"A Complete Disaster": Abortion and the Politics of Hospital Abortion Committees, 1950-1970

by Rickie Solinger
Citation
Title:
"A Complete Disaster": Abortion and the Politics of Hospital Abortion Committees, 1950-1970
Author:
Rickie Solinger
Year: 
1993
Publication: 
Feminist Studies
Volume: 
19
Issue: 
2
Start Page: 
240
End Page: 
268
Publisher: 
Language: 
English
URL: 
Select license: 
Select License
DOI: 
PMID: 
ISSN: 
Abstract:

"A COMPLETE DISASTER": ABORTION AND THE POLITICS OF HOSPITAL ABORTION COMMITTEES, 1950-1970
RICKIE SOLINGER

In the late 1950s, the obstetrical staffs of twenty-six hospitals in Los Angeles and the San Francisco Bay Area, responding to a question- naire, evaluated a number of hypothetical abortion requests. Among them were these three cases:

Mrs. C.is a thirty-eighty-year-old woman who has had six children in the past ten years. At this time, she is two months pregnunt and severely depressed. After an unhappy childhood and mamage, Mrs. C,sees herselfus a failed mother, wife, and housekeeper.

Each of her recent pregnunries made Mrs. C. tired and depressed. During her last pregnancy one year ago, she spent most 4the time in bed, vomiting agreat deal, unable to eat; twice she was hospitalized for dehydration and weight loss. Following delivery, Mrs. C.was chronically de pressed and listless, with multiple physical complaints. Presently, she complains of being tired, of not caring and says she wants to rest and sleep most athe time. She states that she can't eat and that she vomits when she tries. She appears emaciated and hollow-eyed. Although she seems fairly well in contact with reality, she claims to be unable to face the prospect of a seventh pregnancy.

Mrs. A. is thirty-two. She has three healthy children, agesjour, six, and seven. She is now seven weeks' pregnant. There is conclusive evidence that she had an attack of nrbella two weeks ago.

Miss C.is afifteen-year-old daughter ofa minister. Eight week ago she was raped by an es capeejom a state institution /or mental deferfives and became pregnant. Ar a result, Miss C.is experiwing serious emotional distress.'

Naturally, both the lawyers who devised the questionnaire and the physicians who responded to it were aware of Section 274 of the Cali- fornia Penal Code which "proscribe[d] as a felony the performance of an abortion upon a woman 'unless the same is necessary to preserve her life."'2 The lawyers and medical doctors were equally aware that in none of the three cases described above did the pregnancy directly en- danger the life of the petitioner. A physician or a hospital agreeing to terminate any of these pregnancies would do so in violation of Cali- fornia law. The completed questionnaires were returned to professors

Feminist Studies 19, no. 2 (Summer 1993) 0 1993 by Feminist Studies, Inc. 241

Packer and Gampell of Stanford Law School and the results later pub- lished in the StatzJord Law Review. The results indicated that almost one-half of the reporting obstetrical staffs were willing to break the law in cases where psychological or eugenic indications for abortion were present, or in the case of rape. A greater number, however, were un- willing. But even many of the unwilling physicians believed that almost any woman could arrange a legal, therapeutic abortion for herself if she shopped around among hospitals in Los Angeles or San Francis- co. The Packer-Gampell questionnaire and numerous articles written by physicians and published in mainstream medical journals in the 1950s and 1960s reveal a profession deeply divided, embarrassed, an- gry, and frustrated over the issue.

This essay reviews discussion within the medical community in the postwar years concerning contraindications to pregnancy and the cir- cumstances, if any, justifying therapeutic abortion. Such discussions re- flect broader cultural attitudes toward women, mothers, babies, and pregnancy in the postwar era. They also illuminate the turmoil within the profession over these issues and the uneasy, insecure, but sometimes enduring, resolutions physicians devised to quell internal dissension and reinforce medical authority in the two decades immediately pre- ceding Roe v. I.l/ade.

Specifically, the essay argues that having been pushed into a defen- sive posture by the combination of medical advances, the specter of le- gal liability, and the emergence of women taking a new degree of ini- tiative, physicians quickly transformed their uncomfortable defensive- ness into an offensive posture toward women. To do so, they adapted a legalistic, tribunal method which tightened the association between two powerful professions-legal-izing medicine and medical-izing the law, at once.

