[Reprinted from the New York Journal of Gynecology and Obstetrics 
for May, 1894.] 
ABORTION AS A CAUSE OF DISEASE OF THE PELVIC 
ORGANS.* 
By P. F. Chambers, M. D. 
While the formerly accepted doctrine that the uterus is the seat 
or origin of all pelvic disease will never again be revived, still, that it 
is responsible for many more disorders than the extreme modern 
school has taught is beyond a shadow of doubt. 
We are again beginning to look upon the diseased uterus as the 
cause instead of the sequela of ovarian or tubal troubles ; and conse- 
quently directing our attention toward their cures through the 
uterus, rather than a cure of the uterine trouble by removal of the 
ovaries and tubes. 
Years ago, Dr. Noeggerath astonished the profession by stating that 
all the cases of pyosalpinx, as well as many of the other troubles of 
the female pelvis, were caused by gonorrhoeal infection; and, in 
substantiation of his assertion, said the gonococci could be found in 
the pus of the tubes. His theory was for a long while not accepted 
and fortunately never has been so in this country as universally as in 
Europe, for while we accept his statement as true in many cases, still 
we have all met with many cases in unmarried, as well as married, 
women who have had unmistakable pus tubes but who have never 
had gonorrhoea ; and, while among the married women, we have 
been able to find other apparent causes, among the single women the 
cause is yet a mystery. 
I have found, in my experience, the most frequent cause of pelvic 
trouble among married women to be abortion and, I might say in 
* Read before the New York Obstetrical Society, March 6th, 1894. 2 
P. F. Chambers, Af. D. 
the majority of cases, abortions artificially or intentionally pro- 
duced ; meaning, by the term abortion, the casting off of a part or 
the whole of the foetal shell before the viability of the foetus. 
Among married women over thirty years of age who have not 
aborted one or more times, the percentage is very small ; and while, 
with those who have aborted against their wishes, there seems to be 
little trouble as a consequence, among those upon whom the abortion 
was intentionally produced the evil results are manifest and numer- 
ous. It is exceptional to find a woman who will confess to having an 
abortion produced who, as a consequence, is not suffering from some 
serious form of pelvic trouble. And the wonder is not that there are 
so many such sufferers but that there are not more, when we con- 
sider the class upon whom abortions are produced, by whom they are 
produced and the method of procedure. 
In the first place, the operation is usually performed upon a 
woman who would be disgraced by a known pregnancy ; and this 
fact brings in at once a mental element—fear and a consequent deter- 
mination to conceal her illness ; a determination which can only be 
carried out by a total disregard of all laws which would be insisted 
upon in every case of an ordinary operation. She keeps upon her 
feet and often does more than when perfectly well, feeling that to 
remain unsuspected she must be over-zealous. 
In the second place, the operator is usually a charlatan who works 
clandestinely—a friend or the patient herself ; in any event, a person 
ignorant of anatomy, of all surgical technique and who, being anx- 
ious only to fly the ills that be, is regardless of those she knows 
not of. 
As to the method of procedure, the operations are usually per- 
formed clumsily, improperly and without regard to any antiseptic 
precautions. Close questioning will generally bring the information 
that the operator used an instrument like a sound, either connected 
with an electric battery or not, as the case may be, and that no pre- 
cautions were taken in the way of antisepsis. We all know the dan- 
gers of a uterine sound in the hands of the most careful operator 
upon a comparatively healthy woman, when every antiseptic precau- 
tion has been taken. Imagine, then, an unclean sound in the hands 
of a quack ! The proverbial “ bull in a china shop ” would create less 
havoc! 
What other portion of the body would submit to such treatment ? 
And, at the same time, what part of the body could possibly be put 
in a more suitable condition for injury or the absorption of septic Abortion as a Cause of Disease of the Pelvic Organs. 
3 
matter? A slight glance at the anatomy of the uterus during the 
early stages of gestation will readily make evident the truth of my 
statement. 
The uterus being congested at each menstrual period, it is en- 
larged and its mucous membrane thickened and folded upon itself 
and, should conception take place then, the impregnated ovum acts 
as a physiological cause for an increased development, not only of 
the mucous membrane and the muscular walls but also for a hyper- 
trophy of the glands and an increase in size and quantity of the 
blood vessels ; so much so, that there are numbers of venous sinuses 
formed especially opposite the insertion of the placenta—thereby 
favoring osmosis and endosmosis. The Fallopian tubes change their 
position from the apex of the angles on a horizontal line with the 
pelvis to a much lower plane—to about the upper one third of the 
uterus—and the openings become much more permeable. But while 
at parturition the mucous membrane is thrown off by the formation 
of a new membrane, in abortions, especially during the early months, 
this is not the case; the membrane then, if exfoliated at all, becomes 
so by a slower process, often by sloughing, and that, too, in connec- 
tion with the foetal membranes or placenta. 
