ABORTION is said to consist in the separation and expulsion of the immature ovum from the uterus. ( Tyler Smith’s Obstetrics, p. 177]. This very comprehensive definition covers the whole period from the moment of fecundation up to any time short of the complete fulfilment of the entire term of normal utero- gestation. In its more general acceptation, the term abortion is made to refer to such degree of immaturity of the ovum as necessarily insures its destruction on expulsion; in this sense the use of the term would be restricted to the period of non- viability. “An abortion may be possible at any time from the commencement of pregnancy to the end of the sixth month. Plus Traite Theorique et Pratique de l’Art des Accouchements, par P. Cazeaux. Sixieme Edition, p. 332. Paris, 1858). But since there are successive stages of development, which exactly correspond to definite periods of time in gestation, it becomes desirable to assign more definite terms which may serve to indicate the particular period, in which the abortion itself occurs. Accordingly the abortion is properly called ovular, when the expulsion takes place in the first three weeks, or before the embryo can be distinguished in the ovum. The term effluxion was applied by the ancients to those cases in which the product of conception passed off, or flowed away, in the first week. The abortion may be termed embryonic, when it takes place prior to the third month, as if before quickening. When the abortion occurs after this time, and before the period of viability, or before the end of the sixth month, the abortion may be termed foetal. After the period of viability, the expulsion of the foetus, although more or less liable to be followed by its destruction, according as it occurs at a period more or less remote from full term, is still not necessarily fatal. Hence the expulsion which occurs at any time after the period of viability before the completion of the full term, is called premature delivery. The term miscarriage is popularly applied to any expulsion, or premature delivery, which results in the destruction of the product of conception.
Abortions are more frequent in the first two or three months than is those subsequent; and it is believed that many cases of ovular abortion, ( Abortion in properly restricted to the loss of the product of conception; and it seems but unnecessary and useless complication of the subject to include under this head such discharges of unimpregnated ovules as may occur in women to whom sexual intercourse is a thing unknown, as such as have already been described under Ocular Menstruation) or effluxion, occur unnoticed and unsuspected, as well in those who have borne children, as in those who are always sterile.
Neither the plan nor the limits of the present work admit of any complete and systematic treatise on abortion; nor indeed is this necessary, since it has been so ably done by a recent author of our own School. ( Plus A Systematic Treatise on Abortion, by E M. Hale, M.D. Chicago, 1866. While compelled to differ from Professor Hale in some important points of doctrine, we can bear witness to the industry and ability displayed in his recent work). Our present object will be satisfied by setting forth the principal causes by which abortion is produced; the symptoms which forwards us of its imminence; the means to be employed in advance, and the remedies by which its attack may be obviated. And in the conclusion of the chapter we shall take occasion to give what seems to us the true doctrine respecting the inducting of abortion or premature delivery by physicians.
CAUSES OF ABORTION.
The influences which are capable of producing abortion, include almost the entire range of those which injuriously affect the female economy. These causes of abortion may be from without or from within; external or internal, originating in the system of the woman herself or approaching her from the outer world. But in either case and in every instance, they derive no small part of their efficiency from the delicate and sensitive nature, or psoric condition of the constitution itself. Thus it is well known that some women undergo the severest forms of chronic and even of acute disease, and the rudest accidental or intentional violence without aborting; while in others this misfortune will often occur either spontaneously or from the slightest provoking cause, such as a misstep or strain in lifting (Mauriceau, quoted by Davis, ii., p. 1031)
Since abortion consists in the separation and expulsion of the ovum, as in ordinary labor, this must result from contraction of the uterus itself. This contraction of the uterine fibres is therefore to be considered as the immediate cause of the abortion in every case. All other may be termed either predisposing or exciting, ( Ramsbotham’s Obstetrics, p. 586) and for convenience is study they may be classed under three heads: I. Pre-existing Conditions, II. Conditions principally developed by the Pregnancy itself; III. Independent Influences.
I. PRE-EXISTING CONDITIONS. In this class must be enumerated all those disorders which in any given case may seem to determine the abortion, although the same causes may fail to be followed by this result in other instances. The great majority of cases of abortion, from whatever cause or combination of causes produced, occur from the second to the fourth month of pregnancy.
Disorders of the uterus, or of its appendages, which were existent before pregnancy, often become causes of abortion. But since the most of these disorders have already been described in this work, it will be requisite to do little more than enumerate them here.
Either of the various displacements to which the uterus may be subject, and which do not prevent conception, may occasion the subsequent separation and expulsion of its product. In cases of habitual prolapsus uteri; the gravid uterus may become impacted in the pelvis before rising above the sacral promontory at quickening; and the irritation consequent upon such impaction will necessarily be followed by abortion. The same is true of retroversion, the most serious of all uterine displacements, and which becomes all the more formidable when complicated with pregnancy. Retroversion in the pregnant state may be gradual in its development, or may have existed to some extent unnoticed till the increasing size of the uterus at the third or fourth month occasions serious difficulty. Or the gravid uterus may become suddenly retroverted by accident, or over-exertion; but this accident can hardly ever result in pregnancy, unless a predisposition to it had been established by former retroversion. Anteversion, by irritation of the neck of the bladder, may lead to abortion.
Either of the various forms of inflammation, ulceration, and cancerous disease of the uterus may become the efficient cause of abortion. Severe leucorrhoea, especially that which results from chronic inflammation of the cervix uteri; ulcerations of the cervix; fissures and induration of the cervix; phagedenic, syphilitic, and cancerous ulcerations of the cervix, or of the parietes of the uterus, while they do not always prevent conception, will, in the great majority of cases, powerfully tend to produce abortion. Syphilis in the mother, whether recent or chronic, whether present as an ulcerative affection on any part of the genitalia, or existing as a constitutional taint in the system, will more or less invariably lead to abortion; while if the syphilitic poison be imparted to the ovule by the fecundating semen of the male alone, the result may be seen in offspring born alive, indeed, but destined to wither and perish, decreasing in weight form the moment of their birth. In either case, it seems an admirable provision of Providence that, in its severer forms at least, this awful malady should become self- limited, instead of being permitted to extend its destructive influence through all succeeding generations.
Scrofula is stated by some authors to be an efficient cause of abortion; but this must needs be taken with some qualification, since it is well known that many women of most remarkably scrofulous habit are not less remarkably fruitful, raising in some instances large families of children, all of whom evident marks of the same scrofulous diathesis. When the scrofulous influence has resulted in a condition bordering on cachexia, abortion may result form general debility. And yet it should be remembered that tubercular consumption, the most common and fatal form of scrofulous disease, neither indisposes to conception nor predisposes to abortion.
Both plethora, or a remarkably full habit of body, and obesity, or an abnormal accumulation of fat, may be considered forms of scrofulous development; and either of these conditions may lead to abortion. Plethora may promote abortion by inducing local and destructive congestion. This congestion may be either simply uterine, as seen in the menstrual nisus and in the greater tendency to abort at the menstrual periods, especially the first, second, and third; or it may be placental, as in placental apoplexy, or placentitis; or it may be umbilical congestion, and destroy the foetal life, as it were by strangulating its circulation.
