A.M.A. against Abortion
Although for decades the American Medical Association has largely supported physicians who perform abortions, the Association was instrumental in passage of the laws against abortion that were overturned in 1973 by Roe v Wade. The following are Reports, Resolutions, Documents, and articles which illustrate the Association’s earlier strong support of unborn children (from conception) and strong condemnation of unnecessary induced abortion. These articles appeared from 1857, shortly after the Association was founded, and continued well into the 20th century. Dr. Horatio Storer’s American Medical Association reports and documents are included.
These articles and reports from the Transactions of the American Medical Association (TAMA) and the Journal of the American Medical Association (JAMA) are only a small sample of the huge number of articles by physicians condemning abortion during this period that were published in scores of medical journals. Over 100 such articles are reviewed in The Physicians’ Crusade Against Abortion published by Science History Publications. A
Physicians did not write articles supporting therapeutic abortion until well into the 20th century and this was only a fraction of physician articles dealing with abortion. Most physician articles condemned unnecessary abortions.
David Meredith Reese, “Report on Infant Mortality in Large Cities,” TAMA 10 (1857): 93-107.
INFANT MORTALITY IN LARGE CITIES.
SOURCES OF ITS INCREASE,
MEANS FOR ITS DIMINUTION.
D. MEREDITH REESE, M. D., LLD., &c
OF NEW YORK
EXTRACTED FROM THE
TRANSACTIONS OF THE AMERICAN MEDICAL ASSOCIATION.
T. K. AND P. G. COLLINSS, PRINTERS
R E P O R T.
The terms of the question thus submitted to the undersigned, very clearly imply—
1st. That the mortality of infancy, especially in large cities, has reached an extent of magnitude which demands inquiry into its causes and remedies by the medical profession.
2d. That infant mortality in large cities is increasing to a degree which renders it important that the sources of such increase should be sought by diligent investigation.
3d. That the means of diminishing the extent of the mortality among infants and children of tender age, while their discovery and adoption would greatly subserve the interests of humanity, would at the same time redound to the honor and usefulness of our profession, and contribute to the public welfare.
Upon each of these topics, it will be the object of this paper to remark very briefly, by presenting observations of a practical character, derived from experience and observation, together with such inferences as may be legitimately deduced therefrom. The presentation of the literature of the subject will be foreign from the purpose of this paper, as this alone would extend beyond the limits we have prescribed to ourselves. For the same reason, we omit any extensive introduction of statistical and numerical tables, lest these should derogate from our design to render the effort suggestive and practical, capable of elaboration and amplification hereafter by others.
First. By “infant mortality” we understand the mortality of childhood, or, in other words, that fearful item in our official bills of mortality and reports of interments, which records the appalling fact that nearly ONE-HALF of the whole number of deaths, especially in large cities, occur in infancy, and before the subjects have reached The fifth anniversary of their birth. In the city of New York, as will appear by the accompanying statistical table, the whole mortality of the last half century amounted to 363,242 (including the stillborn) while the number of deaths under 5 years of age are shown by the same table to have been 176,043, which is nearly 49 per cent. of the entire mortality of the city, and this for 50 consecutive years. As in New York, so in other large cities, the proportion of infant mortality will be found to vary inconsiderably if at all, so that it may be safely estimated that one-half of the population enumerated in the census die before the age of five years; and. hence the annual infant mortality includes little short of a moiety of the human race, unless it can be shown to be greater in our large cities than through the country and through the world. But of this hereafter.
Of the fearful increase of infant mortality in Now York, regard ing this as a type of other cities, we have the testimony of the same statistical table. In the year 1853, the deaths under 5 years numbered 12,963, while in 1843 only 4588 such deaths occurred, showing the appalling increase of 8375 within 10 years, which is vastly beyond the proportional increase of the population of the city during the decennial period, as shown by the census. Moreover, this increased infant mortality in 1853 as compared with l843 is in a ratio very far beyond that of the aggregate of the deaths in persons of all ages, in each of these years respectively, found in the same table. The deaths under 5 years in 1853 were 12,983, while the deaths of all others in the city of every age numbered only 9739; so that the infant mortality exceeded all the other interments for that year by 3224! This single fact exhibits in a striking light the importance of the subject of infant mortality in view of its frightful extent, and its alarming increase within 10 years. In 1843, the infant mortality exceeded the half of the aggregate mortality of the city by only a few hundreds; but in 1853, the excess over one-half the entire number of interments of all ages in the city reaches as many thousands.
These particular years have been selected only because the semi-centennial table from which we quote includes the 50 years ending in 1853, and because it was only in 1843 that the City Inspector was by law empowered to record all the deaths occurring in the city, irrespective of the place of their interment, and hence from this latter date he vouches for the reliability of the table. The mortality for 1854, ‘55, and ‘58 is appended for comparison, thus bringing our data down to the present year. Other corroborative tables, as those of Drs. Emerson and Condie, of Philadelphia, Dr. Lee and others, may be found in the books, and are too familiar to the profession to be reproduced here. They all show the enormous extent of infant mortality, and its amazing increase, the latter being a fact peculiar to our American cities, for in the great cities of the old world the mortality of infancy has been annually diminishing for many years.
This single fact exhibits in a striking light the vast importance of our inquiry. Why should infant mortality in American cities be greater than even in Paris! 8 per cent. above Glasgow, 10 per cent, above Liverpool, and nearly 13 per cent. greater than in London? Why should it be increasing here and diminishing there? And this too when statistics abundantly show the mean duration of human life to be greater by 3 1/2 per cent. in our American cities taken collectively than in the cities of Europe? Whether we shall be able to point out the reasons for this remarkable disparity or not, by demonstrating that there are other sources and causes existing and operating here than in transatlantic countries, the fact remains that infant mortality has attained gigantic proportions among us, and is increasing with amazing rapidity; and this too when the general salubrity of our climate, and the facilities for sustaining and preserving life with us, are superior to those possessed by any country on the globe.
Having thus succinctly shown the extent and the increase of infant mortality in the largest of our Atlantic cities, and hence inferred a similar state of facts elsewhere; it will now be in place to inquire after the causes of such extent, and to seek for the sources of such increase. We pause however to premise, for reasons which will be hereafter apparent., that we include among the infant mortality all those recorded interments marked as stillborn and premature births, the extent of which, and especially their amazing increase, constitutes one of the most revolting and yet one of the most important features of our inquiry, and one which cannot be contemplated without horror. Let it suffice for the present to say, that during the last 50 years, this New York table reports no less than 24,164 among the stillborn and premature birth interments. And while in 1843 only 760 of this class were recorded, in 1853 no less than 1930 are reported—an increase of 1170, which is nearly 140 per cent. of increase within ten years!
It will be perceived that these “stillborn and premature birth” interments number equal to one-fifth of the entire infant mortality of the last half century, and hence ought not to be overlooked in any estimate made upon this subject. Apart, however, from their numbers, they must be included, for another and a weightier reason, since the causes of mortality among children of tender age are, in a multitude of cases, to be found only by extending our inquiries to their intra-uterine life, and the physiological state of the parents, but especially the sanitary condition of the mothers, their hygienic and moral habits, and circumstances. Nothing can be more certain than that the viability of the infant after birth, and its tenacity of life, depend very greatly upon the condition, circumstances, habits, and health of the parents, particularly those of the mothers, during every period of pregnancy. And hence pathological and demoralizing agencies, operating upon parents in reproduction and during utero-gestation, are often the sources of “premature birth and still born” cases, but not less the cause of early death in their offspring after birth, and resulting in a vast proportion of the infant mortality so sadly and universally deplored. These considerations may suffice to justify our plea for including the stillborn interments among the victims of infant mortality.
In contemplating this subject, we shall find it difficult to believe that the inestimable jewel of life is given by the Creator to such myriads of our race, with the design that a large majority of those who receive this boon are destined, in the Divine plan, to perish during their foetal or infantile existence, and that he has left us without any remedy to avert so terrific a catastrophe. Indeed, from what we know of the wonderful viability, and mysterious tenacity of life which characterizes infantile existence, both intra and extra-uterine being, we should infer the contrary; and believe that the benevolent Father of all has other and wiser and better designs towards our race, purposes which are perverted or defeated by a violation of the laws of our being, whereby the children whom God has given us as a blessing, become a curse by our early bereavement, and they perish prematurely, the victims of our ignorance, our misfortunes, our follies, or our crimes. Let us then enter upon an examination of the causes of infant mortality, and. inquire why it is, that more than half the children born in our large cities are numbered with the dead at their very entrance into life. Renouncing the idea of irrevocable fate as the source of this fatality, let us seek for its source in our own public and private disregard or trespass of the laws of health and life, both in relation to ourselves and our children.
First, then, let us look at the cases of “stillborn and premature birth,” which constitute so large a proportion of infant mortality. The causes of these are well understood by the profession, when occurring from hereditary and constitutional vitiation of blood in either parent, from contingent morbid agents acting upon the body or mind of the mother, and from incidental or accidental events occurring during pregnancy and parturition. But it is equally well known to all medical men, that from all these causes combined, such cases arc rare compared with the number of births under professional management; and moreover that they bear no proportion whatever to the astonishing records of the interments from this cause. Let any man compare the stillborn cases with the numbers of living children born in any of our hospitals or asylums for lying-in women —and these mothers are often the most unfavorable cases of maternity—and be will discover how rare are the stillborn or premature cases. It is plain, therefore, that their extent and increase in various classes of society are due to other causes. Without entering into any unnecessary detail upon this delicate and ungracious topic, it may suffice w allude only to the ghastly crime of abortionism, which has become a murderous trade in many of our large cities, tolerated, connived at., and even protected by corrupt civil authorities, and often patronized by newspapers whose proprietors insert conspicuously the advertisements of these male and female vampires, for a share in the enormous profits of this inhuman traffic in blood and life. These murderers, for such they are, are well known to the police authorities; their names, residences, and even their guilty customers and victims arc no secret to the authorities; they have their boxes at the post-office, loaded down with their correspondence and fees; take their seats at the opera; promenade our fashionable thoroughfares, and drive their splendid equipages upon our avenues in proud magnificence, while the “blood of the slaughtered innocents” is crying against them for vengeance.
Fidelity to the truth constrains this allusion to a topic which else it were “a shame even to name ;“ but the worst is yet untold. There are fathers who employ and pay these wretches, and, alas! there are mothers who become their victims, and voluntarily sacrifice their unborn infants, and hazard their own lives in the criminal process. Would that it were only the profligate, or even the unfortunate of their sex, whose guilty fear or shame thus seeks to hide the evidence of illicit amours. But the proof is overwhelming, and everywhere known to the profession, that even the married, to postpone the cares of a family, the perils of parturition, the privations and duties of maternity, and sometimes in view of the pecuniary burdens they apprehend as intolerable, consent to the use of drugs, and even the employment of instrumental and other means, to arrest early pregnancy, and to produce premature delivery, persuading themselves into the vulgar fallacy that there is no life before quickening, and that early abortionism is therefore less than murder. That such means are often used unsuccessfully, and are thus brought to the knowledge of medical men in time to repair and prevent the mischief; is a proof of the fidelity of nature in preserving the viability of the infant even under adverse circumstances. But that such often succeed, always by jeoparding, and sometimes by destroying their own lives, is notorious. And that very many “premature births and stillborn children” arc the result of mischiefs inflicted upon mother or child or both, by awkward or unskilful attempts at abortionism, can neither be denied nor doubted. It is humiliating thus to record the wide-spread prevalence of an evil scarcely known to the generation of our fathers. The object of the institution of marriage, viz., the birth and nurture of offspring, the sacredness of the family relation, and all the sanctions of virtuous love in the conjugal and parental relation, seem to be ignored in those degenerate days, and need to be revived in the public creed and practice. It adds to the melancholy aspect of this subject when we record our conviction, that not merely the still born, but much of the mortality of early infancy, results from the injury inflicted upon mother and child by the unnatural and un successful attempts made to prevent conception, and during pregnancy to procure abortion. The same effect is produced in other cases, without any criminal intent, by drugging or “doctoring” women in various ways, while pregnant, under the real or imaginary ailments to which they are subject, or to “prepare them for an easy confinement.” All such prescribers are either knaves or fools, and should be shunned by such patients for their own safety. Pregnancy is not a disease per se, and, in the case of a healthy mother, neither requires nor admits of medication. Nor can it be doubted that many children are destroyed both before and after birth by the practice of drugging the mother, which so reprehensibly prevails among various classes of the community.
By the table it will be apparent that the mortality of infants under 1 year old, greatly exceeds that occurring between 1 and 5 years of age; while the mortality under 2 years is nearly four times that between 2 and 6 years. Moreover, the number of children who die under 5 years of age, is greater than the whole mortality between 5 and 60 years of age I Hence the perils of life during the five years of infancy arc greater than during the fifty-five years subsequent to that age. That this horrible fatality is a necessary evil, we should be slow to admit.
The first year of infancy, as we have seen, exhibits the most appalling waste of life, being one-fifth of the aggregate mortality of our whole city population of all ages and from all causes. The dangers to life attendant upon early infancy, and especially during the first year, are well understood by the profession and the public; these arise from a variety of causes, viz :—
1. Defective vitality at birth, hereditarily transmitted from one or both parents, whereby the infant is not viable, and perishes from inanition; nutrition and development being physically impossible. These are reported in the bills of interments as cases of marasmus, tabes mesenterica, consumption, &c.
2. Mismanagement of infancy, by parents, nurses, or doctors, in feeding and physicking the newly born; depriving them of the nutriment simultaneously flowing into the mother’s breast, as nature’s only and all-sufficient supply for nutrition and development, and substituting therefor the thousand slops, teas, and drugs which officious grannies, of both genders, are wont to prepare and administer. It may safely be computed that a moiety of the mortality among infants of days is the direct result of spooning into the stomachs of new-born children some of the worst simples and compounds which they will ever taste through life, in case they survive the infliction. Not merely molasses, or sugar and water, catnip tea, olive or castor oil, goose-grease, spoon victuals, and the like, but salt and water, soot tea, gin sling, and even urine, are incontinently forced into the infant’s throat before it has known an hour of life. Thousands thus perish in early infancy, their deaths being ascribed variously to colic, cholera, diarrhoea, dysentery, or convulsions, though oftener produced by drugging for the relief of symptoms which the mother’s earliest milk would have prevented or cured; life being sacrificed by soothing syrup, Godfrey’s cordial, Jayne’s carminative, or some other vile mixture of molasses and water, with opium and brandy. These sleeping draughts and anodyne nostrums are more deadly poisons to budding life than all the diseases of infantile existence; and to these a very large proportion of infant mortality is justly to be ascribed, for whole hecatombs of victims are thus poisoned out of life, in the very dawn of their being.
3. The ratio of infant mortality in large cities is conceded to be much greater than in country towns or rural districts, and for the reason that in the former so large a proportion of the births take place in the abodes of the indigent, which, if not in garrets or cellars, or shanties, are sadly deficient in the supply of light., pure air, free ventilation, cleanliness, clothing, fuel, and wholesome food, so necessary to the health, comfort., and safety of the mothers, not less than their offspring, whose vitality is henceforth to be derived from the maternal bosom in the milk, whose quality depends on the blood which circulates in her veins. Multitudes of infants born under these adverse circumstances of atmospheric contamination, perish in a few weeks or months for lack of pure air; and instead of marvelling at the extent and increase of fatality among such, we might rather wonder that any survive.
4. How much of the infant mortality in large cities, and its alarming increase, is the legitimate result of quackery in some one of its varied forms, to which sick children are subjected, may be difficult even to conjecture. That “false theories in medicine have slain more of our race than war, pestilence, and famine combined,” has been affirmed by high authority. It is sustained by historic evidence. Nor have these medical heresies, the offspring of ignorance, presumption, superstition, and avarice ever been more rife, especially in large cities, than they have been of late years, and still continue. Every phase of quackery is characterized by an over-weening faith in drugs, and a delusive confidence in specifics, inspired by the brazen effrontery of the charlatans who “by this craft have their gains,” and who employ themselves in encouraging the people to become, with the aid of their new system of drugging, “everyone his own doctor.” Multitudes fall into this snare, and by the purchase of a box of specifies, and a book of instructions, are assured that they are possessed of the remedies adapted to all the diseases to which “our flesh is heir.” The popular mind is indoctrinated by these quacks into the belief, that in all ordinary diseases they may confide in these specifics, especially for infantile diseases. And that thousands are annually added to our infant mortality by diseases entirely within the control of the healing art, the early periods of curability being lost, in these experiments of ignorance by credulous parents and pretended physicians, is notorious in every city. So true it is in this connection, that “for want of timely aid, millions have died of medicable wounds;“ nor is it less true, that by injudicious and misguided interference with drugs, by the ignorance of mothers, nurses, and doctors, our infant mortality is immeasurably augmented.
It remains, however, now to allude to the very considerable proportion of early mortality among the depraved and vicious families who abound in large cities, which results from the transmission of the hereditary poisons of either scrofulous, scorbutic, or syphilitic disease, from one or both parents to their offspring, whereby their young blood is fatally tainted with constitutional maladies, extending to the second, and even the third generation. The “parents have eaten sour grapes, and the children’s teeth are set on edge.” That multitudes of children thus perish early from diseases which descend from their parents, constituting a fatal inheritance of poisoned blood, is a fact as demonstrable as any other in human pathology. Hence it cannot be overlooked, in any inquiry after the sources of the extent and increase of infant mortality in large cities.
The extent, increase, and sources of infant mortality having been thus briefly considered, our next inquiry is into the means of its diminution, a task infinitely more difficult, and still more important. Is there any remedy for this deplorable and desolating scourge in our largo cities? To this inquiry we now address ourselves, and in view of the sources of this waste of human life already enumerated, it must be obvious that a radical revolution in the public creed and practice, a thorough reform in the opinions, habits, and conditions of the masses of our city population, are indispensable to any diminution, either of the extent or increase of our infant mortality. .
For obvious reasons, we begin our remedial means by alluding to the physical health and moral habits of the parents, which must be regarded as the primary root of the evil in a vast proportion of the cases. To increase and multiply the race was the original design of the Creator in ordaining marriage; and in negotiating every such alliance, both of the sexes should be impressed with the possibility and even probability of offspring. The physical health of both parties in every marriage contract should hence be regarded by each in anticipation of this result, and as equally important with the moral habits, on this account. And as marriage is a civil contract, the fruits of which vastly concern the public welfare, bearing as they do upon the present and the future generation, it is the duty of the State, in every civilized and Christian country, to surround marriage with all the sanctions of law, and to protect the unborn fruits of such alliances from premature destruction by statutory enactments. These should be such as enlightened science and philanthropy suggest, and should be encouraged and enforced by the united power of religion and law.
1. No marriage should be permitted between parties, until the physical health of both has been subjected to professional scrutiny. And such alliances should be prohibited by law, to those of either sex, who are the subjects of those diseases which are known to be hereditary or transmissible to offspring, or such as are fatal to infantile existence. Celibacy should be required by statute of all consumptive, scrofulous, scorbutic, gouty, insane, intemperate, and especially syphilitic individuals of either sex, and this, for grave reasons of state, which concern the public weal. Nor will any course, short of such legal prohibition of marriage, adequately correct the evil of that large proportion of infant mortality thus engendered.
2. To remove the temptations to the unnatural crime of abortionism, and prevent the abandonment and cruel murder of unborn and newly-born infants, among the vicious and depraved portion of our population1 for purposes of concealment, as in the case of the illegitimate offspring of shame, foundling hospitals should be provided by the State, in all our large cities, for the reception of infants, and the concealment of the shame of unhallowed mothers, and the protection and preservation of the infant innocents, who are doomed to abandonment by the guilty authors of their being. These charities, wisely conducted, would diminish the stillborn and premature birth interments, in all our large cities, by a moiety at least; while they would almost annihilate the plea of necessity, urged in behalf of the horrible trade of abortionism, and thus lessen the number of its victims. Lying-in asylums, for expectant mothers, irrespective of character, whether married or unmarried, in which such might conceal their shame, and then “go and sin no more,” are equally called for, to prevent the double suicide, so often resorted to, by such; while diminishing the extent and increase of infant mortality, the foundling hospitals being made open to them all.
3. The “poor we always have with us,” by a sacred legacy from the common Father of us all, and hence, the duty and responsibility of caring for such is recognized in every Christian community. But we have seen that among the suffering poor in our large cities, a fearful ratio of our infant mortality is found; and chiefly among the thousands of families, unreached by any of our public charities. The habitations of the poorer classes of our population, are for the most part in narrow, contracted alleys, filthy courts, or underground cellars; or, at best, in what are called tenant-ho uses, in the miserable apartments of which, thousands of families, each cook, eat, and sleep in a single room, without the light, ventilation, or cleanliness essential to the life of either parents or children. Under such adverse circumstances, often destitute of wholesome food, comfortable clothing, or necessary fuel, the children of such families sicken, pine away, and die, prematurely, to an extent wholly unappreciated by the public, and unrelieved by the philanthropy of either the church or the State. Nor will this increasing source of our infant mortality be arrested, until the civil authorities shall, by public law, require the erection of dwellings for the poor, in accordance with the laws of health and life; and until, in all our cities, there shall be a sanitary medical police, whose duty it shall be to enforce such laws. No medical treatment can, by possibility, arrest diseases, or diminish their fatality, while the victims are found in the squalid and filthy abodes of the indigent, from which pure air, and often the light of heaven, are excluded, as among the wretched multitudes of our “cellar population,” who furnish annually so largo a share of our infant mortality.
4. The erection and endowment of hospitals for sick children are an imperative want in all our large cities, demanded alike by philanthropy and the public welfare, for the children of the poor, who thus only can be removed from the fatal atmosphere of their homes, by which their diseases are engendered, and within which their recovery is impossible. And as each of such habitations of the poor becomes, for lack of air, ventilation, and cleanliness, a centre of disease among its inmates, so, also, is it a nucleus, whence its atmospheric poison radiates through the neighborhood, infecting, by a physical necessity, the whole vicinity. It is thus that endemics become epidemics, and a filthy tenant-house is the source of pestilence, infecting the section in which it is located, and often sweeping over a wide space, or including a city in its ravages. Hence, if the public authorities be indifferent to the claims of humanity, let them be moved by their fears; and let children’s hospitals be founded, for the reception of the squalid offspring of the indigent, as a measure demanded by considerations of the public economy and public safety.
Infant mortality, in large cities, in a great multitude of examples, which no man can number, is caused by the impure and adulterated milk, and other unwholesome articles of food, which are among the necessaries of life. Our profession has ever and anon sought to arouse public attention to this important subject, but in vain. Distilleries in or near large cities would be an intolerable nuisance and curse, apart from the mischiefs of their manufacture of alcoholic drinks, in view of the single fact, that, wherever they exist, their slops will furnish the cheapest food for cows, the milk from which is more pernicious and fatal to infant health and life than alcohol itself to adults; poisoning the very fountains of life. So long as distilleries are tolerated in cities, cow stables will be their appendages, and the milk, fraught with sickness and death, will still perpetuate mortality, especially among the children of the poor. All the artificial adulterations of milk, as by water or chalk, &c., are harmless, nay laudable, compared with the poisonous supply obtained from cows fed on distillery slops, for to this poison chemistry itself affords no antidote, since it defies ail analysis or synthesis, a poison sui generis, utterly destructive both of health and life.
The evils we have deprecated from the bad quality of the milk used for the chief sustenance of infants are greatly enhanced, by the refusal or inability of so many mothers, among the rich as well as the poor, to nurse their children in conformity to nature’s laws. Apart from the moral reasons which have been urged for this wise provision, that every healthy mother should furnish from her own bosom the sole nutriment for her offspring, there are equally forcible reasons of a physical character. All history and all experience prove that the attempt to rear infants by hand, even when the most urgent necessity may demand it, is always hazardous, and generally lethal, and this even before dentition has commenced. And those mothers who, at the dictate of fashion or case, withhold themselves from the office and duty of suckling their own children, while their own breasts yield nutriment, and their health is adequate to the task, inflict upon themselves very great injury, while contributing to swell the aggregate of infant mortality. And, if such be the fact, whatever be the substitute for their own milk, and however satisfactory be the qualifications of the wet-nurse provided; how immeasurably is this evil increased, in view of the adulterated or poisonous milk with which so many mothers supply their offspring, at the tender period when nutrition and development imperatively require the supply which the maternal bosom can alone afford. The feebleness and atrophy, so often fatal to infants, are too frequently the result of the privation, and nothing but dire necessity should ever remove any child for nutriment, to any other fountain than that which nature opens for its supply, simultaneously with its birth.
Finally, let it not be supposed that the extent and increase of infant mortality we deplore is exclusively among the children of the poor. The contrary must be familiar to us all, and statistics could readily be cited which would render it apparent that in the better circumstanced, and even among the wealthier classes of our cities, the instances are rare in which the most favored families succeed in preserving a moiety of their children through the perils of infancy. How much of the mortality in such is to be ascribed to the luxuriant and effeminate modes of life into which mothers, or those about to become mothers, are betrayed by the fashionable follies of the times, it might be difficult to compute, and as difficult to overestimate. And that much, very much, of serious and even fatal infantile disease is the direct result of the indiscretions of nursing mothers whereby the quality and quantity of their milk are deteriorated, and the health of their children overthrown, professional testimony might be cited in abundance. Errors in diet; late hours; crowded assemblies; the excitements of the opera, the theatre, or the ball-room; the transitions from high to low temperature; the exposure to night air, especially with insufficient clothing, such as exacting customs and fashion demand; are all incompatible with the duties of maternity, especially during pregnancy and lactation. The privation of all these by young mothers was voluntarily submitted to in the generation of our parents, and hence more children were reared to bless their households, and the pleasing spectacle of a “houseful of children” was not then so rare as it confessedly is now. Half a score of sons and daughters in a single family, all raised to adult life, and often surviving their parents, was so frequent an occurrence that the loss of children by healthy parents was the exception and not the rule. That it is otherwise now, does not admit of question, and for some of the reasons we have suggested.
It now only remains, in view of the extent and increase of infant mortality in large cities which we have shown to exist, that our profession and the public should be fully impressed with the facts, which observation and experience will fully corroborate, that such mortality need not and ought not any longer to be perpetuated. And if, as we respectfully submit, the sources and causes whence the appalling fatality in infancy and childhood have been demonstrated to flow, be such as are removable by the instrumentality of public and private hygiene, and the general introduction of sanitary reforms into the popular creed and practice, then we may legitimately urge the means and measures suggested for its diminution as eminently worthy of consideration and regard. When we of the medical profession shall have fully enlightened the public mind upon the importance of the subject, and set forth the value of prevention by removing its causes, and the means adequate to the diminution of the evil, then, and not till then, shall we have done our whole duty in relation to the infant mortality, now so revolting and so frightfully increasing, in our large cities. The public press should be enlisted with its almost omnipotent voice, and the pulpit itself should put forth its energies in behalf of sanitary reform. The laws of health and life are of equal divine authority, and their wilful violation as sinful and as certain of retribution, as are the laws of the Mosaic code or the golden rule itself. In the behalf of the myriads of “infants not a span long,” and who are perishing in our midst before they “know their right hands from their left,” and whose young life is wasted for lack of systematic and united efforts to avert this sad catastrophe, we plead for inquiry, exertion, and public reform, in the hope of wiping out this foul blot from the escutcheon of our own country and the world.
Report on Criminal Abortion,” Transactions of the American Medical Association 12 (1859): 75-78.
REPORT ON CRIMINAL ABORTION
The committee appointed in May, 1857, to investigate the subject of Criminal Abortion, with a view to its general suppression, have attended to the duty assigned them, and would present the following report:—
The heinous guilt of criminal abortion, however viewed by the community, is everywhere acknowledged by medical men.
Its frequency—among all classes of society, rich and poor, single and married—most physicians have been led to suspect; very many, from their own experience of its deplorable results, have known. Were any doubt, however, entertained upon this point, it is at once removed by comparisons of the present with our past rates of increase in population, the size of our families, the statistics of our fœtal deaths, by themselves considered, and relatively to the births and to the general mortality. The evidence from these sources is too constant and too overwhelming to be explained on the ground that pregnancies are merely prevented; or on any other supposition than that of fearfully extended crime.
The causes of this general demoralization are manifold. There are three of them, however, and they are the most important, with which the medical profession have especially to do.
The first of these causes is a wide-spread popular ignorance of the true character of the crime—a belief, even among mothers themselves, that the fœtus is not alive till after the period of quickening.
The second of the agents alluded to is the fact that the profession themselves are frequently supposed careless of fœtal life; not that its respectable members are ever knowingly and intentionally accessory to the unjustifiable commission of abortion, but that they are thought at times to omit precautions or measures that might prevent the occurrence of so unfortunate an event.
The third reason of the frightful extent of this crime is found in the grave defects of our laws, both common and statute, as regards the independent and actual existence of the child before birth, as a living being. These errors, which are sufficient in most instances to prevent conviction, are based, and only based, upon mistaken and exploded medical dogmas. With strange inconsistency, the law fully acknowledges the fœtus in utero and its inherent rights, for civil purposes; while personally and as criminally affected, it fails to recognize it, and to its life as yet denies all protection.
Abundant proof upon each of these points has been prepared by the Committee, and is elsewhere[i] being published to the profession; but as the statements now made are almost axiomatic, recapitulation would be here wearisome and is unnecessary.
Out duty is plain. If, by any act, we can effect aught towards the suppression of this crime, it must be done. In questions of abstract right, the medical profession do not acknowledge such words as expediency, time service, cowardice. We are the physical guardians of women; we, alone, thus far, of their offspring in utero. The case is here of life or death—the life or death of thousands—and it depends, almost wholly, upon ourselves.
As a profession we are unanimous in our condemnation of the crime. Mere resolutions to this effect, and nothing more, are therefore useless, evasive, cruel.
If to want of knowledge on a medical point, the slaughter of countless children now steadily perpetrated in our midst, is to be attributed, it is our duty, as physicians, and as good and true men, both publicly and privately, and by every means in our power, to enlighten this ignorance.
If we have ever been thought negligent of the sanctity of fœtal life, the means of correcting the error are before us. If we have ever been so in deed, there are materials, and there is good occasion for the establishment of an obstetric code; which, rigorously kept to the standard of our attainments in knowledge, and generally accepted by the profession, would tend to prevent such unnecessary and unjustifiable destruction of human life.
If the tenets of the law, here unscientific, unjust, inhuman, can be bettered—as citizens, and to the best of our ability we should seek this end. If the evidence upon this point is especially of a medical character, it is our duty to proffer our aid, and in so important a matter to urge it. But if, as is also true, these great fundamental, and fatal faults of the law are owing to doctrinal errors of the profession in a former age, it devolves upon us, by every bond we hold sacred, by our reverence for the fathers in medicine, by our love for our race, and by our responsibility as accountable beings, to see these errors removed and their grievous results abated.
In accordance, therefore, with the facts in the case, the Committee would advise that this body, representing, as it does, the physicians of the land, publicly express its abhorrence of the unnatural and now rapidly increasing crime of abortion; that it avow its true nature, as no simple offence against public morality and decency, no mere misdemeanor, no attempt upon the life of the mother, but the wanton and murderous destruction of her child; and that while it would in no wise transcend its legitimate province or invade the precincts of the law, the Association recommend, by memorial, to the governors and legislatures of the several States, and, as representing the federal district, to the President and Congress, a careful examination and revision of the statutory and of so much of the common law, as relates to this crime. For we hold it to be "a thing deserving all hate and detestation, that a man in his very originall, whiles he is framed, whiles he is enlived, should be put to death under the very hands, and in the shop, of Nature."
In the belief that we have expressed the unanimous opinion of the Association, our report is respectfully submitted.
Horatio R. Storer, of Massachusetts.
Thomas W. Blatchford, of New York
Hugh L. Hodge, of Pennsylvania
Charles A. Pope, of Missouri
Edward H. Barton of South Carolina
A. Lopez, of Alabama
Wm. Henry Brisbane, of Wisconsin,
A. J. Semmes, of District of Columbia
If the recommendation of the report are adopted, the Committee would offer the following resolutions:—
Resolved, That while physicians have long been united in condemning the act of producing abortion, at every period of gestation, except as necessary for preserving the life of either mother or child, it has become the duty of this Association, in view of the prevalence and increasing frequency of the crime, publicly to enter an earnest and solemn protest against such unwarrantable destruction of human life.
Resolved, That in pursuance of the grand and noble calling we profess, the saving of human lives, and of the sacred responsibilities thereby devolving upon us, the Association present this subject to the attention of the several legislative assemblies of the Union, with the prayer that the laws by which the crime of procuring abortion is attempted to be controlled may be revised, and that such other action may be taken in the premises as they in their wisdom may deem necessary.
Resolved, That the Association request the zealous co-operation of the various State Medical Societies in pressing this subject upon the legislatures of either respective States, and that the President and Secretaries of the Association are hereby authorized to carry out, by memorial, these resolutions.
The resolutions appended to the above report were unanimously adopted by the Association.
[i] North American Medico-Chirurgical Review, Jan. 1859, et seq.
“Address of Henry Miller, M.D., President of the Association,” Transactions of the American Medical Association 13 (1860): 55-76.
ADDRESS OF HENRY MILLER, M. D.,
PRESIDENT OF THE ASSOCIATION.
GENTLEMEN OF THE AMERICAN MEDICAL ASSOCIATION:
It affords me great satisfaction to greet you as the representatives of the American Medical Association, in this beautiful city—the seat of Yale College, and one of the capitals of a State, whose enlightened legislation has made provision for the education of all her children. Let us accept our annual meeting, on this classic ground, as an omen that our deliberations shall further the great interest, namely, medical education, whose improvement was the fundamental design of our national association. In order that this cardinal object may be attained, I need not remind you, how necessary is a spirit of moderation and mutual forbearance, in all our discussions; and most fervently do I invoke such a spirit, and pray that it may preside over all our sessions!
The duties of the President of this Association, as prescribed by the Plan of Organization, are exclusively parliamentary. He is not even empowered to fill a vacancy, occurring in any of the subordinate offices; much less is he required to give to the Association information of the state of the Profession, which, it may be presumed, has occupied his thoughts, in this, more than in any other relation to it in which he could be placed. During my term of office, I have been obliged, however, to assume such a power, and, in the performance of this, my last official act, I shall take the liberty of adverting to topics of high concern, not only to our profession, but to the public at large.
