The Anti-midwife Antiabortion Campaign

The antiabortion campaign had its greatest success when it focused its attention not on physicians or on the women who had abortions, but on midwives. Between 1890 and 1920, physicians, public-health workers, and reformers across the United States debated "the midwife problem."^[38] Part of the "problem," as many observers defined it, was the practice of abortion by midwives. F. Elisabeth Crowell, a nurse and an investigator of midwives, reported in 1907 that New York City officials and physicians agreed that midwives were primarily responsible for abortion. "Indeed," she concluded, "some go so far as to say that the two terms 'midwife' and 'abortionist' are synonymous."^[39] As obstetricians tried to establish their specialty, they focused on midwives as the source of their field's low status and led a campaign to control their competitors.^[40] Identifying midwives as abortionists proved to be an effective weapon in the battle to bring midwives under medical scrutiny, and state control. The anti-midwife and antiabortion cam-

paigns became intertwined into one. This campaign arose out of the interests of a small group of specialists, but it won public attention and legislative action as it spoke to larger social concerns about the welfare of immigrant motherhood and the sexuality of young women in the modern American city.

Physicians downplayed the medical side of the abortion story and stressed the role played by midwives, suggesting that all midwives were dangerous. Specialists in obstetrics led this campaign, but condemning midwives for abortion implicitly made all physicians appear morally upright in contrast and shifted attention away from the abortion practices of physicians. Attributing abortion to midwives matched obstetricians' custom of proclaiming their own superiority over midwives (and, later, general practitioners), whom they blamed for overall maternal mortality.^[41]

Although scholars have studied the turn-of-the-century medical opposition to midwives, they have not analyzed the role of abortion in the movement to restrict midwifery. Earlier feminist historians of midwifery concentrated on analyzing the medical battle to gain control of obstetrics and comparing physician and midwife safety in childbirth. Most recently, historians have uncovered the details of midwives' birthing practices and have paid greater attention to the history of rural and African American midwives.^[42] Abortion was a crucial element of the turn-of-the-century campaign to control urban midwives and one that historians have overlooked.

Tracing the anti-midwife antiabortion campaign as it developed in Chicago provides an opportunity to observe how a debate that began within the medical profession became part of popular discourse and political action. As the medical story of midwives and abortion caught the attention of different groups, each gave the story its own emphasis. Nonetheless, all advanced the obstetricians' program to restrict midwives' practices. The combined campaign to control abortion and midwifery took the form of a classic Progressive Era reform movement: a coalition of private interest groups—doctors, female reformers, nurses, and journalists—of the native-born, white middle-class, identified a problem, investigated and documented its extent in "objective" reports, and mobilized to promote a state-sponsored solution.^[43] Also typical of Progressives, the "problem" of midwives and abortion was located in the neighborhoods of the "other," among the city's immigrant masses. Neither the perception that immigrant midwives posed a "problem" nor the tendency to link midwives with abortion was

unique to Chicago physicians and reformers.^[44] The leaders of medicine and reform in Chicago not only advocated midwife regulations in their own city, they influenced the shape of national health policy.^[45]

As the campaign against midwives and abortion moved out of the medical arena and reform circles and into the newspapers, it was strengthened by and became part of the many urban sex reform movements that marked the period. Like other sex reform drives at the turn of the century, the anti-midwife antiabortion campaign identified female sexual behavior and sexual commerce as alarming, and related, urban problems. Americans identified cities as sites where innocents, especially women, were seduced and endangered. Chicago had a notorious reputation as a city of pleasure and vice. The investigations, newspaper exposes, and reform campaigns around prostitution, statutory rape, "women adrift," "birth control," and "race suicide" all attest to the profound upheaval in gender and sexuality that urban industrialization encouraged and made visible. In cities like Chicago it was becoming apparent that newly independent working women were breaking old rules governing sexual behavior and charting new sexual territories that allowed, even celebrated, sexual pleasure separated from procreation and marriage. The era's urban sex reform movements reveal contradictory anxieties about women's newfound sexual freedom and the sexual danger they faced in the city. Sex reformers treated women as both victims of male lust and independent pleasure seekers themselves.^[46] Abortion highlighted women's new sexual liberty; women's deaths as a result of abortion emphasized the dangers of sex. The obstetricians' campaign to restrict midwives succeeded, in part, because the antiabortion campaign channeled anxiety about female sexuality into support for the medical program of midwife control.

One of Chicago's specialists in obstetrics helped launch the national medical campaign to control midwives at an international meeting held in Washington, D.C., in September 1893. Dr. Eliza H. Root presented a paper to the section on obstetrics at the Pan-American Medical Congress in which she analyzed the problem of inadequate medical training in obstetrics as well as the results of the unregulated practice of untrained midwives. Root charged midwives with causing infections and inducing abortions, but remarked that untrained physicians posed even greater dangers to their patients. She suggested instituting "the outdoor plan," which would give medical students needed clinical experience by having them attend births in the homes of poor patients.^[47]

Although Root's talk focused more on the need to improve the obstetrical education of doctors than on midwives' practices, the specialists at the meeting set an important precedent by focusing their discussion on what they regarded as the crimes and inadequacies of midwives. In so doing, they relegated to the background the problems of poor obstetrical practices by physicians and poor obstetrical training in medical education. As a result of Root's paper and the ensuing discussion, the congress's section on obstetrics took what may have been the first collective international and national action against midwives. The section appointed a committee, headed by Root, which drafted a resolution that "protest[ed] . . . the irregular practice of obstetrics by midwives" and called upon the states to require training and testing of midwives before licensing them. The section voted unanimously in support of the resolution and planned to deliver a copy of its resolution to the board of health or medical licensing of each state.^[48] These specialists in obstetrics expected state officials to carry, out policies written in the interest of the medical profession and without consultation with midwives, birthing women, or elected officials. Over the next two decades specialists continued to follow the pattern set at the 1893 medical congress.

