A system of practical medicine. By American authors. Vol. 4

by Unknown

Not alone upon the islands, but among the inhabitants of states not overcrowded like China and Japan, abortion is legalized; so in Paraguay and La Plata, where it is caused in every family after the birth of two living children. Some of the African negroes produce abortion on account of limitation of resources; among the Buddhists, otherwise so humane in their laws, it is frequent—a wonderful disharmony between the conduct of individuals and the dictates of their political and religious laws.

Wherever celibacy is demanded crime and abortion result, as among the Buddhists, whose laws condemn large numbers of vigorous subjects to this existence; and in our own civilization we see the same inevitable result in many of the most closely-populated Catholic countries. Thus abortion is frequent among the Anamites and among the Kambysians, who marry late and are frequently obliged to produce abortion before the time of marriage. Among the Brahmans it is a common practice, induced by religious and political arrangements, the direct result of a law which encourages sexual excesses, and frequently of the restrictions placed upon the needs of woman (widows are condemned by law to eternal celibacy); yet this terrible crime is looked upon as most harmless by the people of India, the destruction of a child that has not seen day being, according to their view, less of an evil than the dishonor of a woman. In Turkey it is so common that a certain price is paid for abortion and another for infanticide, and the law is indulgent to the crime, as it can be paid for cheaply. The cost of removing a non-viable foetus, or even an embryo, is equivalent to a tenth of the price paid for the murder of an infant.

The methods by which expulsion is accomplished are everywhere the same among people civilized and savage, ancient and modern—local and general. Among the local measures external violence is the most simple, as among the Tasmanians, who practise abortion by striking the belly, just as it is done by the priestesses of Formosa; and this is quite common in our day and in our communities. The introduction of instruments and implements into the womb is more intricate, but likewise common; the knitting-needle is a favorite resort in our country, and among primitive peoples a similar practice is resorted to; thus some of the negroes of Africa introduce the sprouting stem of a plant into the uterine cavity. Venesection, the drawing of blood from the vulva, anus, and foot, was often resorted to for the purpose of producing abortion.

Among the more common remedies used in former times are emetics, which are still very often resorted to, cantharides, emmenagogues, sabin, snakeroot, and the famous pennyroyal; so also ergot; the compound cathartic pill of the United States Pharmacopoeia is a favorite remedy,—all of which maim or kill the patient as often as they produce abortion. In New Caledonia a decoction of red-bud and banana-peel or green fruit is taken boiling: in China aperient medicines are publicly advertised for sale, and aphrodisiacs under the name of remedies to free the stomach and give back virginity. Certain negro tribes bring on abortion by manipulation of the abdomen and the use of purgative substances, such as the bark of the koche and sonnaly, which are also used to facilitate labor. Pen-tsae enumerates a large number of remedies as accelerators of abortion or purgatives according to the dose; many of them have a very doubtful action, however. The natives of India most commonly use the black annin, vulgarly called black anise or fourspice; fifteen grammes is an emmenagogue and larger doses produce abortion. The Arab women seek to produce sterility and escape the annoyance of numerous pregnancies, and imagine that they can arrive at that end by drinking a solution of sal soda, a decoction of peach-leaves, and the sap of the male fig tree.

Among peoples savage and civilized, for good reasons and bad, villains sufficient are found to do the bidding of thoughtless and misguided women; the remedies used, internal and external, local and general, are very often so violent as to be followed by the death of the victim. The plea of limited resources, of the inability of supporting a large family, is one common to people of all races in all stages of civilization: permitted by the unwritten law among some, it is practised with equal frequency by others, though strictly condemned. As we have stated, among many of the American nations it is legalized.

Again, there have been people at all times who have scorned the crime, but this is only among those pure, primitive, and still-developing peoples, as, for instance, the ancient Goths and Germans; and the Noxes of South America, as well as some of the negroes of Africa, even permit the husband without hesitation to kill his wife if she should abort. It is among those of the primitive peoples where the blessing of offspring is held in high esteem that the crime of abortion is most condemned and most rare. With the progress of civilization and religion, of refinement and knowledge, this crime, strange as it may seem, rapidly develops. It is not among the low and ignorant—it is among the educated and refined, among the wealthy—that it is most common; and the plea given in excuse of this crime is one most especially urged by the educated and refined, by the devout Christian, that the embryo is not an animated being, not an individual existence—that it does not attain the dignity of a living being until the time of quickening, until the middle of pregnancy. Religious and scientific reasoning is brought to bear in support of this theory in excuse of the many refined criminals; and it is this very point which the physician must urge: that the ovum, the embryo, from the moment of conception is an animated being, an individual existence with a life of its own. Important as the treatment of abortion, in consequence of natural causes, is, its prevention, and, above all, the prevention of criminal abortion, is still more so; and it is this which lies in the hands of the physician, whose most forcible argument must be in the evident and glaring crime which is committed by the destruction of a living being, as is the embryo from the moment of conception, not to forget the injury resulting to the mother. The former appeals to the moral, the latter to the physical, elements of womanly nature.

Whilst abortion, in consequence of natural causes, is a condition more dangerous than labor at term, the interruption of pregnancy by forcible means—criminal abortion—must necessarily be more grave in its consequences. The interference is often a violent one; the aborting woman is in mental distress, unable to seek the necessary comfort or attention; she is oppressed by the crime in her inner conscience; under unfavorable conditions, physical and mental, for the suffering which is most likely to follow.

With the progress in the practice of medical science the art of the abortionist keeps pace, and in civilized communities of to-day one cause of this growing frequency is in the increased numbers and the increased skill of practitioners ready to pander to all the whims of their degenerated customers: but the greater should be the efforts of honorable physicians to dispel the false illusions by which women seem to justify their doings, and to erase this darkest of all thoughts that lurks amid the noblest sentiments in woman's mind. A strong effort was made not long ago by the American Medical Association to urge the importance of this matter upon the profession, resulting from the earnest efforts of that honored obstetrician Hugh L. Hodge, which culminated in a report of the Committee on Criminal Abortion, read before the American Medical Association in 1871, and a number of papers written upon the subject at that time, prominent among which I would mention those of Van de Warker, Tabor Johnson, and John W. Trader. The wave has swept by: what has been accomplished may be gleaned from the police records of our cities.

PHYSIOLOGY OF EARLY PREGNANCY.—For an understanding of the pathological conditions which determine, precede, and accompany this accident a knowledge of the physiological state is as important as normal anatomy is to the pathologist. But as this subject is treated of in full in other articles, we will confine ourselves to a few of the leading features which are most important for purposes of diagnosis and treatment.