Chapter 2
Private Practices

"I can not take your case," Dr. E. W. Edwards told the nervous young woman seated in his office. "But," he added, "I have given your friend the address of a physician I can recommend for that. I know him to be safe or I would not send you to him." He comforted the woman by patting her hand and gave her and the young man with her Dr. John B. Chaffee's address. It was 1888, and the couple had approached a physician near Chicago's Opera House in search of an abortion. They followed his directions to 527 State Street, the heart of Chicago's downtown business district, and climbed upstairs to Dr. Chaffee's office. There, the young man first spoke quietly to the doctor, who immediately agreed to "do the work" and called the patient to a private room, ready to begin. Frightened, she asked about the danger. "It is perfectly safe," he replied. "I would not endanger your life. You will feel perfectly well after it, and no one, not even a physician, could ever tell there had been anything the matter with you." The doctor explained the abortion procedure in an effort to reassure his patient. Nonetheless, she was not prepared to begin that day, and her companion took over the negotiations. "Doctor," he asked, "do you often have cases of this kind—is there much of this abortion practice going on?" "Lord, yes, thousands are doing it all the time. The only thing to do when one gets into trouble is to get out again." When the young man asked where she could stay during the abortion, Dr. Char-fee gave the woman a business card with the name "Mrs. Pierce" on it, recommending this individual as one from whom she could expect "ex-

cellent care . . . and motherly treatment." Armed with this information, the pair walked to 1616 Wabash Avenue to arrange a room and nursing during the doctor's "treatments." Mrs. Pierce welcomed the woman warmly and again reassured her of the operation's safety: "Dr. Chaffee . . . is one of the best in the city. He is very careful, takes plenty of time, guards against inflammation, and is entirely safe to trust one's self to under such circumstances." The fees for nursing, room, and board were $15 per week.^[1]

Finally, after hunting through the city, this couple had successfully located a physician, a nurse, and a room in which the young unmarried woman could safely and secretly have an abortion—her reputation preserved. They were pleased. Both were reporters for the Chicago Times . She was not the desperate unmarried woman she seemed, and he was neither her brother nor lover. Rather, the pair played these roles as part of their investigation of the abortion business in Chicago. They reported their discoveries in a month-long series of "revelations." The story began on December 12, 1888, and stayed on the front page every day through Christmas.^[2] In the method of the New Journalism forged in the 1880s, these investigative journalists had gone undercover and underground, into the "social cesspool," to expose the underworld and elite hypocrisy and, thus, inspire social reform.^[3]

The 1888 Times exposé is the earliest known in-depth study of illegal abortion. The investigation showed abortion to be commercially available in the nation's second largest city despite the criminal abortion law. The reporters retold their conversations with the hundreds of practitioners whom they had approached. They made the private practice of abortion public. As the newspaper published numerous, seemingly confidential conversations with Chicago's practitioners, it described the abortion underground. Abortionists, the journalists found, were drawn from the city's physicians and midwives. Furthermore, as the reporters' meeting with Dr. Edwards indicated, practitioners who did not perform abortions themselves had ties to those who did. Finally, the investigators discovered a widespread sympathy for the plight of unmarried, pregnant women. Doctors Edwards and Chaffee and nurse Pierce, the journalists observed, all seemed to understand a young woman's declared need for an abortion. This chapter begins by analyzing this late-nineteenth-century report on abortion and the creation of a popular story about abortion in the press. It ends by reconstructing the abortion methods and routines followed by physicians and midwives in actual abortion cases in early-twentieth-century Chicago.

The 1888 exposé is an excellent example of an important finding: the medical profession's relationship to abortion was laden with contradictions. The regular medical profession led the campaign to criminalize abortion around the country and publicly opposed abortion, yet numerous individual physicians responded to women's requests for abortion and participated in its illegal practice. Despite outward appearances of unanimity, the profession was divided. Official standards were not accurate depictions of the profession in the past.

The structure and location of health care, particularly in the turn-of-the-century city, provided the conditions in which abortion could flourish. Health care was not a unified system, but diverse, divided, and decentralized. Sectarianism divided physicians into Irregulars and Regulars; education, specialization, class, ethnicity, and sex further divided them. The diverse and decentralized character of health services contributed to the accessibility of abortion. In a city like Chicago with so many competing health care practitioners, those who sought illicit services could always appeal to someone else.^[4] The unobserved nature and domestic location of medical practice further enhanced the availability of abortion by keeping it hidden. Most health care, including abortions, took place in patients' homes, practitioners' offices, or sometimes other nonhospital settings such as Mrs. Pierce's.^[5] Physicians generally practiced alone, and no one scrutinized their decisions or practices; they enjoyed the privilege of autonomy. Midwives also practiced alone, though they faced growing intervention from various investigators during this period. Each of these structural features of turn-of-the-century medicine contributed to the thriving abortion trade.

The ongoing practice of abortion in spite of the criminal law, particularly by physicians, attests to women's ability to explain their lives and their need for reproductive control. Women found ways to communicate their needs to practitioners, both male and female, doctors and midwives, and gain their sympathy and aid. Medical involvement in abortion contradicts the assumption that doctors did not practice abortion. More generally it shows physicians to have been responsive, not impervious, to patient demands. Furthermore, the ability to respond to women's expressed need for controlling their fertility was not restricted by gender. Numerous male physicians, like Doctors Edwards and Chaffee, comprehended the lives of their female patients to such an extent that they helped them obtain abortions.

Some of the tensions around abortion evident at the turn of the century related to the issue of money and medicine and the profession's

desire to separate itself from the market. Medicine was a private business. I use the terms private and business deliberately. Physicians and patients regarded their interactions as private and confidential. Medicine seemed private since it was unobserved and often took place behind closed doors and in domestic spaces. In these intimate settings doctors heard women's words and learned from them. Yet it was a semi-public relationship, since the state monitored medical practice through licensing requirements and the profession attempted to regulate itself. Furthermore, medicine was a business, though physicians preferred to think of themselves as independent professionals who worked for the greater good. "Fee for service," and the tendency to advertise despite professional ethics forbidding it, pointed to the commercial aspects of medicine.^[6] The newspaper exposé made the private commercial practice of abortion public.

Women in rural Illinois and elsewhere in the Midwest, along with women in Chicago, had access to Chicago papers and abortion stories. By the end of the nineteenth century, Chicago was a national printing capital, and numerous newspapers competed for readers' attention. Dailies, weeklies, and a thriving foreign language press sold papers throughout the city for a few pennies each.^[7] Newspapers were an urban phenomenon that described and constructed the idea of the city for their readers.^[8] Chicago attracted people from the region and around the world. Many came for the entertainment and the commercialized sex industry for which the city was known.^[9] The city also attracted women looking for abortions.

The Chicago Times 's vivid and detailed report on the prosperous business of abortion offers an extraordinary opportunity to reconstruct the abortion underground at the turn of the century. Yet this rich story does more than "reveal" reality—it is the product of a particular breed of journalists with their own assumptions and goals. In exploring the underside of the city and exposing it in order to bring about social improvement, these "new journalists" combined exciting writing with moral fervor and an eye to selling papers. The New York World and London's Pall Mall Gazette have been credited with creating this new style of journalism, but the Chicago Times was also recognized as a leader in this investigative, "realistic" mode of reporting. The abortion exposé is a typical example of the "stunts" carried out by reporters of the time, who went in disguise to expose crime and corruption. Two of the most famous reports were Elizabeth Cochran's exposure of the insane asylum on Blackwell's Island for the New York World and W. T.

Stead's exposé of London's sex trade in virgins in the Pall Mall Gazette . Reporters intended the facts to arouse outrage and stimulate reform and, as Judith R. Walkowitz's analysis of the Stead case shows, stories about the sexual underground stimulated excitement and voyeurism as well.^[10]

Not only was the Times well-known for its scandalous style, it was a defender of the immigrant masses and loyal to the Irish Catholics of the city.^[11] The Chicago Times 's investigative report about abortion helped construct social divisions along class and ethnic lines at the same time that it constructed an abortion narrative. As the paper pointed to the hypocrisy within the medical profession, the Protestant clergy, and church-going ladies, it suggested that a specific class—the city's native-born, Protestant elite—was most in need of reform. According to the Times , the medical profession should kick out "malpractitioners" like Chaffee instead of pursuing doctors who advertised; the State Board of Health should revoke the licenses of those who agreed to perform abortions; ministers should focus on the immoral behavior of their congregations instead of the dangers of Sunday newspapers; and ladies should do their duty and bear children. The poor, in contrast, were cast as honorable: only they obeyed God's law to "perpetuat[e] the human race." Protestants compared unfavorably to Catholics, who, the paper asserted, almost never turned to abortion.^[12] Although the paper praised Catholics, it occasionally struck a contradictory note when it appealed to the racial fears of white, native-born Protestants. "Is the Anglo-Saxon-American race to be driven out by the healthy sons and daughters . . . of Celtic, Teutonic, and Latin origin?" it asked. Like Horatio Storer, the Times implied that abortion threatened Yankee political power.^[13] Readers added their own interpretations through letters to the editor. The story of abortion in Chicago, as it rolled off the presses day after day, did not get told in a linear fashion, but shifted as it presented alternate accounts.

