Abortifacients

ABORTIFACIENTS, various substances and methods resorted to for the termination of pregnancy. Abortifacients, which one has to deal with in forensic medical practice, can be subdivided into internal (see Abortive substances) and external. The former usually belong to the category of poisons, with the expulsion of the fetal egg occurring almost exclusively as a result of poisoning the mother; the latter represent various physical and mechanical methods used primarily for direct action on the uterus. Among internal abortifacients, the following are used in particular: 1) Purgatives—croton oil (Croton tiglium), aloe (Aloe), bitter apple fruit (Fructus Colocynthidis). These substances cause gastroenteritis, nephritis, vasomotor disorders in the abdominal organs, and hemorrhages into the fetal membranes, which can cause the expulsion of the fetal egg. 2) Essential oils of various plants: yew tree (Taxus baccata), red cedar (Juniperus virginiana), oil of amber (Ol. Succini), wormwood (Herba Absinthii), Chinese cinnamon (Cinnamomum cassia), as well as wine solutions of spices—mulled wine. Essential oils are not specific abortifacients. Miscarriage occurs as a result of poisoning the mother. Common camphor in large doses can also lead to fetal expulsion due to the rush of blood to the abdominal organs. Coffee beans and coffee are also used with doubtful success in toxic doses (due to increased blood pressure). Among other substances, one should also mention: 1) yellow prussiate of potash (can cause poisoning and death of the fetus); 2) Potassium iodide, taken internally, can sometimes (very rarely) interrupt a pregnancy. Finally, the most diverse substances (nitric acid, mercury, and lead preparations) have been repeatedly used as abortifacients. Fetal expulsion predominantly occurs at the moment of the greatest development of poisoning symptoms or shortly thereafter, and sometimes at later stages. If an expert opinion is requested regarding a substance allegedly used as an "abortifacient," one should take into account whether this substance can generally cause a pathological effect in the body and thereby cause a miscarriage. More effective (though far from always) are external abortifacients, mechanical methods—"abortifacients" in the strict sense of the word. Among them, abdominal massage (uterine massage) is often encountered in criminal practice, used with the aim of causing uterine contractions (it can sometimes interrupt a pregnancy). More crude and often ineffective methods include blows and concussions to the abdomen, jumping from a height, etc. Fetal expulsion occurs due to the rupture of the fetal egg or as a result of mechanical irritation of the uterus. In Sweden, "belly crushers" are known, who expel the fetal egg through repeated pressure on the woman's abdomen. In America, local electric currents are often used to stimulate uterine contractions. In the literature, there are indications of the abortifacient effect of X-rays, which was also confirmed in experiments on pregnant animals. The expulsion of the fetal egg occurs at various times—from a few hours to several days. Much depends on the stage of pregnancy and the condition of the organism and reproductive organs. Pregnant women themselves most often resort to the following techniques: in addition to kneading and tightening the abdomen, they take hot vaginal douches, take hot foot and "sitz" pelvic baths, and apply mustard plasters to the calves, thighs, and lower abdomen. Mechanical abortifacients can also include copious bloodletting (phlebotomy, application of leeches); it cannot be denied that very significant and sudden anemia can in some cases serve as a cause for miscarriage. Despite this, miscarriage due to bloodletting is rare. Individuals who specialize in inducing abortion use methods that are sufficiently established by science. Most often, puncture or rupture of the fetal membranes and the introduction of various foreign bodies into the uterine cavity (bougie, catheter, probe, etc.) are practiced with the aim of detaching the fetal egg, as well as intrauterine injections of soap solution, mercuric chloride, potassium permanganate, etc., and infusions of iodine tincture, iodine-glycerin, and others. There are attempts at abortion through the introduction of pessaries smeared with irritating substances (this method was used even by Arab physicians). Usually, mechanical manipulations are performed by other persons, although in rare cases, pregnant women themselves have introduced various foreign bodies into the uterine cavity (bougies, knitting needles, splinters, wire). Of the methods used in obstetrics, the warm or hot vaginal douche, according to Kiwisch, leads to the goal most slowly; the first contractions appear only after 3–5 days, and often later. Intrauterine injections—the Cohen method—have a faster effect. According to Tardieu, in cases where this method was used for criminal purposes, the expulsion of the fetal egg usually occurred no later than 18 hours after the injection. The Krause method (introduction of an elastic bougie into the uterine cavity), although relatively safe when observing the rules of asepsis, is unreliable, as often, despite repeated introduction of the bougie and even leaving it in the uterine cavity, labor does not occur. Puncture of the fetal membranes reliably leads to the goal, and according to Tardieu, the expulsion of the fetal egg occurs within a few hours and rarely later than 4 days after the intervention. "Curettage" as a method of emptying the pregnant uterus is encountered in criminal practice during medical abortions (see Abortion, Obstetric operations).