II.—What has been done by Physicians to Foster, and what to Prevent, this Evil.
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.