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Friday, September 12, 2014

North Carolina Doctors Discuss Abortion, 1919

“Criminal Abortion” by Dr. Oren Moore of Charlotte, from Transactions: Medical Society of the State of North Carolina, 1919, published by the Medical Society of the State of N.C. and online at Books.google.com

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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