ABORTION AND ITS EFFECT’S. BY JOSEPH TABER JOHNSON, A. M., M. D., PH. I)., OF WASH I NOTON, D. C. Professor of Gynaecology in the University of Georgetown, etc., etc. Reprint prom the Maryland Medical Journal. RAL.TIMOKE : Journal Purlishinq Company. 309 Park Avenue, 1890. ABORTION AND ITS EFFECTS. BY JOSEPH TABER JOHNSON, A. M., M. D., PH. D., OF WASHINGTON, D. C. Piofess r of Gynaecology in the University of Georgetown, etc., etc. Reprint from the Mahylanu Medical Journal. BALTIMORE : Journal Publishing Company Print, No. 309 Park Avenue, 1890. ABORTION AND ITS EFFECTS.* Mr. President and Fellows of the Medi- cal and Chirurgical Faculty of Maryland: It will be especially difficult for me to interest the members of tins ancient and honorable Faculty, after suchmen as Billings, Weir Mitchell, Goodell, Osier and Welch have entertained and instruc- ted you by their eloquence and wisdom. Statistics of libraries and museums, the vagaries of the nervous system, the dangers and duties of the hour, the in- infectiousness of disease, and the license to practise, are all subjects which are full of interest, and have been ably presen- ted. I presume the committee expected me, as a gynaecologist, to discuss some topic in this branch of medicine or in abdominal surgery, and I fully intended "■Annual Oration delivered April 23rd, 1890, before the Medi< al and Chirurgical State Faculty of Maryland at Its 92nd Annual Session. 4 to do so, but when I began to write it occurred to me that only a small propor- tion of the membership of a State Society would be interested in a special topic, and I shall therefore make (no apology for introducing a subject, which, though not of very savory odor, yet is of great inter- est to every member of the profession, whether he be young or old, a specialist or general practitioner, pro- fessor or student. I shall ask your attention, then, with- out further preface or delay, to the importance, the frequency, the wicked- ness, and to some of the effects of procured abortion. All writers upon obstetrics and gynae- cology admit and deplore the frequency with which the immature foetus is ex- pelled from the uterus. Thomas has an entire volume upon abortion now in press and soon to he published, the advance sheets of which I have been kindly allowed to read. Writers upon domestic economy, upon vital statistics, upon the natural increase and decrease of our population, upon law, theology and medicine, all vie with each other in attesting the importance and wickedness of forced abortion, and 5 all, so far as they mention this point, agree that it has not only been distress- ingly frequent in the past, but that it has been steadily upon the increase, So much do I believe this to he the case and so far-reaching are its effects upon the health and morals of our people, that I hazard nothing when I declare that this subject is one of the most, if not the most important question before our profession to-day. Questions of drainage, sewage, quar- antine, vaccination, antiseptics, are all important in the prevention of disease, and have doubtless saved thousands of lives, but they all sink into insignificance in comparison with the importance of the subject under discussion. I believe that statistics might be adduced, if time and your patience would permit, to show conclusively that more lives are annually sacrificed by the unnecessary and inten- tional destruction of the human fcetus, than are saved by all these agencies com- bined. The recognized and described causes of abortion show that it occurs once to •every five labors, and that 90 per cent, of all married women have at least one miscarriage during their child-bearing 6 life. These are frequent enough to excite the sympathy and invoke the ai’d of the profession, but I refer now more especially to that larger class, where there is a violent and premature expul- sion of the product of conception, independent of its age, viability, or normal formation, where it is artificially induced and intentional, and where it is not necessary for the safety of the mother, and would not otherwise have occurred. Some of the Legislations of our older States have been so alarmed at the lessen- ing of their population that they have appointed committees to investigate into the causes thereof ; and Dr. Nathan Allan of Massachusetts, in his report upon this subject, said that the native American stock of that State seemed to be dying out. He mentions small towns and cities where the only increase in the population was among those of recent foreign origin, and that in those cities and districts mostly populated by native American families, there were recorded more deaths than births ; that one hun- dred years ago it was rare to see families of less than six children, and frequently there were ten ; now it is rare to find rcs many as three, and often only one, or 7 none at all. Grave apprehension was expressed inthis report, made more than twenty years ago, for the results which were then pointed out, and which seemed sure to follow. These results have been more than realized in that State. These foreign children have become of age and are now voters. The same influences have been at work during this generation as in the last, in an increased ratio; and to-day the proud city of the puritans, cultured Boston, has become almost, if not quite, an Irish and a Catholic city, rejoicing in the possession of a Mayor by the classic name of O’Brien. So long ago as 1857 the American Medical Association became aroused on this subject, and at its meet- ing in Nashville in that year appointed a committee of eight prominent and able men, to report upon criminal abortion, with a view to its general suppression. A report was made in May of the next year, at Louisville, which, with the resolu tions accompanying it, were unanimously adopted. At