This paper does not attempt, in any full sense, to deal with
the subject in hand, for its technical and ethical phases admit of too many
ramifications, nor is the writer holding aloft a blazing torch of reform,
demonstrating more stringent legal measures and widespread social education,
but it is meant as a few remarks embracing one man’s observations on a more or
less growing condition, backed by a few facts from other men’s experience and
by fragmentary gleanings from the literature.
During the year 1918, the writer was called upon to treat 20
cases of attempted forced abortions, and was approached in about 30 instances
with applications to induce abortions. I suppose, like other physicians,
experience with this type of cases is not unusual, previous to the above date,
but the frequency noted after this period began would be explained by two
theories only—either I had achieved an unwelcome (and I trust an undeserved)
reputation, as an abortionist, or the crime itself was much on the increase in
my locality. This alternative made me decide to consult other physicians among
my associates, both at home and in other towns, and I found that they too were
undergoing the same unsatisfactory experience. I was, therefore, forced to the
conclusion that deliberate abortion is increasing. The literature confirms this
opinion, and if such proof is needed, I refer to Taussig’s statistics from the
professional ranks, and to the well known attitude and writings of the late
Col. Theodore Roosevelt of the lay public, who as far back as 1910 had
recognized the growing tendency towards limiting the size of families and birth
control as a threatening evil. I therefore undertook an analysis of my cases,
with the following results:
Of the 20 attempted cases, there was about an equal
percentage of married and unmarried women, with a fair sprinkling of
unclassified, i.e., women whose domestic situation could not be determined. The
methods used varied greatly—a large bone crochet needle, a hat pin, repeated
springs from the top of a trunk to the floor, ergot, quinine, calomel,
turpentine, and dilation by doctor and nurses.
The results of the attempts in all 20 cases were successful
in terminating pregnancy, but one died of perotinitis, one of septacemia, one
suffered a mutilating pelvic operation to restore health, one was desperately
ill for five weeks with pelvic infection, two were moderately sick with
infections for about two weeks, one induced acute nephritis (turpentine case),
and the others, after a thorough cleaning of the uterus, recovered without
further event.
I next attempted to analyse the reasons both for the 20
attempts and the 31 who applied.
First of all, I wish to comment upon the assurance of these
approaches; there seemed no doubt in the minds of the applicants that I would
not comply. The only question of importance seemed to be the price to be paid.
This forced me to believe that it is possible to have such work done by certain
members of the profession. The reasons for desiring abortion were many:
A number were frankly illegitimate pregnancies. Others were
married women who did not wish to undergo either the pain, inconvenience, or
restriction of freedom of another pregnancy.
A few claimed poverty, a few claimed ill health, and one
class I desire to mention especially, was comprised of five women who had been
told by their physician, after each had passed through a severe to abnormal
labor, that they must never become pregnant again—if they did, their lives
would pay the forfeit. In each instance of this kind, I was unable to discover
any physical reason for their apprehension, but found great difficulty in
combating the morbid mental attitude induced by former medical attendants.
In conclusion, I wish to reiterate that I am not calling for
new laws, more education—in fact I am not demanding anything—I am simply commenting
upon an unusual professional experience which I trust is unique to me, but
which I imagine has been the experience of many of my hearers during the past
year or two.
I do not wish to call attention to the fact that it is
unwise to advise a woman not to become pregnant, unless some sure method of
prevention is suggested. I do hope that a different system of sex education may
appear, which will lessen the number of these cases. And, lastly, I can find it
in my heart to hope that the professional abortionist in the medical ranks,
when discovered, will be so severely dealt with that the unscrupulous laymen will
know that such an animal no longer exists.
Discussion
Dr. K.P.B. Bonner, Morehead City: This paper interests me
greatly because I find that Dr. Moore’s experience is very much in line with
the experience I have been having. For five years I have had applications to
induce criminal abortion at least once a week the year around. It is sometimes
from the husband and sometimes from the wife, and indicates a growing sentiment
against the act of motherhood. This sentiment, if allowed to gain ground, will
result in injury to the home life of America. It seems now that after one or
two children are born it is regarded by the mother as a reflection on her
personally, and as a calamity, if more than two children come to bless the
home. It is the custom to resort to any means, mostly on the part of the
mother, rather than bear children. It is a growing custom, and you can’t
convince them that it is all right to bear children, that it is a natural
process, and a high privilege and duty according to womanhood.
Dr. N.C. Hunter, Laurinburg: The doctor’s paper is
instructive, and form a general standpoint interesting, but I regret the
weakness of the medical profession, which gives way to a tendency to accept
what everybody else wants to throw away. As a profession we are not moralists
or reformers, although this is an individual prerogative none may gainsay the
members of our profession. For my own part, the time necessary to attend to my
own business and morals is not sufficient; but as a profession, we have no more
to do with the subject of criminal abortion that has every other profession or
organization, and they all seem to love to leave it alone. The attitude of our
profession towards other crimes should direct us as to this one. Our business
is with the sick and injured, and to them we owe the benefit of our learning
and skill, to all comers alike. Our attitude toward fallen members of our own
profession should be one of justice tempered with charity. We are now almost
clear of the liquor question, which has long been permitted to lie about our
door, and I am not now anxious to adopt a substitute in the criminal abortion
problem.
Dr. Oren Moore, closing the discussion: In regard as to
whether the women are telling the truth or not, I would say that undoubtedly
some women do falsify. In one case, at least, it was proven the woman did lie,
but there were other of undoubted sincerity, who having absolute confidence in
the family physician were appalled at the prospect of the hazard of another
pregnancy. The point is that the doctor should be very careful in making a
statement of this kind, as he does both the patient and the doctor who follows
him a grave injustice.
As to Dr. Bonner’s criticism, the viewpoint is what I mean
to draw attention to. It may be that ours being a cantonment town conditions
there were worse than in the average town of the state.
As to Dr. Hunter’s remarks, I did not approach this subject
with a view to raise an ethical cyclone, but I should like to ask how we are to
escape the responsibility of which he speaks. I maintain that the doctor in
every community is the director of public mortality; if he is not, he should
be. He is the keeper of public morals per
se. It is not only his duty, but his very great privilege; and no man who
realizes his responsibility can escape or refuse to take the high ground of
morality.
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