Shortly after the last annual meeting, it became necessary to fill the office of junior Secretary, made vacant by the resignation of Dr. Eli Ives, of New Haven: and as it has been customary to confer this office on a resident of the place where the next meeting is to be held, Dr. Stephen G. Hubbard was nominated for it, by the Committee of Arrangements, and on their recommendation I could not hesitate to appoint him, not doubting that he will perform its duties with credit to himself and faithfulness to the Association.
At the last meeting of the Association, the Committee on Criminal Abortion, of which Dr. Horatio R. Storer, of Boston, was chairman, made their report, which was received and referred to the Committee of Publication. By the resolutions appended to the report., which were unanimously adopted, the President and Secretaries were authorized to bring this important subject, by memorial, before Congress and the several State legislatures of the Union, with the prayer that the laws by which it has been attempted to restrain and punish abortionism may be revised, and such legal enactments provided as the heinousness of the crime demands. By reference to the proceedings of the last annual meeting, it will be seen that the Committee on Criminal Abortion were requested to continue their labors, “and especially to take all measures necessary to carry into effect the resolutions reported by them on the first day of the meeting.” Under the warrant of this instruction, the Chairman of the Committee opened a correspondence with me, early last winter, tendering his co-operation in carrying out the wishes of the Association, and offering to place at my disposal extra copies of the report, and also of the papers published by himself in the North American Medico-Chirurgical Review; containing all the medico-legal information necessary to enable our federal and State legislatures to act intelligently in the premises. This offer was gladly accepted, and I am happy to acknowledge my obligations to the able Chairman for his valuable assistance, not only in furnishing the documents referred to, but in the preparation of the Memorial as well as of the Address directed to the various State Medical Societies, requesting their co-operation with the Association, in pressing this important subject on the attention of the legislatures of their respective States. The memorial, with the accompanying documents, was transmitted in January last to the President of the United States and the Governor of each of the States and Territories of the Union, the legislatures of several of them being at the time in session. What disposition has been made of them I am not informed; but the hope may be reasonably indulged that their Excellencies have submitted them to the National, State, and Territorial legislatures, or will embrace the earliest opportunity of doing so.
In dispatching the Address to the State Medical Societies, no little embarrassment was experienced, arising from the want of information touching these organizations: I was consequently forced to direct it to prominent medical gentlemen in most of the States, through whom it has, I hope, reached its destination. To facilitate correspondence with these medical bodies in future, I would respectfully recommend that measures be taken by this Association, to obtain annually a list of the names and residences of their officers, and to publish the same in our Transactions. Besides promoting correspondence, such a course will tend to bind our various medical organizations more closely together, and render them more effective in the great work which it is proposed to accomplish through their instrumentality.
Having laid before you, gentlemen, the measures that have been taken to carry into effect the resolutions, adopted at the last meeting, on this vitally interesting subject, which involves at once the honor of our profession and a great interest of society, I esteem it my duty to forewarn you that obstructions will be thrown in this path of your benevolent operations, which it may require years of ceaseless vigilance and unremitting effort to overcome. Not only is popular ignorance on this subject (one of the most fruitful sources of the crime) to be enlightened; but the hearty co-operation of your compeers is to be enlisted, and the jeers of the flippant, the superficial, and the unthinking in your own ranks are to be withstood. It cannot be doubted that popular sentiment either winks at the procurement of abortion, in the earlier periods of foetal development, or affixes only a slight stigma upon it; condemning it, at most, as an indiscretion on the part of the mother, and as rashness on that of the procurer. This low popular estimate, sanctioned by too many in the profession, is based upon erroneous views of the physiology of generation, derived, doubtless, as all such errors are, from the false speculations of physiologists and naturalists of a former age. What wonder should it be, then, if a pure-minded woman, who would shrink from anything dishonorable, much more criminal, should seek to disembarrass herself from what she may consider a burden, some accumulation of the responsibilities of maternity, by the restoration of the menstrual purgation—believing, as she may, that foetal life is not thereby sacrificed, but only its kindling obviated? This relic of a barbarous physiology needs to be exploded, and the truth should be generally promulgated, that, from the moment of conception, a new being is engendered, in whose constitution, microscopic though its parts may be, lies infolded the substratum in which inheres potentially all that pertains to man. In a word, it is at once constituted an individual being; it is no part of the mother any more than it is of the father, and is, in no wise, any more dependent on her, during its abode in the womb, than it is after birth, when it draws its sustenance from her breasts. In every stage of its development, it is as much an independent being as are its parents, who, together with all the race, alike depend on Him who opens his hand and satisfies the desire of every living thing. With such enlightenment as this, what virtuous woman, nay, what woman, with whom, though fallen, there yet linger the instincts of maternity, would be accessory to so foul a deed as the destruction of her offspring, nestling in the sanctuary assigned it by creative wisdom and benevolence?
It is difficult for legislation in a free country, where the people are the source of all political power, to rise higher than popular sentiment and intelligence; but is it not the duty of all wise legislators, in questions which can only be elucidated by the science of medical jurisprudence, to endeavor rather to elevate popular sentiment and enlighten popular ignorance than to degrade themselves to their low level? And how can lawmakers better give expression to their estimate of the crime of abortionism than by sedulously providing against its commission? The necessity of more stringent legislation has been clearly pointed out by the Chairman of the Committee, in the papers already referred to, and valuable suggestions, to aid in the enactment of a suitable statute, have been offered by him. May we not hope that our appeal to the different legislative bodies of the Union will not be in vain?
The subject of medical education has occupied a large share of the attention of the American Medical Association, since its first organization. …
The 1860 American Medical Association Documents that Produced the Laws Overturned by Roe v Wade
In January 1860, The American Medical Association sent the following “Memorial” to the governor and legislature of each state and territory in the United States:
To the Governor and Legislature of the State of
the Memorial of the American Medical Association, an Organization representing the Medical Profession of the United States.
At a Meeting of the Association held at Louisville in May, 1859, it was formally and unanimously voted, "to present the subject of Criminal Abortion to the attention of the several Legislative Assemblies od the Union, with the prayer that the laws by which the crime is attempted to be controlled may be revised, and that such other action may be taken in the premises, as they in their wisdom may deem necessary.
Statistics reliable and not to be controverted, which are duly submitted in the papers accompanying this Memorial, go to prove that an immense number of living children annually are intentionally destroyed in this country, and that besides the serious injury thereby inflicted upon the public morals, a decided and detrimental influence has already been produced upon the rate of increase of the nation and upon its material prosperity.
The moral guilt of Criminal Abortion depends entirely upon the real and essential nature of the act. It is the intentional destruction of a child within its parent; and physicians are now agreed, from actual and various proof, that the child is alive from the moment of conception.
The evil to society of this crime is evident from the fact, that its instances in this country are now to be counted by hundreds of thousands.
Public sentiment and the natural sense of duty instinctive to parents proving insufficient to check the crime, it would seem that an appeal should be made to the law and to its framers.
In many States of the Union, abortion is not yet legally considered an offence, and is unprovided for by statute; in others, the statutes are so drawn as to be easily evaded, or indeed, by their inconsistencies, directly to encourage the crime they were framed to prevent. This is the case also with the Common Law, which, by a strange contradiction, fails to recognize the unborn child as criminally affected, whilst its existence for all civil purposes is nevertheless fully acknowledged.
It has therefore become the duty of the American Medical Association, in view of the prevalence and increasing frequency of Criminal Abortion in this country, publicly to enter an earnest and solemn protest against such unwarrantable destruction of human life. The duty would be but half fulfilled, did we not call upon those who alone can check and control the crime, early to give this matter their serious attention. The Association would in no wise transcend its office, but that office is here so plain that it has full confidence in the result. We therefore enter its earnest prayer, that the subject of Criminal Abortion in the state of ___________, and the laws in force on the subject in said State may be referred to an appropriate Committee, with directions to report what legislative action may be necessary in the premises.
Accompanying this memorial will be found the Report of the Special Committee of the Association upon this subject, and the papers on which their Report is based.
All of which is respectfully submitted.
f For the Association,
HENRY MILLER, President
S. M. BEMISS, S. G. HUBBARD, Secretaries.
At the same time, the following “Address” was sent to each State Medical Society:
To the President and Councilors of the
State Medical Society.
At the meeting of the American Medical Association held in Louisville, in May last, by a formal and unanimous vote it was
Resolved, That while physicians have long been united in condemning the act of producing abortion, at every period of gestation, except as necessary for preserving the life of either mother or child, it has become the duty of this Association, in view of the prevalence and increasing frequency of the crime, publicly to enter an earnest and solemn protest against such unwarrantable destruction of human life.
Resolved, That in pursuance of the grand and noble calling we profess, the saving of human lives, and of the sacred responsibilities thereby devolving upon us, the Association present this subject to the attention of the several legislative assemblies of the Union, with the prayer that the laws by which the crime of procuring abortion is attempted to be controlled may be revised, and that such other action may be taken in the premises as they in their wisdom may deem necessary.
Resolved, That the Association request the zealous co-operation of the various State Medical Societies in pressing this subject upon the legislatures of their respective States; and that the President and Secretaries of the Association are hereby authorized to carry out, by memorial, these resolutions.
In pursuance of our instructions, a memorial, of which a copy is herewith enclosed, has been transmitted to the Governor and Legislature of the State of , and it now has become our duty earnestly to request of the body you represent, such early and hearty action in furtherance of the memorial of the Association, as may insure its full success against the common, though unnatural crime it aims to check.
For the Association,
HENRY MILLER, President
S. M. BEMISS, S. G. HUBBARD, Secretaries.
The above documents discuss the May 1859 meeting of the American Medical Association in Louisville where the Resolutions aimed at strengthening laws against abortion were unanimously adopted. The officers signing these two documents were not the physicians responsible for the antiabortion effort. The Committee on Criminal Abortion who provided the Report on Criminal Abortion and these associated Resolutions was made up of Chairman, Horatio Robinson Storer, of Boston, Hugh Lenox Hodge, of Philadelphia, Charles A. Pope, of Missouri, Alexander Semmes, of the District of Columbia, A. Lopez, of Mobile, Henry Brisbane, of Wisconsin, Thomas Blatchford, of New York, and Edward H. Barton, of South Carolina. Storer had requested formation of the Committee in March 1857 and the Association agreed at the Nashville meeting in May 1857. Only Storer was appointed but he was given the authority to select other Committee members. Ill health prevented Storer from presenting the Committee Report at the 1858 Washington meeting. Storer did not get around to selecting the other Committee members until two months before the Report was presented on May 3, 1859. He had already written the Report that the members praised when they agreed to join the Committee and agreed to add their names to it.
Storer’s key role in the effort was discussed by Henry Miller in his 1860 Presidential Address on the first day of the Annual Meeting in New Haven, Connecticut:
At the last meeting of the Association, the Committee on Criminal Abortion, of which Dr. Horatio R. Storer, of Boston, was chairman, made their report, which was received and referred to the Committee of Publication. By the resolutions appended to the report, which were unanimously adopted, the President and Secretaries were authorized to bring this important subject, by memorial, before Congress and the several State legislatures of the Union, with the prayer that the laws by which it has been attempted to restrain and punish abortionism may be revisited, and such legal enactments provided as the heinousness of the crime demands. By reference to the proceedings of the last annual meeting, it will be seen that the Committee on Criminal Abortion were requested to continue their labors, “and especially to take any measures necessary to carry into effect the resolutions reported by them on the first day of the meeting.” Under the warrant of this instruction, the Chairman of the Committee opened a correspondence with me, early last winter, tendering his co-operation in carrying out the wishes of the Association, and offering to place at my disposal extra copies of the report, and also of the papers published by himself in the North American Medico-Chirurgical Review, containing all the medico-legal information necessary to enable our federal and State legislatures to act intelligently in the premises. The offer was gladly accepted, and I am happy to acknowledge my obligations to the able Chairman for his valuable assistance, not only in furnishing the documents referred to, but in the preparation of the Memorial as well as of the Address directed to the various State Medical Societies, requesting their co-operation with the Association, in pressing this important subject on the attention of the legislatures of their respective States. The memorial, with the accompanying documents, was transmitted in January last to the President of the United States and the Governor of each of the States and Territories of the Union, the legislatures of several of them being at the time in session. What disposition has been made of them I am not informed; but the hope may be reasonably indulged that their Excellencies have submitted them to the National, te, and Territorial legislatures, or will embrace the earliest opportunity of doing so.
Miller would soon learn that the Connecticut Legislature had received the Memorial. The Minutes for Day 3 of the same New Haven meeting included:
A communication was received from the Judiciary Committee of the Connecticut Legislature, to which was referred the memorial of this Association concerning Criminal Abortions, requesting the appointment of a committee to frame a suitable bill to serve as a guide for their action.
On motion, the paper was accepted, and the Chair authorized to appoint the Committee asked for, and the following gentlemen were appointed: Drs. Worthington Hooker, Conn.; David L Daggett, Conn.; D. Humphreys Storer, Mass.
Had Horatio Robinson Storer been in attendance at New Haven he no doubt would have been selected for the Committee. It is possible he assisted his father, David Humphreys Storer, in preparing the result, which was a unique piece of legislation that combined “into a single forceful act the denial of the quickening doctrine, the notion of women’s liability, and anti-advertising principles.” It was the forerunner of similar legislation that would be passed in almost every state and territory in the next two decades.
 The blank copies of the Memorial and Address were preserved by descendants of Dr. Horatio Robinson Storer and loaned to the author along with a wealth of other letters and documents in the 1990s. The papers were essential for preparation of the biography of Dr. Storer: Dyer, FN. Champion of Women and the Unborn: Horatio Robinson Storer, M.D. Canton, MA: Science History Publications/USA, 1999. Both documents have since been contributed by Dr. Storer’s great-grandchildren, Ethel Storer and Robert Treat Paine Storer, Jr., to the Boston Medical Library in the Francis A. Countway Library of Medicine. They are parts of accession number Acc. 2001-063. The Indiana State Archives has a copy of the “Memorial” sent to them sometime in 1860.
 Dyer, FN, Storer’s articles and the AMA report. In: Dyer, FN, The Physicians’ Crusade Against Abortion. Sagamore Beach, MA: Science History Publications/USA, 2005: 56.
 Miller, H, Address of Henry Miller, M.D., President of the Association. Transactions of the American Medical Association. 1860;13:55-76, 56.
 Minutes of the thirteenth annual meeting. Transactions of the American Medical Association. 1860;13:41-42.
 Mohr, JC, Abortion in America: The Origins and Evolution of National Policy, 1800-1900. New York: Oxford University Press, 1978: 202.
Frederick N. Dyer, Ph.D.
8017 Innisbrook Ct.
Columbus GA 31909
Minutes, 1865 Annual Meeting,
Transactions of the American Medical Association, Volume 0015, 1865, Page 50
Dr. STOCKWELL, of Michigan, presented the following:—
“Whereas, Criminal abortion has become an alarmingly common evil, we need some means to educate the community as to its criminality and physical evils; therefore,
“Resolved, That our delegates be requested to ask the American Medical Association to offer a premium for the best short and comprehensive tract calculated for circulation among females, and designed to enlighten them upon the criminality arid physical evils of forced abortion.”
The above preamble and resolution were signed by Philo Tillson, President, and S. L. Andrews, Secretary, of the Northeastern District Medical Association of Michigan, as having been adopted by that Association at its annual meeting held on the 19th day of May, 1864, and which its delegate, Dr. STOCKWELL, was instructed to present for the consideration of the American Medical Association.
On motion, the resolution was adopted by this Association, and the following added: Moved, that the subject be referred to the Committee on Prize Essays.
Minutes, 1866 Annual Meeting, Transactions of the American Medical Association 16 (1866): 1-60, page 38
The Committee on Prize Essays, Dr. D. HUMPHREYS STORER, of Massachusetts, Chairman, reported as follows:—
“The Committee on Prize Essays beg leave to report that they have received a dissertation ‘On the Surgical Treatment of Morbid Growths within the Larynx,’ bearing the motto ‘Quod vidi scripsi,’ which they would unanimously recommend as worthy the usual prize of the Association.
“They would also award the premium offered at the last annual meeting of the Association for ‘the best short and comprehensive tract calculated for circulation among females, and designed to enlighten them upon the criminality and physical evils of abortion,’ to an essay with the motto ‘Casta placent superis, casta cum mente venito, et manibus puris sumito fontis aquam.’
“In the preface to which the writer very modestly remarks: ‘If it be considered by the Committee worthy its end, they will please adjudge it no fee, nor measure it by any pecuniary recompense. Were the finances of the Association such as to warrant it in more than the most absolutely necessary expenditures, yet would the approbation of the committee and of the profession at large be more grateful to the writer than any tangible, and, therefore, trivial reward.’
D. HUMPHREYS STORER,
J MASON WARREN
H. I. BOWDITCH,
JOHN H. DIX.”
The seals were then broken, and Dr. LOUIS ELSBERG, of New York, proved to be the successful competitor for the first of the prizes mentioned, and Dr. HORATIO R. STORER, of Massachusetts, the author of the Essay on Criminal Abortion.
On motion, the report was accepted and the essays referred to the Committee of Publication.
Horatio Robinson Storer, “The Criminality and Physical Evils of Forced Abortions,” Transactions of the American Medical Association 16 (1866): 709-45.
CRIMINALITY AND PHYSICAL EVILS
PRIZE ESSAY TO WHICH THE AMERICAN MEDICAL ASSOCIATION
AWARDED THE GOLD MEDAL FOR MDCCCLXV.
HORATIO ROBINSON STORER, M. D., OF BOSTON
ASSISTANT IN OBSTETRICS AND MEDICAL JURISPRUDENCE IN HARVARD UNIVERSITY, SURGEON TO THE NEW ENGLAND HOSPITAL FOR WOMEN, AND PROFESSOR OF OBSTETRICS AND THEDISEASES OF WOMEN IN BERKSHIRE MEDICAL COLLEGE.
WRITTEN, PUBLISHED, AND ISSUED FOR GENERAL CIRCULATION, BY
ORDER OF THE AMERICAN MEDICAL ASSOCIATION.
Cesta placent superis. Casta cum mente venito,
Et manibus puris sumito fortis aquam.
TABLE OF CONTENTS.
I. Origin and purpose of the present essay
II. What has been done by physicians to foster and what to prevent the evil
III. What is the true nature of an intentional abortion when not requisite to save the life of the mother
IV. The inherent dangers of abortion to a woman’s health and to her life
V. The frequency of forced abortions, even among the married
VI. The excuses and pretexts that are given for the act
VII. Alternatives, public and private, ad measures of relief
THE CRIMINALITY AND PHYSICAL EVILS OF
It will be noticed that in the following essay, the recipient of the special prize for 1864—5 of the American Medical Association, its author makes frequent reference, as to those of another, to his own previous labors. This circumstance, now that his identity has been revealed, might at first seem an infringement of the rules of good taste. In the facts, however, that he felt compelled to take unusual pains to conceal that identity prior to the decision of the Committee, with all of whose members he has long enjoyed intimate acquaintance, and that little other published material as yet exists, from which to draw upon this subject, save his own, he places his excuse, end throws himself upon the generous sympathy and forbearance of his readers. [The remainder of the prefatory remarks stand just as they were presented to the Committee,]
The writer, who knew nothing of the project to elicit a direct and effective appeal to women upon the subject of criminal abortion, until after it had been decided at the New York meeting, has long been a member of the Association. He is aware, from personal observation, that induced miscarriage is of very frequent occurrence, and that its effects are to the last degree disastrous to the country at large. He has seen the change that has been effected in professional feeling upon the subject as to the need that this depopulation, or rather prevention of repopulation of the country, should be arrested, since the publication of the report of the Association’s Special Committee, which was appointed at Nashville in 1857.
It is, perhaps, presumptuous for him to undertake a task so strongly appealing to all one’s eloquence, sympathy, and zeal, and for the proper performance of which there exist so many gentlemen in the profession better qualified than himself. He does it, however, as the passing traveller in distant lands, by casting his pebble upon the pile of similar contributions that mark a single wayside grave helps to raise a monument to warn of danger and to tell of crime, in the hope that this waif of his may, perchance, effect somewhat toward arousing the nation to the countless foetal deaths intentionally produced each day in Its midst, and to prevent them.
The Association has empowered the Prize Committee to award the premium of the present year to the best popular tract upon the subject of induced abortion. The writer presents the accompanying paper neither for fame nor for reward. It has been prepared solely for the good of the community. If it be considered by the Committee worthy its end, they will please adjudge it no fee, nor measure it by any pecuniary recompense. Were the finances of the Association such as to warrant it in more than the most absolutely necessary expenditures, yet would the approbation of the Committee, and of the profession at large, be more grateful to the writer than any tangible and therefore trivial reward.
It is a singular and appropriate coincidence that the action of the Association, originating as it did from Boston, in 1857, and recognizing in no uncertain language, alike by the resolutions that were formally adopted by the Louisville Convention, and by the memorial presented by its President to the different legislative assemblies and State Medical Societies of the Union, the necessity of a radical change as to the popular estimate of the crime, should now culminate and become effective at a meeting of the Association in Boston, by an authorized appeal in behalf of the profession to the community, which alone makes and enforces the laws, till now a dead letter as regards abortion, and which alone commits, palliates, and suffers from the crime. It is an equally striking and appropriate coincidence that the Chairman of the Committee, at whose hand the selection of that appeal must be made, though the Committee had been chosen for a general purpose before it had been decided by the Association to elicit essays upon this special subject, should be the physician who, in New England, first appreciated the frequency of criminal abortions, pointed out their true character, and denounced them.
If this essay prove successful, its author only asks that the seal which covers his identity may not be broken until the announcement is made upon the platform of the convention, pledging himself that this is but for a whim of his own, and that he is well, and he trusts favorably, known by many of the best men of the Association throughout the Union.
I.—ORIGIN AND PURPOSE OF THE PRESENT ESSAY.
At the meeting of the American Medical Association, held at New York, in 1864, it was, after mature deliberation, decided to issue “a short and comprehensive tract, for circulation among females, for the purpose of enlightening them upon the criminality and physical evils of forced abortions.”
The source of this essay is, therefore, in itself’, well worthy of attention. The Association referred to represents the medical profession of America, for it is composed of delegates, and only of delegates, from every regularly organized hospital, medical society, and medical college throughout the land, its members being, therefore, almost all of them gentlemen advanced in years, of extended experience, and of acknowledged reputation. That they should unanimously have concurred in recommending any measure is, so far, proof that it was needed.
There are those, perhaps, who may suppose that in advising that pregnancies, once begun, should be allowed to go on to their full period, physicians are actuated by a selfish motive. On the contrary, it will be shown that miscarriages are often a thousand-fold more dangerous in their immediate consequences, and, therefore, more decidedly requiring medical treatment than the average of natural labors; that they are not only frequently much more hazardous to life at the time, but to subsequent health, their results in some instances remaining latent for many years, at times not showing themselves until the so-called turn of life, and then giving rise to uncontrollable and fatal hemorrhage, or to the development of cancer, or other incurable disease. It is in reality the physician’s province, indeed, it is his sacred duty, to prevent disease as well as to cure it, and this, even though it must plainly lessen the business and the emoluments that would otherwise fall into his hands. Would women listen to the appeal now to be made to them, an immense deal of ill health would be prevented, and thousands of maternal as well as foetal lives would annually be saved.
And, moreover, in the fact that the profession thus transcends, almost for the first time, upon any topic in this country, the barrier which for mutual protection, both of science and the community, has always been allowed to stand, and directly addresses itself to the judgment and to the hearts of women upon a topic vital to themselves and to the nation, there is afforded most conclusive evidence that the subject is of the highest importance, that the step now taken is a necessary one, and the motives that prompt it sincere.
To women, on the other hand, how interesting the topic! It is one that affects, and more directly, perhaps, than can anything else, their health, their lives. It concerns their discretion, their conscience, their moral character, their peace of mind, even its very possession, for cases of insanity in women from the physical shock of an induced abortion, or from subsequent remorse, are not uncommon. It involves often all the elements of domestic happiness, the extent or existence of the home circle, the matron’s own self-respect, and often the very gift or return of conjugal love, for, as has forcibly been asserted of marriage where conception or the birth of children is intentionally prevented, such is, in reality, but legalized prostitution, a sensual rather than a spiritual union.
Who can deny these premises? The experience of every physician confirms them, as do a glance throughout every circle of society, and the experience, personal or by observation, of almost every nurse, every matron, every mother. Let us then, physicians and the community, meet each other half way—ready to acknowledge, upon due evidence, the frightful extent of the evil that exists in our homes—an evil, in part occasioned by ignorance and carelessness, and that we are both, in a measure, accountable for, and ready to assist each other in its cure. I propose ‘to show that induced abortions arc not only a crime against life, the child being always alive, or practically supposed to be so; against the mother, for the laws do not allow suicide, or the commission of acts upon one’s own person involving great risk to life; against nature and all natural instinct, and against public interests and morality, but that, barring ethical considerations, and looked at in a selfish light alone, they are so dangerous to the woman’s health, her own physical and domestic best interests, that their induction, permittal, or solicitation by one cognizant of their true character, should almost be looked upon as proof of actual insanity.
II—WHAT HAS BEEN DONE BY PHYSICIANS TO FOSTER, AND WHAT TO
PREVENT THIS EVIL.
Ina our appeal we shall endeavor to go straight toward the mark, nothing concealing, undervaluing, or selfishly excusing. And, first of all, what part have physicians had in this great tragedy, wherein so many women have been chief players? For it is to the medical attendant that the community have a right to look for counsel, for assistance, and for protection, and the present is an evil more especially and directly coming within these bounds.
From time immemorial, such have been the deplorable tendencies of unbridled desire, of selfishness and extravagance, of an absence of true conjugal affection, that there has existed in countless human breasts a wanton disregard for foetal life, a practical approval of infanticide. This has, however, in the main been confined either to savage tribes, or to nations, like the Chinese, with a redundant population, with each of whom the slaughter of children after their birth is common, or to the lowest classes of more civilized communities, impelled either by shame, or, as in the burial clubs of the London poor, the revelations of which a year or two since so startled the world, by the stimulus of comparatively excessive pecuniary gain.
That infanticide is of occasional occurrence in our own country, the effect of vice or of insanity, has long been known; instances being occasionally brought to the surface of society and to notice by the police, and through courts of law.
The closely allied crime of abortion also dates back through all history; like every other form or fruit of wickedness, originating in those deep-lying passions coeval with the existence of mankind. Till of late, however, even physicians, who from time to time have accidentally become cognizant of an isolated instance, have supposed or hoped, and here the wish was father to the thought, that the evil was of slight and trivial extent., and, therefore, and undoubtedly with the feeling that a thing so frightful and so repugnant to every instinct should be ignored, the profession have until within a few years preserved an almost unbroken silence upon the subject.
Some ten years since[,] this matter was thoroughly taken in hand by a physician much interested in the diseases of women, the younger Dr. Storer, of Boston, with the frank acknowledgment that it was to his father, the Professor of Midwifery in Harvard University, that the credit of initiating the anti-abortion movement in New England was justly due. Prof. Hodge, of Philadelphia, like the elder Dr. Storer, had previously commented in a public lecture to his class, afterwards printed, upon the immorality and frequency of induced miscarriage; and in Europe one or two physicians of eminence, as Dr. Radford, had endeavored to arouse the profession to the real value of foetal life. The subject had also received some slight attention in works upon medical jurisprudence, but in special treatises upon abortion and sterility, their causes and treatment, of which the most celebrated has been that of Dr. Whitehead, of England, the chance of this occurrence and condition being dependent upon a criminal origin had been almost entirely lost sight of. In investigating the cases of disease in the better classes that came under observation, it was now ascertained that a very large proportion of them were directly owing to a previous abortion, and that in many of them this occurrence had been intentional; the physician’s consultation room proving in reality a confessional, wherein, under the implied pledge of secrecy and inviolate confidence, the most weighty and at times astounding revelations are daily made. In such instances as those to which we are now referring, the disclosures are in answer to no idle curiosity, but to the necessity which always exists of knowing and understanding every point relating to the causation, the treatment, the cure of obscure disease.
The profession were soon aroused to an appreciation of facts whose existence it was shown could so easily be proved by every physician, and in 1857 a committee, consisting of some of the more prominent and most reliable practitioners in various parts of the country, with the younger Storer as chairman, was appointed by the American Medical Association, at its meeting in Nashville, to investigate the crime with a view to its possible suppression. The report of this committee was rendered at Louisville, in 1859, and, supported as it was by a mass of evidence of almost boundless scope, the measures proposed, chiefly of a legislative character, were unanimously indorsed by the Association. The evidence upon which the report was based was subsequently published at Philadelphia, as a separate volume, “the first of a series of contributions to Obstetric Jurisprudence” by its writer, under the title of “Criminal Abortion in America,” and was feelingly dedicated “to those whom it may concern—Physician, Attorney, Juror, Judge, and Parent.”
This detail, otherwise out of place in an appeal to the community, is rendered perhaps necessary, that an exact and true impression may be given of the steps that have been taken by medical men, to redeem themselves from the imputation of having been sluggish guardians of the public weal. Since the time of the Louisville report, the profession have been fully alive to the claims of the subject, and it is not with unnatural satisfaction that its author, in a subsequent publication, has taken occasion to observe that the importance and legitimacy of the investigation has now been acknowledged in the current files of every medical journal, in the published transactions of the national and minor medical associations, in many medical addresses, as that by Dr. Miller, of Louisville, at the meeting of the Association at New Haven, in 1860, and in nearly every general obstetric work of any importance issued in this country since that date, Bedford’s Principles and Practice of Obstetrics, for instance, and in many works of criminal law and medical jurisprudence, as Elwell, Wharton and Stille’, and Hartshorne’s edition of Taylor, to a much greater extent than the subject in these works had ever been treated before.
I am constrained to acknowledge my indebtedness to the various publications of the writer from whom I have quoted, for much of the evidence I shall now present upon the subject of forced abortions. I trust that thus offered it may lose none of its freshness, point, and force. My frequent extracts from one who has given more thought to the subject than probably any other person in the country, will I am sure need no excuse.
An opinion has obtained credence to a certain extent, and it has been fostered by the miserable wretches, for pecuniary gain, at once pandering to the lust and fattening upon the blood of their victims, that induced abortions are not unfrequently effected by the better class of physicians. Such representations are grossly untrue, for wherever and whenever a practitioner of any standing in the profession has been known, or believed, to be guilty of producing abortion, except absolutely to save a woman’s life, he has immediately and universally been cast from fellowship, in all cases losing the respect of his associates and frequently, by formal action, being expelled from all professional associations he may have held or enjoyed.
The old Hippocratic oath, to which each of his pupils was sworn by the father of medicine, pledged the physician never to be guilty of unnecessarily inducing miscarriage. That the standard, in this respect, of the profession of the present day has not deteriorated, is proved by the first of the resolutions adopted by the Convention at Louisville, in 1859: “That while physicians have long been united in condemning the procuring of abortion, at every period of gestation, except as necessary for preserving the life of either mother or child, it has become the duty of this Association, in view of the prevalence and increasing frequency of the crime, publicly to enter an earnest and solemn protest against such unwarrantable destruction of human life.”
It is true, however, that while physicians are unanimous as to the sanctity of foetal life, they have yet to a certain extent innocently and unintentionally given grounds for the prevalent ignorance upon this subject to which I shall soon allude. The fact that in some cases of difficult labor, it becomes imperatively necessary to remove the child piecemeal, if dead, or, if living, to destroy it for the sake of saving the mother’s life, ought not to imply that the Physician has attached a trifling value to the child itself. Compared with the mother, who is already mature and playing so important a part in the world, he justly allows the balance to fall, but he fully recognizes that he is assuming a tremendous responsibility, that his action is only justified by the excuse of dire necessity, and he suffers, if he is a man of any sensibility and feeling, an amount of mental anguish not easily to be described, and that none of us, who have been compelled to so terrible a duty, need feel ashamed to confess.
There are cases again, where, during pregnancy, the patient may be reduced by the shock of severe and long-continued pain or excessive vomiting, and its consequent inanition, to the verge of the grave. In such instances, it has been supposed that abortion was necessary to preserve the woman’s life. The advance of’ science, however, has now shown that this procedure is not only often unnecessary, but in reality unscientific; the disturbances referred to occurring, as they generally do, in the earlier months of gestation, being due not to the direct pressure of the womb upon the stomach or other organs, but to a so-called reflex and sympathetic disturbance of those organs, through the agency of the nervous system; and that a cure can in general be readily effected without in any way endangering the vitality of the child.
There are other instances that might be cited, cases of dangerous organic disease, as cancer of the womb, in which, however improbable it might seem, pregnancy does occasionally occur; cases of insanity, of epilepsy, or of other mental lesion, where there is fear of transmitting the malady to a line of offspring; cases of general ill health, where there is perhaps a chance of the patient becoming an invalid for life, but for all these and similar emergencies, there is a single answer, and but this one—that abortion, however it may seem indicated, should never be induced by a physician upon his own uncorroborated opinion, and, in a matter so grave, affecting, with his own reputation, the life of at least one if not of a second human being, every man worthy of so weighty and responsible a trust will seek in consultation a second opinion. This is a matter of’ such importance to the welfare of the community, that long ago the law should have provided for its various dangers, and should wisely have left it to no man’s discretion or purity of character to withstand the tremendous temptations which must be allowed to here exist. The law now provides, in one or more of our States at least, that the certificate of a single physician, no matter what his skill or standing, cannot commit a patient to the often necessary and beneficial seclusion of a lunatic asylum; two are required. How much more requisite is it that in the question we are now considering, to one mode of deciding which the physician may be prompted by pity, by personal sympathy, the entreaties of a favorite patient, and not seldom by the direct offer of comparatively enormous pecuniary compensation, the law should offer him its protecting shield, saving him even from himself and helping him to sec that the fee for an unnecessarily induced or allowed abortion is in reality the price of blood. As a class, it cannot be gainsaid that physicians of standing will spurn with indignation the direct bribe; let them look to it that they never carelessly permit what they condemn, by endeavoring to bring on the woman’s periodical discharge when it is possible that she may have conceived, or by carelessly passing an instrument into her womb without ascertaining whether or not it contain the fruit of impregnation, or by allowing the completion of a miscarriage that may threaten or even have commenced, without resorting to every measure, of whatever character, that can possibly result in its arrest and the consequent completion of the full period.
III.—WHAT IS THE TRUE NATURE OF AN INTENTIONAL ABORTION
WHEN NOT REQUISITE TO SAVE THE LIFE OF THE MOTHER.
