Part 4

"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.

I have stated that in no case should abortion be permitted, or allowed 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.