In addition, many influential physicians in this era drastically rede- fined pregnancy in a direction prochoice advocates must still confro~lt today. In the postwar decades, medical and psychiatric discourse un- coupled the woman and the fetus while, at the same time, binding women, in ever-tighter traces, to their pregnancies. These experts claimed that medical-technological advances removed all physical im- pediments to pregnancy. The advances could also reveal the fetus-as- homuculus. Pregnant females, in turn, became carriers and agents of protective custody. Many medical commentators in these years came to cast pregnancyfirst as a process of fulfillment and realization for the fe- tus. Still important, but now secondarily so, pregnancy was viewed as an essential expression of female identity and destiny.3

This new approach to pregnancy, fetuses and pregnant women (although subordinated for a time to a dscourse of women's choice) has clearly provided the "scientific" underpinnings of the antichoice move- ment today. The postwar tribunal method of enforcing this perspective could be the state strategy of tomorrow. As we observe the dignity and protection of fertile women (embodied in Roe v. Wade) threatened in the early 1990s, it is well to consider the arguments and processes that experts used in our recent past to eliminate access to these rights. It is also worthwhile to consider that the strategies discussed here-as perva- sively and powehlly promoted as they were-proved highly vulnerable to the grassroots counterclaim for choice.

LEGAL ABORTIONS BEFORE ROE K WADE
Dissension over abortion within the medcal community was not a long- standing, intraprofessional problem. The post-Civil War state laws against abortion, which turned back the tradtional right of grls and women to abort in the first trimester of pregnancy, stipulated that abortions were permissible only in cases where, due to a medical condition, the preg- nant woman's life was in danger. These new, late-nineteenth-century laws granted the determination to licensed physicians only. Through the late 1940s, legal abortions were performed ofien and routinely in most hospitals acr& the country. ~edicall~

approved contraindidations to pregnancy included cardiovascular conditions (rheumatic heart, hyper- tensive-cardovascular, coronary artery, and congenital heat disease); kid- ney dysfunction (chronic nephritis, hydronephrosis, polycystic kidneys, single kidney, renal stones, and pyelonephristis); neurologic diseases (epi- lepsy, multiple sclerosis, myasthenia gravis, and Mknitre's disease); tox- emia; respiratory disease (tuberculosis, bronchiectasis); uterine disease (cancer of the cervix, fibroids); orthopedic problems, and blood diseases such as leukemia, ulcerative colitis, diabetes, premature separation of the placenta, otosclerosis, bowel obstruction, lupus, and thyrotoxicosis. Phy- sicians occasionally performed abortions on women suffering ftom se- vere psychiatric disorders.4

With such an extensive list of contraindications to pregnancy, abortion ratios at some hospitals were high in various decades before 1950, espe- cially in comparison to what they would soon be, for example: 1 abor- tion to every 76 live births at Bellevue Hospital in New York; 1 to every 167 at New York Lying-In; and 1 to every 169 deliveries at Iowa Uni- versity Hospital.5 Given the state of medcal knowledge and the range of medical options, as well as prevailing ideas about the physical toll preg- nancy took on women, non-Catholic physicians were often willing to sacrifice the pregnancy in favor of the well-being of the woman. Med- ical decisions concerning these matters were often predicated upon an assumption that pregnancy itself was a physical event or a medcal condi- tion which happened to girls and women, sometimes under conditions that were not physically or medically favorable. In these cases, it could be assumed that pregnancy could interact with and worsen a preexisting condition. A prominent obstetrician reminded his colleagues in 1958 that "for years medicine has taught that pregnancy, though a normal physiologic process, is such a tremendous burden that it adds an unbear- able load to any ill, dseased, or handicapped person and, therefore, the two were not compatible."6 This perspective assumed that the woman's body was an integrated system which the pregnancy could undermine or bsintegrate. The pregnancy itself might well take precedence over ds- ease as the more destructive agent. Where contraindications existed, pregnancy-or the "unborn childM-was not granted precedence, or heal- ing power, or constructed as a special condtion virtually separate from the biologcal body or psychologcal mind of the impregnated female. The pregnancy was an addtive, not an autonomous factor. By the twen- tieth century, girls and women in the United States had lost the tradi- tional right to abortion by choice in the first trimester. But the newer association of law and medicine still sanctioned abortion under medcally indicated, life-threatening conditions. In short, abortion served a func- tion when pregnancy invaded and threatened a woman's body.