There are those who will be influenced by evidence presented from abstract morality and religion. To such I shall first address myself. There are others who care nothing for ethical considerations, and who arrogate to themselves a right to decide as to the morality of taking or destroying the life of an unborn child. For these also I have an unanswerable argument—their own self-interest—an appeal to which will usually arrest the most hardened adept in other crime, much more these intelligent and otherwise innocent women, who have mostly erred through ignorance and a misapprehension of their own physical condition, and their own physical dangers, their own physical welfare.
Physicians have now arrived at the unanimous opinion, that the foetus in utero is alive from the very moment of conception.
“To extinguish the first spark of life is a crime of the same nature both against our Maker and society, as to destroy an infant, a child, or a man.”
More than two hundred years ago the same idea was as vigorously as quaintly expressed. it is a thing deserving all hate and detestation that a man in his very originall, whiles he is framed, whiles he is enlived, should be put to death under the very hands and in the shop of nature.”
The law, whose judgments are arrived at so deliberately, and usually so safely, has come to the same conclusion, and though in some of its decisions it has lost sight of this fundamental truth, it has averred in most pithy and emphatic language that “quick with child is having conceived.”
By that higher than human law, which, though scoffed at by many a tongue, is yet acknowledged by every conscience, “the wilful killing of a human being, at any stage of its existence, is murder.”
Abortion or miscarriage is known by every woman to consist of the premature expulsion of the product of conception. It is not as well known, however, if the statements of patients are to be relied upon, that this product of conception is in reality endowed with vitality from the moment of conception itself. It is important, therefore, to decide in what the moment of conception consists. It has now been ascertained that every variety of animal life originates from an egg, even primarily those lowest forms in which occur the phenomena of so-called alternate generation; in each and every one of them, mammals or invertebrates, the origin is from as distinct an egg as is laid by bird, tortoise, or fish; the human species being no exception to this general rule. Before this egg has left the woman’s ovary, before impregnation has been effected, it may perhaps be considered as a part and parcel of herself, but not afterwards. When it has reached the womb, that nest provided for the little one by kindly nature, it has assumed a separate and independent existence, though still dependent upon the mother for subsistence. For this end the embryo is again attached to its parent’s person, temporarily only, although so intimately, that it may become nourished from her blood, just as months afterwards it is from the milk her breasts afford. This is no fanciful analogy; its truth is proved by countless facts. In the kangaroo, for instance, the offspring is born into the world at an extremely early stage of development, “resembling an earthworm in its color and semi-transparent integument,” and then is placed by the mother in an external, abdominal, or marsupial pouch, to portions of which corresponding, so far as function goes, at once to teats and to the uterine sinuses, those embryos cling by an almost vascular connection until they are sufficiently advanced to bear detachment, or in reality to be born. The first impregnation of the egg, whether in man or in the kangaroo, is the birth of the offspring to life; its emergence into the outside world for wholly separate existence is, for one as for the other, but an accident in time. It has been asserted by some authors, as by Meigs, that conception is only coincident with the attachment of the impregnated to the uterine cavity for its temporary abode therein, or, in exceptional cases, as in extra-uterine pregnancy so called, with its attachment to some other tissue of the mother; thereby attempting to establish a difference between impregnation and conception; a difference that is at once philosophically unfounded, and plainly disproved by all analogical evidence, as the fact, for instance, that in most fishes impregnation occurs entirely external to the body of the mother, from which the ova had previously, or during the process of copulation, permanently been discharged.
Many women suppose that the child is not alive till quickening has occurred, others that it is practically deal till it has breathed. As well one of these suppositions as the other; they are both of them erroneous.
Many women never quicken at all, though their children are born living; others quicken earlier or later than the usual standard of time; or, others again may in their own persons have noticed either or all of these peculiarities in different pregnancies. Quickening is in fact but a sensation, the perception of the first throes of life—but of a twofold occurrence, and this not merely the motion of the child, but often the sudden emergence of the womb upwards from its confinement in the low regions of the pelvis into the freer space of the abdomen. The motions of the child, which have been proved by Simpson, of Edinburgh, to be its involuntary efforts, through the reflex action of its nervous system, to retain itself in certain attitudes and positions essential to its security, its sustenance, and its proper development, are usually present for a period long prior to the possibility of their being perceived by the parent. They may very constantly be recognized by the physician in cases where no sensation is felt by the mother, and the foetus has been seen to move when born, during miscarriage, at a very early period.
During the early months of pregnancy, while the foetus is very small in proportion to the size of the cavity which contains it, sounds, produced by its movements, may be distinguished by the attentive ear applied to the abdomen of the mother, as gentle taps repeated at intervals, and continued uninterruptedly for a considerable time. These sounds may sometimes be heard several weeks bcfore the usual period of the mothers becoming conscious of the motion of the child, and also earlier than the pulsations of the foetal heart or the uterine souffle, as the murmur of the circulation in the walls of that organ, or in the tissue of the after-birth, is technically termed. These motions must be allowed to prove life, and independent life. In what does this life really differ from that of the child five minutes in the world? Is not then forced abortion a crime? Moreover, instances have occurred where, the membranes having been accidentally ruptured, the child has breathed, and even cried, though yet unborn, as proved alike by the sounds within the mother, well authenticated by bystanders, and by auscultation of her abdomen, and by the fact that sometimes, when not born living, the lungs of the foetus have been found fully expanded, a process which can be effected only by respiration, and of which the proofs are such as can be occasioned in no other way whatever.
In the majority of instances of forced abortion, the act is committed prior to the usual period of quickening. There are other patients, who have confessed to me that they have destroyed their children long after they have felt them leap within their womb. There are others, still, whom I have known to wilfully suffocate them during birth, or to prevent the air from reaching them under the bedclothes; and there are others, who have wilfully killed their wholly separated and breathing offspring, by strangling them or drowning them, or throwing them into a noisome vault. Wherein among all these criminals does there in reality exist any difference in guilt?
I would gladly arrive at and avow any other conviction than that I have now presented, were it possible in the light of fact and of science, for I know it must carry grief and remorse to many an otherwise innocent bosom. The truth is, that our silence has rendered all of us accessory to the crime, and now that the time has come to strip down the veil and apply the searching caustic or knife to this foul sore in the body politic, the physician needs courage as well as his patient, and may well overflow with regretful sympathy.
That there has existed a wide and sincere ignorance of the true character of the act, I have already allowed; it is a point to which I shall again refer. At present let us turn from the crime against the child, to the crime as against the mother’s own life and health. I here refer more particularly to her own agency therein. Of the guilt of abortion when committed by another person than herself, and with reference both to the mother’s life and that of the child, there can be no doubt, but it is with the woman’s own agency in the act, as principal, or accessory by its solicitation or permission, that we have now to deal; not as to its abstract wrong alone, but as to its physical dangers and therefore its utter folly.
IV.—THE INHERENT DANGERS OF ABORTION TO A WOMAN’S HEALTH
AND TO HER LIFE.
It is generally supposed, not merely that a woman can wilfully throw off the product of conception without guilt or moral harm, but that she can do it with positive or comparative impunity as regards her own health. This is a very grievous and most fatal error, and I do not hesitate to assert, from extended observation, that, despite apparent and isolated instances to the contrary—
1. A larger proportion of women die during or in consequence of an abortion, than during or in consequence of childbed at the full term of pregnancy;
2. A very much larger proportion of women become confirmed invalids, perhaps for life; and
3. The tendency to serious and often fatal organic disease, as cancer, is rendered much greater at the so-called turn of life, which has very generally and not without good reason been considered as especially the critical period of a woman’s existence.
These, as I have said, are conclusions that cannot be gainsaid, as they are based on facts; and that these facts are merely what ought in the very nature of things to occur, can readily enough be shown.
1. Nature does all her work, of whatever character it may be, in accordance with certain simple and general laws, any infringement of which must necessarily cause derangement, disaster, or ruin.
In the present instance, it has been ascertained, by careful dissections and microscopic study, that the woman’s general system, both as a whole and as regards each individual organ and its tissues, is slowly and gradually prepared for the great change which naturally occurs at the end of nine months’ gestation; and that if this change is by any means prematurely induced, whether by accident or design, it finds the system unprepared. Not even do I except from this law the earlier months of pregnancy; when, it is thought by so many, that abortion can be brought on without any physical shock.
During pregnancy all the vital energies of the mother are devoted to a single end, the protection and nourishment of the child. Such wise provision is made for its security, such intimate vascular connection is established between the foetal circulation and the blood vessels of the mother, thus its premature rupture is usually attended by profuse hemorrhage, often fatal, often persistent to a greater or less degree for many months after the act has been completed, and always attended with more or less shock to the maternal system, even though the full effect of this is not noticed for years.
In birth at the full period, it is found that what is called by pathologists fatty degeneration of the tissues occurs both in the walls of the mother’s womb, and in the placenta or after-birth, by which attachment is kept up with the child. This change, in all other instances a diseased process, is here an essential and healthy one. By it the occurrence of labor at its normal period is to a certain extent determined; by it is provision made against an inordinate discharge of blood during the separation and escape of the after-birth, and by it is the return of the uterus to the comparatively insignificant size, that is natural to it when unimpregnated, insured. Any deviation from this process at the full term, which prevents the whole chain of events now enumerated from being completed, lays the foundation of, and causes, a wide range of uterine accidents and disease, displacements of various kinds, falling of the womb downwards or to either side, with the long list of neuralgic pains in the back, groins, thighs, and elsewhere that they occasion; constant and inordinate leucorrhoea; sympathetic attacks of ovarian irritation, running even into dropsy, etc. etc. These are only a portion of the results that might be enumerated.
Now while all this is true of any interference with the natural process at the full time, it is just as true, and if anything more certain, when pregnancy has been prematurely terminated; and out of many hundred invalid women, whose cases I have critically examined, in a very large proportion I have traced these symptoms to the mental conviction of the patient, as well as to my own, directly back to an induced abortion.
Again—not merely does nature prepare the appendages of the child and the womb of its mother for the separation that in due time is to ensue between them, it also provides an additional means of insuring its successful accomplishment, through the action that takes place in the woman’s breasts, namely, the secretion of the milk. Though the escape of this fluid does not ordinarily occur in any quantity until some little time after birth has been effected, yet the changes that ensue have gradually been progressing for days or weeks or even months; for, as is well known. In some women the lacteal secretion is present before birth, at times even during a large part of pregnancy, and in all women there is doubtless a decided tendency of the circulation towards the breasts, prior to the birth of the child, just as there has been so extreme a tendency of the circulation for so long a time towards the womb. It is indeed to take the place of the latter that the former is established, and to prevent the evil consequences that might otherwise ensue. The sympathy between the mammary glands and the uterus is now well established; it is shown in many different ways: in some women the application of the child to the breasts is immediately followed by after-pains, and in others these pains, which are usually but contractions of the womb to expel any clots that may have accumulated, are attended by a freer secretion or discharge of the milk. It is not uncommon when the monthly discharge is scanty or suddenly checked, for the breasts to become enlarged and painful, as is so often the case soon after impregnation, while on the other hand one of the most efficient means we have of establishing the periodical flow, when suppressed, is by the application of sinapisms to the surface of the breasts. In view of these facts it will readily be understood why it is that women who make good nurses are so much less likely than others to suffer from the various disorders of the womb, and why they are also less likely to rapidly conceive, and why, moreover, too long lactation should not be indulged in for either of these so desirable ends. The demands of fashion shorten or prevent nursing, the demands of fashion often forbid a woman from bearing children; but whether this is attained by the prevention of impregnation, or by the induction of miscarriage, it is almost inevitably attended, as is to a certain extent the sudden cessation of suckling, by a grievous shock to the mother’s system, that sooner or later undermines her heath, if even it does not directly induce her death.
I have asserted that dangers attend the occurrence of abortion which directly threaten a mother’s life. This is true of all miscarriages whether accidental or otherwise: but these dangers are enhanced when the act is intentional. When caused by an accident, the disturbance is often of a secondary character, the vitality of the ovum being destroyed or the activity of the maternal circulation checked before the separation of the two beings from each other finally takes place. But in a forced abortion there is no such preservative action; the separation is immediate if produced by instruments, which often besides do grievous damage to the tissues of the mother with which they are brought into contact, lacerating them and often inducing subsequent sloughing or mortification; or, if the act is effected by medicines, it is usually inconsequence of violent purgation or vomiting, which of themselves often occasion local inflammation of the stomach or intestines, and death. Add to this that even though the occurrence of any such feeling may be denied, there is probably always a certain measure of compunction for the deed, in the woman’s heart—a touch of pity for the little being about to be sacrificed—a trace of regret for the child, that, if born, would have proved so dear—a trace of shame at casting from her the pledge of a husband’s or lover’s affection—a trace of remorse for what she knows to be a wrong, no matter to what small extent, or how justifiable, it may seem to herself and we have an explanation of the additional element in these intentional abortions, which increases the evil effect upon the mother, not as regards her bodily health alone, but in some sad cases to the extent oven of utterly overthrowing her reason.
The causes of an immediately or secondarily fatal result of labor at the full period are few; in abortion nearly every one of these is present, with the addition of others peculiar to the sudden and untimely interruption of a natural process and the death of the product of conception. There is the same or greater physical shock, the same or greater liability to hemorrhage, the same and much greater liability to subsequent uterine or ovarian disease. To these elements we must add another and by no means an unimportant one; a degree of mental disturbance, often profound, from disappointment or fear, that to the same extent may be said rarely to exist in labors at the full period.
Viewing this subject in a medical light, we find that death, however frequent, is by no means the most common or the worst result of the attempts at criminal abortion. This statement applies not to the mother alone, but, in a degree, to the child.
We shall perceive that many of the measures resorted to are by no means certain of success, often indeed decidedly inefficacious in causing the immediate expulsion of the foetus from the womb; though almost always producing more or less severe local or general injury to the mother, and often, directly or by sympathy, to the child.
The membranes or placenta may be but partially detached, and the ovum may be retained. This does not necessarily occasion degeneration, as into a mole, or hydatids, or entire arrest of development. The latter may be partial, as under many forms, from some cause or another, does constantly occur; if from an unsuccessful attempt at abortion, would this be confessed, or indeed always suggest itself to the mother’s own mind? Fractures of the foetal limbs prior to birth are often reported, unattributable in any way to the funis, which may amputate, indeed, but seldom break a limb. A fall or a blow is recollected; perhaps it was accidental, perhaps not, for resort to these for criminal purposes is very common. In precisely the same manner may injury be occasioned to the nervous system of the foetus, as in a hydrocephalic case long under the writer’s own observation, where the cause and effect were plainly evident. Intra-uterine convulsions have been reported; as induced by external violence they are probably not uncommon, and the disease thus begun may eventuate in epilepsy, paralysis, or idiocy.
To the mother there may happen correspondingly frequent and serious results. Not alone death, immediate or subsequent, may occur from metritis, hemorrhage, peritonitic or phlebitic inflammation, from almost every cause possibly attending not merely labor at the full period, comparatively safe, but miscarriage increased and multiplied by ignorance, by wounds, and violence; but if life still remain, it is too often rendered worse than death.
The results of abortion from natural causes, as obstetric disease, separate or in common, of mother, foetus or membranes, or from a morbid habit consequent on its repetition, are much worse than those following the average of labors at the full period. If the abortion be from accident, from external violence, mental shock, great constitutional disturbance from disease or poison, or even necessarily induced by the skilful physician in early pregnancy, the risks are worse. But if, taking into account the patient’s constitution, her previous health, and the period of gestation, the abortion has been criminal, these risks are infinitely increased. Those who escape them are few.
In thirty-four cases of criminal abortion reported by Tardieu, where the history was known, twenty-two were followed, as a consequence, by death, and only twelve were not. In fifteen cases necessarily induced by physicians, not one was fatal.
It is a mistake to suppose, with Devergie, that death must be immediate, and owing only to the causes just mentioned. The rapidity of death, even where directly the consequence, greatly varies; though generally taking place almost at once if there be hemorrhage, it may be delayed even for hours where there has been great laceration of the uterus, its surrounding tissues, and even of the intestines; if metro-peritonitis ensue, the patient may survive for from one to four days, even indeed to seven and ten. But there are other fatal cases, where on autopsy there is revealed no appreciable lesion; death, the penalty of unwarrantably interfering with nature, being occasioned by syncope, by excess of pain, or by moral shock from the thought of the crime.
That abortions, even when criminally induced, may sometimes be safely borne by the system, is of little avail to disprove the evidence of numberless cases to the contrary. We have instanced death. Pelvic cellulitis, on the other hand, fistulæ, vesical, uterine, or between the organs alluded to; adhesions of the os or vagina, rendering liable subsequent rupture of the womb, during labor or from retained menses, or, in the latter case, discharge of the accretion through a Fallopian tube and consequent peritonitis; diseases and degenerations, inflammatory or malignant, of both uterus and ovary; of this long and fearful list, each, too frequently incurable, may be the direct and evident consequence, to one patient or another, of an intentional and unjustifiable abortion.
We have seen that in some instances, the thought of the crime, coming upon the mind at a time when the physical system is weak and prostrated, is sufficient to occasion death. The same tremendous idea, so laden with the consciousness of guilt against God, humanity, and oven mere natural instinct, is undoubtedly able, where not affecting life, to produce insanity. This it may do either by its first and sudden occurrence to the mind; or, subsequently, by those long and unavailing regrets, that remorse, if conscience exist, is sure to bring. Were we wrong in considering death the preferable alternative?
To the above remarks it might truthfully be added, that not only is the foetus endangered by the attempt at abortion, and the mother’s health, but that the stamp of disease thus impressed is very apt to be perceived upon any children she may subsequently bear. Not only do women become sterile in consequence of a miscarriage; and then, longing for offspring, find themselves permanently incapacitated for conception; but, in other cases, impregnation, or rather the attachment of the ovum to the uterus, being but imperfectly effected, or the mother’s system being so insidiously undermined, the children that are subsequently brought forth are unhealthy, deformed, or diseased. This matter of conception and gestation, after a miscarriage, has of late been made the subject of special study, and there is little doubt that from this, as the primal origin, arises much of the nervous, mental, and organic derangement and deficiency, that, occurring in children, cuts short or embitters their lives.
It may be alleged by those who, sceptical or not sceptical as to these conclusions, have reason nevertheless to desire to throw discredit upon them, that the weekly or annual bills of mortality, the mortuary statistics, do not show such direct influence from the crime of abortion as t have claimed exists.
On the other hand, it must not be forgotten that in these cases there always is present every reason for concealment. In the earlier months of pregnancy it is very difficult to prove, in the living subject, that pregnancy bas occurred. Such a conclusion being arrived at, before the sound of the foetal heart can be heard, for this is the only sign that is positively certain, by merely circumstantial and probable evidence, which becomes of weight only as it is accumulated and found corroborative. In the dead subject, the victim of an abortion in the earlier months, the case is often equally obscure, or at least doubtful, unless the product of conception has not yet escaped, or having been thrown off has been detected or preserved. When found, it of course proves pregnancy, whether the parent be living or dead; that is, in the former instance, if its discharge can be traced directly to the woman in question, and to no other, and correlative circumstances may show that an abortion has occurred; but this may have been accidental and guiltless. Where the act has been committed by an accomplice, the proofs of such commission and of the intent, though this is generally implied by the act itself, are by no means always forthcoming. Where the abortion has been induced by the woman herself as is now so frequently the case, certainty upon the point becomes far more difficult. The only positive evidence by which to judge of the real frequency of the crime is confession, and it is from the confessions of many hundreds of women, in all classes of society, married and unmarried, rich and poor, otherwise good, bad, or indifferent, that physicians have obtained their knowledge of the true frequency of the crime.
The confidential relations in which the physician stands to his patient; the understanding that nothing can wring from him her disclosures, save the direct commands of the law, so unlikely in any given case to become cognizant of its existence, elicit from a woman in almost every instance, especially if she believes herself in peril of death, a frank statement of the means by which she has been brought low; for it is evident, that upon such knowledge must depend the measures of relief to which the physician may resort. Could the test of confession be always applied, as is, however, manifestly impossible, so many women die during or in consequence of an abortion, without the attendance of a physician and without making any sign, it would be found that many of the cases now reported upon our bills of mortality as death from hemorrhage, from menorrhagia, from dysentery, from peritonitis, from inflammation of the bowels or of the womb, from obscure tumor, or from uterine cancer, would be found in reality to be deaths from intentional abortion. At first sight, it would seem impossible that such grossly erroneous opinions as the above could be rendered; but their likelihood is readily perceived when it is recollected how often, when the best medical skill has been secured, attending circumstances are such as to excite little or no suspicion of the true state of the ease, and a physical examination of the patient is therefore neglected. Women are still allowed to die of ovarian or of other tumors that might be easily and successfully removed, and in default of a proper examination are sometimes mistakenly pronounced instances of disease of the liver or of ordinary abdominal dropsy, and as such are buried. If such and similar errors can occur in chronic cases, where time and opportunity have permitted the most thorough examination and study, still more likely are they to take place during the hurry and anxieties of an acute and alarming attack, where the conscience and shame of the patient are alike interested in causing or keeping up a deception.
It will have been seen then, not merely that an induced abortion may be attended with great immediate danger to the mother, but that in reality it is very often fatal, either from the so-ca1led shock to her system, or from hemorrhage, or from immediately ensuing peritonitis.
2. Should the woman survive these immediate consequences, no matter how excellently she may have seemed to rally, she is by no means safe as to her subsequent health. There are a host of diseases, some of them very dangerous, to which she is directly liable.
The product of conception is not always entirely gotten rid of. If a fragment remains, no matter how trifling in size, it may serve as the channel of a most severe and constant hemorrhagic discharge. Of this, examples are by no means infrequent; the flux lasting at times for very many months, and, if the cause is not finally detected and removed, hurrying the patient to her grave.
The product of conception is sometimes retained entire, after its detachment from the uterine walls has been supposed wholly effected. It may be carried for many years, always acting as a foreign body; at times occasioning extreme irritation, shown perhaps only by distant and otherwise inexplicable symptoms, or it may lie dormant for a time without apparent trouble—finally making itself known by some sudden explosion of disease, whether by purulent absorption and general pyæmia; by ulceration and discharge of foetal debris, through the intestines, bladder, or even abdominal integuments; or by metritic inflammation, followed by sympathetic or consequent fatal peritonitis.
The patient after an abortion is very liable to one or another of the forms of uterine displacement, which are now known to lie at the foundation of so very large a proportion of the lame backs, formerly supposed consequent on spinal irritation; of the painfully neuralgic breasts, so often suggestive of incipient cancer; of the disabled limbs, pronounced affected with sciatica, cramps or even paralysis; of the impatient bladders, from whose irritability or incontinence the kidneys are supposed diseased; of the obscure abdominal aches and pains, which unjustly condemn so many a liver and so many an ovary; of the constipation from mere mechanical pressure, which is so often thought to argue stoppage from stricture or other organic disease; of the severe and intractable headaches that, resisting all and every form of direct or constitutional treatment, are supposed to indicate an incurable affection of the brain; of the easily deranged stomachs, that are so suggestive of ulceration or of malignant degeneration; of the general hypochondria and despondency, that of the most gentle, even almost angelic, dispositions make the shrew and virago, and of the purest and most innocent produce, in her own conceit, the worst of sinners, even at times effecting suicide. Who that has suffered will think this picture overdrawn? Who that has practised will not recognize in displacements, the key by which these riddles may be solved?
Their mode of causation is plain. After an abortion, just as after labor at the fall term, the womb is more weighty than natural—its walls thicker and heavier than usual, caused alike by the excess of blood they contain, and by the increased deposition of muscular fibre. After childbed, it has been shown that this increase is normally lessened by certain physiological processes attending the natural completion of that function. After an abortion, these processes are absent or are but imperfectly performed. It is notorious that during the slight increase of weight from simple congestion that occurs at the regular monthly periods, women are very liable to displacement on any effort, extreme or slight, whether riding on horseback, gently lifting, or even straining at stool; during or after an abortion, the risk is very greatly increased.
With equal justice could I refer to the chances of trouble that otherwise accompany the premature ending of pregnancy. In many instances, I have now been summoned to attend, and frequently to operate upon, the consequences of local uterine or vaginal inflammation or of laceration, for both of these results may ensue where the womb has not been prepared to evacuate itself by the normal closure of pregnancy—and this, whether or not instruments may have been employed. Adhesions of varying situation and extent are not uncommon as the result of an abortion. They may be slight, and merely tilt or draw the womb to one side, giving rise only to severe local or distant neuralgia, and rendering the occurrence of a subsequent pregnancy somewhat dangerous; they may be more decided, and as bridles or septa partially close the canal of the vagina, rendering menstruation and conjugal intercourse alike difficult and painful; they may be so complete as entirely to obliterate the mouth of the womb or of the external passage, in these instances preventing the escape of the menses and rendering an operation necessary to avoid a rupture that might perhaps be fatal. Should it be the outer entrance that is occluded, the woman is of course entirely shut off from her husband’s embrace, an effect that, however grateful to many an invalid, her shame would hardly be willing to accept as the consequence of disease.
These that I have mentioned are but a tithe of the pathological effects daily revealed to physicians, as consequent upon an intentional abortion. They are, however, sufficient for our purpose.
3. But not merely is a woman in peril both as to life and health, alike at the time of an abortion and for months or years subsequently. She may seem to herself and to others successfully to have escaped these dangers, and yet when she has reached the critical turn of life, succumb.
At this eventful period, when the fountains of youth dry up, and the scanty circulation is turned from its accustomed channel, the woman ceases from the periodical discharges, which in health and with care are the secret of her beauty, her attractions, her charms. At its occurrence not merely is a change produced in the system generally, but the womb, no longer required, becomes atrophied and dwindles into insignificance. It may have had impressed upon it, years and years back, the stamp of derangement, till now not rendered effective; for, as in other portions of the body, a part once weakened may retain itself in tolerably good condition until some accident or other change develops or awakens the seed of disease. Thus it is that an ancient hypertrophy, or a chronic irritation, may become scirrhous and degenerate into undoubted carcinoma, or chronic menorrhagia or uterine leucorrhoea become intractable hemorrhage, or a latent fibroid deposit develop into an irrepressible and, perhaps, irremediable tumor.
Little the comfort for a woman to have had her own way against the dictates of her conscience, the advice, perhaps, of her physician, if to the dangers she must directly incur, she must add the looking forward through all the rest of her life to possible disease, invalidism, or death as the direct consequence of her folly; no wonder if she should consider prevention better than such cure as this, and yet, the prevention of pregnancy, by whatever means it may be sought, by cold vaginal injections, or by incomplete or impeded sexual intercourse, is alike destructive to sensual enjoyment and to the woman’s health; her only safeguard is either to restrict approach to a portion of the menstrual interval, or to refrain from it altogether.
Not merely are certain of the measures to which I have alluded detrimental to the health of the woman, they are so to both parties engaged, and it is to their frequent employment, freely confessed as this is to the physician, that much of the ill health of the community, both of men and women, is to be attributed. Though they may seem sanctioned by the rites of marriage, they are in some respects worse for the physical health, I might almost say for the moral health likewise, than illicit intercourse or even prostitution, for they bring both parties down to all the evils and dangers, mental and physical, of self-abuse.
V.—THE FREQUENCY OF FORCED ABORTIONS, EVEN AMONG THE MARRIED.
All are familiar with the fact, to be perceived everywhere upon the most casual scrutiny, that the standard size of families is not on the average what used to be seen, in other words, that instances of an excess over three or four children are not nearly as common as we know was the case a generation or two back. No one supposes that men or women have, as a whole, so deteriorated in procreative ability as this might otherwise seem to imply. There can be but one solution to the problem, either that pregnancies are very generally prevented, or that, occurring, they are prematurely cut short. We have seen that countless confessions prove that this surmise is true.
In the treatise to which we have already alluded, its author has shown by a series of unanswerable deductions, based on material gathered from many sources both at home and abroad, that forced abortions in America are of very frequent occurrence, and that this frequency is rapidly increasing, not in the cities alone, but in the country districts where there is less excuse on the ground of excessive expenditures, the claims of fashionable life, or an overcrowding of the population. It was proved, for instance, that in one State that was named, one of the wealthiest in the Union, the natural increase of the population, or the excess of the births over the deaths, has of late years been wholly by those of recent foreign origin. This was the state of things existing in 1850; three years later it was evident that the births in that commonwealth, with the usual increase, had resulted in favor of foreign parents in an increased ratio. In other words, it is found that, in so far as depends upon the American and native element, and in the absence of the existing immigration from abroad, the population of our older States, even allowing for the loss by emigration, is stationary or decreasing.
The strange and otherwise unaccountable phenomenon to which we are now referring, appears to have been first elucidated in a memoir, upon the decrease of the rate of increase of population now obtaining in Europe and America, read by the same author in 1858 to the American Academy of Arts and Sciences, as a contribution to the science of political economy. That paper with all its mass of evidence, that as yet there seems to have been no attempt to controvert, we find embodied in the treatise to which I have referred, and which will prove of absorbing interest to even the casual reader.
Thus it is seen that abortion is a crime not merely against the life of the child, and the health of its mother, and against good morals, but that it strikes a blow at the very foundation of society itself.
One of the strange and unexpected results at which the author we have so often referred to has arrived, but which he has both proved to a demonstration and satisfactorily explained, is that abortions are infinitely more frequent among Protestant women than among Catholic; a fact, however, that becomes less unaccountable in view of the known size, comparatively so great, of the families of the latter—in the Irish, for instance—the point being that the different frequency of the abortions depends not upon a difference in social position or in fecundity, but in the religion. We should suppose a priori that the Protestant, especially if of New England and Puritan stock, would be much the safer against all such assaults of the world, the flesh, and the devil. The following is the concise and convincing solution of the paradox that has been given ;—
“It is not, of course, intended to imply that Protestantism, as such, in any way encourages, or indeed permits, the practice of inducing abortion; its tenets are uncompromisingly hostile to all crime. So great, however, is the popular ignorance regarding this offence, that an abstract morality is here comparatively powerless; and there can be no doubt that the Romish ordinance, flanked on the one hand by the confessional, and by denouncement and excommunication on the other, has saved to the world thousands of infant lives.”
There is another surprising result that must strike every candid observer whose position gives him extended and frequent observation of women, and of late years the study and treatment of their special diseases has become so recognized that there are many physicians thus rendered competent to judge; it is this, but a second one of the many very frightful characteristics of induced abortion, that the act is proportionately much more common in the married than in the unmarried, basing the calculation upon an equal number of pregnancies in each case.
This fact also may be easily accounted for. Abortion is undoubtedly more common in the earlier than in the later months of pregnancy, because the sensible signs of foetal vitality are then less permanently present and the conscience is then better able to persuade itself that the child may possibly be without life or the alarm wholly a false one. It is less common with first than with subsequent children, though instances of its occurrence with the former are certainly not rare. A woman who has never been pregnant does not as a general rule conceive as readily as one who has already been impregnated before, perhaps partly from the fact that intercourse under certain circumstances is more likely to be excessive in such cases, at times producing acute or subacute inflammation of the cervix uteri and consequent sterility, as is so constantly observed in prostitutes, very many of whom upon ceasing their trade, after accumulating a little property, as in France, or upon being sent to outlying colonies, as in England, and becoming married, at once fall pregnant.
The unmarried woman, if enceinte, has not the opportunity of lying by for a few days’ sickness without exciting suspicion, that the married can easily seize for themselves. She is often not so conversant with the early symptoms of gestation, and is more prone to wait until its existence has been rendered certain by the sensation of quickening, in the hope doubtless not unfrequently that this certainty may persuade her paramour to marriage, instead of deciding him against it, as is so often the case. It may be allowed, I think, that infanticide, the murder of a child after its birth, or its exposure to the vicissitudes and perils of chance, is more common among the unmarried, but that destruction of the foetus in utero, the rather prevails where the rites of law and religion would seem to have extended to that foetus every possible safeguard.
In the latest of the papers upon the subject of abortion, to which we have already alluded, there is furnished additional evidence as to the frequency of induced miscarriage.
“The infrequency of abortions,” it is said, “as compared with labors at the full period is disproved by the experience of every physician in special or large general practice, who will faithfully investigate the subject. The truth of this statement has been fully verified in the instance of abortion criminally induced, by many of my professional friends who were at first inclined to doubt the accuracy of my inferences on that point; with reference to abortions more naturally occurring, the evidence is of course more easily arrived at and is in consequence proportionately more striking.
In many cases of sterility it will be found that the number of abortions in a single patient have been almost innumerable; and, it may be added, in n large proportion of the cases of uterine disease occurring in the married, inquiry as to their past history will reveal abortions, unsuspected perhaps even by the family physician, as the cause. It is not so much the general practitioner, the hospital attendant, or the accoucheur as such, who can testify as to the true frequency of abortion; for many cases, even of the most deplorably fatal results, do not seek for medical assistance at the time of the accident. The real balance sheet of these cases is to be made out by the hands which are more especially called to the treatment of chronic uterine disease.”
But not only is abortion of excessively frequent occurrence. The nefarious practice is yearly extending, as does every vice that custom and habit have rendered familiar. It is foolish to trust that a change for the better may be spontaneously effected. “Longer silence and waiting by the profession would be criminal. If these wretched women, these married, lawful mothers, aye, and these Christian husbands, are thus murdering their children by thousands through ignorance, they must be taught the truth; but if, as there is reason to believe is too often the case, they have been influenced to do so by fashion, extravagance of living, or lust, no language of condemnation can be too strong.”
VI.—THE EXCUSES AND PRETEXTS THAT ARE GIVEN FOR THE ACT.
I have already stated that in many instances it is alleged by the mother that she is ignorant of the true character of the act of wilful abortion, and in some cases I am satisfied that the excuse is sincerely given; although in these days of the general diffusion of a certain amount of physiological knowledge, such ignorance would seem incredible.
The above is however the only excuse that can be given with any show of plausibility, and even this holds for naught should the case by any chance come under the cognizance of the law, just as would a plea of ignorance of the law itself; it being always taken for granted, that any intentional act implies a knowledge of its own nature and its consequences, be these trivial or grave.
I have stated that in no case should abortion be permitted, or allowed to be permitted, by the advice or approval of a single physician; that in all cases where such counsel is taken, it should be from a consultation of at least two competent men. Submitted to such a tribunal, seldom indeed would the sanction be given.
