SOME ASPECTS OF ABORTION. 351 



one can not doubt, for the changes in the endometrium and decidua frequently 

 seem to be so profound. 



Certain alleged minor causes to which recourse is had by patients recur so 

 frequently in the histories that this fact alone suggests that they probably are not 

 the true or ultimate causes. Among such causes, a slip or a slight fall on the stairs 

 and minor psychic disturbances may be cited. That psychic disturbances may 

 interrupt gestation seems quite likely, but they probably merely are the immediate, 

 not the ultimate, cause of the abortion. They could be regarded as the ultimate 

 cause only if the conceptus is aborted well preserved, for otherwise one would have 

 to assume that psychic causes can produce uterine contractions sufficiently severe 

 to cause the death of the conceptus, and that later, after the conceptus has become 

 macerated, recurring similar psychic disturbances finally effect the expulsion of 

 the macerated specimen. 



Since infectious diseases no doubt very often are the immediate rather than 

 the ultimate cause of abortion, as Harris (1919) found in the case of influenza, it 

 undoubtedly may be assumed that many of the abortions caused by such and simi- 

 lar complications would have occurred later. They remind one of the defective 

 fruit which persists insecurely upon the tree until a sudden gust of wind showers 

 it to the ground. The findings of Harris regarding the effects of influenza and 

 pneumonia upon gestation, seem to be confirmed also by the small series of cases 

 of abortion among the present series in which the abortion was attributed to an 

 infectious disease. But in considering the alleged causes of abortion, one must 

 bear in mind that when a woman knows of a plausible exonerating reason for the 

 termination of the gestation she has every incentive to state it. That this is the 

 case is indicated by the various strange and, to the initiated, highly improbable 

 or even impossible reasons often assigned for the interruption of a pregnancy. 



Associated constitutional or venereal diseases were recorded in only 76 out of 

 697 selected histories. In 463 of these 697 cases the cause of abortion was not 

 given. In 52 out of the 76 cases in which associated diseases were present, other 

 causes for the termination of pregnancy also were recorded. Hence the suggestion 

 that the associated diseases probably were merely the immediate or incidental 

 causes in these cases seems decidedly probable. 



What strikes one's attention in the perusal of some of the histories is the long 

 period during which many of these young conceptuses really were in process of 

 abortion, as indicated not only by the anatomic as contrasted with the menstrual 

 age, but also by the repeated hemorrhages. Since in most of these cases the 

 abortion probably was inevitable from the beginning, it would seem that the 

 conclusion of Giacomini, reached also by Mall, that one should not temporize 

 with such cases, but promptly relieve the patient of an abnormal, dead or dying 

 conceptus, would seem to be justified. That some general practitioners apparently 

 are beginning to realize this situation is instanced by Dr. Bacon, who, in connection 

 with a recent specimen donated to the collection, wrote: "This makes the second 

 or third case in which I have apparently delayed an abortion and, when the gesta- 

 tion finally was ended, was rewarded with an abnormal child for my pains. 1 