A PROFESSIONAL CRISIS
By the early postwar years, the medical consensus about the indications for abortion had fractured, and therapeutic abortion rates were plumrnet- ing in hospitals across the country. One authoritative study reported that the therapeutic abortion rate per 1,000 live births in the United States declined &om 5.1 in 1943 to 2.9 in 1953, a 43 percent deche.7 A study of legal, hospital abortions in New York after the war demonstrated that the "overall frequency of therapeutic abortions declined by almost 50 per- cent."s Bellevue's ratio was moving toward the 1:362 mark it would hit in 1965. Other studies showed that hospitals attached to the universities of Virginia and California which had ratios of 1:120 and 1:88, respectively,

in the 1940s, reduced their rates by one-third to one-half wer the next fifieen years.9

The sharp decline in legal, therapeutic abortions performed in hospi- tals reflected the fact that by mid-century, mainstream medical opinion held that medical-technological and obstetrical advances obviated the need to interrupt pregnancy for most of the medical conditions previ- ously considered incompatible with pregnancy.1° The same obstetrician who recalled the era when pregnancy was considered an "added burden, extra strain, and increased load" for ill or handicapped women in the re- cent past, pointed out that now obstetricians and their medical col- leagues had access "to better understanding of such complications and a greater realization that with correct therapy the dsease and pregnancy are cornpatible."ll

Shared access to new technologies and treatments, however, did not mean that physicians shared a professional opinion about when and how these innovations should be applied.12 In fact, the new medical develop- ments gave rise to a very complicated situation for physicians; the situa- tion could be called a nisis which extended over a twenty-year period, at least.

The crisis derived, in part, hm a profoundly paradoxical relationship

between medical progress, the law, and politics. On the one hand, physi-

cians were scientific and humanitarian heroes for subduing the role of

pregnancy as an "added burden" and for devising methodologies to con-

quer diseases threatening to pregnancy and the pregnant female. On the

other hand, state laws still required that the Me of the pregnant women

must be medically endangered to permit abortion. The legal system yer-

sisted in requiring a condition that the medical system said rarely existed.

Consequently, legal demands were at odds with medical advances which

claimed to have virtually removed the basis for medical judgments con-

cerning indications for abortions.

Given their continuing legal relationship to abortion, however, and

their interest in sustaining medical authority over pregnant women,

physicians struggled to establish new bases for medical decision rnaking.13

By the early 1950s, a number of physicians were airing these struggles be-

fore the medical community in the pages of the most prestigious medical

journals in the United States. They described a bitterly contentious in-

traprofessional situation. The reports indicated that any sense of common

purpose among physicians considering abortion had been severely under-

mined in the afiermath of medical advances. A 1952 article in the Anteri

mnJournal of Obstetrics and Gynecology referred to "considerable argument"

and "this disunanimity of opinion" among physicians concerning the sub- ject of indication for abortion.14 The next year, the]ournal ofthe Amerian Medial Association carried an article condemning the "conhsion and uncertainty" surrounding this issue within the profession.15 Other articles chronicled specific disagreements among physicians16 and presciently de- spaired that a state of harmony could ever again be attained. Two Chica- go physicians asserted that no agreement among medical doctors can "be achieved regarding either indvidual indications [for abortion] or general principles."l7 Another physician called his attempt to study the therapeu- tic abortion situation "a complete disaster" because "the categories of

opinion were almost equal in number to the men concerned."l8

Many physicians &d not consider these open debates a sign of health within the profession. On the contrary, there is evidence that many felt that the new disunity over the abortion issue hurt the standmg of physi- cians as expert, objective practitioners of medical science.19 Dissension also raised questions about the source and scope of medical authority. One physician observed, unhappily, that "if interruption of a pre-viable pregnancy is requested, the law at present dictates what medical opinion should be."20 Another put the abortion issue and his professional dis- content in a larger context of "restrictive efforts in every field of medi- cine. . . . Qualifications and regulations and boards are limiting the scope of the practice of individual physicians. Law now directs specific methods of treatment and prophylaxis for certain diseases."21 Others expressed deep uneasiness that they were facing pressures to look beyond their tra- ditional subject-the physical condition of the individual pregnant woman. They were being urged, inappropriately, to include social factors in their medical clagn0ses.2~

