Part 2

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.