Ill health would be no excuse, for there is hardly a conceivable case, where the invalidism could either not be relieved in some other mode, or where by an abortion it would not be made worse. The fear of child-bed would be no excuse, for we have seen that its risks are in reality less than those of an abortion, and its pains and anguish can now be materially mitigated or entirely subdued by anæsthesia, which the skill of medical science can induce and should induce in every case of labor. My remarks apply not to first pregnancies alone, when one might expect that women would naturally be anxious and timid, but even to those cases of pregnancy that have been preceded by difficult and dangerous labors.
It has been urged, and not so absurdly as would at first sight appear, that the present possibilities of painless and so much safer delivery, by changing thus completely the primal curse, from anguish to a state frequently of positive pleasure, remove a drawback of actual advantage, and by offering too many inducements for pregnancy, tend to keep women in that state the greater part of their menstrual lives.
Much of the low morale of the community, as regards the guilt of abortion, depends upon the very erroneous doctrines extensively inculcated by popular authors and lecturers for their own sinister purposes.
“One of these, is the doctrine that it is detrimental to a woman’s health to bear children beyond a certain number, or oftener than at certain stated periods, and that any number of abortions are not merely excusable, as preventives, but advisable; it being entirely forgotten that frequency of connection may be kept within bounds, and the times of its occurrence regulated, by those who are not willing to hazard its consequences; that if women will, to escape trouble or for fashion’s sake, forego the duty and privilege of nursing, a law entailed upon them by nature, and seldom neglected without disastrous results to their own constitutions, they must expect more frequent impregnation; that the habit of aborting is generally attended with the habit of more readily conceiving; and that abortions, accidental, and still more if induced, are generally attended by the loss of subsequent health, if not of life.
“This error is one which would justify abortion as necessary for the mother’s own good; a selfish plea. The other is based on a more generous motive. It is that the fewer one’s children, the more healthy they are likely to be, and the more worth to society. It is, however, equally fallacious with the first, and is without foundation in fact. The Spartans and Romans, so confidently appealed to, gave birth probably to as many weakly children as did our own women; that they destroyed many for this reason in infancy, is notorious. The brawny Highlanders are not the only offspring of their parents; the others cannot endure the national processes of hardening by exposure and diet, and so die young from natural causes. But were this theory true even so far as it goes, the world, our own country, could ill spare its frailer children, who oftenest, perhaps, represent its intellect and its genius.”
VII.—ALTERNATIVES, PUBLIC AND PRIVATE, AND MEASURES OF RELIEF.
It may be asked if there is no latitude to be allowed for extreme cases of the character already described; we are compelled to answer, none. If each woman were allowed to judge for herself in this matter, her decision upon the abstract question would be too sure to be warped by personal considerations, and those of the moment. Woman’s mind is prone to depression, and, indeed, to temporary actual derangement, under the stimulus of uterine excitation, and this alike at the time of puberty and the final cessation of the menses, at the monthly period and at conception, during pregnancy, at labor and during lactation; a matter that also seems to have been more thoroughly investigated by the authority I have so freely drawn from in reference to the question of abortion, than by any other writer in this country. During the state of gestation the woman is therefore liable to thoughts, convictions even, that at other times she would turn from in disgust or dismay; and in this fact, that must be as familiar to herself as it is to the physician, we find her most valid excuse for the crime.
Is there then no alternative but for women, when married and prone to conception, to occasionally bear children? This, as we have seen, is the end for which they are physiologically constituted and for which they are destined by nature. In it lies their most efficient safeguard for length of days and immunity from disease. Intentionally to prevent the occurrence of pregnancy, otherwise than by total abstinence from coition, intentionally to bring it, when begun, to a premature close, are alike disastrous to a woman’s mental, moral, and physical well-being.
There are various alternatives to these so degrading habits of the community. To some of them equal objections apply. But, in reality, there is little difference between the immorality by which a man forsakes his home for an occasional visit to a house of prostitution, that he may preserve his wife from the chance of pregnancy, and the immorality by which that wife brings herself wilfully to destroy the living fruit of her womb. Allowing for the weakness and frailty of human nature, the first were surely the preferable of the twain. But we need not compare these odious customs, each so common and each so wrong. With greater frugality of living, and greater self-denial, and self-control in more trivial matters, there need be no interference, at least no intentional interference, on the part of either husband or wife with the first great law of human weal and human happiness, in accordance with which, by the divine institution of home and its mutual joys, the due propagation and natural increase of the species was intended to be insured.
Were well-arranged foundling hospitals provided in all our large cities, they would prove a most efficient means of preventing the sacrifice of hundreds of the children of shame, arid, so far from encouraging immorality, they would afford one of its surest preventives, for by keeping a woman from the crime of infanticide or the equally guilty intentional miscarriage, they would save her from one element of the self-condemnation and hatred which so often hurries the victim of seduction downward to the life of the brothel. A certain amount of illicit intercourse between the sexes will always take place, no matter how condemned by law, until the public standard of morals shall be so elevated as to render the practice unknown. This is a fact that is self-evident, and cannot be frowned out of existence. How much better to provide for its innocent victims, its irresponsible offspring, than, as now, to permit the so frequent destruction of both. It is foolish to assert that by such provision we but pander to sin. In many of these instances the woman is innocent of intentional wrong, being led astray by her perfect confidence in the constancy and good faith of a lover, and in others she is, doubtless, ignorant of the true character of the act she is committing. Should she be driven from what is comparatively a venial, and not so unnatural an offence, to one of the deadliest crimes?
But for the married, who have not this strong stimulus of necessity, and the excuse of having been led astray or deceived, there need be no public channel provided, through which to purchase safety for their children. Is it not, indeed, inconceivable that the very women who, when their darlings of a month old, or a year, are snatched from them by disease, find the parting attended with so acute a pang, can so deliberately provide for and congratulate themselves, and each other, upon a wilful abortion? Here, words fail us.
“Of the mother, by consent or by her own hand, imbrued with her infant’s blood; of the equally guilty father, who counsels or allows the crime; of the wretches, who by their wholesale murders far out-herod Burke and Hare; of the public sentiment which palliates, pardons, and would even praise this, so common, violation of all law, human and divine, of all instinct, all reason, all pity, all mercy, all love, we leave those to speak who can.”
We have now seen that the induction of a forced abortion is, in reality, a crime against the infant, its mother, the family circle, and society; that it is attended with extreme danger, whether .immediate or remote, to the mother’s happiness, to her health, mental and physical, and to her life; that there is, in reality, no valid excuse for it that can be urged, save when it has been decided to be absolute necessity by two competent medical men, and that there are alternatives, such as greater temperance and frugality of living, which, if practised, would be equally for the public and for private good.
We have also seen that not only is abortion wrong, no matter from what quarter we contemplate the act, but so also is the deliberate prevention of pregnancy in the married alike detrimental to the health and to the moral sense, Moderation and temperance here, as elsewhere, afford the golden rule. Under the circumstances to which I allude, total abstinence may, as far as the health is concerned, be as injurious as is the other extreme of excessive indulgence. To the woman in good bodily condition, occasional child bearing is an important means of healthful self-preservation; to the invalid, an intentional miscarriage is no means of cure; if she be in poor health, let her seek aid and relief in the proper quarter, but not by thus tampering with natural and physiological laws, alike imperilling both body and soul.
Were woman intended as a mere plaything, or for the gratification of her own or her husband’s desires, there would have been need for her of neither uterus nor ovaries, nor would the prevention of their being used for their clearly legitimate purpose have been attended by such tremendous penalties as is in reality the case.
We have seen that in a perverted and mistaken public opinion lies the secret of the whole matter. “Ladies boast to each other of the impunity with which they have aborted, as they do of their expenditures, of their dress, of their success in society. There is a fashion in this, as in all other female customs, good and bad. The wretch whose account with the Almighty is heaviest with guilt, too often becomes a heroine. So truly is this the case, that the woman who dares at the present day publicly or privately to acknowledge it the holiest duty of her sex to bring forth living children, ‘that first, highest, and in earlier times almost universal lot,’ is worthy, and should receive, the highest admiration and praise.”
We have seen that it is no trifling matter, this awful waste of human life. It is a subject that demands the best efforts of the whole medical profession, both as a body and as men, whose every relation its members are alike best able to appreciate, to understand, and to advise concerning. “Physicians alone,” says Prof. Hodge, “can rectify public opinion, they alone can present the subject in such a manner that legislators can exercise their powers aright in the preparation of suitable laws; that moralists and theologians can be furnished with facts to enforce the truth upon the moral sense of the community, so that not only may the crime of infanticide be abolished, but criminal abortion properly reprehended; and that women in every rank and condition of life may be made sensible of the value of the foetus, and of the high responsibility which rests upon its parents.”
“If the community were made to understand and to feel that marriage, where the parties shrink from its highest responsibilities, is nothing less than legalized prostitution, many would shrink from their present public confession of cowardly, selfish, and sinful lust. If they were taught by the speech and daily practice of their medical attendants, that a value attaches to the unborn child, hardly increased by the accident of its birth, they also would be persuaded or compelled to a similar belief in its sanctity, and to a commensurate respect.”
We have seen that the above is the deliberate decision of those, from their observation and knowledge of the subject best able to judge. “Whatever estimate may attach to our opinion,” says an eminent medical journalist, “we believe that not only ought these things not so to be, but that the public should know it from good authority. For ourselves, we have no fear that the truth in reference to the crime of procuring abortion would do aught but good. It would appear that sheer ignorance, in many honest people, is the spring of the horrible intra-uterine murder which exists among us; why not thon enlighten this ignorance? It would be far more effectually done by some bold and manly appeal, than by the scattered influence of honorable practitioners alone. Will not the mischief; by and by, be all the more deadly, for delaying exposure and attempting relief?”
We have also seen that “it might be, it very likely would be, for our immediate pecuniary interest, as a profession, to preserve silence; for we have shown that abortions, of all causes, tend to break down and ruin the health of the community at large. But to harbor this thought, even for a moment, were dishonorable.” This subject, at all times so important for the consideration of the people at large, is invested with unusual interest at a period like the present., when, at the close of a long and closely contested war, greater fields for human development and success are opened than ever before. All the fruitfulness of the present generation, tasked to its utmost, can hardly fill the gaps in our population that have of late been made by disease and the sword, while the great territories of the far West just opening to civilization, and the fertile savannas of the South now disenthralled and first made habitable by freemen, offer homes for countless millions yet unborn. Shall they be filled by our own children or by those of aliens? This is a question that our own women must answer; upon their loins depends the future destiny of the nation.
In the hope that the present appeal may do somewhat to stem the tide of fashion and depraved public opinion; that it may tend to persuade our women that forced abortions are alike unchristian, immoral, and physically detrimental; that it may dissipate the ignorance concerning the existence of foetal lite that so extensively prevails; and be the means of promoting the ratio of increase of our national population so unnaturally kept down, the American Medical Association addresses itself to all American mothers; for thus, in the closing words of the essay from which I have so frequently and so freely drawn, would “the profession again be true to its mighty and responsible office of shutting the great gates of human death.”
The following resolution, presented by Dr. Ellsworth Elliott, of New York, was adopted by the Association at the recommendation of the Section on Practica1 Medicine and Obstetrics.
“Resolved, That the Committee on Publication be requested to adopt such appropriate measure’s as will insure, a speedy and general circulation of the Prize Essay on Abortion, provided this can be done without expense to the Association.”
 “The preamble and resolution were signed by Philo Tillson, President, and S. L. Andrews, Secretary, of the Northeastern District Medical Association of Michigan, as having been adopted by that Association, at its annual meeting, held on the 19th day of May, 1864, and which its delegate, Dr. Stockwell, was instructed to present to the Association.”—Trans. Am. Med. Association, 1864, p. 60.
 Now that the decision of the Prize Committee has been made, the purpose of the above stipulation becomes evident. The committee consisted of Drs. D. Humphreys Storer, Henry I. Bowditch, J. Mason I Warren, and John H. Dix, of Boston; the chairman of the committee being the writer’s father.
 The committee consisted of Dr. H. R. Storer, of Boston; T. W. Blatchford, of Troy. N. Y.; H. L. Hodge, of Philadelphia; C. A. Pope, of SL. Louis; Barton, of South Carolina; A. Lopez, of Mobile: and W. H. Brisbane, of Arena, Wisconsin.
 Studies of Abortion, Boston Medical and Surgical Journal, February 5, 1863.
 Percival: Medical Ethics, p. 79.
 Man Transformed, Oxford 1653.
 Regina v. Wycherly, 8 Carrington and Payne, 265.
 Criminal Abortion in America, p. 5.
 Owen: Cyclopaedia of Anatomy and Physiology, iii. p. 322.
 NaegeIe: Treatise on Obstetric Auscultation, p. 50.
 Studies of Abortion, Boston Med. and Surg. Journ., Feb. 5, 1863.
 Criminal Abortion in America, p. 42.
 Essay on Criminal Abortion, p. 42.
 Studies of Abortion, etc.
 Essay on Criminal Abortion, p.106.
 Essay on Criminal Abortion, p. 34.
 Essay on Criminal Abortion, p. 32.
 H. R. Storer: The Causation, Cause, and Treatment or Insanity in Women; a gynæcist’s idea thereof; Transactions of the American Medical Association, vol. xvi., 1865.
 Essay on Criminal Abortion, p. 13.
 A Woman’s Thoughts about Woman. By the author of “John Halifax,
Gentleman.” p. 14.
 Dr. Storer’s Essay, p. 55.
 Introductory Lecture at University of Pennsylvania, 1854, p. 19.
 Essay, etc., p. 101.
 Boston Medical and Surgical Journal, editorial, December 13, 1855.
 Essay, etc., p. 106.
Minutes 1870 Annual Meeting TAMA 21 1870 1 67 35 Odonnell committee on abortion
On motion of Dr. D. A. O’DONNELL, of Maryland, it was unanimously
Resolved, That a committee of three be appointed whose duty
it shall be to represent the evil of criminal abortion in its proper
light, and to take into consideration the best course to be pursued
by the profession in arresting its progress, and in forcing from
our ranks all who now, or may hereafter, pursue this iniquitous
course. And that the said Committee shall report at the next
annual meeting of this Association.
Resolved, That the members of this Association, in expressing
their unqualified denunciation of such persons, are acting in
accordance with the high trust reposed in them, and paying a just
tribute to their individual characters, and to a noble and honorable profession.
Committee—Drs. D. A. O’DONNELL, of Maryland; WASHINGTON
L. ATLEE, of Pennsylvania, and HENRY F. ASKEW, of Delaware.
Dominick A. O’Donnell and Washington Atlee, “Report on Criminal Abortion,” TAMA 22 (1871): 239-58.
REPORT ON CRIMINAL ABORTION.
It is of Divine authority that “the life of man on earth is a warfare;” and if the same authority who enunciated the foregoing sentence could have withdrawn in spirit to other times and to other scenes; if he could have taken a prospective view of the profession of medicine in the nineteenth century; if he could have seen the physician of the present day trimming his midnight lamp, and poring over his dusty volumes, or gleaning information from the periodicals of the day; if he could have witnessed his anxiety and sleepless nights, watching at the bedside of suffering and of death; if he could have followed him in his devious paths by day, through storms and sunshine, seeking to cure or ameliorate disease, or to arrest the march of death—he would no doubt have said that “the life of the physician on earth is indeed a warfare.” He would have encouraged him in his undertaking; he would have pointed to his ultimate reward; he would have said to him, “Go on in the performance of the duties of your laudable and charitable calling; go on in one of the noblest works which God bas ever assigned to man; but beware while you are engaged in relieving suffering humanity, beware while you are engaged in curing the diseases of the body, that you do not convoy poison to the soul.”
To the worthy, to the conscientious, to the honorable physician, this admonition need not be addressed, for he watches over his people as a faithful shepherd would over his flock, and while ministering to the sufferings of both rich and poor with equal solicitude, helpless innocence never fails to receive a large proportion of his care and sympathy. And it matters not what his shortcoming in other respects may be, it matters not what his peculiar tendencies may be, he never loses sight of his sacred calling; he never loses sight of the high trust reposed in him, and regards a violation of that trust as one of the basest sins which could stain the human character. He feels that every act connected with his profession is a service done to God, and is ever mindful not to incur the malediction pronounced in Scripture, “Cursed is he that doeth the work of the Lord negligently.” “Followed up,” says Professor Watson, “in the true and Christian spirit of gratitude towards God and love towards man, this noble profession is second only in usefulness and dignity to that of the servants of the church, and, like it, when faithfully administered, it will assuredly become its own abundant reward.”
But we must not atop here; we must take a more extended view of the subject; we must present the other side of the picture, and there we shall discover an enemy in the camp; there we shall witness as hideous a view of moral deformity as the evil spirit could present. There we shall find a class of men in every respect the opposite of the former; men who cling to a noble profession only to dishonor it; men who seek not to save, but to destroy; men known not only to the profession, but to the public, as abortionists. These men are not confined to any particular locality; their sphere of action is not limited to cities, but to large districts of country. And we may, therefore, say with St. Paul, We are in perils in the city, in perils in the wilderness, in perils in the sea. in perils from false brethren. “Periculis in civitate, periculis in solitudine, periculis in mare, periculis in falsis fratribus.” Yes, it is false brethren we have most to fear; men who are false to their profession, false to principle, false to honor, false to humanity, false to God.
God’s first commandment to Adam and Eve in the garden of Eden was, to increase and multiply—”Crescite et multiplicamini, dixit Dominus;” and so solicitous was he in carrying out his divine object, that certain impresses were stamped on the character of both male and female by which they are brought together, and to purify that union and to render intact and without reproach the parents and their offspring, the institution of matrimony was established. God’s solicitude for his favorite creatures did not stop here; he has taught them those duties, those obligations, which they owe to him, and which they owe one to another. And with a view to the preservation of the race, and to enforcing obedience to his laws, he has issued among other commandments to Moses on Sinai, one which has a special significance in this case; one which has never been repealed, and which will stand when all human institutions will have passed away, as a monument of the immutability of its Great Author, and will hold in terrorem the wicked at the day of judgment—that commandment “Thou shalt not kill” This commandment is given to all, and applies to all without exception. And notwithstanding these safeguards which God has placed around the human family; notwithstanding his promises to reward those who keep his commandments, and his denunciation of all who violate them; notwithstanding all this, we see in our midst a class of men, regardless of all laws, human and divine, regardless of all principle, regardless of all honor, who daily destroy that fair fabric of God’s creation; who daily pull down what he has built up; who act in antagonism to that profession of which they claim to be members. And shall that profession remain silent in view of these evils? Shall they tolerate such a precedent that other men may follow it? Or shall they not rise in their might and strangle this monster in his lair? Or shall they became recreant to their duty, and say—
“Let man take in hand the balance and the rod,
Rejudge His justice—be the god of God.”
In this form the question now presents itself, Shall the profession of medicine assort its supremacy? Shall it purify its own ranks? Shall it regulate its own household? Shall it cast off forever a morbid excrescence which adheres to a noble stock; which stands as a disgrace to the body politic, and must ultimately have a demoralizing influence wherever it can reach, and especially on the younger members of the profession? The question is, Shall God or the arch-enemy gain the ascendency?
And woman, whose high destiny was to be instrumental in propagating the human family; who ought to be the appropriate representative of a refined age, a model of purity, the centre of honor and affection—she descends from her high position associates with these degraded characters, and becomes a participant in the destruction of her own offspring. She becomes unmindful of the course marked out for her by Providence, she overlooks the duties imposed on her by the marriage contract. She yields to the pleasures but shrinks from the pains and responsibilities of maternity; and, destitute of all delicacy and refinement, resigns herself, body and soul, into the hands of these unscrupulous and wicked men. Let not the husband of such a wife flatter himself that he possesses her affection. Nor can she in turn ever merit even the respect of a virtuous husband. She sinks into old age like a withered tree, stripped of its foliage; with the stain of blood upon her soul, she dies without the hand of affection to smooth her pillow.
Such was not the intention of the Deity with regard to woman; such is not the character of her high destiny. Scripture informs us that barrenness was in former days regarded as a reproach; that it was looked upon as a mark of God’s displeasure, and, independent of that natural desire on the part of a married woman, which God has implanted in the human breast, to bring forth a being like unto herself, she has the stimulus imparted to her by the example of the good and virtuous of all ages and all nations. God conferred the highest compliment on Jacob, when he informed him that his offspring would be as numerous as the sands of the sea. And it is recorded in Scriptures as one of His wonderful works that He maketh the barren woman to dwell in a house, the joyful mother of children, “Qui habiture facit sterilem in domo matrem filiorum letentem.”
The Roman matron Cornelia, who was unaided by the light of Christianity, or even by the knowledge of the existence of a true God, could look upon her offspring with pride, and when asked by her lady acquaintance and friend to produce her jewels, she pointed to her children, with the significant remark, “These are my jewels;” and such are the feelings, and such would be the language, of an honest matron of the present day. “These children are my jewels; more precious to me than all the jewels of earth. They are the pride of my youth, and will be the solace and support of my declining years; they are the pledges of a virtuous and honorable affection.”
In referring to the evils produced by abortionists, we are much indebted to the pen of Dr. Allen, of Massachusetts, for some valuable and important information on that subject. This gentleman has written an essay “On Population,” and has made New England, together with the State of New York, the field of his investigations, and it is much to be regretted that we do not find a few more such patient and industrious laborers in this new and interesting field of inquiry. If such an inquiry could be instituted throughout the different States of the Union, and carried out with the same zeal, and the same honest and independent spirit as Dr. Allen has evinced, it would lay bare such a series of facts as would bring the people to feel that there is something of a grave nature, something mischievous, something radically wrong, in their midst. And if the Legislature of each State would enact a law making it obligatory to institute such an inquiry every fifteen or twenty years, it would be found not only that the money would be well spent, but that it would lead to the correction of some of the abuses which are now so fatal to morals and so destructive to human increase. To expose from time to time such a picture to public view would lead to more serious reflection, and would in the end point to the necessity of breaking up those destructive agencies which are now so fashion able among us. Dr. Allen has taken the census as his guide, and it is not likely that, with such a guide, he should have fallen into any serious error on the subject. It was our intention to have condensed some of these facts and to present them in that form, but we have since concluded to give a few paragraphs from his own pen.
Speaking of the population of France, ho says: “It seems from the census and registration of France, that the population of that great nation has become almost stationary, and that the number of births there has been steadily decreasing for the last fifty years.”
He then adds: “A similar class of facts is found to prevail with the descendants of the first settlers of New England. The Puritans were originally a prolific people. They had on an average, for several successive generations, from six to ten children to each married couple, but within the present century the average has dropped down from six to about three, and the birth-rate of the original stock in some cities has even been less than it is in France. Had not the older cities received recruits from the country or additions from the foreign element, their population would have been seriously affected.”
Again, he says: “In the county of New York—which is mostly made up of the city—reporting about one-half of the population as foreign, we find this remarkable fact. While nine hundred and sixty-five American women had each ten children and upwards, there were twenty-eight hundred and fifty foreign women, having each ten children and upwards, making three times as many. The compiler of this census states that he is convinced that there is at the present time no increase of population among the descendants of the first settlers 0f the State of New York.”
The doctor further adds: “There is another class of facts gathered by way of comparison, which is somewhat curious and difficult of solution. If we compare the number of children born by the strictly American, with that of the Irish, the Scotch, the English, and the German, the difference is surprising. We find that the latter, both in Europe and in this country, have, on an average, two if not three times as many as the former, even though both classes may live in the same locality and under the same general influences.” Again, “if we make the comparison between the present generation in New England, and their ancestors living one hundred years ago, we find that the number of children at that period averaged two or three times as many as in the same number of families at the present day. Here the comparison is made between a people of the same stock, living on the same ground, under the same climate and free institutions.”
After alluding to various causes assigned by different writers for such changes in the population of a country—which causes he rejects as not applicable in this case—he goes on to say: “The only remaining cause, ‘prudential considerations,’ cannot be passed over so lightly. These have had their influences in a great variety of ways; in postponing marriage till a later age in life; in regarding the care and expense of children as a burden, as well as in preferring pleasure and fashion to domestic duties and responsibilities. To such an extent has this ‘prudence’ been carried, that a great variety of means have been adopted to prevent conception, and in case of pregnancy to produce abortion. This practice has been carried on so extensively as to affect somewhat the increase of population—partly by its direct but more indirectly by the injury to the health and constitution of its victims. But passing by for the present the deep criminality and fearful extent of this practice, why should such a crime become so prevalent in all classes of society—even with married women—among the intelligent, the refined, and the religious? Why, too, should the natural instincts of women be so changed in regard to offspring? Why should so low an estimate be placed upon the value of human life? Why should such a persistent effort be made to defeat one of the most important objects of the marriage institution, and that by a party of all others most deeply interested? Surely there must have occurred some radical change in the organization of woman to account for such an unnatural disposition, as well as for this great decrease of population from preceding generations. No such facts can be found in the history of any other civilized people, race, or nation on the globe.”
In reviewing the first paragraphs quoted from the valuable essay of Dr. Allen, we find an evidence of such changes in the population of New England and that of the State of New York as is well calculated not only to surprise, but to excite alarm; and if the same inquiry were instituted in the other States of the Union, we know not where a limit would be found to the progress of this evil. In the last paragraph quoted, it is plain to the view of the most skeptical that in the “prudential considerations” referred to, together with the operations of abortionists, etc., will be found the causes— the fons et origo—of all those evils. The doctrine is now pretty well established that the character of the offspring depends physically and to a certain extent morally on that of the mother—that during their intra-uterine life the physical developments of the mother are imparted to the children, and that soon after birth those characters become manifest. Now, as Dr. Allen has in another place given us a perfect representative of the human family in the following words, and holds out such a one as best suited for the propagation of the species, we must see in what way man has so far degenerated as to be no longer capable of coming up to the normal standard. He says, “The human body in its normal or most healthy state may be compared to a perfect machine made up of a great variety of parts, each part performing its own work and not interfering with that of the others, so that the ‘wear and tear’ will come on all parts of the machinery alike.”
We must inquire in advance, Can the human constitution, as above described, exist for a long time in its normal condition under the circumstances above alluded to? Can this harmony and correspondence of action exist long in a community where the laws of nature are every day violated? Where the laws of God in carrying out the object of creation are set at defiance—where the very sources of life are invaded by the rude hands of the destroyer?
Taking, however, the above as the type and the standard by which the human family is most likely to be propagated in its fullest perfection, let us inquire further what has been the cause of the present falling off from that standard. In looking to the causes referred to in such cases, we can point only to two which deserve a notice—war which lasted for a few years. and “prudential considerations” with their train of evil attendants—abortionists, etc. It must be remembered that the evils now complained of are not the work of a day—that they have been progressive in their march for the last fifty, perhaps a hundred years—that their growth has been constant and persistent, and that it has at length resulted in the most important and startling revelations: and to the industry and independence of Dr. Allen, the public and the profession are indebted for a knowledge of these facts. It is well established that involuntary abortion, being the result of internal derangement, or disease, or accident, seldom occurs without doing serious mischief to the constitution either locally or generally, and it is maintained by many that labor at full time, being a natural process, does not affect the general health as much or as severely as the former. If such be the fact, and we are sustained in that opinion, what must be the result in the case of her who must pass through the rude hands of an abortionist, the paid assassin, who, being capable of taking the life of her offspring, can have little sympathy or regard for the well-being of the mother except so far as he may be influenced by the fear of a criminal prosecution. The damage is not confined to the innocent and unoffending victims sacrificed in this way. Besides the probable destruction of the life of the mother as we have witnessed, her system under the most favorable circumstances receives a shock from which it is not likely to recover in after times—producing barrenness in some—in others, if they should have children, those children must bear the impresses of the mother, and thus a race formerly strong and vigorous must soon degenerate and wear out. Imagine the effect of such a course on a people, kept up for several successive generations, and our philosophy need carry us no further—we see in that fact the seeds of decay. If the parents inherit an impaired or diseased constitution, the effects of such weakness or disease must descend to their children and to their children’s children (if they have any, and so on ad infinitum. If the root become diseased, that disease must sooner or later extend to the branches.
The question is often asked, Why are young women more virtuous in certain respects than men? And the answer is frequently given, that the dread of exposure restrains the other sex in this particular. Without stopping to argue this question, and without admitting its correctness, we must view from a moral stand-point the influence which the presence of abortionists must have on the youth of both sexes—at least on the ill-disposed of them—from the time they are capable of sinning until they are married. Admit ting, for argument sake, the fashionable view that young females are restrained from sinning owing to the fact that they dread detection and exposure, what will be the effect when they are informed that this restraint is removed—that exposure is no longer a necessary consequence—that the timely interference of an abortionist will remove all such danger and do away with all such unnecessary scruples. Is not a bad motive better than none at all? And if they are restrained from sinning even by fear of exposure, they also avoid the horrid crime of fœticide, which, according to their views, must necessarily follow. And with such a barrier removed and such restraints done away with—where all is passion and no sense of moral responsibility—what must be the result to them and their progeny? Such are the causes of late marriages and the results of such marriages.
Prof. Hodge, of Philadelphia, thus writes: “We blush to record the fact that in this country, in our cities and towns, in this city, where literature, science, morality, and Christianity are supposed to have so much influence, where all the domestic and social virtues are reported as in full and delightful exercise, even here individuals, male and female, exist, who are continually imbruing their hands and consciences in the blood of unborn infants.”
Taking a comparative view of fœtal deaths between Paris and New York, we quote from Swayne’s work, with additions by Dr. Hutchins. The writer remarks: “If we compare New York city with Paris, we shall find that” the ratio of fœtal deaths to the population has swollen from one in 1633 in the year 1805 to one in 340 in 1849, while in France in 1851 there was only one in 1000. We shall find, secondly, that the fœtal deaths, as compared with the total mortality, have increased from one in thirty-seven in 1805, to one in ten, rejecting fractions, in 1868. And thirdly, that the reported early abortions, of which the greater number escaped registry, bear the ratio to the living births of one in four, rejecting fractions, while elsewhere they are only one in seventy- eight.
It is not a little surprising that at this late date in the nineteenth century; in these days of boasted civilization, of science, and literature; in these days of steam navigation, railroad travel, and telegraphic communication—that we must, notwithstanding these and many other advantages, look to days gone by for examples of that which, above all others, should interest us most—a proper appreciation of human life. Why is it that man places so low an estimate on that which God values so highly? Why is it that infanticide is regarded as one of the highest crimes known to the law, and is punished with death; and that fœticide—that the unborn child, having as good a right to life as the former, is daily sacrificed (and with the consent of the mother), by the rude hands of an abortionist, and yet the penalty for the latter crime is limited to a fine and a few years’ imprisonment in the penitentiary. That the views of the public on this subject are not such as they were in former days is clear from the foregoing facts, as will be more fully shown hereafter—otherwise this wholesale destruction of unborn infants would not be tolerated.
The idea has become so fashionable, and is so well suited to the tastes of the ill-disposed, that up to a certain period of utero—gestation the fœtus is not endowed with vitality, that they seem to have found in this doctrine a cloak for their guilt—a solace for their crimes. It is true that on this subject there are two theories, only one of which can be correct. But it matters not which view is taken, nothing can justify the destruction of the fœtus. By some it is supposed that at a certain period after conception, at a certain stage of development of the human embryo, a second conception takes place, or, in other words, that God, as in the case of Adam, breathes into it a living soul, and that from that period the presence of that soul, or life, becomes manifest.
The other and the more rational view is, that God by His eternal “fiat,” at the moment of conception, creates and breathes into the product of that conception a living soul, and that that soul under the same general law and guidance inhabits its frail tenement until by its appropriate nourishment that tenement has assumed definite proportions to enable it (the new being) to move and give other evidences of life.
This view is not only rational, but it seems to accord with the economy of God in other respects.
Those who entertain the former doctrine do not reflect that all nature is endowed with its appropriate kind of vitality, animal or vegetable. They do not reflect that in the acorn there is a germ which, being placed under favorable circumstances, will give rise to the lofty oak. They do not consider that the grain of wheat when placed in contact with soil, heat, and moisture, will soon begin to show signs of vitality; but they deny the human embryo all claims to these vital principles which they see in the vegetable kingdom, and simply because no motion is discernible up to a certain period. Are we not all aware of the fact that vitality exists in a dormant state? Have we not beard much of suspended animation where the signs of life had disappeared even for a long time, and yet the soul was retained in that body, as was evinced by the recovery of the patient? Who that has witnessed a patient in the collapsed stage of Asiatic cholera will ever become skeptical on a question of this kind? There, when the poor frame becomes exhausted; when it is no longer capable of experiencing pain or suffering; when the eyes become atrophied and sunk in the sockets; when the face has assumed its worse than Hippocratic appearance, shrunk, blue, and emaciated; when the pulsation of the heart and arteries is nowhere discoverable, and where speech, motion, and consciousness are suspended, and yet the soul remains in that body, perhaps trembling on his lips, and thus it may remain for a considerable time before it can take its flight to eternity. Has not every man of experience in his profession seen cases of stillborn children in whom for a long time no life was manifest, and yet under suitable appliances they at length breathed and moved and lived? Here was life and no motion; here were souls. It matters little, however, what view may be taken of this subject, or what stage of development the embryo may have reached, it is to be the man of other days, and is more entitled to life than he who meditates its destruction.
I quote from a work of Dr. Barry, of Kentucky, on embryology, who thus writes: “St. Basil did not wish that a distinction should be made between the animate and inanimate fœtus, because be considered that the soul was created just at the moment of conception. Zachias, Dr. Debreyne, and Dr. Rossan, and indeed all distinguished modern physiologists, have concurred in this opinion. It is no more difficult for God to create the body and the soul simultaneously, than to create one after the other; and although we cannot perceive in the human ovum traces of organization for a little time after conception, it appears to us that we should not thence conclude that a homoncule does not exist in it. It is not repugnant to our understanding to admit that at the moment of conception, the liquid molecules destined to form the new being do aggregate in such a manner as to constitute a body, which does not become sensible to us, until by nutrition it has acquired some consistence. Neither is it repugnant to admit the immediate animation of the new liquid or gelatinous body.”
If the life of man,” says Dr. Debreyne, “ceases immediately on the separation of’ the soul from the body, we may believe that it commences as soon as the soul becomes united to the body, whatever may be the smallness or rudimentary form of the latter. Now as soon as the ovum is fecundated, a result which takes place as soon as the generative act is completed, it grows; it does not grow, but because it is animated at the very moment of conception.”
