have found the slightest form of 
cervico-metritis where the constitutional disturbance was 
very grave, and the symptoms had continued a long 
time ; and lastl}^, I have known the symptoms to con- 
nect themselves so completely with some distant organ, 
as the head, the stomach, the heart, the mammge, or 
the extremities, that indirect causes alone led me to 
suspect the uterine complication." 

How is the mere symptomotologist to select the appro- 
priate remedy for a case of ulcerated os, if he ignores 
all pathological conditions? He has nothing to do 
with conditions^ therefore he must not avail himself of 
the general state of the patient — i. e., whether she is 
disposed to ulcerations ; nor can he be guided by the 
disckaoyes, for a discharge is a pathological symptom. 
Even if we allow him to be guided by the appearance 
of the discharge, j;)^^ vaginam, he would be as likely to 
be misled, unless the microscope revealed to him its 
real character. 

It is because our Materia Medica is so incomplete, 
esj)ecially in objective symptoms (structural lesions), 
that our therapeutics of ulceration of the uterus are so 
uncertain and unsettled. Says Dr. Madden: "On 
going over the whole of the remedies which have been 
proved by Hahnemann and his followers, ^^' * * I can 
only find four purely pathological symptoms which 



200 HALE OlSr ABOETIOIN". 

indicate organic changes in the uterus, and these are as 
follows : 

(1) " Irregularity of the os uteri" — natrum muriali- 
mm). 

(2) "Metritis"-^S66'«Z6 cwnutum. 

(3) " Softness of uterus" — opium. 

(4) " Swelling of cervix" — cantharis. 

It is needless to add that the symptoms noted under 
natt'wm muriaticwm^ and that under opimn^ cannot be 
trustworthy. Secale^ in poisonous doses, causes a severe 
form of metritis, and the same may be predicated of 
cantharis. So that, of all the medicines in our Materia 
Medica, but two have a recorded and reliable objective 
symptom relating to the uterus.^ 

The condition of the knowledge of uterine path- 
ology, at the time Hahnemann and his immediate suc- 
cessors made their provings, is a valid reason for the 
absence of such symptoms ; but the provers of the 
present day cannot have any such excuse for not pre- 
senting us with pathological symptoms, if not on 
women, certainly upon female animals. Imagine a 
proving of sepia., pulsatilla., sabina^ sulphur^ pJiytolacca, 
hali hicJiromat., etc., conducted in such a manner as to 
elicit subjective and objective symptoms. Then, in- 
deed, could we prescribe with some degree of confi- 
dence for the disease under consideration. 

For particular information concerning the Homoeo- 
pathic treatment of ulceration of the os and cervix, I 
would refer the physician to " Madden on Uterine Dis- 
eases," " Jahr on Diseases of Women," " Gollmaun on 
Diseases of Urinary and Sexual Organs," and the 
papers which have appeared in our various journals, 

* Aquaphohin causes " mflammation of the uterus in cows." See 
" Proving oi Aquapliobin^^ — PMla. Jour, of Horn., vol. iii., p. 362. 



TEEATMENT OF ABOETION. 201 

also Dr. Ludlam's forthcoming work on Diseases of 
Women. 

Madden found the most useful remedies in uterine 
diseases generally, to be pulsatilla^ sepia, sulpJiur, nux 
vomica, and platina. He also used local applications 
of nitraie of silver, per-nitrate of mercury, and potassa 
fusa, and claims that these drugs have a specific action 
on uterine disorders, acting Homceopathically, whether 
as constitutional or local remedies. 

Jahr recommends (1) nitric acid and thuja ; (2) 
arsenicum, helladonna, china, cicuta, cocculu^, mercuTius, 
^Pulsatilla, sepia, silicea, and sulphur. Of these, nitric 
acid, arsenicum, mercurius, sepia, silicea, and sulphiw, 
are most worthy to be relied upon. It is doubtful if 
the others are Homoeopathic to ulceration at all. Jahr 
mentions a few others which are probably appropriate, 
namely, calcarea, aurum, graphites, pePi^olewm, ruta, 
sabina, secale, hepar sulph., and lachesis. Dr. Marcy* 
recommends against " simple inflammation of the mu- 
cous membranes lining the cervical canal and the cervix 
uteri," sepia, secale^ sahina, pulsatilla, cocculus, apis 
mel., calc. carh. ^' also, mezereum, conium, nitric add, 
petroleum, hovista, horax, platina, hali Garh.,ferr. iod., 
and sulphur. 

For ^'•suspected ulcerations," he has found most use- 
ful, secale, apis, and thuja; also the above mentioned 
remedies. 

Leadam seems to teach that " simple induration" of 
the OS uteri and cervix uteri, precedes ulceration, and 
is the result of chronic inflammation. The remedies 
which he advises for this condition are, helladonna, 
platina, calendula, sepia, conium, q/rsenicum, iodium, 
aurum, etc. 

* N. A. Jour, of Horn., vol. v., p. 80. 



202 HALE ON ABOETION. 

The constitutional remedies whicli observation, ex- 
perience, and information gleaned from all sources, 
indicate as most appropriate for the inflammation and 
engorgement, which precedes ulceration, are — sabina^ 
secale, cimicifuga^ caulojphyUin^ belladonna^ Pulsatilla, 
apis met., aquapJiohin, podophyllum, murex, mitchella, 
cantluiTis, and platinum clilor., when the condition is 
acute or recent. In chronic cases, sepia, sulphur, helo- 
nias, aletris, platina, lachesis, conium, thuja, and mere. 
iod., are more often indicated. 

Any remedy which has been found useful, or is 
indicated by its pathogenesis, in inflammation and 
induration of other portions of the body having a like 
tissue with the cervix uteri, will be likely to prove 
serviceable in this affection. 

In the treatment of inflammatory congestion, and 
induration of the os and cervix, the use of topical 
applications should not be neglected. The Homoeo- 
pathic school are divided in opinion, as to the pro- 
priety of such applications, the conservative, or Hahne- 
mannian party, claiming that the internal administration 
of the proper remedy is alone sufficient to bring about 
a cure — the progressive party believing it necessary and 
proper to apply the same medicine which is prescribed 
internally, to the diseased portion or tissue, or medicines 
that by their local action are Homoeopathic to the 
lesion present, when topically applied. 

I incline to the latter belief, because my observation 
and experience has shown me that our success is greater 
when remedies are applied to the diseased structures, 
topically, as well as when reaching them through the 
medium of the general circulation. 

The treatment laid down in these pages is conse- 
quently based on this belief. At the same time, I am 



TEEATMENT OF ABORTIOlSr. 203 

willing to allow tlie largest liberty of action to all tlie 
members of the Homoeopathic school. 

The toxical treatment of the inflammatory condition 
which precedes ulceration, should consist of the appli- 
cation by enema or lint, of the following medicines (or 
others which seem indicated). 

(1) For simple inflammation — aconite^ gelseminum^ 
arnica^ calendula^ haptisia^ cimicifuga^ and secale. 

(2) Inflammation with induration — the above, and 
also urtica urens, helladonna^ hali hyd.^ hali hrom.^ 
conium^ and clematis. 

These remedies should be prepared in proportion of 
ten or twenty drops of the mother tincture to four 
ounces of water, and the whole quantity used at once ; 
or if the remedy is applied by means of lint^ it should 
be saturated with a preparation made in proportion of 
ten or twenty drops to one half ounce of water. The 
water may be cool or warm, as the physician judges 
best. It should be remembered that cold applications 
to the OS uteri, during pregnancy, are sometimes capable 
of exciting reflex irritation. 

The syringe used for such purposes may be the com- 
mon vaginal syringe, made of hard rubber, and holding 
two ounces ; or one of the various instruments which are 
sold. I prefer the Essex syringe, with the air chamber. 
The tube* should be inserted so that the bulb is nearly 
in contact with the os, and the fluid should be thrown in 
a slow^ continuous stream. If thrown with too much 
force, uterine contractions (in case of pregnancy) may 
be caused. If lint is used, it should be applied through 
a speculum ; it should be pressed gently against the os, 

* A large vaginal tube, with a large bulb, perforated with holes one- 
sixteenth or one twelfth of an inch in diameter — should be obtained with 
the syringe. It is made expressly for this use, and can be purchased from 
Mr. Halsey, the publisher of this work. 



204 HALE 01^ ABORTIOIS". 

and kept in situ with a sound, or anything which will 
answer that purpose, while the speculum is withdrawn. 
The best time to apply medicated lint is at night ; it may 
Le removed in the morning ; this the patient can gener- 
ally do ; indeed she can often apply it herself, if the 
uterus is low in the pelvis. These general directions 
are applicable in case of any disease of os and cervix, 
when remedies are to be used topically. 

We will now consider briefly the treatment of the 
varieties of ulceration. 

Slrryple Granulating Ulcer. 

The remedies most generally useful are arsenicum^ 
platinum clilor.^ pJiytolacca^ stillingia^ sahina^ hali hy- 
driodatus^ mercurius iodatus^ secale^ sepia^ nitric acid^ 
podophyllum^ liepar sulpJi.^ calendula^ hreosotum^ nym- 
pJicea odorata, cornus circinata^ hali chlor.^ hydfrastis 
canadensis^ argentum nitricum. 

The same remedies should be applied topically in such 
proportions as have been heretofore indicated in this 
work, leaving the special preparations (as nitrate of sil- 
ver^ etc.) to the judgment of the practitioner. My ex- 
perience with arg. nit.^ in simple erosions, leads me to 
prefer the enema to be very weak — 2 grs. to 8 5 — and 
frequently used. 

Varicose Ulceration. 

The practical experience of physicians, and the j)ath- 
ogenesis of medicines, seem to indicate that this variety 
is best treated by use of 

Collinsonia^ hama^nelis., lycopodium^pidsatilla^ graph- 
ites^ lachesis^ thuja., sepia., trillium., sulphw, nux vomica., 
and arnica., prescribed for internal and topical use. 



TEEATMEISTT OF ABOETION. 205 

The liamamelis is tlie most generally useful remedy 
in this disease. But to be efficacious it should be used 
in material doses (10 or 15 drops of the tincture inter- 
nally) and the watery infusion^" used as an enema. 
Thuja^ triUium^ nux vomica., and arnica, may be also 
used in infusion, but of less strength. f Lycopodium, 
lachesis, graphites, and sulphur, are efficacious internall}^, 
in the 30th or 200th potency. 

Fisswred Ulcer. 

In the Repertories we find recommended for rhagades 
generally, alumina, calc. carh., hepa/i' sulph., lycopodium, 
mercurius, petroleum, rhus tox., and sulphur. 

It is probable these may be equally useful in fissured 
ulcer of the os uteri. But in my estimation the chief 
remedy is nitric acid. Those who are acquainted with 
the specific curative power of this remedy in fissures of 
the anus, fissures of the tongue and lips, can readily 
believe this assertion. It has cured this lesion, in the 
low and high dilutions, with or without its local appli- 
cation, yet I am inclined to recommend that, in old and 
severe cases, it be applied locally. This may be accom- 
plished by the use of an enema in the proportion of ten 
drops of the dilute acid to four ounces of water ; or the 
dilute acid itself, applied with a soft brush. The ulcer 
should first be wiped dry to the bottom of the fissure, 
with a piece of lint attached to a probe, and the brush 
pushed into the depth of the ulcer. The remedies first 
named, also nitrate of silver^ and glycerole of aloes, 
may be applied in a similar manner. The glycerole of 
aloes is already widely and favorably known as almost 

* Hamamelis (the bark) 1 i — warm water 1 qt. — infuse 3 hours, 
f 3 i of the powder, leaves, or flowers, to 1 qt. water. 
X Arg. nit. (crystals) gr. x. — aqua dest. 1 f . 



206 HALE OX ABOETIOlSr. 

a specific for rhagades in tlie skin. In tlie few cases in 
whicli I liave used it in similar states of tlie mucous 
membranes, it lias proved equally efficacious. The hi- 
chr ornate of potash lias been found very useful in certain 
conditions similar to fissured ulceration. Dr. Dudgeon 
used it internally and topically. 

FoUiculm" Ulceration. 

Tlie remedies are (1) meTC. iod. and hin-iod.^ Icali 
iod.^ Tcali hrom.^ pkytolacca^ stillingia^ haptisia., sahina^ 
milpJiur, nitric acid^ silicea^ sanguinaria^ thuja. 

(2) Argentum nit. ^ per-manganate of potash^ chlorate 
of potash^ and potassa fusa. 

The fii'st class should be used internally and topical- 
ly ; the second^ in most cases topically alone, although 
in some cases their internal administration may be 
appropriate. 

If the follicular ulcer is seen in its incipient stage, 
one or two applications of the crude nitrate of silver to 
the surface will suffice to heal it: at a later period, 
when an excavated ulcer is present, the strong solution 
of that caustic, or the per-manganate of potash (of the 
same strength) should be applied with a pointed brush, 
pushed to the bottom of the excavation. In some cases, 
according to Madden and Tilt, the potassa cum calce^ 
applied in the form of the crude stich^ causes rapid fill- 
ing up of the ulcer. 

Phagedmnic Ulcer. 

This is the "corroding ulcer" of Leadam, w^ho is 
sanguine in the recommendation of arsenicum as the 
principal remedy. That author also advises sulphw, 
secale^ lachesis^ iodiur)i^ carh. veg.^ Siud pulsatilla. 



TEEATMENT OF ABOETION. 207 

With the single exception, however, of lachesis, it is 
extremely doubtful if any of the last-named are Homoe- 
opathic to phagedaena, in any form : not even secede, 
which is only useful in chy gangrene, if in gangrene 
at all. 

The remedies appropriate in this form of disease — 
true phagedsenic ulceration (not cancerous), are, nitric 
acid, muriatic acid, per-manganaU of jootasli, hydrastis 
canad., pliytolacca, iodide of a/}'se7iic, ai'seniate of i7vn, 
tartrate of iron and potassa / nymplioea odorata, mere, 
hin-iod., Icali hyd. and stillingia. 

These remedies should be used thoroughly and per- 
severingly, internally and topically, as before described. 
The tOA'trate of iron and potassa was said by Kicord 
to be the " sworn enemy of phagedsena." One patient, 
with an ill-looking ulcer of this character upon the os, 
I cured with the first trituration of this remedy alone. 
There was present considerable ansemia and debility. 
Dr. P. H. Hale, of Michigan, uses the nympJicea odorata 
(white pond lily) with much success in this form of 
ulceration. 

The remedies, however, which have been most useful 
in my hands, for phagedaena, whether syphilitic or not, 
have been the hin-iodide of mercwry, in alternation with 
Icali hyd. It is a curious fact, but one observed by 
others besides myself, that some remedies will cure 
promptly when given in alternation, after they have 
failed singly. This is the case with the above remedies. 
Neither the hin-iodide nor iodide of potash were capable 
of curing alone, but when alternated, they removed the 
diseased condition rapidly. I usually prescribe the 
former in the third decimal trituration : the latter in 
solution, after the formula given below* (about the 

* 9 Kali hydriodatus 3 i. 

Aqua dest. or syrup, simp. § viii. One teaspoonful three times daily. 



208 HALE ON ABOETIOlSr. 

second dilution) : eacli three times daily : the former 
before meals, the latter about two hours after, I know 
of no treatment so uniformly successful, and strongly 
advise its adoption. Dr. W. T. Helmuth informs me 
that he uses successfully, in this condition, the same 
medicines in nearly the same manner. 

Next to this, I prefer the use of per-manganate of 
potash. Manganese is a blood-restorer, like iron^ and 
the large amount of chlorine contained in the prepara- 
tion, makes it a powerful remedy over diseased states 
which lead to phagedaena. Besides, it is a powerful but 
safe caustic, acting as a local Homoeopathic remedy. 
The third dilution may be administered internally, and 
the strong solution (ten grs. to one ounce of water) ap- 
plied with a brush or lint. 

SyphiUtic Ulceration. 

The treatment of chancres on the os uteri, or the 
ulceration which follows it, does not materially differ 
from that adopted for the last named variety. 

Simple chancre of the os will often heal kindly under 
the use of mercurius sol., or mere, iodatus, or nitric 
acid, together with a wash of aqua calendulw, dilute 
nitric acid., or the preparations previously mentioned 
for enemas. 

Indurated chancre requires the same mercurial reme- 
dies, aided by hali hydriodatus., stillingia, or Phyto- 
lacca. 

Phagedoenic ulcerations, of a syphilitic character, 
require the same treatment as phagedsena arising from 
non-specific causes. In this affection I have used the 
mere, hin-iod. and hali hydriodatus in alternation, with 
the happiest results. 



TEEATMENT OF ABOETIOlSr. 209 

Awrum^ Icali hiclwom.^ 'platinum clilor.^ iris versicolor^ 
and arseniGum^ liave all been highly recommended in 
syphilitic ulcers, but my experience with them has 
been so limited, that I am unable to report favorably 
in relation to their therapeutic value. 

Mesumh 

There are many remedies not specially indicated in 
ulceration of the os and cervix, which may be useful 
and indispensable to the cure of that affection. 

It is well known that certain states of the system, 
namely, anaemia, psora, some miasmatic or dyscratic 
poison, may retard and even prevent the cure of local 
or general diseases of a different character. Thus, if 
considerable angemia be present, we may select the 
remedy for the local affection with ever so much care, but 
if we do not take into account the general condition, and 
select some remedy to meet it, we shall fail to effect a 
cure. It is very rarely the case that any one remedy 
will meet both conditions, namely — the ulcer (syphilitic 
or not) and the anaemia; we therefore are obliged to 
alternate two remedies, for example, ferrum and mer- 
curius: china 2^11^ phytolacca : liydrastis ^yA hali hy^ri- 
odatus. 

Again, if a psoric taint exist in the organism, we 
will have to act upon the advice of Hahnemann, and 
give an occasional dose of some anti-psoric — sul])hur^ 
calcarea^ etc. (30th or 200th), to antidote that miasm, 
and the cure will afterwards progress rapidly. 

In miasmatic districts we sometimes have to use 
arsenic, or quinine, before other remedies will exercise 
a curative effect on the disease. 

During the prevalence of epidemics of diphtheria, 
14 



210 HALE ON ABOETIOIS". 

ulcers of all kinds are apt to take on a diphtheritic 
character — ulcers situated on the os and cervix are not 
an exception. When this occurs — and the careful phy- 
sician will be on the alert for such a complication — 
the remedies recommended for diphtheria will have to 
be resorted to. 

I hardly need add, what every practical physician 
should know, that during the treatment of ulceration, 
the physiological functions of the various organs should 
be kept, as much as possible, in a normal condition. 
Respiration, digestion, and depuration, should go on 
properly, or the cure will be retarded. 

The diet of the patient should be varied to suit the 
exigencies of each individual case, the use of stimulants 
advised or not, as the system demands. The amount 
and character of exercise should be regulated in the 
same manner. 

It has always appeared to me that the postural treat- 
ment of ulcers of the cervix, has not received the at- 
tention which it demands. If w^e are treating an ulcer 
on the foot or leg, we know it will heal in much less 
time if the limb is placed horizontally, so that the 
column of blood does not press upon the irritable tissues 
in or near the ulcer. Should not the same hold true, 
to a certain degree, in the case of ulcers situated upon 
the most depending portion of the uterus ? We are 
aware that some writers do advise the patient to assume 
and remain in the recumbent position while under 
treatment, but not for the reason above alluded to. I 
am satisfied that if this suggestion be borne in mind 
by the physician, and acted upon in certain cases, his 
success will be much greater, especially if he is treating 
a case of ulceration occurring during pregnancy, when, 



TEEATMENT OF ABOETIOlSr. 211 

more than at any other period, the uterus is loaded 
with blood. 

There is another reason why the recumbent posture 
should be advised. It is well known that ulcers and 
abrasions of th@ os, are kept open, and irritated by the 
constant contact with, and rubbing against the pos- 
terior wall of the vagina, upon which the cervix rests 
in most cases in the early months of pregnancy. The 
most carefully selected remedies will not effect a cure, 
when this irritation is kept up. In non-pregnant 
women we can insert a pessary, and lift the uterus up 
from the vaginal wall, but during pregnancy the use of 
pessaries are generally objectionable, and our best 
means of aiding the medicinal treatment is to allow 
the patient to stand or sit but a small portion of the 
time, or until the ulcer shall be covered by a healthy 
mucous membrane. 

It is in these cases, especially in women of large 
size, that the abdominal bandage is found a useful 
mechanical auxiliary. The best bandage is made of 
elastic silk and rubber, woven whole, or laced at the 
back or sides. 

On account of the irritation and congestion conse- 
quent upon the act of coition^ it is best to prohibit 
sexual intercourse almost entirely during the treatment 
of uterine ulceration in pregnant women. 

Ova/i'ian Diseases, 

When we have to deal with a simple ovarian 
irritation from perverted physiological influences, the 
treatment will be nearly the same as recommended 
jfor " Return of Menstrual Crisis," — namely, the avoid- 
ance of all sensual emotions, coition, etc., and the. 
use of remedies which have a sedative effect upon 



212 HALE ON ABOETION. 

the ovaries. These are (1) cantharis, cannabis indica, 
a/pis mel.^ platina^ sahina, podophyllum^ lacJiesis^ zincum 
valerianatu'tn, all of which should be used in the higher 
dilutions ; and (2) bromide of potash^ and conium, if the 
remedies of the first class fail to relieve. The latter 
medicines must, however, be given in doses of one grain, 
or more, of the j\ trituration, twice or thrice daily. 

Neuralgia of the ovaries (if such a disease exists) 
requires the use of atropine^ aconite^ apis^ colocynth^ 
lachesis^ and zincum vcderianatum. 

Congestion and inflammation is treated successfully 
with aconite^ veratrum, viride^ gelsem^inum^ belladonna^ 
mercurius^ apis 'mel., lachesis^ and platinum. Ovarian 
tumors and dropsy may be held in check by apis^ 
lachesis^ lycopodium,^ arsenic^ iodine^ hali hrom.., hali 
chlor. and pliytolacca. In some cases the ovaries can 
be punctured, and the escape of pus or serum may allow 
pregnancy to go on undisturbed. It is quite doubtful 
if a diseased ovary could be removed without resulting 
in abortion ; cases might occur where the experiment 
would be justifiable. 



SECTION VI. 

UTEKINE DISPLACEMENTS. 

The treatment of displacements of the uterus during 
pregnancy in such a manner as to avoid the risk of an 
abortion, is a matter of considerable difficulty. Most 
writers on Diseases of Women insist upon the employ- 
ment of medicinal and postural measures alone, and, 
assert it to be improper to resort to mechanical appli- 
ances in any case. But the absolute banishment of 



TEEATMENT OF ABORTION. 213 

mecliauical aids in such cases is not based on practical 
experience, as will be shown in the following para- 
graphs. 

Prolapsus ITteri. — A certain amount of prolapsus is 
a common accompaniment of pregnancy in the early 
months ; but after a time the uterus no longer descends, 
the ovum acting as a very efficient intra-uterine pessary. 
If this does not occur at a proper time, all that is re- 
quired is a return of the uterus to its normal position 
by gentle pressure, and the continuance in the recum- 
bent position for a time, together with the administra- 
tion of the following remedies : 

Belladonna^ if the pelvic organs are abnormally con- 
gested, with throbbing at the cervix and heat of the 
parts, observable by the touch. 

Nux vomica^ when the vaginal and other muscles 
upon which the uterus depends for its support, are in a 
relaxed, atonic condition, and there is constipation from 
torpor of the bowels. This remedy may be used also 
as a vaginal enema. 

Podophyllum^ coUinsonia and cbsguIus^ are applicable 
if there is general fullness of the veins of the pelvis — 
especially the haemorrhoidal veins — constipation or 
diarrhoea, and uterine tenderness. 

Caulophyllin^ macrotin and secale if the pain and 
pressing-down in the uterus are the most prominent 
symptoms. 

Pessaries are not generally well borne, owing to their 
tendency to excite reflex irritation. In two cases, how- 
ever, of prolapsus from great relaxation, I used the 
ring-^e&^QiVj for nearly two weeks, without any other 
than beneficial effects. These patients were quite de- 
bilitated, but this was overcome by the use of citrate of 
iron and strychnia and helonias^ with a generous diet. 



214 HALE OlSr ABORTIOl!^. 

If adhesions have taken place, abortion is inevitable, 
and may as well be hastened, and the patient saved 
the risk of a miscarriage at a later period. 

Ante-version. — In the first month or two of pregnancy 
a slight anteversion of the uterus is its normal position. 
If this is greater than natural, an elastic abdominal 
bandage should be worn, the patient advised to lie a 
good deal on her back, and the rectum emptied daily 
by an enema. The medicines most likely to be of use 
are helladonna, nux vomica^ cimicifuga, caulo^liyllura^ 
podophyllum^ senecio gracilis^ and collinsonia. For the 
irritation of the bladder we may give cantharis^ canna- 
bis^ chimapliilla^ senecio aureus^ sabina^ terebinth ^' and 
use the catheter if necessary. 

Retroversion. — The treatment of retroversion of the 
pregnant womb should be conducted with great cau- 
tion, unless we are satisfied that adhesions exist, or such 
an amount of impaction is present as to utterly pre- 
clude its replacement, in which case the induction of 
abortion is an absolute necessity, unless nature does not 
perform the operation herself, and relieve the uterus of 
its contents. When we have ascertained that a retro- 
flexion exists, every means in our power should be 
adopted to prevent further displacement. The bladder 
should be kept empty, and the bowels never sufifered 
to go more than a day without evacuation. For this 
latter purpose, the use of nux vomica., podophyllum., and 
sulphur., should be aided by aperient food — coarse 
bread, fruit, etc. — and, if necessary, the use of injections. 
If, however, vetYOversioii has occurred, attempts to 
restore it to position should at once be adopted. The 
rectum and bladder must be emptied of their contents, 
and the fundus-uteri be elevated by gentle, firm and 
persistent pressure by the two fore-fingers of the right 



TEEATMENT of ABOETIOlSr. 215 

hand. If this does not succeed, the patient should be 
placed on her knees in bed, with her head lowered ; 
the fore-finger of one hand should be introduced into 
the vagina, the other into the rectum ; the os should 
then be drawn down with the one, and the fundus 
elevated with the other. In some cases the finger is 
unable to seize the os, so as to exert the necessary trac- 
tion, in which case the bent extremity of the nterine 
sound may be carefully introduced a short distance into 
the OS, and the uterus drawn downward thereby. 

M. Gariel has proposed that one of his vulcanized 
india-rubber pessaries should be introduced into the 
rectum, and that the fundus-uteri should be raised by 
inflating the pessary. I do not know if this plan has 
been tried in practice, but it would probably be effect- 
ive in a case admitting of mechanical re-adjustment of 
the uterus. If it should cause abortion, it would only 
hasten an inevitable result. Tyler Smith thinks it 
might lacerate the soft parts unless great caution 
was observed. The instrument itself consists of a 
dilatable air pessary, terminating in a tube, and an 
air reservoir, with small taps afiixed to each. After 
immersion in warm water, the collapsed pessary is in- 
sinuated into the rectum, behind the uterus, by means 
of a probe. The air reservoir is then fitted to the tube 
of the pessary, the taps are opened, and by the pressure 
of the hand the air contained in the reservoir is trans- 
ferred to the pessary, so as to lift the uterus out of the 
hollow of the sacrum. This instrument is also called 
a colpeurynteuT^ and is sold at all Pharmacies. 

The uterine sound should never be used if the con- 
tinuance of pregnancy is desired, or unless previous 
abortions during gestation, owing to the inability of 



216 HALE ON ABORTTOlvr. 

replacing tlie uterus, should remove all hope of con- 
ductiDg the pregnancy to a natural termination. 

The '■'' levator jperineij'^ invented by Dr. Sims, for the 
purpose of exposing the whole of the vaginal walls as 
well as the os uteri, has been used by Dr. Helmuth 
with success in a case of retroversion during pregnancy. 
When the necessary traction was made, the uterus 
quick)y resumed its normal position. To use this in- 
strument, place the patient as nearly as possible lying 
uj^on her breast and stomach, her left arm thrown be- 
hind, and the chest rotated forward, bringing the sternum 
quite in contact with the bed ; the feet drawn up, one ex- 
tremity of the instrument is to be inserted into the vulva, 
and by the other the perineum is to be forcibly lifted up, 
allowing the atmosphere to dilate the vagina. This 
will give a full view of the entire vaginal cavity — 
" better," says Dr. Gardner, " than the ordinary cone- 
shaped, or even the many-valved instruments." Thus, 
besides its use of replacing the retroverted womb, this 
contrivance may be used instead of the speculum for the 
diagnosis, and as an aid in the treatment of the various 
aifections of the os cervix, and vagina. 

For the H^pecial medicinal treatment of retroverted 
uterus, reference is made to my treatise on that subject.* 

The principal remedies to be used, after replacement 
by mechanical means, and the enjoinment of a position 
on the face or side when in bed or in the recumbent 
position, are : aletris^ helonias^ nux vomica^ se]}ia^ ignatia^ 
macrotin^ iodide of iron^ 'podo]}lii]llum^ and secale. 

In plethoric women, or those with a large abdomi- 
nal development, the use of an elastic bandage, worn 
while the patient is on her feet or sitting up, is quite 
an aid to our efforts in the prevention and cure of this 

* Therapeutics of Retroversion of the Uterus. 



TEEATMEISTT OF ABOETIOlSr. 217 

malposition. It acts by lifting the weighty intestines 
off from the uterus, heavier than normal with conges- 
tion or its natural contents, and it also allows the 
relaxed muscles which support the uterus to regain 
their strength and tone. 



SECTION VII. 

EEMEDIAL TEEATMENT OF ABOETIOIST. 

The remedial treatment of abortion may be divided 
into 

(1) The Mechanical. 

(2) The Medicinal. 

The mechanical consists of those measures which are 
to be used when the symptoms of abortion have already 
set in, and may have in view two ends — namely, («) the 
arrest of the morbid process, and the saving of the life 
of both mother and child, and (h) the expulsion of the 
foetus and placenta, and the safety of the mother. 

The medicinal consists in the use of those remedial 
agents which have for their object the same ends as 
the above ; also the palliation of the painful and dan- 
gerous symptoms which arise during the progress of 
an abortion. 

These cannot be treated of separately, as it would 
cause confusion and needless repetition, we shall there- 
fore allude to both in such places as are necessary. 

I here feel it my duty to protest against the stereo- 
typed recommendations of Homceopathic writers rela- 



218 HALE ON ABOETION. 

tive to the treatment of some of tlie early symptoms of 
abortion. 

We are told that if the accident is caused by a fall, 
blow, or concussion, we must give arnica^ and if from 
a strain, we should prescribe rhus tox. Why? Be- 
cause the former is a good remedy for the effects of a 
fall, bruise, or concussion, and the latter those following 
a ^'■strainr This is as absurd as it is unscientific. Yet 
those who have recommended this treatment are the 
greatest sticklers for symptomatic indications. 

