Part 1

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.