The rise of psychiatric indications as grounds for abortion23 solved the issue of medical authority for many practitioners but deepened the un- easiness of many others not convinced in the 1950s that psychiatry be- longed within the ranks of medical science.24 A Cleveland obstetrician identified his hospital's biggest abortion problem as "those cases done for psychatric indications, many times questionable psychatric reasons."25 Another obstetrician wrote that "medical men . . . have been able to markedly reduce the therapeutic abortion rate throughout the country only to find that this least justifiable of all indications, psychiatric reasons, has been allowed to run rampant."26 A sociologist assessed the situation this way:

In recommending legal abortion, the psychiatrist faces the additional problem of hos- tility-or at least skepticism-on the part of the medical men who may be involved in

ruling on his cases. Thus obstetricians may feel that psychiatric diagnoses are being used as subterfuges in instances where abortion is not really justified, and they are par- ticularly unconvinced by assertions which the psychiatrist may feel [compelled to make] that the patient is likely to commit suicide if pregnancy is not terminated.Z7

Many essayists in the medical journals were most concerned that the use of psychiatric findings in favor of abortion hther undermined the traditions and the reputation of medicine as a scientific endeavor. Psychi- atry was merely a "long practiced art," at best "an infant science."% One physician referred to psychatry and the application of its principles to the abortion decision as "a most nebulous, nonobjective, nonscientific approach to medicine" and pictured psychiatrists as engaged in "bedevil- ing" their colleagues to perform therapeutic abortions.29 Two California obstetricians argued that physicians who relied on psychiatrists to restore medical grounds for abortion and reestablish a justification for medical participation in the decision, felt their case weakened: "The extraordi- nary Age of opinion represented among the psychiatrists is a far cry from the scientific objectivity that one hopes would apply to deterrnina- tions affecting the life and health of patients."30

Disqualified as insufKciently scientific by many of these physicians, the psychiatrist could be identified as the "unwitting accomplice" in relation to abortion, a label with more legal than medical sigdicance.31 Psychia- trists were portrayed in this way as pawns of importuning women, unlike real medical doctors who initiated any abortion decision in the interest of their passive, pregnant patients. onk physician went a remarkable step hrther in associating psychiatrists with women who inappropriately ini- tiated their own treatment.

In some parts of the country [criminal abortions] can be obtained so easily that when pa- tients apply for a psychiatric consultation, for the puxpose, so they state, of obtaining a psychiatric recommendation to the effect that their pregnancy be interrupted, the very fact that they make such an appointment seems to be almost presumptive proof that they do not wish the abortion, but rather psychiatric help in order to carry their child to term.32

In the early postwar years, then, physicians struggled with the issue of abortion sans portmanteau. Many felt compelled to argue defensively for the obsolescence of medical indications while, at the same time, taking the offensive, arguing to sustain their professional prerogatives as abortion decisionmakers. Psychiatrists, alone, provided capacious medical grounds for abortion, but many practitioners rejected the terrain as polluted. Women, for three generations forced by law to submit to physicians as abortion decisionmakers, had now begun to initiate and pressure medical doctors to provide them with abortions, sometimes on whatever shifting grounds were approved at a gwen time and place.33 All physicians had to absorb the fallout that followed intramural dissension and undermined the united tbnt of expertise. Similarly, all physicians involved in "thera- peutic" abortion decisions had to adjust their personal, political, and pro- fessional judgments to the fact that the law and the law enforcement sys- tem were at least theoretically conditioning and monitoring their med- ical practice.