The fact is, arnica is by no means a specific for the 
first symptoms of abortion, any more than any other 
remedy used by us in similar cases. The mere postural 
treatment which the patient is subjected to, after a fall, 
will sometimes succeed in warding off the abortion, 
while, without such treatment, arnica would be of no 
benefit. Regarding I'hus tox.^ it is very doubtful if that 
remedy is ever indicated in abortion. 

From whatever cause the symptoms of an impending 
abortion may arise, the remedy must be selected strictly 
in accordance with the symptoms of the patient, and 
the pathological condition known or supposed to exist, 
and in addition such postural and dietetic rules as seem 
appropriate. 

In nearly all cases, as soon as any of the symptoms 
mentioned above, as indicating an impending abortion, 
appear, we should insist that the patient immediately 
divest herself of all tight and heavy clothing, and 
assume the recumbent position on a bed or lounge, and 
lie as still as possible, avoiding all sudden movements, 
emotional excitement, or any effort whatever involving 
the motion of the abdominal viscera. 

Her diet should be of the simplest character, very 
light, easily digestible food, cool beverages, and the 



TREATMENT OF ABORTION. ' 219 

avoidance of all warm and stimulating drink* or food. 
It is sometimes well to elevate the pelvis somewhat 
higher than a level position, by placing a folded blanket 
under the hips, especially where there is present con- 
gestion of the uterus, or a previous concussion ; also in 
cases of prolapsus. In retroversion, the position should 
be on the side or face. 

If the symptoms consist of the usual pains^ un- 
attended by discharge of blood, one of the following 
remedies will be most likely to remove the uterine irri- 
tation, and arrest the abortion: caulopJiyllum^ cimi- 
cifuga^ cdetrisfar.^ chamomilla^ secale^ gelseminum^ nux 
vomica^ helladonna^ tanacetum, or any medicine cap- 
able of arousing the motor action of the uterus. 

If, on the contrary, w^e have haemorrhage, without 
any or but little uterine pain, we shall find most 
useful — sahina^ cinnamon^ erigeron^ ipecaauanlia^ secale^ 
sulphuriG acid^ and arnica. 

If both haemorrhage and pain are present, the remedy 
which will cover the whole group of symptoms must 
be selected, or failing in this, two remedies may be 
alternated at such intervals as shall seem proper. 

I cannot advise the use of applications of cold or 
warm water in such cases. The danger of reflex action 
from them more than outweighs any benefit which may 
accrue. 

[There is one remedy much relied upon by the Allo- 
pathic school, in the treatment of threatened abortion, 
which is certainly very successful, if a large amount of 
testimony is sufficient to prove its usefulness. This is 
the administration of full doses of opium^ laudanum^ 

* I have known an exception to this. In several cases of threatened 
abortion at the second month, when pain and flowing had already set in, 
the symptoms were permanently arrested by a wine glass of Jiot gin and 
water. Did the juniper act as a Homoeopathic remedy in these cases? 



220 HALE ON ABOETION". 

or unofpliine (the former are said to be most efficient), 
as soon as possible after the appearance of the symp- 
toms. The dose of laudanum usually prescribed, is 
from twenty to forty drops.] 

Should the means above recommended fail to arrest 
the premonitory symptoms, and those appear which 
indicate a rupture of the ovum; or extravasation of 
blood between the membranes and the uterus ; or the 
separation of the placenta — namely, chills, with more 
or less regular pains and haemorrhage — we may still 
administer remedies in the hope of preventing a ter- 
mination in actual miscarriage, I consider the proba- 
bilities of such favorable termination as very small 
when the above symptoms have set in, but the follow- 
ing remedies may be tried : 

Aconite^ if there is chill, with shivering (rigors), 
with anxiety, coldness of the extremities ; sensation of 
heaviness in the uterine region. 

Belladonna^ for pressing and tensive pains in the 
whole abdomen, with sense of constriction or distension; 
lumbar pains, as if the sacrum would break ; pressure 
downward in the abdomen and pelvic organs, as if 
everything would fall out. 

Caulo2)hyllum^ when the pains are regular, like labor 
pains, the os uteri relaxed, some discharge of bloody 
mucus, and sometimes cramps in the extremities. This 
remedy is particularly useful in cases of habitual abor- 
tion from any cause. It should be administered daily 
for a week before the period of the usual abortion, or 
as soon as any suspicious symptoms appear. It will 
often prevent or arrest a premature labor in the last 
months of pregnancy. 

Cimicifuga is useful in cases where the pains are 
similar to those under caulophyllum^ but attended with 



TEEATMENT OF ABORTION. 221 

intense headache, as if the brain and eyes were pressing 
from within outwards ; soreness of the uterine region, 
relaxation of the os and vagina. It is indicated for 
women subject to rheumatism, or spinal irritation, and 
hypochondriacal lowness of spirits. 

Gelseminimi^ when there is general prostration and 
rigor, without coldness, with paralytic sensations in the 
extremities, fullness and dullness of the head, and 
obscuration of vision. The pain and haemorrhage are 
not very marked. It is indicated in women subject to 
depressing emotions, and in cases where the symptoms 
were apparently brought on by fright or fear. 

Cinnamon^ if the hsemorrhage is profuse and bright 
red, without other notable symptoms. In similar cases 
erigeron and erechtliites are indicated. 

Hiita graveolens^ when there is great prostration, con- 
fusion of mind (sometimes pain in the stomach and 
violent retching), double vision, feeble pulse, cold 
extremities, twitching in the limbs, and intense pain in 
the sacral region. 

8ahina for "discharge of dark-colored coagulated 
blood, pressing and drawing pains, from the small of 
the back to the sexual parts; soft and flat abdomen; 
continual urging to stool, with diarrhoea, nausea and 
vomiting ; fever, with shuddering and heat." Also for 
cases accompanied with inflammation of the small intes- 
tines (enteritis and peritonitis), jaundice, and excessive 
irritation of the urinary organs. It is most applicable 
to plethoric women, whose menses are habitually pro- 
fuse and painful. 

Secede is most useful in cases where the uterine pain 
is constant and unintermitting^ and in which there is 
organic disease ; or deficient vitality of the uterus with 
haemorrhage of black and thin blood, fear of death. 



222 HALE ON" ABOETIOE". 

pulse small and most extinguished, os open and dilated. 
It is suitable to feeble, exhausted, cachectic women with 
disposition to passive haemorrhage or convulsions. 

Pulsatilla for intermittent haemorrhage, recurring 
every now and then with redoubled violence, accompa- 
nied with expulsive pains and discharge of dark' blood 
with coagula. 

Many other remedies might be enumerated, especially 
those mentioned under the head of '■''Medicinal Causes^'' 
each of which may in certain cases be indicated. 

Eclectic physicians have great confidence in aletris 
fa/rinosa^ asserting that it will arrest abortion, even after 
severe haemorrhage has set in. 

Allopathic treatment is generally worse than useless. 
It may be summed up thus: bleeding, leeches, cold 
applications, astringents internally and externally, dry 
cupping and drugs. There is one remedy, however, 
which I have before alluded to, in use by that school, 
which seems to be successfully used, namely — laudanum. 

" This remedy," says Cazeaux, " is one of the most 
efficacious, and sometimes it alone has enabled us to 
arrest a labor, whose termination seemed to be inevit- 
able, and thus has permitted gestation to pursue its 
regular course." 

"I cannot refrain from citing the following instance 
in illustration : A woman advanced to three months 
and a half, was taken with pains in the abdomen and 
loins, after a violent altercation with her husband ; on 
the following day the pains augmented and a little 
bloody fluid escaped from the genital organs ; the pains 
still continuing, and the discharge being somewhat in- 
creased, on the third day the patient came on foot to 
the Clinique. I found, on her arrival, that the uterine 
contraction was very distinct, the pains sharp, and 
renewed every eight or ten minutes ; pure blood was 
discharging from the vulva, and the orifice was suffi- 



TREATMENT OF ABOETIOE". 223 

ciently dilated to 'permit the finger to pass readily up as 
far as the naked membranes. I administered sixty 
drops of laudanum^ divided into three doses, wMch 
were given at intervals of three-quarters of an hour, 
and by the end of this time, the pain disappeared, 
everything resumed its natural order, and the gestation 
went on till full term." ^ 

Cazeaux says he might multiply such cases almost 
ad infinitum. Other obstetric writers give similar 
testimony in favor of opium. In view of this we should 
not hesitate to use it in cases of abortion when the usual 
remedies seemed powerless. It is not strictly Homoeo- 
pathic, but should be considered as a dynamico-mechan- 
ical remedy, in the same class with chloroform^ ether., 
splints and mechanical appliances generally. It acts 
by producing perfect sedation of the uterus. It is as- 
serted by some physicians, that large doses of gelsemi- 
num will have the same effect, but it is not so manage- 
able and reliable as laudanum. 

Bulphuric acid^ in quantities as large as can be 
safely borne, is said to have been used very successfully, 
but I have had no experience with it, except in cases 
of haemorrhage after abortion. 

These measures, which have for their object the 
saving of the life of the ovum, must not be persisted in 
too long. When the haemorrhage is so profuse as to 
endanger the safety of the mother, our attention must 
be entirely turned in that direction. 

The first object to be attained is, of course, the arrest 
of the haemorrhage. We will suppose that all the medi- 
cines most likely to effect that object, and which we 
have had time to use, have been tried, and the os uteri 
is not dilated or dilatable : we must now resort to other 
means. The most important of these are, {a) the 

* Braithwaite, Part 46, page 208. 



224 HALE ON ABOETIOlSr. 

tampon; (h) COLD water and ice; (g) hot watee. 
Tlie tampon, when well applied, acts in two ways : 1st, 
by opposing the escape of blood externally, thus forcing 
it to coagulate, and consequently to obliterate the 
bleeding vessels; 2d, by irritating the womb by its 
contact, thereby determinating its contraction, and 
the expulsion of the product of conception. This cir- 
cumstance, indeed, is one of the best-founded objections 
to the use of the tampon in the early months of gesta- 
tion. But it appears to me to be rather an advantage 
than otherwise. The cessation of the flooding is always 
a necessary consequence of the uterine contractions. 
The mother's life is not bought too dear, when it is 
saved by the expulsion of a foetus. Cazeaux asserts 
that the use of the tampon is not always necessarily 
followed by abortion, but the exceptional cases must 
be rare. However, • it matters not : the life of the 
mother is of the most importance. 

The- tampon should not be used after the sixth 
month : even at the fifth month, the physician should 
carefully watch the body of the uterus, after the tam- 
pon has been applied, to assure himself, every moment, 
that its volume is not increasing. There is but little 
reason to fear the conversion of an open into a concealed 
haemorrhage before the fifth month. Unless there is 
abnormal relaxation of the uterine walls, it would seem 
impossible for a large quantity of blood to accumulate 
in that organ. There is, perhaps, the possible danger 
of an escape of blood through the Fallopian tubes into 
the peritoneal cavities ; but as those tubes are blocked 
up during gestation, such a result would be highly 
improbable. 

The introduction of the tampon is generally per- 
formed in the following manner : " Some dossils or 



TEEATlSklElSTT OF ABORTION. 225 

pellets- of charpie are prepared — sometimes dry, at 
others smeared witli cerate — and the vao;ina is then 
stuffed with these gradually, care being taken to have 
the first portions ap|)lied directly to the uterine neck : 
it would be better, perhaps, to connect them by means 
of a thread, so that they can afterwards be withdrawn 
more easily. When the vagina is filled, some thick 
masses of charpie directly over the vulva to sustain the 
pellets, and the whole is held in position by a T band- 
age."^" (See note, Speculum.) But it is not always 
that we have the time and opportunity to procure such 
choice material, and we must not hesitate to avail our- 
selves of anything which will answer the purpose. We 
can use soft linen or cotton cloth cut in strips or square 
pieces ; a soft linen or silk handkerchief ; an old nap- 
kin ; or even a piece of sponge. Strips of cloth, nap- 
kins, etc., may be introduced thus : wet them in tepid 
water, and placing one end or corner against the end 
of the forefinger, push it up the vagina until it comes 
in contact with the mouth of the womb ; withdraw the 
finger carefully and push the rest of the cloth slowly, 
carefully, and by degrees, into the vagina until the 
canal is compactly and closely filled. 

A sponge may be wet with cool w^ater, or hamamelis 
water, and pushed up the vagina. The blood infiltrat- 
ing into the pores of the sponge, soon coagulates and 
forms a voluminous clot, which seals up the vagina 
hermetically, without giving rise, says Dewees, to any 
of the accidents produced by the ordinary tampon : be- 
sides, it is borne without inconvenience, and may be 
left there until the expulsion of the ovum, although it 
would be better, says Cazeaux, to remove it after the 
lapse of a few hours, to observe the progress of the 

* Cazeaux's Midwifery, page 345. 

15 



226 HALE OTT ABOETIOIT. 

dilatation, and tlien replace it if tlie neck is still closed. 
I liave never had much confidence in the sponge, for 
the reason that it is not as sure to prevent the escape 
of blood externally, as other materials. 

The colpeurynteui\ or dilatable india-rubber pessary, 
may be used as a tampon, filled with air, or better, with 
ice water. For directions how to use this instrument, 
see "Treatment of Retroversion," on previous page; 
also the North American Journal of Homeopathy ^ vol. 
9, page 312. 

In the few cases in which I used the colpeurynteur, I 
was not pleased with its use. I could not expand it 
sufficiently to prevent the escape of blood between it 
and the vaginal walls.. Any tampon should be re- 
moved every six or twelve hours, and always within 
twenty-four, for the reasons — 1st, to ascertain if the os 
uteri is sufficiently dilated ; and 2d, to find if the foetus, 
or placenta, or both, have been expelled. As has 
been stated previously, it is rare that serious haemor- 
rhage occurs before the expulsion of the foetus, we shall 
generally be required to use the tampon after that oc- 
currence. It was also stated that the danger from 
haemorrhage usually ceased after the expulsion of the 
placenta (except after the sixth month), therefore, if 
upon removing the tampon we find the foetus and pla- 
centa, or placenta alone, attached to the tampon, or 
lying in the vagina, we shall not need to insert the 
tampon again. 

With the use of the tampon, we may advantageously 
administer such remedies as caulophyllum^ macrotin^ 
gossijjium^ erigeron^ secale or opium^ in material quan- 
tities, or sufficient to cause expulsive contraction. 

Cold Water and lee.. — The application of cold water 
and ice to the epigastrium, thighs and uterus, to arrest 



TKEATMEISTT OF ABOETIOlSr. 227 

lifemorrhage, is a very old practice. The theory is, 
that cold causes uterine contractions, and also decreases 
the calibre of the blood vessels. It is directed to be 
applied in several ways, namely : by means of com- 
presses wetted in cool or ice water, and applied directly 
to the hypogastrium and vulva, or by a bandage which 
is worn around the thighs. It has been recommended 
to use ice water injections ^er vaginam^ and even to 
plug the vagina with pieces of ice. Bags of pulverized 
ice have been placed upon the hypogastrium directly 
over the uterus. The applications may each be resorted 
to in cases where the exigency seems to demand. I 
prefer, in all cases prior to the fifth month, to use the 
tampon ; but the materials for a tampon may possibly 
not be at hand, or the sensitiveness of the tissues may 
be so extreme that it cannot be used, in which instances 
cold water may be applied immediately. In several 
cases I have used snow^ applied directly to the uterine re- 
gion, or with only the thickness of a napkin intervening. 
After the fifth month, these applications of cold water, 
etc., are necessary adjuvants to medicinal remedies ; 
but before that time, I do not consider them of such per- 
manent utility as to warrant us in depending upon their 
use alone. In order to be of value they have to be 
continued for a long time, or until the placenta has 
been expelled, during which time the woman is exposed 
to injury by the constant contact of wet bed-clothes. 
Many of the disastrous sequelae of abortion I believe to 
proceed from the use and abuse of cold water. 

Hot Water. — There is, however, one method of ap- 
plying water in cases of uterine haemorrhage, which 
appears to be practical and scientific. It consists in 
the application of cloths saturated with water as hot as 
can be borne without pain, applied to the lower lumbar 



228 HALE ON ABOETIOI>r. 

region. Tliis plan was first recommended by an emi- 
nent English physician,^' on the ground that liot appli- 
cations to the spine cause contractions of the arteries 
supplied by the nerves of that region of the spinal cord. 
It also causes contractions of the uterus in the same 
manner as dry cupping apj)lied to the lumbar region. 
The hot applications should be changed very often, 
and the loss of heat prevented by a covering of oiled 
silk. 

I have tested this plan in several cases of uterine 
haemorrhage, even before the placenta was expelled. It 
seemed to cause contractions of the uterus, which re- 
sulted in the arrest of the flooding, and in some cases 
in expulsion of the after-birth. In one case of advanced 
uterine cancer, where the floodings were frequent and 
copious, they were always quickly arrested by the 
application of napkins wrung out of hot water, and 
applied to the lumbar region. 

It must be borne in mind, that all the above medi- 
cinal and mechanical means have only been resorted to 
because the os uteri was not dilated or dilatable \ for as 
soon as this condition of the os is present, we are not 
justified in depending on the above-mentioned means. 

The rule to he ado])ted in all cases of abortion, is : as 
soon as tlie os. is dilatahle or dilated, so as to admit tjie 
index finger, the hliont hook or intra-uterine 'placental 
forceps should he used for the extraction of the placenta, 
or such other portions of the embryo as may he in the 
uterus. 

In the early part of my practice I adopted this rule, 
and have always found it the best, and that any devia- 
tion from it resulted in a protracted and troublesome 
case, unless nature expelled the offending substances. ^ 

* Braithwaite, 1863. 



TEEATMENT OF ABOETION. 229 

The hlunt liook is tlie most generally useful instru- 
ment. It should be about 15 or 18 inches in length, 
witli the hook at one extremity. An extempore hook 
may, in case of emergency, be made with, a piece of 
strong wire. 



BLUNT HOOK. 

The following is the best method of using the hook. 
The woman lying on her back, with the knees drawn 
up, and thighs placed a proper distance apart (the pa- 
tient may lie on the side of the bed, diagonally, or at 
right angles with the length of the bed, as the physi- 
cian may choose); pass the index finger of the right 
hand (or left, if most convenient) up to the os uteri; 
ascertain if the finger can be passed into the uterine 
cavity; if so, pass the blunt liook along the palmar 
surface of the finger until it reaches the dilated os. 
The instrument is then to be carefully introduced into 
the interior of the uterus, unless the placenta is found 
protruding from the os, or engaged in the canal of the 
cervix, when it is easily removed. The hook once in 
the uterine cavity, we may feel for the placenta just as 
we would feel for a cork in a bottle, in the dark. Any 
one experienced in the use of the kook will readily de- 
tect when it conies in contact with the placenta. When 
this occurs, slowly and carefully draw it towards the 
cervix. When it arrives at that point, we should try 
to bring it in contact with the end of the index finger, 
which perhaps has not been withdrawn. With the 
point of the finger pressing against one side of the mass, 
the hook is readily forced into the other, and the whole 
extracted easily. Should the placenta prove too fragile, 



230 HALE OTSr ABOETIOIir. 

it will have to be extracted in pieces. A little patience 
and tact will enable tbe physician to get the whole 
away. 

It is often difficult, and even quite impossible, to ex- 
tract the placenta whole, or in fragments, if it is very 
fragile. The ordinary blunt hook will not hold in the 
tissue, but upon the slightest traction tears through ; 
and this will occur again and again, making the removal 
of the mass a very tedious process. 

In view of this difficulty, I have for several years 
used an instrument of my own invention, which has 
many advantages over the common hook. The bent 
extremity, instead of consisting of a single wire, is 
looped^ as will be seen in the accompanying cut. The 
loop is about three-eighths of an inch across, and this 
allows the instrument to get a better hold upon the 
placenta, and traction will not force it through the fra- 
gile tissue. It is to be introduced and used exactly in 
the same manner as the blunt hook. 



LOOPED HOOK. 

Tlie Forceps. — The intra-uterine placental forceps is 
a valuable instrument in some cases. Although not as 
generally manageable and efficient as the blunt or looped 
hook, there are many cases where it can be used easily. 
It differs from the ordinary placental forceps in having 
a longer curve, as will be seen by the accompanying 
figure. I do not consider the short forceps of any value 
except in cases where the placenta is protruding from 
the OS, or lies in the vagina, and here the hook will 
answer every purpose. 



TREATMENT OF ABORTIOlSr. 



231 




LONG FOECEPS. 

Tlie inetliod of introducing the long forceps is tlie 
same as advised for the blunt hook. The operator 
should be very careful or he will pinch the mucous 
membrane of the vagina or vulva, thereby causing the 
woman much pain. When the blades of the forceps are 
in the cavity of the uterus, the instrument should be 
carefully opened and closed, moving it before each 
closure, to a different portion of the interior. When 
the placenta has been seized, the fact will be known by 
the handles of the forceps not coming in contact. When 
this occurs, carefully withdraw the instrument, follow- 
ing the axis of the strait, and the whole or a portion 
of the placenta will be discovered by the finger in the 
vagina, between the blades of the forceps. If only a 
j)ortion is extracted, renew the attempts untilthe whole 
is brought away. 

If the OS uteri is well dilated, and the placenta is felt 
engaging in the cervix, or presenting at the os, or even 
remains in the cavity of the uterus which lies low in the 




SHORT FORCEPS. 



232 HALE OlSr ABOETION. 

pelvis, tlien tlie sliort forceps may be used with advan- 
tage. The directions given for the use of the long, or 
intra-uterine forceps apply to this instrument. 

The hook and forceps may be used at any period of 
pregnancy, and always as soon as the condition of the 
OS will permit their introduction. At almost any pe- 
riod, their presence in the womb excites it to contractile 
efforts, so that there is, little or no haemorrhage at the 
time of their use. Should we fail to seize the placenta 
in a reasonable time, the tampon should be used, proper 
remedies administered, and the case left for twenty-four 
hours. 

It often happens that while previous to the use of 
the hook, forceps or tampon, uterine pains were absent, 
they afterwards appear and become expulsive. If, 
therefore, after the tampon has been placed in the va- 
gina, labor-like pains set in, and after increasing for a 
time in intensity, suddenly cease, we are warranted in 
believing the placenta has been expelled. We may 
then remove the tampon, and in the majority of cases, 
the placenta will be found in the vagina. We may, 
however, find only a large clot, or the foetus, which in 
passing out of the uterus has caused the above symptoms, 
but after the expulsion of a clot or foetus, the pains 
commence again after a few hours, or less time ; whereas 
after the expulsion of the placenta, pains do not return, 
unless the patient is beyond the fifth month, when they 
are really after-pains. 

It has been mentioned, that in cases of abortion be- 
fore the sixth month, the danger from haemorrhage 
is hefore the expulsion of the placenta and membranes; 
while after that date dangerous haemorrhage usually 
occurs after the after-birth has been expelled. If this 
statement be fixed in the mind, it will be a valuable 



"^ TEEATMENT OF ABOETIOlSr. 233 

guide to tlie practitioner in tlie treatment of tliat acci- 
dent. 

Before the sixth montli medicinal remedies cannot 
permanently clieck haemorrhage previous to the dis- 
charge of the placenta. They may, for a time, exer- 
cise their specific effect over the Weeding vessels, but 
if the cause of irritation remains, the haemorrhage will 
soon return. Remedies like secede, or caulophyllum, 
will cause the uterus to contract firmly upon the pla- 
centa, or force it into the canal of the cervix, but if 
they do not effect its expulsion, the flooding will return. 
There is no safety for the woman until the whole pro- 
duct of conception has 'passed out of the uterus. 

After the sixth month severe hasmorrhage rarely 
occurs while the placenta remains in the womb, and it is 
thewant of proper contraction in that organ which causes 
the flooding. In tliis case, medicines may be used to 
advantage, in connexion with the application of cold or 
hot water, as before mentioned, but the tampon should 
never he used. The remedies most generally useful in 
post-partum haemorrhage after the sixth month, are. 
Secede, ccmlopliyllum., macrotin, erigeron, ipecac, etc. 

There are other measures which may be resorted to 
in dangerous and severe cases. 

Dry cupping over the lower lumbar vertebrae, is said 
to cause firm and persistent uterine contractions. 

Gcdvanisni, when applied in a proper manner, has 
been successfully used in cases of alarming haemorrhage. 
One pole should be applied to the os uteri, or pubes — 
the other to the sacral or lower lumbar region, and an 
interrupted current passed through the uterus. Firm 
contraction is said to immediately ensue. 

The same means adopted for the arrest of haemor- 
rhage during the last three months of pregnancy, are 



234 HALE OlSr ABOETIOlSr. 

the most useful ones to facilitate the expulsion of the 
contents of the uterus. The same contractions which 
expel the placenta will prove efficient for the preven- 
tion of flooding, if they continue for a proper length 
of time. 

As regards the management of the after-birth (and 
by after-birth is here meant all decidual or placental 
substances left after the expulsion of the embryo or 
foetus), it will be considered in a separate chapter. 



SECTION yiii. 

CONDUCT OF THE PHYSICIAlSr. 

The medical man who is called upon to attend a case 
of Abortion, occupies a peculiar and anomalous position. 
There are three classes of cases with which he has to 
deal, and each requires a different method of action on 
his part. The first^ are married women of respect- 
ability, in whom the abortion has been brought on by 
accident, or some of the diseases mentioned among the 
causes enumerated. In these instances there is usually 
no hesitation on the part of the patient in admitting to 
the physician the nature of the illness, and she may not 
have any objection to its publicity among her friends 
or neighbors. In some cases, however, women of sensi- 
tive minds are averse to having a knowledge of the 
character of the sickness made known even to their 
nearest friends. In these cases, the evident duty of the 
physician is, if he has timely notice, to use all the 
means at his disposal to save the life of the child and 
arrest the progress of abortion, if he can do so with per- 



TREATMENT OF ABORTION. 235 

feet safety to the mother ; or, if called too late, he must 
exercise his highest skill in conducting the abortion to 
a safe conclusion, and afterwards proceed to effect a 
cure of the disease (if any existed) which acted as a 
cause of the accident. 

The second class comprises married women who en- 
tertain wrong ideas concerning their duty, and imagine 
that lack of means, ill health, or other adverse circum- 
stances are sufficient reasons why they should not bear 
children. This, together with a wish to shirk the 
trials and responsibilities of maternity, as well as a 
desire to lead easy lives, or lives of fashion and luxury, 
leads them to take measures to prevent the fruit of con- 
ception from reaching maturity. To accomplish this 
they resort to quacks, charlatans, or unprincipled women, 
who are accustomed to indujce abortion ; or use the va- 
rious nostrums so shamelessly advertised in many 
periodicals, or the instruments which are in the hands 
of so very many of the women of this country. The 
abortion produced by any of the above means, they at- 
tempt to endure the suffering, and risk the danger, 
rather than call a physician and thereby have their 
criminal conduct known to the medical attendant, or 
their own family. Such patients, when they do call a 
physician, attempt to hide from him the real nature of 
the malady, and hope that he will treat the case suc- 
cessfully without a knowledge of the actual nature of 
the case. They will call it a dysmenorrhoea, an injury 
from a fall, etc., or a simple menorrhagia, and it re- 
quires considerable tact to ascertain from them the 
facts. 

In these cases, the physician should come to no hasty 
conclusion, married women rarely seek aid for an attack 
of dysmenorrhoea or menorrhagia, and is is a good rule 



236 HALE OTT ABOETION.^ 

to suspect tlie occurrence of an abortion when called to 
attend sucli alleged cases. If tlie woman denies that 
there is any haemorrhage, as they will often do, or de- 
clares the attack to be colic or dysentery, then the 
trouble of detecting the real disease is much more diffi- 
cult. But the facts being ascertained, (see " Examina- 
tion of the Patient,") the causes of the abortion, as well 
as the symptoms present should all be taken into ac- 
count, and the case treated as above advised. 

The tliird class are those unfortunate women, married 
and unmarried, the victims of the seducer, or of their 
own perverted passions, who have stepped aside from 
the paths of virtue, and with the frailty which pertains 
to humanity, transgressed the laws of God and man. 
In such cases the honorable physician is placed in a 
very delicate and trying position. The patient has 
perhaps applied to him to rid her of the consequences 
of her sinful conduct, but upon his refusal to do a crim- 
inal act she has resorted to some of the unlawful means 
mentioned above, and brought about the impending or 
actual abortion. In such cases it is difficult to decide 
what should be the conduct of a physician in one res- 
pect : namely, should he attempt to arrest the abortion, 
and thereby bring the mother to inevitable shame and 
save the life of an illegitimate child, whose unnatural 
parentage will be a disgrace all through life ? Probably 
the best and most consistent conduct for the physician 
to adopt, should be to simply let outraged nature take 
her own course, and only interfere by warding off those 
symptoms which threaten the life of the mother. 

In relation to the conduct of the physician during 
and after the abortion I have a few suggestions to 
make. There is a great lack of the proper honor and 
delicacy, regarding a mention of such accidents, both with 



TEEATMEISTT OF ABOETIOlSr. 237 

physicians and otliers. It is common for nurses, friends 
and physicians to say, that " Mrs. A. or B. has ' slipped 
upj'''' or to allude to the accident in some such vulgar 
manner. The unwarranted impertinence of neighbors, 
who insist upon knowing the nature of every woman's 
illness, is another reprehensible habit. It forces the 
physician to equivocate or divulge his patient's secret. 
The rule which should be invariably adopted by 
every medical man, is this : Whether in or out of his 
yatienfs room^ during her illness or after ^ no matter ivhat 
her condition in life, character or standing in society^ in 
shorty under any circumstances whatever^ he should avoid 
all mention of the occurrence of an abortion in his patient. 
If people are so devoid of good breeding as to ask im- 
pertinent questions, he is justified in equivocating to 
the extent of blinding the questioner. 



SECTION IX. 

EXAMINATION" OF THE PATIENT. 

To physicians who have had much experience in the 
treatment of abortion, I need not dilate on the impor- 
tance of ascertaining as soon as possible that an abor- 
tion is impending or in progress, nor need I mention 
the almost insuperable difficulty which exists in some 
cases, of satisfying ourselves during our first visits, 
whether the above accident is what we are called to 
treat. 

Patients belonging to the fwst class previously men- 
tioned, rarely cause us any trouble, but will frankly say 
to the medical attendant, "Doctor, I am threatened 



238 HALE OK ABOETION. 

witli an Abortion and would like to liave you arrest it 
if possible," or " I am having a miscarriage." This 
class will often intelligently acquaint us with the history 
of the case, the present and previous symptoms, and 
submit sensibly to all necessary examinations for the 
purpose of ascertaining the real condition. As there is 
always more or less nervous agitation attending such 
cases, manifesting itself especially when the physician 
is present, a few directions may not be amiss to the 
student or young practitioner. 