It is notable that the specialist whose paper inspired this early action in the medical campaign against midwives was a female physician. Many women physicians shared Root's interest in controlling midwifery. Chicago's Dr. Sarah Hackett Stevenson, one of the most prominent female physicians of the nineteenth century, corroborated Root's comments at the meeting and "spoke at length upon the incompetency of foreign midwives in Chicago."^[49] The Woman's Medical Journal proudly reported on Root's presentation at the Congress, describing it as a "strong and powerful paper on the evils of midwifery, and the desirability of a national law for the extermination of this class."^[50]

Root's interest in midwives grew out of her dual identities as a specialist in obstetrics and as a female physician; both groups saw midwives as their rivals. Female physicians had fought to differentiate themselves from less educated and less honored midwives. Women had often based their claims to join the medical profession on their sex and what they could offer women patients during childbirth or gynecological procedures: special feminine sympathy, modesty, and safety, in a feminine atmosphere free of the fear of sexual impropriety.^[51] Midwives, however, also offered sympathy based on their shared womanhood and on shared class and cultural backgrounds as well. Dr. Stevenson had made the

competition between female health practitioners explicit a few years earlier. She wrote of the need for "stringent laws against midwives. There is no longer necessity for this class," she argued, because "women physicians and trained nurses more than fill the demand." Dr. Elizabeth Jarrett of New York labeled midwives "ignorant, unskillful, [and] dirty" and looked forward to their replacement by superior female physicians. "The woman doctor and the midwife," she declared, "have nothing in common."^[52]

The events of the anti-midwife antiabortion campaign highlight the ways in which class and education could divide women. The campaign against midwives was more than simply a battle between male physicians and female midwives; the dynamics of class, ethnicity, and professional interests complicate the picture.^[53] Female physicians and reformers joined the turn-of-the-century campaign to control the intertwined "problems" of midwives and abortion. Their involvement in an antiabortion campaign was unprecedented. The earlier medical crusade had attacked feminists, female physicians, and middle-class women in general as well as abortion.^[54]

Attention to the abortion practices of some midwives enabled specialists in obstetrics and health officials to impose greater control over all midwives. In 1896 the Chicago City Health Department enacted pioneering regulations for midwives on the theory that controlling midwives would control abortion. Dr. Charles S. Bacon, the president of the health department's obstetric staff, declared that "the practice of abortion has become a very great evil, largely as a result of a lack of midwife control." Bacon credited the state board of health with initiating "the movement" for midwife regulation by publishing the details of thirty-four abortion-related deaths caused by midwives. "These cases in Chicago," he explained, "were the immediate cause of the movement which led to the establishment of the system of midwife regulation that now prevails." The Chicago Health Department wrote twelve rules for midwives, which the state board of health approved in 1896. One rule forbade "any midwife hav[ing] in her possession . . . any drug or instrument or other article which may be used to procure an abortion."^[55]

In securing the twelve rules for midwives in 1896, Chicago obstetricians won the power to oversee midwives a decade before New York City doctors and succeeded in defining childbirth as a medical event long before the national midwife debates reached their peak in the 1910s.^[56] Bacon and the other obstetricians in the health department were concerned about more than midwives' abortion practices—they

resented midwives' obstetric practices in general. As Bacon explained, doctors "objec[t] to midwives" because they "usurp the functions of physicians." Midwives took business that, physicians believed, rightfully belonged to them. In addition, he blamed midwives for raising maternal mortality.^[57]

The rules for midwives were written from the perspective of the newly specializing field of obstetrics, which viewed childbearing as a pathological event requiring special medical expertise. The regulations narrowly defined the role of midwives in the birthing process and put midwives directly under the supervision of the city's leading obstetricians. The rules required midwives to register with the Chicago medical inspector of midwives and to keep casebooks and allowed them to attend only "cases of natural labor." In cases of "unnatural" or "abnormal" labor, the rules obliged midwives to call in a physician. To enforce these regulations, the health department organized its own voluntary obstetric staff of "the most eminent men in the city." The staff, of fifty-one obstetricians and ten other doctors, was expected to "attend cases when called on by the midwives, to inspect her [case]book and outfit and in general to help in carrying out the regulations." Department obstetricians also investigated maternal deaths and, when necessary, "impress[ed] the offending midwife with new ideas of their [sic ] responsibility."^[58] Yet, despite the new rules, as later events showed, the health department and its obstetricians had by no means gained complete control over Chicago midwives. Nor had the practice of abortion disappeared.

