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ARTIFICIAL MISCARRIAGE                                              333

5.   Physical causes winch separate the ovum,   For instance, a blow or
3 fall or some Jgther accident even of a trivial nature.   Mis carriage ~from "
such-eauses usually occurs among women who are predisposed to it.

B. Causes affecting the Foetus. — 1. Death of the Fcetus.— Death of the
foetus occurring from a faulty development, s;££hnis__and other diseases
leads to secondary changes, and ultimately produces the uterine contractions
which end in its expulsion.

2. Diseases of decidua, and inflammation and fatty degeneration of the


1. Justifiable Miscarriage. — This is also known as therapeutic mis-
carriage, the induction of which is justifiable only when caused in good
faith to jsaye the life of the .woman,2 if it is materially endangered by the
continuance of pregnancy, but not to save the family honour or for any other
ethical reason. It is much better to defer the operation till the child has
attained viability, if it is possible, so that the mother and the child may be
saved. If miscarriage lias to be induced before the child has become viable,
the physician should never undertake the operation without


with another medical practitioner, preferably one holding
superior qualifications, or an obstetrician specialist, nor without the written
consent of the woman and her husband or her guardian. If the consent is
verbal, it should be duly attested.

A suggestion has been made that the procuring of abortion should be
regarded as justifiable, if the mother's health is likely to be permanently
damaged by the continuation of pregnancy. Lord Riddell3 thinks that the
induction of miscarriage is not only justifiable but a duty when the continua-
tion of pregnancy indicates grave danger to the mother's health whether
the result is likely to be permanent or not. Some physicians also think "that
therapeutic abortion is necessary and should be classed as justifiable when
performed for eugenic consideration, e.g. in cases of epilepsy ^-mental rKg^A^
abuse of intoxicating drugs and conception alter rape, butas the law in
IncEa stands at present, an abortion performed for sucti purposes is regarded
as illegal, unless the continuance of pregnancy endangered' the woman's life.

Dr. Aleck Bourne performed an abortion on a girl of about 15 years who became
pregnant after she had been assaulted "by some soldiers and raped under so revolting a
set of circumstances as could be imagined. He thought that the girl would, in all prob-
ability, if she had gone to full-term, have suffered from grave and lasting nervous
damage which would have expressed itself in psychoneurotic and physical illness perhaps
for the whole of her life. He did not consult any of his -colleagues, as in such cases
he was accustomed to act as "the second opinion" himself. He was charged with un-
lawfully using an instrument with intent to cause miscarriage, and the case turned on
•fee interpretation for the first time of ihe word "unlawfully". The trial took place on
the 18th and 19th July 1938, at the Old Bailey, before Mr. Justice Macnaghten. The
Judge, in summing up, said " that no line can be <lrawn between danger to life and
danger to health ; that no doctor knows whether life is in danger until the patient is
dead ; and that if on reasonable grounds based on adequate knowledge after consultation
with colleagues a doctor forms an opinion that the probable consequences of the conti-
nuance of pregnancy would make the woman a physical wreck, then he is not only
entitled, but it is his duty, to perform an abortion. To preserve a woman's life is not
merely to save her from death ; it is also to save her from illness which would destroy
so much of her life that it would hardly be worth living." The jury returned the unani-
mous verdict of not guilty and the judge acquitted Dr. Bourne.4

Indications. — 'The indications for producing justifiable miscarriage are—
1.   Obstruction to the passage of a foetus owing to the contracted,^
deformed pelvis or the presence of a tumour,

2.   Sections 312 and 315, IP.G, AiDoendix IV.

3.   Brit. Med. Jour., Jan. 29, 192T, p. 188.

4.   -Brit, Med, Jonr*, July 3% 193& p. 225,