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 secretion 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 even 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?[13]
To the above remarks it might truthfully be added, that not only is
the fœtus 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 I have claimed exists.
On the other hand, it must not be forgotten that in these cases there
is always present every reason for concealment. In the earlier months
of pregnancy it is very difficult to prove, in the living subject, that
pregnancy has occurred. Such a conclusion being arrived at, before
the sound of the fœtal 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, elicits 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 deaths 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 case, 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-called 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 the 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 fœtal 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 full term, the womb is more weighty than natural--its
walls thicker and heavier than usual, 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
neuralgias, 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 in consequence of an intentional
abortion. They are, however, sufficient for our purpose.
* * * * *
3. But not only 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
leucorrhœa 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 _à 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."[14]
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 fœtal 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 out-lying 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 fœtus in utero, the rather prevails where the rites
of law and religion would seem to have extended to that fœtus 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 a 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."[15]
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, ay, 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."[16]
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 nought 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.