As it is customary for the messenger, if it is some 
relative, to acquaint the physician with the nature of 
the illness, it is to be supposed he will learn something 
of the nature of the case, either mth or without direct 
questioning, in which case he will feel somewhat pre- 
pared to meet his patient. Upon entering the room, after 
some brief salutations, he should quietly take a seat by 
the bedside of the woman, and place his fingers upon her 
wrist. Meanwhile the state of the pulse and the ap- 
pearance of the patient may be noted. If the pulse is 
weak or thready and the face and lips blanched, it is 
presumed that severe haemorrhage has occurred ; if, on 
the contrary, the pulse is full, hard or normal, and the 
face red or natural, there is irritative fever, general re- 
action, or only the premonitions of abortion, or actual 
abortion in the early months. We must not, however, 
judge too hastily, as the mental excitement of the 
patient may cause a suffused face and quick pulse. 

Generally the first appropriate question to the pa- 
tient or her nurse, is : " When did this illness begin?" 
next "What have been the symptoms until now?" 
There are instances, however, where the evident ex- 
sanguification should impel us to ask at once, " How 
long has she been flooding?" In some cases even, it 



TREATMENT OP ABOETION. 239 

will be found absolutely necessary, witLout asking a 
single question, to state to tlie patient or nurse what 
must be done, call for material for a tampon and use it 
immediately, and then ply the patient with active 
stimulants. 

So soon as the immediate danger is over, or an abor- 
tion is ascertained to be progressing, the physician 
should inquire if the foetus and placenta have been ex- 
pelled. This is a point upon which the closest inves- 
tigation is necessary. We are often informed, that 
"every thing has come away," when in fact the patient 
or her nurse has seen only the foetus and clots of blood, 
or perhaps nothing but a mass or masses of coagula. 
Not one patient or nurse in a thousand ever examines 
sufficiently the expelled substances. The foetus and 
after birth, at an early stage, may be passed, enveloped 
in large coagula, and altogether escape superficial 
scrutiny, or neither may be present, yet are supposed 
to be from the general appearance of the mass. 

It often becomes necessary to have the substances 
extruded, produced, that we may examine carefully 
their character. Each clot should be broken and its 
interior examined for embryo or placenta. If we can- 
not satisfy ourselves on this point, we must rest in un- 
certainty until an examination can be made. If one 
fact, however, is borne in mind, it will greatly aid us 
in forming our opinion, namely, before the sixth month 
hcemorQ'hage Tarely, if evei\ occurs, after the placenta is 
expelled. The expulsion of the foetus alone, only causes 
a subsidence of the pains for a time ; it does not have 
any influence over the arrest of haemorrhage. 

We have supposed cases where the abortion was ad- 
mitted, or was evident at first. 

The second and third classes are more difficult to treat, 



240 HALE OK ABOETION-. 

because of tlie obstacles thrown in tbe way of a proper 
knowledge of the case. 

A. physician is called to see a woman. He has no 
intimation of the nature of her illness. She is said to 
be in " great pain " or " very sick." She says to him, 
" I want relief from the pain across me," or " I have a 
colic." She will state it is from a cold, and assert that 
it was from a suppression, or intimate that she has been 
regular, and the attack is only dysmenorrhoeal. A 
woman who has determined to hide her shame will use 
every subterfuge that cunning and equivocation can 
devise. She will deny the presence of flooding, even 
when her exsanguined appearance plainly indicates the 
fact. The character of the pain will be an indication 
to the watchful physician. But an ordinary colic is 
often intermitting, as also are the pains of dysmenor- 
rhoea or dysentery. 

The only way we can, in some cases, arrive at a cor- 
rect diagnosis, is to seem to assent to the assertions of 
the patient, while we are questioning in relation to 
symptoms which, while they seem unimportant to her, 
are valuable indications to us. When we are satisfied 
than an abortion is in progress or impending, we should 
not hesitate to acquaint the patient with our convic- 
tions, in a courteous but decided manner. Instances 
are not rare, where careless or ignorant physicians have 
attended cases of abortion during the first half of gesta- 
tion, under the idea that they were cases of enteralgia, 
enteritis, dysmenorrhoea, or even dysentery ; the woman 
succeeding perfectly in hiding the evidences of the mis- 
carriage. Every physician should be on the alert and 
not allow himself to be caught in such a mortifying 
predicament. Finally, in an examination of a patient, 
it should be remembered, that no matter what her social 



TEEATMENT OF ABORTIOlSr. 241 

condition, lier character, or the character of those 
around her, the sick-room is no place for unseemly or 
rude jests. No coarse allusions or indelicate remarks 
should be indulged in or alloived by the physician. No 
one having any regard for manly or professional dignity 
will countenance such conduct. All manual examina- 
tions should be conducted with delicacy and gentleness, 
without any unnecessary exposure of the patient. If 
instruments are used, all unnecessary flourish and exhi- 
bition should be avoided, for these are the tricks of 
quacks and ignorant pretenders. 



SECTION X. 

MAISTAGEMENT OF LABOR. 

" Abortion," says Professor Hodge, " is a true labor. 
The two characteristic peculiarities are-^first, that there 
is no placenta, but the whole merabrana decidua is in 
close and vascular connection with the internal surface 
of the uterus."^ Dr. Hodge restricts the term abortion 
to an expulsion of the ovum before the fourth month, 
after which period the placenta is formed, and the deci- 
dual membranes are separated from the uterine surfaces. 

The practitioner, when called to attend an abortion, 
should go prepared to meet any emergency which may 
arise. If he neglects this, and the woman dies, or suf- 
fers from dangerous symptoms which might have been 
remedied by the proper medicines and instruments, he 
is culpable in the highest degree for his criminal care- 
lessness or ignorance. 

* System of Obstetrics, page 464. 

16 --^ 



242 HALE ON ABOETION. 

He should take with liim, besides Ms ordinary pocket- 
case of remedies, some crude ergot freshly prepared, or 
a reliable vinous tincture ; or the first decimal tritura- 
tion of caulopliylUn ; some oil of erigeron^ tV ; a blunt 
hook, or abortion forceps ; and a piece of charpie, or a 
sponge, to use as a tampon. If the physician has a 
well-regulated office, all these can be collected in a 
moment. Their possession may be of invaluable ser- 
vice to him, and enable him to save the life of bis 
patient, and his own reputation, both of which might be 
lost while a messenger was riding miles away to procure 
the articles desired. 

The treatment of the premonitory symptoms has 
already been laid down ; also the treatment of the 
symptoms, such as haemorrhage, etc., which may occur 
during the progress of an abortion. 

The management proper of the different stages, will 
now be considered. 

If, upon examination, the os is found closed, no 
haemorrhage, and no change taken place in the body of 
the. uterus, except some descent of that organ in the 
pelvis, and some unusual turgescence and fullness of the 
pelvic viscera, such as simple organic irritation would 
cause ; the physician can do no more than to prescribe 
the appropriate remedy for the condition, and give the 
proper directions relating to diet and posture, and leave 
the patient for the time. (See Treatment, page 218). 
If, however, nervous irritation or contraction has ensued, 
and the neck of the uterus is found developed at the 
upper part, it will indicate a partial descent of the 
ovum into the canal of the cervix. If this occurs, the 
conical form of the lower portion of the uterus will be 
found considerably altered — it will have become more 
spherical. Dr. Lee states that, in all such cases, expul- 



TEEATMENT OF ABOETION. 243 

sion will surely follow. This termination will be still 
more probable if, in addition, the os uteri is found par- 
tially dilated, and especially if a portion of the ovum 
be found protruding. There are cases, however, espe- 
cially in multiparous women, where the internal os 
remains contracted, while the external is soft and some- 
what patulous. In these instances, if alternate pains be 
not severe, there is ground for hope that the ovum will 
be retained. 

If, with the above condition, there is still no haemor- 
rhage, the patient may be left as before, under tlie use 
of the remedies, etc., appropriate to the symptoms and 
state. The remedies indicated are — gelsemmum^ cimici- 
fu{/ci, caulophyllum, gossipium and secede^ from the 3rd 
dilution upwards. It is in this condition that full doses 
of opium have been found most useful by the old school, 
and also even when haemorrhage is present. (See case, 
page 223). 

The best position for the patient to assume, is on the 
back, with the hips elevated, unless in case of retrover- 
sion, when the woman should lie on the face. Again, 
if it be positively ascertained that the ovum is blighted, 
that the liquor amnii is evacuated,^" that the haemor- 
rhage is profuse, and regular alternating pains are 
established, and especially if the measures for preven- 
tion have been inefficient, the practitioner should favor, 
not retard, the expulsive process; and, at the same 
time, render it as easy and as safe as possible. 

In this place I must advert to my division of utero- 
gestation into three stages, for the management of this 
expulsive stage of abortion, must be varied with each 
stage of pregnancy. 

* This occurrence is rare at the early months, as, in a great number of 
cases, the ovum is discharged entire ; and in all instances the quantity of the 
amniotic fluid is so small that, when discharged, it escapes notice. 



244 HALE OE" ABOETIOK. 

In the first stage, it is rare tliat we find raiicli dilata- 
tion of the OS uteri, or can find the embryo presenting. 
Should we detect the embryo engaged in the canal of 
the cervix, or even in the vagina, it is not best to re- 
move it, for its presence in either canal may be useful 
in exciting uterine contractions ; while its removal can 
do no good, but rather retard the progress of labor. Its 
presence in the cervical canal may also be useful in 
preventing hemorrhage, acting as a plug. We should 
not leave the woman in this condition, without placing 
a tampon m situ^ for fear that hsemorrhage occurs in 
our absence. The presence of the tampon will be of 
service, too, in hastening the termination of the expul- 
sive process. 

The delivery of the after-birth, or secundines, which, 
in this stage of pregnancy, consist only of the decidual 
membranes, is the most important duty of the physi- 
cian. It is difficult to accomplish this with the ordinary 
wire crochet, or blunt hook, owing to the delicacy of 
the membranes, and their general adherence to the 
uterine walls. Neither can we rely upon those uterine- 
motor medicines (caulophyllin, ergot, etc.) for, in this 
stage, the contractile power of the uterus is small, owing 
to the undeveloped condition of its muscular tissue. 

We must either allow them — if not thrown off by the 
efforts of nature — to decay, and pass away in a fluid 
state, or extract them by instrumental means other 
than the hook. The intra-uterine placental forceps, 
to which I have alluded on another page, may be used ; 
or the " abortion forceps," originally recommended by 
Levret, or Hodge's forceps, " the blades of which," he 
says, " are so arranged that they may present the form 
of a lever, allowing their easy introduction through the 
cervix into the uterus, exterior to the ovum." (It is 



TEEATMENT OF ABOETION. 245 

only in the third month, or after, however, that such an 
an instrument can be used.) But, probably, the instru- 
ment best adapted to remove the contents of the uterus, 
if the OS and cervix are dilated so as to admit the finger, 
is the " abortion vectis," which I have invented. It is, 
it is true, only a modification of Hodge's "lever and 
crotchet," but it is specially adapted for the removal of 
the embryo in this Jirst stage. The lever and crotchet 
combined, is better adapted for use in the second stage. 




ABOETIOlSr VECTIS. 

The abortion vectis can be insinuated into the uterus, 
betwen the embryo and the uterine parietes, and, with 
careful oscillating movements, we may separate the ovum 
from its adhesions, and generally withdraw it entire. 
So soon as this is accomplished, haemorrhage and pain 
will cease, and the abortion is at an end. If, however, 
even a small portion of the membrane is left in the 
womb, it will, in certain constitutions, act as a local 
irritant, keeping up pain and haemorrhage, until it has 
disintegrated and passed off; or, its absorption may 
cause irritative fever, which must be treated with 
sulphite of soda, hapiisia, arsenicum, or chlorate of 
potash, internally, together with injections of chlorate 
ov per-manganate of potash, or haptisia, into the interior 
of the uterus, to wash away the offending substance, 
and act as a local disinfectant. The instrument best 
adapted for this purpose is a hard rubber syringe, 
holding two ounces, and provided with an extra long 
and slender pipe. 



246 HALE ON ABOETION. 

If tlie abortion occurs during tlie second stage of 
pregnancy, tlie management of the labor differs some- 
what from that of the first stage. The delivery of the 
embryo-foetus should be left to nature, as recommended 
in the first stage, and for the same reasons, the delivery 
of the placenta and membranes may have to be as- 
sisted in a somewhat different manner. After the 
third month the placenta is perfect, and is attached 
to the uterus, while at the same time the decidua 
ceases to be in such contact with the uterine wall as 
in the previous stage, the circulation between the 
mother and child being carried on solely through the 
placenta. 

In this stage, abortion may occur with complete 
detachment of the whole placenta at once, in which 
case the embryonic mass drops into the lower segment 
of the uterus, and may be expelled entire, as in the 
first stage. Oftener, however, the membranes are rup- 
tured, and the foetus escapes while the placenta retains 
its connections. In other cases we may have ab- 
normal adherence of the placenta, in which instance the 
contractions of the uterus, though sometimes quite 
powerful, are insufiicient to detach it. Here the 
"abortion vectis" will form a valuable instrument, if 
the OS is open sufliciently to admit of its introduction. 
After it has been detached, however, the blunt or 
looped hook or forceps will form the best instrument 
for its extraction. 

If the OS is not sufliciently dilated we may use the 
tampon, and give gelse'niinum or helladonna until dila- 
tion occurs. We may then have to administer ccmlo- 
])hylUn^ or ergot^ the former in doses of two to four 
grains of the tV^li, the latter in the officinal dose given 
from time immemorial — namely, one drachm to a tea- 



TEEATMENT OF ABOETIOK". 247 

cup of hot water, taken at four draughts fifteen minutes 
apart. Those who think the 3rd or 30th attenuation 
will answer as well are allowed their opinion. 

An adherent placenta, remaining in spite of the 
efforts of nature or art, is supposed to be the origin of 
molar or hydatid masses. But it quite often happens 
that the whole placenta undergoes putrefactive disin- 
tegration, or the portions left after instrumental inter- 
ference, decay ; in which case we may have foetid dis- 
charges and irritative fever, previously alluded to and 
treatment given. 

The management of labor after the sixth month 
{tliird stage of pregnancy), is essentially the same as 
recommended for labor at full time (see standard works 
on Obstetrics). I Avill only add a few observations to 
refresh the memory of the practitioner, namely : 

The expulsion of the ovum may here be aided by 
the internal use of uterine motor excitants ; by instru- 
ments; and by remedies Homoeopathic to non-relax- 
ation of the OS and soft parts. 

The delivery of the placenta may be aided by trac- 
tion with the cord (which cannot be done in the earlier 
months), by GaulophylUn^ ergot^ etc.; and by the instru- 
ments heretofore named. 

The haemorrhage must be arrested with ergot^ cold 
water, galvanism, dry cupping, erigeron^ the tight band- 
age, etc., as recommended in cases of natural labor. 

Here the tampon should never he used^ nor those 
remedies recommended for haemorrhage during the 
first stage. They are not often adapted to the patho- 
logical state upon which post-partum flooding depends, 
and will generally prove insufficient. 



248 HALE ON ABORTIOISr. 



SECTION XI. 

SEQUELS OF ABOETION. 

The post-pa7'tu7)i treatment of abortion, altliougli not 
of the same importance as the remedied, is a subject 
wMcli should be fully considered. I believe it has not 
received that attention from physicians which the sub- 
ject demands. 

The i)ost-2xirtwn treatment may be properly divided 
into 

(ft) Postural. 

(b) Dietetic. 

(c) Medicinal, 
(e) Meclianical. 

The 'postural treatment is altogether too much neg- 
lected by a great majority of physicians. 

It is too often the case that a patient who has had 
an abortion during the first, or even second stage of 
pregnancy, is allowed by the attendant to rise from her 
bed the next day, or a few days thereafter, and attend 
to her household duties or recreations. I have known 
women engage in severe work or exercise, or attend 
parties or balls, but a few days after an abortion in the 
second month. The physician has a responsibility in 
this matter. It is his duty to state to the patient, her 
nurse, or certain members of the family, the importance 
of the recumbent posture for a certain length of time 
after the delivery. This period varies somewhat with 
the period of pregnancy in which the abortion has 
occurred. 



TEEATMENT OF ABORTION. 249 

It depends, too, in a great measure, upon the severity 
of the symptoms during the progress of the abortion, 
and upon the constitution and morbid conditions of the 
patient. 

Abortion in the first stage of pregnancy is rarely 
attended with great loss of blood, the pain is not very 
severe, and consequently, the strength of the woman 
is not much exhausted. But an engorged condition of 
the uterus is generally present, and if the woman is too 
soon and too often on her feet, or sits up too much, the 
womb is inclined to sink into the pelvis, and a pro- 
lapsus or retroversion ensues. 

If the abortion has been short in its duration, and 
the symptoms few and not severe, confinement to the 
bed or couch need not continue more than four or 
five days. If, however, getting up and standing or 
walking for an hour or two causes any local uneasi- 
ness in the back or abdomen, the recumbent posture 
should be maintained a portion of the time for several 
days longer. 

If, on the contrary, the symptoms have been severe ; 
there has been much haemorrhage ; a slow expulsion 
of the embryo, or its retention in utero ; or if it is 
found on examination that the uterus or its cervix is 
congested, or the os lacerated or abraded, explicit 
directions should be given not to allow the patient to 
sit up or stand on her feet more than a minute or two 
at a time until eight or ten days have expired. The 
woman who leaves her bed under these circumstances 
before that time, does so at the imminent hazard of her 
future health, and perhaps her life. 

During the second period, the postural treatment of 
patients who have aborted is of still greater impor- 
tance. As it approaches the sixth month, confinement 



250 HALE ON ABOETIOT^. 

becomes more and more hazardous, and its sequelae 
more like those of labor at term. 

Hsemorrhage, when it occurs, is more apt to be pro- 
fuse and exhausting, the labor more tedious and dan- 
gerous, and the after treatment more important. It is 
believed by practical and observing physicians that 
cancer of the uterus, ulceration of the os and cervix, 
chronic metritis, prolapsus and retroversion, frequently 
occur from a too early assumption of the erect position 
after abortion in the middle period of gestation. In 
nearly every case, should the symptoms appear ever so 
slight and unimportant, the woman should keep her 
bed for a week after the labor has been completed. 
There are certain cases, however, where the placenta is 
retained; but the patient improves in streugth and 
health notwithstanding. The placenta may not be 
expelled for weeks after the woman has left her bed, 
no decay or putrefaction having taken place. In these 
cases, we cannot, of course, confine the patient to her 
bed until its expulsion occurs, nor would it be proper 
to do so. 

If severe haemorrhage, congestion, or inflammation, 
or irritative fever has occurred, the patient should on 
no account get up until the twelfth day, even if she 
feels perfectly able to do so. In these instances, how- 
ever, the woman has not the power of rising, even if 
she desires to, such is the local pain, general weakness, 
vertigo, etc., which is caused by the effort. 

If the accident has occurred during the last three 
months of pregnancy, nearly the same rules, last men- 
tioned, should govern us in our postural treatment. 
The same directions should be given as would be 
proper after delivery at the ninth month, as the patho- 



TREATMENT OF ABORTION. 251 

logical conditions wliicli ensue are nearly the same as 
at the latter period. 

Dietetic. — The diet of the patient who has suffered 
an abortion is not an unimportant item. Its character 
will depend on the condition of the system. If fever 
is present, due to any local inflammation, the aliment 
should be very light, easily assimilable, and bland. 
Toast water, rice gruel, flour or farina porridge, light 
toast or crackers, together with cooling beverages, will 
be best relished by the patient, and most appropriate. 
If the fever is irritative, from local irritation or the 
absorption of morbid matters into the circulation, the 
food allowed should be of a more nutritious character. 
Milk, rice, toast, animal broths, beef-tea, wine and 
whey, cocoa, etc., may be allowed. The physician 
should be careful to form a connect diagnosis in these 
cases, and not mistake the iTritahle pulse of this con- 
dition for the quick, hard pulse of fever from inflamma- 
tion. 

If the patient has lost much blood, or been greatly 
reduced by the length of the illness, or prostrated by 
the irritative fever which has attended it, the diet will 
have to be not only exceedingly nutritious, but sufii- 
ciently stimulating. We shall be under the necessity 
of ordering milk-punch, egg-nogg, beef-tea, mutton-broth, 
soups, all such meats as the patient can relish, and 
allow her to take them in such quantities as her condi- 
tion requires. It is very necessary in these cases to 
give the nutriment at short intervals. If food is given 
every two or three hours, the quantity taken will be 
less, and the stomach is not so liable to be overloaded. 
Dr. Inman states that he has seen cases where it was 
necessary to administer to the patient concentrated 
nutriment every hour, in order to prevent dangerous 



252 HALE OlSr ABOETIO]Sr. 

prostration. It is Lardly necessary to caution against 
allowing indigestible articles of diet, among whicli may 
be mentioned raw apples or other uncooked fruits, 
pickles, salt meats or iisli, pastry, confectionery, etc. 
In tMs category might be placed ice-cream, were it not 
that this article is often allowable, especially in cases 
of great prostration or irritative fever, where there is 
present great thirst, dryness of the mouth, and a desire 
for cooling drinks. It may be given in small quanti- 
ties, a spoonful at a time, and allowed to be slowly 
melted in the mouth. If taken in too large quantities, 
or too hastily, it may give rise to colic and even 
spasms. 

The medicinal treatment of the sequelse of abortion 
will depend upon the nature of the pathological condi- 
tion, and the symptoms present. 

These sequelae have, the most of them, been de- 
scribed, and their treatment given, in that part of this 
work devoted to the causes and their treatment. There 
are other maladies, which are not mentioned ; but which 
properly belong to the consequences of abortion. They 
are, pelvic cellulitis ; hypertrophy of the uterus ; fis- 
tulae, (vesical, uterine, or between the organs alluded 
to) ; adhesions of the os and vagina, rendering liable 
subsequent rupture of the womb during labor or from 
retained menses, or, in the latter case, discharge of the 
secretion through the Fallopian tubes and consequent 
peritonitis; and, finally, inflammation of the mammae, 
puerperal metritis, phlebitis, dropsy, and paralysis of 
the lower extremities. Others might be named ; but 
it would sAvell the list to an extent incompatible with 
the limits of this treatise. 

The medicinal treatment of these sequelae will be 
briefly alluded to. 



TREATMEISTT OF ABORTIOlSr. 253 

Pelvic ceUulitis will require those remedies which 
favor resolution or healthy suppuration, namely : Mer- 
curius^ belladonna, 7ie])ar sulph.^ and pliytolacca. In 
some cases the abscess will have to be punctured to 
give vent to the pus, which, if confined, would burrow, 
and create troublesome complications. 

Hypertrophy of the Uterus. — I have observed in 
many cases of abortion before the sixth month, a large 
increase in the size of the abdomen in the hypogastric 
region. It was not ascites, for external examination failed 
to detect the fluctuation found in dropsy, and moreover 
the urinary secretion was normal in quantity. An 
examination of the uterus showed it to be much 
enlarged — often much larger than before the abortion. 
I believe this to be a serous infiltration into the uterine 
parieties, superadded to that condition which Professor 
Simpson has described as '' Sub-involution of the Uterus." 

I have treated such cases successfully with sepia, 
arsenicum, Jcali hromatum and hali hydriodicum. 

FistuloB, adhesions, etc., will require the attention of 
the skillful surgeon ; but they may be prevented by 
proper attention on the part of the physician, who, if 
he has the least fear of such consequences, should 
make occasional examinations, and by placing a dilator 
in the os, or pledgets of lint in the vagina, prevent 
such evils. 

Inflammation of the Mammce. When the abortion 
has occurred after the third month, it is not unusual 
for milk to be secreted. When this happens it will be 
necessary to arrest the secretion as soon as it can be 
safely done. This end is best attained by prescribing, 
for internal remedies, Jcali hyd.Hodatum, phosphortis and 
'magnesia sulphurica ; and externally embrocations of 
aconite-water (3j to 3J), pjhytolacca, helladonna, or 



254 HALE OlSr ABORTIOlSr. 

iodide of potash^ ia ointment or solution. If, from 
neglect, or in spite of these means, inflammation and 
abscess supervene, adopt tlie treatment herein-before 
recommended. 

Puerperal metritis will require veratrum viride^ hellor 
donna^ stramonium^ cimicifuga^ and external applica- 
tions of aconite. 

Puerperal peritonitis.^ tlie same remedies. (This dis- 
ease is not of such frequent occurrence as is believed. 
It is often confounded with myalgia.^ which requires 
caulophyllum^ mix vomica^ cimicifuga^ helonias^ china 
hryonia^ and colocyntli^ with external applications of a 
lotion oi gelseminmn or arnica?). 

Plilebitis calls for arnica^ helladonna^ and liamamelis^ 
— the latter externally applied if possible. 

Dropsy after abortion is removed by apocynum can- 
nahinwm^ eupatoriwm purpureum, apis mel.^ cantharis^ 
senecio aureus^ and arsenicum. 

Paralysis of the lower extremities will yield to can- 
lopliyllum^ liedeoma^ nux vomica^ ignatia^ citrate of iron 
and strychnia., secale^ and msculus glabra. 

Mental aberrations are not uncommon after abortions, 
and may proceed from reflex influences, or from grief 
or remorse. These will require careful symptomatic 
treatment. One of the best remedies for the mental 
depression following abortion is the cimicifuga^ which 
has been successfully used by Professor Simpson, and 
lately by myself. 

One of the most common of the sequelae of abortion 
is prematu/re and profuse menses. They sometimes 
occur every three weeks ; sometimes every two weeks. 
Although sabina^ ipecac^ sidphur^ ^-^^ platinum are fre- 
quently indicated and successful, I have been most suc- 
cessful, in fact in nearly every case, with senecin and 



TEEATMENT OF ABOETION. 255 

calca/rea carh. In these, as in some other instances in 
our practice, neither seems to be as useful alone, as 
when used in alternation. 

I usually prescribe the senecin in the second decimal 
trituration, a dose every afternoon and evening, and a 
single dose of calcarea, third trituration, every morn- 

It is best to give tbese remedies, beginning just after 
the last menstrual period, and continuing them until 
the next regular period, unless the menses are prema- 
ture, in which case they may be superseded by ipecac 
or sabina during the flow. 

It is rare that the second period will be premature 
after beginning the use of the above remedies. 

Chronic menorrJiagia of a very obstinate character 
sometimes follows an abortion. It may arise from 
atony of the uterus, from irritability, or from a condi- 
tion of the lining membrane, described by some writers 
as consisting of an enlarged and hypertrophied state of 
the villous coat, — a kind of fungous growth of its pa- 
pillse, from which blood oozes upon the least irritation. 

For atonic conditions, we should use helonias^ trilUum^ 
secale^ aletris^ terebinth^ sulphuric acid^ and sahina^ in 
the lower dilutions. 

For irritation, sabina. caulophyllum^ platina^ etc. The 
last cause of menorrhagia can only be cured by abso- 
lute rest and a long course of treatment, with carefully 
selected remedies, among which may be mentioned 
erigerorij secale^ trillium^ calc.^ senecio^ china^ ferrum^ 
Pulsatilla^ etc., unless we resort to local applications to 
the diseased surface, applied with the intra-uterine 
syringe. 

Several cases have occurred in my practice, which 
persisted for many months, notwithstanding the use 



256 HALE OK ABORTION. 

of all the most approved medicines recommended for 
menorvliagia^ until topical means were resorted to. 
One case I cured with, injections of tinctura ferr. muri- 
atis^ 10 drops to 3J of water, half of which was used 
once a day. After the third day, the haemorrhage 
ceased, and did not return. In another case the ^96r- 
nitrate of iron^ was used successfully. 

The mecJianical treatment includes those appliances 
which will serve to prevent the occurrence of uterine 
displacements, or the closure of the vagina or os uteri 
by adhesions. 

A prolapsus may be prevented or cured by the same 
means, together with cool injections containing hama- 
meJis^ mix vomica^ or Jielonias^ the use of cool hip baths, 
and^ the hypogastric bandage. 

For the prevention of adhesions, the vagina and 
uterus should be examined, in cases where excoriation 
or laceration is supposed to have occurred, to ascertain 
if the vaginal and cervical canals are normally open. The 
finger will do to explore the former, the sound the latter. 
If a closure is to be found, pledgets of lint, or pieces of 
linen spread with calendula cerate on both sides, should 
be introduced and kept in situ till the danger has 
passed by. 

For ret/i^oversion I do not hesitate to use the closed 
lever pessary or the ring, as seems best indicated, and 
have thus prevented in many cases the uterus from 
assuming a retro verted condition, which it had attained 
previous to the abortion. 

In my pamphlet on Retroversion and Retroflexion of 
the Uterus (page 2), I alluded to the fact that that 
form of displacement was a frequent cause, accompani- 
ment, and consequence of abortion. I advert to it 



TEEATMENT OF ABOETION. 257 

again because tlie subject is too important to be lost 
siglit of by the practical physician. 

As a cause of abortion, it has been fully treated of in 
the foregoing pages. As an aGC07npam'ment, I did not 
mention it to the extent I intended to do. A flexed or 
retroverted uterus is one of the chiefest obstacles to the 
natural expulsion or extraction of the placenta or any 
of the products of an arrested conception. Coagula of 
blood even are sometimes retained a long time in the 
cavity of the uterus from this cause alone. 

When the foetus dies, or the membrane becomes de- 
tached from the womb, that organ sinks in the pelvis, 
and if any tendency to retroversion exists, that accident 
is pretty sure to occur. In this case the expelling power 
of the uterus is altogether destroyed, and it strives with 
unavailing efforts to throw off its contents. A single 
glance at the anatomical peculiarities of the uterus will 
show us how futile these efforts must be. A hollow, 
pear-shaped muscle is flexed at its neck, or almost 
doubled upon itself. In this condition the severest 
spasmodic action of its muscular tissue becomes utterly 
useless. I have known the most intense spasmodic 
pains to continue day after day, weary the patient out, 
and no good result until the uterus was replaced and 
kept in a normal position until the offending placenta 
was expelled. A case which occurred in my practice 
not long since, so aptly illustrates this subject, that I 
cannot forbear giving it. A delicate, nervous woman, 
who had had several miscarriages, attended with retro- 
version, for which she had been treated by several 
physicians of eminence in our school came under my 
care. On one occasion, she had lain several weeks with 
a retained placenta, from retroversion, suffering in the 
meantime from metritis, spasmodic pains, etc., until 
17 



258 HALE OK ABOETION. 

tlie uterus was held in its proper position by a ring 
pessary, when the placenta came away in a horribly 
putrid state of semi-liquid putrescency. 