The series ran under the headline "Infanticide." It began by describing the problem in Paris of single women from the country coming to the city, where they delivered and then killed their babies in order to avoid the humiliation of having to give their names to government officials. When the story moved to Chicago, however, the investigation did not focus on infanticide, but on abortion. The charge that infanticide was rampant in the city was frightening, for it called up images of murdering cherished babies, an image that editorial cartoons of babies and toddlers reinforced. (The use of illustrations was another modern

Plate 1. "It Comes down the Ages." The Times exposé helped
equate abortion with infanticide by including sketches of children.
Chicago Times , December 22, 1888, p. 4.

technique characteristic of the New Journalism.^[14] See plate 1.) Child-murder , another term the paper used, constructed abortion as the active killing of children, rather than a means for bringing on the menses. These words and sketches erased the difference between abortions early in pregnancy, long before quickening, and the murder of living individuals. While this language expressed the horror some felt about abortion (as shown in letters to the editor), it taught others a new way to think about abortion. It denied the view held by many that abortion was a necessary and tolerable practice, an attitude that the paper's own investigation uncovered. Using the word infanticide invited ugly images and avoided terms that suggested sexuality and the female reproductive organs. Although the reporters used the word abortion , they treated it as a dirty word; the newswoman was surprised that Chaffee did not "take offense" when her partner used the term.^[15]

The paper played to the voyeuristic interests of everyone in Chicago as the journalists constructed their stories in a manner intended to sell newspapers as well as to bring about reform. The "Infanticide" series began on a Wednesday with charges that Chicago harbored immorality equal to that of Paris and promises that incredible "revelations" about Chicago would begin the following day.^[16] The newspaper began by

naming midwives willing to perform abortions and alluded that physicians would be named as well.^[17] On Saturday, the exposure of physicians, including Doctors Edwards and Chaffee, began. The paper promised that 10,000 extra copies would be printed for the Sunday edition and a few days later boasted that circulation had surpassed previous records.^[18]

The Times began its exposé of the commercial underworld of abortion by going into the neighborhoods of midwives. Headlines tempted people to read, "How the Midwives Look upon Abortion and with What Ease They Can Be Hired to Perform It." The male reporter began by describing the "neatly painted, two-story frame house" in front of which hung a sign that said "Mme. Karl, Midwife" and invited his readers into her sitting room with him as he made the midwife's acquaintance. He told Mme. Karl of "a young lady relative [who] must be saved from the disgrace that must fall upon her . . . if she were permitted to become a mother." Could she help? The "plump" and "good-looking woman," as he described Karl, questioned him about how he got her name and remarked, "That is a very risky business." She needed to speak to the woman herself, but, she assured him, "It will be no trouble to get rid of it." Once she examined the patient, she would arrange for a doctor to perform the operation. After finishing his report on Karl, he described his visits to other midwives. Mme. M. Schoenian lived above a store and had a tin sign that advertised her midwifery services in German and English. "A stout, very stout, dumpy woman," Mme. Schoenian agreed to perform the abortion herself and promised safety. "I don't need any doctor," she explained. "I charge from $15 to $30, according to how long it takes."^[19]

In this way, the reporter described the appearance of midwives and their homes, their cleanliness or lack thereof, and their accents, along with recording his conversations with them about abortion. These descriptions told readers that many of the midwives were immigrants and lived in poorer neighborhoods. The paper published the names and addresses of sixteen midwives who either agreed to perform abortions or gave the male relative, a reporter in disguise, a referral. The city's midwives, he concluded, were "all willing to perform the work necessary if . . . no exposure would result."^[20]

Yet some midwives had refused to do abortions and offered to deliver the baby and arrange for its adoption instead. Midwives clearly provided a variety of reproductive services, from abortion to attending deliveries to arranging adoptions. When the journalist asked Mrs. Eliz-

abeth Pemmer about an abortion for his unmarried "sister," she exclaimed, "Ugh! My God! I can not do that, but I will keep her until the child is born and then for $25 will get it into a good foundling house." Pemmer took unwed women into her home, cared for them up to the time of delivery, and promised secrecy. Mrs. Mary E. Thiery reacted the same way. (When the reporter pressed them, one finally offered an abortifacient; the other named a midwife.)^[21]

The reporter, he noted in print, felt at "a disadvantage" as a lone man; he needed a woman at his side to present a more convincing show and to uncover the medical side of the abortion business. Midwives spoke of physicians whom they called for assistance, but would not give him their names. Eventually, "a young woman of intelligence, nerve, and newspaper training"—"the girl reporter" as the newspaper dubbed her—was added to the team. Both remained anonymous. When the (male) reporter introduced his new partner to his readers, he remarked that he was "in charge" of the investigation.^[22]

The "girl reporter" stole the show nevertheless as she added a new dimension to the story: gender. Her reports showed how gender shaped her feelings in ways different from her male partner's. She told of feeling ashamed as she declared her own sexual impurity, even though the story was false. The girl reporter soon became a topic of interest herself and the object of speculation, adulation, and condemnation.^[23]

The "girl reporter" discovered that some of the most eminent men in the medical profession were willing to participate in illegal abortion. Dr. George M. Chamberlain, one of Chicago's prominent physicians, agreed to "relieve her," but Dr. Chamberlain first asked who sent her to him, a question that, in the reporter's view, immediately revealed his guilt. Chamberlain was a staff member at St. Luke's Hospital and a member of both the AMA and the Illinois State Medical Society. The reporter pointedly remarked that this physician had gained his hospital position through his connections with "aristocratic ladies."^[24] Perhaps, she implied, he had helped some of these ladies out of predicaments similar to the one she pretended. Dr. Milton Jay, dean of the Bennett Medical College of Eclectic Medicine and Surgery, also consented to perform an abortion.^[25]

In concluding her day's report, the girl reporter mused as to a diary, "Tonight as I write this I am sick of the whole business." This personal writing style made the story intimate and interesting. It was a rare pleasure for readers to have the sensation of sharing a young woman's diary. It also consciously broke up the format of newspaper articles as it

moved from reports to a more reflective style. "I did not suppose there was so much rascality among the 'reputable' people. I am sick of it," she continued, "because two or three of the physicians who expressed their entire willingness to take up my case were men I had heard the highest praise of." The elite doctors did not seem to be any better than the quacks from whom they distinguished themselves.^[26]

The Chicago Times had a particular interest in exposing the respectable doctors; the girl reporter had remarked that she had been "commissioned only to see the physicians of the better class." She realized that "the dark and dirty stairways" of Clark Street probably led to innumerable physicians willing to perform the deed, but ferreting out the practitioners already believed to be the worst in the city was not the purpose of the investigation.^[27] The city's reporters, elite, and medical profession expected to find illegal practices in the city's neighborhoods already labeled poor and criminal and populated by foreigners. What was unexpected and damaging to those who enjoyed the privileges of the upper classes was showing that men of the "better class," as well as their inferiors, participated in the illegal business of abortion. Poking at the hypocrisy of members of the class that regarded itself better than the immigrant masses was the paper's goal. And, not unimportant, it was a good way to sell papers to both the common people and high society.

