But if the abortion becomes "inevitable", a different policy must be assumed. The patient must be put under the influence of ether or chloroform and submitted to a regular surgical operation, and for this the most scrupulously painstaking preparations must be made. A degree of cleanliness must be attained never thought of by the most careful housewife the object in view being to render the field of the operation, the instruments, the hands of the surgeon and of his assistants and nurses, and everything which might touch the area to be operated upon, absolutely free from those microscopic vegetable organisms which are the cause of putrefaction and septicaemia.
All the minutice of this surgical technique cannot be here explained, but some idea can be given by the following short description :
The hands and arms of the operator and his assistants are thoroughly scrubbed for five or ten minutes with a stiff brush and hot soap suds and water, the finger nails are cut close and carefully cleaned, and then the hands and arms are soaked for several minutes in some powerful germicide solution, such as a strong solution of permanganate of potash followed by a dip in oxalic acid solution, in absolute alcohol, in a solution of bichloride of mercury, 1:1,000, or in some other antiseptic known to be effective.
The instruments, the towels and the dressings have all been rendered absolutely "sterile" by either boiling, or baking them in an oven, or exposing them to superheated steam. The patient has been prepared for the operation by appropriate medical treatment, and the parts adjacent to the field of operation have been scrubbed with hot soap suds and irrigated with an antiseptic or boiled water. The body and limbs of the patient are then covered with several wet, sterilized towels, and, the anaesthesia being attended to by an assistant who does nothing else, all is ready for the operation. The preparations occupy far more time and trouble than the operation itself, and no less degree of care and skill is required than a surgeon would employ in trephining the skull.
After the operation the patient is not permitted to leave her bed for at least a week, while rest and quiet are enjoined for several days more until the uterus has regained its normal size and position, and the raw surface within it has entirely healed. With all these precautions, done by skilful hands, diligently watched by a skilled surgeon, and treated by rest in bed, good nursing, and a watchful expectancy against sepsis, the operation is usually unattended by evil consequences; but, fortunately, the necessity for resorting to therapeutic abortion is now extremely infrequent since modern surgical advances have made the Csesarean section and symphyseotomy so safe, though the reputable doctor is frequently called upon to take charge of a case immediately after the attempt has been made by the abortionist.
How different are the procedures and the subsequent history of the case if the abortion have been done criminally!
In this event a serious operation is done by stealth, with no preliminary preparations, by an operator who is no surgeon, heartless, immoral, with hands reeking with the blood of other misdeeds, and with no assistants, upon a patient who is desperate, disgraced, abandoned, and perhaps exhausted by her efforts at concealment.
The woman, having probably sought some reputable physician to relieve her and having been refused, seeks an advertising abortionist or ignorant midwife, and in many instances even operates upon herself. Everything is done with a total disregard for all surgical rules, in the preparation of the patient, in the preparation of the charlatan's hands and instruments, and in the subsequent care and treatment of the case. The abortionist desires the fee and nothing else, except that the woman shall not die her shattered health being a matter of no concern to the coarse and unskilful brute.
The desperate and exhausted woman, embarrassed at the necessity for concealment, arrives alone, often after a long journey, with no friend or witness, at the wretched office of this foul man, or woman, and bargains over the life of the babe within her womb. Preparations for the operation would excite suspicion, so there are none. The clandestine operator, ignorant of anatomy and surgical technique, clumsily passes a dirty and septic catheter, or other instrument, into the womb and ruptures the ovum. The vagina is then stuffed with cotton to conceal the hemorrhage, and the woman, having paid the largest fee which can be extracted from her, is told to depart, never to return until she again requires similar treatment.