In the instance in which she came under my care, 
the foetus (of three months) was expelled ; the 
pains ceased for nearly a day, but returned severely 
after she had imprudently made considerable effort at 
stool. After the pains had lasted several hours, I was 
called, and found them very agonizing and spasmodic. 
On exaimnation, the uterus was found almost completely 
retro verted. Not having with me a sound^ I left some 
mother tincture of caidophyllum^ ten drops to be taken 
every half Kour until I returned. Not getting relief 
in two hours, she took, on her own responsibility, a 
teas])oonful of the tincture at a single dose. The pain 
ceased altogether in fifteen minutes ! This action of 
caulophyllum should not surprise us, for it is semndarily 
Homoeopathic to sj)asm, in which case we know it 
often requires massive doses to prove curative. On 
getting on her feet again, however, the pain returned 
with its original intensity. On my arrival, the uterine 
sound was with much difficulty introduced, and with 
considerable effort the uterus was lifted into normal 
position. Knowing that it would become retro verted 
immediately if the sound were withdrawn, I introduced 
a curved elastic pessary while the sound was still in the 
uterus. This can be done by any one familiar with 
the former instrument. The sound was then with- 
drawn, and the uterus elevated as much as possible. 
Ergot was given in the usual manner, and the placenta 
was expelled in less than two hours. All pain ceased, 
and the pessary was allowed to remain for eight clays, 
when the patient was discharged. 

There have been several cases, which I was obliged 



TEEATMENT OF ABOETION". 259 

to treat in the same manner, and in view of the uniform 
success which has attended the method, I do not hesi- 
tate to advise the insertion of the elastic curved or ring 
pessary, in every instance of retained placenta from 
retroversion. 

It will sometimes happen that this form of displace- 
ment will not occur until after the abortion has fully 
terminated with the complete discharge of the foetus, 
placenta, and membranes. The patient gets up too 
soon, and the effort of standing, or straining at stool, or 
lifting, causes the heavy fundus-uteri to fall backward. 
The attending physician should warn his patient of 
the nature and probable occurrence of the accident, and 
the means to avoid it. She should be instructed to 
report if certain symptoms obtain, that immediate 
measures for relief may be taken. As soon as the dis- 
placement is known to have occurred, the physician 
should enjoin the recumbent position, replace the organ 
by means of the processes hereinbefore described, and 
place the patient upon the use of iodide of iron, podo- 
pliyllum, nux vomica^ helonias, or belladonna, until the^ 
danger of a recurrence of the accident is passed. 



PART V. 



OBSTETRIC ABORTION. 



OBSTETRIC ABOETION. 263 



SECTION I. 



OBSTETRIC ABORTION. 



It would be a manifest omission, and detract largely 
from the value of tMs work, were I to leave out of it a 
full consideration of the subject of obstetric abortion, 
namel J : the conditions under which it is proper and 
necessary that labor should be brought on before the 
ninth month. 

I shall proceed to treat of this subject in three divi- 
sions, which will correspond with the three divisions 
of utero-gestation which I have heretofore described. 

Fi/rst. The various methods in use to cause expulsion 
of the contents of the gravid uterus, after the sixth 
month, and before the time for the normal termination 
of pregnancy. This is designated as premature labor. 

Second. The methods adopted to bring about the 
same results during the middle period of gestation, or 
from the end of the third to the end of the sixth month. 
This is termed /ce^a^ abortion. 

Third. The methods which may be used during the 
first three months after conception. This is embryonic 
abolition. 

The abormal conditions whicb make it necessary to 
resort to these operations will be mentioned. 

(1) Prematwe Labor. 

The subject of prematit/re labor cannot, in a work of 
this scope, be more than briefly mentioned. Every 
physician is supposed to have in his library the works 



264 HALE ONABOETION. 

of tlie most eminent obstetricians, in whicli will be found 
all the information required on this point. 

Premature labor is an operation by which the lives 
of both mother and child may be saved. It is only 
admissible to resort to it in cases where the child can- 
not be born alive unless by the dreadful operations of 
the Cesarian section or symphyseotomy, both of which 
endanger the life of the mother in the highest degree ; 
also in cases where delivery is only possible by embry- 
ulcia, or the extraction of the foetus by fatal mutila- 
tion. 

Premature labor is restricted to that period subse- 
quent to. the " viability " of the fcetus. This period is 
technically included within the last three months of 
pregnancy. There is but little hope, however, that a 
child, born in the sixth month of gestation, will sur- 
vive, although cases are on record where children 
have lived at six months. At the seventh month chil- 
dren often live, and quite generally in the eighth. 

The necessity for the induction of premature labor 
arises mainly from a dispropoiiion between the passages 
of the pelvis and the size of the head of the child at the 
full period of utero-gestation. At this time, it may be 
presumed that the bi-parietal diameter of the foetus 
measures at least three inches and four lines, and there- 
fore a living child can hardly be born, even by aid of 
forceps, unless there be three and a quarter inches in 
the short diameter of the pelvis. Embryotomy, or 
some other operation, would be the alternative. 

The same declaration applies to other sources of ob- 
struction than simple deformity, as in cases of exostosis, 
of ovarian and other tumors in the pelvis, of indurated 
or contracted vagina, and in those also of permanent 
induration, thickening or scirrhous of the os and cervix 



OBSTETRIC ABOETION". 265 

uteri, or where there are fibrous or steatomous tumors 
in the lower segment of the uterus, so located or so 
large that the delivery at term would be impracticable. 
Also, it may be applicable in cases where successive 
pregnancies have demonstrated that the child is born 
dead in consequence of the size of the head, and its very 
complete state of ossification. 

To estimate as nearly as possible at what period labor 
should be induced, the practitioner should examine care- 

First^ As far as practicable, the degree of deformity 
or obstruction which exists ; and, 

Secondly^ The usual length of the bi-parietal diame- 
ter during the last three months of utero-gestation. 

The modes of measuring the degree of deformity of 
the pelvis will be found detailed in the standard works 
on obstetrics. 

? As regards the diameters of the child's head, the fol- 
lowing tables, prepared by M. Figueira and E-itgen, 
will afford a proximate idea of the length of the diame- 
ters at the different periods of gestation ; although great 
allowances must be made for the relative development 
of different children, the uncertainty of the exact 
periods of conception, and, of course, of the stage of 
pregnancy, and for the flexibility or compressibility of 
the foetal head, so that a cranium apparently too large 
may or can be often safely delivered. 

Measurement of the bi-parietal diameter according to 

Figueira : 

In. Lines. 



At 7th month, 2 9 

"71 " 3 

"8th " 3 1 

"81 " 3 2 

"9th " 3 4 



266 



HALE ON AEOETIOlSr. 



According to Ritgen, labor may be induced at the 

In.L. 
29th week, or 6^ month, when the antero-posterior diam. is 2 7 



20th " 


6| 


31st " 


7th 


35th " 


8th 


36th " 


8^ 


37th " 


A 





2 8 




2 9 




2 10 




2 11 




3 — 



The best writers on obstetrics do not hesitate to 
assert, that, if the antero-posterior diameter of the brim 
be three inches and six lines, it will be justifiable to 
Induce labor prior to the full period — that it will be 
better for the mother, and far safer for the infant. 

Besides the above, which may be termed mechanical 
obstructions to labor at full time, there is another class 
of cases where the induction of premature labor is called 
for on account of the foetus alone. There are cases, 
where, from some diseased condition of the placenta, 
the child dies in utero before the end of the ninth 
month. These diseases have been mentioned in previ- 
ous chapters. There are other cases where the child 
dies during parturition, owing to a premature detach- 
ment of the placenta and consequent haemorrhage dur- 
ing labor. The remedy for such conditions is premature 
labor at a time prior to that at which the death of the 
foetus has usually occurred. 

There is still another class of cases where disease of 
the mother makes the operation justifiable, — namely, 
vomiting, chorea, mania, albuminaria, disease of heart 
and lungs, debility, etc. 

Vomiting. — Under the inhuman belief that the life 
of the child should be saved at the risk of that of the 
mother, women have been suffered to die from the effects 
of severe and protracted vomiting, or left to drag out a 



OBSTETEIC ABOETION". 267 

life of misery with clironic gastritis, or ulceration of tlie 
stomacli. Several obstetric writers claim that the in- 
duction of abortion is never necessary from this cause. 
Opposed to these, we have the testimony of Dubois, 
Stoltz, and others, who assert that this is oftener a dan- 
gerous occurrence than is supposed. M. Dubois recently 
stated before the Academy of MecVicine^' that, in the 
course of thirteen years, he had met with twenty cases 
in which vomiting proved fatal to pregnant women. 
Professor Stoltz of Strasburg relates four cases which 
came under his observation. In three of these death 
occurred, and life was saved by the operation in the 
fourth, although the case seemed hopeless. M. Dubois 
refers to the fact, that, when the process of gestation 
becomes arrested, whether spontaneously, or not, vom- 
iting is ordinarily put an end to, although the woman 
may not be delivered for several days after -of a dead 
child, and may yet die of the effects of what she has 
already undergone. Women, apparently at the point 
of death, have been saved by the spontaneous death of 
the foetus, this being expelled only some time afterward. 
There can be no doubt of the moral propriety of ter- 
minating gestation in certain cases of vomiting. " The 
difficulty," says M. Dubois, "is to fix the period at 
which this should be resorted to ; for it is the natural 
desire to delay this as long as possible, which delay often 
leads to a fatal result, the woman dying in fact from the 
exhaustion and prolonged abstinence, which the vomit- 
ing has produced, prior to the operation for arresting 
it being undertaken." Stoltz lays great stress upon the 
operation being performed in good time, because if we 
wait until the effects of the sympathetic reaction con- 
stitute in themselves a serious disease, the evacuation 

* Bulletin de I'Acad., torn, xvii., pp. 557-583. 



268 HALE OK ABOETIOE-. 

of the womb does not induce a cessation of these, and 
may, in certain cases, <i^en hasten death^ — life, so to 
say, hanging upon a thread. It is undoubtedly difficult 
to say ivJien the moment has arrived that we can no 
longer hope for benefit from nature or therapeutical 
agents. In Homceopathic practice, much may be reason- 
ably expected of the latter ; but their use should not be 
insisted upon too long. M. Dubois lays it down as a 
rule, " Never to undertake the operation when the signs 
of extreme exhaustion are present, as evidenced by con- 
siderable loss of vision, cephalagia, comatose somnolence, 
and disorder of the intellectual faculties. On the other 
hand, we should also abstain from operating when the 
vomiting, though violent and frequent, still allows of 
some aliment being retained ; when the patient, though 
wasted and feeble, is not obliged to keep her bed ; when 
the suffering has not yet induced intense and continu- 
ous febrile action ; and when other means still remain 
untried. In the first case we would not save our pa- 
tient, but perhaps accelerate her death, and bring dis- 
credit on the operation ; while in the other we would 
sacrifice a pregnancy which might have gone on till the 
full time. It is therefore the intermediate period which 
should be chosen, and this is characterized by the fol- 
lowing signs: — 1. Almost incessant vomiting, by which 
all alimentary substances, and sometimes the smallest 
drop of water, are rejected. 2. Wasting and debility, 
which condemn the patient to absolute rest. 3. Syn- 
cope, brought on by the least movement or mental 
emotion. 4. A marked change in the features. 5. Se- 
vere and continuous febrile action. 6. An excessive 
and penetrating acidity of the breath. 7. The failure 
of all other means. But even within this period, which 
is of variable duration, the opportune moment must be 



OBSTETEIC ABOETION. 269 

chosen. This seems to have arrived when the inefficacy 
of the most approved treatment has been proved, when 
fever is found to persist, and the debility and wasting 
of the patient are making sensible progress. The at- 
tendant should now^ declare that the operation is indi- 
cated, leaving the patient and her friends the duty of 
deciding upon its adoption." 

I should consider it an unjustifiable procrastination 
for the physician to wait until some of the above con-> 
ditions had obtained. The life of a woman, a wife, a 
mother, is too precious to be sacrificed to any mistaken 
sense of duty. 

Many methods of inducing premature labor have been 
practised. The earliest plan adopted was that of punc- 
turing the membranes. At first a quill was used, 
sharpened at the point; afterwards a stillette, or stil- 
letted catheter, was used. This is sometimes described 
as a canula, with a trocar sheathed in its cavity. The 
method of operating with this instrument is as follows : 



STILLETTE. 

Place the patient on her back, near the side of. the 
bed, or better, in the position usually adopted for the 
operation of " turning," (at right angles with the length 
of the bed, with the hips near the edge, and the thighs 
flexed). With the index-finger of the right hand, find 
the OS uteri — the point of the instrument, with the tro- 
car or stillete sheathed, is moved along the palmar sur- 
face of the finger until it reaches the os, w^hen it is to 
be insinuated, up through the canal of the cervix, into 
the interior of the uterus. The extent to which the 
point is made to enter the uterine cavity depends alto- 



270 HALE OX AB0ETI0I7. 

getlier upon tlie period of pregnancy. When it has 
reached the proper position (against the membranes) 
the stillette is to be protruded, when it will enter and 
puncture the membranes. I cannot advise the use of 
this instrument in any stage of pregnancy, as it is best 
in all cases to retain the membranes intact as long as 
possible. The ouly exception to this rule is, in cases 
where the membranes are punctured liigli up^ in the last 
months of pregnancy. But in this instance, a curved 
canula is used, and the waters escape very slowly. I 
prefer, however, other methods to this. 

The improper use of the stillette, in the hands of the 
ignorant and reckless, has caused sudden death. One 
case came under the observation of Dr. P. H. Hale. A 
woman procured a stillette of a " nurse," who gave her 
directions how to use it. She introduced the instru- 
ment as far into the uterus as possible, then protruded 
the sharp point nearly two inches with considerable 
■ force. She immediately fainted, and never rallied from 
the collapse. Death took place in less than half an hour 
after the injury. There was no flooding. No fost- 
onortem was allowed. The husband, who was in the 
room at the time, did not approve of the operation 
which the woman attempted to perform. She took the 
risk, and paid for her criminality with her life. This 
is only one of many instances where the woman uses 
such instruments against the will of the husband. This 
ev^ry physician will bear witness to. 

In the case above mentioned, How did the stillette 
cause death so suddenly ?" It is an interesting question 
for the pathologist to solve. 

But this plan has of late years been discarded as 
dangerous both to mother and child. It has, however, 
been revived somewhat by M. Meissner, under another 



OBSTETRIC ABOETIOK. 271 

and better form — namely, puncturing the membranes 
Jiig-k up^ by means of a curved stilletted catheter care- 
fully introduced between the membranes and the uterus, 
avoiding, the site of the placenta. This plan has been 
successful in many instances. The waters escape so 
gradually that the passages become lubricated and re- 
laxed, and pains make" their appearance in the course 
of twenty-four hours. 

The sponge-tent^ invented hj Kluge is another plan 
frequently adopted. It acts both as an irritant and a 
mechanical dilator, thus bringing on labor by causing 
reflex action, and oj)ening the os and cervix by its ex- 
pansion. It is used in the following manner : Warm 
emollient injections are used ; then the conical prepared 
sponge is carried up to the uterine orifice by means of 
a jDair of long curved forceps (intra-uterine forceps) and 
is made to enter the canal of the cervix, where it is 
kept in place by means of a tampon of pieces of cloth, 
or a sponge. If pains are not established in twenty- 
four hours, use another and larger tent. Sometimes 
the plan of M. Meissner is combined with Kluge' s with 
good results. 

Small caoutchouc hags have been recommended by 
Dr. Barnes, of England, and used very successfully, in- 
stead of the sponge tent. They are introduced into the 
canal of the cervix, and filled wdth water. For full 
particulars relative to this method, reference is made to 
the articles on that method. 

" This instrument," says Dr. Barnes, " is of a fiddle- 
shape, having, when distended, a narrower cylindrical 
central portion, dilating at either end into a bulging or 
mushroom-like expansion. The object of this is to pre- 
vent the bag from slipping forward into the uterus, or 
backward into the vagina. The bag is prolonged into 
a long narrow tube with a stop-cock at the end, to keep 



272 HALE ON ABOETIOF. 

in the water when injected. The injecting meclinm is 
the ordinary Higginson's syringe (or ' Essex') — an in- 
strument which should always be carried in the obstet- 
ric trosseau, as it is useful for many other purposes. 
Three bags of different sizes are sufficient as a series. 
To facilitate the introduction of the flaccid bag into the 
cervix uteri, a small pouch is attached outside to receive 
the end of the uterine sound, which, guided by the 
finger of the left hand applied to the os uteri, serves to 
push the bag into the cervical canal." 

Dr. Barnes claims that by the use of these bags, pre- 
mature labor may be induced at a predetermined hour. 
The operation is entirely within the control of the 
operator. The vagina is first dilated by the use of 
the colpeurynteur ; then the smallest or medium bag 
(" dilator") is introduced into the cervix, care being 
taken that the terminal bulging part shall pass through, 
the OS uteri internum, while the inferior bulging end 
emerges in the vagina. When water is thrown in, the 
dilator is thus secured by its shape in situ^ and the 
eccentric pressure bears upon the whole cervical canal, 
and especially upon the two points of greatest resist- 
ance — the OS externum and internum. This stage ought 
not, as a rule, to occupy less than three or four hours. 
If the smallest or medium-sized dilator does not expand 
the cervix sufficiently, the largest size must be used. If, 
when full dilation occurs, pains do not set in, a portion 
of the liquor amnii may be drawn off, and the uterus 
compelled to collapse. A portion of the liquor should 
be left in to facilitate turning, if that should become 
necessary. CaulopJiyllin or eo^got may be used after full 
dilation and puncturing of the membranes, if the uterus 
seems to be in a condition of inertia. 

The tampon^ used as recommended for uterine haem- 
orrhage, has been resorted to. It should be large 



OBSTETRIC ABOETIOE". 273 

enougli to expand the- upper portion of the vagina, to 
such an extent as to excite reflex irritation. This plan 
is, however, painful, and slow in its operation, and is 
adopted by but few. 

The Golpeurynteur is often used to induce premature 
labor. The instrument is a simple bag of vulcanized 
india-rubber, which is to be introduced into the vagina, 
and then dilated with air, warm or cold water, as may 
be deemed expedient. After being more or less fully 
expanded (and it may be advisable at first to grad- 
ually inflate it, and increase, as the pressure is less and 
less inconvenient) the aperture is closed by a stop-cock, 
and the bag allowed to remain in the vagina. A full 
description of the instrument and its use was given in 
the treatment of retroversion. The meaning of the 
Greek words from which this instrument is derived, is 
vagina-dilator, and expresses the idea of the effect it 
produces, dilating the vagina, and even pulling open 
the OS uteri, and by its forcible pressure exciting, by 
sympathy the action of the uterus. 

The loater douche was introduced into practice by 
the late Professor Kiwisch, of Wurzburg. Tyler Smith, 
Cazeaux and others, prefer this method above all 
others, especially when the life of the child is an 
object. If a stream of hot or cold water be directed 
against, or, still better, within the os uteri, at intervals 
of three or four hours, for the space of ten minutes or a 
charter of an hour at each application, labor is certainly 
and speedily brought on. The water may be made by 
means of a syphon and reservoir, to descend upon the 
uterus from a height, or it may be forced into or against 
the OS by a common injecting apparatus which is capa- 
ble of throwing a continuous stream, like the Essex 
syringe heretofore described. 
18 



274 HALE ON ABOETION. 

Kiwisch explained the modus operandi of the douche 
on the supposition that it caused swelling of the parts 
by imbibition of fluid, and separation of decidua from 
the uterus. Probably the reflex and peristaltic actions 
of the uterus are also excited. Tyler Smith found the 
douche more efficacious, when warm and cold water 
were injected alternately, than when either warm or 
cold was applied alone. The great advantages of the 
douche are, that the premature labor excited is more 
certain, and imitates to a greater degree natural parturi- 
tion ; also.it never injures the genital organs, the mem- 
branes of the ovum, or the foetus. 

Separation of the Tnembranes from the os and cervix 
uteri, by the catheter, bougie, or sound, is highly 
recommended by Professor Simpson, who is high 
authority in obstetric matters. The instrument is 
oiled and cautiously insinuated between the membranes 
and the uterine surface, and with short, gentle move- 
ments from side to side, carried up towards the fundus 
of the womb. Care should be taken that the placental 
vessels are not ruptured. An ordinary flexible bougie, 
introduced a considerable distance between the mem- 
branes and uterus, and allowed to remain, will cause 
premature labor. 

This plan has been improved upon by an eminent 
obstetrician, wlio introduces a flexible English catheter, 
by means of a wire of sufficient size inside, nearly up to 
the fundus uteri. The wire is then withdrawn, and a 
quantity of warm olive oil injected into the uterus, 
through the catheter by means of a syringe. Glycerine 
or milk will answer the purpose as well as oil. Another 
physician uses a flattened female catheter, to which is 
attached a common injecting syringe, and after its in- 
troduction between tke membranes and the uterine 



OBSTETEIC ABOETION. 275 

wall, a quart of tepid water is injected, slowly, so as 
to act by gradually separating the membranes. 

A syringe, having a very long, slightly flexible tube 
of hard rubber twelve or fifteen inches in length, would 
be preferable, as there would be no necessity for the 
introduction of the catheter. Two openings in the end 
of the tube, at its sides, would be better than the usual 
orifice in the end. The amount of fluid thrown up at 
once shoujd not exceed two or three ounces. Its ope- 
ration is to separate the membranes over a large surface, 
and at the same time excite the reflex and peristaltic 
actions of the uterus. 




INTEA-UTERmE SYEINGE. 

The administration of ergot is recommended by 
Dr. Ramsbotham, but, as it seems to us, upon insuf- 
ficient grounds. The majority of obstetricians are 
opposed to its use, and those who have investigated 
the action of this drug are the least inclined to use it. 
If medicines are tried, there are others much safer and 
more efficient. Caulophyllvn has in several instances 
brought on premature labor in the eighth month ; the 
same is asserted of Cimicifugin. In order to be 
effectual, these drugs must be used in large doses — 
two grains of the former, or one of the latter, repeated 
every hour or two. 

The application of cupping glasses to the mammce^ 
is advised by Scanzoni. Sucking-pumps made of caout- 
chouc, were applied in one case for two hours, seven 
times during three days. After the third application 



276 HALE ON ABOETIO]S\ 

the cervix uteri was shortened ; after the sixth severe 
labor pains came on, and after the seventh the child 
was born.* 

Separation of the membranes hy the introduction of at- 
mospheric air^ or gas^ has, I believe, been recommended 
for the purpose of inducing premature labor. I cannot 
recommend this plan, as I believe it to be decidedly 
unsafe, and the most dangerous of all methods, not 
excepting the stiletted canula. Dr. Hitchcockf reports 
a case which shows conclusively that by this method 
air may be forced into the uterine sinuses and cause 
death by entering the circulation. 

The case occurred in Kalamazoo county, Michigan, 
and happened during an attempt to cause abortion. 
*' The operator, through an instrument introduced into 
the womb, or at least into the vagina, blew air with 
his mouth, when immediately the woman screamed, 
struck at the operator, fainted, and was found a minute 
or two afterwards blue in the face and insensible, the 
muscles about the arms and neck having a trembling 
motion." The case presented an entire correspondence 
with the symptoms described as occurring in cases 
where death is known to have occurred from the acci- 
dental entrance of air into the circulation during sur- 
gical operations. T\ie post-mortem appearances observed 
were also altogether consistent with the theory of death 
from the introduction of air into the circulation ; namely, 
extreme congestion of the lungs, entire absence of blood 
from the left, and nearly so from the right cavities of 
the heart ; the escape of air from the uterus the instant 
its walls were incised ; the marble whiteness of the ex- 
tremities, and the unusual paleness of the brain and its 
membranes. 

* Braithwaite, Part XXVIII., page 263. 
t Trans. Ainer, Med. Association, 1865. 



OBSTETRIC ABORTIOE-. 277 

Galvanism. — The employment of galvanism or 
electro-magnetism was first suggested by Huder in 1808, 
for tlie purpose of bringing on uterine contractions, 
after all other means failed. This is accomplished by 
placing one pole of the battery on either side of the 
uterus, continuing the application of the current for 
half an hour or an hour each time, and renewing it 
once or twice daily ; the ordinary magneto-electric 
apparatus in use is the best form, as repeated shocks 
prove more effectual and certain in stimulating the 
uterus to contractions than a continued current. In 
applying the poles, it will be proper to attach to the 
discs a sponge moistened with water, or salt and water, 
or pieces of thin flannel likewise moistened may be 
placed between the discs and the abdomen. Some 
apply one pole to the neck of the uterus, and the other 
to the spine or abdomen immediately above the fundus. 

Dr. Radford says that '' galvanism not only originates 
the temporary contractions of the uterus, but also pro- 
duces such a lasting impression on that organ that pains 
continue to occur until the labor is terminated. It 
produces severe pains in the loins, and great bearing 
down efforts, followed by dilation of the os, and expul- 
sive pains. 

Dr. King says, " I have employed this agent in a few 
cases, and with invariable success, though the number 
and intensity of the applications had necessarily to be 
varied in each." 

In cases of premature labor, the fcetus does not 
appear to be injured by the application of galvanism. 
Cases of still-birth seldom occur from its use, while in 
the majority of cases where ergot is used the child is 
born dead. 

Dr. Radford writes, " Galvanism is especially advan- 



278 HALE ON ABOETION". 

tageous as a general stimulant in all those cases in 
whidi tlie vital powers are extremely depressed from 
loss of blood. Its beneficial effects are to be observed 
in tlie change of countenance, restoring an animated 
expression ; in its influence on the heart and arteries ; 
in changing the character of respiration ; and its warm- 
ing influence upon the general surface. I have several 
times observed, in cases in which other powerful stim- 
ulants have failed to produce any beneficial results, the 
most decided advantages accrue from its application." 

This recommendation would lead us to use this agent 
in the prostration and chill which sometimes ushers in 
an abortion. In such cases the abortion is inevitable ; 
and galvanism would be productive of great benefit 
both by bringing on healthy reaction and aiding the 
uterus in expelling its contents. 

Galvanism will cause embryonic and foetal abortion, 
as well as premature labor. I have made use of it in 
several cases. In one it caused an easy abortion in the 
fourth month (this was a case of dangerous vomiting) ; 
in another it acted satisfactorily in the eighth week of 
pregnancy. In a case where it w^as decided necessary 
to terminate the pregnancy, it was used but once, and 
for five minutes only. Pains immediately set in, accom- 
panied by some haemorrhage. The abortion would 
undoubtedly have proceeded to a termination, had not 
the woman, under the idea of hastening the labor, drank 
a " hot gin sling." Strange to say, this stimulant im- 
mediately arrested the abortivant process, the pain and 
haemorrhage ceased, and did not return. (Was it by 
virtue of the juniper {sabina) contained in it ? ) Four 
weeks were suffered to elapse, when the abortion was 
brought on by the use of the catheter. 

Dr. Robert Barnes, Lecturer on Midwifery to the 



OBSTETEIC ABOETIOE". 279 

Koyal Free Hospital Medical College, England, once 
wrote a paper on tlie Use of Galvanism in Obstetrics. 
It is worthy of attentive perusal, as it enters fully into 
a consideration of the action of this agent. 

The article was published in Braithwaite's Retro- 
spect, Part xxix., pages 259 — 268, and is copied by Dr. 
King, in his Obstetrics, pages 669 — 681. 



SECTION II, 



ECETAL ABOETION. 



Fostal abortion consists in the expulsion of the pro- 
duct of conception during the second stage of pregnancy, 
viz., from the date of the connection of the placenta 
with the uterus, to the date of mobility of the child. 

The induction of abortion during this stage may be 
resorted to for the same reasons given above, where it 
is not deemed prudent to tvait until the child is viable. 
The same obstructions, existing to a greater degree, 
will make it proper to cause the expulsion of the foetus 
before the seventh month. In these cases, the life of 
the mother is to be considered beyond all other con- 
siderations. 

The same means may be used, and will be found 
equally efficient as those adopted during the last three 
months of pregnancy. The same precautions, having 
in view the non-injury to the placental vessels, are to 
be adopted, because it is better to have the placenta 
detached by the contractions of the uterus, than by any 
instrument. By so doing much haemorrhage is avoided, 
which might become dangerous before the uterus could 



280 HALE ON ABOETIOlSr. 

be made to expel tlie secunclines. As before noticed, 
the haemorrhage before the sixth month, generally 
occurs before the expulsion of the placenta, whereas, in 
premature labor, it is afterwards. 

For the safe and speedy induction of fcetal ahortion^ 
I prefer, as mentioned under premature labor, the use 
of the fiexihle bougie or catheter^ or the injection of bland 
fluids between the "tnenibranes and the uterus. A com- 
bination of the two operations is probably the best 
that can be adopted. My favorite method is to intro- 
duce a smooth flexible catheter or bougie (having one 
or two orifices in the sides of its extremity) by means 
of a wire stiff enough to act as a conductor. It should 
be introduced carefully, so as to gently insinuate it 
between the membranes and the uterus. I especially 
recommend the operator not to puncture the mem- 
branes, for according to all experience, this accident 
should be avoided during the whole period of preg- 
nancy. When the instrument has been carried up 
nearly to the fundus of the uterus, on its posterior 
surface, the wire is withdrawn, and one or two ounces 
of warm milk, glycerine, olive oil, or water, is 
to be injected by means of any syringe which will 
throw a continuous stream. The modus o])erandi is 
plain. The fluid permeates between the membranes 
and the uterus, separating them throughout the whole 




FLEXIBLE BOUGIE OR CATHETElt. 

or a large portion of their extent. It may even sepa- 
rate the placenta during the fourth or fifth month. At 



OBSTETEIC ABOETIO]^. 281 

tlie same time the presence of the fluid causes uterine 
contractions of a forcible character, which generally 
ends in the expulsion of the foetus and secundines, with 
little or no haemorrhage. The cliiU^ or Tigor^ previ- 
ously mentioned among the sym]3toms of abortion, is a 
sure indication that the operation has been successful 
and efficient. 

It sometimes happens that it is difficult, and even 
impossible, to inject any fluid into the uterus through 
the catheter or bougie, owing, probably, to the com- 
pression of the instrument by the contraction of the 
cervix uteri, or the whole organ. To avoid this diffi- 
culty, I have frequently made use of a hard rubber 
syringe, holding two ounces, and having a tube about 
eight to ten inches in length, and about one-fourth or 
one-sixth of an inch in diameter, with a very smoothly 
rounded point. (See cut on page 275). 

The only instrument of this character now sold, has 
its tube straio'ht. But before it can be used for the 
purpose here recommended, it must be bent to the 
requisite curve. The extent of this curve will depend 
on the position and size of the uterus, and the period 
of pregnancy. The tact and judgment of the phy- 
sician must be the guide in this matter. To prepare 
the tube so that it can be bent to the requisite curve, 
it is only necessary to plunge it into boiling water for 
a minute, when it will become quite ductile, and may 
be made to assume any curve desired. 

When the tube has been introduced into the uterus — 
as directed for the bougie — the piston is to be slowly 
pushed down, so as to force the fluid gently out, and 
effect a gradual separation of the membranes. 