Physicians' responses to women's requests for abortion can be broken down into four groups. On one end was the physician who refused to perform an abortion or help a woman in any way; the Times quoted a number of these physicians whom it congratulated. Next were the physicians like Dr. Edwards who did not do abortions themselves, but referred women to other physicians who would. These doctors played a crucial role in aiding women seeking abortions. This was the most common form of medical involvement in abortion throughout the era of illegal abortion. Then there were physicians, like Dr. Chamberlain, who occasionally performed abortions for their own patients. The majority of physicians probably fell into these last two categories. Finally, a few, like Dr. Chaffee, performed abortions regularly; they were the so-called professional abortionists.^[28]

The Times investigation made it obvious that physicians were an important source of abortions and that abortion was part of regular medicine. The paper named forty-eight doctors who, when approached by an unwed woman seeking an abortion, agreed to help her. Thirty-four doctors agreed to perform the abortion themselves. Thirteen refused

the gift reporter's request, but referred her to someone else who would; all but one sent her to a doctor. One sold her a box of pills and referred her to another doctor. Two-thirds of the doctors who agreed to perform an abortion were Regulars, several of whom belonged to the AMA. Many belonged to a national or local medical society.^[29]

When the journalists, posing as sister and brother, approached Dr. James H. Etheridge about an abortion, he refused their request. "I don't handle such cases," he told them. "There are enough ways in this state for a man to get into the penitentiary without taking a crowbar and prying his way in." Yet Dr. Etheridge, like many others, relented and offered helpful information. He suggested they visit another office at Wabash Avenue and Harmon Court, where they might "find a man who would get the lady out of trouble." Two days after this account the paper reported that Etheridge had "emphatically indorsed this exposure." He praised the series and promised that doctors exposed as abortionists by the Times "will be promptly handed over to the judiciary committee of the Chicago Medical Society, who will handle them without gloves." Dr. Etheridge signed the letter as president of the Chicago Medical Society.^[30]

The newspaper asked President Etheridge to explain himself. Etheridge offered a different interpretation of his conversation with the reporters. Although he might look like a "go-between," he told the reporter, he had some ideas of his own about how to capture abortionists. He had sent the couple to a known abortionist, figuring that if anything happened to the woman, he would be able to track the abortionist. His story echoed a contemporaneous cultural phenomenon of middle-class explorers of the underground who, when the murders of prostitutes by "Jack the Ripper" grabbed London's fears and fantasies, joined the police in detective work in poor neighborhoods.^[31]

Etheridge was not the only doctor who supported the Times 's antiabortion crusade; the medical profession as a whole gave the newspaper "a hearty response." Medical men and women—both Regulars and Homeopaths—hastily joined the battle against abortion and the criticism of Chicago's women, midwives, and professional abortionists. The Chicago Medical Society held mass meetings and the national journal of the AMA commented on the investigations. Scores of physicians, in response to the Times' solicitation to put themselves "on record," wrote in support.^[32] The Medico-Legal Society promised "moral and financial support to bring these abortionists to justice," and the Times gave its evidence to the society to help convict the abortionists. Medi-

cal students added their own drama to the story by saluting professors found to be honorable by surprising them with speeches and flowers. Students applauded the brave investigative work of the "girl reporter" as well: homeopathic medical students sent her flowers, and dental students sent her a gold pen. She thanked them and promised to use the pen's "pointed sharpness . . . to prick the sham and pretense" that sustained "social evil."^[33]

The reaction of the city's regular medical association, the Chicago Medical Society., to the Times's accusations points to hypocrisy in medical support for the newspaper's antiabortion campaign. The charges against reputable physicians put the city's Regulars in an uncomfortable position since regular doctors had led the campaign to criminalize abortion and regarded themselves as superior, medically and morally, to other practitioners. The paper had accused several members of the Chicago Medical Society, including its president, of agreeing to help the woman who wanted an abortion. On December 17, 1888, the society met in a room "crowded to its utmost capacity" with 130 members and visitors to discuss the charges. Society members denounced the paper's investigation and defended their associates. One physician suggested that the society should conduct its own internal investigation. The purpose, however, would not be to expel colleagues, but to "exonerat[e] the members named." Dr. Jacob Frank's comments revealed his hostility to women working as journalists. He urged the society to defend its members against any charges "made by any woman . . . who went sneaking around like a snake, trying to make a reputation." Two journalists, one male and one female, had reported on abortion in Chicago, but she alone was the object of name calling. The group voted "to investigate the charges against three of its members, Drs. Thurston, Stanley and Silva."^[34] The society did not investigate President Etheridge. Dr. Etheridge claimed that he planned only to gather evidence against the abortionist and that he trusted the community would understand for he was "well enough known" to be above suspicion. Etheridge relied upon his stature to protect him from blame, which it did. The society unanimously passed a motion "express[ing] its confidence in the professional integrity of its president."^[35]

In the end, the Chicago Medical Society protected its members. The society applauded its president, exonerated one physician, failed to investigate others, and expelled only one, Dr. Thurston, for reasons unexplained in their own minutes. The Times claimed that Thurston had been expelled as a result of its exposé, though the society denied it.^[36]

The 1888 exposé revealed the commercial world of abortion in Chicago at the precise moment that Chicago was gaining national recognition as a major medical center. As the city expanded and business boomed, medicine thrived as well. By the 1880s, Chicago had a national reputation as a nucleus of medical education, institutions, and organizations and had gained fame as a leader in connecting the laboratory and bacteriology to medicine. The city was a center of both regular and irregular medicine, with four outstanding regular medical schools, two homeopathic colleges, and an eclectic school, as well as proprietary medical schools, pharmaceutical colleges, and nursing and midwifery schools. The AMA's headquarters was located in Chicago. Two postgraduate clinics for training surgeons and other specialists, over two dozen hospitals, twenty dispensaries, and numerous medical societies and journals added to the pride of the city's medical establishment.^[37] The exposure of the medical practice of abortion in Chicago suggested corruption at the center of medicine, belying medicine's pure and scientific exterior.

The exposure of medical involvement in abortion threatened the profession's identity as morally pure and trustworthy, thus jeopardizing its legal privileges and social authority. The physician-abortionists named in the exposé, an editorial in the Journal of the American Medical Association (hereafter referred to as JAMA ) declared, "have blackened the good name of our noble profession." The claim that the profession could be trusted to be morally upright underpinned physician claims to independence in decision making and practice. The AMA had initiated the crusade to criminalize abortion thirty years earlier and had its headquarters in Chicago, yet could not patrol its own members. As an Indianapolis physician noted, "the medical profession must have felt embarrassed and humiliated" by the disclosures. The doctor, according to JAMA , "is supposed to be more intelligent , to be actuated by higher and more noble principles" (emphasis added).^[38] Medical professional identity had become tied to a sense of moral superiority.^[39]

Association with abortion threatened the medical profession in general, but it was especially threatening for physicians whose status was more precarious. Because they had long been disparaged as abortionists by male doctors and by the press, women physicians particularly needed to distance themselves from abortion.^[40] Female physicians complained of the number of women who expected them to induce abortions out of feminine sympathy. Dr. Odelia Blinn reported in a letter to the Times that in one year more than three hundred women had asked

her for an abortion. When the reporter approached Dr. Sarah Hackett Stevenson, nationally famous as the first woman admitted to the AMA, Dr. Stevenson refused to provide an abortion, advising her instead to marry. One woman physician agreed to perform an abortion.^[41] Female physicians, who had trouble gaining respect from male colleagues, could not afford to be associated with abortion.

The Times 's representation of the women who had abortions was mixed. On the one hand, the use of a reporter playing an unmarried woman to learn about the abortion trade suggested that it was this type of woman who most used abortion. On the other hand, the reporter expressed her surprise that it was married "society women," more than desperate unwed women of the lower classes, who patronized abortionists. Physicians confirmed in letters to the editor that married women had abortions. The class identity of the woman who sought abortions was more consistent: she was rich. The reporters told their contacts many times that money was no object. According to the Times , upper-class women patronized abortionists. Their access to abortion was another form of class privilege. "The doctors who were ready to comply with my request had an extensive practice among the best class of people," the female journalist reported. "Their fees were high" and few "shop-girls and the servant girls," she informed her readers, could have been "applicants for the succor which I claimed to be so much in need of."^[42]

These images of society women having abortions echoed mid-nineteenth-century ideas that "frivolous" women avoided their maternal duties by having abortions in favor of careers or social activities. "Sisters of Chicago," the newswoman asked, "are our own morals, the health and morals of the next generation to be sacrificed that we may not lose a winter's round of receptions and dances?" According to her description of contemporary marriage, young husbands imagined "a happy fireside and family," but their wives dreamed of "society" and "elegant entertainment." The idea that middle-class men and women both might want to limit family size did not enter her musings. The women the reporter described could be condemned by men of their own class for abandoning motherhood and by working-class women and men for their class privileges.^[43]