a subsequent meeting a popular prize essay was authorized by the Association in which the wickedness of the crime should be set forth, its fre- quency condemned, and its injurious 8 effects fully explained, so that any woman could easily understand. The essay accepted was written by Dr. It. R. Storer, of Boston, and was entitled “Why Not ? Or, A Book for Every Woman/’ A very large number were printed and were placed for sale in the book-stores through- out the length and breadth of the land. Medical, secular and religious journals commented favorably upon the essay, and the frequency and criminality of abortion was clearly set forth, and its perpetrators were severely denounced. I have thus far and from official testimony endeav- ored to show the importance of my subject and the views which were held by the highest medical body in the land upon its importance, and the great need which existed for its suppression. It has also been shown that at least two States in our Union had become so alarmed over the decrease in the American element of their population, that legislative action was taken for its discovery and prevention. Very interesting and instructive reading may be founds in the reports of Dr. Nathan Allan, of Lowell, and Dr. Snow, of Providence, upon this subject. From the same sources which proved to Dr. Storer and the American Medical 9 Association the frequency of this crime, we can now gather greatly increased and multiplied testimony that this wanton, unnatural, unnecessary and basely wicked destruction of foetal life has not only not been suppressed in obedience to unani- mously passed resolutions, but that it constantly has been, and is now, largely upon the increase in our country, and for that matter throughout the entire civilized world. This crime is not indigenous to any location, section, climate or continent. Its perpetration is as world-wide as are its murderous and otherwise injurious effects upon those engaged in this unholy warfare. Storer showed, in 1866, from indisputable evidence, that abortion and still-births were twelve times more fre- quent in some of our cities than the worst statistics had ever shown to exist in Paris or Vienna. From the same reasoning we cannot believe that a better condition exists in those cities now ; on the con- trary, we are forced to the conviction that unnecessary abortions are made to occ ur in a greatly increased ratio, and the country districts, usually the most pure and upright in their morals, are not far behind the cities in proportion 10 to their population in their destruction of metal life. American families have not increased in size, and no facts exist to prove that the fecundity of the men and women has in any way been lessened by the advances in civilization. The evidence of physicians could be adduced, if necessary, to demonstrate these facts. Vital statistics might be quoted to show that in the true American stock in some parts of our country the ratio of deaths over the births has steadily increased. The published number of maternal deaths from this malpractice does not appear to be decreasing. The arrests and trials for abortion, while they may in a. very faint degree indicate its frequency, do, on the other hand, and in a very emphatic manner, demonstrate the laxity of morals and the law in permitting so many of the guilty to escape their just punishment. The obsta- cles to conviction, the difficulties of proof, the inefficiency of the law, as well as the evident lack of a desire to convict, on the part of all those engaged in these trials, may explain the fact that of the 32 arrests and trials of abortionists reported by the Attorney General of the State of 11 Massachusetts, in a period of eight years,, not one single conviction resulted. Englemann says, “Abortionists every- where are known. In the larger cities of this continent, as well as Europe, they achieve a widespread fame, are well known, and yet rarely, if ever, convicted. It is a notorious fact that these worst of criminals almost invariably escape, and even in the States of Germany, where the- laws are strict and rigidly enforced, where the crime of abortion is punished by imprisonment of from four to twenty years, that eminent teacher of medical jurisprudence, J. L. Caspar, says that of all the many accused, never a one was condemned, and in no one case was the crime proven. They are sheltered by the words of the law and the sympathy of the community.”* In many cases the arrest and trial is not for the crime intended. The inten- tion is, and of a necessity must always be, to kill the foetus ; this being done in the dark, like other deeds of evil, there are no witnesses, and the crime usually escapes public notice, unless a bungler in the art should at the same time injure- or destroy the mother also. ♦Article on Abortion, Pepper’s System of Medicine- 12 There is little or no trouble in securing •conviction then, for malpractice ; but the indignation of the virtuous public and the majesty of violated law are only then aroused and invoked because the unskilful manipulator killed two human beings instead of one. It is for the crime against the mother which was not intended, but which unfortunately and accidentally happened, that the criminal is brought to trial. A story is told of a wicked and unjust judge in the early days of the wild and woody West, who, in pronouncing sen- tence upon a man proven guilty of seduction—a crime which is the twin aister to abortion—stated to him that it was not so much for committing the wicked deed that he sentenced him to hard labor in the common jail, but it was for allowing himself to be caught in the act and making so much public a can dal and family exposure. Another reason given by Storer in his book before referred to, for his belief in the frequency of abortion, is the pecuniary