In normal abortion (if I may so use the term)—that is, those fol- 
lowing a contraction of the womb caused by external influences and not 
mechanical interference—the uterus usually expels the entire contents, 
the foetus, amnion and chorion, the decidua vera and reflexa ; and 
though a raw surface is left it is, as a rule, attended with little if any 
trouble ; the woman generally takes good care of herself and remains 
in bed for several days, which allows the uterus to contract, a new 
membrane to form and the parts to assume their natural functions. 
An examination a few weeks later will show the uterus normal in 
position and size, the membranes healthy and the woman perfectly 
well. 
But should the uterus fail to expel the entire contents, as it fre- 
quently does ! Suppose some of the membranes remain or, if at a 
more advanced stage, the placenta or a portion of it is left behind I 
In a week or ten days putrefaction sets in. The patient becomes 
restless, feels languid or more frequently has a chill followed by fever, 
loss of appetite and general malaise, showing septic absorption ; and 
these symptoms are the forerunners of a long series of pelvic troubles 
if not of acute and immediate danger. 
The glands, blood vessels and mucous membrane being in the 
condition above described, an absorption of the septic matter readily 4 
P. F. Chambers, M. F. 
takes place and, as a consequence, we have to deal with catarrhal en- 
dometritis by inflammation of the endometrium, metritis by extension 
of septic matter into the muscular tissue, salpingitis, ovaritis and 
other peri-uterine inflammations, by further extension of the sepsis 
through thus Fallopian tubes and by the lymphatics. 
It not infrequently happens that the doctor is called immediately 
after the attempt at abortion has been made, and the question natur- 
ally arises, what shall be done to prevent further trduble ? If the 
damage done has been great enough to cause the expulsion of the 
foetal shell, a part of it or even enough to cause its future expulsion, 
the only thing to be done is to thoroughly empty the uterus as soon 
as possible, and unquestionably the best method, if in the first two 
months of gestation, is by the use of divulsors, curette and irrigation 
with sterilized water. If the abortion occurs after the formation of 
the placenta, that is after the close of the second month, I prefer to 
use my fingers for dilating as much as possible, and in addition to the 
curette the intra-uterine forceps are necessary to empty thoroughly 
the cavity ; in the meantime, of course, practicing very carefully 
every antiseptic precaution, then putting the woman to bed and keep- 
ing her there for at least ten days. 
It is not my purpose to enumerate the methods of preventing abor- 
tions nor the best methods of producing them, as my paper treats 
only of abortion as a cause of pelvic disease. To enter into the 
treatment of the results would embrace the entire field, from the 
hot vaginal douche to cceliotomy for the removal of the diseased 
organs. 
The fact that we are again accepting the theory that many, if not 
most of the diseases of the pelvic organs, have as their point of origin 
some previous, if not present trouble, of the uterus should at least again 
direct our thoughts toward trying to devise some method of treatment 
to reach the diseased part through the same channel. There has al- 
ready been a reaction from the dictum that all cures of diseases of 
the ovaries and tubes can only be accomplished by extirpation. 
While I do not wish it understood that I disapprove of operations, 
still I prefer to be put on record as one who resorts to them only 
when the simpler means have completely failed ; it seems both natu- 
ral and feasible to attack a disease at its origin, and many of the 
tubal troubles at least can be entirely cured by the simpler and more 
conservative method of divulsion, curetting and drainage. 
The success of an operation, or the reverse, has heretofore been 
determined by the immediate results, but when it has been possible to Abortion as a Cause of Disease of the Pelvic Organs. 
5 
follow the case as time passed on even the physical results have been 
found to be far from satisfactory in very many cases. 
Again the lowered moral tone coincident with the extirpation of 
ovaries and Fallopian tubes renders still more imperative our obliga- 
tion as ministers to the social weal. 
Then let us persevere in this good work. Let us perfect our 
method of treatment of the uterus and appendages through the vagina, 
so that in a few years it may be as rare an occurrence to remove a 
Fallopian tube for pyosalpinx as it is nowadays for some of us to leave 
them, feeling assured that we shall thus best serve the interests of so- 
ciety and science. 
I have written this paper not with the idea that I could bring for- 
ward a single new thought, but simply to impress the hope that the 
facts would make it obligatory upon us as honorable members of an 
honorable profession to do all in our power to discourage the great 
and growing evil of producing abortions, not only from a moral stand- 
point but also as one of the most frequent causes of diseases of 
women.