The paper's coverage of the women who sought abortions sparked a gender struggle over the cause of abortion and the moral quality of the sexes. A handful of letters from women physicians and other female writers injected into the local discourse the nineteenth-century feminist

analysis of abortion and demands for changes in male sexual behavior. The double standard, marital rape, and male sexual immorality were at the root of abortion, they argued. The cause of abortion, "Justitia" argued, could be found in the marriage bed, where "'marital' (or husband's) rights are claimed from reluctant wives as continually and habitually as the sun sets or the tides flow." When conception resulted, the writer bluntly pointed out, it had taken two, but husbands blamed their wives for pregnancies. Wives of drunkards, she said, suffered even more knowing their children would be damaged as a result of their fathers' sins. Dr. Odelia Blinn recalled the hundreds of women who had asked her for abortions. "The vast majority," she observed, "were married women," who sought abortions because of their husbands. The doctor urged a single standard of sexuality and teaching men, like women, chastity. "Has it ever occurred to The Times to investigate what men are doing while women are committing infanticide?" demanded Dr. Blinn. The paper should investigate prostitution, she suggested; then the other sex would "feel the blow" of being publicly charged with immorality.^[44]

As women criticized the representation of women in the Times , men used those same representations to attack women and feminine concern about male alcohol abuse and sexual immorality. Instead of charging men with immorality, they recommended that women better themselves. Abortion "is a more degrading evil than drunkenness," argued one downstate Illinois paper, "but women will shamelessly commit this crime who roll their eyes in holy horror at a man who sells or a man who drinks whisky." The Times quoted an Iowa physician who had remarked at an AMA meeting, "Our young men are properly taught the evil effects of alcoholic excess—why should not young women be warned of the nature and results of feticide?"^[45]

Medical men criticized the paper for using a journalist who represented herself as an "unwed" woman whose desperation evoked their sympathy. Their complaints reveal both paternalistic and antagonistic attitudes toward women. "It was hardly fair," observed one medical journal, "to enlist the sympathy of the doctor and to tempt him by the relation of a story that necessarily appealed to the heart of every father. How many of these guilty ones would have been tempted had the female reporter stated that she was a married woman and did not wish to bear children?" The writer suspected only one would have agreed. This medical observer viewed young female patients as daughters, as dependents who had been seduced and abandoned, who deserved his com-

passion. For a married woman avoiding what he regarded as her wifely and feminine duty, however, he had no sympathy. The Journal of the AMA similarly felt that the profession had been wronged by the paper's use of a "presumably captivating young woman," who told her story "with many a pearly tear trembling on her pretty little eyelids."^[46] Doctors who aided her, this last commentator's remarks suggest, had responded to the woman's physical, as well as her emotional, appeal. Pretty young women apparently tempted men both sexually and professionally. This language hinted at the links between abortion and forbidden sexuality.

Angered at how the profession had been besmirched by the exposé, the AMA turned on women who sought abortions. JAMA , which had initially urged the prosecution of abortionists, switched to recommending prosecution of women. When women solicited abortions from doctors, an editorial advised, doctors should dispense with "moral lectures . . . [and] hand them over to the police." The journal's editor now felt "pity" for the physician "whose weak sympathy leads him to commit crime to prevent disgrace to an unfortunate young woman," but not for the desperate woman. "Let us condemn the other party to the act," he suggested.^[47]

An anonymous physician offered a more sympathetic perspective when he revealed his distress in facing an unmarried woman seeking an abortion. For this physician, the paper's use of an unmarried woman raised moral ambiguities rather than angry defenses. In a letter to the Times , the doctor told of an incident when he refused to help an unmarried woman, who "knelt before me and prayed of me with uplifted hands to relieve her." Two days later she committed suicide. If he had been visited by the "unwed" reporter, the doctor admitted, he might not, remembering his earlier patient, have refused her. "It is our duty to preserve life whenever possible," he asserted, and asked, "Did I do it?" Medicine and law allowed the physician to sacrifice the fetus to save the life of the mother. As this doctor introduced a layer of ethical complexity to the discussion, he introduced scientific-sounding language that treated pregnancy as a developmental process. He called the fetus "an unconscious, imperfect germ," in contrast to the Times 's labeling the fetus a "child." The Times avoided the difficult question posed by this doctor; in a subheading it answered, "He Did His Full Duty," and reiterated, "Abortion is Not Justifiable under Any Circumstances."^[48]

The exposure of abortion in Chicago embarrassed the AMA and the city, but abortion services could be bought from physicians in many

other cities as well. The Times likened several American cities to London, where, it reported, abortionists "prosper." San Francisco, New York, Philadelphia, Cincinnati, and St. Louis were all "lesser Londons." The paper's readers informed the Times that abortion thrived elsewhere in the Midwest, including Wisconsin, Iowa, and the small towns of Illinois.^[49] "The chief responsibility for the prevalence of criminal abortion rests upon the medical profession," declared Nebraska physician Inez Philbrick in 1904. "In every, community," she remarked, "members of the profession live by its induction." Others concurred and charged that physician-abortionists belonged to their medical societies.^[50] Chicago was not unique. The character of social relations and commerce in the city facilitated abortion.

The Legal Loophole: Therapeutic Abortions

The underlying structure of medicine and the law at the turn of the century fostered the practice of abortion everywhere. When the Chicago Times focused on the business of abortion, it ignored the exception in the state criminal abortion law that allowed physicians to perform therapeutic abortions. The law itself contributed to the medical practice of abortion. The Illinois abortion statute exempted "any person who procures or attempts to produce the miscarriage of any pregnant woman for bona fide medical or surgical purposes." What constituted a bona fide reason, however, was left undefined.^[51] The Illinois Supreme Court did not rule on the indications for therapeutic abortion until the 1970s.^[52] Physicians could legitimately, according to the law and medical ethics, perform therapeutic abortions in order to save the life of the pregnant woman.

Determining when an abortion was necessary—and thus legal—was left to the medical profession. The medical discourse on abortion (neglected by the Times ) centered on the medical "indications" that required therapeutic abortion. Medical texts gave physicians guidance about the conditions that indicated a therapeutic abortion and taught them which instruments and techniques to use in performing therapeutic abortions. Prescriptive texts did not, however, provide definite answers about when a physician should perform an abortion. Instead, the literature reveals disagreement and conflicting attitudes toward abortion and medicine within the profession. This professional discussion

was not produced for public consumption, but was a semiprivate discourse within and for the profession only. Within these protected, professional venues, doctors could express disagreement.

These ongoing debates among doctors were, on the most obvious level, about medical knowledge and proper treatment; no one wanted women to endure unnecessary therapeutic abortions or to die because one had not been performed. They concerned larger issues than proper medicine, however. The discourse was an effort to mark out a territory for physicians where abortions were unquestionably legitimate and create a clear line that differentiated this area from the area of criminality. Yet, for all the efforts of antiabortion physicians and specialists in obstetrics, who claimed therapeutic abortion as their procedure, legal therapeutic abortion resisted definition, and the line between legal and illegal was always vague.

The legal loophole provided a space in which doctors and women could negotiate and allowed physicians to perform abortions in the privacy of their own offices or homes. Since physicians customarily reached medical diagnoses and decisions independently and practiced alone, they might determine that a therapeutic abortion was medically indicated and perform one without anyone ever knowing of it. Disagreement within the medical profession about when a therapeutic abortion was indicated gave doctors flexibility. They could, whether in conscious collusion or unconscious sympathy, use the legal loophole to provide wanted abortions. The medical indications for this procedure left room for social reasons and personal judgment as well as for "real" reasons, but there is no way to distinguish among them. Indeed, medical diagnosis and therapeutics always implicitly, if not explicitly, included a social and cultural component.^[53]

The medical profession as a whole assumed the legitimacy of performing therapeutic abortions. The most vehement of the antiabortion physicians had always insisted on the principle that if pregnancy threatened a woman's life, her life was primary and the fetus had to be sacrificed. On rare occasions physicians explicitly voiced their belief in the morality and necessity of therapeutic abortion. They usually did so only because they had been challenged by someone presenting the Catholic Church's position, which opposed all abortions, including those to save the life of the woman. At a 1904 symposium on abortion sponsored by the Chicago Medical Society, Dr. Charles B. Reed defended the morality of therapeutic abortions after listening to the comments of a Catholic priest. The Reverend O'Callaghan had explained

Catholic doctrine and argued that an abortion could not be justified even "when absolutely necessary to save the mother." In response, Reed began his talk by stating that with "the advance of moral feeling, the opinion has developed that . . . where the lives of both mother and child are imperiled and one can be saved, the child should be sacrificed, since the value of the mother to the State is far greater than that of the unborn babe." As one Minnesota physician remarked on the issue, the "reasoning that may satisfy the conscience of a theologian does not satisfy the conscience of the physician." At Milwaukee's Catholic Marquette University School of Medicine, the differences between Jesuit trustees and medical school faculty over therapeutic abortions exploded and led to mass resignations by the school's professors.^[54]