As the Chicago Medical Society's Criminal Abortion Committee reached the unhappy conclusion that physicians did not support their efforts to bring physician-abortionists to law, they turned their attention to another group. The committee had discovered the "relatively great frequency of the crime of abortion among midwives" and, in 1907, proposed that the society form a new Committee on Midwives to investigate midwives, which it did. The society supported the close scrutiny of their competitors, not their colleagues.^[59]

Obstetricians within the medical society joined hands with female reformers to investigate midwifery in Chicago. Hull-House, the settlement house started by Jane Addams, agreed to finance the investigation and the Visiting Nurse Association assisted. Reformers and nurses, like physicians, assumed that high maternal and infant mortality rates, particularly among poor and immigrant populations, could be attributed to midwives. Investigations of midwives were part of a number of activ-

ities—such as clean milk drives and classes to teach women about good nutrition and prenatal and infant care—pursued by female urban reformers who hoped to improve the health of poor immigrant women and their families.^[60] Gender awareness informed the analysis of the female physicians, nurses, and reformers who joined the effort to regulate midwives. They saw themselves as protectors of other classes of women. Reformers focused on improving the maternal health of poor and immigrant (married) women and protecting young (unmarried) working women from sexual seduction and exploitation.

Rudolph Holmes, head of the medical society's abortion committee and an obstetrician, chaired the new Committee on Midwives. The new committee included Dr. Bacon; Dr. Herbert M. Stowe, another obstetrician; and two female physicians involved in reform, Doctors Alice Hamilton and Caroline Hedger, who shared an interest in maternal and infant health and were associated with Hull-House and the University of Chicago Settlement House respectively.^[61] The committee hired Miss F. Elisabeth Crowell to investigate Chicago's midwives. Crowell, a registered nurse and charity worker, had investigated New York midwives two years before and had published an influential and critical report on her investigation. Of the 500 New York midwives she investigated, she suspected that 35 percent practiced abortion.^[62] The Chicago committee modeled their investigation of midwives on the New York study, as did Baltimore reformers.^[63]

The Chicago Medical Society's Committee on Midwives found, as expected, that the practice of abortion thrived among Chicago's midwives. More than two hundred of the five or six hundred midwives in Chicago were investigated. The committee's "special detective" found that a full third of Chicago's midwives "should be classified as criminal." She found forty-nine midwives willing to operate, four who offered to sell drugs, five who had been indicted for criminal abortion deaths, and twenty-two whom she marked as "suspicious." Nineteen took patients into their homes and ran what the report labeled "abortion shops."^[64]

The "detective" uncovered alliances between physicians and midwives in the illegal abortion trade. She visited one physician who ran a midwifery school and who, for an added fee, instructed students in the "modus operandi of successful abortion work." The committee also found physicians and midwives who split an abortion practice and the fees. "In the case of a disastrous finale," the committee reported, "the cloak of an honorable calling is wide enough to cover and hide from

suspicion both the criminal physician and the criminal midwife." If the midwife had any trouble, she called her physician collaborator, who, if necessary, signed a false death certificate, assigning death to perhaps "pneumonia" or "cardiac failure."^[65]

In spite of the evidence of the medical practice of abortion, the 1908 report on "The Midwives of Chicago" blamed midwives alone for illegal abortion and pressed for increased state control over them. "It is generally conceded," wrote Crowell in the committee's report, published in JAMA , "that midwives are the chief agents in procuring . . . abortions."^[66] The committee compared the state regulation of medicine and midwifery and found that "the laws governing . . . midwifery are utterly absurd and inadequate" compared to those regulating obstetrics. The state required medical students to attend three obstetrical cases, but made no similar requirements of midwives.^[67] The committee favored raising the standards for midwives and educating them. No matter how midwives' training improved, however, Crowell argued for the "regulation and inspection of the midwife's practice after she has been turned loose . . . on an ignorant and credulous community." Ideally, the investigators suggested, the state board of health would employ inspectors to supervise Chicago's midwives and "immediately suspen[d]" the licenses of those responsible for infected or mismanaged cases.^[68]

As the committee condemned midwives for abortion, it glossed over the involvement of doctors in this criminal practice. It did not recommend that the state inspect the medical practices of physicians and immediately suspend their licenses for abortion or mismanagement. The medical profession preferred to conduct its own, quiet, internal investigations of physicians and expel physician-abortionists itself rather than inviting state agents to oversee medical practices. Physicians could lose their licenses for performing abortions, but in Illinois, only after having been convicted of abortion and having had a hearing before the state board of health. However, since it was extremely difficult for the state to win convictions for criminal abortion, few doctors stood the chance of losing their licenses for illegal abortion.^[69] Furthermore, the committee assumed that physicians had better obstetrical training than midwives, but, because of the patterns of social childbirth, some midwives, had, in fact, observed more deliveries than had young doctors.^[70]

As a result of the 1908 investigation, Chicago midwives faced increased surveillance and new municipal rules. Again, an investigation initiated because some midwives practiced abortion resulted in restric-

tions on the birthing practices of all midwives. Although the president of the Illinois Board of Health doubted a new state licensing law for midwives could be won, local officials acted on the report. The Chicago City Council amended the hospital ordinance to prevent midwives and others from treating confinement cases in their own homes. The revised ordinance made anything resembling an "abortion shop" illegal. At the same time, the ordinance preserved hospitals as institutions under medical control. It had not been unusual at the turn of the century for business women to set up private hospitals in their homes, which served the needs of both patients and physicians. The new ordinance prohibited midwives from bringing patients into their own homes or anywhere else unless licensed by the city, but permitted only physicians to obtain licenses for hospitals or maternity centers.^[71]

