

CHAPTER XVIII. 



SOME ASPECTS OF ABORTION. 1 



In considering the possible reasons for the interruption of gestation, one must 

 not only distinguish between the alleged and the real causes, but must also bear 

 in mind the fact that we still speak of the occurrence of spontaneous and habitual 

 abortion. It is scarcely necessary to emphasize that there can, of course, be no 

 such thing as spontaneous abortion, for no gestation can be presumed to be inter- 

 rupted without a cause, whatever its nature. This is self-evident, and I gladly 

 would let the matter pass without comment were it not for the fact that the con- 

 clusion that a certain abortion was spontaneous often ends further inquiry. 



Hegar (1904) directed especial attention to the presence of pathologic changes 

 in the conceptus as a cause of abortion, thus clearly recognizing that the difficulty 

 may not lie in the maternal organism, although it must not be forgotten that 

 many of the so-called pathologic changes present in conceptuses nevertheless 

 may be due to adverse influences, somatic and maternal rather than germinal in 

 origin. However, since the presence of anomalies in the fetus usually is determined 

 by inspection of the gross specimen, it is evident that only the presence of external 

 deformities generally is noted. But from dissecting-room experience alone we 

 know that pronounced anomalies commonly are present internally without having 

 become evident externally. This may be true of such extreme anomalies as situs 

 viscerum inversus even, and when one considers how much more disadvantageous 

 for the development of the cyema such a condition must be than such minor things 

 as polydactyly and brachydactyly, hare-lip, cleft palate, or club-foot and hand, 

 it becomes apparent that internal must far more frequently be the cause of fetal 

 death than the external anomalies. The latter have long been recognized as prob- 

 able causes of fetal death and the subsequent termination of gestation merely 

 because they are so evident. It is true that external not infrequently are associated 

 with internal anomalies, but the effect of the latter upon the life of the cyema 

 probably has been underestimated largely because they can be revealed only by 

 painstaking examination. However, the frequent presence of marked internal 

 anomalies in the bodies of individuals who have passed middle life, or even the 

 proverbial threescore and ten, also indicates that the r61e of external anomalies 

 in the termination of gestation probably has been overestimated. For aside from 

 such major defects as the various forms of cranio-rachischisis, it is difficult to see 

 how minor external anomalies, such as polydactyly or brachydactyly, hyper- 

 phalangism, cleft palate, or hare-lip or anarthroses and synarthroses, in them- 

 selves can lead to the death of the fetus and hence to the interruption of pregnancy. 

 The same thing is true of anomalous renal development, except in so far, perhaps, 

 as it is extremely pronounced or associated with anomalies in the organs of inter- 

 nal secretion. Cardiac anomalies, especially septal defects, and internal hydro- 



1 The word abortion is here used in the general sense of an interruption of gestation, regardless of the time or the cause. 



339 