Medical discussion of therapeutic abortion revolved around precisely when the medical situation demanded that a therapeutic abortion be performed, not its legitimacy. Turn-of-the-century physicians accepted a series of physical and disease indications for abortion.^[55] "Probably the most common reason," reported one Illinois doctor in 1899, was hyperemesis gravidarum, or excessive nausea and vomiting, which dehydrated and starved the woman. Excessive vomiting as a result of pregnancy was "a serious emergency," which could kill a woman. According to one doctor, the nineteenth century recorded many deaths due to excessive vomiting during pregnancy, but as physicians increasingly did abortions, the number of these deaths fell. Advances in medicine eventually eliminated vomiting as an indication for therapeutic abortion, but change progressed unevenly. Although physicians reported a cure for vomiting during pregnancy in 1925, physicians continued to disagree, and some still advised abortion for vomiting a decade later.^[56] Tuberculosis became a leading indication for abortion by the 1910s, but physicians debated this indication through the 1940s.^[57]

Excessive vomiting was the most important indication for abortion and one which allowed women and their doctors room for maneuvering. Vomiting was common during pregnancy; how much was "excessive"? The ambiguity of an indication such as vomiting allowed it to be used to justify an abortion that might be desirable on personal as well as medical grounds. Physicians who knew their patient wanted a way out of a pregnancy might determine that the vomiting was dangerous and induce an abortion to protect her. The doctor might have knowingly stretched the "truth" to accommodate his patient or might simply have reached the conclusion the patient desired; there is no way to know. Furthermore, it was an easy symptom for women to self-induce.

Resourceful women learned to feign the symptoms of pernicious vomiting in order to obtain the therapeutic abortions they wanted, and as a result, some medical leaders urged students and colleagues to distrust their female patients' descriptions of their disorders. The legal status of abortion injected distrust into the relationship between physicians and female patients. Dr. Joseph B. DeLee advised in his 1916 textbook on obstetrics, "A word of warning: Let the inexperienced physician beware of simulated disease. A woman will read up on some disease which she knows sometimes gives the indication for abortion, and will try to impress the doctor that she is deathly ill." Pregnant women, according to Dr. E. A. Weiss, "purposely simulate[d] and prolong[ed] the vomiting and distress" in order to win wished-for therapeutic abortions. Physicians, however, were not just tricked by their patients. Weiss believed that there was an "increasing tendency on the part of the laity as well as the profession to take advantage of the law and [medical] teaching," which allowed therapeutic abortion. Dr. Walter Dorsett, chairman of the AMA section on obstetrics, charged that these "fad doctors," who were willing to find reasons to perform therapeutic abortions, were popular among women.^[58]

Therapeutic abortion was a contested subject in medicine, as manifested in the question and answer section of JAMA . The correspondence between AMA members and medical advisers makes it evident that physicians did not always agree with or follow the official line. It bears repeating that scholars cannot take official medical texts as accurate descriptions of medical belief or practice, but must read them carefully as prescriptive literature written by leaders of the profession, who hope to shape medicine in particular ways. In this case, the texts point to disagreement among doctors. Query letters from physicians to JAMA asking for advice on therapeutic abortions show both the more conservative prescriptive advice given by the AMA and the more liberal interpretation of the abortion law by physicians in practice.

Physicians induced abortions for eugenic and other social reasons, though these were officially proscribed. For example, in 1902 a doctor asked whether it was justifiable to perform a therapeutic abortion in a case where the woman was "mentally unsound" and "the child," he was sure, "would be a degenerate." The doctor explained that the "husband is a neurasthenic with a bad heredity; her mother has paranoia and has been in the asylum for 35 years; her father was an inebriate." JAMA tersely answered: "It would be criminal." Two weeks later another correspondent suggested that some doctors disagreed with the journal's position. The Indiana doctor wrote, "There are tens of thou-

sands of intelligent people in and outside of the medical profession who join with me in asking you why it would be a crime?" JAMA answered shortly, "Because the laws . . . make no exceptions for such conditions," and concluded, "We do not care to discuss the propriety of modification of the law."^[59] The AMA's objection was based not on the need for consent and the danger of coercion, but on its narrow interpretation of when the law allowed physicians to perform abortions.

JAMA' s answer to a query about the possibility of performing an abortion when the pregnancy resulted from rape simultaneously demonstrates the AMA's role in teaching doctors its interpretation of the law and suggests that some did perform abortions for rape. When a physician asked whether an abortion could be justified when pregnancy followed the drugging and rape of a sixteen-year-old girl "of unquestionable reputation," the editor answered firmly in the negative. The physician had confirmed the young woman's moral purity and performed a medical examination and microscopic examinations of her clothing and "vaginal contents" before concluding that a rape had occurred. Nonetheless, JAMA' s response exhibited age-old doubts about the veracity of women when they charged rape. The editor asked the doctor to remember "that pregnancy is rare after real rape, and that the fright may easily cause suppression of menstruation and other subjective symptoms." "The enormity of the crime of rape," JAMA judged, "does not justify murder. This is law." ]AMA 's answer to this letter was more explicit than the laws, which did not specify what justified therapeutic abortions.^[60]

When the journal listed the social reasons that did not indicate a therapeutic abortion, it simultaneously described some of the reasons for which physicians performed abortions. According to JAMA , state statutes usually "tolerate" only abortions performed "to preserve the life of the mother from some impending danger. The danger must be real; the bare possibility of death is not sufficient." Furthermore, the medical adviser warned, "under no conditions can an abortion be lawfully induced for the sole purpose of preserving a woman's reputation, or of contributing to her comfort or pleasure, or because of the patient's financial circumstances." These caveats revealed that physicians performed abortions out of concern for their patients: in order to hide the pregnancies of unwed women, because of poverty, and because their patients wanted them.^[61] Though not officially approved, abortions were performed by physicians when women expressed their anxieties about pregnancy.^[62]

Sometimes, even JAMA admitted, physicians had to grant women

the right to make decisions about their own pregnancies. A 1902 discussion about contracted pelvis, a physical deformity that prevented a woman from delivering a baby vaginally, demonstrates the complexity of medical decision making and the active role played by patients themselves. A Florida physician wrote of a patient with contracted pelvis, who had had a therapeutic abortion previously. He had "urged and insisted" upon a cesarean section, "but both Mr. and Mrs. R. reject the idea as too dangerous and too expensive." He feared having to perform abortions every few months. The JAMA editor admitted that a woman and "her husband have some right" to decide between a dangerous operation to save the fetus or an abortion to save the woman. But the editor limited this right to women who became pregnant "in ignorance" of their pelvic condition. For this woman, who knew of her condition, "her right to a choice in the conduct of the case is undoubtedly much lessened." The advising physician assumed that the woman's pregnancy was her fault and, therefore, in his eyes, she had a less compelling right to make decisions about her own health and body. How the woman was supposed to avoid pregnancy he did not mention, but the medical profession had opposed the teaching of birth control. The JAMA editor favored convincing the couple to agree to a cesarean section, even though the operation was often fatal.^[63]

Nonetheless, the advisor acknowledged that the couple might be able to win an abortion despite the doctor's preference and propaganda. The patient deserved the best advice, and, he continued, "sometimes this is not accepted, and we must be content with an alternative." The editor finished by reminding the doctor to call a consultant before performing an abortion. The contradictory answer indicates that the editor realized that many would be unable to convince patients to risk death with a cesarean section and physicians would have to perform abortions. In these types of cases, physicians let women decide the course of action.^[64] Different women no doubt weighed their desire for children and the dangers of surgery differently.