In September 1910, the much talked about Chicago midwives talked back through the legal system and a local paper. Chicago midwives, normally the objects of discussion among middle-class professionals, officials, and reformers, inserted themselves into the debate and told their own, very different story. In the midwives' version, the midwife "problem" was not abortion, but the blackmailing of midwives by state officials. Chicago midwives began investigating the investigators and documenting official corruption and abuse of midwives. They presented to the state's attorney's office twelve affidavits complaining of mistreatment by Illinois health officials. The midwives accused Charles G. Hoffman, an assistant attorney for the state board of health, of threatening midwives with prosecution and extorting them. A meeting of seventy midwives resolved to call on "every midwife in Chicago" and collect additional affidavits from any who had been victimized. A committee was appointed and began work immediately. By the time the city's midwives assembled at a "mass meeting" two weeks later, they had organized themselves into two organizations, the Chicago Midwives' Association and the Midwives' Anti-Graft Association. The midwives demanded that the governor fire Hoffman. They presented additional affidavits telling of abuse, planned a petition, and listened to speeches protesting the state's treatment of midwives.^[72]

Mrs. Marie Rolick told the crowd of a visit by a state board of health "spy," who had asked for an abortion. Mrs. Rolick warned other midwives of a male "'hobble-skirted' spy with curly, wavy, blond hair," who would try to trick them. The male spy, "masquerading as a girl," came with another man and knocked on Rolick's door. Rolick reported that "the man offered me $35 to perform an operation and I only laughed.

He persisted and," she said, "I got angry, grabbed a revolver and threatened to shoot. The 'girl' grabbed her dresses around her and she had a pair of trousers on. . . . my suspicions were well founded."^[73]

Mrs. Rolick's "thrilling tale," as the local newspaper billed it, turned the tables on local officials.^[74] As investigators and state officials warned midwives to beware of practicing abortion, this midwife warned investigators to beware of midwives armed and willing to fire. Whether or not male investigators really cross-dressed in order to catch midwives, Rolick refashioned the story told by investigators like Miss Crowell and cast herself as a heroine in the drama. In Rolick's narrative there were "spies" (a more malicious term than investigator ) who hoped to catch midwives performing abortions. The midwife herself appears to be smart and strong—she knew a spy when she saw one and fearlessly threatened "her" with a gun. Unfortunately, the outcome of Chicago midwives' protests and organizing in 1910 remains unclear.

Chicago's midwives showed themselves to be neither passive in the face of attacks nor ignorant about how to defend themselves. These press reports are rare documents in the history of midwifery, for they record an episode when midwives united to articulate their opposition to mistreatment by state health officials.^[75] The 1910 incident suggests that historians need to revise their assumptions about midwives' inability to organize and defend themselves.^[76] Chicago midwives were less isolated both from each other and from American political culture than is usually assumed. And yet midwife organization and resistance was sporadic and ultimately ineffective in preserving midwifery as a craft. Chicago midwives tried to shift attention to abuse by state officers, but they lacked the political and social power to gain control of local debates.

Within weeks of the midwives' public complaints about spies, they were again the subject of secret investigations. The 1910 state-sponsored study of vice in Chicago suggests that reformers imagined abortion, midwives, and prostitution to be linked in the same sexual underground. Investigators for the Chicago vice commission "visited" Chicago's midwives in order to discover whether they performed abortions. Although the vice commission noted that there was "some doubt as to whether or not there is any connection between the practice of abortion and the social evil," they argued for one. "Incidents are on record," the commission informed city officials, "where girls who have had abortions performed have become reckless and discouraged, and have actually entered upon a life of prostitution." Reformers under-

stood both abortion and prostitution as part of the same exploitative commerce in female sexuality. Both were sexually deviant and both symbolized the dangers the city posed to virtuous women.^[77]

The vice commission investigated twenty midwives who had raised the commission's suspicions by advertising. The report showed that midwives knew they were often under surveillance: three told the secret investigators that "people at the City Hall watched them." Six refused to perform abortions, the commission agents reported, two referred them to someone else, and, "the remaining twelve agreed to perform the supposed abortion for different sums of money" (emphasis in original). Although the commission suspected certain physicians and pharmacists of being in the abortion business, it did not look into their practices. The commission excused its partial inquiry with the explanation that "time has been too limited."^[78] Reformers expected to investigate midwives; they were the usual target of investigation, and even when evidence indicated that others participated in illegal activities, reformers did not feel compelled to inspect them. In short, probing the practices of midwives had become a habit.

Neither the rules for midwives enacted by the health department in 1896 nor the 1908 ordinance forbidding the institution of hospitals by midwives (let alone the laws forbidding abortion) put a stop to midwives' obstetric and abortion practices. One influential reformer, Grace Abbott, a Hull-House resident and founder of the Immigrants' Protective League, concluded in a March 1915 report that the recommendations made by the 1908 Committee on Midwives had come to naught.^[79]

Abbott urged a new strategy: recognizing midwives and training them. Even though her colleagues at Hull-House had participated in the investigation of midwives with the Chicago Medical Society seven years earlier, "laymen and doctors," Abbott now reported, "ha[d] divided . . . into two opposing camps." The policy of Hull-House reformers to listen to their neighbors, particularly immigrant women, had given them a fresh perspective on midwives. Abbott dismissed the fixation on the abortion practices of some midwives as irrelevant to the question of their safety as birthing attendants. Abbott recognized that poor immigrant women relied on midwives to attend them during childbirth and that improving midwives' skills could improve the maternal and infant health of the foreign-born community. Though Abbott criticized physicians and suggested a policy many would dislike, she reassured them that physicians well-trained in obstetrics were

preferable to midwives and that supporters of midwife training and licensing did not intend to "make a doctor out of a midwife." Immigrants, however, she pointed out, preferred midwives because they were women and often refused to be seen by male physicians. The "traditions and prejudices" of immigrant women and men made midwives inevitable and their training a necessity.^[80]

