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 childbed 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.[17]
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 the 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 do 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.[18]
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.[19] 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, and, 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 hurry
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 by 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."[20]
VIII.--_Recapitulation._
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 an
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,'[21] is worthy, and should receive, the highest
admiration and praise."[22]
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 fœtus, and
of the high responsibility which rests upon its parents."[23]
"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."[24]
We have seen that the above is the deliberate decision of those who,
from their observation and knowledge of the subject, are 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, then, 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?"[25]
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."[26]
* * * * *
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 disinthralled 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 fœtal life that so extensively prevails, and be the
means of promoting the ratio of increase of our national population, so
unnaturally kept down, the National 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."
APPENDIX.
In the prefatory remarks attention was called to the fact that the
writer may have incidentally expressed personal opinions of his
own, in the course of his Essay, that are not fully coincided in by
every member of the medical profession, and reference was made to
correspondence that had already occurred in connection with this
subject. This correspondence is now presented, and will explain itself.
It will be noticed that I withhold the name of the gentleman who
addressed me, this being done at his own particular request, though
I would willingly have given him opportunity publicly to assume
the position against anæsthetics in childbed, so long held by his
illustrious townsman, Prof. Meigs. Discretion, however, has thus far
been found, by the opponents of anæsthesia, to be the better part of
valor. In a subsequent letter, under date of February 19, my friend
writes me as follows: "When the pamphlet appears, I will aid you to my
utmost ability in its circulation, and believe it will be productive of
eminent good."
The criticism referred to is as follows:
"+PHILADELPHIA+, Feb. 10, 1866.
"+MY DEAR DOCTOR+:
"Your Essay gives much satisfaction to all who have read it, of
course, a very select few (the book being still in the printer's
hands), but several have most strenuously objected to one or two
points, inasmuch as the profession are to take hold of the matter and
endeavor to place it in the hands of their female patients. The only
one concerning which I have deemed it necessary to write you, is your
remark relative to the use of anæsthesia in all cases of labor. Now,
Doctor, though many are fully with you, yet many would object most
decidedly; in fact, it is by special request that I now ask you to
omit, if possible, those few lines. Some of our profession--I believe
many more would if they had read the Essay--object to placing it in
the hands of their patients, and thus condemning their own action and
advice. Many in this city, to my positive knowledge, object to the
use of anæsthesia in labor, _in toto_. Many others only use it in
special cases. While the number of those who use or advise it in all
cases is _very, very_ small. I am satisfied the omission of these few
lines would give great satisfaction, and remove almost entirely all
objections to the paper.
"I had not the pleasure of reading it prior to seeing the proof, and
must express to you my congratulations for your success. Nothing
pleased me so much as the gratification so pleasantly expressed
by your good father, as he so unexpectedly found his son to be the
essayist. For that reason, I am much pleased that you requested, 'for
a whim,' to have the seals broken upon the platform.
"Very sincerely,
"Your friend,
"---- ----."
To the above letter I thus replied:
"+HOTEL PELHAM, BOSTON+, 12 Feb., 1866.
"+MY DEAR DOCTOR+:
"I have received your kind letter of the 10th inst., and am glad you
have spoken so frankly. I should be delighted to grant the request
thus courteously made, were it possible for me consistently or
conscientiously to do so.
"This subject of anæsthesia in labor is one to which, for now thirteen
years, I have given earnest attention, and is one of the most
important that has ever presented itself to medical men.
"It is my sincere conviction that the use of anæsthetics in childbed
is not only indicated by every consideration of humanity, but that
it serves materially to lessen the average rate of mortality to both
mother and child.
"Previously to the present date my voice has given no uncertain sound
upon this question. I send you, by to-day's mail, a copy of my little
book, "Eutokia," which, two or three years since, excited some
attention from the profession, both at home and abroad, and has made,
I am happy to know, many converts to the true faith.
"If you will turn to the preface of the American edition of my
Simpson's Obstetrics, published in 1855, you will find upon page xvi.
the following language, none of which, in the added experience and
reflection of all these years, can I honestly retract. 'But yesterday,
and the man who dared give ether or chloroform in labor was considered
as breaking alike the laws of nature and of God; the time is probably
close at hand when such will be said of all who withhold them, even in
natural labor.'
"In the present instance, the Essay has been carefully scrutinized by
a Committee of the Association,--that on Prize Essays,--and has been
unqualifiedly approved. It has been accepted by the Association, has
been ordered to be printed, and, by special vote, to be pushed to the
most extended circulation possible, in the belief that its influence
would be only for the highest good of the community. I am always
responsible at the bar of professional opinion for any sentiment that
I may utter, and avow none that I am not prepared to defend. If any
gentleman differs from me in opinion, let him carefully prepare an
essay upon the subject, present it to the Association, and, if they so
decide, I will cheerfully vote that it also be presented to the people
as a rejoinder to myself.
"With all respect for those who think otherwise, I cannot omit or
change one word of the Essay, and have no right to do so if I would.
"As the present, however, is a point that, though only incidentally
mentioned, yet involves some conflict of professional opinion, while
the Association are of a single mind as to the matter of Criminal
Abortion, I shall cheerfully append your letter to the published
edition, and thus save your associates from any implied credit or
discredit of indorsing my own opinion. This course will be unnecessary
with regard to the Transactions, as the Association is known to be
irresponsible for any views advanced by its members, save when adopted
by special resolution, and its volume does not reach the parties in
reality most interested, namely, the parturient women, whose anguish,
so far as such may be unnecessary, it should be our highest duty to
relieve.
"Thanking you for the generally favorable opinion you convey to me for
yourself and those for whom you write, for I always value the approval
of my friends next to my own self-respect,
"I am yours, sincerely,
"+HORATIO R. STORER+.
"+DR.+ ---- ----."
* * * * *
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