auccess of known abortionists, and of the venders of abortion-producing nostrums, and again, the experience of physicians on account of direct and frequent appli- 13 cations made to them to commit this crime, and in the immediate and multi- tudinous after-effects, which they see in their daily practice upon its unhappy victims. The evidences from these quarters, if they were convincing twenty years ago, have surely lost none of their force and convincing qualities with the lapse of time. The public advertisements of known abortionists in our newspapers and some religious journals are more public and more numerous now than they were then, and the public display and ready sale of abortion-producing nostrums by our druggists is confessedly upon the increase. A generation ago these facts were all so fully and completely proven by the able committee of the American Medical Association and set forth in popular lan- guage in its prize essay for distribution among the women of our land, that no effort was ever publicly made to gainsay or disprove any of the positions taken— they were all admitted and deplored. The effect for a time was salutary, and its author received letters innumerable from good people and from mothers made happy by the possession of healthy offspring, 14 whose habit it had previously been to resort to abortion. The public conscience was aroused and the promoters of the move in the Associ- ation no doubt congratulated themselves that they had accomplished a great good for society and the State, for morals, law and religion. Secular, medical and re- ligious journals approved, clergymen preached and a sense of security probably settled down upon the virtuous public that another growing evil had been boldly met, the battle against it successfully waged and the victory won ; but the sequel in this generation proves that it was no more of a victory than was gained over his creditors by the impecunious Micawber when he gave them his note of hand, and thanked the Lord that his debts were paid. There is no longer any doubt from a consideration of all the evidences before re lied upon to prove its frequency, that abor- tion is now fully as frequent as it ever was in this country, and, moreover, that it is alarmingly on the increase ; not only is this believed to be true of the cities, but the remotest country districts seem to be infected also. The excuses given are the same now 15 as they were then, and the wickedness of the act is, and always will be, the same. In one respect our otherwise noble pro- fession is sadly at fault; it has not acted up to the courage of its convictions. Of a necessity it must be, and I believe that it is, unanimous in the knowledge and belief that the foetus is just as much alive at one period of its intra-uterine existence as another ; it must be alive or dead all the time. If alive, it is just as much a crime to kill it in the first month of pregnancy as in the ninth, or after it is born. Our text-books all teach, and our profession holds, that the spark of life is infused at conception, and we must believe, with Percival, that ‘‘to ex- tinguish this 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.” Many otherwise good and exemplary women, who would rather part with their right hands, or let their tongues cleave to the roof of their mouths than to commit a crime, seem ('to believe that prior to quickening it is no more harm to cause the evacuation of the contents of their wombs, than it is that of their bladders or their bowels. The law itself is largely 16 upon their side in this most important question, the penalties affixed to this crime being slight before quick- ening and vastly insufficient afterwards. Before a woman is quick with child, abortion being considered simply as a misdemeanor, after quickening as a felony, and only is the child considered sufficiently alive to be killed, in the eye of the law, which ought to protect it, when it has been entirely born and is sep- arated from its mother and living an independent existence. The experience of every physician is, that good women as well as bad, are committing this wrong in utter ignorance of the fact that it is a crime. They will boldly argue the question and will fully admit its wickedness, after they can feel the motion of the child. They condemn its destruction as a cruel murder after quickening, and would no more be guilty of embruing their fair hands in its innocent blood, after they could feel it move, than they would be accessory to the destruction of their liv- ing children. The fault of our profes- sion is that this belief exists at all. If we really believe in accordance with the evidence and teaching of our science, 17 that the foetus is alive before quickening, it must he our fault if this dense ignor- ance longer exists in the minds of our people, and that it so hinders the proper and just administration of the law. If the child is alive, as we believe and teach in the first, second, and third months of pregnancy just as much as it is in seventh eighth, and ninth ; then its destructien must he as wicked in one month as another. If the murder of an unarmed man in the dark and behind his back is deemed by all good people as a dastardly and cowardly act, and if the murder of innocent and unprotected childi’en is loudly denounced the world over, what language can be sufficient to express our disapprobation and contempt for those heartless and soulless miscreants who are in the most wholesale and cowardly man- ner, killing countless numbers of child- ren, who are not even protected by the law. Those who are engaged in the perpetration of abortion should no longer be able to shield their crimes behind this cloak of real or pretended ignorance. There is not a household in the land or in the civilized world which is not more or less permeated by the