Passing by, for the present, the many proofs and authorities which might be adduced to sustain these views, we shall barely allude to that negative evidence to the contrary, which females with their evil abettors regard as conclusive, that life does not exist in the fœtus because no motion is felt. We would ask how many organs are in active operation in the female system, each one performing the office assigned it, and all combining to form a perfect whole, and yet who has ever felt these operations or motions going on within her, or who ever thinks or is conscious of their existence unless her attention is called to it by disease or by the instruction of some itinerant physiologist.
Again, it may be asked, what amount of motion may exist in the uterus, or how long such motion may continue, surrounded as the embryo is by the liquor amnii and its investing membranes and yet no such motion be communicated to the nervous centres of the mother?
I here quote from “Archbold’s Criminal Practice and Pleadings,” 2d vol., page 96. He says: “It was generally supposed that the fœtus becomes animated at the period of quickening; but this idea is exploded. Physiology considers the fœtus as much a living being immediately after conception as at any other time before delivery, and its future progress but as the development and increase of those constituent principles which it then received. It considers quickening as a mere adventitious event, and looks upon life as entirely consistent with the most profound fœtal repose and consequent inaction. Long before quickening takes place, motion, the pulsation of the heart, and other signs of vitality, have been distinctly perceived, and, according to approved authority, the fœtus enjoys life long before the sensation of quickening is felt by the mother. Indeed, no other doctrine appears to be consonant with reason or physiology but that which admits the embryo to possess vitality from the very moment of conception.”
It is a remarkable fact that the further we advance in civilization, and what the world calls refinement, of the present day, the further do we recede from the main object which should be the end and aim of the institution of all good governments—the well-being of the human family and the preservation of human life. For within our own memory the time was when fœticide or criminal abortion was little known and seldom heard of in this country, and to the latter part of the nineteenth century is due the establishment and the spread of this—the greatest curse which could befall the human family; and it matters not in what way we turn our attention or in what way we direct our footsteps, whether in towns or in cities, the same extensive, wide-spread evil is everywhere to be found, decimating the human family. This will be a glorious legacy for the enlightened profession of medicine of the present day to bequeath to their successors, and so on to the end of time—for if this curse cannot be controlled now, it is not likely ever to be reached hereafter. It becomes a national sin, and national sins merit and may receive national punishments. Look at the once powerful, magnanimous, chivalrous France, now humiliated, blooding, and prostrate at the feet of a relentless fœ.
These modern Herods, like their prototype, have a summary mode of dealing with their victims. They perform the triple office of Legislative, Judiciary, and Executive, and, to crown the tragedy, they become the executioners. They seem impatient for the sacrifice; the “fiat” goes forth, and those innocent and helpless victims are not permitted ever to breathe that vital air which God in His providence has destined for their use in common with the rest of the human family. Their resting-place is rudely invaded, and that which would grow and ripen into manhood is out off from existence by the hand of an educated assassin. Mark the monster as he approaches his work! With a countenance which generally characterizes the movements of the interior—which serves as an index to a corrupt heart, he stands by the bedside of his victim, with poisoned cup or instrument in hand, ready to proceed to the work of destruction. Does any compunction assail his corrupt soul, as he gazes on the field of his labors? Does be measure the extent of the foul deed he is about to commit? Or does he not fear that the uplifted hand of an avenging God will suddenly fall on his guilty head? No; Judas-like, he solaces himself with the prospect of thirty pieces of silver, and this forms the climax of hi aspirations!
But, as is found in many other cases of murder, there is no extenuating circumstance here that can change or modify the character of his guilt. As in ordinary cases of murder, there is no anger to prompt him to the deed, no wrongs to be avenged, no jealousies to be appeased. These he cannot point to as extenuating circumstances, and it matters not at what stage of development his victim may have arrived—it matters not how small or how apparently insignificant it may be—it is a murder, a foul, unprovoked murder; and its blood, like the blood of Abel, will cry from earth to Heaven for vengeance. This being is destined by Providence to be the man of other days, the “homo est qui futurus est.”
The penalties inflicted for the commission of this crime varied in different nations and at different times. In France, up to the beginning of the nineteenth century, fœticide, like infanticide, was punished with death, and all who aided or abetted in the crime were sentenced to twenty years in chains; and by a later law, mothers who produce abortion in themselves are sentenced to close confinement, and practitioners of medicine who become accessory to this act are condemned to hard labor.
In England, the statute of George the Third makes it a capital offence to cause the miscarriage of a woman quick with child, and felony of a mitigated character to cause a miscarriage before quickening. Early in the nineteenth century a law was passed, under the auspices of Lord Ellenborough, then Chief Justice of the King’s Bench, declaring that any person wilfully or maliciously taking or administering any medicine or using any instruments with intent to produce miscarriage of any woman before quickening, and all counsellors, aiders, and abettors, shall be declared guilty of felony, and shall be liable to fine, imprisonment, public whipping, and transportation for a term not exceeding fourteen years. The same act also provides that if the same was done after quickening, it should be punished with death.
By a subsequent act under Victoria it was declared that any one committing this crime, whether before or after quickening, shall be transported beyond the seas for the term of his or her natural life, or for any term not less than fifteen years, or to imprisonment for any term not more than three years.
It is much to be regretted that these enactments have been adopted in a modified form throughout the different States of this Union, and we are under the impression that if more rigorous laws were enacted and enforced, a check would soon be given to the progress of these evils.
We must now turn our attention to the most important question connected with this most important subject, and see what can be done towards arresting the progress of this horrid crime. We have heard much of late in relation to cruelty to inferior animals, and in many of the States of this Union societies are formed whose sole object is to watch over and to bring to justice those who violate this very humane law. We would ask these philanthropists, while engaged in so laudable an undertaking, if it has ever occurred to them that in their midst it is of daily occurrence that men—aye, and women too—arc presenting their poisoned cups and using their stilettoes to spill the blood of human victims, to take the lives of innocent, of unborn infants, and thus retard the growth of the human family—in other words, that there are murders, foul, unprovoked murders, daily committed among us, and no one to take cognizance of the fact. We have heard and read much of barbarous nations where human victims were offered in sacrifice, and while we deplore and severely condemn such a proceeding and such infatuation, we seldom (if ever) think of the sacrifices offered by our modern high-priests, the abortionists. We hear much of the wonderful feats of detectives in our large cities, in restoring ill-gotten goods, in making “descents on gambling saloons” and other improper places; but is there anything done towards breaking up those wholesale shambles where human victims are daily sacrificed, or is there anything done towards arresting the principals or their accessories in their guilt?
If the authorities were called upon to look to these matters and bring to justice a few of the guilty ones, much good might be done in arresting these evils.
The future of the profession of medicine in this country, and the character of that profession, will depend on the course pursued by private and public teachers of the present day. The professors in public institutions, especially, hold a high and responsible position. The same legislatures which granted them power to teach and to confer degrees, bestowed on them at the same time a judicial office or authority to decide between the candidates for professional honors and the people, and on the faithful performance of that duty depend the health and lives of the community. These professors are particularly solicitous, each in his own department, to place before his class all the important facts and useful information connected with his subject. In telling them what they are to do, is it not right that they should also point out to them what they shall not do? Shall we at this advanced period in the nineteenth century continue to boast of the advancement of the medical science, and yet have to admit that in point of morality we are retrograding? Is it necessary that at this late date we should be reminded of the lesson which the great father of medicine taught his students before turning them into society? Hippocrates required of them, under oath, not to use certain drugs made use of by Aspasia—because those drugs had the effect of producing abortion. If our professors of the present day are unwilling to subject their students to this ordeal, is it not at least necessary that some instruction should be given to them on this subject? Five minutes devoted to the subject in question by each professor every session, denouncing this crime, would make such an impression on the minds of his students as would not be effaced during the short period of the longest life. And though they might not succeed in correcting all the evil tendencies with which they have to deal, yet, by placing before them this crime in all its hideous deformity—in its legal and moral aspects—together with the inevitable ruin to character which must follow, we cannot doubt that a most favorable impression would be the result. Under all circumstances, they would have the consciousness of having done their duty to their students, to their profession, and to the community. But to turn out on the public young doctors without principle, without. a sense of moral responsibility, without the instruction necessary to guide them safely through a professional career, is to entail a curse on society, which does not die with their natural lives, but may descend to other times and to other generations. If the peace and good order of a community depend on the purity of the judiciary and the faithful execution of the laws, is it less necessary that they to whom is intrusted the guardianship of the health and lives of the people should in the performance of that duty stand, like Cæsar’s wife, above reproach, above suspicion?
To the clerical gentlemen of all denominations we must look for, and will not be disappointed in receiving, essential aid in this undertaking. To them in a special manner is assigned the duty of reclaiming the wicked and protecting the innocent; and it will be regarded as a pleasure, as well as their duty, to instruct the former, and impress on their minds a sense of that moral responsibility which alone can guide the weak and correct the evils of which we are speaking. For although we must guardedly avoid all allusion to such subjects in presence of unmarried persons of both sexes, yet the judicious clergyman may assemble the married ones together, and there warn them against the wolves that lie in wait for them. Here the horrid crime of fœticide may be represented to them in all its dangerous consequences to both soul and body—bearing in mind that text of Scripture: “Take heed that you despise not one of these little ones.” “Videte ne contemnatis unum ex his pusillis.” So general and wide-spread has this crime now become, that married women, especially, either know too much or have heard something connected with the subject, and it is only necessary to strike at the root of the evil by showing, by pointing out in a proper manner, their moral responsibility and the nature and enormity of this crime, and by representing in a suitable light the characters of the men who would encourage or engage in it.
By pursuing a similar course with regard to married men, their views and their conduct may be so far corrected as greatly to aid in the suppression of this horrid crime. A lesson may be here taught by referring to 38th chapter of Genesis, 10th verse, which we forbear to quote here.
If a deputation from each medical society were appointed to visit every clergyman within their respective districts, “this ball would soon be put in motion,” and kept in motion until every abortionist, male and female, would be driven from the land. It was in this way temperance societies were got up; a very laudable and important undertaking, but certainly not as much so as where human life is at stake. By a united effort of this kind, by establishing a crusade against those characters, they would find such a storm raised around their heads as would lead them to a proper appreciation of their position before the profession and the public.
In the seventeenth century the plague visited Marseilles, and so virulent was the poison, and so fatal was it in its course, that it was styled “the black death.” So little was understood by the physicians of that city with regard to its pathology and treatment, that one of them, more zealous than the others, hoping by a post-mortem examination to be enabled to enlighten his brethren of the profession on the subject, and thus benefit mankind, determined on making the experiment. He accordingly, with scalpel in hand and all the appliances necessary to commit to paper the result of his investigations, entered the dissecting-room, which to him was to be the chamber of death.
Now it is not a plague that we are called upon to treat, nor is it necessary to sacrifice our lives in the undertaking, but when we witness such zeal, such heroic self-sacrifice as this, can we hesitate to make some comparatively small sacrifices for the good of the human family? The plague, though dangerous and fatal in its course, had certain limits assigned to its extension, but the evil with which we have to deal is not confined to a city or to any particular district of country; its march is onward, its increase is progressive with the increase of population, its boundaries are marked only by the limits of this hemisphere, and, if not checked soon, time alone can tell the extent of the ruin which must result to the human family.
Patrick Henry, a name so well known to the readers of American history, having seen, on the one hand, the broken faith of, and continued encroachment on the rights of the people by, the British government, and, on the other, observing the apathy and luke-warmness of the colonists on hearing of the arrival of British forces on the American soil, in a speech in the Virginia Assembly, uses the following language: “Gentlemen cry peace, peace; but, gentlemen, there is no peace, for the British are marching upon us.”
It is true, we have not in the present case a British army to meet. We have no foreign enemy to contend with, but we have a domestic enemy, and that enemy is in our midst; it surrounds us; yes, we have an unprincipled, an insidious, an unmitigated fœ to deal with, an enemy to the human family, as dark and as malignant as the spirit that sent it, and it now becomes us to do our part faithfully towards God in this matter, to crush the monster, and to place the profession right before the public. For it is at this late date in the nineteenth century a doubtful question whether or not the profession of medicine, with all its boasted intelligence, with all the aids and appliances which science and art can bestow—it is doubtful, with such a disgusting caudal appendage as the abortionist attached to it, whether that profession is an advantage or a disadvantage, whether it is a blessing or a curse, to the human family. And we are not a little surprised and sometimes annoyed to hear language from respectable members of our profession which sounds to us like that used by the friends of Patrick Henry. If, as in the case referred to, a British army were landed on our shores, how soon an opposing one would be raised to meet it! Every man would be at his post, every advantageous point of attack would be selected; the question would not be asked, “what can be done?” but “go to work and do it,” such would be the war-cry. The abortionists are more destructive to human life than ten British armies; but there are few to raise their voices in behalf of helpless, uncomplaining, unborn children. If our private interests were at stake, how quickly each one of us would seek the intervention of law, and thus assert his rights! But even law has failed to protect helpless innocence, the pulpit has never taken hold of the subject in the proper manner, and it now becomes the duty of the medical profession, as guardians of the health of the people, to take the matter in hand, and if they stand forward with a determined will and united front, they cannot fail to accomplish their object.
Every practising physician in the land (as well as every good man) has a certain amount of interest at stake in this matter. Every physician, as far as his practice extends, should feel that in his professional department he is the shepherd of his flock, and it becomes his duty to see that those wolves in sheep’s clothing should not make any inroads among them. The members of the profession should form themselves into a special police to watch, and to detect and bring to justice these characters. They should shrink with horror from all intercourse with them, professionally or otherwise. These men should be marked as Cain was marked; they should be made the outcasts of society. If an epidemic, if the Asiatic cholera were again to visit our shores, or the yellow fever should prevail to a great extent in any of our large cities, the medical profession would at once be aroused from their slumbers, all their energies would be called into play, every effort would be made, every engine would be set to work, to cure the disease or limit its extension; and yet these monsters of iniquity are permitted to stalk abroad in open day, carrying worse than contagion with them, poisoning wherever they are permitted to touch, invading the very sources of life, and fattening on the blood of their victims. And yet the profession of medicine remains inactive—that profession which is styled an honorable one; that profession so far-famed for its charity and benevolence, whose mission on earth is to do as much good and as little evil as possible to the human family—that profession, in the face of these evils, tolerates in its midst these men, who, with corrupt hearts and blood-stained hands, destroy what they cannot reinstate, corrupt souls, and destroy the fairest fabric that God has ever created, and yet all this is done under the ægis, under the cloak, of that profession.
It is time that the seal of reprobation were placed on these characters by all honest men; it is time that respectable men should cease to consult with them, should cease to speak to them, should cease to notice them except with contempt; and we are inclined to think, if such a course be pursued towards them, they will soon be induced to seek another locality, where they will find it to their advantage to pursue a more honorable course.
If in the foregoing report our language has appeared to some strong and severe, or even intemperate, let the gentlemen pause for a moment and reflect on the importance and gravity of our subject, and believe that to do justice to the undertaking, free from all improper feeling or selfish considerations, was the end and aim of our efforts. We had to deal with human life. In a matter of less importance we could entertain no compromise. An honest judge on the bench would call things by their proper names. We could do no loss.
In conclusion, your Committee would offer the following:—
Resolved, That we repudiate and denounce the conduct of abortionists, and that we will hold no intercourse with them either professionally or otherwise, and that we will, whenever an opportunity presents, guard and protect the public against the machinations of these characters by pointing out the physical and moral ruin which follows in their wake.
Resolved, That in the opinion of this Convention, it will be unlawful and unprofessional for any physician to induce abortion or premature labor, without the concurrent opinion of at least one respectable consulting physician, and then always with a view to the safety of the child—if that be possible.
Resolved, That we respectfully and earnestly suggest to private teachers and professors in public institutions the propriety of adopting, according to their judgment, the means best suited for preserving their pupils, and those who may hereafter come under their care, from the degrading crime of abortion.
Resolved, That we respectfully call the attention of the clergy of all denominations to the perverted views of morality entertained by a large class of females—aye, mind men also—on this important question, and the ruin which has resulted and continues to result daily to the human family from such views.
Resolved, That we respectfully solicit the different medical societies, both State and local, to send delegates to the clergymen in their respective districts to request their aid in so important an undertaking.
Resolved, That it becomes the duty of every physician in the United States, of fair standing in his profession, to resort to every honorable and legal means in his power to crush out from among us this pest of society; and, in doing so, he but elevates himself and his profession to that eminence and moral standard for which God has designed it, and which an honorable and high-toned public sentiment must expect at the hands of its members.
D. A. O’DONNELL,
W. L. ATLEE,
Edward Hazen Parker, “The Relation of the Medical and Legal Professions to Criminal Abortion,” TAMA 31 (1880): 465-471.
TILE RELATION OF THE MEDICAL AND LEGAL PROFESSIONS
TO CRIMINAL ABORTION.
By EDWARD H. PARKER, M.D.,
Within a few years, in one of the counties of the State of New York three cases of attempts to produce criminal abortion have been brought to light, and I propose to make them the occasion for some observations upon the relations of the two professions of medicine and law to this crime.
Case I. A physician was called to see a young unmarried woman suffering from a profuse uterine hemorrhage. On his inquiring as to what was the matter, she at once said she was having a miscarriage. What brought it on? Dr.______ operated for the purpose. Her lover also said that he took her to the doctor’s office, and paid him for his services. The operator had left town, and so she had to be cared for by others. The medical attendant at once put himself in communication with the proper law officers, and followed their directions. The girl recovered. Her affidavit was made as to the facts in the case; the doctor and the lover were arrested; a hearing was at once given them before a justice. The counsel for the accused was allowed to bully and coax the girl into n series of statements entirely different from those of the affidavit, and the accused were at once discharged.
Case II. A woman, supposing herself to be pregnant, submitted to an operation by an ignorant and blind woman for the purpose of producing an abortion. Immediately after the operation the patient complained of intense abdominal pain, was nauseated, grew rapidly worse and died in four days. A coroner’s jury (the coroner was a medical man) heard the evidence of another woman who was present at the operation, and saw a metallic instrument passed under the bedclothes and soon withdrawn covered with blood, and who also was with the patient till she died; heard the evidence of the physicians who made the post-mortem examination that there had been no pregnancy, and that the fundus of the uterus had been perforated by some instrument which caused a fatal peritonitis; and brought a verdict in accordance with these facts. The coroner committed the operator. The grand jury brought in two indictments against her. When the indictment came to trial, the woman who was present at the operation did not appear to be in the court room, though site arrived a few minutes later, and the judge ordered the prisoner to be discharged. Having been again brought to trial on the other indictment, her counsel argued that she could not be put in jeopardy of her life twice for the same offence, and the judge again ordered her to be discharged.
CA SE III. A young woman, finding herself illegally pregnant, had an abortion produced by a doctor. Being very ill and supposing she was about to die, she made an ante-mortem statement of the facts, and gave the names of the man and of the doctor. She finally recovered. Under the promise of immunity to herself and her lover they consented to give their evidence, and the doctor was tried, convicted, and sent to the State prison. Before half his term had expired he was pardoned by the governor—or rather, to use the language of the pardon clerk, the governor “ Commuted his sentence from four years to two years with deductions.” The pardon clerk also writes as follows: “Both the judge and the district attorney have written favor ableletters in the prisoner’s behalf.” Copies of these letters are in my possession, and the material points of them, for my present purpose, are as follows: The district attorney says: “Referring to yours of _____ date, A. B. was convicted on the testimony of C. D., the girl upon whom the miscarriage was produced, and of E. F., who was the girl’s friend, and was present when the operation was performed, and procured the same to be done. The girl was sick but a short time, but during her illness disclosed when, where, and why the miscarriage was produced. A. B. has been a physician in this city during my residence here, and for a long time before, and this is the first offence to my knowledge. He lived in the outskirts of the city and was rather a quiet man, and as I never had any occasion to employ him as a physician, and never heard him discussed much, I cannot say anything about his character previous to his conviction, except that he was a peaceable, inoffensive, and orderly citizen. After his trial, and during his trial, he was very much affected, and appeared to me more than ordinarily concerned about his unfortunate condition.”
The judge writes as follows “A. B. is a farmer’s son, with good abilities, and fair education. He somehow has got down in life, and is very poor. The person on whom he practised was a young girl. She suffered her condition to continue until very advanced state of pregnancy, and then insisted on the abortion being procured, against the advice of the father of the child, against all representations of danger; and, notwithstanding the young man offered to marry her, she still insisted. The young man made application to A. B., and he, in an evil moment, yielded. The operation nearly resulted in the girl’s death, but she finally recovered. I have not learned of any other offence against the doctor.” After a brief reference to the convict’s relations, the judge adds: “If the governor could see in this statement anything which would induce him to pardon the convicted person, I should be very grateful, as it will relieve people from a sharp disgrace, in some measure.”
Now, if we analyze these cases in the relations of the two professions to them, we find that the medical profession is to be credited with two of the operations, but that it is to be credited with the efforts to bring all three criminals to justice. The legal profession is to be credited with a conviction in Case III., and to be charged with the escape of the guilty parties in Cases I. and II., as well as the discharge of the one convicted before he had served out half his term.
But let us examine these three cases a little more minutely. In Case I. the law officer, by including the doctor and the young man in the same indictment, closed the mouth of the latter, so that he could not be used as a witness. The only admissible evidence, then, was that of the young woman herself, and she was willing enough to shield both. It was no matter what she had told others; so long as she lived their testimony could not be used. The accused person in this case escaped by the blunder (whether stupid or adroit I cannot say) of the law officer.
In Case II., where the prisoner was charged with causing death of a woman--stabbed, in fact, just as much as if a dagger had been plunged into the body—the prosecuting officer was so heedless as not to have taken care that his principal witness was in court; and the judge did not consider it important enough to delay the business so long as is often done, when the dispute is only about the soundness of a horse.
Case III. Is so plain that it goes to the jury, conviction follows, and the sentence of four years is the penalty; but when a year and a half had passed, the prisoner is liberated by order of one lawyer—who happens to be the governor—and with the consent, if not recommendation, of the prosecuting officer and judge who tried him.
Now, it is not at all my intention to throw any blame upon governor, judge, or district attorney, personally. They are all men of ability and excellent standing, who cannot for a moment be supposed to be influenced by any unworthy motives; quite the contrary. But they are all lawyers, and seem to me fairly to represent the prevalent feeling of their profession as to this crime.
That posit ion is apparently this—that the crime is against the mother mainly, it not entirely, and that the death of the foetus in utero is an unimportant affair. The judge in his letter seems to make a point against the girl that “she suffered her condition to continue until a very advanced state of pregnancy,’’ not remembering, perhaps not knowing, that she thus increased her own chances of recovery.
The district attorney also says, “the girl was sick but a short time” in a sort of apologetic manner. Nowhere does the destruction of the foetus come into consideration, so far as we can judge.
This peculiarity of the legal profession arises, I apprehend, from the old notion of “quickening,” as representing some mysterious change then occurring which places the child in a different condition. We know that the phrase “quick with child” occurs in different laws, and some penalties for crimes committed by a woman in the condition described by these words are delayed in their execution. This “quickening” is simply the recognition by the mother or others examining her, of motion on the part of the chiId in utero. Feeble at first, the motion increases, till it sometimes seems as if the young child were about to leap into the world through the thin abdominal walls rather than to wait for the more tedious passage per vias naturales.
The teachings of the medical profession are, under the more careful physiological studies of the last hundred years, that the old notion of quickening is absurd and false; that there is no time from the moment of conception to the moment of birth when the fetus is not a human being; and that its life is as sacred at one period as at another. Quickening, which may occur earlier or later as the child is vigorous or not, also depends in a measure upon the sensitiveness of the mother to feeble motions, one noticing them earlier than another. A child that may not be killed the day after it is born, can no more properly be killed the day before it is born—unless it be to save the mother, who is in imminent jeopardy, and when no other course is practicable. Indeed, it is claimed by some that the living child in utero, whose passage into the world alive is impossible by the natural passages, has the right to have the mother’s life imperilled [sic] by the Cæsarean section that it may have a chance of escape. But if the child may not be sacrificed the day before its birth can it be at any prior day? in the ninth month of gestation? or in the eighth month? or in the seventh? or when? From conception till the close of a life rounding its three score years and ten, physiology shows that the same individual exists, with no more distinctive periods which allow its life to be law lawfully taken before birth than occur during its extra-uterine life.
The medical profession also knows that abortion or miscarriage, whether artificially produced or not, always places the mother in great jeopardy; and no one, I presume, ever assumes the medical charge of such a case without dread, and is peculiarly happy when the innocent woman can be told that she is out of danger.
Thus, then, the physicians as a body denounce this double crime, fatal if necessary to the child, and often proving to be so to the mother.
Thus, then, the lawyers, recognizing the peril to the mother, seem to think she may demand that the operation shall be done by taking upon herself the risk, just as she might decide to have a tumor removed, which by its growth might be inconvenient though not dangerous, if she were willing to risk the peril of the anaesthetic, and the other possibilities of erysipelas or septicaemia, and that the operator in either case would be equally innocent. The destruction, I might say the murder, of the child does not seem to be an item taken into consideration.
There is little doubt that the position taken by the lawyers is generally entertained by the community. Married as well as unmarried women apply to medical men to have an abortion produced with as much if not more readiness that they do to have a cancerous breast removed. Mothers will say that they prefer the life of the daughter shall be imperilled [sic] rather than have disgrace fall upon her. I have been told when refusing to do the operation on a married woman that I was too squeamish. A professional friend refusing to operate for a fee of five hundred dollars was told that it was a great loss to the community when Madam Restell died.
It is, therefore, desirable to make the enormity of the crime more generally know, that physicians, who as a body refuse to do this operation, may be protected from the temptation which the comparatively large sums offered, and paid too, very naturally hold out to them. Our profession is not a wealthy one, and a five hundred dollar fee, and much more twice that sum, for a few minutes’ work, requiring no great amount of skill, has very great attract ions. I think I may properly quote the experience of a distinguished professor of obstetrics, now dead, but held in kind remembrance by hundreds throughout the country. He told me that, when his first wife was very ill and he was poor enough, a thousand dollars were offered to him to do this operation. Said he, “I thought how many things this would enable me to get for my poor wife, who needed them, but which I could not buy, but thank God—and as he said this his lip trembled—thank God, I said no.’’ Now this same temptation, recognized in the excuses for the convict in Case III., comes to many a young man just commencing to practise medicine, and to many an older man who has perhaps “somehow got downhill,’’ and who have not Gilman’s rugged virtue to defend them. Can we wonder that they yield?
While the whole tone of the medical profession as a body is against this crime, I see no other safeguards against its commission so likely to be effectual as a determined effort on the part of the courts to enforce the laws—which are, I am told, quite sufficient—and a rigid holding of the criminal to the full amount of his sentence. I pity the innocent friends of the criminal, but the possibility of bringing such disgrace upon them ought to have deterred him from committing the crime. Let slackness in prosecution, or a ready throwing out of court for insufficient reasons, or easy access to gubernatorial clemency be characteristic of these cases, and the tempter will be still successful. But let the opposite to these characterize the crime, and they will do much to strengthen weak-kneed virtue.
My purpose in in bringing the subject before this Association, eminently representative of the medical profession of this country is to urge upon it, either as a body, or upon its members as individuals, a decided and continued effort to enlighten the community in general, and the legal profession especially, upon the enormity of the crime of foeticide. The peril to the woman great as it is, is safely escaped by very many--exactly what proportion it is impossible to say--but an abortion is of necessity fatal to the child, and the number of human lives thus destroyed is enormous.
I therefore respectfully present the following propositions, urging their adoption by this Section and, if possible, by the whole Association:--
1. Abortion should never be brought on by the use of medicinal or instrumental means unless necessary to the safety of the mother in consequence of pathological complications.
2. The destruction of the foetus in utero for any other reason, properly ranks with other forms of murder.
3. Abortion produced artificially always places the mother’s life in jeopardy and thus becomes a double crime.
4. The severe punishment of the operator when possible, without any probability of executive clemency, is due in justice to the honorable members of the medical profession, and yet more to the community at large.
Journal of the American Medical Association.
EDITED FOR THE ASSOCIATION BY N. S. DAVIS.
Vol. VII. CHICAGO, NOVEMBER 6, 1886. No.19. pp. 505-509
THE ETHICS OF ABORTION, AS A METHOD OF TREATMENT IN LEGITIMATE PRACTICE.*
BY J. E. KELLY, F.R.C.S.I., M.R.I.A.,
OF NEW YORK.
LATE SURGEON TO THE JARVIS ST. HOSPITAL: PROFESSOR OF SURGERY, ETC.,
*Read before the Gynecological Society of Boston, Sept. 9, 1886.
The object of this paper is to investigate the ethical relation of the physician to the production of abortion in legitimate practice, and to consider his duties and responsibilities, when the question would intrude itself without the possibility of evasion, as in those cases of deformed pelvis and uncontrollable vomiting in which the operation is regarded as the last hope of the afflicted female.
Owing to the recognized and stable position which abortion has attained in therapeutics, I have refrained from questioning its claim to be classed among the resources of medicine, and I have also excluded the consideration of its criminal or felonious aspect, much as I may marvel at the prevalence of a horrible crime which is devastating this fair land, and curtailing by the million, the development of its population and its power. This aspect of the subject has been treated by many able writers, whose experience, naturally, has been far greater than that which has been afforded me by the revelations attending a comparatively short residence in Boston. I have endeavored to avoid, as far as it is possible in dealing with a subject so involved, all arguments based upon the doctrines of any particular creed, as well as any special reference to medico-legal authorities, because I wish to induce my audience to approach the subject dispassionately, and to permit each individual to reflect upon it independently of the preconceptions derived from religious teachings and professional prejudice. In the complex conditions of modern civilization the most honorable and humane men are frequently constrained by their surroundings to entertain views and to perform acts from which, upon consideration, they would shrink aghast. This insensibility is largely the result of the accretion of thought and the consequent growth of habits and popular beliefs; the confusion of the relative bearings of associated ideas, and the resulting perversion of personal opinion and human sympathy. We perform many acts of injustice and cruelty owing to the difficulty of disentangling the great underlying principles, and in the struggle for existence, which suppresses all tendency to introspection, we are precipitated into psychological quagmires by custom, confusion, and self-interest. Such, I am satisfied, is the condition of the professional mind in relation to abortion, and I write this paper for the purpose of inducing the thoughtful physician to reconsider his duty and responsibilities, as well as to investigate the basis of the popular idea, that owing to the adoption of the most humane calling, a physician should be expected to produce abortion at the behest or for the benefit of any individual. I have appended a few suggestions indicating a possible method of relieving the profession from this unjust and odious responsibility, while extending to the parent and the fœtus the fullest measure of human justice.
As a preliminary to the consideration of the “Ethics of Abortion” it is necessary to recall the salient points relating to the vitality and the individuality of the fœtus, and to endeavor to determine at what point of intra-uterine life it attains a right to be regarded as a fellow mortal. It is unnecessary to remind you that as physiologists we cannot accept the dictum of Aristotle, who held that the fœtus did not attain viability until the fortieth day after the fruitful coition, neither can we coincide with those legal authorities who hold that the human offspring is not a human being until it ceases to be pars viscerum matris, and is completely extruded from the body of the mother. It is satisfactory to know that the definition is not universally accepted, many judicial writers regarding it as erroneous and productive of crime, owing to the immunity from punishment, which it affords to the evil-doer. On the other hand it is interesting to discover that theologians and biologists agree upon the period at which independent life becomes the attribute of the fœtus. The former hold as a dogma, that with the act of impregnation, instantaneously originates an absolutely independent life which confers upon the individual the indestructible soul, with all its associated rights and responsibilities, while the latter insist that at the moment of the fusion of the male and female germs vitality is established and the essential components of the mature individual are represented, the development which subsequently elaborates all the structural details proceeding by the innate differentiation of the impregnated ovum.
I would remind you that at a very early stage of the so-called vegetative life of the fœtus the essential characters of the vertebrate animal appear in rapid succession to the primitive groove which presents itself in the blastodermic membrane within a few days of impregnation. The vertebral column appears in the first week and arrives at the cartilaginous stage in the sixth; the intestinal tract is recognizable in the second week; the heart and lungs are visible in the third week and the duplex character of the former is apparent in the seventh; the cerebro-spinal centres appear in the third week, the brain being distinguishable in the fourth. This characteristic human organ is rapidly developed, and in the fourth month it differs only in size from its condition at birth, while the organs of the special senses as well as the sympathetic and sensori-motor nerves are developed simultaneously with the brain.
We must remember that immediately after impregnation, vital phenomena are manifested in cell-proliferation, differentiation, nutrition and organization. With the exception of respiration, all the functions are performed early in fœtal life: the heart pulsates; the circulation is complete and independent of that of the mother; the intestines contract and the feces are expelled; urine, as well as bile and the other intestinal fluids are produced; the skin develops hair and epithelium, while its secretions are produced in abundance. At a very early period we recognize the physical conditions essential to the manifestation of the simpler nervous phenomena, namely, a nervous centre connected with afferent and efferent nerves. In the fourth or fifth month mobility is very apparent in the well-known and complex symptom of “quickening,” and from that period we have ample proof of reflex and, apparently, of spontaneous or sensorimotor phenomena. If we coincide with Locke as to the capacity for ideation which infants possess, it is difficult to deny similar powers to the fœtus immediately before birth, and still more so to define the dawn of sensation and volition in an individual possessing all the essential organs in a condition differing only in degree from their more mature development. The capacity of the fœtus to perceive pain is impossible of proof, yet it is but fair to recognize that this power is contemporaneous with the development of the sensory zone of the cerebrum, in the fourth month. Consequently we may reasonably conclude that at least after this period, abortion is a source of suffering to the fœtus proportionate to its age and the violence employed in the operation. The conclusion at which we must arrive, a conclusion corroborated by the teachings of religion, is that from the instant at which impregnation occurs and the ovum receives life, the fœtus is human, and at all periods differs in degree and not in kind from the infant and the adult. Therefore, we must regard it as a “human being” with an inalienable right to life, and that its destruction is homicide.