In filling the syringe, previous to its introduction, 
care should be taken to exclude all ah^^ as the presence 



282 HALE OTT ABOETION. 

of air in tlie uterus is neither safe or desirable. The 
woman should remain in the recumbent position for 
half an hour or more after the oj)eration, or until the 
oc6urrence of the rigors. For obvious reasons, the 
best time for the operation is in the evening after the 
patient has retired for the night. It is advisable that 
the bladder and rectum be emptied of their contents ; 
the latter by enema, if any foecal matter has accumu- 
lated there. 

It is taught by some medical writers that it is haz- 
ardous to- inject fluids into the uterus. Whatever 
danger there may be in the unimpregnated state from 
fluids passing through the Fallopian tubes into the 
peritoneal cavity, thereby causing inflammation, this 
objection is not valid in the condition under consider- 
ation, for during pregnancy those tubes are undoubtedly 
plugged up with tenacious mucus, which would effectu- 
ally prevent the passage of any fluid. 

This simple and effective method is far preferable to 
j)uncturing the membranes, which nearly always results 
in a tedious labor ; or the douche, which is altogether 
complicated and slow of operation ; or the administra- 
tion of drugs, which is always uncertain, and generally 
injurious. No other method yet known is at all com- 
parable with it, and in my opinion none other should 
be adopted by the conscientious physician who seeks 
in all cases the good of his patient above all else. 



OBSTETEIO ABORTION. 283 



SECTION III. 



EMBEYONIC ABORTIOIST. 



The induction of abortion during the three months 
following conception, is sometimes necessary and justi- 
fiable. If the pregnancy is not to be allowed to go on 
until such time as the child is viable, it is absurd to 
wait any time after the physician has decided on the 
necessity of the operation, as every day's delay renders 
it more liable to be productive of injury to the woman. 
The following question was put to Dr. Hunter, in 1768, 
by W. Cooper, and was shortly after decided in the 
affirmative by most English practitioners : 

" When a woman, three or four months pregnant, 
has so contracted a pelvis as to preclude all hope of 
a j)ossible expulsion or extraction of a viable foetus, 
may we think of inducing abortion ?" 

One of the latest obstetric writers — Cazeaux — 
declares the accoucher is warranted in producing abor- 
tion, whenever a woman who is five or six months 
pregnant, at most, shall have less than two and a half 
inches in the smallest diameter of the pelvis. I can 
not see the propriety of waiting until the woman is so 
far advanced. If the physician is cognizant of the 
pelvic deformity, and also of the commencement of 
pregnancy, he should induce the abortion at the 
earliest possible moment consistent with the patient's 
state of health. He should, of course, be sure the 
woman is pregnant, before any operation is performed ; 
but it is my opinion that he had better err in this 
respect, than allow a pregnancy to go on till a late 



284 HALE ON ABOETIOlSr. 

date. For tlie introduction of tlie sound or bougie, or 
the injection of fluids, if carefully done is not produc- 
tive of injury, and may even bring back the menses, if 
tbat was tlie only obstruction. The indications for 
producing an abortion during the first tliird of preg- 
nancy, may be thus summed up : Extreme contraction 
of the pelvis ; voluminous, immoveable, and non- 
operable tumors of the excavation ; extreme dropsy of 
the amnion ; irreducible displacements of the womb ; 
hsemorrhages which have resisted the employment of 
the most rational measures ; eclampsia, >mania, chorea, 
and obstinate, dangerous vomiting. 

If any of these indications obtain, the sooner after 
conception the embryo is destroyed, the better for the 
health and safety of the patient. 

Method of Operating. — ^iSTearly all the methods men- 
tioned above, except the injection of fluids, are inoper- 
ative when used during the first stage of gestation. 
They may induce the abortion, but only after a tedious 
trial, and nearly always to the injury of the uterus. I 
allude to the sponge-tent, e7'got^ douche, puncture of the 
membrane, electricity, and colpeurysis. 

The most eflicient methods are : (1) The introduction 
of the bougie. (2) The injection of fluids. (3) The 
forceps. (4) The uterine sound. 

The hougie or flexible ccitlieter is an effective instru- 
ment for terminating pregnancy before the end of the 
third month. If introduced into the uterus without 
rupturing, the membranes, it will bring on labor with 
expulsion of the ovum entire, with the decidua. Before 
the fourth month, so close is that tissue to the uterus, 
that it is a matter of doubt whether a bougie or any 
other instrument can be insinuated between the two 
adherent surfaces. The instrument must then pass 



OBSTETRIC ABOETIOIT. 285 

through the orifice at the cervix, and between the 
membranes of the ovum and the decidua. It is best 
not to use sufficient force to rupture the delicate mem- 
branes of the ovum, so delicate that I imagine they are 
destroyed in a large majority of the cases where instru- 
ments are used in the early months, especially during 
the first eight weeks. 

To use the bougie successfully, select a smooth one, 
about one quarter of an inch in diameter, with a curved 
wire of sufficient size to render it a good conductor (the 
wires generally found in bougies and catheters are too 
small for this purpose.) Have the woman lie on her 
back, near the side of the bed, with the knees draw^n 
up and the hips slightly elevated. First ascertain by 
the touch the position of the os uteri, its condition, etc. 
Moisten the instrument with oil or glycerine, and pass 
its point along the palmar surface of the index finger 
of the right hand, the end of which should rest upon 
the lower lip of the os uteri. Insinuate the instrument 
into the cervix, and push it gently upward towards the 
uterine cavity until it meets with some obstruction. 
These obstructions are generally the lacunae or folds of 
the mucous lining of the neck. Care should be taken 
not to lacerate these folds by any forcible measures, as 
such injuries lead to chronic inflammations of the cer- 
vical canal. By the use of tact, patience, and gentle 
efforts, the instrument will after a time pass suddenly 
into the uterine cavity. In some cases of primapara, 
the introduction of any instrument through the cervical 
canal is a matter of much difficulty. The most careful 
physician and practical amateur may fail after efforts 
lasting a quarter of an hour. Sometimes when we are 
about to give up our efforts, the bougie will glide into 
the cavity with the utmost ease and readiness. Any 



286 HALE ON ABORTION. 

one wlio will take the trouble to examine the minute 
anatomy of the cervical canal, and note the small size of 
the inner orifice of the canal, and the numerous lacunae 
or crypts of the enlarged middle portion, will under- 
stand the reason of the difficulty. 

When the bougie shall have entered the cavity of the 
uterus, it should be slowly pushed upwards until it 
seems to meet with an obstruction to its further pro- 
gress. Here all efforts to introduce it further should 
cease, else we may rupture the membranes of the ovum. 
Now, with the finger and thumb of the right hand, 
hold the bougie firmly in its place, and with the other 
hand slowly withdraw the wire, not directly down- 
wards, but with a circular movement, outward and 
upward, so that the curve of the tvire will follow the 
axis of the pelvis. By so doing we avoid any unneces- 
sary irritation of the interior of the uterus, or a rupture 
of the membranes. 

After the wire has been withdrawn, coil the end of 
the bougie until it can be placed in the vagina, resting 
on the perineum, or if it is not flexible enough to be 
easily coiled, the -protruding end may be cut off. At 
any rate, leave the instrmnent in the toomb^ until 
haemorrhage or labor pains set in, when it may be 
removed. To keep it in situ until such an occasion, no 
aid is needed if the woman remains in bed ; but if she 
is to sit up or walk, a bandage should be worn. 

The time which intervenes between the introduction 
of the instrument (if it be retained) and the occurrence 
of pains, etc., varies from six to twenty-four hours, 
rarely exceeding the latter. It is very rare that haemor- 
rhage occurs during a foetal abortion caused by the 
proper use of the bougie. 

I do not approve of the plan adopted by some obste- 



OBSTETEIC ABOETIOK". 287 

tricians, of rotating the bougie when in the womb, 
and then withdrawing it. Not only is injury done 
thereby, but the induction of abortion by such a method 
is very uncertain. This leads us to the considera- 
tion of 

The Uterine Sound. Professor Simpson makes use 
of this instrument for the induction of abortion in the 
■> early months of pregnancy. The silver male catheter 
has been substituted for it in some instances. Professor 
Simpson directs that after its introduction it is to be 
turned three or four times round, and then withdrawn. 
That this method will prove effectual in a majority of 
cases, I do not doubt; in fact, my observations lead 
me to believe it will generally destroy the embryo. But 
Simpson admits that the operation is not always imme- 
diately effectual, and states that he has been obliged to 
repeat it several times in some cases, before the uterus 
would take on expulsive action, or before he was satis- 
fied the embryo was destroyed. There are many other 
objections to the use of the sound, especially in the 
third month of gestation. If not used with great care, 
the interior of the uterus will be abraded or other- 
wise injured by its forcible rotation. Next to the 
bougie, however, it is the best and most certain method 
of causing abortion now known. Its introduction is 
effected in the same manner as that of the bou2:ie. 




TJTEEINE SOUND. 



288 HALE OK ABORTION. 

The injection of fluids, as described under Premature 
Labor, may be resorted to when the above means are 
not at hand, or when it is deemed advisable not to use 
them. The introduction of the curved tube should be 
conducted as described above. Not more than one 
ounce of liquid should be injected at once. When the 
syringe is used, a sensation of faintness, or actual syn- 
cope sometimes occurs immediately after the operation. 
The rigor occurs sooner than when other instruments 
are used. 

The Forceps. — This instrument is similar to a variety 
of "bullet forceps," used in military surgery for the seizure 
and extraction of foreign substances in the tissues. It 
consists of four " claws," which are sheathed in a tube 
during its introduction, and are made to protrude and 
open when in the interior of the uterus. The instru- 
ment is pushed upward to the fundus uteri, to the posi- 
tion the ovum is supposed to occupy, when the "claws" 
are closed upon the embryo, if reached, and the whole 
forcibly extracted. This instrument is the one most 
generally employed by those villaius who disgrace the 
medical profession and humanity by practising the vile 
trade of producing criminal abortion. The instrument 
may, however, be used by the honorable physician for 
legitimate purposes. It may be used when the other 
instruments mentioned are not obtainable, or proper ; 
or for the purpose of removing a retained placenta or 
membranes, or any residual mass. 



AEOETION FOECEPS. 



OBSTETRIC ABOETIOJSr. 289 

Various other instruments liave been used by pliysi- 
ciaus and abortionists. The stiletted catheter was once 
in general use. There are several varieties of this in- 
strument, but all upon the general plan of a sheathed 
needle or lancet, which can be protruded when intro- 
duced into the uterus, and having for their aim the 
rupture of the membrane of the ovum. 

Besides the mecJianiccd measures above enumerated, 
for the purpose of inducing abortion in the first stage 
of pregnancy, the medicinal means may not pass unno- 
ticed. When premature labor or foetal abortion is 
induced by medicines, they set up uterine contractions, 
and thereby dislodge and expel the uterine contents. 
But owing to the non-development of the muscular 
tissue of the womb in the earlier months, such effectual 
contractions can rarely, if ever, be aroused. Medicines, 
therefore, which cause abortion during the first three 
months, must cause it by simulating the menstrual 
process — namely, uterine congestion and licemovrliage^ 
with the exfoliation of the decidua. 

Now, nearly all the medicines mentioned under 
"Medicinal Causes of Abortion," are capable, under 
certain circumstances, of causing so much congestion, 
as to set up a pseudo-menstrual nidus, and the conse- 
quent arrest of gestation. If, however, the uterus is in 
a healthy condition, I do not think such medicines, 
unless taken in massive and dangerous doses, are ever 
capable of such effects ; but when the uterus is diseased, 
and has been " irritable," then almost any one of them, 
if administered at or near the usual menstrual periods, 
will be very apt to cause such afSux of blood as to lead 
to the destruction of the product of conception. 
19 



290 HALE OlSr ABORTIO]Sr. 



SECTION IV, 



OYULAE ABORTION. 



Another variety of abortion might be considered 
under the title of Ovular. 

This might be defined as the destruction of the ovum 
at any time after it leaves the Graafian vesicle, and be- 
fore it has been impregnated by the seminal fluid. 

In other words, any measures M^hich are adopted to 
prevent the impregnation of the ovum, must result in 
its destruction. 

If, from good and sufiicient causes, it is considered 
best that the fruit of conception should not be allowed 
to go on to the end of utero-gestation, would it not be 
better, in a medico-legal, as well as in a moral point of 
view, to arrest or prevent conception itself ? 

If premature labor is to be avoided in all cases, and 
only resorted to to save (he life of the mother or child, 
or both ; if it is preferable to allow the mother to 
run the risk of her life, and sufi>3r from dangerous dis- 
eases ; if foetal and embryonic abortion is only to be 
resorted to in the most dangerous cases, and avoided 
because morally and legally it is a crime, equal to, if 
not identical with, murder ; if so many grave obstacles 
are in the way, inducing us to avoid any of these opera- 
tions, — would it not be better, in all cases, for the phy- 
sician to advise that ovular ahortion be allowed ? By 
adopting this plan to prevent the occurrence of gesta- 
tion, no crime is committed, and there is no risk of 
human life. I admit that this is not feasible in a large 



OVULAE ABOETIOlSr. 291 

proportion of tlie cases. Pliysicians are rarely consulted 
until after pregnancy is well advanced, and often not 
until the period of confinement itself. But after the 
physician has attended one confinement where the life 
of the child had to be sacrificed to save the mother, it 
is his duty to inform his patient of the danger of a 
future pregnancy, and advise and instruct her as to the 
best possible manner of preventing the occurrence of 
that state. 

All perfect theories are probably Utopian. A theory 
which should regulate. and define the laws which relate 
to marriage is so Utopian that it may never be real- 
ized. If it were possible to regulate this matter by 
absolute law, the following rules would have, to be car- 
ried into effect : 

(a) No woman should marry until it was decided 
by a competent physician that no physical deformity 
existed which would incapacitate her from bearing a 
living, average sized child, at fall time. 

(h) After a woman has had one labor, attended 
with great danger to herself, and involving the death 
of the child, it should be rendered obligatory upon the' 
parents to prevent the occurrence of future conceptions.. 

If these two rules were adopted by all civilized 
nations, it would narrow down the necessity for the 
induction of abortion to a very small number of cases. 
of difficult and dangerous labor. 

Even in the present condition of society, much might 
be done if physicians would do their duty, and they 
were upheld by public opinion and public confidence.. 
The fault is both with the physician and people. Phy- 
sicians are not honest and frank enough with their 
patients : they do not give them the proper advice and 
instruction in the premises. We read of women pass- 



292 HALE ON ABOETIOK". 

ing througli a succession of pregnancies, ending in ea^li 
case with craniotomy or Caesarian section, and every time 
Tinder tlie care of tlie d,siniQ family physician ! Did the 
physician do his duty in these cases % Did he instruct 
the parents how to prevent a conception which was 
fraught with such dangerous results? Why do not 
family physicians protest against allowing young 
women to marry, whom they know, or believe, are not 
in normal physical condition to bear children ? The 
people are, perhaps, more to blame than physicians, in 
this matter; This arises from the general ignorance 
Tvhich prevails on all subjects pertaining to the physi- 
ology of generation. This ignorance is almost absolute, 
for not one layman in a thousand, even if he is other- 
wise well-read and intelligent, has a correct knowledge 
of this function. In fact, the most ridiculous and 
absurd notions are held by the people, and, I regret to 
say, by many physicians, in relation to the passage of 
the ovum, the manner of its impregnation, and the 
nature of the seminal fluid. 

Books which teach the latest discovered facts relat- 
ing to generation are kept out of the hands of the 
young, and virtually out of the hands of the public, by 
the very nature of the technical language in which they 
are written. Every man and woman, before entering 
into marriage, should be conversant, in some way or 
other, with all the positive facts concerning the genera- 
tive process. 

That I may not be blamed for asserting that physi- 
cians, even, are ignorant of facts, I will quote from a 
w^ork by a distinguished author, who is considered an 
authority by the profession. Speaking of i7npote7icy, 
he says : 



OVULAR ABORTION. 293 

" Eacj Illation is weak and precipitate, so that tlie 
seminal fluid cannot be thrown into the cavity of the 
uterus * * * it is not sufficient, in order to feci>ndate, 
simply to spread the fluid over the vagina : it must be 
projected with sufficient force through the orifice of the 
uterine neck."* 

This assertion is at variance with all the well-known 
facts relating to impregnation. A fraction of a drop 
of the seminal fluid upon the vaginal mucous membrane 
is sufficient to result in impregnation, if the proper time 
is selected for the experiment. T^ot only is the 
author's knowledge of physiology deficient, but his ana- 
tomical knowledge is in a worse condition. The uter- 
ine neck is scarcely ever sufficiently open to permit of 
the seminal fluid being thrown in by ejaculation. It 
does not open during coition, and need not be open in 
the manner implied by Lallemand. It may be, a,nd is 
generally, closed, but not impervious. Nothing short 
of actual occlusion can prevent the spermatozoa from 
insinuating themselves into the uterine cavity. The 
majority of the people entertain an idea similar to Lal- 
lemand' s, and think they take due precaution, when in 
fact no real precaution is taken to prevent impregnation. 

Ovular Abortion^ may be allowed by adopting certain 
regulations concerning the act of coition. 

First^ hy regulating the time of its occurrence. — In all 
except about six per cent, of cases, according to M. 
Kociborski, coition will not result in impregnation, if 
not performed until ten days after the cessation of the 
menses, nor within four days previous to, or during 
their occurrence. Coitus immediately after or during 
menstruation, has often been advised as a cure for ster- 
ility, and frequently with success. Among the Jews, 

* Lallemand on Spermatorrhoea. 



294 HALE OW ABOETION. 

women are not allowed sexual intercourse until twelve 
days after menstruation ; yet the women of that race 
are noted for their fertility. This is accounted for on 
the supposition that impregnation took place just pre- 
vious to menstruation. When conception occurs at this 
time, the catamenia sometimes appear, and are some- 
times absent ; if they appear their duration is generally 
less than usuaL''""" 

I am inclined to think that the rates of six or seven 
per cent, are too small. Some women will conceive at 
any period between the menses, even when only the 
slightest particle of seminal fluid is brought in contact 
with the vaginal surface. 

The rule above mentioned, relating to the avoidance 
of coition at certain times cannot be considered as reli- 
able in all instances. It is based on the theory, which, 
in the majority of cases seems supported by facts, that 
the ovum is extruded from the generative passages be- 
fore the twelfth day after, and does not appear therein 
before the fourtk day previous to the menstrual period. 

When the experiment has been tried, and found to 
be reliable, the rule may be adopted to prevent concep- 
tion, but there is some risk in trying the experiment. 

Some women are in the habit, acting probably under 
the advice of physicians, of taking some powerful 
emmenagogue just previous to the usual menstrual 
period. Such drugs may act in two ways — namely^ 
by causing the already impregnated ovum to be ex- 
pelled witli the unnatural menstrual flow, or increas- 
ing the amount and force of a natural flow (menorrha- 
gia) which will wash away the unimpregnated ovum 
in a shorter time than usual. 

Second^ hy regulating the mcinner of its performance. — 

* Carpenter, Physiology, page 361. 



OVULAE ABOETION. 295 

We have seen that under certain circumstances, in a 
large proportion of cases, Ovular Abortion will occur if 
coition is not included in. 

We will now consider the second method of inducing 
ovular abortion; namely, by preventing the seminal 
fluid from coming in contact with the ovum in the geni- 
tal passage. 

This can only be done by placing some mechanical 
and impervious impediment in such a manner as will 
prevent the seminal fluid from escaping into the genital 
passages. 

As the ovum must be impregnated in the uterus, Fal- 
lopian tubes, or ovaria, if any obstacle is so placed as to 
prevent the passage of the spermatozoa through the 
neck into the cavity of the uterus, impregnation will 
not take place. As the cervical canal cannot be closed 
by any mechanical contrivance^ we must turn to other 
means to prevent the entrance of the vivifying animal- 
cules. 

Dr. Casanova, in a work more ingenious than reli- 
able,* gives, in a chapter on the " Prophylaxis of Con- 
ception," the following as a preventive of impregnation: 
" The possibility of rendering fecundity ineffectual by 
artificial means, is founded in the fact that if an. appro- 
priate foreign body be interposed between the sexual 
organs of the male and those of the female, mh coitii^ 
fecundation will not take place, because the body will 
stand as a bar or impediment to the absorption of the 
aura spermatica emitted against it in the act of copu- 
lation." 

Dr. Casanova illustrates this phenomena by allusion 
to the discovery of Sir H. Davy, that a wire-gauze 
lamp prevents the flame within from reaching and 

* Contributions to Physiology and Medical Jurisprudence, page 96. 



296 HALE OlSr ABOKTION. 

exploding tlie explosive gas without. He goes on to 
say that if a small piece of sponge, or any analogous 
substance, be placed within the vaginal canal, sub coitu^ 
it will produce the same effect as the wire-gauze : i. e.^ 
it will represent the intermediary agent which will 
interrupt the aura seminalis from being absorbed from 
within, thus rendering fecundation impossible." 

Although he says, " I have tried the experiment 
therapeutically more than once, and found the pheno- 
mena to correspond, and to be in perfect harmony with 
truth," we" are obliged to deny the truth of his theory, 
and the reliability of his experiments. There are 
doubtless cases where this evidently ineffectual means 
would prevent impregnation, for there are cases where 
even the slightest precautions are sufficient. In refuta- 
tion of his assertion, I will state that I have known of 
many instances where the plan he describes — a plan 
not new in this country — was carefully and thoroughly 
tried, and in not one of these instances was it sufficiently 
effectual to be reliable. 

The reason is easily explainable by the fact that 
only an infinitesimal quantity of the seminal fluid is 
requisite for the purpose of impregnation. When we 
remember that the mucous membrane of the vagina is 
thrown into rugse or folds, which are more decided 
immediately after coition, it will be seen that a consid- 
erable quantity of the seminal fluid will be caught in 
these folds, and retained there after the sponge has 
been withdrawn, for it is impossible for a sponge, unless 
it be of great size to sweep out all the animalculse. For 
this reason also, all those contrivances which have for 
their object the removal of the semen with a sponge or 
other similar material, are unreliable in most cases. 

Dr. Casanova does not believe that impregnation is 



OVULAR ABOKTION. 297 

caused by the actual contact of the spermatozoa with 
the ovum, but by the absorption of what he terms the 
" aura seminalis,''^ a kind of imponderable force. Even 
if this were true — and the theory is utterly untenable 
— it would be so much the worse for his plan, for it 
is evident that no material substance of a porous nature 
will prevent the absorption of an imponderable aicra. 

I have been shown an india-rubber ball used for the 
purpose of preventing impregnation. It was directed 
to introduce it into the vagina, and place it against the 
OS uteri, and allow it to remain six or twelve hours 
after coition. This plan, however, afforded no protec- 
tion from the influence of the semen, for conception 
took place in spite of it, and for very obvious reasons, 
namely : the spermatozoa will live several days in the 
secretions of the vagina. Leewenhock and other ob- 
servers have discovered them in a living condition in 
the uterus and Fallopian tubes, seven and eight days 
after connection. Of what use, then, is such a contriv- 
ance ? I have known conception to take place notwith- 
standing coitus was performed while a large inflated 
rubber pessary was in the vagina, apparently complete- 
ly filling up that canal. A study of the nature of the 
spermatozoa will convince any one that they are capa- 
ble of insinuating themselves between any such sub- 
stance and the vaginal wall. 

There is but one contrivance that is sufficiently relia- 
ble to be mentioned and recommended, and one which 
is absolutely reliable so long as it remains intact, name- 
ly : a covering made to he worn hy the male, of sufficient 
size to cover the ivhole of the penis. It should be made 
of firm, elastic india-rubber, or good gold-beater's skin. 
The first named material is to be preferred when a 
good quality is used. They are for sale under the 



298 HALE ON ABOPwTIOIT. 

name of '■'■condomj'' by every druggist, and in all phar- 
macies, and the trade in them is considered legitimate. 
In selecting them, care must be taken that the material 
is firm, and contains no small orifices, and will resist the 
pressure of the air. Some will easily tear when air is 
forced into them. These are unfit for use, as are those 
from which the air escapes in minute quantities, with a 
very low, whistling sound, almost imperceptible to the 
ear. These pin-holes, as they may be called, are still 
large enough to permit the passage of a minute Cjuan- 
tity of the fluid containing spermatozoa. After each 
connection, the "covering" should be examined care- 
fully, to see that no rent has occurred during the act, 
and if such is found to be the case, injections will have 
to be used, as directed below. Some of these " cover- 
ings " are quite durable, and if proper care is taken of 
them, by cleaning, keeping them dry and inflated, and 
not allowing them to become adherent to the box where 
they are placed, they may be used many times, and re- 
main uninjured aud impervious. 

When it is known that spermatozoa remain in the 
urethra for many hours after coition, or until free urina- 
tion occurs,* it will be obvious to all that no second 
entrance of the penis into the vagina will be safe, unless 
protected by the covering, or after urination has taken 
place. Ignorance of the fact has led to the occurrence 
of impregnation, where the parties were very much 
astonished at the result. 

I will not notice at any length the plan of compress- 
ing the urethra so as to prevent the semen from escap- 
ing during the orgasm, and until the withdrawal has 
been effected, for such a plan would be productive of 

* Lallemaud on Spermatorrhoea, p. 263. 



OVULAPw ABORTION. ^ 299 

tlie most serious consequences, and result in organic dis- 
ease of the male organ of generation. 

I hardly need allude to the absurd doctrine taught 
by Dr. Casanova, that unless the woman particvpates, 
or enjoys the copulatwe act, conception will not take 
place. His foolish arguments to explain away the facts 
which disprove this theory, are unworthy the slightest 
notice from men of intelligence and science. It mat- 
ters not what the condition of the woman is, whether 
insensible, indifferent, or absolutely frigid, if the ovum 
is in the genital passages, and the semen comes in con- 
tact with it, impregnation will take place. 

We now come to the third and last method of caus- 
ing or permitting Ovular Abortion, namely : the des- 
truction of the spermatozoa. 

In order to treat this subject in a proper manner, we 
must make some inquiries into the nature of these pecu- 
liar organisms, upon which depend the fertilizing qual- 
ities of the seminal fluid. 

Noth withstanding the denial, by Casanova and a few 
other writers, that the spermatozoa are independent or- 
ganisms, or veritable animalcules, it is needless, in the 
present da}^, to enter into any lengthy refutation of the 
views of such authorities. 

Dr. Casanova says they are not animalcules, " though 
they possess that optical illusion, a sort of, but not an 
independent animal life — that is, a life of motion, only, 
caused by the effects of light." (!) Such an absurd and 
incoherent assertion is too ridiculous to receive serious 
notice, and would not be noticed at all in this place, 
were it not that it is desired to convey to the reader a 
truthful idea of the nature and importance of these or- 
ganisms. I am aware that Dr. Carpenter writes that 
the spermatozoa " have no more claim to a distinct ani- 



300 HALE ON ABOETIOlSr. 

mal cliaracter than have the ciliated epithelia of mu- 
cous membrane, which likewise continue in movement 
when separated from the body. They appear to be 
nothing else than cell-germs, furnished with a peculiar 
power of movement, by means of which they are ena- 
bled to make their way into the situation where they 
may be received, cherished and developed." These as- 
sertions are as untenable as that of Dr. Casanova. I will 
here mention a few facts in relation to the nature and 
qualities of the spermatozoa, sufficient to disprove all 
the above statements. 

(«') Leewenhock, Grerber, Valentin*, Dujardin, Wag- 
ner, and other eminent microscopists, all testify to hav- 
ing discovered traces of organization in spermatozoa. 
Commenting on this, Hassall properly observes f that 
" the determination of the fact that the spermatozoa are 
possessed of even the smallest amount of organization, 
would involve their classification in the animal kingdom." 

Q)) The motions of the spermatozoa are proof of 
their animal nature. Hassall says, " All the spermato- 
zoa contained in a drop of semen which has undergone 
dilution will not start into motion at once ; many of 
them will remain for a time perfectly motionless, aud 
then suddenly, as it were by an act of volition, begin to 
move themselves in all directions." Speaking of their 
" mode of progression," the same writer says, — " The 
motions of the spermatozoa are effected principally by 
means of the tail, which is moved alternately from side 
to side, and during the progression, the head is always 
in advance." It is stated that the spermatozoa of differ- 
ent animals move in a different manner, because they 
differ very much in theii' form and structure. This 

* " The spermatozoa of the bear have a mouth, anus and stomach, or a 
convoluted intestine. (See illustration in MuUer's Embryology, p. 1475). 
f Microscopic Anatomy, vol. 1, p. 225. 



OVULAR ABOETIOIT. ' 301 

would not be tlie case if tliey were "nothing more than 
ciliated epithelium." 

Hassall also states that " in the varied motions exe- 
cuted by the spermatozoa, they exhibit all the charac- 
ters of volition ; thus they move sometimes quickly, at 
others slowly, alter their course, stop altogether for a 
time, and again resume their eccentric movements. 
These movements it is impossible to explain by refer- 
ence to any hygroscopic properties which may be inhe- 
rent in the spermatozoa, they appear to be so purely 
voluntary." 

Dr. Morris Wilson''^ says the spermatozoa when mov- 
ing through a fluid, " turn readily out of tJie way of 
any obstructions^ but they have not the backward 
motion of vibriones." (Would ciliated epithelium 
avoid obstructions?) 

{g) The spermatozoa are influenced by the poisons, 
or chemical agents, in the same manner as animal organ- 
isms. While they " retain their locomotive powers for 
a very long time in fluids of a bland character — for ex- 
ample, in blood, milk, mucus and pus, on the contrary, 
in reagents of an opposite character, and in those pos- 
sessed of poisonous properties, they soon cease to move ; 
thus in saliva and urine, unless these fluids be very 
much diluted, their motions are soon destroyed, and 
immediately cease in the acids and alkalies, iodine, 
strychnine and the watery solution of opium. "f The 
narcotic poisons do not arrest the motions of ciliated 
epithelium. 

LehmanJ says " the motion of the spermatozoa is de- 
stroyed by the solution of opium and strychnine ; the 
tail then generally remains extended." (Is not the ani- 

* "Diseases of the Vesiculae Seminales," in Lallemand's SpermatorrhcEa, p. 346. 
f Hassall's Microscopic Anatomy. f Physiological Chemistry, p. 70. 



302 - HALE ON ABOETIOISr. 

malcule rendered tetanic by tlie poison?) Hassall 
thinks, the result of the application of these poi- 
sons, furnishes an additional argument in favor of the 
animality of the spermatozoa, and one which it would 
be difficult, if not impossible, satisfactorily to contro- 
vert. 

D'alton* makes the bold assertion that the spermato- 
zoa cannot properly be considered as animals. He says 
their motions are " precisely analogous " to that of cili- 
ated epithelium. He further says that they are organic 
forms, produced in the testicles, and forming a part of 
their tissues, just as the eggs, which are produced in 
the ovaries, are a part of those organs. Draperf says, 
" it has never yet been established that anything 
answering to a true structural arrangement exists, and, 
upon the whole, it may be concluded that the appear- 
ances which have been by some supposed to indicate 
organization, are, in reality, only an optical illusion." 

