The product of conception is sometimes retained entire, after its detachment from the uterine walls has been supposed wholly effected. It may be carried for many years, always acting as a foreign body; at times occasioning extreme irritation, shown perhaps only by distant and otherwise inexplicable symptoms, or it may lie dormant for a time without apparent trouble—finally making itself known by some sudden explosion of disease, whether by purulent absorption and general pyæmia; by ulceration and discharge of fœtal debris, through the intestines, bladder, or even abdominal integuments; or, by metritic inflammation, followed by sympathetic or consequent fatal peritonitis.
The patient, after an abortion, is very liable to one or another of the forms of uterine displacement, which are now known to lie at the foundation of so very large a proportion of the lame backs, formerly supposed consequent on spinal irritation; of the painfully neuralgic breasts, so often suggestive of incipient cancer; of the disabled limbs, pronounced affected with sciatica, cramps, or even paralysis; of the impatient bladders, from whose irritability or incontinence the kidneys are supposed diseased; of the obscure abdominal aches and pains, which unjustly condemn so many a liver and so many an ovary; of the constipation from mere mechanical pressure, which is so often thought to argue stoppage from stricture or other organic disease; of the severe and intractable headaches that, resisting all and every form of direct or constitutional treatment, are supposed to indicate an incurable affection of the brain; of the easily deranged stomachs, that are so suggestive of ulceration or of malignant degeneration; of the general hypochondria and despondency, that of the most gentle, even almost angelic, dispositions make the shrew and virago, and of the purest and most innocent produce, in her own conceit, the worst of sinners, even at times effecting suicide. Who that has suffered will think this picture overdrawn? Who that has practised will not recognize in displacements, the key by which these riddles may be solved?
Their mode of causation is plain. After an abortion, just as after labor at the full term, the womb is more weighty than natural—its walls thicker and heavier than usual, alike by the excess of blood they contain, and by the increased deposition of muscular fibre. After childbed, it has been shown that this increase is normally lessened by certain physiological processes attending the natural completion of that function. After an abortion, these processes are absent or are but imperfectly performed. It is notorious that during the slight increase of weight from simple congestion that occurs at the regular monthly periods, women are very liable to displacement on any effort, extreme or slight, whether riding on horseback, gently lifting, or even straining at stool; during or after an abortion, the risk is very greatly increased.
With equal justice could I refer to the chances of trouble that otherwise accompany the premature ending of pregnancy. In many instances, I have now been summoned to attend, and frequently to operate upon, the consequences of local uterine or vaginal inflammation or of laceration, for both of these results may ensue where the womb has not been prepared to evacuate itself by the normal closure of pregnancy—and this, whether or not instruments may have been employed. Adhesions of varying situation and extent are not uncommon as the result of an abortion. They may be slight, and merely tilt or draw the womb to one side, giving rise only to severe local or distant neuralgias, and rendering the occurrence of a subsequent pregnancy somewhat dangerous; they may be more decided, and as bridles or septa partially close the canal of the vagina, rendering menstruation and conjugal intercourse alike difficult and painful; they may be so complete as entirely to obliterate the mouth of the womb or of the external passage, in these instances preventing the escape of the menses, and rendering an operation necessary to avoid a rupture that might perhaps be fatal. Should it be the outer entrance that is occluded, the woman is of course entirely shut off from her husband's embrace; an effect that, however grateful to many an invalid, her shame would hardly be willing to accept as the consequence of disease.
These that I have mentioned are but a tithe of the pathological effects daily revealed to physicians, as in consequence of an intentional abortion. They are, however, sufficient for our purpose.