If you permit me to remind you that homicide includes the destruction of human life under every possible circumstance, and that it is divisible into justifiable, excusable and felonious, I shall endeavor to assign to abortion its proper position in this category. Here I may mention that for the sake of brevity and precision I have adopted the legal signification of “Abortion” which includes the destruction of the fœtus at all periods and under all circumstances between conception and “full term.” Justifiable homicide comprises all those cases in which life is voluntarily destroyed owing to a motive which renders the act meritorious, as in warfare; in obedience to the command of a properly constituted authority; by an official in the performance of a duty imposed upon him; in the prevention of forcible or heinous crime, or for the protection of the life or honor of the slayer or of some person dependent upon him. The justification is, however, limited by the most stringent conditions, and to slay the greatest malefactor extra-judicially is wilful murder, A judge without a commission from the authorities cannot command the execution of a criminal even after the most impartial trial; the execution must correspond accurately with the sentence. A homicide committed by an officer of the law must be absolutely necessary for the performance of an imposed duty; even an individual in self-defence or interfering to avert a great crime, must have adequate motives for his action. Any departure from these conditions converts the act into wilful murder. Homicide is excusable when it is caused by mischance or accident, except when the slayer manifests a wanton disregard for the safety of others; and when the life or valuable property of the slayer, who must not provoke the affray, is in imminent danger. Felonious homicide is always wilful murder, or murder of the first degree, unless alleviated into manslaughter, or murder of the second degree, by being the involuntary and unfortunate consequence of some act not strictly lawful, or occasioned by some sudden and sufficient provocation. Wilful murder is characterized by premeditation or malice afore thought, which, among many other conditions, includes the intention or, even without the intention, the knowledge of the liability of the act to kill or injure any person though that person be other than the victim of the violence. Abortion is not justifiable homicide because it is not commanded or permitted by any authority, the law forbidding it under every circumstance, and all Christian religions agreeing in refusing to countenance the deed. It is nor decreed by a legal tribunal or committed by a specially commissioned officer of justice in the performance of a necessary duty, or by the operator as a public executioner It cannot be said to prevent the fœtus from committing a violent or heinous crime; the life, honor, or property of the physician or that of any one having an ethical claim upon him for protection is not in danger. In addition, it is obvious that the restrictions which qualify the privilege are also in full force against the act. Abortion is not excusable homicide because it cannot be the result of mischance or accident; it is not performed in self-defence by the physician, nor can the contingency be considered as unprovoked by the parent. Abortion cannot be held to be manslaughter because the very nature of the case demands grave premeditation and definite plan of action, which constitute malice aforethought; sudden and sufficiently violent provocation is impossible on the part of the fœtus, and abortion is performed with the obvious intention to commit an aggravated felony, and the operator has a perfect knowledge of the fatal nature of the act. Thus, presenting all the essential conditions, we must look upon abortion as nothing less than wilful murder. But is it not still a greater crime? Crimes are divided into natural and unnatural, the latter consisting of all those acts which are contrary to the great fundamental and natural instincts of self-preservation and reproduction of species. Abortion is an act which is directly antagonistic to reproduction, and as such, like suicide and other crimes which are unnamable, it is unnatural. Consequently it is a greater crime even than wilful murder; a
“Murder most foul and most unnatural.”
We shall now consider the relations of parents to their offspring, and the foundation of their claims to the life which they have conferred. Divesting this gift of its inscrutable and preternatural qualities, let us regard it in the light of an ordinary worldly benefaction. According to the statutes regulating Ownership, when a gift is of such a nature that it cannot be formally bestowed and accepted, any act conferring upon the recipient or donee the power of using the article constitutes him the absolute owner. Apparently this is the statute which approximates most closely to the transference of life from the parents to the fœtus. Possession is another legal basis of ownership which, for the prevention of injustice, throws the onus of proof on the claimant, and, in addition, as the transmitted life is neither real nor personal property, a claim to its resumption cannot be based upon any existing law. The gift of vitality, which is essential to the existence of the recipient, is voluntarily or thoughtlessly discarded by the parents in the pursuit of pleasure and the gratification of a passion. The donors must be held to be cognizant of the probable effects of this act, and the deed is ratified by being sealed with the image of God which conveys to the fœtus the infinitely greater gift of the immortal soul. Consequently the life must be regarded as the inalienable and lawful property of the recipient, who can be deprived of it only by an unjust and despotic act. Such are the usual conditions under which life is transmitted from the parents to the offspring, and for the gift the latter appears to be under no moral obligation, and least of all that of surrendering it. Filial duty is rather the result of subsequent solicitude and parental services which, accumulating during the periods of infancy and adolescence, render the claim of the parent upon the life of the offspring directly proportionate to its age. However, if we admit for a moment the right of the parent to the life of the offspring, it is easy to conjecture many cases after birth in which the resumption might be defended by all the arguments used in favor of abortion, in addition to the other considerations which I have just suggested. Let us assume, for example, that a parent reduced by hæmorrhage has, humanly speaking, but one chance of life, that by transfusion of blood, and that the only available source is her infant, to whom the abstraction of the requisite amount would be, without question, necessarily fatal. It may be contended that in this instance an essential element is absent, namely, that of mutual danger and the necessary forfeiture of both the lives if one should not be sacrificed. Let us modify the situation but slightly by supposing them to be famishing castaways in mid-ocean, and that the parent sacrifices her child for her own sustenance. Then, indeed, the right of the mother to kill her offspring with the object of saving her own and, in her estimation, the more valuable life, must be regarded as at least as well founded as is that of the mother who demands the destruction of the child within her womb to free her from the fatal consequences of her voluntary act. A parallel contingency in real life occurred recently which resulted in the trial of two men for the murder of their companion. They were starving at sea in an open boat, and to prolong their own lives by drinking his blood, they hastened, by a few minutes, the death of an expiring boy by cutting his throat. After a most exhaustive trial, in which the case was argued by some of the most distinguished lawyers at the English bar, they were found guilty of wilful murder and sentenced to suffer the extreme penalty of the law.
Of the many arguments which are advanced in favor of abortion, that which appeals most strongly to the sense of the community is the propriety of preserving, at any price, the life of the mother, who is frequently a loved wife, a valued friend and the inestimable centre of a family circle. This is a plea which I should be the last to reject, but we must not permit any collateral considerations to blind us to the object of our investigation, namely, to determine the fullest measure of justice to which the mother and the fœtus are entitled and the position of the physician in relation to the performance of abortion. It is often contended that the undeveloped condition of the fœtus and its dependent and defenceless state detract from its claim to existence, but if we exclude the element of birth this is an argument which with equal propriety may be advanced-against the rights of many adults, most children and all infants. Mental deficiency might be pleaded with equal justice in defence of the murder of many of our fellow-creatures, as the imbecile, the insane, and even the comatose, but, far from extenuating the act, their condition only aggravates any violence which is offered to them; while monsters, the cyanotic and the victims of arrested development could be as justly destroyed on the ground of incomplete physical conformation as the immature fœtus.
By a modification of the arguments which are based upon the shifting and delusive assumption that abortion is sanctioned by being conducive to the benefit of society, it would not be difficult to defend a proposal for the stamping out of virulent epidemics, such as cholera and yellow fever, by the killing of those who are first stricken with the disease. Another defence of abortion is based upon the futile and deceptive comparison of the relative value of the lives of the mother and fœtus. This is but an effort to contrast the known with the unknown, for the natural development of this unborn being may possibly result in a career greater than any with which the old world or the new has ever yet been blessed, greater even than that of a Cæsar or a Socrates, an Aquinas or a Washington. It must be acknowledged, however, that the approximate value of human life is based upon its probable duration and the estimate of society. If we accept as a test the probable duration of life, we must decide in favor of the fœtus, for although the probabilities are greater in a child of ten years than in an unborn babe, the latter, owing to the low mortality in pregnancy and parturition, has a better prospect of life than any adult. Assuming that the estimation of society or of the friends be accepted as a basis of judgment and action, almost invariably the mother’s life will be that which the physician will be implored to preserve. It is possible, however, that in rare instances, as when a great inheritance, a title, or a dynasty depends upon a child’s life, he may be commanded, at his peril, to sacrifice the mother and save the child. Law and religion are opposed equally to both the acts. Custom is more tolerant of the fœticide, but expediency, which is the sole sustainer of abortion, sometimes may vary its verdict and declare itself favorable to the preservation of the more valued, even though the younger, life.
It may appear to the casual or superficial thinker that the mother, at least, is justified by the first law of nature to destroy, by her own action, the life of the fœtus, if she possess the requisite knowledge and skill, but we must remember the conditions which limit this natural right. The slayer must not provoke the affray or the “difficulty,” and the Catholic doctrine adds the proviso that to justify the killing the victim must be an “unjust aggressor.” Neither of these conditions is fulfilled, because the mother is generally a consenting and often an inciting party to the act of conception, and the proverbial innocence of the “unborn babe” makes aggressive injustice impossible. Therefore the mother has no right to destroy her offspring with the object of preserving her own life. The father has still less justification for interference, because, although it is his duty to protect his wife, he, at least, has been voluntarily accessory to the originating act, and his .privileges are in other senses more limited than those of the mother.
We have considered the relations of all the individuals implicated in an abortion, with the exception of the physician, who must act either as a skilled agent or as a principal. If we regard him as an agent who has been engaged to perform a specific act, his rights and privileges cannot be in excess of those who employed him; and if, as I have endeavored to demonstrate, the mother or father have no right to destroy or to engage another to destroy the fœtus, the physician must act upon his own responsibility, and we shall proceed to investigate his position. The duty of a physician may be summarized thus: He must perform every just and lawful act which is essential to the life and conducive to the physical welfare of the patient whose care he has undertaken. Let us consider for a moment the responsibilities which he incurs in producing abortion. He decides that the procedure is essential, notwithstanding the probability that, owing to the rarity of the operation, his experience may be defective and consequently his judgment erroneous and misleading. Here I would remind you that in the practice of the more distinguished obstetricians, the proportion of intentional abortion appears to be inversely to their years, and it must be remembered also, that although the decision may occasionally be in the hands of an able and experienced physician, under existing conditions it is determined, more frequently, by the ordinary practitioner, who is often but poorly equipped for such a solemn responsibility. In addition, the case is decided not even by an honest, if ignorant, practitioner, but too frequently by the unreliable followers of one of the many “pathies” which help to swell the American death rate, or by the incapable and unconscionable quack. The physician under takes an operation which is necessarily destructive of one human life, and, owing to its dangerous nature, most hazardous to another, and possibly, as in cases of multiple conception, the operation may result in the death of three, or even a greater number, of human beings. Unless he permits his own judgment to be subordinated to the equally fallible human opinion of his employer, he voluntarily undertakes a deed sanctioned by no law, but always regarded, often perhaps too impassively, as a felony, and punishable accordingly. Without any commission, and frequently prejudiced towards a certain view, he constitutes himself the judge of a court from which time admits of no appeal; before him a dumb and defenceless prisoner is arraigned for the intent to inflict an injury of which it is unconscious; he ignores that impartiality so essential in an arbiter of life and death, and is simultaneously the judge and the counsel for the prosecution; he decides adversely to the accused, condemns him to the most frightful and painful death, and lastly, as the executioner of his own sentence, he sends an unborn fellow-being from a world he has never seen into that “great Beyond,” which the strong man and the wise man dread to enter even, after the most prolonged and anxious consideration. In the saddest chapter of the saddest history, that of the Irish rebellion of 1798, one figure towers aloft by reason of his stature and his fiendish cruelty. His literally veracious epitaph ran thus:
“Here lies that brutal Hempenstall, Judge, jury, gallows, hangman, all”
I cannot discern how he differed from the physician who produces abortion, except that Hempenstall held a special commission from the King of England authorizing his brutal iniquities, he was maddened by his turbulent surroundings and excited by the inhuman antagonism which resulted from his victims being matured men, capable of resisting him, and of being possibly all that his education and his prejudices depicted them, while the physician has no warrant compelling him to perform the deed, his victim is a defenceless and unoffending fellow mortal; his surroundings and his teaching tend to calm deliberation and just conclusions, his duty is to preserve the life of his patient by every just and lawful act, and, mark you, all mankind who, formally or informally, come under his care, are equally his patients, the fœtus as well as the mother, and if he would not be a Bravo, neither fear nor favor nor remuneration can ever justify the sacrifice of the life or interest of one patient for the pleasure of another. Finally, that great dictum which underlies all true religions, “Do no evil that good may follow,” deprives him of every flimsy and inadequate plea suggested by that insolence of ignorance so essentially a human attribute, reaching its highest development in the pursuit—here, it can hardly be regarded as a profession--which often, with the most inadequate preparation, arrogates to itself and has conferred upon it, by an otherwise rational public, the greatest worldly responsibility.
While personally repudiating all sympathy with abortion in any form, I shall conclude with the following suggestions, which may be justified by the principle that “new circumstances demand new laws.” The prevalence of abortion as an established procedure in modern medicine, the freedom with which it is practised and the enthusiasm with which it is advocated by gentlemen of great professional influence in this city, some of whom I heard in public indignantly denounce other individuals, medical, lay, and clerical, because they conscientiously refused to assist or sanction the destruction of the embryo, are the circumstances which convince me that no existing enactment, either human or divine, can prevent many physicians from practising abortion in good faith, and consequently that some “new laws” are needed which shall tend to limit its application to the minimum, and to alleviate, in the juridical sense at least, the repugnant act of abortion into ‘justifiable fœticide.” Such a restriction, while affording every advantage compatible with justice to the mother, should insure to the fœtus every possible security by adequate investigation and representation, in accordance with established legal procedure. Every court or tribunal consists of three essential elements, the plaintiff, the defendant, and the judge. The two first-named are frequently permitted to “appear” by proxy, and generally their interests are guarded by skilled advocates. In criminal law, where a fourth element is introduced in the person of the executioner, the greatest precautions are exercised to secure for the most notorious malefactor every advantage which can accrue from thorough investigation, the admission of favorable testimony, and the assistance of able lawyers, who are frequently supplied by the authorities. Even when a cadaver is discovered the State institutes a most exhaustive investigation in order to determine the circumstances connected with the death, and the climax is reached when the Law, having executed a criminal, makes a formal inquiry into the cause of his death!
If such care be bestowed upon the elucidation of the causes of death and the equitable trial of abandoned criminals, it is natural that we should inquire if the State does not neglect its duty by permitting this notorious and daily destruction of human life without a rigid investigation and the assertion of its unquestionable right to veto or to sanction each case, according to its merits. If the authorities could be awakened to the necessity of establishing a tribunal for the purpose of restraining those practitioners who are not deterred by ethical considerations or religious scruples, its construction should be an easy matter for the practical legislator. According to precedent it might consist of the presiding officer or judge, a physician of the highest professional probity and juridical reputation; an able practitioner as the counsel or defendant of the fœtus, the parent being represented by her personal medical attendant, and the fourth member of the court would be the executive officer. That such an officer as a State abortionist should be appointed is apparent, owing to the many Instances in which no power could compel the attending physician to perform so repugnant an operation, while even if he were willing to undertake it, his opportunities might not afford him the essential skill and experience. It would hardly be in keeping with that rigid impartiality so desirable in a presiding officer if, as the executioner of his own mandate, he were to perform an operation for which he would necessarily be remunerated; neither would it be in keeping with the function of the physician to whom we have alluded as the representative or defender of the fœtus, to destroy the life of his client. With such a tribunal the operation would be shorn of some of its most objectionable features.
A restraint would be imposed upon those who regard their personal judgment as all-sufficient and final, if the practitioner were compelled to report to the executive those cases in which he considered abortion essential; the members of the noblest profession would be protected from a degrading demand to commit a felony; the popular opinion which ascribes to the medical profession the odium of encouraging abortion, owing to the levity with which physicians frequently discuss the subject, would be expIoded; without the sacrifice of dignity or emolument the physician would transfer to the strong arm of the law a great responsibility; without any infringement of her liberty the patient would have the advantage of supervision and treatment by skillful and experienced physicians in consultation with her own attendant; and finally, two classes of criminal abortion which occur but too often and without attempt at concealment, would be eliminated. The first is that in which the patient, anxious to evade the trials of maternity, imposes upon the in experienced or careless physician by simulating the alarming symptoms of pernicious pregnancy until he is persuaded that abortion alone can preserve her life; in the other class the practitioner, more or less above suspicion, justifies or cloaks a criminal abortion by averring that the evacuation of the womb is essential. An instance illustrative of one or other of these classes was disclosed in the course of a notorious divorce trial which recently scandalized this city. The attending physicians deposed that the abortion was essential, while other witnesses asserted that it was performed to avoid the expense and inconvenience of motherhood. A practical step towards the suppression of, at least, some forms of fœticide, would be inaugurated by rendering Its performance more dangerous to those abandoned wretches who abuse the most precious human instinct, dishonor the fair fame of medicine, and defile the national reputation by their dastardly and incredible outrages against the sanctity of life.
Isaac N. Quimby “Introduction to Medical Jurisprudence,” JAMA 9 (August 6, 1887): 162-67.
The American Medical Association appointed a special committee in 1887 “to report at its next meeting, upon the criminality of foeticide and such measures as may be commended for legislative action for its prevention and punishment.” This was at the request of the New Jersey physician, Isaac N. Quimby, who delivered an address, “Introduction to Medical Jurisprudence,” at the Annual Meeting in Chicago. One of the first problems Quimby addressed was foeticide [pages 163-4]:
Infanticide, at common law consists in the doing of any act whereby the death of an infant child is caused after it is fully born alive. It is distinguished, by law, from the killing of a child within its mother’s womb, which is known as foeticide.
When the death of a newly-born infant is occasioned by an unlawful act, as distinguished from mere accident or unavoidable casualty, such an act constitutes the crime of felonious homicide, and may be either murder or manslaughter, according to the circumstance of the particular case. In every instance, however, the death must occur after the actual birth of the child, or no crime is committed. If a. person uses means for the procurement of an abortion upon the mother, either by the administration of medicines or by the use of instruments, or in any other way whatever, and the foetus is destroyed before birth, the act is neither murder nor manslaughter, at common law, but only a misdemeanor! It is not indictable to procure an abortion with the consent of the woman unless she is quick with child; and quick with child is defined by the law to mean that the period has not arrived when the life of the infant has commenced; a fallacy based upon an old English law, which no longer obtains, that the use of the term abortion, medically, is limited to the expulsion of the contents of the womb before the sixth month of gestation. But that law has long since been repealed; abortion under English laws now means the expulsion of the foetus at any period of gestation, and its procurement is reckoned a felony. This ancient, but now exploded theory that life in the foetus does not commence until the third or fourth month of gestation, is founded upon ignorance and the misconception of facts—and contrary ,to the revealed truths and investigations of modern science.
This fallacious idea that there is no life until quickening takes place, has been the foundation of, and formed the basis, and been the excuse to ease or appease the guilty conscience, which has led to the destruction of thousands of human lives.
In physiology a cell or cellule constitutes the origin or commencement of every plant and animal and the elementary form of every tissue, in fact the entire organized human body may be considered to be made up of a congeries of cells, each set having its own life and appropriate functions. From these cells the embryo and foetus is developed. This is a truth so well settled that no well-informed physician would care to deny it. Should we not then assert most positively that the life of the foetus commences at the moment conception takes place, and therefore the destruction of the fœtus, at any, period of gestation, should constitute murder? Abortion is alarmingly prevalent and increasing especially among the higher classes and well to do American women. Ladies present themselves to their physicians—with a thousand and one excuses—for getting clear of their offspring. And it is a lamentable fact that there are persons who call themselves physicians willing listeners to their earnest entreaties and appeals.
I was consulted not long since, by a reputable physician of experience upon this subject, and he asked this question: “Which do you think the greater crime, the production of a miscarriage, upon the repeated and earnest solicitation of the mother, or compel her to go the full period of gestation, with great worriment, and perhaps sacrifice of her life in giving birth to her child?” I replied, “Doctor, what is the object of our noble profession? Is it to save or to destroy life?” Besides, there is more danger in the unnatural and hazardous procedure of abortion, than the natural process of gestation and parturition.
The physician’s responsibility in this matter is very grave, and they should do all in their power to discourage this prevailing tendency of the times to foeticide, and teach that life commences with conception. God forbid that anyone calling himself a physician should be tempted by any appeal however pressing and piteous, or by any fee however large, to become the assassin of the unborn, in any stage of its development. I suggest that a special committee be appointed by the Association to report at its next meeting, upon the criminality of foeticide and such measures as may be commended for legislative action for its prevention and punishment.
The next subject to which I would invite special attention is to the duties commonly exercised by coroners, …
 This committee was appointed consisting of Drs. J.N. Quimby, N.J., W.B. Atkinson, Pa., and W. H. Byford, Ill.
Henry C. Markham, “Foeticide and Its Prevention,” JAMA 11 (December 8, 1888): 805-6.
Fœticide and Its Prevention
Read in the Section on Medical Jurisprudence at the Thirty-ninth
Annual Meeting of the American Medical Association, May, 1888
BY H. C. MARKHAM, M.D.,
Of INDEPENDENCE, IOWA.
In approaching the consideration of the subject of fœticide we are at the outset confronted by two facts, both of which possess an important significance. We first note that the highest crime—from some standpoints at least—of which criminal humanity is capable, and whose prevalence doubtless exceeds the highest estimate, is of no more judicial importance, in either treatise or statute, than when the evil was scarcely known, and motherhood was everywhere the crowning glory of woman. The second fact is little less an anomaly: that in the presence and despite the elevation, culture, refinement and, more than all else, the religious training and influences operating upon and in modern social life, that in the class of society making in all these respects the highest claims, this vice has developed, the enormity and extent of which is but feebly recognized outside the medical profession.
As aiding our purpose, which is that of endeavoring to discover remedies for the repression, if not suppression, of the crime of offspring murder, it may be useful to attempt an explanation of the causes whose operation has given this crime its peculiar status or, it may be said, have prevented its having any proper legal status In the calendar of capital crimes. So intimately blended and associated are the moral, judicial and medical phases of fœticide, that its relegation to the especial realm of either the law, the church, or medicine, has never been satisfactorily agreed upon. As neither profession has felt the obligation or responsibility concerning the evil which otherwise would exist, the evil, therefore, has naturally failed to receive in any proper degree an adequate consideration. To the moralist and jurist it presents a barrier of delicacy whose sacred realm they instinctively shrink from invading. The resistless power, also, of social pride and ambition would seem to leave little hope of reform through moral agencies. The highest level of ethical profession, in the geography of the modern social world, is honeycombed by this lurking and hideous evil. The conditions insuring perfect concealment and the absolute certainty of the ignorance of the public as to its commission impart characteristics both unique and formidable to the crime. Fœticide is also the one great crime in which the chief victim, or sufferer, is wholly defenseless and without hope of an advocate. The type of unresisting innocence, it possesses no posthumous resources whose magic wand may set in relentless pursuit of the guilty the instruments of justice.
The champions of the temperance cause, in order to enforce and prove their claims, have only to point to the living victims of dissipation. Those espousing the cause of social purity easily refer to living illustrations of tile evils they seek to remove. Statistics are the weapons most feared by the foes of public good. But fœticide enjoys immunity from all these methods of attack. As this important subject is, for inherent reasons, unsuited for judicial investigation, and successfully opposes religious influences, the obligation necessarily rests upon the medical profession to propose a method for checking the fearful progress of the evil. It scarcely subserves the purposes of this paper to attempt a delineation of the diabolical attributes and features of the crime from a moral standpoint, or to essay a medical statement and description of results, both pathological and physiological, of its committal. Neither is it essential, however, apropos it may be to the discussion, to note its social relations; how the resistless lust for fashionable dissipation and distinction has rendered barrenness essential in their gratification. The limitations of time compel here an omission of these phases of the subject, however much they deserve that attention hitherto unreceived.
Judicially viewed, fœticide has characteristics and relations which render its treatment not only delicate but difficult. Of no other crime is it true that in nearly, every instance of its commission there exists ample and unimpeachable evidence of the same, which evidence is also both vital and unavailable. Until a change occurs as to the application of professional rules and tenets in giving evidence in this class of cases, there is little ground for expecting success in the prosecution of the same. Refusing to be used as witnesses to aid the State in punishing those guilty is in contravention of the chief mission of medical science, which is no less than the removal of the causes of physical degeneracy and vice. The position of medical men as witnesses in cases of fœticide is for this reason exceptional, not compelling him, as in other cases, to defend the precepts of his profession and the rights of his patients by refusing to disclose the secrets and confidence of the latter.
Fœticide no more entitles the patient to this secrecy and confidence than does small-pox or other danger to the public, the stamping out of which is the duty of medicine to perform—per contra, it as greatly obligates the disclosure of the same. Is it not to be feared that the assurance of medical aid and confidence if danger follows operates as a strong incentive to attempt the performance of the crime upon themselves by those desiring it—a practice which the profession well knows is rapidly increasing. Probably no fact is indirectly more promotive of fœticide than the absence of laws regulating medical practice; thereby enabling abortionists, disguised as members of an honorable profession, to pursue their nefarious avocation with comparative impunity. Nothing less than adultery itself can exceed the wrong inflicted upon the husband who suffers wilful betrayal of his hopes and expectations of offspring. If congenital, and hence irresponsible physical procreative incompetency is adequate cause for legal dissolution of marital relations, how much more—measured by every possible standard—is the intentional procurement of the misfortune. Added to this loss is the keenness of disappointment which near realization tends to induce. Medical men will verify this as being no fancy or rare event, as too frequently, when called to rescue the victim from her self-induced peril, has it been a duty to impart to the anxious husband the cause of the danger and the first knowledge of his already severe loss.
Fœticide as a ground for divorce of either party to the marriage contract; whether it result from guilt of the wife, on the one hand, against the wishes of the husband, or whether the husband compels the unwilling submission of the wife to its unwilling procurement on the other, is, in either instance, both just and practical. Penalties aimed at “abortionists” as a class of criminals are little less than valueless. The party inciting the act—its actual principal—must be made to fear the consequences. The question is worthy the most serious consideration, whether the present facilities, and the alarming extent of their improvement, for disseminating criminal knowledge of the practice, does not remove the usual objections to a popular presentation of the evil as such. That once thought unsuitable for general publicity, is now sown widely by the vultures who fatten upon the harvests. Our young men are properly taught the evil effects of alcoholic excess—why should not young women be warned of the nature and results of fœticide? There can be, from thoughtful students of the subject, only an affirmative reply. The task of the performance of this duty rests upon the medical profession, and every prompting of interest in the welfare of our race induces the hope that medicine may not betray the trust.
Independence, Ia., AprIl 23, 1888. .
Editorial: “Professional Abortionists”
Journal of the American Medical Association (December 29, 1888) 912-3.
(The Editor of the journal was Nathan Smith Davis who was the major impetus in the founding of the American Medical Association.)
The preface to the first edition of Sydenham’s “Method of Curing Fevers,” which appeared in 1666, opened as follows: “Whoever takes up medicine should seriously consider the following points: firstly, that he must one day render to the Supreme Judge an account of the lives of those sick men who have been intrusted to his care. Secondly, that such skill and science as, by the blessing of God, he has attained, are to be specially directed towards the honor of his Maker and the welfare of his fellow-creatures, since it is a base thing for the great gifts of heaven to become the servants of avarice or ambition. Thirdly, he must remember it is no mean ignoble animal that he deals with.”
Within the past two weeks the public, and the medical profession of Chicago have learned, through exposures in the Chicago Times, that there are numbers of professional midwives and licensed physicians in this city, who declare that for a money consideration they will commit the loathsome crime of abortion, or, if some will not they can recommend others that will. The Times has printed the names of midwives and physicians who declare they are ready to do murder, and most foul murder, for money, or else recommend some one that will commit a violation most wicked of the laws of God, Nature, and man. As between the assassin, or the thief, and the man that recommends the assassin or thief there is but little difference. Between the licensed midwife-abortionist and the licensed physician-abortionist what is the difference? It is one of degree, and the deeper degree of infamy attaches to the latter. He is supposed to be more intelligent, to be actuated by higher and more noble principles, and to have for the chief end and aim of his life-work the preservation of human life.
Nothing we can say in this age can paint the crime of abortion in all its loathsomeness, nor its perpetrators, and the inciters to or abetters of its perpetration in all their moral blackness and professional degredation. “The licensed Herods” that have been exposed, that are willing to commit murder, that have blackened the good name of our noble profession, and given themselves over to the eternal infamy and abhorrence of all mankind, have but themselves and their sordid motives to thank for the present exposure, and its possible consequences.
In expressing themselves as willing to commit this crime, or to recommend others that will, men show themselves possessed of consciences too near in kind to those of brutes and beasts to be reached by moral agencies. What remorse may come to them will be born of the fact of exposure —the sorrow of the thief that he is caught. It is not our purpose, nor is it proper for us to be judge and jury in regard to these cases. The State of Illinois has laws, and instruments for their execution; it has a State Board of Health; and there is a large medical society in this city, to which some of the offenders belong. Men that will commit abortion are unfit for citizenship in any civilized state, are too far lost to moral responsibility for the profession of medicine, and too degraded to be the associates of honest men. Then let the police, the courts, the State Board of Health, and the medical societies take the record furnished by the Times and deliberately proceed with the execution of the laws of the State and the ethics of the profession with strict impartiality and unswerving justice. . To leave the matter where it is, a simple newspaper exposure, will result in its horrors being forgotten in six months, while the black list will remain as a convenient directory for those who may be in want of abortionists in the future.
Will honest men endure the fellowship of lawless, abhorrent and infamous men that traffic for personal gain in the weakness and shame of poor erring humanity?
Criminal abortion, the National disgrace. Has culminated in the exposure in Chicago. It is to be regretted that the matter was not worked up at the same time in other cities, so as to clear the country of the harpies that foul the medical profession.
After all, we may trace the origin of this matter, in a great measure, to our system of medical education, and to the attitude of the public and the newspapers in regard to higher medical education and State regulation of medical education and practice. We do not claim that all highly educated men are moral, nor that badly educated men are always immoral. But if the public and the newspapers will cease their interference with plans and projects for higher medical education, and for more stringent regulation of the practice of medicine, the medical profession will be improved, both for its own good and for that of the public.
J. Milton Duff, “Chairman’s Address,” JAMA 21 (August 26, 1893): 290-93, 291.
Read before the Section of Obstetrics and Diseases of Women, at the Forty-fourth Annual Meeting of the American Medical Association.
BY J. MILTON DUFF
The address included the following:
The alarming increase in the number of criminal abortions with all the physical, moral and social evil it entails is a subject which demands the serious attention of the profession, of moralists and humanitarians. It has been suggested that in order to reduce the physical wrongs engendered by the performance of this operation by irresponsible incompetents, that the regular profession engage in it in a scientific manner.
Let the blush of shame mantle the cheeks of those who suggest this prostitution of our noble profession in the furtherance of such a pernicious crime against God and society. As a profession we have no right to assume the position of lukewarmness and of masterly inactivity in this manner. It is our duty to be aggressive and as far as in our power [to] educate the public up to a thorough appreciation of the pernicious results of this evil. Whenever opportunity offers to detect in this fiendish wok those whose names black the lists of our profession we should see that they are stamped as villains, and as speedily as possible brought to justice.
William McCollom, “Criminal Abortion,” JAMA 26 (February 8, 1896): 257-59, 257.
BY WILLIAM McCOLLOM, M.D.
BROOKLYN, N. Y.
I use the words in their legal sense, viz, the effecting of the unlawful expulsion of the contents of the ‘womb at any time after conception before the term of gestation is complete. The very old English law made a distinction between the crime perpetrated before and after quickening. The rulings of the supreme court of several of the American States corresponded with the old English law which was abolished a half century, more or less, ago. The Pennsylvania court was one of the first to discard the old doctrine and the courts of many of the other States have progressively fallen into line, and have ruled that it is a crime to destroy embryo life after gestation has begun. Judge Coulter, of Pennsylvania, ruled that “it is not the murder of a living child which constitutes the offence, but the destruction of gestation.” An attempt by a physician or other person to procure an abortion is a crime, though the effort fail and the abortion is not produced, and it renders the party criminally guilty. When a physician prescribes medicine or gives advice and allows the patient or party to believe, or gives her reason for believing that it is given for the destruction of embryo life, though he does not intend such destruction, is little better than a criminal. I have heard physicians confess to such deception without seeming to realize that they were seriously compromising honesty and integrity and countenancing sin and crime.
Criminal abortion is frightfully prevalent and the practice is apparently on the increase among professed Christian women. It should be and it is the duty of the physician to enlighten applicants for relief from pregnancy who have no adequate idea of the criminality of the act. The women of the Church of Rome are better instructed and made to keenly feel the great sin of murdering unborn human life. I might raise the question whether the clergy are doing their duty in the matter or not, but I am addressing medical men only. Let us do our duty, if our spiritual advisers neglect to do theirs, in denouncing this common crime and great sin. It is evident that women of the lower class have no adequate idea of the criminality of the act, for they unblushingly apply to the physician and to the druggist for medicine to abort pregnancy, or, in other words, to bring about the monthly sickness. Great ignorance of the criminality of the practice is manifested by educated women, but it is not ignorance alone but a downright lack of moral sense as well, which greatly needs educating. The common law at the present day does not make the destruction of an unborn child murder. I quote Blackstone on English law: “Though to kill the fetus in utero is as such by common law no murder, yet if it be born alive and die subsequently to birth from wounds received in the womb, or from the means used to expel it, the offence becomes murder in those who cause or employ them.” I also quote from another distinguished jurist, ‘Wharton, “Law of Homicide,” 93: “If a person intending to procure an abortion, does an act which causes the child to be born earlier than its natural time, and therefore in a state much less capable of living and it afterward die in consequence of such premature exposure, the person who by this misconduct brings the child into the world, and puts it into a situation in which it can not live, is guilty of murder, though no direct injury to the child is proved; and the mere existence of a possibility that something might have been done to prevent death, does not lessen the crime.” We are inclined to the belief that such law is not good common sense; to kill the child in utero according to Blackstone is not murder or infanticide, but to inflict such injury upon it that though it is born alive and dies in consequence of the injury it is murder.
Some years ago I attended a woman, the wife of an attorney-at-law, seven months or more advanced in pregnancy, the child stillborn; the brain had been punctured through the eye from some instrument; this was not technically murder under common law, but I bluntly charged the mother with murder in the presence of her husband and friends, pointing out the evidence of it, and there was no denial. I have repeatedly been shocked at the manifest lack of moral sense in intelligent women in applying for medicine to reestablish the menstrual function when it was evident that they believed the absence of the menses due to pregnancy. The woman sometimes attempts o justify the act because she does not positively know that conception has taken place. The physician’s excuse for giving noxious drugs or for sounding the womb when miscarriage results that he did not know that the suppression was due to pregnancy renders him not less criminally liable.
