On the other hand, it must not be forgotten that in these cases there is always present every reason for concealment. In the earlier months of pregnancy it is very difficult to prove, in the living subject, that pregnancy has occurred. Such a conclusion being arrived at, before the sound of the fœtal heart can be heard, for this is the only sign that is positively certain, by merely circumstantial and probable evidence, which becomes of weight only as it is accumulated and found corroborative. In the dead subject, the victim of an abortion in the earlier months, the case is often equally obscure, or at least doubtful, unless the product of conception has not yet escaped, or, having been thrown off, has been detected or preserved. When found, it of course proves pregnancy, whether the parent be living or dead; that is, in the former instance, if its discharge can be traced directly to the woman in question, and to no other, and correlative circumstances may show that an abortion has occurred; but this may have been accidental and guiltless. Where the act has been committed by an accomplice, the proofs of such commission and of the intent, though this is generally implied by the act itself, are by no means always forthcoming. Where the abortion has been induced by the woman herself, as is now so frequently the case, certainty upon the point becomes far more difficult. The only positive evidence by which to judge of the real frequency of the crime is confession, and it is from the confessions of many hundreds of women, in all classes of society, married and unmarried, rich and poor, otherwise good, bad, or indifferent, that physicians have obtained their knowledge of the true frequency of the crime.
The confidential relations in which the physician stands to his patient; the understanding that nothing can wring from him her disclosures, save the direct commands of the law, so unlikely in any given case to become cognizant of its existence, elicits from a woman in almost every instance, especially if she believes herself in peril of death, a frank statement of the means by which she has been brought low; for it is evident that upon such knowledge must depend the measures of relief to which the physician may resort. Could the test of confession be always applied, as is, however, manifestly impossible, so many women die during or in consequence of an abortion, without the attendance of a physician and without making any sign, it would be found that many of the cases now reported upon our bills of mortality as deaths from hemorrhage, from menorrhagia, from dysentery, from peritonitis, from inflammation of the bowels or of the womb, from obscure tumor, or from uterine cancer, would be found in reality to be deaths from intentional abortion. At first sight, it would seem impossible that such grossly erroneous opinions as the above could be rendered; but their likelihood is readily perceived when it is recollected how often, when the best medical skill has been secured, attending circumstances are such as to excite little or no suspicion of the true state of the case, and a physical examination of the patient is therefore neglected. Women are still allowed to die of ovarian or of other tumors that might be easily and successfully removed, and, in default of a proper examination, are sometimes mistakenly pronounced instances of disease of the liver or of ordinary abdominal dropsy, and as such are buried. If such and similar errors can occur in chronic cases, where time and opportunity have permitted the most thorough examination and study, still more likely are they to take place during the hurry and anxieties of an acute and alarming attack, where the conscience and shame of the patient are alike interested in causing or keeping up a deception.
It will have been seen, then, not merely that an induced abortion may be attended with great immediate danger to the mother, but that in reality it is very often fatal, either from the so-called shock to her system, or from hemorrhage, or from immediately ensuing peritonitis.
2. Should the woman survive these immediate consequences, no matter how excellently she may have seemed to rally, she is by no means safe as to her subsequent health. There are a host of diseases, some of them very dangerous, to which she is directly liable.
The product of conception is not always entirely gotten rid of. If a fragment remains, no matter how trifling in size, it may serve as the channel of the most severe and constant hemorrhagic discharge. Of this, examples are by no means infrequent; the flux lasting at times for very many months, and, if the cause is not finally detected and removed, hurrying the patient to her grave.