Physicians responded to the problem of contracted pelvis with different procedures over time. Therapeutic abortion, induced early in a pregnancy, was an advance over the nineteenth-century method of performing craniotomies, when at the time of delivery the physician punctured the fetal head and pulled out the fully-formed fetus piece by piece in order to preserve the woman's life. By 1920 cesarean sections had replaced therapeutic abortion as the preferred response to the problem of contracted pelvis, though a c-section was still dangerous and probably

more dangerous than an early abortion. The profession decided for women that it preferred to perform surgery that resulted in babies, even if it endangered women's lives. As medical knowledge and skill advanced, women lost their place in making decisions about whether or not they would undergo a more dangerous operation. For some, the increasingly safe c-section was a boon; for those who wanted to rid themselves of a pregnant, however, they no longer had a legitimate out.^[65]

The economics of medicine at the turn of the century gave women power in their relationship to doctors. If necessary, a well-to-do woman could threaten to end the doctor's relationship with her entire family. Affluent women, who saw private physicians regularly and often selected the family doctor, had the greatest ability to pressure physicians into providing abortions. For the doctor, losing a family's medical business could mean losing years of fees for child deliveries, children's illnesses, and injuries. The threat of losing—or the promise of winning—a family's business often proved effective. According to medical commentators, these threats worked especially well with young doctors. The competition in the profession, the problem of "overcrowding" as doctors called it, helped make doctors willing to respond to patient demands. Some general practitioners, noted one doctor in 1909, fell into doing abortions after "los[ing] family after family because of their stand against performing abortions." Milwaukee physician E. F. Fish painted a dreary picture to account for the practice of abortion by "young men in the profession." After refusing requests for abortions, the young doctor, "finally, hungry, penniless, his clothing threadbare, his rent due . . . yields to temptation—because he needs money."^[66]

The 1888 exposé, the medical discussion about therapeutic abortion, and police reports all point to the readiness of many physicians to help women obtain abortions. Some agreed to do abortions; many more assisted women in an essential way by giving them the name of an abortionist. The evidence of city or regional medical networks underscores the depth of medical involvement in abortion. In one 1929 case in New York, prosecutors found checks showing that the abortionist paid kickbacks to fifty or sixty area physicians.^[67]JAMA regularly reported on physicians convicted of abortion.^[68]

Law and economics contributed to the practice of abortion, but legal loopholes and money alone do not explain the evident willingness of doctors to perform abortions or refer patients to others who would. Why did doctors help women who sought what was known as the "ille-

gal operation"? Part of the explanation for physicians' capacity to sympathize with women's requests for abortion lies in the nature of medical practice at the turn of the century. Medical practice embedded physicians in family life and female lives. Physicians practiced in the home. There, they primarily interacted with the woman of the house. She called in the doctor for help when her own knowledge and nursing failed and was there when he attended any member of her family. She talked with the doctor about the illness or injury for which he had been called and consulted with him on treatment. It was she who carried out (or not) his orders to feed, bathe, and medicate the patient and continued to care for the sick in her family after he left. (A few families hired nurses, but even then the woman of the household supervised the nurse.) One of the main duties of family practice for any doctor was attending women during childbirth, which, for most women, still took place in the home. This event often first brought the doctor into a family. A physician who succeeded in attending a delivery had a good chance of being called again. Success meant more than delivering a baby, however; it meant developing a working relationship with the birthing woman and her female friends and relatives who attended the delivery along with the physician. Family doctors had to be able to get along with the women in the family. As a result, physicians tended to know women, and, since physicians observed the family in its home while caring for its illnesses, doctors tended to be familiar with their female patients' worries, financial difficulties, household and child-rearing burdens, as well as their fears and physical injuries related to childbearing and general health. Medical practice itself created new understandings in doctors, and medicine may have attracted men who knew how to communicate across gender lines.^[69]

Middle-class women were not the only ones to benefit from medical understanding of the female condition. Physicians who cared for many women and many families could have insights into a woman's life without knowing an individual woman well. When women told doctors of their lives, explaining the particularities that made an abortion necessary, many doctors understood. They knew that women's bodies had been weakened from childbearing and wearied from housework, and they had observed the hardships of rearing several children in a poor household. For example, Kate Simon tells of a much-respected Dr. James who performed abortions for poor immigrant women in a Jewish-Italian neighborhood of the Bronx in the 1920s. When he was occasionally arrested, other doctors came to his defense.^[70] In short, medical practice sensitized many doctors to the lives of women.

Though urban areas like Chicago provided a favorable environment for the business of abortion, it was not solely an urban phenomenon. It may have been common among rural physicians to perform abortions as part of their family practices. A Milwaukee doctor reported hearing a "country" doctor say, "We all do that kind of work when it is in a nice family and a girl has to be protected."^[71] As this physician's comment reveals, the woman's status affected whether a physician sympathized with her and would perform an abortion. The doctor judged whether a pregnancy out of wedlock was to be expected of a particular "girl" or whether it could be excused and aborted as a mistake. The occasional abortion for a deserving patient would never be known by anyone other than the doctor, his patient, and her family. Several long-time, respected, small-town doctors were prosecuted, however, for abortion when patients died. Doctor John W. Aiken, for example, had been the eminent and only physician for over thirty years in Tennessee, Illinois, when he was prosecuted for murder by abortion in 1899. Small towns could lose their only physician in cases like these.^[72]

Not every doctor listened and agreed to perform abortions. Many lived up to their profession's rules and refused women's requests. When these doctors reported their experiences, they highlighted their own noble characters while confirming that plenty of others did not share their antipathy to abortion. Physicians who refused to do abortions grimly reported losing patients. In 1900, after observing medicine in Chicago since the 1860s, Dr. Denslow Lewis, a professor of gynecology and president of the Attending Staff of Cook County Hospital, remarked that prominent citizens and physicians regarded abortion "as a matter of routine." He knew of one married woman whose family physician had performed eleven abortions for her. Lewis himself had "lost the patronage of well-known society women" when he refused to perform abortions for them. A prominent gentleman remonstrated Dr. Mary Dixon-Jones of New York when she would not perform an abortion for his wife. "Any doctor who wanted a good practice should take care of his families," the gentleman told her. "This was the physician's duty, and it was done by the best." Another doctor told a familiar tale of being asked to induce an abortion. "For promptly refusing," he recalled, "she dismissed me."^[73] These patients knew they could find more responsive practitioners elsewhere.

The 1888 Times exposé provided a handy list of abortionists. Ironically, as the newspaper advertised its intention to suppress abortion, it also stimulated it. Furthermore, not only did abortion information appear on the front page of newspapers, it appeared in the advertising

pages in the back. Dr. Rudolph W. Holmes charged in 1904 that Chicago's "daily papers, magazines, and even some so-called religious papers are most fruitful means of disseminating the knowledge concerning the means for producing abortion." Almost every daily paper in the city, he maintained, carried advertisements with information about abortion, though they were not listed under that word. Sellers of abortifacients caught women's attention by advertising their products as "ladies' safe remedy." Physicians and midwives who advertised themselves as specialists in the "diseases of women" sometimes agreed to induce abortions.^[74]

Patterns of Practice

Historians have generally treated midwives and doctors separately, but these two groups of practitioners did not practice in two separate worlds.^[75] It is important to see the similarities and connections between them as well as their differences. Midwives and doctors provided reproductive health care services in an era when health care was practiced primarily in the practitioner's office or the patient's home rather than in a hospital. Because of the location and structure of care at the turn of the century, their style of practice shared certain characteristics. The Times uncovered the availability of abortion in Chicago; other records of actual abortion cases in the Chicago area, drawn from legal records and newspaper accounts, permit a closer examination of actual turn-of-the-century abortion practices.^[76]

The abortion practice, like other obstetrical practices, seems to have been split between doctors and midwives. In 1915, midwives delivered about half of Chicago's babies,^[77] and the available evidence suggests that midwives and doctors performed abortions in approximately equal numbers at the turn of the century as well. A 1917 study of women who came to the Washington University Dispensary in St. Louis found that physicians and midwives had "an equal share in the nefarious practice" of illegal abortion. Of fifty-one women who had had induced abortions, physicians and midwives each had induced 24 percent of them.^[78] A New York study of the patient histories of 10,000 working-class women found that physicians had induced almost four times as many abortions as had midwives,^[79] while a study of III convictions for illegal abortion in New York between 1925 and 1950 found that the abortion-

ists were midwives in 22.5 percent of the cases and doctors in 27.9 percent.^[80] Investigators of midwives in Chicago, New York, Boston, and Baltimore suspected that 5 percent to more than 50 percent of midwives practiced illegal abortion.^[81] Though studies conducted at the time estimated the proportion of midwives involved in abortion, they never asked the same question of the medical profession, an omission that reveals the investigators' automatic respect for the medical profession and automatic suspicion of midwives. There is no way to determine what proportion of either group performed abortions, but patient histories and mortality data indicate that both midwives and doctors did.