Abbott made a concrete proposal for carrying out the public policy she favored: Cook County Hospital should open a school for midwives. A 1913 investigation, she reported, found seventy-one midwives who welcomed the idea. Abbott had surveyed the training opportunities available to midwives and concluded that what little Chicago had to offer was terrible. Several physicians ran their own officially unrecognized proprietary schools for midwives, but Abbott questioned their qualifications and judged the training worthless because midwives merely listened to lectures without observing actual deliveries. (This had been the tradition in medical education as well. In fact, one of the nation's leading obstetricians reported that most medical students observed only one delivery.) Abbott again reassured the medical community that training midwives would not hurt physicians; since medical students did not work in the maternity ward at the county hospital, her proposal "would not mean the sacrifice of medical students to the training of midwives.^[81]

Abortion in Chicago exploded into public view just two months after the publication of Abbott's report, when the bizarre abortion-related death of Miss Anna Johnson appeared on the front pages of the city's newspapers. On May 26, 1915, Anna Johnson was found dead with a bullet hole in her head in the home of Dr. Eva Shaver, a graduate of a "notorious" medical school shut down by the state board of health. Newspapers told a confusing and ever-changing story of Johnson's death. Dr. Shaver claimed that she had recently hired Johnson as a maid and the girl had committed suicide. Police speculated that Shaver had killed Johnson in an attempt to cover up a badly performed abortion and looked for dead babies buried under the floors of the doctor's home. Johnson's "sweetheart," Marshall Hostetler, told the coroner that the couple had met at a dancehall over a year before and had planned to marry. When she discovered her pregnancy, he bought abortifacient pills from Dr. Shaver's son for Johnson, and when those failed to work, he arranged for her to go to Dr. Shaver's home for an illegal operation. Johnson had tried "to hide her shame" by having an abortion and ended up murdered.^[82]

Although the accused abortionist in this case was a physician, this incident revived the campaign against midwives and abortion and infused it with a new vitality. Journalists and officials still assumed that female practitioners were midwives, and midwives, abortionists.^[83] The Johnson case illuminates the Progressive Era's understanding of abortion as sexually dangerous and as symbolic of heterosexual relations. Press coverage of the story followed well-worn paths in the newspaper trade and in sexual discourse. The story titillated Chicago's citizens and sold papers while it reinforced the sense of the city as a place of sexual danger for young unmarried women.^[84]

The coverage of Johnson's death sent different messages about abortion than had the 1888 exposé, which had suggested it was easy for women to get an abortion. A new story was being constructed. The story now told by the press warned young women that challenging sexual norms could kill them. Newspaper headlines such as "Unmarried Lead Deaths" and "Health Committee to Take up Baby and Women Killing Inquiry at Once" all emphasized the deaths of unmarried women following abortions. The Tribune grandly displayed photos of Shaver's apartment, Anna Johnson, and the pills she had taken. (See plate 5.) The paper emphasized the certainty that death followed on the heels of abortion by listing, in a separate column next to the photos, the names and accounts of twenty-four Chicago women who had died because of abortions in the last five months. "How many girls die in Chicago each year as Anna Johnson died?" the Tribune asked. The paper answered that the coroner reported that abortions had caused at least "601 deaths in the last eight years!"^[85]

This report, however, exaggerated the number of deaths due to criminal abortions induced by midwives, physicians, and others. No more than 15 percent of these abortion deaths were identified as caused by criminal abortions. Some of the abortion-related deaths recorded by the coroner had followed miscarriages (spontaneous abortions), and many more were the result of self-induced abortions, a dangerous practice rarely mentioned in the press. Furthermore, not all of the women who had abortions or who died from them were young unmarried "girls" like Johnson; most were married and most survived, but newspapers featured the unwed.^[86]

At the same time that press coverage emphasized the victimization of unmarried women, it included a strand that blamed married women for "race suicide." The sympathetic tone toward victimized girlhood contained an undertone of fear and anger toward female control of re-

Plate 5. "The Quack House, the Victim, the Agency." Local newspapers
covered abortion as mystery, romance, and crime. In these photos the paper
called attention to the pills as "Evidence," luridly labeled Dr. Shaver's office the
"House of Murder," and included a portrait of Anna Johnson, the young victim."
The scrollwork was typical of theatrical advertising. Note that the doctor's
office and sign faced the street. Chicago Daily Tribune , May 29, 1915.

production. Coroner Hoffman, according to one paper, "insisted that retreats wherein 'race suicide' is practiced and preached must be suppressed as a growing menace." His words marked this battle as part of a larger attack on the separation of sex from procreation, the increasing use of contraception by Americans, particularly among the white, native-born elite, and, especially, the feminist movement for birth control. Officials and physicians recognized abortion as one method of birth control and midwives as providers of birth control to the working class. Dr. W. H. Stackable, a member of the Chicago Medical Society's abortion committee, estimated that 60 percent of the women who had abortions were married. Married women had abortions "because they either wish to avoid the responsibility or because they already have large families; neither reason," Stackable remarked, "constitutes a defense." In the midst of this attack on abortion, the circuit court's chief justice refused to grant one woman a divorce because she had had an illegal abortion. Justice John P. McGoorty declared, "A woman who would destroy life in that manner is not fit for decent society. It is the duty of any healthy married woman to bear children. Divorce is refused." To these men of medicine and law, women were obligated to bear children; those who did not deserved to be punished.^[87]