Under the older English law for an attempt to procure a criminal abortion without proof of the woman’s pregnancy conviction could not take place. More recent rulings as well as amended laws now make the attempt to procure a miscarriage a crime. It has been the law of France for more than fifty years, that the proof of pregnancy is not essential to the commission of the crime. We try to excuse Christian women for asking us to terminate pregnancy on the ground of ignorance of the law of man, if not of the law of God. If they took as much pains to become enlightened in the common law regarding it as they do to how it can be accomplished with or without aid from others they would not long remain in ignorance in the matter. Physicians long in general practice know that the practice of criminal abortion is common, and that it is not confined to the laity or to the quack and the pretender. Sometimes the ordinary physician who may be a member of a regular medical society violates his duty; and the distinguished college professor without the fear of God or of sufficient fear of human law takes his large fee for the criminal act. I am not drawing on the imagination, but state what I know to be true. Such statement does not sound well, but this fearful immoral destructive practice can not be checked unless facts are stated and proclamation is made of this great evil.
I have no belief that the practice is common among physicians who have a reputable standing with the profession in the neighborhoods where they are known. The moral status of physicians is high and I trust that we have no more black sheep than the other learned professions. As we go down the scale from the higher to the lower the evil grows greater, until the criminal abortionist, who may be a graduate of a regular medical college, loses all shame and not only sends out his advertisements to the laity, but his cards at frequent intervals to reputable physicians as well. These villains would not continue to inform the medical profession at considerable expense to themselves year after year unless their business was helped by it. A little lower down in intelligence, if not in wickedness, comes the so-called midwife and the woman who prefixes doctor to her name, and poses as a dermatologist or specialist in disease of females; they flourish in many localities.
Now we come to the economical woman and her economical friend, with their skewers, steel knitting needles and other instruments of murder. Quite recently an intelligent, educated professed Christian woman whom I attended in a miscarriage in the fourth month of pregnancy, confessed without expression of sorrow or remorse that she had effected the abortion with her own hand by pushing a knitting needle into the womb, following the instruction of another young woman who had repeatedly succeeded in destroying embryo life in her own person and was kindly instructing her young friends in the art without hope of pecuniary reward. It is only necessary for me to briefly call attention to the existing criminal facts, for all physicians who have had full opportunity to observe know that the alleged statements are true, and not overdrawn; true of the city and true of the country.
Much might be said of the far-reaching, demoralizing destructive influence upon woman, upon the community, upon the State, upon the world; but the portraiture of the facts, bad as they would appear, I fear would have little influence in arresting the practice. The moral sense in woman, and possibly in the medical profession as well, has degenerated as regards this matter. The physician is so related to woman in his professional duties that he can do much, if he will, to instruct her as to the law and to show her that she would be a criminal, and shock her into a sense of her duty. It is presumed that few people know that the penal code of many of the States make the woman guilty of manslaughter if she consents to the procuring of a miscarriage. I quote from section 194, New York penal code: “A woman quick with child, who takes, or uses, or submits to the use of any drug, medicine or substance, or any instrument or other means, with intent to procure her own miscarriage, unless the same is necessary to preserve her own life or that of the child whereof she is pregnant, if the death of such child is thereby produced, is guilty of manslaughter in the second degree.”
When one woman advises another woman to procure an abortion, instructs her as to the method or assists her in any way in its performance, she becomes a criminal and is guilty of manslaughter.
Section 191, Penal Code of New York, says: “A person who provides, supplies or administers to a woman, whether pregnant or not, or who prescribes for or advises or procures a woman to take any medicine, drug or substance, or who uses or employs, or causes to be used or employed, any instrument or other means, with intent to procure the miscarriage of a woman, unless the same is necessary to preserve her life, in case of the death of the woman or of any quick child of which she.is pregnant is thereby produced, is guilty of manslaughter in the first degree.”
The field for missionary work is a large one and should be faithfully worked, both by the conscientious physician as well as by the Protestant Christian clergy, who perhaps fully understand the enormity of the sin if they do not know how prevalent it is. It is not a pleasant subject to discuss before a mixed audience. Young women could be reached, instructed and warned by a properly published circular or tract sent to them by Christian organizations at intervals where personal instruction would not be practicable. There is little to criticise, as it relates to the laws of most of the older and some of the newer States of America. A recent ruling, June, 1895, by the supreme court of Kansas, rendering an important section of the Crimes Act as it relates to criminal abortion invalid, is a long step of about fifty years backward. The law provides that an attempt on the part of any one to abort “any woman pregnant with a quick child” “shall be guilty of manslaughter in the second degree;” this is declared inoperative and invalid “where neither the death of the child nor the mother results from the acts committed.” The low moral sense of the community, as it relates to the offence has much to do in the non—enforcement of the law. The criminal is seldom put under arrest unless the woman is murdered, and then the party, if convicted, frequently gets the minimum penalty prescribed by law. If physicians would do their duty and make complaint in all cases when it comes to their knowledge that physicians or other persons are violating the law in the destruction of unborn human life, it would do much to lessen the practice. I have more than once made written appeal accompanied with a threat that unless I could be satisfied that the practice would stop, I would enter formal complaint to the legal authorities. Parties have responded, pleaded for mercy and given solemn promise never to again produce the miscarriage of a pregnant woman for any reason n until they had held a consultation with a reputable physician, and its necessity was advised. It is not safe or best that any doctor procure the miscarriage of a woman in case of necessity until a consultation with another physician is had; such practice would protect himself against suspicion of wrong-doing, and materially help to trace and convict the criminal. So long as it is allowed the physician to produce the miscarriage or the abortion of woman without consultation the evil will not be materially checked, for the criminal abortionist is a perjurer and when under trial in court will swear if necessary to avoid conviction, that the act was performed to prevent the death of the woman from disease, pelvic deformity, or for some reason given, satisfactory to the jury. It is very easy to speak upon this shocking criminality practiced by professed Protestant Christian men and women, as well as by the ungodly, and to moralize upon the destructive influence, especially upon woman, but it is difficult to solve the question when we ask, What is the remedy? How can it be checked?
Denslow Lewis, “Facts Regarding Criminal Abortion,” JAMA 35 (October 13, 1900): 943-47, 943-44.
FACTS REGARDING CRIMINAL ABORTION *
DENSLOW LEWIS, M.D. (
Professor of Gynecology in the Chicago Policlinic; President of the
Attending Staff of Cook County Hospital.
I know a man of marked erudition who wrote a book on the primitive religions. His opening paragraph is as follows: “The facts in this book are true.” There is more common sense than rhetoric in this remark. We are all liable to be mistaken in our estimate of conditions. Too many statements are accepted as true simply because frequent unchallenged repetition has made us believe there is no possibility of contradiction. Continued reiteration dulls the sense of perception and discourages investigation. Moreover, social conditions change, laws become obsolete, public opinion varies and our appreciation of justice is often irrational and selfish. For this season it is important to know the truth. In a consideration of criminal abortion no prophylaxis is consistent without a knowledge of etiology, and discussion is without profit unless the naked facts are presented.
When married women become pregnant, I estimate that 80 per cent, of them wish they were not. There rarely seems to be a convenient season for having babies. If the woman has one child she is apt to think it is too soon to have another. If she has never been pregnant, it is too soon after marriage, it interferes with a trip somewhere or some social engagement, or else she is too delicate, or her husband can not afford it. Some excuse is usually found for dissatisfaction, and in most cases some attempt is made to re-establish menstruation.
The older ladies of the community are prolific in advice. Hot drinks, hot douches and hot baths are recommended. Violent exercise is suggested and jumping off a chair or rolling down stairs is a favorite procedure. Certain teas are given, especially an infusion of tansy and pennyroyal. Cathartics are supposed to be useful, and the different emmenagogue pills are too easily procurable. As a last resort ergot may be taken, or, if the woman is ignorant, arsenic, metallic mercury or other mineral poison may be used, often with a fatal result.
It is remarkable that among the most intelligent, refined and religious women of civilized communities a suspicion of wrong-doing is so rarely entertained. I believe this is because the idea prevails that there is no life present until the beat of the fetal heart is perceptible. The history of the earliest nations records the fact that, with the sole exception of the Jews [l], criminal abortion has always been a well-known practice. To-day it is as prevalent as ever, and the only real restraint I know of is the teaching of the Catholic church. It is improbable that any change of sentiment will occur until there develops some systematic effort to teach the truth regarding all matters connected with the reproduction of the species. Judging from my own feeble efforts in this direction,  a maudlin sentimentality and a narrow-minded conception of the duties and privileges of the medical profession will too often interpose objections even to the scientific consideration of these important subjects in medical societies and in medical journals. When a man like Howard A. Kelly, of Baltimore, claims that the child should be kept in ignorance of sexual matters; when he says, as he said to me at the Columbus meeting of the American Medical Association, that the discussion of the subject is attended with filth and we besmirch ourselves by discussing it in public, it is high time that our efforts began with an attempt at the education of some of the eminent members of the profession, so that they may know that there is more in gynecology than the passing of a ureteral catheter, more in the practice of medicine than the perfection of operative technique or the collection of fees.
The methods of procuring abortion recommended by the laity are usually futile. The tenacity with which the fecundated ovum clings to its attachment when once it is anchored to the uterine wall is a matter of surprise. Women have fallen from great heights and have sustained injuries sufficient to fracture limbs; they have been beaten to unconsciousness, and, indeed, have suffered even fatal traumatism without severing the connection between mother and child. It may be of interest for me to cite a few cases:
A woman, about seven months pregnant, fell down stairs and struck astride the edge of an upright open barrel. She complained of intense pain in the left pubic region on the least motion. Whitaker found an oblique fracture of the body of the left os pubis. There was little displacement, no lesion of the bladder or rectum, and no attempt at miscarriage. A roller bandage was applied around the pelvis, opiates were administered and the urine was drawn with a catheter for three days. In six weeks the patient could walk about the room. Normal labor occurred at term. The fracture reopened and symptoms of peritonitis presented themselves. They yielded kindly to treatment, and the patient recovered. 
A woman, 19 years of age, and about six months pregnant, jumped from a second story window, and immediately got up and ran away. Soon she could not walk, and was obliged to remain in bed three weeks complaining of violent pains over the right hip. For three days after the fall she had a slight bloody flow from the vulva and complained of lumbar pains. Nothing abnormal was found on examination and the patient left the hospital in a few days without further complications. 
Lest it be thought that injuries of this kind are usually devoid of danger, it is proper for me to say that my records show many cases of variable traumatisms often fatal, due to falls,  lifting,  jumping,  crushing,  kicks,  tossing by a cow,  and other accidents. In one case a woman, eighty days pregnant with twins, had one fetus as the result of a fall from a wall10 feet high, but was safely delivered of the other at term.  There are also cases where very slight injury has produced abortion and sometimes the death of the mother as well, and where the simple procedures advised by the old ladies have produced disastrous results.
While walking across her bedroom in the dark a woman ran against the corner of a table, striking her abdomen, though not with any great force. She thought no more of this occurrence, but two weeks later she had an abortion, and an examination of the fetus, which was not quite four months old, showed that it had been struck upon the spine by the blow referred to. Thomas claims that this was unquestionably the cause of its death and the resulting abortion. 
The use of vaginal douches of hot water sometimes induces premature uterine contraction and causes abortion. In a case tried some forty-five years ago in England, in which abortion occurred in consequence of the injecting of some unknown liquid into the vagina, an acquittal was ordered by the judge on the ground that the liquid was not proved to be noxious.  In the United States such proof is not required. It suffices that the intent be proved, for the crime consists in the attempt and not the result. Indeed, there is still crime, even if the woman be not pregnant.
The use of alum-water injections has caused death. A woman four months pregnant was heard walking in her room and an hour afterward was found lying dead on her face, a saturated solution of alum on one side and a syringe on the other. The autopsy showed the decidua vera and placenta partially detached and small blood-clots behind them. There was no sign of contusion anywhere. It was decided that the alum solution had entered the uterine sinuses and thus by way of the venous circulation reached the heart, where more clots were found, which were deemed to have been the cause of death, 
The methods mentioned are usually persisted in until about the third month of pregnancy. By that time the woman is no longer in doubt as to her condition. She can no longer persuade herself that the cessation of menstruation is due to taking cold. She realizes that she is pregnant and that more effective measures are necessary at once, for she has the idea that after another month there are no means of inducing abortion without materially increasing the danger. She attempts more radical measures, or she consults her family physician, a midwife, or some physician recommended as an expert by the ladies of her acquaintance.
I can not refrain from saying in this connection that the induction of abortion is, to my mind, the most reprehensible of medical practices. I wish I could truthfully add, that none but disreputable men could be persuaded to undertake it. I know from my experience of twenty-two years as a medical man in this city and from the observation of many cases of criminal abortion in private, hospital and medicolegal practice, that the public, and many physicians as well, look upon the induction of abortion as a matter of routine. I have been told by prominent men that they expected their physicians to take care of them. I have lost the patronage of well-known society women because I refused to “help them out,” as they expressed it. I have noticed that pregnancy, in some of these women, did not go on to term, and I know who is their physician now.
And yet, if I am honest, there is another aspect to this subject which can not consistently be ignored. I have seen girls of 13 well advanced in pregnancy. I remember a little one whom I saw in a maternity with which I am connected. All unconscious of any wrong-doing, she sat, with the waiting women, contentedly playing with her doll. There is something wrong with our society if such things can exist. It seems to me that one potent remedy is the instruction of children so that they may know the dangers that beset them. There is to my mind, something lacking in the intelligence of those men who would deny to the child all knowledge of the usual consequences of sexual intercourse. It is manifestly unjust to condemn her when no attempt has ever been made to give her the slightest inkling of the truth.
The manipulations resorted to for the induction of abortion consist of the injections of liquids or the insertion of foreign bodies within the uterus with a view of exciting uterine contraction by their presence, or rupturing the membranes so as to occasion the death of the fetus or of separating fetal from maternal surface. As a matter of interest I may state that I have known women or their attendants to make use, for this purpose, of catheters, slate or lead pencils, knitting or crochet needles, glove-stretchers, hat-pins, nozzles of syringes, picture wire, hair-pins, corset bone, lemonade straws, toothpicks, pieces of chalk, tents of sea-tangle, tupelo, sponge or laminaria, as well as the direct intrauterine injections of glycerin or water, plain or variously medicated.
This is only my individual experience. Cases are recorded of the employment of the greatest variety of objects, sometimes with most serious and fatal results. The history of obstetric medicine from the earliest periods down to the present day reveals the practice of most barbarous methods, and shows most pitiable results only equaled by the traumatisms and fatalities occurring as a consequence of ignorant or unskilful attempts at deliver at term. I will not go into details regarding these practices, which Ploss has described most fully.  I saw one case at Biskra, in the Algerian Sahara, where a woman of the tribe of Ouled-Nail aborted following the insertion into the uterus of a sharpened piece of wood resembling a skewer. Dr. H. Smith reports to the London Obstetrical Society an instance of a woman producing abortion on herself thirty-five times by means of a knitting needle. 
The injuries that result from the use of these measures are necessarily varied. The average pregnant woman is ignorant of surgical procedures and the difficulty of attempts at abortion on her own person is apparent. Even in competent hands, under justifiable circumstances, the operation has not seldom proved disastrous. When the parts are diseased or structurally weakened, the induction of abortion or of labor has sometimes resulted in perforation or other injury, or has been the starting-point of a fatal infection.
Death has occurred simply from the introduction of a foreign body into the uterus. Vibert tells of a girl four and one-half months pregnant who had a canula inserted into the cervix. When the abortionist was about to inject some water the girl fell to the floor and died in a few minutes. At the autopsy all organs were found to be healthy, including the uterus, which presented only a few “fibroid bodies,” not larger than a nut. Death can only be explained by a reflex action, by an “inhibition” of the nervous system provoked by irritation of the cervix. 
The intrauterine injection of fluids—preferably of glycerin—has of late years been recommended as a means of inducing abortion. It is said to have the advantage of causing a rapid separation of the membranes from the maternal surface and of speedily exciting uterine contractions. I have had no experience in this method of treatment, but the intrauterine injection is not devoid of danger, as numerous cases of injury clearly show. Death may occur in consequence of the entrance of air into the circulation. Martin, of Berlin, has seen two cases of this character after the use of injections, and additional cases have occurred in this country.  Moreover, the instrument used has caused traumatism, in one instance amounting to a perforation of the uterus and resulting in metroperitonitis and death.  Mercurial poisoning has also occurred from the use of bichlorid solution. 
When foreign bodies are used to produce abortion, especially by the woman herself, the uterus is not always entered. Thomas’s case is well known. A physician’s wife, thinking herself pregnant, passed an umbrella rib, not into the uterus, but to the right of the cervix, through the vaginal wall, abdominal cavity and diaphragm until it penetrated the right lung to the extent of two or three inches, in which position it was found at the autopsy. The foreign body had remained in situ for at least a week and it was observed that an abscess had formed in the lung tissue around the point. Abdominal section had been proposed but rejected. 
Javaux tells about an elastic sound which encircled the cervix and was wound around it in a knot. This sound was introduced by a midwife to induce abortion, and the desired result was obtained in two weeks. The sound, however, remained in place for two years and a half, causing abdominal pain, especially during menstruation, until it was removed with forceps. 
The injuries resulting from the use of catheters and other foreign bodies introduced within the uterus with criminal intent, and as a rule by the vagina, vary from a laceration to a complete internal perforation. In many instances such an injury heals without serious disturbance of the general health, unless there be infection. In the latter case, septicemia and salpingitis, often with pyosalpinx, are the usual results; but all the well-known effects of an extension of infection are possible. In my own experience I recall a case seen in consultation with the late Dr. Nesbit, of Sycamore, Ill., in which there occurred a metastatic abscess of the brain, first recognized at the autopsy, and another case, which I treated in the Presbyterian Hospital for four months, where fourteen abscesses formed in the patient’s legs and
The subsequent history of the foreign body is of interest. Its presence or absence is an element in the prognosis and modifies the treatment very materially. Let us consider the possibilities in detail. First of all, it may perforate the uterus and pass through into the peritoneal cavity.
I had a unique case of this kind some years ago. A physician was endeavoring to produce abortion in a woman about three months pregnant, by means of a silver male catheter. The patient was nervous and had suffered from melancholia. The point of the catheter was introduced within the uterus, when suddenly the woman made a convulsive movement, and the physician, to his horror, saw the catheter disappear. When I was called to the patient, some hours afterward, I recognized a uterine perforation of the posterior wall through which I could pass a sound some 10 to 15 cm., but I could not feel the catheter within the abdominal cavity. Celiotomy was performed, but nothing was discovered in the pelvis. Finally the intestines were brought out of the abdominal cavity and after some little search I found the catheter under the liver and removed it. The uterine wound was closed with three sero-serous sutures and the right tube and ovary were removed, for it was noticed they were diseased. The patient made an uneventful recovery, and some sis months later, after a normal labor, was delivered of a child, which is now 11 years old.
Dr. Gill Wylie reports a case presenting certain points in common with mine. A girl inserted a glass rod into the uterus. It slipped beyond her reach, probably perforating the uterus. The following day the girl went to her work as typewriter. Some five weeks afterward she aborted, and about two weeks after that time a tumor, the size of an egg, was felt in the left ovarian region. Celiotomy showed adhesions about the uterus and left ovary. This ovary and tube was removed, as well as the glass rod which was found near the left kidney. No point of perforation was found. The patient made a good recovery. 
Dr. Hektoen has on two occasions, at post-mortem examinations, found perforations of the uterus, made during attempts at criminal abortion; in one instance he found a catheter under the liver. 
A case is reported where at the autopsy of a young woman who died when three or four months pregnant, an irregularly-shaped hole was seen in the posterior wall of the uterus, and directly behind it, lying transversely in the pelvic cavity, was found a sea-tangle or laminaria tent about the size of a thumb. Death was due to septic peritonitis, the result of a criminal abortion. It is probable the tent was inserted in the uterus and afterward an attempt was made to remove it. One end of the tent was split and showed marks of forceps teeth or something of the kind and the string was gone. It is probable the operator became frightened and made a desperate effort to get hold of the tent with the forceps and in so doing he forced it through the uterine wall. 
In August, 1892, I saw Wertheim perform a Cesarean section in Schauta’s clinic at Vienna. The omentum, if I remember correctly, was to some extent adherent to the parietal peritoneum. At all events, it was injected and showed evidence of inflammation, but the most curious circumstance in connection with this case, which, by the way, vas operated on in strict accordance with Sanger’s directions and resulted successfully for both mother and child, was a large needle about 7 cm. long, which was found imbedded in the omentum. It is hardly possible a needle of this size could have wandered into this curious location. It seems to me probable that it had entered the peritoneal cavity by way of the vagina in an attempt at an interruption of pregnancy.
Then the foreign body may remain in the uterus causing various sequelæ in consequence of its presence, sometimes without producing abortion. I instance a few cases.
A woman at the Hospital St. Louis, in Paris, was admitted with hectic fever and dull pains in the loins and hypogastrium. A hard, irregular tumor filled the pelvis and extended into the right iliac fossa. A wooden spit 12 cm. long was removed from the uterus, where it had remained since an abortion produced by it two years previously.  This woman gradually recovered.
There is a case of an operation for sinus of six months’ standing situated over the sacrum. The following day pus escaped from the vagina and a foreign body was felt partly in the vagina and partly in the uterus. It was a bougie over 5 inches long and had been introduced eleven months previously, abortion following in two days. 
Sometimes the foreign body which has produced the abortion remains within the uterus for a variable period, without appreciable inconvenience. Bunge speaks of a needle being pushed into the internal os and remaining there twelve days after the abortion. 
Occasionally the foreign body, retained within the uterus for a considerable length of time, becomes the starting-point for a suppurative process, through the agency of which it is expelled into the adjoining viscera or penetrates the neighboring tissues. I will speak of two cases of this kind. .
A seton needle was introduced into the uterus of a young girl for criminal purposes. A three months’ fetus was wounded by the instrument and expelled. Two days afterward the secundines followed but the needle remained in utero. About a month afterward an abscess formed in the inguinal region, accompanied by severe pain. On the seventy-fifth day the needle, six inches long, appeared at the surface. 
A woman used a branch of a tree to penetrate the uterus. She pushed it in so firmly that it became imbedded in the region of the kidney. The twig, which was six inches long and as thick as a goose quill, remained in the pelvis five months without the patient’s knowledge and finally penetrated the rectum. ‘
A case is reported of fatal injury of the internal iliac artery. A woman, six months pregnant, consulted a charlatan, who performed an operation, which at the end of twelve hours was followed by the death of the patient and brought the man into custody. The autopsy showed an enormous quantity of blood, partly coagulated, in the abdominal cavity. The posterior wall of the uterus showed an opening of the diameter of an ordinary sound extending to the right iliac artery, which was itself perforated a little below its origin. Three other punctures had their starting-point in the cervix. In spite of these punctures the fetus had not been reached, the membranes remained intact.” 
The cases I have cited are exceptional. The usual history is different. There occurs a death, under suspicious circumstances, of a woman suspected to be pregnant. An autopsy is held, resulting in the discovery of lesions due to violence and the presence of sepsis as the determining cause of death. There are many cases of this character recorded in medical literature. Tardieu especially has fully described them. 
Evidences of injury are usually found in the wall of the uterus, and consist of lacerations varying in extent from an abrasion to a perforation. The cervix may be bruised and gangrenous inflammation, dphtheric patches or diversified signs of infection may he noticed. Often thr fetus will be found enveloped in its membranes, which may be intact and free from inflammation. The woman in such a case will have died in consequence of an unsuccessful attempt at abortion.
When there is a trial in criminal abortion cases the defense is apt to be an attempt to demonstrate the occurrence of the lesions from external violence, such as a fall or shock, or the assertion that the injuries found are due to disease. Such a defense is, as a rule, easily disproved. A uterus in the early months of pregnancy can not be injured by a contusion severe enough to determine a serious inflammation nor a disorganization of the muscular tissue.
Of course, it is known, as Barnes has pointed out, that the non-pregnant uterus may burst and that rupture may occur at any period of gestation independent of labor. In the former case there is disease of its tissues or there is a closing of the os and an accumulation of fluid in the cavity. During pregnancy, when rupture occurs, independent of trauma, the uterus may have been the subject of Cesarean section or the seat of tubercular degeneration. Cases of spontaneous rupture, or rupture occurring after a long walk, severe vomiting or other apparently trivial cause, are recorded as early as the third month.
In spite of these rarities of obstetric practice, the medical expert will have but little difficulty, as a rule, in determining the probabilities. A microscopic examination of the uterine tissues at the seat of the lesion will be of value, for if no evidence of disease is found the presumption of an external agency will be strengthened. An ordinary abortion does not produce rupture of the uterus nor other extensive or serious lesions. Moreover, the character of the lesion, the appearance of the perforation, if there be such an injury, the color and condition of its borders, the consistency of the neighboring parts—all these will indicate whether the solution of continuity is recent or not, and will assist, in connection with the other pathologic conditions observed, arriving at a definite conclusion.
I must call attention to two curious cases where women produced abortion on themselves by forcing respectivel a hairpin and a knitting-needle into the uterus through the abdominal wall. In the first case a young girl was delivered of a dead infant at term. After she left the hospital it was learned that she had driven a long hairpin through her navel to a great depth with the avowed intention of destroying the child. She had suffered great pain afterward, which she concealed. It was noticed that some pus issued from her umbilicus after delivery, but this discharge gradually ceased and the patient left the hospital in good condition. 
Duncan relates the other case. A girl six months pregnant tried to produce an abortion by thrusting a knitting-needle through the vagina into the uterus. Failing in this attempt, she forced the needle through her umbilicus. Two days later abdominal section was performed and the tip of the needle was seen projecting from the fundus uteri. It was seized with forceps and removed, a stitch being inserted in the uterine puncture, as there was some hemorrhage. Two days later the patient miscarried and a black spot was seen on the child’s buttocks where apparently the needle had penetrated. The mother recovered. 
The facts regarding criminal abortions are not fully stated without reference to the remote effects occasioned by repeated attempts—often successful—at an interruption of pregnancy. A few days ago I met a robust married woman who told me she had had eleven abortions induced by her family physician during the past six years. She appeared to be well, and perhaps she was. Most women live through the ordeal, or our graveyards would be full to overflowing. The etiologic relationship of criminal abortion to new-growths and degenerative changes has not been fully determined. The connection between many diseased states of the nervous system is well recognized, but not very satisfactorily explained. At the same time it is certain that induced abortion is often the cause of some infections with all that the word implies. In addition to the sequelæ of direct and indirect traumatism, already referred to, it is known that there often results some condition which makes pregnancy impossible. The sterility of prostitutes, remarked by Parent-Duchatelet, is estimated by Fritsch at three-fifths of all such women. Among other women who have suffered abortion during the early years of their married life, it is often observed that pregnancy is impossible when the time comes for a child to be most ardently desired. Pitiable, indeed, is the condition of such a woman. Regrets are useless now. There is only remorse and perhaps indignation that the medical men who, in her youth, acceded to her request, had not the manhood to tell her of her folly and to warn her of her danger.
1. Parish: Med. Rec., Vol. xliii. p. 691.
2. Denslow Lewis: The Gynecologic Consideration of the Sexual Act, p. 20.
3. Whitaker: Am. Jour. Med. Sci., 1857, N. S. xxxiv, p. 283.
4. Faucon: Jour, de Sci. Méd. de Lille, 1883.
5. Hyde: Boston Med. and Surg. Jour.. 1841-2, xxix, p. 377.
6. Plenio: Centralbl. f. Gyn., Bd. xiii. p. 236.
7. Randell: Lancet, 1841.2, xxix, pp. 45-49, and xxx, p. 983.
8. Moir, Edin: Med. Jour. Oct. 1865, xi. p. 313. Fairbanks: Trans. Obst. Soc. Loud., 1868, ix, p. 1.
9. Phillips: Trans. Obst. Soc. Lond., 1890. p. 32.
10. Cummins: Dublin Quart. Jour. Med. Sd., 1858, xxv, p. 228.
11. Sirois: L’union Méd. du Canada. n. s. Vol. i, p. 345.
12. Thomas: Abortion and its Treatment, p. 24.
13. Lancet, July 23. 1853. p. 89.
14. Palmer: Med. and Surg. Reporter, Phil. Vol. xxiv, 1871. p. 207.
15. Ploss: Das Weib.
16. Smith, H.: Trans. Obst. Soc. Lond.
17. Vibert. Aunal, d’hygiène publique, 1893, 3 ser. xxix.
18. Martin: Berlin Klin. Woch. No. 38, 1874.
19. Lacassagne: Arch. de l’anthrop. crim. Paris, 1889. iv, p. 74.
20. Gebhardt: Zeitschr. f. Geb. u. Gyn. Vol. xxi, p. 2.
21. Thomas: Abortion and its Treatment. p. 36.
22. Javaux: Centralbl. f. Gyn., Vol. xxiv. p. 571.
23. Wylie: Am. Jour. of Obst.. Vol. xxv, p, 690.
24. Hektoen: Am. Jour. of Obst., Vol. xxvi, p. 69.
25. Durell: Boston Med. and Surg. Jour. Vol. cxxx, p. 382.
26. Maisonneuve: Gaz. Médicale, 1841.
27. Ward, A. S.: Boston Med. and Surg. Jour. 1894, p. 1187.
28. Bunge: Deut. Med. Wochenschrift. 1891. No. 5.
29. Archives Gén. de Méd.. Prem. serie, T. iii. p. 1823.
30. Zuhmeister: Schmidt’s Jahrbucher.
31. Raynard: Am. Jour. Med. Sci., 1853. p. 77.
32. Tardien: Etude Médico-légale sur l’avortement.
33. B. C. Hirst-Harris: Abdominal and Uterine Tolerance in Pregnant Women. 1892. p. 11.
34. Duncan: Trans. London Obst. Soc. 1892. Vol. xxxiv, p. 223.
William H. Sanders, “The Physiologic and Legal Status of the Fetus in Utero,” JAMA 46 (February 24, 1906): 551-53.
.THE PHYSIOLOGIC AND LEGAL STATUS OF
THE FETUS IN UTERO.*
W. H. SANDERS, M.D.
Health Officer of Alabama.
*Read in the Section on Obstetrics and Diseases of Women of the American Medical Association at the Fifty-sixth Annual Session, July, 1905.
The two most important events connected with a life-history are its beginning and ending.
Embryology has persistently sought to discover and to interpret the earliest manifestations of the former, while pathology, with equal tenacity of purpose, has endeavored to ascertain the causes and incidents of the latter. So far as the beginning of a life-cycle is concerned, embryology has thoroughly established the doctrines, of gamogenesis and agamogenesis, the former being the rule among the higher orders of plants and animals, the latter among the lower orders. Reproduction among human beings must, therefore, obey the law of gamogenesis; hence, two ancestors—male and female—contribute to the origin of every new member of the human race, the contributing elements being spermatozoon and ovum, respectively.
While these germ-cells possess inherent vitality and motor power, especially the spermatozoon, neither one can separately and alone evolve itself into a higher or more complex morphologic entity. Put the two together, however, under favorable conditions, and a new unit results, one capable, under proper environments, of evolving itself into a fully-developed human being, that is, the new unit represents all of the potentialities of which the future adult becomes the outward and visible expression.
In contributing the germs they respectively furnish, the male and female have done all they can do toward the creation of the new unit and toward its endowment with physiologic and psychologic functions similar to their own. From that time forth the new being, possessing all of the attributes of living bioplasm—motion, absorption, sensation, and fission, or multiplication—must be the architect and builder of its own body. True, for nine months the female performs the essential and hospitable function of hostess, and generously supplies the young, and presumably, welcome, guest with oxygen, inhaled through her own lungs; with food, elaborated in her own digestive system, and with warmth supplied by her own blood, but in fulfilling these high functions she s simply furnishing the material, the brick and mortar, o to speak, out of which the young builder must erect its own corporeal superstructure. .
In the work going on, the part played by the female corresponds with the offi ce of brick and mortar carrier, that by the young builder, with the office of skilled. artisan, who takes hold of the materials brought and puts them together in the shape and form of a human body. The new being as it grows and develops is not the passive result of work done by the physiologic forces of the female, but is an autochthon, using, however, very refined material furnished by the hostess. The principle is precisely the same as one that prevails in social life. A hostess places dishes, delicious and wholesome, before her guests, but is powerless to force them to partake thereof; they must, by their own volition, take hold of and appropriate the food brought within their reach.
Science does not forbid, on the contrary justifies, the belief that, could the fertilized ovum, before it has formed attachments to the womb in which it receives its fertilization, be transferred without violence to another womb in a similar condition to the first, its career, of growth and development might proceed undisturbed. Indeed, could the transfer be made to an artificial womb, or incubator, in which the conditions were identical with those of the natural womb, its growth and development, might still proceed undisturbed. The conjunction of spermatozoon and ovum must, therefore, be a great biologic event, one that endows the newly-formed unit with physiologic functions and pyschologic attributes; indeed, makes it, in a qualified sense, an independent human being. Although the powers of this new being are feeble, its potentialities are great, the evolvement of which constitutes the growth, development, and achievements of its life-history.
The cardinal postulate I desire to emphasize is that the vitality, the life-force, and’ the physiologic functions of the new being reside within itself and not in the hostess. As has been said, the latter sends blood to the fetus, freighted with food and air, but she is powerless to force it to accept either; the new being eats because it is hungry and breathes because it feels the need of oxygen, both acts being vital efforts of its own. Soon after receiving its endowment of physiologic functions the new comer settles down in its velvety and temporary home, prepared by the proliferating lining of the maternal womb, and dominated by an instinct, yea, an intelligence, coeval with its own corporeal origin, proceeds to differentiate itself into bone, sinew, tendon, muscle, blood vessels, viscera, brain, and nerve, and with the skill of a consummate artist fashions these in miniature of an adult human being, the highest type of animal ‘life. The fetus performs these physiologic functions by virtue of its own vitality and power, originally derived, it is true, from the two parental germs, but when these have been consolidated into a new unit—a tertium quid—a self-acting and, in a qualified sense, a self-sustaining human being has been created.