Notwithstanding the assertions of these high author- 
ities, we must remember that the later discoveries with 
the microscope have overturned a great many just as 
bold assertions of the earlier physiologists. 

It Avill be more in accordance with true scientific 
modes of thought, not to assert of the spermatozoa a 
want of organization, because we cannot discover and 
demonstrate it, but to await the results of more minute 
investigations. 

Not only is it necessary to impregnation that the 
seminal fluid should contain these animalcules, but 
they must be perfectly organized, and alive. 

Wagner found that in the semen of hybrids the sper- 
matozoa were altogether wanting, or occurred in small 
numbers, and were ill-formed and ill-conditioned. It is 

* Human Physiology, p. 543. f Human Physiology, p. 519. 



OVULAE ABOETIOlSr. 303 

a well-known fact that hybrids are incapable of bear- 
ing offspring. 

In men suffering from impotence, the seminal fluid is 
found destitute of spermatozoa, or if present, they seem 
to be either lifeless or of feeble vitality. 

It is generally believed that the introduction of 
semen into the uterus, the spermatozoa of which were 
dead, would not result in impregnation. M. M. Pro- 
vost and Dumas, who filtered the seminal fluid, found 
that the fluid portion, which passed through the filter, 
would not vivify the eggs (of a frog), while the more 
solid, part, consisting of the spermatozoa, produced im- 
pregnation. The apparently contradictory experiment 
of Spallanzini does not controvert this, for it is not ab- 
solutely known that the spermatozoa of frogs die in 
thirty-five hours after being placed in water at a tem- 
perature of seventeen to nineteen degrees, or even in 
fifty-five hours in water three degrees above zero, while 
it is known that the spermatozoa of fishes will live sev- 
eral days and retain their power of impregnation. 
Moreover, in all cold-blooded animals, cold does not 
have that destructive effect that it does on the warm- 
blooded. 

From all the above,nt is evident that three proposi- 
tions may be laid down : 

I. That impregnation may occur, it is necessary that 
the semen contain living, perfectly organized spermato- 
zoa, and that these animalcules must come in contact 
with the ovum while in the living condition. 

II. That any agent which is capable, when brought 
in contact with the spermatozoa, of destroying their 
life, will prevent their power of impregnation. 

III. That if they are wholly washed out of the 



304 HALE ON ABORTIOE". 

vagina and cervical canal immediately after coition, 
impregnation cannot take place. 

It follows, tlierefore, that to cause Ovular Ahortion^ 
by other than rules relating to the time of the act of 
coition, or the mechanical prevention of the contact of 
the spermatozoa with the ovum, the results of the 
second and third proposition must be obtained. 

To destroy the life of the spermatozoa while in the 
vagina, some substance inimical to their vitality must 
be thrown into that passage in such a manner as to 
come in contact with them, when holding the seminal 
fluid in solution. 

We must first ascertain the substances which, when 
thus brought in contact with the spermatozoa, will 
destroy their vitality and power of impregnation. 

Among the most prominent of these agents are, cold 
water^ watery solution of opium^ spirits of wine^ salts, 
acids, alkalies, astringents, strychnine, and probably all 
narcotics and other poisons. Gelseminum, arnica, aco- 
nite, and other medicines, are among the latter. Has- 
sall says the spermatozoa are devoid of life in persons 
who have died from the poisonous effects of prussic 
acid. 

Under certain conditions, any one of the above men- 
tioned agents might be resorted to for the purpose of 
causing devitalization of the spermatozoa, in order to 
insure ovular abortion. 

The selection of the agent would depend on the 
health of the woman, and the local diseases to which 
she was subject. The physician of the parties should 
be the judge of this matter. 

Cold loater should generally have the preference in 
the majority of cases. By reference to a previous para- 
graph it will be seen that cold water causes motion 



OVULAR ABOETION". 305 

to cease in liuman spermatozoa — rolls therQ up and 
destroys tlieir power of impregnating tlie ovum. 

O^ium would hardly be admissible except under 
peculiar circumstances. The same may be said of 
spirits of tvine and strychnine. 

The latter, however, may be used cautiously, when 
there is great relaxation of the vaginal muscles, with 
prolapsus. I have known vaginal injections of a solution 
of strychnine, (one grain to one quart of water) to cure 
a most obstinate case of chronic prolapsus from atony 
of the muscular tissues. One drachm of the tincture of 
nux vomica in the same amount of w^ater has been 
equally effectual. Either preparation, in cold water, if 
injected immediately after coition, would doubtless 
result in the destruction of the animalcules. 

A solution of cormnon salt is quite popular as an 
enema for the prevention of conception. It is used at 
about the strength of ordinary sea-water. I have been 
informed by many of my patients who have used this 
agent, that it cured, in a short time, a profuse and long 
lasting leucorrhoea, and was quite effectual for the origi- 
nal purpose. 

The acids^ even when used quite dilute, have the 
effect of destroying the motions of the spermatozoa. 
Acetic acid^ or vinegar, largely diluted with water, is 
used to a considerable extent. Sulphuric acid has been 
recommended, and cases have come under my observa- 
tion where this was habitually resorted to. The water 
used as an enema is rendered slightly acid by it, not 
sufficiently so to cause any smarting of the mucous 
surface. A very popular and effectual mixture for 
vaginal enema is made of sulphuric acid and alum.^ 

* 5 Acid. Sulph. dil. 3j. 



Alumen, 


3j. 


Aqua, 


Iqt. 


20 





306 HALE ON ABOKTIOIT. 

Nitric and muriatic acids miglit be beneficial in certain 
diseased conditions of the vagina and os uteri, and per- 
fectly safe as well as reliable for the purposes desired. 

The alkalies might be advised or permitted in cer- 
tain cases. It is said by Donne that when the secretion 
from the uterus is too alkaline, and that of the vagina 
too acid, they destroy the life of the spermatozoa and 
thereby induce sterility. 

Astringents have always enjoyed the most extensive 
popularity. They are resorted to by women in all 
parts of the world, under the instinctive idea that they 
contract the mouth of the womb, and prevent the en- 
trance of the seminal fluid. If this was the extent of 
the action of astringents, their use would be of no value ; 
in fact, they are of but little value unless used in such 
-<|uantities as to destroy the life of all the animalcules. 
Alum is the most commonly used; sulphate of zinc 
■ranks next in popularity. Tannin^ and vegetable sub- 
stances containing that substance — namely, geranium, 
oak-bark, etc., have all been used with success. 

Aconite^ gelseminum^ helladonna^ arnica., and liam- 
amelis., might each be recommended for the purpose 
of preventing impregnation. Each would destroy the 
spermatozoa, and in inflammatory or congested condi- 
tions of the OS, cervix, and vagina, would prove curative 
by their local action. 

Injections of any medicinal solution, or even of very 
cold water, no matter how destructive they may be to 
the spermatozoa, will prove useless unless they are used 
in a proper manner. It will not suffice to use them in 
small quantities, or hurriedly. Neither will it do to 
wait longer than two or three minutes after coition. 

The spermatozoa are very active when mixed with 
healthy vaginal mucus ; and, in women who have borne 



OVULAE ABORTIOlSr. 307 

cliildren, or in whom the cervical canal is patent, the 
animalcules enter the os uteri by their own volition in 
an incredibly short time. They also become lodged in 
the folds of tLe vaginal mucous membrane, where they 
remain unharmed for hours or days if the enema is not 
most thoroughly used. 

The injection, to be effectual- for the prevention of 
impregnation by destroying the spermatozoa, must be 
used immediately after coition ; it must be thrown in 
with considerable force, and in a large quantity, in 
order to reach the animalcules which may be lodged in 
the mouth of the womb, or the rugse of the vagina. 

The ordinary vaginal syringe, holding but a few 
ounces, is not a proper instrument, unless it is very 
large, and is used six or eight times. The orifices of 
all vaginal syringes are generally too small, and should 
be enlarged. The most appropriate instrument is the 
Essex syringe with an extra large tube. Not less than 
one pint of water should be used, and if one or two 
quarts is thrown up, the danger of impregnation is 
materially lessened in proportion. 

The third proposition implies the use of ?2(97^-medicated 
fluids thrown into the vaginal canal for the purpose of 
washing away all the animalcules lodged therein during 
coition. For this purj^ose fluids might be used 
which were not inimical to the life of the spermatozoa, 
namely, warm water, milk, etc., and if a suflicient 
quantity was used would probably be effectual. There 
would be danger, however, that the bland character of 
these fluids would preserve the life of a few of the 
animalcules, and thus allow impregnation to take 
place. 

Cold water is the most generally useful fluid to be 
used as an enema. It should be used immediately after 



308 HALE ON ABOETIOlSr. 

coition, and in quantity not less than one quart. The 
temperature need not be lower than 42°, and should 
not be higher than 60°. An Essex syringe, throwing 
a continuous stream, should be used, and the water 
should be directed to all parts of the vagina, particu- 
larly the upper portion, around the cervix uteri. The 
best position for the woman to assume is the sitting- 
posture, on the side of a stool or any low seat, in such 
a position that the water when thrown up will gravitate 
downward and outward. None of the fluid should be 
allowed to remain in the vagina. 

This last method is preferable to all the others, as a 
general one. No risk of injury is incurred. I have 
never known but one instance, where cool vaginal injec- 
tions could not be borne, and in this it only caused a 
a temporary spasmodic and painful action of the uterus. 

There is but one condition in which it would prove 
ineffectual ; namely, when the uterus li^s so low in the 
pelvis, and the cervical canal so opeoi^ as to permit the 
entrance of the seminal fluid into the uterine cavity 
during the act of coition. In this state of the organ, 
impregnation could hardly be prevented, as it is not 
always safe to inject fluids into the cavity of an unim- 
pregnated uterus. 



TABULAE VIEW. 



809 



The following Table will give at a glance the condition of the uterine contents^ 
and the treatment to be adopted, during the three great periods of 
utero-gestation. 



From conception to end of 
third montii. 



Placenta not devel- 
oped. 

Decidual membrane 
adherent to the uterus. 

Contractile power of 
the uterus too feeble to 
expel embryo, etc., or 
arrest hsemorrhage. 

Haemorrhage before ex- 
pulsion of after-birth. 

Remedies for Hem- 
orrhage. — Sabina, erig- 
eron, tanacetum, arnica, 
hamamelis, trillium, cin- 
namon, ice, cold water, 
hot water, tampon, stfZpA. 
acid. 



ReMCTVAL OPDECrDUA. 

-Blunt hooks — forceps 
-injections. 



From end of third month to 
end of sixth. 



Placenta developed and 
attached to uterus. 

Decidual membrane 
non-adherent. 



From end of sixth month to 
full term. 



Placenta developed and 
attached to uterus. 

Decidual membrane 
non-adherent. 



Contractile power of Uterus capable of fore- 



uterus capable, in some 
instances, of expelling 
placenta and embryo. 

Haemorrhage before ex- 
pulsion of after-birth. 

Remedies for Hem- 
orrhage. — Sabina, cro- 
cus, erigeron, erecMhites, 
secale, cinnamon, ice, and 
cold or hot water, gal- 
vanism tampon. 



Removal of After- 
birth. — Secale, dry cup- 
ping, galvanism, Pulsa- 
tilla, caulophyllin, macro- 
tin, gossypium, reflex irri- 
tation by tampon, etc.; 
blunt hook, forceps. 



ible expulsive contrac- 
tions. 



Haemorrhage after ex- 
pulsion of after-birth. 

Remedies for Hem- 
orrhage. — Secale, caulo- 
phyllin, macrotin, erig- 
eron, ice, cold and hot 
water, galvanism (tam- 
pon never). Pressure on 
uterus, or manipulations 
with the hand. 

Removal of After- 
birth. — Forceps, blunt 
hook, secale, caulophyllin, 
macrotin, gossypium, gal- 
vanism, dry cupping, 
uterine irritation by cold 
water or the hands (tam- 
pon neve?'). 



PART VI. 

JURISPRUDENCE OF ABORTION, 



SECTION I. 

The consideration of tlie Jurisprudence of Abortion, 
includes tlie moral and legal bearings of botli obstetric 
and criminal abortion. 

I cannot commence this portion of the work in a 
more appropriate manner than by quoting entire a Lec- 
ture delivered by my venerable friend and colleague, 
who lately occupied the chair of Medical Jurisprudence 
in Hahnemann Medical College. 

CEIMINAL ABORTION: 

A LECTURE BEFORE THE CLASS OF HAHNEMANN MEDICAL COLLEGE, DECEMBER, 1864. 

BY PROF. A. E. SMALL. 

Next to the crime of infanticide is that of criminal abortion. It 
matters not by whom committed, whether by the mother herself or 
some interested friend, nurse or physician. The procuring of abor- 
tion, under all circumstances, is a direct violation of the laws of 
the physical constitution, and almost always a violation of that holy 
commandment, " Thou shalt not kill." 

Before we proceed to discuss the nature of this crime in the light 
of reason, and in reference to what legislation there has been upon 
the subject, it is proper to test its heinousness in the light of the 
moral law, which regards the willful killing of a human being, at any 
stage of its existence, as nothing short of murder. When we consider 
the fact that fcetal life is human life, distinct from that of the 
mother's, and dependent upon, an organization as distinct from that 
of the mother's as if it were entirely liberated from its resting place 
in her womb, we cannot avoid the conclusion that the destruction 
of such a being would be the destruction of a human life, and that 
he or she who had an agency in perpetrating the deed would, in 
the eye of the moral law, be guilty of murder. In order to gain a 
better understanding of the bearings of the subject, abortion in the 
abstract must be considered. 

To begin with a proper definition — it is a violent and premature 
expulsion of the product of conception, independently of its age, 
viability and normal formation. In the investigation of the subject 



314 HALE ON ABOETION. 

as a crime, all cases of abortion that result from natural causes, or 
the result of accident, or justified by the rules of medicine, whether 
to save the life of the mother or her child, will be set aside. ~We 
shall confine our discourse to such cases only where the attempt at 
premature expulsion of the product of conception is artificially 
unnecessarily and intentionally made, and without which they would 
not otherwise have occurred. 

The laws of the land do not recognize that unnecessary abortion 
fer se is a crime, inasmuch as the act is not directed against the life 
of the mother, and because, too, she is generally a party to the 
action performed, and when no manifest injury or loss of life hap- 
pens to the mother, it is regarded a mere misdemeanor ; or, if other- 
wise, the law does not take cognizance of the act as a capital 
offense. 

Able authorities upon the subject have pointed out the inconsist- 
ency of the law as contemplating the crime as directed against the 
mother, and not against the foetus, when in fact no criminal intent 
against the mother can be af&rmed, but against the foetus. 

The act, when unnecessarily performed, manifestly seems to have 
been undertaken from one of two reasons — either to prevent the pro- 
duct of conception from receiving life ; or if living, to destroy it. 
We shall produce evidence to show that the foriner cannot be the 
case, and, consequently, that the latter is the sole intent when 
the act is committed. 

To constitute a crime, a malicious or wicked attempt is supposed 
to exist, and as the intent in attempting to produce abortion is 
against the product of conception, and not against the mother, we 
cannot but regard this assumption of the law as erroneous ; tending 
rather to increase the frequent repetition of the crime instead of 
exerting a wholesome influence against it. For unless the woman 
die in consequence of the attempt, it is declared, in every state of 
pregnancy, a mere misdemeanor ; or where injury is done the mother, 
not necessarily fatal to her life, the crime may be considered a felony, 
and punishable by fine or temporary imprisonment. The mag- 
nitude of the crime against the second human victim being entirely 
overlooked. 

We shall, for the present, omit the further consideration of the 
subject as treated both in common and statutory law, our purpose 
being to show that abortion is primarily a crime of the most heinous 
character, directed with malicious intent against human embryotic 
and foetal life, and in pursuing this course we shall attempt to show 
the fallacy of the arguments urged by interested parties in extenua- 
tion of the offense. 

Excepting all accidental and necessary cases of abortion, it must 
be evident that abortions must be intentional, and must be occa- 
sioned by the " malice aforethought " of the law. It has been 
stated that the malicious intention, unless otherwise shown, is not 
directed against the mother, but against the product of her womb. 
Hence the whole criminality of the offense turns on this one fact — 



JUEISPEUDENCE OF ABORTION. 315 

the real nature of the fcetus in utero. If the foetus be a lifeless ex- 
cretion, however soon it might have received life, the offense would 
have been of minor consequence. 

" If the fcetus be already, and from the verj outset, a living 
human being, and existing independently of its mother, though draw- 
ing its substance from her, its destruction, in every stage of preg- 
nancy, is MURDER. Every act of procuring abortion," rules Judge 
King, of Philadelphia, " contrary to the usual interpretation of the 
law, is murder, whether the person perpetrating such act intended 
to kill the woman, or merely feloniously to destroy the fruit of her 
womb." 

In Dr. Storer's contributions to Obstetric Jurisprudence may be 
found a complete reply to the plea of ignorance of the nature of the 
crime, which is often urged in extenuation. He says : 

" Ignorance of the law is held no excuse. The plea of ignorance 
of guilt could hardly better prevail, where its existence is implied 
by common sense, by analogy, and b}^ all natural instinct, binding 
even on brutes. * * * Common sense would lead us to the 
conclusion that the fcstus is, from the very outset, a living and dis- 
tinct being. It is alike absurd to suppose identity of bodies and 
independence of life, or independence of bodies and identity of life ; 
the mother and the child within her, in abstract existence, must be 
entirely identical from conceptioii to birth, or entirely distinct. 
Allowing, then, as must be done, that the ovum does not originate 
in the uterus ; that for a time, however slight, during its passage 
through the Fallopian tube, its connection with the mother is wholly 
broken ; that its subsequent history is one merely of development, 
its attachment merely for nutrition and shelter — it is not rational to 
suppose that its total independence, thus once established, becomes 
again merged into total identity, however temporary ; or that life 
depending on nine months' growth, or on birth, because confess- 
edly existing long before the latter period — since quickening at 
least, a time varying widely as to limits, — dates from any other 
period than conception." 

"Another argument is furnished us, but differing. The fcetus, 
previous to quickening, must exist in one of two states, either 
death or life. The former cannot take place, nor can it ever exist 
except as a finality. If its signs do not at once manifest them- 
selves, as is generally the case, and the fcetus is retained in utero, 
it must either become magnified or disintegrated — it can never be- 
come vivified. If, therefore, death has not taken place, and we can 
conceive no other state of the fcetus save one, that — namely, life, 
must exist from the beginning." 

" These reasons are strengthened by the reasonings from analogy. 
The utter loss of direct influence by the female bird upon its off- 
spring from the time the egg has left her, and the marked effect 
originally of the male. The independence in body, in movement and 
in life, of young marsupial mammals, almost from the very moment 
of their conception, identical analogically with the intra-uterine 



316 HALE OF ABOETIOlSr. 

state of other embryos — nourishment by teat merely replacing that 
by placenta at an earlier period ; the same in birds, shown by move- 
ments in their egg, on cold emersion before the end of incubation. 
The permanence of low vitality or of impaired or distorted nervous 
force, arising from early arrest or error of development, and neces- 
sarily contemporaneous with it, are all instances in point." 

" The human instinct, unaided by reason, invariably leads to the 
protection of embryonic and foetal life. It is said that reason sup- 
plants this instinct which is enjoyed in common by the brutes. But 
this may be doubted, inasmuch as the absence of reason in idiots 
and insane persons does not impair the maternal instinct. What- 
ever ideas the human mind, by reasoning, may have forced itself to 
believe or entertain, let the slightest proof of the existence of foetal 
life be alleged, and maternal instinct at once makes itself known." 

Thus far, incidental proof concerning the commencement of foetal 
life, and consequently the manifest guilt of unjustifiable abortion, 
becomes apparent. If there exists any doubt of the vitality of the 
contents of the womb in early pregnancy, none whatever can be 
cherished after the period of quickening. 

This period, which betokens the existence of a living foetus in 
the womb of the mother, declares emphatically that there is an intra- 
vterine life that may be destroyed by violent hands ; that this posi- 
tive evidence becomes revealed to the mother by unmistakable sen- 
sations, is universally admitted ; 'and this accounts for the fact of 
abortions being much more rare after this period than previous. 

But singular as it may seem, quickening is often absent through- 
out pregnancy, and other evidences are relied on to establish the 
fact. These cases are confessedly exceptions to the rule. In most 
cases of pregnancy it does occur, but varying very greatly in point 
of time. In the same woman, in successive seasons of pregnancy, 
the period of quickening, reckoning from conception, has varied 
from fifteen to thirty days. In the greater number, the period 
occurs from the one hundred and twentieth to the one hundred and 
thirtieth day after conception. But from intra-iderine causes, this 
period may be lengthened to one hundred and forty, or even one 
hundred and fifty days, and yet, from facts which cannot be disputed, 
the foetus is living. 

We have witnessed premature births in several instances where 
the mother was in doubt of her situation till the hour of parturition 
arrived. Only a few weeks ago, a lady who had been married two 
years or more applied for counsel in reference to her health, stated 
that she had not menstruated for seven months, that her form had 
changed but little, and that at no time had she been conscious of 
any sensation that would lead her to suppose that she had been car- 
rying in her womb a living child. At the same time, her feet were 
swollen, which, in connection with other signs of anasarca, led her 
to believe that she was the victim of disease not dependent on preg- 
nancy. Scarcely a week, however, elapsed, before there was ocu- 
lar demonstration of the- incorrectness of her conclusions ; the hour 
of parturition arrived, and she gave birth to a living child. 



JUEISPEUDEFCE OF ABORTIOlSr. 317 

In premature births, where quickening has not occurred, we have 
the most positive evidence of earlj independent and vital existence. 
These births sometimes occur previous to the time when quickening 
may be looked for, and in some instances by the ear there is conclu- 
sive evidence to be gained of the existence of a living being in utero, 
when no quickening has taken place. 

It will he conceded, then, that the period of manifest quickening 
is by no reasonable conclusion to be regarded the commencement of 
fcetal life. The period set by some of the old writers was the third 
day after conception, and this is quite as reasonable, and yet neither 
is to be accredited as true. 

In order to arrive at the conclusion that embryotic life exists 
from the commencement to the end of pregnancy, it is not necessary 
to set up the claim of sentience and will, as some writers have done. 
For while perfection of endoAvment does not exist with the embryo, 
its independent life can be conceded, with prophetic endowments 
for future development, in the womb and after birth, of all the 
attributes of human perfection. We must concede this, if any- 
thing, for how can the embryo merge into the foetus without a per- 
fectly independent excito-motory system, distinct from that of the 
mother? If we admit this, we are brought directly to the conclu- 
sion, that the existence of a distinct and independent nervous cen- 
tre must be as self-acting and living as that of the mother. 

If we have succeeded in proving the existence of foetal life, be- 
fore quickening has taken or can take place, even though but the be- 
ginning of undeveloped faculties, — the inalienable rights of a human 
being are implied, and this should compel us to believe that unneces- 
sary abortion is a crime. 

This once established, we are struck with a full sense of human 
degradation ; mothers imbruing their hands in their infants' blood ; 
fathers equally guilty, counseling and procuring the commission 
of the crime ; nurses who lend themselves to the infamy ; mem- 
bers of the medical profession, made wicked by their wholesale 
murders, out-Heroding Herod — eclipsing in criminality the pirate 
upon the seas, the midnight robber or highwayman ; wretches who 
make this kind of murder a trade ; who go forth with falsehood 
and lies, in defiance of the mandates of the Almighty ; public com- 
placency that nurses the crime, or palliates it, or with insultmg 
claims of legal assumption that it is a mere misdemeanor to go forth 
as a destroying angel to prey upon human life. Who can uphold 
or defend so common a violation of all just law, human and divine ? 
Who can justify such assault upon all instinct and reason? Let 
those answer who would seek, if they could, some reasonable excuse 
for this waywardness. 

That criminal abortion is carried on to a great extent in our 
countr}^, is indeed probable, and that it is carried on apparently by 
those having high claims to respectability, we also admit, and fur- 
ther, we admit the plausibility of the motives that frequently lead 
to the act ; and these are of sufficient importance to enter concisely 



318 HALE 0]Sr ABOETIOlSr. 

into our discussion. Poes not the motive give moral quality to tlie 
act? — some may inquire. We have already said that necessary and 
justifiable abortions, in accordance with the rules of medicine, are 
sometimes demanded. The lives of human beings are, under more 
circumstances than a few, sacrificed to prevent greater evils. But 
far be it from us to offer any palliation for the crime of murder. 
"When a woman, a wife, either with or without the consent of her 
husband, applies to an abortionist for the purpose of ridding herself 
of the product of conception, she will always make a show of rea- 
son for the act, by attempting to show a necessity for it. She may 
set up the claim of being unable to have the responsibilitj'' of child- 
ren ; that she cannot educate them or keep them fed and clothed, or 
above degradation ; that her own health will not permit it ; that the 
period of gestation subjects her to confinement and keeps her from 
society, and she might as well be dead as alive. We have known 
some physicians to listen to an appeal like this, and yield to the dic- 
tates of a blind sympathy, especially when a generous fee was forth- 
coming to more effectually close their minds against all sense of moral 
obligation, and plant themselves upon the flimsy reasoning of such 
women, and while prostrate before mammon would write a prescrip- 
tion for some powerful deobstruent. But they lend countenance to 
crime by such acts, and become particeps criminis in a murderous 
transaction. 

Such a woman's reasonings are as baseless as a fabric upon the 
sand. She has a husband to father her offspring, a Heavenly Father 
to protect her on the voyage of life, and in all probability an angel 
sent for her future comfort ; and would any but a God- forsaken 
father and mother, and a God-forsaken physician, ever enter into a 
conspiracy to destroy human life upon sucli flimsy grounds? Thou- 
sands of cases of this kind are constantly occurring in the large 
cities and towns of our country, to enrich such female wretches as 
Mads. Restell, Beaumont and others, who levy imposing taxes in 
order to support them in the crime. By all that is human, all that 
is noble and grand in the attributes of true manhood, and by every 
consideration that relates to time and eternity, every honorable phy- 
sician should set his face against this practice, and hold it up as 
murder, in public and private. Let him scorn to sympathize with 
the barbarity, and feel that fees taken for such agency would pro- 
duce an uncomfortable sens9,tion about his neck, and bind him as 
firm as fate to perdition. 

But it may be urged that illegitimate pregnancy is a different 
matter, and that every right-minded physician should be ready to 
save the reputation of a great many victims of this sort from utter 
ruin, and their families from disgrace. A mere glance at the crime 
of abortion, without considering its heinous nature, might cause the 
unwary physician to fall into temptation. A young lady of pre- 
vious good reputation has fallen. Will it raise her from degrada- 
tion to make a violent assault upon the intra-iderine life that is the 
fruit of her imprudence, or, in other words, would any physician 



JURISPRUDENCE OF ABORTION. 319 

feel himself worthy of saying his prayers at night, after he had lent 
his hand to commit a deliberate murder to save the reputation of an 
already disgraced young woman ? What good would he accomplish 
by the act? Experience proves that the fallen one seldom recovers, 
and her seducer is made no better, and the physician made more in- 
famous than either. 

Such, nevertheless, should command our sympathy, and we should 
do all we can to promote their temporal, physical and moral well- 
being. And we can do much in that direction, if we regard first of 
all our duty to God and our obligation to obey all just laws, both 
human and divine. It will be proper to guard the reputation as far 
as we can, and by all possible means consistent with divine and 
human laws. But God forbid that we should do evil that good may 
come. 



I cordially and sincerely subscribe to most of tlie 
^dews above set fortli, so far as relates to the destruc- 
tion of the ovum, without good and sufficient cause. I 
differ, however, with some of my professional brethren, 
in relation to the propriety of inducing abortion or pre- 
mature labor when certain diseases and conditions exist. 

I hold that in no instance should the life, or even 
Jiealth of the mother be sacrificed to save that of an im- 
pregnated ovum, before the date of its " viability." 

The dogma that the embryo, before that date, is of 
the same importance as after, is yet debatable. I can 
not, therefore, look upon the destruction of the ovum 
before that period as murdeT. If we were to carry the 
criminality of the deed back to the period of impregna- 
tion^ we may as well caiTy it back to the period of 
ovulation^ and believe with the ancient Hindoos, that 
the voluntary loss of an unimpregnated ovum was a 
criminal act. According to Robertson, early marriages 
in India were obligatory, in consequence of an ancient 
theory of generation, much resembling the latest modern 
ovarian theory. It was taught that if an unmarried 
girl has the menstrual secretion in her father's house, 
he incurs a guilt equal to the destruction of the foetus ; 



320 HALE ON ABOETION. 

for tlie girl is capable of conceiving, and should be 
allowed to conceive ; menstruation being tlie loss of an 
ovum, which, is equivalent to the loss of a foetus. 

According to the laws of the Shastras, females must 
be given in marriage hefore the occurrence of mens- 
truation ; and, should consummation of the marriage 
not take place until after this event, the marriage is a 
sin. 

These ancient doctrines are not to be treated with 
indifference. The ovum is the receptacle or vehicle of 
the human soul. If the receptacle is voluntarily allowed 
to be discharged unimpregnated, it certainly is a crimi- 
nal offence in a certain degree, for the existence of a 
human heing is prevented. 

On the contrary, lawgivers or physiologists have no 
right to establish any date, anterior to viability, after 
which the unnecessary induction of abortion is a crimi- 
nal offence. 

In relation to this subject, I herewith present a paper 
on the subject of Criminal Abortion, prepared by my 
colleague, Dr. Charles Woodhouse, the present incum- 
bent of the chair of Medical Jurisprudence and Insanity 
in Hahnemann Medical College. 

CEIMINAL ABORTION — ITS JURISPRUDENCE. 

In our remarks on this branch of our subject, it is a matter of 
regret that the laws of our country in relation to it, are far from 
being all that the interests of societj demand. But it is the duty 
of the medical man, and especially the medical author, to do what 
he can to correct these mistakes, and supply their deficiencies. It 
is in this conviction that we consider, in this place, this momentous 
subject. 