THE RISE OF HOSPITAL ABORTION COMMITTEES
By the mid-1950s, most non-Catholic hospitals had begun to address their vulnerability in relation to abortion by finding ways to reassert medical authority over the issue and to sustain physicians' control over pregnant girls and women. Two strategies governed this process in a great many hospitals across the country. First, physicians recognized that they had to reassemble themselves as a collectivity from which profes- sional expert diagnoses and decisions regarhng individual women could be issued in one voice. In this setting, psychiatrists could be team players. They could bring their special perspective on the indwidual into the are- na of experts and thus come to the aid of the profession while validating their own standing. Second, physicians redefined pregnancy in relation to women's bodies in such a way as to efface the woman herself while giving precedence to the law and the fetus. Again, psychiatrists played a pivotal role in accomplishing the redefinition.

By the mid-1950s, in many hospitals, physicians assembled themselves collectively into abortion boards or committees. As a group, obstetri- cians, cardiologists, psychatrists, and others considered abortion recom- mendations and requests and issued definitive decisions on each case. The chief of a department of obstetrics and gynecology in a large north- eastern hospital described the way decisionmaking processes changed in many hospitals in the early 1950s.

At Mount Sinai Hospital [in New York], before [Alan Guttmacheis innovations], a request for therapeutic abortion merely had to be signed by two senior staff members. Guttmacher established the abortion committee of five members: the chief in medicine, representatives of pediatrics and of surgery, the chief of psychiatry, and the chief of ob- stetrics and gynecology who acts as chairman. Requests to the committee must be sup- ported by two consultants recommending the procedure and outlining the indications for it. One of the consultants must appear before the committee to answer additional questions. The committee must be unanimous in its approval of any request.34

These committees protected physicians, individually and as a profes- sion, in a number of ways. Of paramount importance to rnany was the legal protection the boards provided. Four medical doctors, characteriz- ing the therapeutic abortionist as a "fetal executioner," stressed that group review of all cases was crucial because the "legal burden" other- wise rested on the individual obstetrician.35 The Journal of the Indiana Medical Association recommended group work early in the crisis: "To make as certain as human precaution can make it, that a physician might not be subjected to difficulties later on, he should have consultation with other physicians. . . ."36 Another group of medical doctors studied the legal situation in Michigan in 1950 and determined that hospitals were compelled to establish abortion committees in order "to protect the phy- sician" because "while abortions could be performed legally [in that state, if the mother's life was in danger], in the event of suit, the physi- cian had no legal protection," in the absence of a committee. Rudolph W Holmes insisted that because the law drew such a "tenuous" line of demarcation between legal and illegal abortions, "it behooves medical staffs of all reputable hospitals to institute [abortion boards]. It would be a great protection to the operator as well as a deterrent to dangerous as- persions by outsiders."37

For many concerned physicians, insiders could be as dangerous as out- siders. These medical doctors felt that committees functioned best to mute, neutralize, or "curb liberal obstetricians" favoring too rnany abor- tions or abortions on questionable grounds. The California survey con- ducted in the mid-1950s and reported in the Startford Latv Review revealed that most physicians in the twenty-six reporting hospitals felt that the committee's central function was "to police activities of a doctor whose procedures might otherwise bring himself and his colleagues into disrepute."38 A number of medical doctors simply described the structure as "an effective method of control."39

These interests in reputation and control were undoubtedly central concerns of many physicians in part because so many of them spoke and behaved one way publicly and another way privately. For example, a number of professional, illegal abortionists who conducted thriving busi- nesses in this era have reported that hundreds of medical doctors-surely among them, those who publicly claimed medical, hospital control over abortion decisions-routinely referred clients for illegal abortions.40 By insisting on the righteousness of the mechanisms of hospital abortion committees, physicians could disassociate themselves from professional and public concerns about widespread illegal abortions, thus dlrninishing personal vulnerability and, perhaps, individual crises of conscience.

