Transcriber's Notes
1. Typographical errors and hyphenation inconsistencies were
corrected.
2 The text version is coded for italics and other mark-ups i.e.,
(a) Italics are indicated thus _italic_;
(b) Smallcaps thus +CAPS+:
* * * * *
WHY NOT?
A BOOK FOR EVERY WOMAN.
The Prize Essay
TO WHICH THE AMERICAN MEDICAL ASSOCIATION
AWARDED THE GOLD MEDAL
FOR MDCCCLXV.
BY
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 the Diseases of Women
in Berkshire Medical College.
ISSUED FOR GENERAL CIRCULATION, BY ORDER OF THE
AMERICAN MEDICAL ASSOCIATION.
_Casta placent superis. Casta cum mente venito,
Et manibus puris sumito fontis aquam._
BOSTON:
LEE AND SHEPARD.
1866.
Entered, according to Act of Congress, in the year 1866, by
LEE AND SHEPARD,
In the Clerk's Office of the District Court of the
District of Massachusetts.
At the Sixteenth Annual Meeting of the American Medical Association,
held at Boston in June, 1865, it was, upon recommendation of the
Section on Practical Medicine and Obstetrics,--
_Resolved_, That the Committee on Publication be requested to
adopt such appropriate measures as will insure a speedy and general
circulation of the Prize Essay written for women; provided this can
be done without expense to the Association.
CONTENTS.
+PAGE+
+PREFATORY REMARKS+ 5
I. Origin and Purpose of the Present Essay 11
II. What has been done by Physicians to Foster,
and what to Prevent, the Evil 15
III. What is the True Nature of an Intentional
Abortion when not Requisite to Save the
Life of the Mother 27
IV. The Inherent Dangers of Abortion to a Woman's
Health and to her Life 36
V. The Frequency of Forced Abortions, even among
the Married 62
VI. The Excuses and Pretexts that are given for the
Act 70
VII. Alternatives, Public and Private, and Measures
of Relief 74
VIII. Recapitulation 79
+APPENDIX.+--Correspondence 88
PREFATORY REMARKS.
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, and throws
himself upon the generous sympathy and forbearance of his readers.
The Essay, when placed in the hands of the Committee, was accompanied
by the following statement, which it may not be out of place to
reproduce at the present time:--
"The writer, knowing 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,[1] 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 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 fœtal 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 it is an equally striking and appropriate coincidence
that the Chairman of the Committee, at whose hands 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."[2]
There is one point, in connection with the present Essay, to which I
feel bound, in fairness alike to my professional brethren and to those
for whom I have now written, to direct attention.
As every author who has decided opinions, and is alive to their
importance, must naturally and very necessarily do, I have incidentally
taken occasion to express myself upon certain collateral topics, but
only in so far as they were directly connected with, and germane to,
the main subject under discussion. Such statements are all of them to
be considered merely as expressions of my own individual opinion, and
not as the views, necessarily, of the mass of the profession.
An instance of the kind referred to is where I allude to the advantages
of giving anæsthetics in child-bed, even though the labor is what is
termed a natural one; and I adduce correspondence upon this subject in
an appendix to the Essay.
As upon some of these questions physicians honestly differ among
themselves, I have thought this disclaimer alike due to others and to
myself; they are matters, however, only incidental to the Essay, upon
the general subject of which the profession are wholly unanimous in
opinion.
+HOTEL PELHAM, BOSTON+,
April, 1866.
WHY NOT?
A BOOK FOR EVERY WOMAN.
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
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 them, an immense deal of ill-health would be prevented,
and thousands of maternal as well as fœtal lives would annually be
saved.
And, moreover, in the fact that the profession thus transcends, almost
for the first time, upon any matter 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 question 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 should be ready to assist
each other in its cure. I propose to show that induced abortions
are 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._
In our appeal we shall endeavor to go straight towards 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, there has existed in countless human breasts a
wanton disregard for fœtal 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 deeply-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 fœtal 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.[3] 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,[4]
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, over which he presided, 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 Stillé, 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."[5]
It is true, however, that while physicians are unanimous as to the
sanctity of fœtal 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 owing 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 at least of our States, 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 see 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 no
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 fœtus 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."[6]
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."[7]
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."[8]
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."[9]
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,"[10] 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, these 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
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 egg 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 dead 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 fœtus has been seen to move when born, during miscarriage, at a
very early period.
During the early months of pregnancy, while the fœtus 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 before the usual period
of the mother's becoming conscious of the motion of the child, and
also earlier than the pulsations of the fœtal heart or the uterine
souffle,[11] 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 fœtus 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 women, 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 to 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 fœtal circulation and the blood-vessels of
the mother, that 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 forwards or backwards, with the
long list of neuralgic pains in the back, groins, thighs, and elsewhere
that they occasion; constant and inordinate leucorrhœa; sympathetic
attacks of ovarian irritation, running even into dropsy, &c., &c. 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 health, 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 in consequence 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
even 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.[12]
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 fœtus 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 fœtal 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 fœtus, as in a hydrocephalic case long
under the writer's own observation, where the cause and effect were
plainly evident. Intrauterine 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, fœtus, 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.