influence and teaching of the noble science which 18 we practise, and this ignorance of the law of life, or of the fact of life, before quickening, could, if we were sufficiently alive to its importance, be utterly done away with and wiped off the face of the earth in a single year. Otherwise, good women would no longer boast of the number of foetuses they had gotten rid of, and they would no longer teach their sisters how they could accomplish the same “innocent” feat. When it is known and universally acknowledged that to extinguish the first spark of human life is a crime of the same nature, both against our Maker and society, as it is to destroy an infant, a child, or a man; then, and not until then will abortion cease to he a common occurrence, and good men and women become ready to assume the responsibility of their own deliberate acts. The luxuries of life, the demands of fashionable society, the dislike of child- ren, the expense of their maintenance and education, questions of taste, indo- lence and convenience can no longer be pleaded as an excuse for the committal of a cowardly, dirty, contemptible, bloody, and wholly unnatural crime. When wholesome laws are enacted and 19 enforced, which will punish not only the principals, but all the aiders and abettors and accessories to this crime, just as they do other murders ; then its commis- sion will be confined to those, who, to carry out their wicked purposes, are willing to defy any and all laws, in spite of the disastrous consequences which they invite and invoke to follow. Lawyers and judges need enlightment upon this subject as well as women ; they should learn that we do not, and cannot discrim- inate between one month and another when the foetus is more or less alive; that quickening amounts to nothing. We all know that some women quicken as early as three, or three and a half months, and others not until six, and some not at all: and who will arise and say that in these late cases of quickening the foetus is not just as much alive as in the early ones, and just as much entitled to the protec- tion of the law? That life is not infused at quickening we are all agreed. The foetus then being as much alive before quickening as after ; the popular belief and convenient ignor- ance on this point, it becomes the moral and Christian duty of our profession to cprrect. 20 The pregnant woman receives a great many hints as the signs and symptoms accumulate and corroborate each other tliat a live and growing foetus is develop- ing in her uterus, but she now waits for a decided kick before she will believe that the foetus is alive. This kick is waited for anxiously by the woman as well as the law, to announce that the child is sufficiently formed for its destruction to constitute even a misdemeanor. It must kick very decidedly and un- mistakably for several months before its killing constitutes a felony, and as one judge has held, should it be knocked on the head with a hammer, or strangled with a garter after its head is born, but before it is wholly delivered and separated from its mother, it is not sufficiently alive in the eye of the law, for its killing to constitute murder. Having drawn attention to the impor- tance, frequency and wickedness of pro- cured abortion, I beg in conclusion to remind you of some of its effects upon the morals and the physical well being of those engaged in this nefarious practice. By those who in their hearts consider it wrong to destroy the unborn child, there must be an undermining of the 21 moral nature which will show its effects in many other other directions than the one under discussion. But of this phase of the subject T will leave others to speak. In one respect, however, it deeply con- cerns us as well as its unhappy victims. The remorse which comes to some, over the killing of their unborn children sometimes develops into melancholia and terminates in suicide or the mad house. Many a woman has lost her life by the addition of this depressing element to the slighter forms of septicaemia following a procured abortion. Thus Tardiew re- ports that of one hundred and sixteen cases of criminal abortion collected by himself in Paris, sixty died outright and many had a lingering convalesence, while out of two hundred and thirty-four cases of abortion occurring from various causes and treated by physicians in the Rotunda Hospital :n Dublin, only one died, and the cause of death in her case was from mitral disease of the heart. Lusk, in his classic work on obstetrics says that death in consequence of criminal abortion is especially frequent. Yet of the many cases who enter Bellevue Hospital for treatment, whose histories he has found in the record books o the hospital, all 22 have ended in recovery. Cases of in- duced abortion in their desire to avoid notice and publicity, frequently fail to properly care for themselves ; they get up and about too soon, while the uterus is still large and heavy, and thereby lay the foundation for future suffering and the life of an invalid. Hirst, in Mann’s System of Obstetrics Pp. 316, says : “Criminal abortions with the additional risks of septicaemia from the unskilful use of instruments, and the probability of infection from unclean hands and implements, would show a surprisingly high rate of mortality if it were possible to collect accurate statistics, which for obvious reasons it is impossible to do.” Englemann says, “woman requires skilled aid in labor, the physiological ter- mination of pregnancy, more necessary still is this in the premature pathological in- terruption of this condition in abortion.” Benninger reported twenty-one cases of tetanus following abortion in the British Gynaecological Journal in 1888. Charpentier in his great work pub- lished three year3 ago says : “the prog- nosis of abortion for the mother is grave ; for even