The press story of Johnson and Hostetler played on the old theme of male seduction and abandonment of innocent women, but recast the standard gender roles of the tale. In the Johnson melodrama, the woman appeared as the victim, but so too did the man. A second woman performed the lead role of villain. The papers generally presented the lead male in the story, Johnson's "sweetheart," Hostetler, as a victim. Although he was a suspect himself at certain points and had a turbulent (perhaps even violent?) relationship with Johnson, he had lost his beloved sweetheart and "sobbed" and "collapsed" repeatedly at the inquest into her death. He had been duped by the evil Dr. Shaver and her son Clarence into allowing them to induce an abortion and, after Johnson's death, into hiding to avoid the law. Furthermore, it was later reported, as he talked to prosecutors, his life was threatened. The villain in this case became not the young man who had impregnated Johnson and failed to marry her, but the female physician-abortionist, Eva Shaver.^[88]

As newspapers reported the Johnson tragedy and highlighted the dangers of abortion, they moved the discussion of abortion and midwifery out of the smaller circles of the medical societies and reform groups and into the public eye. At the same time, the press drew the

public into a medically defined, citywide war on abortion and midwifery. As reporters and officials reworked the abortion story by adding the exciting angles of sex and murder, they successfully aroused the curiosity and concern of citizens and politicians. The new story conformed, however, to the analysis of public policy and abortion constructed over the years by specialists in obstetrics. As before, the death of a woman as a result of abortion prompted an attack on midwives. This time, however, local press and politicians, not doctors, led the crusade. The new leaders followed doctors in automatically blaming midwives for the problem of abortion in their city and supporting regulation of midwives as the solution even though this meant ignoring that the Johnson case contradicted their own story because the accused abortionist was not a midwife at all, but a physician.

Turning Dr. Shaver into a midwife in the discourse reveals the strength of old prejudices against female physicians. The coroner's declared "war" against abortion immediately turned into a "campaign against midwives."^[89] The Chicago Herald cried out, "Midwives under Fire," and announced that Johnson's death "Turns Searchlight on Maternity Homes and Chicago Midwifery."^[90] The "searchlight" never focused on Chicago's medical profession. Coroner Peter Hoffman emphasized the guilt of midwives, though the data collected by his own office showed midwives and doctors to be almost equally responsible for women's abortion-related deaths.^[91] Dr. Stackable of the Chicago Medical Society charged that 75 percent of the city's abortionists were midwives. Although he "admitted" that physicians performed abortions, and called for stricter enforcement of the laws against both midwives and physicians, neither newspapers nor city officials highlighted the large number of physicians involved in illegal abortion.^[92]

Press coverage of Anna Johnson's death inspired local women's organizations to call for the suppression of abortion and regulation of midwifery. The day after the report of Johnson's death the local press defended its coverage with the remark that "nothing but publicity and the arousing of public wrath against the abortionists, say the women's organizations interested, can check their operations."^[93] Dr. Effie L. Lobdell of the Welfare League of Chicago suggested that physicians should be able to arrest women who asked them for abortions. The Woman's City Club favored "more stringent regulation" of midwives, as did the Chicago Woman's Aid.^[94] When Coroner Hoffman vowed to "exterminat[e] . . . 'wild-cat maternity homes,'" he recognized the influence of Chicago's club women and asked them to "aid the author-

ities in putting an end to the sale of drugs used in illegal practices."^[95] He expected civic and women's organizations to help him eradicate the city's abortionists. The Chicago Medical Society and city ministers soon joined the chorus condemning abortion and endorsed efforts to end its practice in Chicago.^[96]

Newspaper readers jumped into the local investigation of "abortion crimes" by writing letters to the "Tribune Quack Department." Several sent names and addresses of abortionists in their neighborhoods. "I would advise," wrote one, "a canvas among the 'lady' physicians and midwives of the west side in the Bohemian settlement," at least two of whom, the writer knew "positively," were abortionists. One woman wrote of her own abortion, but the "crime" in her story was her "former sweetheart's" behavior. He had promised to marry, but then refused. "All that I am living for," she concluded, "is to see the day that they will do justice to men that believe in doing wrong to young girls."^[97]

Faced with a public outcry for action, officials at all levels of government quickly enlisted in the battle against abortion by ordering investigations and passing new legislation. Coroner Hoffman led the "war." He suggested that "scores of midwives" used their homes as maternity homes and had their patients pretend to be roomers or servants to cover up their abortion practices. "These wildcat maternity homes and ignorant, lawbreaking midwives must be driven out of Chicago," declared the coroner. The coroner called on other officials to aid him in the fight against abortion. He, the police chief, the city health department, and the state's attorney's office all planned to investigate the maternity centers. The city health department complained that it had no control over midwives and planned, the Herald reported, to "seek at once the adoption of an ordinance placing them under its supervision."^[98] The Illinois Board of Health's secretary agreed "entirely . . . with the move in the city of Chicago to drive out the abortionists" and promised to "assist in every possible way in the suppression of the evil."^[99] Within a few days of Johnson's death, on June 1, 1915, the Chicago City Council unanimously passed a motion ordering its health committee to investigate the underground commerce in abortion as "practiced by midwives and others."^[100] U.S. district attorney and post office officials promised inquiries into the abortifacient business.^[101]