Emily Projahn was thirty-three years old and had given birth to four children, two of whom survived. In August of 1916 her period did not come. It did not show up in September. After having missed her period for two months, she and her husband visited a doctor whom her husband had seen previously, Dr. C. W. Mercereau at 4954 Milwaukee Avenue. It was a Friday evening and they spoke to him of their trouble. Dr. Mercereau agreed to do the operation and told them the fee would be $10 and $2 for calling on her afterwards. They paid half the fee that night. Mr. Projahn later explained that the doctor "asked me to be quiet and not say anything more about it. I said I would." The doctor then shut the door and prepared to perform the operation. He had his patient lie in a surgical chair and used an instrument. Mrs. Projahn called the instrument a "womb opener." Her husband described it as "nickel-plated, silver-like" and "ten or twelve inches long." The doctor told her to "stay on her feet until she got sick enough to go to bed." When they got home that evening, Mrs. Projahn was bleeding. A week later she called Dr. Mercereau, who came to their home and prescribed medicine. He visited her at home twice. After three weeks of chills and fever, she called in a second doctor, who hospitalized her.^[82]

Emily Projahn's abortion was not atypical. The operation was performed in the physician's office, and the doctor followed up by visiting her at home and prescribing medications. Apparently, most physicians performed abortions in their offices.^[83] A number of physicians saw their patients one or more times after the operation. Both the patients and their abortionists expected doctors to provide continuing care, as they would with any other health problem. Repeated visits, as in the case of one woman whose doctor saw her five additional times, indicated the procedure had gone badly.^[84]

Some physician-abortionists managed their own hospitals. The existence of these hospitals emphasizes the ubiquity of abortion and sug-

gests that some practiced rather openly without fear of trouble. In the 1920s in Chicago, Dr. Amante Rongetti, a regularly licensed physician and surgeon, performed abortions in his own Ashland Boulevard Hospital with beds for twenty-five patients. Dr. Justin L. Mitchell was the medical head of the Michigan Boulevard Sanitarium, where he performed illegal abortions.^[85]

Physician fees for abortion varied widely in this period, ranging from $10 to $175. On average, physicians received $48; the most frequently paid amount was $50.^[86] Dr. Mercereau charged the Projahns a low fee. Several doctors received less than they asked for. One doctor demanded $150 for the abortion he performed on Ester Reed. When her mother objected, he cruelly told her to sell her furniture and clothing to get the money. Reed's mother gave him $50, and, though he complained, he began the procedure and two days later finished it at their home.^[87]

Doctors induced abortions by methods described in medical texts. There were three ways to induce an abortion: by ingesting drugs, a method generally viewed as dangerous or ineffective by the medical profession; by introducing something, such as a rubber catheter, a gauze tampon, or other object, into the cervix to irritate it, bring on contractions, and cause the woman to miscarry; or by dilating the cervix with metal dilators or gauze tampons and then using a curette, a spoon-shaped instrument, to scrape fetal and placental tissue out of the uterus (preferably with the woman under anesthesia). The latter was known as a dilation and curettage, or "D & C."^[88] Probably most physicians used instruments to induce abortions.^[89] Dr. Mercereau may have induced Mrs. Projahn's miscarriage by introducing through the cervix a uterine sound, a slender, pointed instrument for measuring the depth of the uterus. Three Chicago physicians introduced catheters to bring about abortions. Four sold drugs. Pills were cheaper than an operation, which made them a popular first attempt. If they failed, however, the woman faced a later (more risky, and possibly more expensive) abortion. At least one doctor used chloroform during the operation, and two used gauze. According to Edna Lamb's statement in 1917, Dr. Charles Kline-top packed her cervix with gauze in order to induce an abortion.^[90] In the words of one nurse, she and the doctor made it look "just like a woman just having a miscarriage.^[91]

The majority of the Chicago physician-abortionists I have identified were Regulars, and a third belonged to the AMA. Over a third belonged to the Chicago Medical Society or the Illinois State Medical Society. Five of the physician-abortionists were Homeopaths, one an

Eclectic. Of this group of thirty-eight physician-abortionists, most were men, seven were women. Although these findings cannot be extended to the universe of physician-abortionists, they establish the involvement of regular, mainstream physicians in abortion.^[92]

The women who went to midwives for abortions were mostly of a different class than the women who found physician-abortionists. Native-born, middle-class women were most likely to see physicians; immigrant and working-class women were more likely to go to immigrant midwives. Most of Chicago's midwives and their clients in delivery or abortion cases were white, European immigrants. Over 97 percent of the city's midwives were foreign-born. The few native-born white or black midwives practicing in Chicago may have performed abortions as well, but they have not appeared in the sources.^[93] Immigrant women probably preferred immigrant midwives when they needed abortions for the same reasons they preferred them during childbirth—midwives were female, foreign-born, and cheap.

In 1916, Rosie Kawera of Chicago asked a friend to go with her to visit Mrs. Wilhelmina Benn, a licensed midwife. Kawera explained to her friend that "she had a little baby; she wanted to get some medicine to get it out." Kawera was twenty-nine years old, Russian-born, married to a "moulder," mother of an eleven-month-old baby, and two months pregnant. She borrowed $10 from her brother and went to Mrs. Benn's. While her friend waited in the kitchen, Kawera went into the bedroom, where Mrs. Benn inserted what Kawera called "a little pipe." Mrs. Benn told Kawera to keep it in overnight and to phone whenever she got "sick."^[94]

Midwives sympathized with women who faced unwanted pregnancies. When the male reporter for the Times approached Mme. Schoenian, she told him, "I feel so sorry for the poor things and do all I can for them." The reporter concluded that Schoenian expressed the feelings of most of Chicago's midwives: they felt "sympathy for the 'poor girl'" and considered performing abortions "a benevolent undertaking." The reporter seemed to suggest that midwives had a feminist analysis of abortion, believing that "the necessity for secrecy came from 'man's inhumanity to man'—or woman rather."^[95] It is unlikely that immigrant women who refused to be attended by male doctors during childbirth considered going to men for abortions.^[96]

Not only did midwives identify with their patients as women, they shared their culture and language. Rosie Kawera and her midwife, Mrs. Benn, were both Russian-born. Frauciszka Gawlik, Austrian-born and

married to a Polish man, went to a Polish- and German-speaking midwife for her abortion.^[97] Though the majority of native-born, white women had physicians attend them during childbirth, some, knowing of midwives' reputation for being abortionists, may have looked for midwives when they needed abortions.

Finally, midwives charged about half as much as doctors, whether for performing an abortion or delivering a baby. Both midwives and doctors, however, charged twice as much for abortions as they did for deliveries. Midwives charged about $10 for attending a birth; doctors charged $20 to $25. A 1910 investigation found midwives' average fee for an abortion was almost $28.^[98] My sample of Chicago midwives and physicians who performed abortions at the turn of the century indicates that midwives charged, on the average, $20 for an abortion.^[99]

Once a woman found a midwife willing to perform an abortion and they agreed upon a price, they had to decide when and where the procedure would be performed. Midwives provided abortions and after-care in several different locations: in the homes of their patients, in their own offices or homes, or in the homes of other women who acted as nurses. The different places in which midwives worked reflected the variety in the location of medical care in the early twentieth century. Some midwives performed abortions at their own homes. Mrs. Kawera went to Mrs. Benn's home for her abortion. Mrs. Jennie Carantzalis, a licensed midwife and nurse, had an office with a receptionist in her own home. Other midwives induced abortions at their patients' homes, as did Mrs. Babetta Newmayer. Midwives visited their abortion patients at home to check on their recovery just as midwives checked up on patients following a delivery.^[100]

Some midwives had their abortion patients stay with them or at another woman's home for a few days so that they could oversee their recovery. For some patients, particularly single women who wanted to keep their pregnancies secret, being able to abort and recover for a few days somewhere other than their own homes was a distinct advantage. One 1910 investigation reported that half of the midwives who agreed to perform an abortion (six of twelve midwives) wanted to keep the patient in their homes for a few days after the procedure. One midwife, who used drugs to induce abortions, reportedly "said the patient could stay with her so she could watch the case." When Esther Stark went to midwife Mary Groh for an abortion, Groh arranged to have her board with Mrs. Scholtes for a few days after her "treatment." Midwives could not practice in hospitals, but, in a sense, some midwives created

their own informal "hospitals" when they arranged for other women to nurse abortion patients in a setting that was neither the patient's home nor the practitioner's office.^[101]

A few midwives had busy abortion practices and seemed to work almost exclusively as abortionists. The Chicago Vice Commission found four women waiting for abortions in one midwife's basement apartment. Another midwife, the commission reported, "said she had a patient in the house and another one who had just had an operation was in the next room."^[102] For the women having abortions, it may have been reassuring to recover surrounded by other women sharing the same experience.