Moreover, as Carole Joffe has recently demonstrated so vividly, a num- ber of respectable medcal doctorsshe calls them "physicians of con- sciencew-performed thousands of abortions in secret in these years, be- cause of their deeply held conviction that women should be able to choose whether and when to have babies.41 These physicians of con- science were serving a hnction for many of their law-abiding colleagues who regularly referred unhappily pregnant girls and women to them. They were also symbols of the broken ranks of the profession and repre- sented a threat to that profession's probity and its safety. Because, appar- ently, so many hundreds of obstetricians, gynecologists, psychiatrists, and others were at least second-party participants in illegal abortions, the hospital abortion committee became important as it promoted the fic- tions of medcal solidarity and the profession's legal compliance.

Many contemporary commentators referred to the actual legal vulner- ability of physicians who performed abortions as a "phantom," and many pointed out that "no reputable physician has ever been convicted for performing an abortion in a reputable hospital."42 This was the case both before and afier abortion committees began to operate. It seems proba- ble, then, that the most valuable service the boards actually performed was to bolster the image of physicians as members of a highly function- ing professional body guided by scientific expertise and collective wis- dom. The committee could transform public dssension within the med- ical community into public harmony, and at the same time, reduce the incidence of abortion. Careful study of the early functioning of one abor- tion committee showed that requests had fallen dramatically and "that the inchcations proposed during [the second year] conformed more to med- ical practice."43 Two medlcal doctors, reflecting on their three-year expe- rience on an abortion board in Newark, New Jersey, lauded the structure because of its "impartial, anonymous, efficient performance." Incidentally, these physicians provided an example of how such scienthc, expert quali- ties shaped the board's decisionmalung. Two women who had contracted rubella, one at six and one at nine weeks gestation, applied for permission to abort but were rejected by the committee because in both cases, the illness was "not objectively observed by a physician."44

Moreover, physicians could more confidently assert their right and duty to retain medcal control over the abortion decision once they estab- lished the committee as a respectable forum dechcated to processing indi- vidual women in an orderly fashion. In short order, the committee be- came a vehicle for bringing professional wisdom to bear on the issue, in part as a way to forestall the situation "where the decision for abortion may be made by legal, social or welfare groups outside of the profes- sion."45

In an era when the law was increasingly positioned between the med- ical practitioner and the patient, many physicians recognized a need not only to reassert a proprietary role in the abortion decision but also a need to assert, through the abortion board, medical doctors' intentions to carry out their medical responsibility judiciously, even judicially. Fac- ing a discrepancy between hospital by-laws and state laws governing per- missible abortions,46 physicians constituted the abortion committee as a quasi-legal forum and associated themselves with the wisdom and objec- tivity of the law. In this way, they also courted and apparently won the trust and respect of the legal profession, as well as a measure of protection against liability. Obstetricians, reporting on the success of the committee in one hospital, pointed to two outstanding achievements. First, abortion requests had almost halved since the board was established. And then, "another way of assaying the value of our committee is the informal opinion of our legal fiiends as well as a Judge of Probate Court that . . . all physicians [should] have the benefit of such committee approval. . .."47

As physicians assumed a judicial role regardmg individual requests for abortion-whether the requests originated with the obstetrician, another medical specialist, or the pregnant woman herself-inevitably committee physicians, donning their robes in earnest, perceived the individual wom- an as "on trial."48 UUnfortunately, however, in many cases, the cardinal principle of the U.S. legal system seems to have been inoperative. Physi- cians warned each other not to assume the woman's innocence. A New York medical doctor put it this way: "The physician must have a high in- dex of suspicion for the patient who tries to pull a fast one." The source of danger was the "individual [woman] seeking to satisfy selfish needs"; the consequences of ignoring the danger were "somewhat analogous to medical opinion in any industrial compensatory action in which motiva- tion may play a large role, and medical practice can be degraded"49 One physician spoke for many of his colleagues when he warned of the "clever, scheming women, simply trying to hoodwink the psychiatrist and obstetrician," when they asked permission to abort.50 Another identi- fied "woman's main role here on earth as conceiving, delivering and rais- ing children." Thus, he concluded, any woman who claims not to want a certain pregnancy, must not be believed.51 In this environment, it is not surprising that, as one physician put it, "we have had a great many less re- quests for abortion [in his California hospital] since the patient and the doctor know that the patient must . . . have her case become an open trial so to speak to be decided on its merits."52