In medicine, we understand by abortion the expulsion of the 
fcEtus before the sixth month of gestation. If this expulsion takes 



JUEISPEUDEJSrCE OF ABOETION". 321 

place between tlie sixth and nintii month, this, in medical parlance, 
is termed miscarriage, or premature labor. The popular word for 
both is miscarriage. And the law does not make the distinction 
made by medical men. In many instances the law, unfortunately, 
recognizes the popular falsehood, that a woman may be at a cer- 
tain point of time, " not quick with child," and in the next 
instant " quick with child," and this event is supposed always to 
take place several months after conception. It is needless to say, 
that no sound physiologist can give the least sanction to this error ; 
an error fruitful in sin and crime, however venerable for age. Law- 
makers, as well as people, need enlightenment on this matter. 
Those who believe that at a certain period, say the fourth month 
after conception, the foetus for the the first moment begins to live, 
will agree that it is no moral wrong to remove it before that time, 
and justify themselves for this crime on this false ground. But a 
little reflection must satisfy the reason, that the foetus from the 
beginning must exist in one of two states, life or death. If dead 
from the beginning of gestation, that death is ii finality. The mother 
has no power to give life to a dead foetus within her. If the fcstus 
is alive at the fourth or fifth month, or in any period of utero-gesta- 
tion, it must have been alive from the beginning. Unless the word 
"quickening," in connection with this subject, can be so used as to 
guard against error, it had better not be used at all. It is to be 
hoped that, at all events, the absurd distinction of "quick and not 
quick with child," will soon be banished from the legal codes of all 
civilized lands. And inasmuch as the laws, in many States, do not, 
(to use the language of Storer), "recognize the true nature of the 
crime of abortion, draw unwarrantable distinctions, allow many 
criminals to escape, neglect to establish a standard of justification, 
and in many respects are at variance with equity and justice," 
every true physician should aim to perfect, as far as his influence 
may go, codes for courts, and ideas for the people, until the Divine 
command, " Thou shalt not kill." shall be understood to apply alike 
to the taking away of all human life, fcetal or otherwise. 

We will now give a brief view of some of the laws of different 
countries and States, on abortion : 

England. — In this country the absurd distinction of " quick and 
not quick" is now done away with. "Within the reign of the pres- 
ent Queen the following law has been enacted: " Whosoever, with 
the intent to procure the miscarriage of any woman, shall unlaw- 
fully administer to her, or cause to be taken by her, any poison or 

21 



322 HALE ON ABORTION. 

other noxious thing, or shall unlawfully use anj 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 transported beyond the seas for the term of his 
or her natural life, or for any term not less than fifteen years, or to 
be imprisoned for any term not exceeding three years." It will be 
seen at a gi-ance, that- this law makes no exception in respect to 
medical men, who may adopt, for any purpose or with any motive, 
this practice. It would doubtless be essential for him to show, in 
case of prosecution for this offence, that his motives were as good 
as those of the surgeon's in amputating a badly diseased limb, to 
save himself from the penalties of the law. The English law is 
clearly against the practice, by any body. 

Scotland. — Mr. Allison, a late writer on Scottish law, states it 
thus : •' If a person gives a potion to a woman to procure abortion, 
and she die in consequence, this will be murder in the person giving 
it, if the potion was of that powerful kind which evidently puts the 
woman's life at hazard." Further, "Administering drugs to procure 
abortion is an offence at common law, and that equally whether the 
desired effect be produced or not." In 1806 and 1823, persons who 
used instruments for this purpose, were sentenced to transportation 
for this offence. However it may be in actual practice, the Scotch 
law, as given by Allison, makes no exception in behalf of medical 
men. Like the law of England, it shows some advance in a right 
direction, by discarding the phrase, " quick and not quick," etc. 

Fkance. — The Code of Napoleon declares that every person who, 
by means of ointments, beverages, medicines, acts of violence, or 
by other means, shall procure the untimely delivery of a' pregnant 
woman, although with her consent, shall be sentenced to confine- 
ment." The mother procuring abortion on herself is similarly pun- 
ished, under the same code. And it also provides that "Physicians, 
surgeons, apothecaries, and other officers of health, who shall pre- 
scribe or administer such means of abortion, shall, if miscarriage 
ensue, be sentenced to hard labor for a limited time." 

Austria. — The criminal code of this country, established in 1787, 
by Joseph II., decrees that a woman with child, using means to 
procure abortion, is to be imprisoned not less than fifteen years, nor 
more than thirty, and condemned to the public works. If married, 
the punishment is still greater. Even advising abortion is severely 
punished, and where the accomplice is the father of the infant, the 
punishment is increased. 



JUEISPEUDElSrCE OF ABOETION. 823 

Germany. — Deck gives the following summaiy of the laws of 
Germany : If produced within thirty weeks from the time of con- 
ception, the woman or her aiders are imprisoned from two to six 
years. The punishment when committed 'in the last month of 
pregnancy, is imprisonment from eight to ten years. 

Italy. — The laws punish the woman who makes the attempt 
only, to confinement from six months to a year ; if she is successful 
in the attempt, she is confined from one to five years. If the father 
of the foetus is a party to the crime, his punishment is still greater. 
The party attempting abortion against the will of the mother is 
punished with four to ten years' severe imprisonment ; and if the 
life of the mother is endangered, or her health impaired, the impris- 
onment is five to ten years. 

State of New York. — The laws of this State, on abortion, are 
now embraced in three sections, one of which provides that for the 
willful commission of this crime, by medicine or instrument, the 
offender shall be imprisoned in the county jail not less than three 
months, nor over one year. This section omits the distinction of 
"quick and not quick." Another section provides for punishing 
the offence, committed on a woman quick with child, with intent to 
destroy the child, unless necessary to save the life of the mother. 
Otherwise than for this purpose, if either child or mother die in 
consequence, the offence is manslaughter in the second degree, and 
the punishment is State prison, for not over seven nor less than 
four years. A further section provides that the willful killing of an 
unborn quick child, by an injury to its mother, which would be 
murder if it resulted in her death, is manslaughter in the first degree, 
and the penalty is State prison for not less than seven years. This 
great State has for its motto " Excelsior," and doubtless may for 
many good reasons still use it ; but it needs to follow in the wake 
of England and Scotland, and younger sister States, in discarding 
from its laws on abortion the pernicious and absurd phrase, " quick 
and not quick," etc. 

State of Connecticut. — Here this absurd distinction of ''quick 
and not quick," still remains, but the crime may be punished by 
State prison for life. 

State of Ohio. — In the laws of this State, the same absurd dis- 
tinction is kept up as in New York and Connecticut, but there is a 
provision justifying the physician in saving the life of the mother, 
even at the expense of that of the foetus. 



324 HALE ON ABOETION. 

State of Massachusetts. — In 1845, tins State adopted a law, 
discarding the distinction of "quick," etc., and providing that abor- 
tion, bj whatsoever means produced, if the woman die, shall be pun- 
ished by imprisonment for not less than five years, nor more than 
twenty. If the woman do not die, the offence is a misdemeanor, 
and the punishment not over seven years, nor less than one, and by 
a fine of not over $2,000. 

State of Missouki. — The penalty for this crime here is impris- 
onment not over seven years, and a fine not over $3,000. 

State of Virginia. — This offence is here punished by confine- 
ment in the penitentiary not less than one nor over four years. 

In all these named States, provisions are made for esempting 
from punishment any physician, or other person, where the act is 
done in good faith, with intent to preserve the life of either mother 
or child. (See Beck. Med, Jurisprudence, Vol. I., page 584). 

State op Illinois. — In the laws of this State, the absurd dis- 
tinction .alluded to is not retained. The punishment is confine- 
ment in the penitentiary not over three years, and a fine not over 
$1,000. 

State of Iowa. — From the year 1851 to 1858 there were in this 
State, strange to say, no laws punishing the procurement of abor- 
tion. Prior to the year 1851, the "willful killing of an unborn 
quick child, by drugs or violence," was punished as manslaughter. 
But for this omission of duty and once legal recognition of the false 
distinction -of "quick and not quick," etc., Iowa has nobly atoned 
by giving a Yerj good law (a model for some other States) on this 
subject. It reads as follows : " That every person who shall will- 
fully administer to any pregnant woman any medicine, drug, sub- 
stance or thing whatever, with the intent thereby to procure the 
miscarriage of any such woman, unless the same shall be necessary 
io preserve the life of such woman, shall, upon conviction thereof, 
be punished by imprisonment in the county jail for a term not 
exceeding one year, and be fined in the sum not exceeding one- 
thousand dollars." 

State of California. — The law against abortion in California, 
says The Medical and Surgical Reporier, is exceedingly stringent. It 
declares that the person on whom an abortion is practised shall be 
held as guilty as the abortionist. The object of this feature of the 
law is to relieve the physician of vexatious lawsuits, to which he is 
sometimes subject by the attempt of certain wicked females to fasten 
upon him criminal abortion, when he has not even been applied to at 



JURISPEUDElSrCE OF ABOETIOIT. 325 

all in the matter. A case of this kind is said to have occurred in 
San Francisco, and illustrates the necessity of the law in that State, 
even though the cases which may occur under it may be rare. 
Procuring abortion is justly regarded as a crime of great magnitude, 
and the laws of all the States, so far as we are informed, inflict upon 
the perpetrator of it a heavy penalty ; and the law is right. Its 
penalties are none too severe ; indeed hardly enough so, to prevent 
its occasional, if not frequent violation. 

These citations of som'e of the laws on abortion, are sufficient to 
show how this crime is viewed in different States and countries, and 
also to call attention to such improvements in them as the facts in 
physiology and the authority of the divine law shall suggest and 
require. The laws should in no case create or perpetuate the dis- 
tinction of " quick and not quick with child," as it is repudiated by 
right reason and sound physiology. The fact should also be pressed 
upon the attention of law-makers that a pregnant woman may, her- 
self, be mistaken as to whether quickening has taken place or not, 
and that she may bear a living child without having been ever con- 
scious of quickening having ever taken place in her case at all. 
The laws should leave no loop-holes for the escape of the offender, 
who knows the nature and enormity of the crime he or she commits. 
One State, for instance, could be cited, where the laws are perhaps 
sufficiently severe against the crime of abortion, when produced by 
drugs, but, singularly enough, says nothing against its production by 
instruments. The moralist has a duty to do in the premises, and all 
books on abortion should be deemed exceedingly faulty, which do 
not bear testimony against this evil, and help to aid its suppression. 

[Dr. Woodhouse has obtained, with much difficulty, the existing 
laws relating to abortion in the States above mentioned. In the 
other States of the Union we cannot ascertain what change, if any, 
has been made in their laws relating to criminal abortion, since the 
date of the work on that subject by Dr. Storer.] 

Dr. Storer, writing in I860,* gives the following as the laws of 
the various States : 

" In the following States — Rhode Island, New Jersey, Pennsyl- 
vania, Delaware, Maryland, North Carolina, South Carolina, Geor- 
gia, Florida, Kentucky, Tennessee, Iowa,f and the District of 
Columbia, there appear to exist no statutes against abortion, and 

* Criminal Abortion, p. 75. f Iowa has since passed a very good law. 



326 



HALE ON ABOETIOlSr. 



tlie crime can only be reached at common law and by the rulings of 
the courts." 

So far the instances in this country of an absence of special stat- 
utes. "Where such exist, they may be variously classified. Reserv- 
ing for a little ail other considerations, we find them at once falling 
into four great divisions. 

I. Those acknowledging the crime only after quickening has 
occurred : 

Connecticut, Minnesota, 

Mississippi, Oregon. 

Arkansas, 

II. Those acknowledging the crime throughout pregnancy, but 
supposing its guilt to vary with the period to. which this has ad- 
vanced : 

Maine, Ohio, 

New Hampshire, Michigan, 

New York, "Washington. 

III. Those acknowledging the crime throughout pregnancy, un- 
mitigated ; but still requiring proof of the existence of this state : 

. Vermont, Missouri, 

Massachusetts, Alabama, 

Illinois, Louisiana, 

"Wisconsin, Texas, 

Virginia, California. 
Kansas, 

IV. That, like the present English statute, requiring no such 
proof, and punishing also the attempt, even though pregnancy do 
not exist ; 

Indiana. 

Briefly to recapitulate these groups : 

Maine, Class II. Alabama, Class III. 

New Hampshire, " II. Mississippi, ' '• I. 

Vermont, " III. Louisiana, " III. 

Massachusetts, " III. Texas, " III. 

Rhode Island, no statute. Ohio, Class II. 

Connecticut, Glass I. Indiana, " IV. 

New York, " II. . Illinois, " III. 

New Jersey, none. Michigan, " II. 

Pennsylvania, none. Kentucky, none. 

Delaware, none. Tennessee, none. 

Maryland, none. Missouri, Class III. 

District of Columbia, none. Arkansas, " I. 

Virginia, Class III. "Wisconsin, ^' III. 

North Carolina, none. Iowa, none. 

South Carolina, none. Minnesota, Class . I. 

Georgia, ^ none. California, " III. 

Plorida, none. Oregon, ^' I. 



* JURISPEUDElSrCE OF ABOETIOK. 327 

Mississippi. — " The willful killing of an unborn quick child, by 
anj injury to the mother of such child, which would be murder if it 
resulted in the death of the mother, shall be deemed manslaughter. 

" Every person who shall administer to any woman pregnant Avith 
a quick child, any medicine, drug, or substance whatever, or shall 
use or employ any instrument or other means, with intent thereby 
to destroy such child, unless tJie same shall have been necessary to 
preserve the life of such mother, or shall have been advised by a 
physician to be necessary for such purpose, shall be deemed guilty 
of manslaughter."* Punishment, by fine not less, than one thou- 
sand dollars, or imprisonment in the county jail for not more than 
one year, or in the penitentiary for not less than two years. 

Arkansas. — " The willful killin-g of an unborn quick child, by 
any injury to the mother of such child, which would be murder if it 
resulted in the death of such mother, shall be adjudged manslaughter. 

"Every person who shall administer to any woman pregnant with 
a quick child, any medicine, drug, or substance whatever, or shall 
employ any instrument or other means, w^ith intent thereby to 
destroy such child, and thereby shall cause its death, unless the 
same shall be necessary to preserve the life of the mother, or shall 
have been advised by a regular physician to be necessary for such 
purpose, shall be deemed guilty of manslaughter. "f 

Minnesota. — The willful killing of an unborn infant child, by any 
injury to the mother of such child, which would be murder if it 
resulted in the death of such mother, shall be deemed manslaughter 
in the first degree. 

"Every person who shall administer to any woman pregnant with 
a quick child, any medicine, drug, or substance whatever, or shall 
use or employ any instrument or other means, with intent thereby 
to destroy such child, unless the same shall have been necessary to 
preserve the life of such mother, or shall have been advised by two 
physicians to be necessary for such purpose, shall, in case the death 
of such child or of such mother be thereby produced, be deemed 
guilty of manslaughter in the second degree.";}; Punishment for 
first degree, imprisonment in the territorial prison for not less than 
seven years ; and for second degree, not more than seven years nor 
less than four. 

Maine. — Whoever administers to any woman pregnant Avith child, 
whether such child is quick or not, any medicine, drug, or other sub- 
stance, or uses any instrument or other means, unless the same were 
done as necessary for the preservation of the mother's life, shall be 
punished, if done with intent to destroy such child, and thereby it 
was destroyed before birth, by imprisonment not more than five 
years, or by fine not exceeding one thousand dollars ; if done with 
intent to procure the miscarriage of such woman, by imprisonment 

* Revised Code of Mississippi, 1857, chap. 64, p. 601. 
f Digest of Statutes of Arkansas, 1848, chap. 51, p. 325. 
X Revised Statutes of Minnesota, 1851, chap. 100, p. 493. 



328 HALE OTSr ABOETIOIS'. 

less [sic) than one year, and bj fine not exceeding one thousand 
dollars."* 

New Hampshire. — "Every person who shall willfully administer 
to any pregnant woman any medicine, drug, substance or thing what- 
eyer, or shall use or employ any instrument or means whatever, with 
intent thereby to procure the miscarriage of any such woman, unless 
the same shall have- been necessary to preserve the life of such 
woman, or shall have been advised by two physicians to be necessary 
for that purpose, shall, upon conviction, be punished by imprison- 
ment in the county jail not more than one year, or by a fine not 
exceeding one thousand dollars, or by both such fine and imprison- 
ment, at the discretion of the court. 

" Every person who shall administer to any woman pregnant with 
a quick child, any medicine, drug, or substance whatever, with in- 
tent thereby to destroy such child, unless the same shall have been 
necessaxy to preserve the life of such woman, or shall have been 
advised by two physicians to be necessary for such purpose, shall, 
upon conviction, be piunished by fine not exceeding one thousand 
dollars, and by confinement to hard labor not less than one year nor 
more than ten years. 

"Any person who shall cause the death of any pregnant woman, 
in the perpetration or attempt to perpetrate either of the crimes 
mentioned in the two preceding sections, or in consequence of the 
perpetration or the attempt to perpetrate either of said crimes, 
shall be taken and deemed to be guilty of murder in the second 
degree, and be punished accordingly. 

"Any woman who shall voluntarily submit to the violation of the 
provisions of this act (this and the three preceding sectionsf) upon 
herself, shall be punished hy imprisonment in the county jail not 
exceeding one year, or by fine not exceeding one thousand dollars, 
or by both said fine and imprisonment, at the discretion of the 
court."! 

Ohio. — "Any physician, or other person, who shall willfully ad- 
minister to ally pregnant woman, any medicine, drug, substance, or 
thing whatever, or shall use any instrument, or other means what- 
ever, with intent thereby to procure the miscarriage of any such 
woman, unless the same shall have been necessary to preserve the 
life of such woman, or shall have been advised b}^ two physicians to 
be necessary for that purpose, shall, upon conviction, be punished 
by imprisonment in the county jail not more than one year, or by 
fine not exceeding five hundred dollars, or by both such fine and 
imprisonment. 

"Any physician, or other person, who shall administer to any 
woman, pregnant with a quick child, any medicine, dri;g, or sub- 
stance whatever, or shall use or employ any instrument, or other 

" Revised Statutes of Maine, 1857, chap. 124, p. 685. 

•|- The above should evidently read, "the first two sections," to be possible. 

i Compiled Statutes of :N'ew Hampshire, 1853, chap. 227, p. 543. 



JUEISPEUDEFCE OF ABOETIOlSr. " 329 

means, Avith intent tlierebj to destroy such child, unless the same 
shall have been necessarj to preserve the life of such mother, or 
shall have been advised bj two physicians to be necessary for such 
purpose, shall, in case of the death of such child or mother, in con- 
sequence thereof, be deemed guilty of a high misdemeanor, and upon 
conviction thereof, shall be imprisoned in the penitentiary not more 
than seven years, nor less than one year."* 

Michigan. — " The willful killing of an unborn quick child, by 
any injury to the mother of such child, which would be murder if it 
resulted in the death of such mother, shall be deemed manslaughter. 

"Every person who shall administer to any woman pregnant with 
a quick child, any medicine, drug, or substance whatever, or shall 
use or employ any instrument, or other means, with intent thereby 
to destroy such child, unless the same shall have been necessary to 
preserve the life of such mother, or shall have been advised by two 
physicians to be necessary for such purpose, shall, in case the death 
of such child or of such mother be thereby produced, be deemed 
guilty of manslaughter. 

" Every person who shall willfully administer to any pregnant 
woman, any medicine, drug, substance, or thing whatever, or shall 
employ any instrument, or other means whatever, with intent there- 
by to procure the miscarriage of any such woman, unless the same 
shall have been necessary to preserve the life of such woman, or 
shall have been advised by two physicians to be necessarj^ for that 
purpose, shall, upon conviction, be punished by imprisonment in a 
county jail not more than one year, or by a fine not exceeding five 
hundred dollars, or by both such fine and imprisonment. "f 

Veemont. — " Whoever maliciously or without lawful justifica- 
tion, with intent to cause and procure the miscarriage of a woman, 
then pregnant with child, shall administer to her, prescribe for her, 
or advise or direct her to take or swallow any poison, drug, medi- 
cine, or noxious thing, or shall cause or procure her, with like intent, 
to take or swallow any poison, drug, medicine, or noxious thing ; 
and whoever maliciously and without lawful justification, shall use 
any instrument, or means whatever, with the like intent, and every 
person with the like intent, knowingly aiding and assisting such 
offenders, shall be deemed guilty of felony, if the woman die in con- 
sequence thereof, and shall be imprisoned in the State prison not 
more than ten years, nor less than five years ; and if the woman 
does not die in consequence thereof, such offenders shall be deemed 
guilty of a misdemeanor, and shall be punished by imprisonment in 
the State prison not exceeding three years, nor less than one year, 
and pay a fine not exceeding two hundred dollars.";]; 

"Wisconsin. — " Every person who shall administer to any preg- 
nant woman, or prescribe for any such woman, or advise or procure 

* Eevised Statutes of Ohio, 1854, chap. 163, p. 296. 
f Compiled Laws of Michigan, 1857, vol. ii. chap. 180, p. 1509. The statute 
of the Territory of Washington is very similar to those above. 
I Compiled Statutes of Vermont, 1850, chap. 108, p. 560. 



330 HALE OlSr ABOETIOH^. 

any sucli woman to take any medicine, drug, or substance, or thing 
whatever, or shall use or employ any instrument, or other means 
whatever, or advise or procure the same to be used, with intent 
thereby to procure the miscarriage of any such woman, shall, upon 
conviction, be punished by imprisonment in a county jail, not more 
than one year nor less than three months, or by fine not exceeding 
five hundred dollars, or by both fine and imprisonment, at the dis- 
cretion of the court. 

" Every woman who shall take any medicine, drug, substance, or 
thing whatever, or who shall use or employ any instrument, or shall 
submit to any operation, or other means whatever, with intent to 
procure a miscarriage, shall, upon conviction, be punished by impris- 
onment in a county jail not more than six months, nor less than one 
month, or by a fine not exceeding three hundred dollars, or by both 
fine and imprisonment, at the discretion of the court."* 

Alabama.— ^" Any person who willfully administers to any preg- 
nant woman, any drug or substance, or uses and employs any instru- 
ment or other means to procure her miscarriage, unless the same is 
necessary to preserve her life, and done for that purpose, must, on 
conviction, be fined not more than "five hundred dollars, and impris- 
oned not less than three nor more than twelve months. "f. 

Louisiana. — ""Whoever shall feloniously administer, or cause to 
be administered, any drug, potion, or any other thing, to any woman, 
for the purpose of procuring a premature delivery, and whoever shall 
administer, or cause to be administered, to any woman pregnant with 
child, any drug, potion, or any other thing, for the purpose of pro- 
curing abortion, or a premature delivery, shall be imprisoned at hard 
labor for not less than one, nor more than ten years. "J 

Texas. — "If any person shall designedly administer to a pregnant 
woman, with her consent, any drug or medicine, or shall use toward 
her any violence, or any means whatever, externally or internally 
applied, and shall thereby procure^an abortion, he shall be punished 
by confinement in the penitentiary not less than two nor more than 
five years ; if it be done without her consent, the punishment shall 
be doubled. 

"Any person who furnishes "the means for procuring an abortion, 
knowing the purpose intended, is gnilty as an accomplice. 

" If the means used shall fail to produce an abortion, the offender 
is nevertheless guilty of an attempt to procure abortion, provided it 
be shown that such means were calculated to produce that result, 
and shall receive one-half the punishment prescribed. 

"If the death of the mother is occasioned by an abortion so pro- 
duced, or by an attempt to efi'ect the same, it is murder. 

* Revised Statutes of Wisconsin, 1858, cliap. 169, sect. 58. It will be 
noticed that the second section of the above statute differs from the first, in 
requiring the proof of pregnancy. 

f Code of Alabama, 1853, sect. 3330, p. 583. 

t Revised Statutes of Louisiana, 1856, p. 138. By its wording, this statute 
might be forced into the next division. 



JUEISPEUDElSrCE OF ABOETION. 331 

"If any person shall, during the parturition of the mother, destroy 
the vitality or life of a child, which child would otherwise have been 
Lorn alive, he shall be punished by confinement in the penitentiary 
for life, or any period not less than five years, at the discretion of 
the jury.* 

"Nothing contained in this chapter shall be deemed to apply to 
the case of an abortion procured, or attempted to be procured, by 
medical advice for the purpose of saving the life of the mother. "f 

Indiana. — " Every person who shall willfully administer to any 
pregnant woman, or to any woman whom he supposes to be pregnant, 
anything whatever, or shall employ any means with intent thereby 
to procure the miscarriage of such woman, unless the same is neces- 
sary to preserve her life, shall be punished by imprisonment in the 
county jail not exceeding twelve months, and be fined not exceeding- 
five hundred dollars.";); 

Kansas. — " Every physician or other person who shall willfully 
administer to any pregnant woman, any medicine, drug, or substance 
whatever, or shall use or employ any instrument or means whatso- 
ever, with intent thereby to procure abortion, or the miscarriage of 
any such woman, unless the same shall have been necessary to pre- 
serve the life of such woman, or shall have been advised by a physi- 
cian to be necessary for that purpose, shall, upon conviction, be 
adjudged guilty of a misdemeanor, and punished by imprisonment 
in a county jail not exceeding one year, or by fine not exceeding- 
five hundred dollars, or by both such fine and imprisonment." |1 

After commenting on the imperfections of the laws of the States 

relating to criminal abortion, Dr. Storer makes the following just 

remarks : 

" If our previous assumptions of the actual character of criminal 
abortion be granted, and we believe that they have been proved to a 
demonstration, it must follow from the subsequent remarks that the 
common law, both in theory and in practice, is insufficient to control 
the crime ; that in many States of this Union the statutory laws do 
not recognize its true nature ; that they draw unwarrantable dis- 
tinctions of guilt ; that they are not sufficiently comprehensive, 
directly allowing many criminals to escape, permitting unconsum- 
mated attempts, and improperly discriminating between the meas- 
ures employed ; that they require proofs often unnecessary or impos- 
sible to afford ; that they neglect to establish a standard of justifi- 

* I insert this clause not merely for its relation to the points we are now 
considering, but for its important bearing on the broad question of infanticide 
during labor ; concerning wliich it stands in bold and direct antagonism to 
all the rulings of the common law in this country and abroad. In other 
respects also, though not faultless, the Texas statute is rationally and admir- 
ably drawn. 

f Penal Code of Texas, 1857, p. 103. 

i Revised Statutes of Indiana, 1852, p, 437. 

II Statutes of Kansas, 1855, chap. 48, p. 343. 



332 HALE ON ABOETIOlSr. 

cation, and thereby sanction many clear instances of tlie crime ; that 
by a sj^stem of punishments wholly incommensurate with those 
inflicted for all other offences whatsoever, they thus encourage 
instead of prevent its increase ; and that in many respects they 
are at variance, not merely with equity and abstract justice, but 
with the fundamental principles of law itself. 

" ' It is to be hoped,' has forcibly been written, ' that the period 
is not far remote, when laws so cruel in their effects, so inconsistent 
with the progress of knowledge and civilization, and so revolting 
to the feelings and claims of humanity, will be s»wept from our 
statutes.'* 

" In a similar trust, it now behooves us to consider whether, and 
in what manner, the difficulties in the way of generally suppressing 
the crime of abortion can be overcome. 

CAN IT BE AT ALL CONTEOLLED BY LAW ? 

" To this important question I do not hesitate to give an unqualified 
answer in the affirmative. The fact that criminal abortion is not 
controlled by law anywhere, cannot be entertained as a valid argu- 
ment to the contraiy of this assertion ; for it is equally the fact, as 
we have seen, that laws against abortion do not as yet exist, which 
are in all respects just, sufficient, and not to be evaded. 

''It is evident that in aiming to suppress this crime, the law should 
provide not merely for its punishment, but indirectly as well as 
directly, and so far as possible, for its prevention. The punishment 
of a crime cannot be just, if the laws have not endeavored to prevent 
that crime by the best means which times and circumstances would 
allow, f and this is to be accomplished by a twofold process — by 
rendering on the one hand its detection more probable, and on the 
other its punishment more certain. 

As indirect though important measures for the former of these 
ends, we have already mentioned laws for registration, | and against 

* Lee, note to Guy's Principles of Forensic Medicine, p. 134. 
f Beccaki, Crimes and Punishments, 104. 
:{: "An efficient and practical remedy for tlie prevention of this crime would 
be a law requiring tlie causes of death to be certified by the physician in 
attendance, or where there has been no physician, by one called in for the 
purpose. In this way the cause of death, botli in infants and mothers, could 
be traced to attempts to procure abortion. In three cases which occurred 
in Boston in 1855, the death was reported by friends to be owing to natural 
causes, and in eacli it was subsequently ascertained that the patient died in 
consequence of injuries received in procuring abortion. It is probable that 
such cases are by no means rare ; and if the cause of death were known, an 
immediate investigation might lead to the detection of the guilty party." — 
{Boston Med. and Surg. Journal, Dec. 1857, p. 365.) 

[Note. — There is no law of the State of Illinois against the concealment 
of births, and, we believe, none against secret burials. In this city (Chicago) 
there is also no ordinance against the concealment of births ; and although 
there is an ordinance providing for the registration of deaths, and against 
secret burials, yet, owing to the culpable neglect of the city authorities, the 



JUEISPEUDENCE OF ABOETIOlSr. 333 

concealment of births and secret burials. As a single proof of their 
possible influence in this respect, out of many that might be adduced, 
we instance the fact that in Paris the number of premature foetuses 
deposited at the Morgue, during the nine years from 1846 to 1854, 
inclusive, was found to exceed by more than two-thirds that of the 
full decade just preceding, from 1836 to 1845.* To render this dif- 
ference more apparent, we have compiled the following table : 

Age of Foetuses deposited. Ten years : Nine years : 

1836 to 1845. 1846 to 1854. 

From 2 to 3 months 21 58 

" 3 to 4 " 35 13 

" 4 to 5 " 56 102 

" 5 to 6 '' 69 82 



Total 181 315 

" Part of this advance, it is true, is attributable to the increase in 
the population of Paris, and in the prevalence of criminal abortion ; 
but in great measure it is clearly owing to the enforcement of a 
more rigid law against secret burials. The above remarks are 
strikingly corroborated by the fact that of trials for the crime — and 
we must not forget that these bear but a small ratio to the whole 
number of cases preliminarily investigatedf — there were in France, 
during the latter of these periods, fully four times the number 
occurring from 1836 to 1845. 

" The establishment of foundling hospitals, by the State govern- 
ments, has been urged as a preventive of the crime, aiid, on the 
other hand, fears have been expressed lest the same means should 
increase it. For ourselves, however, and from some experience in 

law is almost a dead letter. Not only do the undertakers neglect to report 
many cases of burial, but they are unwarrantably permitted to report to the 
health officer on the causes of death ! In consequence the reports of that 
officer are a standing disgrace to any civilized community, on account of the 
gross ignorance which tliey expose. Not only this, but they undoubtedly 
hide a vast amoimt of crime, behind their unmeaning and unscientific terms. 

We will take as an example, the yearly record of the city mortality for 
1865. The whole number of deaths for that year were 3,659. Of this 
number the following are set down as the causes of death : 

Congestion (!!) 90 

Cramps (!!!!) 183 

What was the matter with these 183 persons, who died of "cramps?" 
and the 90 who died of " congestion ? " Is it not disgraceful that such 
returns are permitted in a civilized city? How many of these deaths were 
really from criminal causes ? How many resulted from criminal abortion ? 
This is only known to the All-seeing Eye, and the guilty ones. There were 
also 133 stillborn infants buried in 1865. Did all these die natural deaths? 
Does any one suppose that this small number includes all the still-born of 
this great city? — Hale.] 