Local and state health officials invited the local medical society to participate in making public-policy decisions. "Private" and "public" officialdom merged, a characteristic feature of early-twentieth-century

political life. The week after the city council's action, "public and private health officials," the press reported, met at the city health commissioner's office and agreed upon a "co-operative crusade to drive professional abortionists from the city and state." Hoffman had invited the police chief, the state's attorney, officials from the city and state boards of health, and members of the Chicago Medical Society to meet, but not representatives of women's clubs or settlement houses. Although club women had been important to the coroner for spurring on investigation, they were not included in public-policy discussions. The authorities proposed a state maternity home for "unfortunate girls," a "higher standard for midwives," and the passage of Illinois House Bill 477, legislation designed to close a loophole in the law that they believed protected abortionists. The bill would allow the state board of health to revoke the licenses of doctors and midwives who had received licenses before 1899, many of whom were thought to be abortionists.^[102]

There were some exceptions to the common cry. Echoing the proposal made by Abbott a few months earlier, some recommended better training of midwives. The Chicago Medical Society's president, Dr. James A. Clark, remarked, "About the most important thing is to raise the standard of midwives." The county hospitals, he suggested, should open schools of midwifery. Clark's proposal placed him within the group of physicians who viewed midwives as a necessity, whose skills could be improved. Nonetheless, though these physicians held a more sympathetic attitude toward midwives than those who favored an outright ban on midwives, they shared the belief that midwives should be brought under greater medical control and, eventually, be replaced by physicians. Abbott had objected to the obsession with midwives' abortion practices, yet an abortion-related death and an antiabortion antimidwife campaign brought attention to her proposal for midwife education. Despite the support of the medical society's president for a school for midwives, none opened at Cook County Hospital.^[103]

While no advances were made in helping Chicago's midwives improve their skills, the 1915 campaign against abortion strengthened the state's enforcement of the criminal abortion laws. The Illinois legislature corrected the Medical Practice Act to allow the state to revoke licenses of midwives and physicians licensed before 1899. In Chicago, police made more arrests for abortion that year than ever before, topping the previous year's high with forty-seven arrests. Dr. Shaver was held for trial for Anna Johnson's death and in 1916 convicted of manslaughter for the abortion-related death of another woman.^[104]

The events surrounding Anna Johnson's death in 1915 showed how the program to control midwives could advance when it became attached to social anxiety about female sexuality. Specialists who sought increased state control over midwives had political success because, in the public arena, their proposal to control midwives promised not only to control the abortion business, but also to "protect" young, unmarried women from the twin dangers of sex and death. The Johnson case reminded young women that claiming sexual freedom and control over their own fertility could be deadly.

The message was mixed, however; while some took heed of newspaper warnings, others ignored them. Mrs. Cecile Hauptli and Edna Lamb talked about a newspaper story and "what a number of girls did die from abortions." Yet they agreed it was "a very well known fact" that some doctors performed abortions, and they named two. "If you know where to look," Lamb remarked, "you can find doctors all over the city, that will do those things." They had gotten the message that "girls did die" because of abortions, but they discounted the deadly story told by the newspapers. Finding a safe abortionist, Lamb's remarks suggested, was a matter of being savvy.^[105]

The newspapers' emphasis on the danger of midwives made at least one Chicago citizen doubt midwives' skills and take his daughter to a doctor instead for an abortion. This man recalled telling the doctor, "The newspaper got it many cases where midwifes [sic ] kill many young girls and young women." The doctor reassured him: "Don't you be afraid. It is no danger at all." During the procedure, the doctor perforated his patient's uterus, pulled out her intestines, and caused her death. The physician responsible for this disaster was Dr. Charles R.A. Windmueller, a graduate of the University of Illinois College of Medicine in Chicago, a licensed regular physician, and an AMA member.^[106]

Neither press nor politicians initiated a war against doctors as a result of this young woman's death. Dr. Windmueller was held to the grand jury for the woman's death, but physicians as a group were not blamed for abortion. In contrast to midwives, who were regularly condemned for abortion as a group, physicians caught doing illegal (and fatal) abortions were treated as disreputable individuals, not as representatives of their entire profession.

The combined campaign to control both midwives and abortion faded in Chicago despite the intense attention given abortion by reporters and politicians in the late spring of 1915. The Chicago City Council neither received a requested report on midwives nor passed

any ordinances to regulate them further. In 1916, the number of arrests for abortion fell to little more than half of the previous year's total.^[107] Press coverage of abortion still inspired local prosecutors to bring cases to court more quickly, but antiabortion campaigns did not turn into anti-midwife crusades. The Chicago Examiner , for instance, ran a series on the deaths of young women due to abortion in 1918. The paper claimed that its "exposé . . . of a ring of unscrupulous doctors who prey upon young girls' misfortunes" had convinced the prosecutor to bring several old abortion cases to trial.^[108] The accused abortionists included both physicians and midwives, but this exposé did not target midwives and did not result in new regulations governing their practices.

In turn-of-the-century Chicago, specialists in obstetrics won increased state supervision and restriction of the city's midwives in 1896, 1908, and 1915. In each instance, the identification of midwives as abortionists facilitated the passage of new rules controlling midwives' practices. However, obstetricians did not have the social power to dictate regulation of their competitors: their narrow professional interests had to appeal to other concerns to achieve political success. As their professional rivalry merged with popular discourse about women in the city, the specialists' program to control midwives made headway. Reformers, whether interested in lowering maternal mortality among immigrant women or fighting vice, investigated midwives. When reporters and city officials connected midwives and abortion to contemporary anxieties about the sexual vulnerability and independence of single women, politicians at every level acted to control midwives. Reformers, reporters, and politicians all reworked the midwife story and put their own slant on it, yet they followed the medical line that linked midwives to abortion and urged their regulation as the solution. Controlling midwives seemed to be the answer to an array of perceived social problems. Meanwhile, the role of physicians in performing abortions was overlooked. stigmatizing midwives as abortionists was only one weapon used by specialists in their political campaign to suppress midwifery. But, as the events in Chicago show, it proved to be a powerful one.