At the end of nine months the silent and unseen artist has filled his temporary home with his living self, whereon the hostess by means of forces marvelously scientific and practical ushers him into the outside world as a plump and rosy baby. When was that baby born, a few minutes ago or nine months ago? Science and logic give one and the same answer. If birth means the act of coming into life, as the dictionaries tell us, unquestionably the baby under discussion came into life nine months ago, and at the end of that period simply changed its domicile. Why not, then, abolish the term conception, which is liable to be more or less misleading and confusing, especially to the lay mind, and substitute for it the more scientific and correct term, birth? This done, then, the one term, delivery, either premature or at full term, would adequately express the transition of the child from intrauterine to extrauterine life. Besides, the adoption of this nomenclature would help to clarify the entire subject of fetal life and would lead to the enunciation of definite, inflexible, and absolutely correct principles of jurisdiction applying thereto. If the baby in question is a living human being when delivered, was it not a living human being the day before, the month before, six months before, eight months and twenty-seven days before? Can a point of time betwixt conjunction of the parental cells and the delivery of the child be fixed before which it did not possess the nature of a human being and after which it did possess the nature of a human being? Did its nature undergo any change between the time at which conjunction of the male and female germs occurred and that at which the baby appeared in the outside world? Was not the nature of the baby the same from the beginning to the ending of its uterine life? Was it not from first to last simply a question of the growth and development of one and the same being, and after the completion of the period of uterine life will it not continue to be a question of t growth and development of one and the same being up to physical maturity?
With these questions answered in the affirmative, as they must be, we are forced to concede that when the red-hot furnace of congeniality two germs—male and female—are brought together that fuse themselves into one, a new being, crowned with humanity and mentality, comes into life. If this be true, does not the new being, from the first day of its uterine life, acquire a legal and moral status that entitles it to the same protection as that guaranteed to human beings in extrauterine life? Indeed, should it not receive greater protection, for the reason that to the nature of a human being it adds the condition of utter helplessness, a condition that should appeal in mute, but sublime eloquence to the manhood, the womanhood, and, above all, to the motherhood, of those who can shield and protect it? Lives there a man or woman who would assault and slay a little, laughing, prattling babe? If that be a crime from which the coldest-blooded villain would recoil, how much more a crime to assault and slay an innocent babe quietly sleeping in what should be an impregnable fortress—a babe whose voice is hushed and can not be raised in piteous cry, for mercy or for help!
Objection to the use of the terms, birth and delivery, in the senses suggested, might be raised on several grounds:, First, that it would involve the date of every birth in more or less uncertainty; secondly, that the fact of a birth could not be certainly known for four or five months after it had occurred; thirdly that no practical benefit would result from the adoption of the proposed nomenclature. Admit that these objections are entitled to more or less weight, yet, when compared with the advantages that would accrue from the change of nomenclature proposed, the objections dwindle into insignificance. A simple formulation of the advantages will be sufficient to force conviction of the utility of the proposed nomenclature:
1. It would be essentially and scientifically correct to locate birth where and when it actually occurs, in spite of the fact that several months would usually elapse before it could be known that a birth had certainly taken place.
2. It would place a pregnancy, from the first day of its probable occurrence to its termination, on the high legal and moral grounds it deserves to occupy.
3. It would dignify the position of the foetus in utero, and would establish beyond all doubt or confusion the right of the fetus to the same protection, moral and legal, as is accorded to human beings who have completed the period of their uterine existences.
4. It would unify the terms, fluxion, abortion, and miscarriage, under the one term, premature delivery; then, two expressions, premature delivery and delivery at full term, would cover the entire subject.
5. It would enable lawmakers to enact clear and definite laws for the protection of the foetus in utero, which laws, jurists and juries could administer without doubt or confusion.
6. It would have a strong tendency to promote virtue and to pre-vent crime, and to build up in every community a positive demand for the protection of human life at its tenderest and most helpless period; it would tend to educate the people on a subject in reference to which they stand in great need of education and would thereby save the lives of many innocent and undelivered babies.
If the argument thus far be sound and tenable, does not the legal status of the fetus become clear and fixed? It is not strange that before science had ascertained the steps and stages of reproduction the law providing for the protection of the fetus should have been inadequate, but after these steps and stages became definitely established no inadequacy on this point should have prevailed. The common law is conspicuously defective in its provisions for the protection of the fetus. The following quotations on this point are made from the American and English Encyclopedia of law: “According to some authorities, it never was an act, punishable at common law to commit abortion with the consent of the mother, provided it was done before ‘the child became quick; but others are not disposed thus to restrict the criminal act, and hold that it may be committed at any stage of pregnancy. If the abortion was committed after quickening, it ,was punishable only as a misdemeanor. If done without the woman’s consent, the act was held to constitute an aggravated assault.”
Inasmuch as the common law was wholly inadequate for the protection of the fetus it became imperative that this defect should be supplied by statute law. Quoting from the same authority cited above, it is gratifying to find the following statement: “The statutes enacted on this subject in most of the states fail to draw any distinction between the commission of the offense, or attempt at commission, before and after the quickening of the child in the womb, making it a felony in either case. But some states still retain the distinction, punishing the act or attempt more severely when done after quickening. In Michigan it is essential that the child be quickened. The means denounced by the various statutes are the unlawful or malicious supplying or administering to a pregnant woman, or causing or procuring to be taken by her, any drug, poison, substance or noxious thing, or unlawfully using or causing to be used any instrument or other method whatsoever, with intent to procure or cause an abortion.”
The statutes on this subject recognize the right of a physician to produce an abortion in the interest of the mother. The question arises: Should this right be exercised? Without undertaking to discuss the various conditions under which the exercise of this right might be considered, the broad proposition is laid down that the occasions on which it would become imperative to sacrifice the life of the child to save that of the mother are extremely rare. With the two great resources of rectal alimentation and Cesarean section at command, it is believed that practically every pregnancy can be safely carried to a point at which the life of the child may be saved. The methods and means of maintaining nutrition by rectal alimentation have been so perfected that the production of abortion, or of premature delivery, for gravid nausea should rarely or never be required. At all events, by this resource the woman ought to be carried to the point of certain viability of the child before premature delivery is resorted to. For deformed pelvis surgery with its tremendous advances in skill and technic, offers in Cesarean section a resource for saving the life of the child, and at the same time of jeopardizing to such a small degree that of the mother, that it should be universally employed in such cases. Dr. L. L. Hill, a surgeon of distinction in my state, and fully informed on these questions, furnished me recently the following statistics applying to Cesarean section: “1. Zweifel performed 76 Cesarean sections with 1 death. (J. Whitridge Williams, professor of obstetrics in the Johns Hopkins University, 1903.) 2. In 1903 J. Whitridge Williams collected the reports of 335 cases of Cesarean section by various operators, with a mortality of 6.87 per cent. 3. Not a single death of a mother occurred in 11 Cesarean sections recently performed at Johns Hopkins Hospital. 4. .The mortality in Cesarean section should be about the same as that resulting from operations for simple ovarian tumor.”
Without pursuing this discussion further, I submit to this Section the following propositions, and invite an expression of judgment thereon, not only by the individual members, but by the body:
1. The conjunction of male and female germs constitutes, from a scientific standpoint, birth.
2. The term conception should be abolished and that of birth substituted therefor.
3. In dealing with all stages of pregnancy, even the earliest, physicians should realize the extreme gravity of the condition, and should never condemn to death a fetus, however young, without the maturest consideration, and without calling to their aid the highest professional authority within reach; in a word, without carrying the case to the nearest and wisest medical supreme court accessible.
4. The principles herein contended for should be impressed on the members of the profession, taught to medical students and promulgated widely among the people.
5. Medical men should interest themselves to see that the statutes of their respective states are ample for the protection of the foetus in utero.
Dr. H. O. Marcy, Boston, said that his opinions correspond with those of Dr. Sanders. He believes that the conclusions should be emphasized most positively. A physician may induce an abortion because he believes that the life of the mother is more valuable than the life of the fetus, but he should try to conserve the life of both to the best of his ability.
Dr. W. H. Sanders declared that It was not stated in the paper that abortion should never be brought about, but that it should be the result of very mature consideration and after consultation with the highest and wisest and most experienced authorities within reach.
Charles Sumner Bacon, “The Legal Responsibility of the Physician for the Unborn Child,” JAMA 46 (June 30, 1906): 1981-84.
The Journal of the American Medical Association
VOL. XLVI CHICAGO, ILLINOIS, JUNE 30, 1906. No. 26.
THE LEGAL RESPONSIBILITY OF THE PHYSICIAN FOR THE UNBORN CHILD.
CHAIRMAN’S ADDRESS IN THE SECTION ON OBSTETRICS
AND DISEASES OF WOMEN, AT THE FIFTY-SEVENTH
ANNUAL SESSION OF THE AMERICAN MEDICALASSOCIATION. BOSTON, 1906.
C. S BACON, M.D.
THE LEGAL RESPONSIBILITY OF THE PHYSICIAN FOR THE CHILD IN UTERO.
All physicians, as well as other biologists, must regard the child in the womb as much a human being while still in the womb as after its expulsion. Although dependent on its mother for nourishment and for protection from injury and cold, it is still a living being and as much an independent existence as, for example, an intestinal parasite which depends on its host for protection and nourishment. That it lacks some of the functions of the individual ex utero, for example, the respiratory does not disprove its independence or its human nature. The infant also lacks functions that are possessed by the adult. The self-conscience of the fetus is only in abeyance because not aroused. The embryo or fetus is then to the biologist a separate human individual and not a pars viscerum like the ovary or the appendix.
We must regard this human being as just as independent at the beginning of its intrauterine life as after it has reached a stage where it can live outside of the uterus. The old legal distinction between a fetus animatus and inanimatus has, of course, no biologic foundation, although the statutes of certain states give a kind of authority for the perpetuation of these terms which are now in reality meaningless. The perception by the mother of fetal movements does not prove or disprove the life of the child any more than would a lack of consciousness of movements of other parasites which exist in her body disprove their existence. Likewise, there is no biologic basis for the ancient legal distinction which gave different vital and human attributes on the fetus formatus and the fetus informatus.
LEGAL STATUS OF FETUS.
The legal status of the child in utero does not conform to its biologic status. All human beings ex utero are on the same plane and neither a physician or any one else has the right to take the life of one for the benefit of another or for any reason whatever, unless the state, through its judicial officers, declares the life of an individual forfeited because of his crimes and because its extinction is necessary for the welfare of the state. The unborn child has not the same legal protection. Under certain circumstances its life may be taken. The laws of most states and countries justify feticide when it is necessary to save the life of the mother. The provisions of these laws are of great importance to the medical profession and should be well known. Every physician should understand his legal responsibilities, rights, and obligations in this connection. The religious and ethical questions involved will not be considered in this discussion or only incidentally.
Surgeons of all kinds are learning to appreciate more and more the importance of having a definite understanding or contract with the patients on whom they operate. If the patient is not in condition to give consent or is not old enough to decide, the contract should be made with the legal representatives of the patient. In case no verbal or written or implied contract is made the surgeon operates at his own risk. When a contract exists he is still liable if he does more or differently than arranged for. Of course under any circumstances he is responsible for his management of the case if it is not skillful or if he is negligent.
The risks of the obstetrician are perhaps still greater. Many of the recent malpractice suits occur in obstetrical cases. The laity are coming to believe that puerperal infection is preventable and that its occurrence is due to malpractice. Obstetrical operations are exposed to the same risks as surgical operations. But operations involving the destruction of life of the fetus introduce a question that is quite different from any that can come before the surgeon and involve an additional risk. It is to this special risk or responsibility of the obstetrician that I wish to call attention as the subjective side of the question.
There is another classification of intrauterine life that might seem more natural and reasonable than those already mentioned, namely, that based on the viability or non-viability of the child. Some may ask, is the destruction of a viable child, especially one near or at term, a more serious matter than that of an unformed embryo, or even than the destruction of a 24-weeks’ fetus that can live out of the uterus at most only a few hours? On mature consideration such a question will probably be found to have no biologic basis. As to the juristic side of the question it appears that in most states in this country the law makes no distinction in the legal rights of children in utero.
LAWS OF VARIOUS COUNTRIES AND STATES.
We shall be much disappointed if we expect to find that the laws of the country or of any states form a body of well-digested and consistent and logical rules of action. Logical consistency is hardly a characteristic of any law. The law rather expresses the common opinion or judgment of the people, and this expression must conform to the conflicting variety of sentiments held by people of all stages of mental and moral development. If the law is ahead of the people or imposed on them by outside authority, it is apt to be executed indifferently or not at all, or it may raise opposition that leads to its annulment. In this country, as well as in England, whence our laws originally came, the laws are self-made and are generally an index of popular sentiment.
According to the ancient English common law, by which we mean the ancient precedents, the decisions or dicta of courts not founded on legislative enactment, the embryo or fetus before the term of quickening had no legal rights whatever. Up to the time of quickening no offense could he committed by an operation that led to the destruction or premature delivery of the fetus. If the woman gave consent, the bringing about of an abortion was not recognized as a punishable offense.
Abortion produced without her consent was punishable as assault. The theory of the courts was that life, in contemplation of the law, begins when the child is able to stir in the womb and prior to this time the child does not exist as capable of being the object of criminal intent or action. Hence, when the mother gives her consent, the operation could only be considered as a wrong against something that does not legally exist.
This was the common law till shortly before the separation of the colonies from the mother country. This common law was the basis of the law of this country. In many states, this theory of the legal nonentity of the unquickened fetus was held by the courts to be the law and the early statutes of some states particularly or impliedly approved this theory. Now, however, this provision of the common law has been superseded by the statutes which have been passed by the several states. These statutes, in most of the states, make no distinction between the commission of an offense on the child before or after quickening, although some states still provide a more serious punishment when the act is committed after quickening.
It will not be possible for me to go into an examination of the statutes of the different states, and I must content myself with calling your attention to the practical abrogation of the common law, the substitution of statutary regulations as just outlined, which practically recognize certain rights of the fetus, although they do not place it in the same category with the individual ex utero.
I shall pass by a number of interesting questions which do not pertain strictly to the subject, for example the responsibilities of the mother, and briefly refer to the general provisions that have a bearing on the legal status of the fetus as concerns the physician.
At common law, procurement of an abortion after quickening, with the mother’s consent was forbidden, but was not a crime punishable with imprisonment. If however, the mother died as the result of the abortion, the one who performed the act was guilty of murder.
The statutes of the several states generally provide that any attempt to procure an abortion, either by the administration of drugs or by the employment of instruments, is punishable by imprisonment, unless the act is necessary to preserve the life of the mother. When the death of the mother results the crime becomes manslaughter and is punishable as such.
Before considering the question of most interest to us, namely, that of the justification of the act, a moment’s attention should be given to a few side questions of importance. For example, how far is one responsible for advice to take medicine or to use means to produce an abortion. It is held that one is responsible for such advice if it is acted on, but not otherwise. The question also arises concerning the efficiency of the means employed. Here it is held that the intent governs. The ruling shows that the object of the law is not only or not so much to protect the fetus as to protect the life and the health of the mother from the consequences of the atempts at abortion. This also explains, in part at least, the ruling that the viability of the fetus is not necessary to commission of the crime, although, no doubt, the vitality of the fetus at term, is a very important consideration in determining the justification of an obstetrical operation.
LEGAL JUSTIFIABILITY OF FETICIDE
We now come to the most vital question of the justifiability of feticide. In some wording or other, all statutes provide for exemption from punishment for abortion in case it is necessary to preserve the life of the mother. This provision expressly implies that in the eyes of the law there is a difference in the value of human lives. It is the codification or the reflection of the popular belief or popular conscience that the mother’s life is worth more than that of the child in utero. Whether this popular opinion or this expression of it in the statutes is morally justifiable or not, is not within the limits of my subject to discuss. We are simply concerned to learn definitely what the law provides. There seems to be no doubt of the far-reaching consequences of this provision concerning the necessity of preserving the life of the mother at the expense of her child. It is on this provision that the physician probably must rely for exemption in case of mutilating obstetrical operations made on the living child.
Just what is comprehended in the provision, “necessary to preserve the life of the mother,” must be determined by the court in each case, and decisions have varied in some points. In some states the statutes require that the advice of two physicians be secured to determine the necessity of an abortion. Where such a rule holds it is, of course, necessary to show that the physician acts in good faith, in calling a consultant who is not in collusion with him to perform a criminal act. Where the rule does not hold, consultation is not necessary, but always desirable. It is always necessary to show that the physical condition of the mother requires the abortion. Fear of suicide or of remote results, developing from a possible nervous condition, does not justify the performance of the act. The practice of many physicians who make the probable injury to health an indication for induction of abortion, is not justified by law and might lead to trouble in the event that such a case were brought before a strict constructionist court. It has sometimes been held that the burden of proving the necessity of the abortion falls on the physician and sometimes that the absence of necessity must be proven by the state. No doubt the circumstances in individual cases would have some bearing here, while in different states the practice varies.
So far, our attention has been addressed chiefly to the rights of the non-viable fetus and to the responsibilities incurred by the physician in its destruction. Neither the statutes nor the decisions of the courts in this country have fixed the status of the viable child in utero, except as it has been included with all intrauterine life in the provisions already discussed.
INDICATIONS FOR EMBRYOTOMY
All obstetrical writers in discussing the indications for embryotomy of the living child have laid down certain rules based on their own conclusions concerning the justifiability of. the practice. Nearly all admit that the operation should be done at times. A few, like Pinard, would do away with it entirely. In general, the operation is admitted in cases in which delivery is impossible without Cesarean section or some operation to enlarge the pelvic girdle, and when the latter procedure is refused by the mother. The question is variously discussed from the usual religious and social standpoints, but rarely, or never, is the legal standpoint presented. The individual views of each writer are given and they generally coincide with those of others, so that the two or three sentences devoted to the subject are practically the same in all text-books. I have been able to find nothing authoritative in English concerning the legal status of the operation. Sippel, studying the German criminal law, concludes that: “In practice, the destruction of the life of the child by the induction of abortion or by embryotomy in order to save that of the mother, is not a punishable offense, and modern criminal law practice agrees in this respect. In theory, however, jurisprudence has reached no conclusion as to whether this destruction of fetal life should be allowed or condemned, nor as to how this destruction should be legally construed.” Both Kossmann and von Franque call attention to the fact that in Germany a physician who destroys a living fetus may be in danger from an unfriendly court. In this country, there is little or no doubt that the destructive operation, if necessary to save the life of the mother, would always be justified by the courts.
POINT DECIDED BY MEDICOLECAL SOCIETY OF FRANCE.
One important point has been discussed and decided by the medicolegal society of France. A physician is not compelled to make a destructive operation against his own judgment or conscience. In other words, if a physician advices a Cesarean section or a symphyseotomy or pubiotomy and this operation is refused by the patient or her husband or guardian, he can not be compelled to substitute an embryotomy for the operation he proposes, even if he be the only physician in the place. Such a rule would undoubtedly be followed in this country, although I do not know that any case of the kind has ever been decided. It is inconceivable that a court would hold a physician responsible for the death of a woman because he refused to perform an embryotomy on her living child, and he certainly could not be convicted of civil malpractice in such a case. Of course, the physician has no right to leave his patient who has refused his advised conservative operation and he demands an embryotomy until some other physician has arrived, or until he is summarily dismissed from the case.
As to the legal justification of a destructive operation, probably the same can be said as was stated in regard to therapeutic abortion. In some states it might be necessary for the physician to prove that the operation was necessary to save the mother’s life, while in most states the burden of proof would be on the state to prove that the operation was not necessary.
INDICATIONS FOR OPERATION.
It is not in my province to enumerate the various indications for the operation, any more than it was my plan to discuss the different pathologic states that required the induction of abortion. In general, it might be affirmed that the indications for destructive operations are becoming contracted and many pathologic states that previously were treated by embryotomy, would not now be accepted as indications.
This review of the legal status of the child in utero has led probably to less results than were expected. I have been disappointed in finding less material than was expected. It shows, I believe, that the legal responsibilities of the physician are comparatively simple. No physician need be in doubt in any case. If he believes that the preservation of the life of the mother requires the sacrifice of the child he may operate without fear. It is always better, however, to fortify his opinions by consultation with a reputable colleague. The law does not recognize that the life of the child in utero is of equal value with that of the mother.
In deciding on his moral responsibilities, however, the physician may have much greater difficulty. The statute law is frequently behind or at variance with the ethical law and the variance seems to be marked in this case. Many operations would be legally safe that would be undoubtedly wrong.
It is difficult to deny to the human fetus the innate right of every human being the equal right to life. On the protection of this moral law the child in utero must chiefly rely for its preservation. The moral responsibilities of the physician for the child in utero are greater than his legal responsibilities. It is hard to dispute Pinard when he holds that neither the father, the mother, the physician, nor any other person has the right of life and death over the fetus. The frequency and boldness with which that right is claimed by the father or by the relatives of the mother should meet with firm resistance. I see no ground on which the physician can stand when he decides to destroy the fetus, except a kind of implied, authorization by the state, which agrees to uphold the right of the mother to self-preservation when her life is endangered by that of the fetus.
Walter B. Dorsett, “Criminal Abortion in Its Broadest Sense,” JAMA 51 (September 19, 1908): 957-61.
The Journal of the American Medical Association
VOL. LI CHICAGO, ILLINOIS, SEPTEMBER 19, 1908. No. 12.
CRIMINAL ABORTION IN ITS BROADEST SENSE.
CHAIRMAN’S ADDRESS BEFORE THE SECTION ON OBSTETRICS AND DISEASES OF WOMEN, OF THE AMERICAN MEDICAL ASSOCIATOIN, CHICAGO, 1908
WALTER B. DORSETT, M.D.
I wish to express my deepest gratitude to the members of this, one of the most important sections of the American Medical Association, for having chosen me as their chairman. This honor comes to but few of us in a lifetime, and when 1 was selected could not but feel that the honor carried with it a great responsibility. In accepting the position, it will probably be remembered, I said: “The success of a year’s work would not be accomplished by the chairman but by the work of each individual member.”
In looking over the program one must be impressed by the wealth of subjects to be discussed, as well as the names of the authors of the papers. This certainly should convince us that we are to enjoy a treat seldom offered in bodies of this character. Should I attempt to add anything of a scientific nature, I fear it would rather detract from than add to its interest. I have, therefore, concluded to present a subject that concerns us not alone as obstetricians and gynecologists, but as citizens of a great republic—“Criminal Abortion in Its Broadest Sense.”
It is high time we should have a. heart to heart talk.
The accepted definition of the word “crime” is “a breach of law, whether divine or human.” Laws are rules, whether human or divine, for the government of the human race, and are enacted for the good of mankind. While the subject may be viewed from many standpoints, still there is a common ground on which we all must stand in order to view the subject in its composite form. It is reasonable to assume that the infraction of a law should carry with it a penalty; whether that law is human or divine, else it would be useless to enact laws; and no law holds good that does not have attached a penalty, which should be commensurate with the importance of the law. While there is probably no one In this audience who would deny that criminal abortion is fast becoming more and more common, still there may be many who may not be willing to take a decided step toward its suppression. The question may be asked: “Does it concern us as physicians? Does it concern us as members of the American Medical Association and of this section? Does it concern us as citizens of this, our beloved country?
It is a rule in law that co case can be prosecuted without first obtaining sufficient information from those who possess it. The abdominal surgeon sees almost daily the results of the work of the abortionist and the obstetrician can not be blind to the practice of the disreputable midwife and the unprincipled doctor. Admitting then, that these statement are true, who should be concerned in this matter?
Possessing the information that we undoubtedly do, should it not be our duty as citizens, as well as physicians, and members of this important branch of the great American Medical Association, to suggest some means for the suppression of an evil that threatens such an onslaught to our civilization? When I say possessed with the information. I say it advisedly. Each and every member of this section can at this moment relate sad death-bed scenes that fairly make the blood run cold. Beautiful women are robbed of their lives, beautiful babes made orphans, and whole families wrecked, by a conscienceless scoundrel who goes free and unpunished by the law of our land.
It is useless to expect ecclesiastic intervention. The clergy do not seem to be at all concerned. To furnish them with this information is to throw away your time. Few sermons are preached from the pulpit for fear of shocking the delicate feelings of a fashionably dressed congregation, and the begging for money to save the souls of the far away heathen seems of more importance. They can not but realize the enormity of the crime from knowledge gained at the bedside of the victim of the abortionist. Yet they do not possess the moral courage to express their convictions to those to whom they are “called” to minister. Their education along biologic 1iies has, I am certain, in many cases been sadly neglected.
Young people marrying deliberately agree not to be parents for two or three years. They prefer to enjoy life by getting into and keeping in the social whirl. They may be, and often are, considered good and respectable people—possibly church-going people.
Self-induced abortion, or abortion produced by a fashionable or fad doctor, is, as we know, a fruitful cause of the horrible pus cases in which we are now and then called to operate. This fad doctor is one with a lucrative practice, and is often “the lion” at social functions. He it is who empties the uterus in cases of emesis gravidarum without first racking his precious brain in trying all recognized remedies and methods to check the vomiting. He it is who finds so many cases of contracted pelvis, where it is utterly impossible to do anything but an early abortion to save the woman’s life. He it is who finds so many cases of retention of menses, that require dilatation and curetment. He it is who finds the urine “loaded with albumin,” necessitating an immediate emptying of the uterus to prevent death from Bright’s disease. Such men and women prostitute the profession of medicine and should be exposed.
A careful review of our medical college announcements fails to furnish sufficient evidence of properly taught medical ethics, or medical jurisprudence (I say medical jurisprudence in contradistinction to legal medicine) to justify us at this time in hoping that we may receive much help from them toward the control of criminal abortion.
The average student is not impressed by precept or example with the enormity of the crime, and coming into practice, often a poor young man, is first shocked when he is asked to procure an abortion; but after the wolf has howled at the door for a time he yields to the temptation and often drops into the practice. Far from the Hippocratean teaching of the ancients have our col1eges wandered by their utter disregard as to the morals of their students.
The secular press, that for money consideration. carries the offensive advertisements of abortionists and manufacturers of abortifacients in direct violation to our municipal, state and federal laws, will be slow in responding to a call to suppress criminal abortion, and not until the filing of information with officers of the law will they cease to carry into your household the filthy announcements as to how and where the pregnant mother can most easily and safely rid her womb of the products of conception.
Much has been said by the chief executive of our nation on race suicide, and much has been reiterated by other right thinking people; still, little has been done toward the enactment of new laws or the enforcement of those already on the statute books to punish those guilty of the crime. The prevalence of the crime is so patent, that few physicians can say that they are not frequently importuned by what society calls the “respectable element” to commit abortion. Pleas of limited income, the exacting demands of the social world, the desire to travel, the already too large family, and numerous other “reasons” are to you stories “too oft told” to be repeated here.
In an editorial in the Illinois State Medical Journal, March, 1908, attention is drawn to a statement of Justice John Proctor Clark to the effect that 100.000 abortions are annually committed in New York..
In a paper read before the Chicago Medical Society by Dr. C. S. Bacon it was estimated that from 6,000 to 10,000 abortions are committed annually in the city of Chicago, and that from 20 to 25 per cent. of all pregnancies terminate in abortion and that of this percent. one-half are from induced abortion.
With feticide among our best element, and with a constantly increasing influx of degenerates from foreign countries, what can be expected of us as a nation a few generations hence? We, physicians, above all others, are best prepared to answer the query.
It is not my purpose to institute utopian plans, through or by which criminal abortion can be suppressed, still some suggestions may be in order.
1. The obligatory teaching of medical jurisprudence and medical ethics in its true sense in our medical colleges. This should be statutory, and medical examining boards should be empowered to enforce the laws of their states, and declare all schools not requiring a full course in medical ethics not in good standing and their graduates ineligible to practice medicine.
2. The enactment of good and sufficient laws and the amendment of insufficient laws now on our statute books.
This may raise the question as to how this can be done. Or by some it may be asked, are not our laws good and sufficient as they stand ? In order to answer the last question, I propounded the following questions to a very able lawyer and had him prepare by way of answer a digest of the now existing laws in the several states and territories.
QUESTION 1.—Is the woman herself guilty of any crime? In how many states is she and how many is she not?
ANSWER.—In nine states a woman who solicits, submits to or performs an abortion on herself is guilty of a felony. In seven states the above offense is a misdemeanor, and in time remaining states and territories. viz.. thirty-five, the woman is guilty of no crime.
QUESTION 2.—What is the charge and penalty for giving away, selling or advertising abortive drugs and drugs or appliances to prevent pregnancy?
Answer.—The charge is a felony in but twelve states and territories out of fifty-one, and the penalties vary from imprisonment for from one to ten years, and in some states a fine ranging from $20 to $5,000. In twenty states the offense is only a misdemeanor. In thirty states and territories there are no laws on this subject.
QUESTION 3.—What is the charge and penalty as dependent on the age of the fetus?’
ANSWER.—In four-fifths of the states and territories age of the fetus is immaterial.
QUESTION 4.—What is the effect of death of the woman operated on as to charge and penalty?
ANSWER.—If the death of the woman results from the operation, in eighteen states and territories out of fifty-one the crime is murder and the punishment is death or imprisonment for life. In six states it is murder in the second degree, and the penalty is imprisonment for life or for a term of not less than three years.
QUESTION 5.—May the offending physician or midwife have his or her license revoked?
Answer.—The license may be revoked in only fifteen states out of fifty-one. In thirty-two states there are no laws that can be invoked successfully for the purpose of depriving a physician of his license for this cause. In other words, he may successfully murder indefinitely and go unmolested.
QUESTION 6.—Is a physician who gives subsequent treatment allowed to testify, or is his information privileged?
ANSWER.—There is only one state, Missouri, in which it is provided by statute that a physician is allowed to testify as to facts learned while attending a woman on whom an abortion has been performed.
Are, not these answers startling? I think they show conclusively that our laws are inefficient and inadequate in most, if not all, of our states. Now arises the question, how can new laws be enacted and inefficient laws be amended? My answer is, through the influence of the American Medical Association, through its House of Delegates. Let us, the members of this section through our representative in the House of Delegates appeal to this body and request the president of the American Medical Association to appoint a committee to be known as the Committee on Criminal Abortion, whose duties shall be to see that the state societies have appointed similar committees, whose duty it shall be to enlist the interest of their state legislatures in the enactment of good and sufficient laws against criminal abortion, and that this committee of the House of Delegates report annually as to the status of laws on criminal abortion in the different states, as well as what suggestions they may have to make in the prosecution of the cause.
Each state has an attorney-general, whose office is at the capital of the state. He is paid a salary by the state, and he, above all others, ought to be interested in the enactment and enforcement of wholesome and useful laws in his state. It is the duty of the attorney-general and his assistants to follow up the convictions of the lower courts for the various crimes. A man is tried in the circuit court of criminal court of one of the counties, and if convicted he appeals to the supreme court of the state. The county prosecuting attorney does not follow the case to the supreme court but the whole record of the case is written up and forwarded to the supreme court and it is the duty of the attorney-general to use his best efforts to uphold the conviction. He studies the case, writes a brief for the state and argues it in the supreme court. Many times he finds that he can not uphold a conviction because of some uncertainty in the wording of the law, or on account of some blunder made by the man who wrote it md got it passed in the legislature. The more convictions the attorney-general gets upheld, the greater reputation he gets. He is, if a studious man, better able to decide than the ordinary lawyer, whether a proposed law will meet the requirements of the state constitution and whether it will be held a valid law.
It might be suggested that this committee, or the state committee, acting in accord with the national committee, draft a bill, submit it to the attorney-general of the state and ask suggestions from him as to the proper wording of the law before first submitting it for passage by the legislature. When they are sure the law is in good form, then printed copies of it should be sent to every member of both houses of the legislature, and this should be followed by letters from influentia1 physicians in every county of the state to representatives and senators of their respective counties, or by personal interviews, explaining the object, need and purpose of the law proposed, and they should be urged to vote for it. There is no doubt but we can in this way do much good. Let’s do it.
The following Resolutions of Dorsett’s Section were presented to the House of Delegates at the same Annual Meeting:
Resolved, That the subject of the Chairman’s address be referred to the House of Delegates, and that this body be and is hereby requested to appoint a standing committee which shall be called the National Committee on Criminal Abortion, whose duty shall be to investigate the laws on criminal abortion as they now appear on the statute books of the different states and territories of the Unites States, and to request all state and territorial medical societies to ap-point like committees whose duty shall be to confer with the attorneys general of their states and territories, in the enactment of new and adequate laws governing criminal abortion. Be it further
Resolved, That the state and territorial committees shall confer with the said National Committee on Criminal Abortion, in cooperation with the National Committee on Medical Legislation, shall report annually to the House of Delegates what progress has been made in the several states and territories toward the suppression of criminal abortion, as well as what suggestions they may have to make as to prosecution of the cause.
The House of Delegates referred them to the Reference Committee on Hygiene and Public Health. This Committee provided a Supplemental Report recommending that no action be taken to establish this National Committee on Criminal Abortion, since “it is within the purview of the Committee on Medical Legislation.” The Association concurred with this recommendation. [Journal of the American Medical Association, vol 50, no. 24, page 2011]
The February 16, 1929 Journal of the American Medical Association contained a query about “the requirements of members of the Association relative to therapeutic abortions,” and “the requirements of accepted hospitals before an abortion should be permitted.” The Association answered:
Therapeutic abortions are regulated in some states by statutes. In other states the statutes are silent. Where statutes are in force, strict compliance is necessary. Generally they tolerate a therapeutic aboration [sic] only when the operation is necessary to preserve the life of the mother from some impending danger. The danger must be real; the bare possibility of death is not sufficient. In some statutes it is provided that, before an abortion can be lawfully induced, two or more physicians must agree that it is necessary. Even in states where there is no statute to guide him, a physician will do well to conform to the principles stated. A physician who induces an abortion to preserve only the health of the mother, as distinguished from her life, in a state where the statute tolerates such operations only when they are necessary to preserve life, will probably find it impossible to justify his course legally, and even in the absence of a statute it will be difficult or even impossible for him to do so. Under no conditions can an abortion be lawfully induced for the sole purpose of preserving a woman’s reputation, or of contribution to her comfort or pleasure, or because of the patient’s financial circumstances. Consultants should be selected who are of good repute and not biased by personal or professional relations with the case. The patient and her husband, and, if she is an unmarried minor, her parents or guardian, should be full informed concerning the situation by the attending physician, preferably in the presence of a consultant. If the operation may run counter to the religious faith of the patient, it will be desirable to make that fact clear to her, so that she may make an intelligent choice. The justification for the operation should clearly appear in the case history. The written consent of the husband and wife should be obtained before the operation is done, or, if the patient is an unmarried minor, the written consent of her parents or guardian. Responsible officers of hospitals should see that the laws relating to therapeutic abortions are fully complied with before they permit such operations to be done in institutions under their care.