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

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

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

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

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

Recapitulation

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

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

Abortion may be due to—