Although antiabortion physicians won their battle for greater control over midwives, one physician's remarks revealed that they lost the war to convince women that abortion was evil. In 1922, a frustrated Dr. Palmer Findley, a specialist from Omaha, observed that "the laity" still believed "that there can be no life until fetal movements are felt." Quickening continued to have real moral meaning for women. "We of-

ten find women of unquestioned moral standing bitterly resenting their state of pregnancy, and . . . determined to put an end to the whole affair." But, he reported, "when the date of quickening arrives and they are conscious of sheltering and nourishing a human life, their viewpoint is completely changed."^[109] Although this doctor seemed astonished at the persistence of these ideas, his story emphasizes that people took seriously this particular event—the movement of the fetus—as an indication of life. The public, and even much of the medical profession, had not adopted the new thinking that treated conception as the beginning of life and equated it with a child. Although the campaign had not convinced the public that abortion was wrong or stopped its practice, it did create a more hostile environment in which women sought abortions. Women may have felt harassed by physicians who gave them sermons, and some may have felt guilty; others found it harder to obtain abortions when local physicians and politicians cracked down on the abortion trade.

By 1920, the national campaigns against midwives and abortion had come to an end. The Progressive Era's antiabortion campaign had failed to ignite most physicians, to purge physician-abortionists from the profession, or to eradicate abortion. Few doctors talked anymore about the evil of criminal abortion and how to combat it. Palmer Findley was an exception, and he sounded archaic in 1922. The physician who remained committed to the antiabortion campaigns of the past, Findley remarked, "however courageous, will find little encouragement and much embarrassment if he fights alone."^[110] The medical discussion of abortion narrowed in the 1920s to the ongoing internal medical debate about whether, when, and how to perform therapeutic abortions.

Changes in the larger context regarding reproduction and public policy help explain the decline of the antimidwife antiabortion campaign. Interest in midwives and abortion as "problems" faded as reformers and activist physicians shifted their attention to other national policy questions, namely maternal and infant health and birth control. Once the women's movement won passage of the Sheppard-Towner Act in 1921, which provided federal matching funds to the states to improve maternal and infant health, the majority of the medical profession turned to battling the act instead of midwives and abortion. Physicians feared government control of medicine and the loss of private-paying patients more than midwives who served the poor.^[111]

Leadership for and against Sheppard-Towner came from Chicago. Grace Abbott was appointed head of the federal agency that implemented the Sheppard-Towner Act. Reformers wholeheartedly sup-

ported the federal mandate to improve maternal and infant health; the AMA actively fought it. Female reformers and physicians interested in maternal health who had initially supported the investigation and control of midwives adopted a more respectful attitude toward them as they learned more about midwives and the birthing women they served.^[112] Although a handful of Chicago physicians, including Doctors Bacon and Hedger, supported the act, the state of Illinois, home of the AMA, was one of only three states that refused to participate in the program.^[113]

Not only had a reform movement won the passage of the Sheppard-Towner Act, but another threatening movement, the birth control movement, had arisen during the years of the antiabortion campaign. No group defended abortion, but an increasingly strong and broad-based movement advocated contraceptive use. The birth control movement proclaimed women's right to limit their childbearing and advocated the legalization of contraceptives. For individuals ideologically opposed to female reproductive freedom, birth control was the issue to be fought, not abortion. The birth control movement challenged the law and the medical profession by opening clinics where activists gave women birth control information and devices. Furthermore, birth controllers criticized the medical profession for withholding contraceptives and accused it of being too willing to perform therapeutic abortions.^[114] Physicians committed to upholding moral standards, dedicated to stopping women's efforts to limit childbearing, and alarmed at the activities of nonphysicians fought the new birth control movement from the mid-1910s into the 1930s. Their number included some of the physicians active in the antiabortion campaign.^[115] Hostile physicians linked the two reform movements by using birth control to attack Sheppard-Towner supporters.^[116]

When Congress abolished the Sheppard-Towner Act in 1929 under pressure from the AMA and politically conservative groups, midwives were of little consequence to specialists in obstetrics. By the 1930s, obstetrics was an established specialty and midwives were disappearing from northern cities like Chicago. Obstetricians no longer needed to prop up their own authority by discrediting their competitors or by proclaiming their moral purity. Furthermore, although reformers and doctors had split over Sheppard-Towner, the programs instituted under this act achieved many of the aims of the medical campaign to control midwives. The act encouraged state monitoring of midwives and urged pregnant women to seek physicians as attendants.^[117]

The medical fight against abortion, waged in private encounters be-

tween female patients and physicians as well as in public political and cultural realms, waned as other issues came to the forefront and the professional concerns that had energized the campaign's leaders subsided. Despite the multifaceted nature of the turn-of-the-century medical campaign against abortion, the practice of abortion continued through the early twentieth century. Antiabortionists had lost the cultural fight to reeducate the public about abortion. They had established, however, important links with the state in making public policy concerning reproduction and in enforcing the criminal abortion laws.