* Register of the Morgue, 
f From 1846 to 1850, 188 cases of criminal abortion were discovered in 
Paris, but, for want of proof, only 22 of them were sent to trial. {Comptes 
Bendus Ann. cle la justice Griminelle.) 



334 HALE ON ABOETION. 

such cases, we believe that these fears are groiuidless, and that with 
equal justice might they be entertained of every large charity 
having for its end the improvement, sanitary or otherwise, of the 
masses of society. 

" We have quoted a statute existing in Massachusetts, though 
practically unenforced, against one great agent in the increase of 
abortion, an abuse of its license by the public press. "Were such 
laws to become general, and to be faithfully executed, and were it 
also made penal to sell any drug, popularly known as emmenagogue, 
except as advised by physicians, just as the sale of direct poisons is, 
or should be,' controlled by law, the present system of openly 
advertising by abortionists, would undoubtedly be brought to a 
close, 

"In no matter is it of more importance than in cases of suspected 
criminal abortion that coroners should be intelligent and well edu- 
cated medical" men ; and we could wish that this point might have 
received especial attention from Dr. Semmes, in his late admirable 
report to the American Medical Association.* In the sudden excite- 
ment of an inquest, the guilty are more likely than at a later period 
to be off their guard, and evidence may often be elicited at this time, 
which, at the subsequent trial, it would be impossible to obtain. 
There can be no question of the importance of this point ; the coro- 
ner should be skilled in all that pertains to obstetric jurisprudence ; 
and if similar knowledge were generally possessed by other officers 
of justice, attorney, juror, and judge, a far greater number of con- 
victions, under a proper law, would be secured. 

" As regards the more direct statutes, we have already considered 
their important points. 

" 'In order to render laws effectually preventive,' as has wisely been 
said, 'they should be consistently framed, and based on justice. 'f 
In accordance with this truly axiomatic doctrine, and with various 
rulings of the courts, already quoted, no proof should be demanded 
which is not necessitated by the actual character of the crime. We 
have seen that neither in intent nor in fact is this an attempt against 
the person or life of the mother. If she die in consequence, the 
offender is already amenable for it as homicide ; in the absence of 
any special statute, at common laAV. The crime both in intent and 
in fact, is against the life of the child. 

" The attempt being proved, it is unnecessary that it should have 
been consummated, not merely the completion of a crime bringing 
its punishment, but also certain overt acts with intent to the per- 
petration ; nor is it requisite that any injury, specific or general, 
should have been inflicted upon the person of the mother, 

" The offence being of equal guilt throughout pregnancy, proof of 
quickening, the incident, not the inception of vitality, — indicating 
neither the commencement of a new stage of existence, nor an 

* Eeport on the Medico-legal Duties of Coroner. 1857. 

f Radford, British Record of Obstetric Medicine, vol. i. p. 55. 



JURISPEUDENCE OF ABOETION. 335 

sivance from one stage to another,* — and, therefore, an element 
without the slightest intrinsic value, should not be required. 

" The crime of abortion should be considered to include, as it does, 
in the absolute fact of moral guilt, all cases of attempted or intention- 
ally effected destruction and miscarriage of the product of impreg- 
nation ; and this, whether it be living or dead, normal or abnormal, 
which last expression equally comprehends instances of moles, 
hydatids^ extra-uterine conception, acephalous, anencephalous, and 
other monsters. 

" Proof should not, as now, be required of intent to destroy the 
child. f This should be considered shown by the intent to produce 
miscarriage, in the absence of lawful justification therefor ; the act 
in all stages of pregnancy being attended with great danger to the 
child, and, in much more than a moiety of the period, necessarily 
fatal to it. 

" The attempt being considered criminal, it follows that proof of 
pregnancy is not necessary, and that conviction should be had 
though it were proved that pregnancy did not exist,J even that the 
woman on whom the abortion was attempted, however unlikely, was 
still a virgin. II 

" No discrimination should be made as to the means criminally 
employed, and no escape thus afforded to the guilty ; as we have 
seen still obtaining in Great Britain and many of our own States. 

" The mother, almost always "an accessory before the fact," or 
the principal, should not, as now, be allowed almost perfect im- 
punity. There is no valid reason for such exemption ; there is 
every reason against it. The woman is covered by the laws of most 
continental nations of Europe — France, Austria, Germany, Bava- 
ria, and Italy, — and by many of them her punishment, if married, 
is greatly increased. Similar severity is also exercised in these 
countries against the father of the fcetus, if he, too, is implicated in 
the crime. 

" To allow that abortion is extenuated in the unmarried, it has 
been said, will 'to the moral and political philosopher appear to have 
exalted the sense of shame into the principle of virtue, and to have 
mistaken the great end of penal law, which is not vengeance, but 
the prevention of crime. Law, which is the guardian and bulwark 
of the public weal, must maintain a steady and even rigid watch 
over the general tendencies of human actions. "§ But, on the other 
hand, the measure of punishment should be proportionate, as nearly 
as possible, to the temptation to offend, and to the kind and degree 
of evil produced by the offence."^ 

" We have seen the increase in moral guilt, and of opportunity for 
commission and for escape, in the case of nurses, midwives, and 

* Wharton, Criminal Law, 540. 

•)• Smith vs. The State, 33 Maine, (3 Red.) 48. 

i Rex vs. Phillips ; Regina vs. Goodall ; Regina vs. Heynes, etc. 

I Taylor, Medical Jurisprudence, p. 386. 

§ Percival, Medical Ethics, p. 84. 

t Ibid, p. 85. 



336 HALE ON ABORTION. 

other classes of persons, who, from their profession, are brougl*t 
more directly into contact with pregnant women. Bj the penal 
code of Napoleon the First, remarkable in so manj respects for the 
wisdom of its provisions, an increase of punishment was enacted for 
abortion criminally induced or advised by physicians, surgeons, or 
other officers. of health, including midwives, or by druggists ;* their 
guilt being enhanced by their greater opportunities and knowledge. 

'• Punishments for the crime of abortion should not, as is now 
generally the case, be so framed as to render the statute, in fact, if 
not in name, simply nugatory. Were the murder of adults to be 
made answerable by merely a year or two in prison, far more con- 
victions than at present would undoubtedly be secured ; but it is 
certain that the instances of the crime would be fearfully increased. 
We have reason to believe that it is precisely thus with the case in- 
hand. 

" A standard of justification for the instances of necessary abor- 
tion should be fixed by law. If perfection in this respect be impos- 
sible, let the nearest approach be made to it that can. Since my 
remarks upon the relative rights of the mother and foetus, to the 
chance of life in doubtful cases, Avere published in a former paper of 
the present series, I have received from Dr. Rattermann, late of 
Tubingen, an essay, written by himself, in which this question is 
discussed at length, and the repetition of abortion upon the same 
individual, in the early months of pregnancy, is defended. I have 
carefully considered the several arguments advanced by the gentle- 
' man, and am compelled to adhere to the views I have already 
expressed. 

"In presenting a report upon the flatter, in 1857, by direction 
of the Suffolk District Medical Society of Massachusetts, the writer 
offered the draft of a law, prepared after much thought and consul- 
tation, with legal as well as with medical men, and embodying the 
suggestions made above. This was intended for the consideration 
of the Legislature of the State, in the hope that it might be of aid 
toward a modification of the present defective law. 

" Having seen no reason to change the opinion then avowed, but 
on the contrary, receiving constant confirmation of their truth, I 
now present the essential portions of that draft, acknowledging most 
willingly that its wording may, perhaps, with safety, be simplified 
and condensed ; but contending, in all sincerity and earnestness of 
purpose, that its general tenor is what justice and humanity alike, 
and imperatively, demand at the hands of society. 

" ' Whoever, with intent to cause and procure the miscarriage of 
a woman, shall sell, give, or administer to her, prescribe for her, or 
advise, or direct, or cause, or procure her to take any medicine, or 
drug, or substance whatever, or shall use, or employ, or advise any 
instrument, or other means whatever, with the like intent, unless 
the same shall have been necessary to preserve the life of such 

* Loc. cit., article 317. 



JURISPEUDENCE OF ABORTION. 337 

Avoman, or of her unborn child, and shall have been so pronounced 
(in consultation) bj two competent physicians ; and anj person, with 
the like intent, knowingly aiding and assisting such offender or 
offenders, shall be deemed guilty of felony,' etc. etc.; 'and if such 
offence shall have been committed by a physician, or surgeon, or 
person claiming to be such, or by a midwife, nurse, or druggist, such 
punishment may be increased at the discretion of the court. 

'' ' Every woman who shall solicit, purchase or obtain of any per- 
son, or in any other way procure, or receive, any medicine, drug, or 
substance whatever, and shall take the same, or shall submit to any 
operation or other means whatever, or shall commit any operation or 
violence upon herself, with intent thereby to procure a miscarriage, 
unless the same shall have been by two competent physicians (in 
consultation) pronounced necessary to preserve her own life, or that 
of her unborn child, shall be deemed guilty,' etc. etc. ; ' and if said 
offender be a married woman, the punishment may be increased at 
the discretion of the court.' 

'' It was also advised that the encouragement of criminal abortion, 
by publication, lecture or otherwise, or by the advertisement, sale, 
or circulation of such publication, should be made penal, and that the 
present well-worded statute against the personal advertisements of 
abortionists, and their nostrums, should be rigorously enforced. 

" To the words now quoted were added, and they are still applica- 
ble, the following : 

" ' We have aimed at a statute, which, while it better defined this 
atrocious crime, and covered the usual grounds of escape from con- 
viction, established also the proper standard of competence in all 
medical questions involving issues of life and death. We believe 
that it would be the means of preventing much of the present awful 
waste of human life. But enforce such a law, and the profession 
would never allow its then high place in the community to be un- 
worthily degraded ; nor, as now, would those be permitted, unchal- 
lenged, to remain in fellowship, who were generally believed guilty, 
or suspected even of this crime.'* 

* Report to Suffolk District Med. Society, May, 1857, p. 13. 



23 



GENEEAL INDEX. 



Abortion, statistics of, 19 
" causes of, 31 
" treatment of, 153 
" of animals, 108 
" forceps, 288 
" vectis, 245 

Actual symptoms of abort'n, 124 

Actea alba, a cause of " 92 

Acids in treatment of anaemia, 

160 

Acetic acid as a preventive of 
conception, 305 

Aconite in treatment of abor- 
tion, 220 

Aconite as a preventive of con- 
ception, 306 

Adhesion, treatment of, 253 

Aloes, a cause of abortion, 92 

Aletris farinosa a cause of abor- 
tion, 93 

Aletris farinosa in treatment of 
abortion, 222 

Alum as a preventive of con- 
ception, 305 

Alkalies as a preventive of con- 
ception, 305 

Alabama, laws of, on abort'n, 330 

Anaemia, a cause of abortion, 35 
" treatment of, 154 

Anteversion, a cause of abor- 
tion, 84 

Anteversion, treatment of, 214 

Appearance on examination of 
cervix uteri, 83 

Apis mellifica, a cause of abor- 
tion, 91 

Arnica in treatment of abor- 
tion, 218 



Asarum europeum, a cause of 

abortion, 92 
Asarum canadense, a cause of 

abortion, 93 
Asclepias incarnata, a cause of 

abortion, 93 
Asclepias sjriaca, a cause of 

abortion, 93 
Astringents as preventives of 

conception, 306 
Atrophy of placenta, a cause of 

abortion, 44 



Baptisia tinctoria, a cause of 
abortion, 94 

Belladonna in treatment of abor- 
tion, 220 

Belladonna as a preventive of 
conception, 306 

Blows, Treatment of, 189 

Blunt hook, 229 

Borax, a cause of abortion, 94 

Bovista, a " '' 95 



Calcareous degeneration of pla- 
centa, a cause of abortion, 44 

Calcareous degeneration of pla- 
centa, treatment of, 175 

California, laws of, on abortion, 

324 

Caoutchouc bags, 271 

Can abortion be controlled by 
law, 332 



340 



GENEEAL IISTDEX. 



Case of retroversion of the ute- 
rus, 257 

Causes of abortion, 33 

Cancerous ulcer, a cause of abor- 
tion, 80 

Cantharis, a cause of abortion, 96 

CaulophyUin, a cause ofab'n, 96 
" in treatment of abor- 

tion, 220 

Cerebro-spinal meningitis, a cause 
of abortion, 49 

Centric causes of abortion, 45 
" causes, treatment of, 176 

Cervical leucorrhcea, a cause of 
abortion, 44 

Chancre simplex, treatment of, 

208 

Cholera as a cause of abortion, 39 

Cholera, treatment of, 170 

Chlorosis, treatment of, 159 

Cimicifuga racemosa, a cause of 
abortion, 97 

Cimicifuga racemosa in treat- 
ment of abortion, 220 

Cinnamon in treatment of hem- 
orrhage, 221 

Classification of States according 
to laws, 326 

Cold water in treatment of ab- 
ortion, 226 

Common salt as a preventive of 
conception, 305 

Complications occurring with 
abortion, 131 

Congestion of the placenta, a 
cause of abortion, 43 

Congestion of the uterus, a cause 
of abortion, 61 

Congestion of the 'uterus, treat- 
ment of, 191 

Congestion of the ovaries, a cause 
of abortion, 90 

Concentric causes of abortion, 49 

Concentric causes, treatment of, 

178 

Coitus as a cause of abortion, 87 

Corroding ulcer, a cause of abor- 
tion, 80 

Corpulence, treatment of, 157 

Constipation, treatment of, 186 



Colpeurynteur in treatment of 

abortion, 226 
Colpeurynteur to produce abor- 
tion, 273 
Condom, description and use of, 

298 
Concealment of births and deaths, 

332 
Conduct of physicians when call- 

ed'to case of abortion, 234 
Connecticut, laws of, on abor- 
tion, 323 
Criminal abortion considered, 313 
" " is it increasing, 18 

" " its jurisprudence, 

320 
Cystitis, treatment of, 186 



Danger from use of stillette, 270 
Date of viability of foetus, 117 
Death of the embryo, a cause of 

abortion, 87 
Decidua, character of, 116 
Decodon verticillatus, acause of 

abortion, 99 
Definition of abortion, 36 
Dental causes of abortion, 56 

" treatment of, 180 

Diagnosis of abortion, 133 

" " after fourth 

month, 139 
Diarrhcea, treatment of, 185 
Diameters of child's head, 265 

" pelvis, 266 

Dimensions of fcetus at different 

periods, 119 
Dietetic treatm't of abortion, 251 
Direct blows upon brain, treat- 
ment of, 177 
Diphtheria, treatment of, 168 
Discharges after abortion, 131 
Displacements of the uterus, a 

cause of abortion, 84 
Douche, in treatment of abor- 
tion, 273 
Dropsy of the ovaries, a cause of 
abortion, 90 



GENERAL INDEX. 



341 



Dropsy of the ovaries, treatment 

of, 254 
Dry cupping in treatment of 

abortion, 233 
Draft of abortion law, by Doctor 

Storer, 336 
Duty of physician concerning 

prevention of conception, 291 
Dysmenorrhoea, diagnosis of, 135 
Dysentery " 135 

" treatment of, 183 



Embryonic abortion, 283 
Emotional causes of abortion, 45 
" treatment of, 176 

Engorgement of the cervix uteri, 

192 
England, laws of, on abortion, 

321 
Epilepsy, treatment of, 189 
Ergot, as a cause of abortion, 47 
Essex syringe, 203 
Exanthematous fevers causing 
abortion, 38 



Falls, treatment of, 189 

Fatty deterioration of chorion 
and placenta, a cause of abor- 
tion, 41 

Fatty deterioration of chorion 
and placenta, treatment of, 174 

Fecundity in European countries, 

20 

FoBtus, when so named, 121 
" date of viability of, 117 
" weight and length of, at 
different periods, 119 

Foetal abortion, when necessary, 

279 

Ferrum in Anaemia, 160 

Fevers, yellow, 39 

'' exanthematous, 38 

Fissured ulcer, a cause of abor- 
tion, 77 



Fissured ulcer, treatment of, 205 

Fissure of the anus, 185 

Fistulas, treatment of, 253 

First stage of labor, management 
of, 244 

Flexible bougie, manipulations 
with, 280 . 

Flexible catheter, manipulations 
with, 284 

Follicular ulcer, a cause of abor- 
tion, 79 

Follicular ulcer, treatment of, 206 

Forceps, long, 231 
" short, 231 

French laws on abortion, 322 

Frequency of " 22 

Fucus vesiculosis in corpulence, 

158 

Functional diseases of uterus, 
causes of abortion, 61 

Functional diseases of uterus, 
treatment of, 191 



Galvanism, a cause of abortion, 48 
" in treatm't of " 233 
" to induce " 277 

Gastric irritation, a cause of ab- 
ortion, 56 
Gastric irritation, treatm't of, 182 
Gelseminum in treatment of ab- 
ortion, 221 
Gelseminum to prevent concep- 
tion, 306 
Generation, 115 
Germany, laws of, on abortion, 

322 
Gonorrhoea, a cause of " 69 

" treatment of, 197 

Granular vaginitis, treatment of, 

188 



Habitual abortion, 59 

Hsemorrhage, diagnosis from ab- 
ortion, 137 

Heemorrhage, after sixth month, 
treatment of," 239 



342 



GENEEAL INDEX. 



Hsemorrhoids, treatment of, 185 

Hot water in treatment of abor- 
tion, 227 

How to use stillette, 269 

'' destroy spermatozoa, 299 
" render laws efficient, 334 

Hydatids, a cause of abortion, 41 
" treatment of, 175 

Hydrorrhcea, diagnosis from ab- 
ortion, 137 

Hypertrophy of placenta, a cause 
of abortion, 44 

Hypertrophy of the uterus, treat- 
ment of, 253 

Hypertrophy of cervix, symp- 
toms of, 183 

Hypertrophy of cervix, treat- 
ment of, 192 

Hysteria, treatment of, 189 



Ice in treatment of abortion, 226 

Illinois, laws of, on " 324 

Ilex opaca, a cause of '■'■ 100 

Impregnation, 293 

Indiana, laws of, on " 331 

Induration of the cervix, a cause 
of abortion, 82 

Indurated chancre, treatment of, 
208 

Inflammation of placenta, a cause 
of abortion, 43 

Inflammation of ovarigs, a cause 
of abortion, 90 

Inflammation of mammse, treat- 
ment of, 253 

Injections, 288 

" when to use, 307 

Instrumental irritation, a cause 
of abortion, 88 

Intra uterine syringe, 275 

Iowa, laws of, on abortion, 324 

Ij-regularity of os uteri, treat- 
ment of, 200 

Italy, laws of, on abortion, 323 



Jewish customs, ^94 



Jumping, treatment of injuries 

from, 189 
Jurisprudence of abortion, 320 



Kansas, laws of, on abortion, 331 



Laudanum in treatment of abor- 
tion, 222 

Laws of the Shastras on abortion, 

320 

Laws of foreign countries on ab- 
ortion, 321 

LaAvs of different States on abor- 
tion, 323 

Lecture on criminal abortion — 
Prof. A. E. Small, 313 

Lecture on jurisprudence of abor- 
tion— Prof. C.Woodhouse, 320 

Length of foetus at three to seven 
weeks, 119 

Length of fcetus at two to five 
months, 120 

Length of foetus at six months 
to full term, 121 

Leucorrhoea, a cause of abortion, 

62 

Leucorrhoea, cervical, a cause of 
abortion, 64 

Leucorrhoea, vaginal, a cause of 
abortion, 67 

Leucorrhoea, treatment of, 192 

Leucorrhoea, cervical, treatment 
of, 192 

Leucorrhoea, vaginal, treatment 
of, 194 

Leucorrhoea, sequelae, treatment 
of, 65 

Local causes of abortion, 39 
" diseases, treatment of, 171 
" syphilis, symptoms of, 81 

Louisiana, laws of, on abortion, 

330 



Maine, laws of, on abortion, 327 
Malformation of the ovum, 172 



GENEEAL ESTDEX. 



343 



Malformation of the membranes, 

172 

Mammary irritation, a cause of 
abortion, 56 

Mammary irritation, treatment 
of, 179 

Management of labor, 241 

Manner of coition to prevent 
conception, 294 

Manchester Lying-in Hospital, 
statistics of, 23 

Massachusetts, statistics of, on 
abortion, 22 

Massachusetts, laws of on abor- 
tion, 324 . 

Means employed to destroy sper- 
matozoa, 304 

Mechanical abortion, pathology 
of, 142 

Mechanical obstruction, 265 

" treatment of sequelae 

of abortion, 256 

Medicinal causes of abortion, 46 

" '' treatment of, 178 

" treatm'tofabort'n, 217 

" " in the third 

stage, 252 

Medicines acting as predispo- 
nents to abortion, 91 

Medicines acting as centric 
causes of abortion, 91 

Medicines acting as concentric 
causes of abortion, 91 

Membranes, how separated from 
uterus, 274 

Membranes, how separated by 
air, 276 

Menstrual crisis, a cause of abor- 
tion, 36 

Menstrual crisis, treatm't of, 162 

Mental aberrations, treatment 
of, 254 

Menorrhagia, chronic, treatment 
of, 255 

Mercurialization, a cause of ab- 
ortion, 38 

Mercurialization, treatm't of,164 

Mercury, a cause of abort'n, 101 

Methods of inducing premature 
labor, 269 



Methods of inducing embryonic 

abortion, 284 
Methods of using syringe, 308 
Metritis, diagnosis from abortion, 

134 
Metritis, treatment of, 200 

" puerperal, treatment 

of, -254 
Missouri, laws of, on abort'n, 324 
Minnesota, laws of, on " 327 
Michigan, laws of, on '' 329 
Moles as causes of abortion, 40 

" treatment of, 175 
Muriatic acid, to destroy sperm- 
atozoa, 306 



Neuralgia of ovaries, treatment 
of, 312 

New Hampshire, laws of, on ab- 
ortion, 328 • 

New York, laws of, for abortion, 

323 

NewYork, statistics of abor'n, 20 

a ii li 

from 1804 to 1862, 21 

New York, ratio in, 21 

Nitric acid, to prevent concep- 
tion, 306 

Non-medical fluids, use of, 307 

Nux vomica, to prevent concep- 
tion, 305 



Obstetric abortion, 263 
Obesity, a cause of abortion, 35 
Occurrence of abortion, tabular 

view, 26 
Ohio, laws on abortion, 323 
Opium, to prevent concept'n, 305 
Organic diseases of uterus, a 

cause of abortion, 71 
Organic diseases of placenta, 

treatment of, 173 
Ovarian causes of abortion : 

Irritation, 35 



344 



GENEEAL INDEX. 



Congestion, 58 

Inflammation, 90 

Tumors, 90 

Dropsy, 90 
Ovarian diseases, treatm't of, 211 
" irritation, 
" tumors, 
Ovaritis, 
Ovaralgia, 
Ovular abortion, 



211 
212 
212 
212 
290 

when necessarv, 
290 



Ovum, 115 



Paris, statistics of, on abort'n, 20 

Pathology of ' ■ " 142 

Parotidean irritation, a cause of 
abortion, 55 

Parotidean irritation, treatment 
of, 178 

Paralysis, treatmaent of, 256 

Patient, examination of, 237 
" position of, 243 

Pelvic diameters, 266 

" cellulitis, treatm't of, 253 

Peritonitis, diagnosis from abor- 
tion, 135 

Period of pregnancy at which ab- 
ortion is most frequent, 25 

Period of occurrence of abortion, 
tabular view, 26 

Period of abortion, tabular view, 

309 

Pessaries, a cause of abortion, 88 
" ring, 259 

Podophyllum, a cause of abort'n, 

102 

Position of patient during injec- 
tions, 308 

Postural treatm't of abort'n, 248 

Post partum " " 248 

Phaggedenic ulcer, a cause of ab- 
ortion, 80 

Phagtedenic ulcer, treatment of, 

206 

Phlebitis, treatment of, 254 

Physician's duty when applied to 
to produce abortion, 318 



Physical causes of abortion, 45 
Physiology of generation, 115 
Plethora, a cause of abortion, 35 

" treatment of, 155 
Placental causes of abortion : 
Fatty degeneration, 42 
Congestion, 43 
Inflammation, 43 
Calcareous degeneration, 44 
Tubercular deposits, 44 
Atrophy, 44 
Hypertrophy, 44 
Previa, 44 
Placental fatty degeneration, 

treatment of, 174 
Placental calcareous degenera- 
tion, treatment of, 175 
Placenta previa, treatment of, 

172 

" retention of, 140 

Predisposing causes of abortion, 

35 
" treatment of, 155 

Pregnancy, signs of, 133 
Premature labor, 263 

" when necessary, 

264 
Premonitory symptoms of abor- 
tion, 133 
Preventive treatment of abor- 
tion, 155 
Principal medicines as causes of 

abortion, 91 
Prognosis of abortion, 148 

" when favorable, 148 
" " unfavorable, 150 

Prolapsus, a cause of abortion, 84 
" treatment of, 213 
" mechanical treatment 
of, 256 
Puerperal Peritonitis, treatment 

of, 254 
Puerperal Metritis, treatment of, 

254 
Pulsatilla in treatment of abor- 
tion, 222 



Quinine, a cause of abortion, 46 



GENERAL INDEX. 



845 



Quinine sulphas, a cause of ab- 
ortion, 103 



Ratio of abortion in N. York, 21 
Rectal irritation, a cause of ab- 
ortion, 57 
Rectal irritation, treatm't of, 183 
Reflex causes of abortion, 44 

" " treatment of, 176 

Regulation of coition, 294 • 
" ' " Jewish 

custom, 294 
Register at the Morgue, 333 
Refiote consequences of abortion, 

151 
Remedial treatment of abortion, 

217 
Renal causes of abortion, 57 
Results of abortion, 28 
Resume of treatment, 209 
Retention of ovum, a cause of 

abortion, 140 
Return of menses, a cause of ab- 
ortion, 36 
Return of menses, treatment of, 

162 
Retroversion, a cause of abortion, 

84 
" treatment of, 214 

" mechanical treat- 

ment of, 256 
Rules for use of blunt hook, 228 
Ruta graveolens, a cause of ab- 
ortion, 103 
Ruta graveolens, treatment of, 

221 



Sabina, a cause of abortion, 104 
" in treatment of " 221 
Sanguinaria, a cause of ab'n, 109 
Sarracenia purp., 166 
Scarlatina, treatment of, 166 



Scotland, laws of, on abort'n, 322 
Scrofulous diathesis, a cause of 

abortion, 36 
Scrofulous diathesis, treatment 

of, 162 
Secale corn., a cause of ab'n, 106 
" " in treatm't of " 221 

Separation of membranes from 

uterus, 274 
Separation of membranes from 

uterus by air, 276 
SequelsB of leucorrhoea, a cause 

of abortion, 65 
Sequelae of abortion, 131 

" " 248 

Shastras, laws of, on abort'n, 320 
Simple irritation of ovaries, a 

cause of abortion, 89 
Simple granulating ulcer, treat- 
ment of, 204 
Softening of the uterus, 200 
Sponge tent, 271 

" in treatment of abor'n, 225 
Spermatozoa, character of, 298 

" how destroyed, 299 

Spirits of wine, to prevent con- 
ception, 305 
Stage of pregnancy, first, 244 
" " " sequelae 

of, 249 
Stage of pregnancy, second, 246 
" " " sequelae 

of, 249 
Stage of pregnancy, third, 247 
" '' " sequelae 

of, 250 
Statistics of abortion, 19 
in foreign countries, 20 
in New York, 20 
in Boston, 22 
in Massachusetts, 22 
in Chicago, 22 
Manchester Lying-in Hos- 
pital, 24 
at the Morgue, 28 
States, laws of, on abortion, 323 
Avhich have no laws on ab- 
ortion, 325 
which acknowledge the crime 
after quickening. 326 



846 



GEISTEEAL INDEX. 



■which acknowledge the 
crime, but require proof 
of pregnancy, 326 
which punish an attempt at 
abortion, 326 
Stillette, description of, 270 

" death by, 270 
Strychnine, a cause of ab'n, 47 

" to prevent concept'n, 305 
Sucking pumps, to induce abor- 
tion, 275 
Sulphate of zinc, to prevent con- 
ception, 306 
Sulphuric acid, in abortion, 223 
" " to prevent con- 

ception, 305 
Swelling of cervix, 200 
Syringe, Essex, as a means to 

prevent conception, 307 
Symptoms of induration, 83 
" retroversion, 86 

" abortion, 122 

Syphilis, a cause of abortion, 37 
" sterility, 
treatment of, 163 38 

ulcerat'n, a cause of ab'n, 80 
" treatment of, 208 

constitu'al, cause of ab'n, 81 
local, " " 81 



Table showing frequen(3y of ab- 
ortion, 26 

Tabular view of the three great 
periods of utero-gestation, 309 

Tampon, its use in abortion, 224 

Tanacetum vulga^'is, a cause of 
abortion, 111 

Terebinth, a cause of abort'n,110 

Texas, laws of, on " 330 

Third stage of pregnancy, abor- 
tion at,"247 

Third stage of pregnancy, abor- 
tion at, sequelae, 250 

Thyroidal causes of abortion, 56 
" treatment of, 179 

Treatment of abortion, 155 



Tubercular deposits in placenta, 
a cause of abortion,- 44 



Ulceration of the cervix, a cause 

of abortion, 71 
Ulceration of the cervix, treat- 
ment of, 198 
Ulcer, varicose, cause of ab'n, 76 
" treatment of, 204 
fissural, a cause of ab'n, 77 

" treatment of, 205 
follicular, a cause of ab'n, 79 

" treatment of, 206 

corroding, a cause of ab'n, 80 

calcareous, " " » 80 

syphilitic, " " 81 

" treatment of, 208 

Unnecessary abortion, murder, 

313 
Uterine causes of abortion, 59 
" displacements, treatment 
of, 212 
Utopian theories, 291 
Uterine sound, 289 
Use of speculum, a cause of abor- 
tion, 73 
Ustilago madis, a cause of abor- 
tion, 112 



Vaginitis, a cause of abort'n, 58 

treatment of, 187 

" vesicular, " 188 

" granular " 188 

Vaginal irritation, " 187 

" leucorrhoea, " 194 

" " a cause of 

abortion, 67 

Vaginismus, a cause of abor'n, 50 

" treatment of, 189 

Variola, " 164 

" a cause of abortion, 38 
Variation of period of quicken- 
ing, 316 



GENERAL INDEX. 



347 



Vesical irritation, a cause of 

abortion, 57 
Vesical irritat'n, treatm't of, 186 
Vermont, laws of, on abort'n, 329 
Virginia, " '' 324 

Vomiting, a cause of abort'n, 266 



"Weight of foetus, at three to 

seven weeks, 119 
"Weight of foetus, at two to five 

months, 120 



"Weight of foetus, at six months 

to full term, 121 
"Wisconsin, laws of, on ab'n, 329 



Yellow fever, a cause of ab'n, 39 



Zymotic diseases, a cause of 
abortion, 37 



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