Midwives used drugs and instruments to induce abortions. Studies of Chicago midwives in 1908 and 1913 found both in their possession. One investigator commented, "A midwife who has in her equipment a speculum, uterine sounds, dilators, curettes and wired gum catheters, is beyond all question or doubt carrying on a criminal practice." Some midwives, like Hattie Chlevinski and Mrs. Veronica Ripczynski, gave their abortion patients special teas. Midwife Sophie Mann advised her patient to take hot baths, to use a hot water bottle on her stomach, and to use some other remedy "concerning vinegar" (perhaps a douche? ).^[103]

Midwives Cecilia Styskal, Catherine Haisler, and Jennie Carantzalis all used rubber catheters to induce abortions for their patients. Mrs. Wilhelmina Benn, who inserted "a little pipe" in her patient, may have been using a catheter too. Inducing abortions by inserting a catheter into the cervix to irritate the uterus and induce labor was a common method—used both by physicians and by women at home. At a 1931 trial for criminal abortion, a sixteen-year-old woman described in detail the abortion induced for her by Jennie Carantzalis. She recalled that the midwife had her lie down on a table and inserted "an instrument that opens up" into her vagina (perhaps a dilator?). "She started turning it around there, and it hurt me. . .. I started bleeding and then she took a long instrument that looked like a scissors and she put cotton in them." The woman explained that the midwife "dipped [the cotton] in some liquid and put it in my vagina and was cleaning it out. . .. Then she put a long rubber tube un [sic ] me." The midwife inserted more cotton and then, the woman recalled, "she gave me something to put around me, because I was flowing real fast. . .. She said, sit down on the chair a few minutes, and you will be all right." Carantzalis prescribed quinine pills to be taken every three hours, told her to walk around, and instructed that the tube "was supposed to be taken out within

24 hours, the next day at 4:00 o'clock." The next day the young woman was feverish, had "terrific pains," and aborted the fetus.^[104]

The Chicago case study shows that midwives and doctors practiced abortion in similar ways. Both prescribed drugs and used catheters to induce miscarriages. Physicians used instruments most frequently, though a few midwives carried curettes in their bags. Some physicians and midwives, as the 1888 exposé made evident, worked together. However, doctors charged twice as much as midwives for abortion services, a pricing structure that matched the class of the practitioners and their patients.

As a general rule, midwives and physicians cared for different patient populations. Midwives primarily served poor, immigrant women, while doctors primarily attended native-born and more affluent women. Both shared class, ethnicity, and culture with their patients; shared backgrounds probably eased women's anxieties. Some women may have crossed these boundaries of background and neighborhood in order to find strangers, whom they believed likelier to perform an abortion or found easier to consult because they did not personally know them.

Midwives shared the experiences of womanhood with their patients, which male physicians could not. Though women who wanted abortions often tried to get them from female physicians, expecting that gender identity would produce aid, many female doctors refused. Some women physicians did perform abortions, and they may have understood this in terms of gender, but there is no way to discover whether, in terms of their relative numbers, more male or more female physicians provided abortions. Contrary to the expectations of women then and some feminists now, the evidence does not allow us to assume that female physicians were more likely to respond to women's demands and perform abortions. The evidence for the turn of the century, suggests the opposite, since feminists abhorred abortion and many, many male physicians provided abortions. As midwives disappeared from northern cities by the 1930s,^[105] poor women lost a group of practitioners who identified with their gender, culture, and class and provided a range of reproductive services.

This chapter has emphasized the availability of abortion and its ongoing, successful practice, yet the safety of illegal abortions needs to be considered. Even though most women survived their abortions, many died. In 1910, for example, the Cook County coroner recorded the deaths of fifty-two women due to abortion. Seventeen, or 33 per-

cent, had been caused by self-induced abortions, suggesting the dangers of self-reliance. Eight, or 15 percent, followed criminal abortions. In twenty-seven deaths, the cause was unknown—some may have been miscarriages, some illegal abortions. The proportion of deaths known to be caused by criminal abortions was typical.^[106] No doubt additional abortion-related deaths were ascribed to other causes.^[107] Some abortionists were truly terrible. Dr. Lucy Hagenow, for example, provided abortions in her offices on the north side of Chicago and caused the deaths of (at least) six women due to abortion in 1896, 1899, 1905, 1906, and 1907 and, after being imprisoned for a number of years, operated on another woman who died in 1926.^[108] This list of deaths caused by one person is stunning. It is important to remember abortionists such as this one while keeping in mind that the available records overemphasize abortion deaths. Hagenow's imprisonment protected women who sought abortions for several years.

The mortality associated with abortion must be assessed within the context of overall maternal mortality. Childbearing was dangerous, and pregnant women feared dying during childbirth. In the 1920s, observers believed that at least 20,000 women died each year in the United States due to puerperal causes. In 1930, the United States still had one of the highest maternal mortality rates in the world, and this rate did not fall until the late 1930s.^[109] The U.S. Children's Bureau's scrupulous study of maternal mortality in fifteen states found that induced abortions were responsible for at least 14 percent of the maternal deaths, and the rate was higher in urban areas.^[110] It is impossible to determine the risk associated with the abortion procedure itself since we do not know the total number of abortions induced or the number of abortion- related deaths. Most likely abortion was more dangerous than childbirth since it always required intervention with instruments and hands that could introduce infections, whereas some women delivered without interference. Nor can we ascertain the relative responsibility of different practitioners without knowing who performed abortions and with what results.

Nonetheless, I suspect that midwives and doctors had comparable safety records for abortions. I do not think we should assume, as most contemporary observers did, that midwives were necessarily more dangerous than physicians. Medical studies of maternal mortality from the 1910s, 1920s, and 1930s repeatedly showed that midwives had lower mortality rates than physicians.^[111] Of course, skill at delivering babies does not automatically translate into skill in performing abortions. Other evidence shows that midwives and physicians were responsible

Plate 2. Perforation of the uterus with the curette was one of the hazards of abortion: it
could occur during an induced abortion or as a result of a physician's attempt to
treat an abortion. Illustration by Robert Latou Dickinson in Frederick J. Taussig,
Abortion, Spontaneous and Induced: Medical and Social Aspects
(St. Louis: C.V. Mosby, 1936), 231. Courtesy C. V. Mosby Co.

for similar numbers of abortion-related deaths. Cook County coroner's records of women's deaths resulting from abortion between 1905 and 1915 showed that out of over one hundred cases where women had died because of criminal abortions, midwives were responsible in fifty-four cases; physicians, in forty-nine. In Milwaukee between 1903 and 1908, of thirty-two abortion-related fatalities, seven of the abortions were performed by doctors, three by midwives, and four were self-induced; in the remaining eighteen cases, who performed the abortions was unknown. A Minneapolis study of abortion-related deaths between 1927 and 1936 found physicians responsible for more than twice as many deaths as midwives.^[112]

Finally, physicians' growing use of the curette in abortion cases contributed to the number of abortion-related deaths. (See plate 2.) One expert in obstetrics and abortion, Frederick J. Taussig, observed that as physicians increasingly performed abortions and attended miscarriages, where they did emergency curettements as recommended by most

specialists, the rate of uterine perforations and deaths as a result of perforation rose steadily. "The agent most frequently responsible for this injury, it must be confessed, is the physician," Taussig concluded. "The midwife and lay abortionist are relatively less responsible."^[113]

As the problem of perforation makes clear, operations performed by physicians at the turn of the century could be quite risky for the woman patient. And though skilled physicians could perform therapeutic abortions safely,^[114] not all physicians were competent. Surgery expanded steadily after 1880 with the development of antiseptic and aseptic technique, and the growing number of operations performed by general practitioners, rather than specialists in surgery, became an issue of concern to specialists and the public.^[115] As physicians increasingly intervened in pregnancy, whether to deliver a baby, induce an abortion, or curette an incomplete abortion (spontaneous or induced), they sometimes introduced infections and injured their patients.

Answering the question "Who was better, doctors or midwives?" is less important than recognizing that the great variation in education and skill of medical practitioners and the lack of oversight over their practices at the turn of the century meant that the safety of obstetrical procedures varied a great deal. The risk associated with an abortion depended on the technical expertise of the individual practitioner—whether midwife or doctor. ^[116] Some of the midwives and physicians who induced abortions were quite talented at the operation; others were incompetent and injured or killed their patients. The privacy and autonomy of medical practice that allowed doctors to perform abortions for their patients in this period also allowed every general practitioner, regardless of skill or training, to perform surgical operations such as curettages. The very conditions that permitted the widespread practice of abortion added to the risks of abortion.