if life is rarely compromised, health frequently is.” He adds further 23 that “the prognosis is most unfavorable in oases where the miscarriage is the result of criminal manipulations.” The American editor of this work says in a note, “miscarriage is fraught with more danger to the woman than labor at term, because as Goodell aptly puts it, the process is like plucking immature fruit.” The occurrence of abortion takes the uterus at a disadvantage. It is imma- ture ; it is not ready to expel its con- tents ; its contracting powers are not developed, and its contractions are im- perfect after as well as before the. act. The membranes are especially adherent and frequently, if not alwrays, some por- tion of them is retained after the prema- ture expulsion of the embryo. The decidua is soft, enlarged, and its bulky remains easily form the nidus for the development of germs for the future production of septicaemia or menorrhagia. Traumatism is frequently present, invit- ing the absorption of septic germs and if blood-poisoning in a grave form is fortu- nately escaped, cellulitis, salpingitis, ovarian or pelvic abscess is liable to de- velop. Subinvolution and its resulting increased size and weight of the uterus 24 often making the life of the woman a burden from the endometritis, salpingitis endocervicitis and the various uterine dis- placements which naturally follow as a painful train of symptoms. These are all rendered more probable from the embarrassing necessity for keep- ing up appearances and diverting atten- tion and suspicion from their real cause. These effects of abortion, when it occurs from natural causes and when treated by skilful physicians, are difficult enough to avert, and are only prevented by rest in bed, good nursing and con- tinued and careful preventive measures ; when they occur, however, as they often do, in boarding houses and hotels, and among those women who desire great secrecy to avoid exposure and shame, these attentions are either not sought or permitted. The mental state, added to the physical condition, has proved too great a strain for many an erring woman. Remorse of conscience has been the last straw which has driven some of these unhappy victims of their own error and folly to suicide or insanity. Convalescence is generally prolonged from these causes, and the patient has many weeks, and perhaps months, if not 25 years, of invalidism in which to regret the errors of an ill-spent hour. Our free dispensaries and charity hos- pitals afford innumerable examples of broken constitutions and ruined lives which have had their sad beginning in an improperly treated abortion. It is the usual explanation given by a majority of the frequenters of the gynaecological clinic, that the displacement or inflam- mation of the uterus for which the sufferer applies for relief—that her symp- toms dated back to an abortion, three, five, or ten yeare ago. Many of the cases now operated on for otherwise incurable pus-tubes, or chronic inflam- matory disease of the ovaries, date all their troubles back to a neglected abor- tion. These sufferings are not all con- fined to the charity patients in the lower walks of life. They are as common as is the custom of abortion itself. No one rank in society appropriates them all. The experience of gynaecologists the world over will confirm the statement that a majority of the patients that we are called upon to treat in our offices, or in the fine residences of their fair owners, are the outcome of abortions or of the 26 preventive measures used against con- ception. This latter subject was fully exposed and discussed not long ago by a distin- guished writer and teacher from a neigh- boring city in an address upon “The Dangers and Duties of the Hour” before this body and upon this platform. This discussion of my subject forms a very appropriate appendix to his masterly oration, and my chief regret is that your committee selected no better man to bring before you the dangers and duties of the hour so far as they relate to this still more important subject. It is an every-day occurrence for ladies to consult busy gynaecologists in our large cities in regard to symptoms, which, upon enquiry, are found to date back to an unfortunate abortion. It would be quite within the limits of truth were I to state that two- thirds of the work of the gynoecologists of this age finds its chief cause in the evils discussed upon this platform by Dr. Goodell and myself. It is a sad com- mentary upon the Christian civilization of the age ; but the experience of honest workers in this department of our science 1 believe would corroborate the truth of this saddening statement. 27 Our sadness, however, is somewhat lessened when we are able to state also that the causes which we lament are among those which are demonstrated as preventable. If many err through igno- rance we may here find a glorious oppor- tunity for the exercise of the law of prevention. Much has been said of late of the greater mission of our science in the prevention than in the cure of disease. How can a better field of labor be found than in the direction I have indicated. Where and how can medical men save more lives or prevent more suffering than by teaching women the dangers of abor- tion and thus saving their bodies, and perhaps their souls, from ruin in this li/e and the life to come* In this exer- cise of our great mission we may be sure of the approval of our own consciences, of the co-operation of the great Physician in the prevention of much sin and sorrow, and of the final judgment of “Well done, thou good and faithful servant.” Upon motion of Prof. Wm. T. Howard a unanimous vote of thanks was tendered to Dr. Johnson, for his very timely and interesting address, and a copy requested for publication in the transactions of the Faculty. 920 Farragut Square.