In order-to function successfully, abortion committees accepted addi- tional assumptions about the relationship between abortion, medicine, and the role of the medical doctor. First, many physicians stressed the traditional, exclusive relationship between medical science and the indi- vidual patient, a relationship that could best be honored and protected by the committee of medical scientists. In this case, the individual was a simply biological or organic entity; social, economic, or other environ- mental factors were irrelevant to an individual pregnant woman's situa- tion and to an abortion determination. Two physicians who felt that some of their colleagues were being inappropriately swayed by what one called the "intense [non-medical] motivations" of importuning wom- en,53 cautioned:

It would seem that a few abortions were brought about through the combined influence of economic pressure, social factors, and convenience. To deny that these forces had not influenced us would be incorrect; to accept them would be unwise; and the best course would be to view future indications in the light of strict medical principles directed to- ward preserving the life and health of the mother.s4

Six years later, another medlcal doctor referred to the "real need" to dis- regard any but the strictly rnedlcal indications present in the individual pregnant woman. To stray from this focus was to stray from science and &om the physician's role as a rnedlcal healer. It was also an invitation for critics to impute social or political or unethical agendas to medlcal doc- tors. For example, those who exceeded their medical expertise could be accused this way: "To specify certain social indications for legal abortion is equal to legal license for the abortionist"; or this way: medical doctors who granted permission liberally, on the other-than-medical grounds, perhaps did so because they "enjoy this procedure" and because of a "complete lack of professional and moral principles [which leads them to] do anything out of a desire to win a friend or to make a dollar."55 Hold- ing a tight focus on the individual sustained the pregnant woman as a sci- entific specimen which could be viewed against a neutral background. The physicians' task could be sustained as scientific. Medical doctors need not, indeed, they must not, assume the role, particularly, of social critics. Although the objectivity, the neutrality, anonymity, and dlgnity of the law had something to offer medlcal doctors considering the abortion is- sue, in the 1950s the sociologist's arena was a minefield.

There was, however, one way that social science could support and validate therapeutic abortion practices in hospitals in the postwar years. By this time, statistical information was widely recognized by sociolo- gists, psychologists, political scientists, educators, and other academics and public policy experts, as a highly valuable legitimating tool. Num- bers became a valid basis for explaining, analyzing, predicting, and even justifjmg behavior. Inferences and conclusion, policies and politics based on statistics became "scientifically valid."56 As part of this trend, abortion committees agreed to practice scientitic medicine by statistics. Drawing on this development, one participant asserted that "the need for thera- peutic abortion should be no higher than one per one thousand mater- nities."57 A critic of this general orientation observed that many hospitals were "now practicing abortion by statistics [so] the patient is no longer a medical case but a number balanced against a quota. If she arrives afier the monthly quota has been filled, she may well be rejected despite the urgency of her medical needs."58 One report of hospital practices cited a "gynecologist [who] said his place had gotten a reputation for being easy, so tightened up and now approved one in ten."59 Similarly, Alan Gutt- macher in New York said that his hospital, Mt. Sinai, was formerly sad- dled by the reputation of being an easy place to get an abortion. As a consequence, he set up an abortion board. "The result is that applicants for interruption of pregnancy have decreased tremendously because of the vigdance of the board and the fact that the case has to go through

such a procedure."60

A number of studies argued for the efficacy of committees on the sim- ple grounds that abortions decreased afier the boards were established.61 In this additional respect, then, committee-based, statistically shaped abortion decisionmaking bolstered the reputation of the medical profes- sion as a collectivity of scientists. At the same time, practitioners protect- ed themselves hm outside negativity. Low statistics demonstrated good scientific, nonideological practice. One commentator reported that the fear of being labeled with the reputation of "abortion miU" was so perva- sive among hospital st& in the postwar era that "many hospitals now consider a minimum abortion rate a status symbol. 'The fewer abortions, the better we look,' a Philadelphia doctor put it."62

Finally, as suggested earlier, although the psychiatric perspective had been initially problematic for many medical doctors involved in abortion determinations, by the late 1950s, the situation had changed. By this time, the abortion committees had provided psychiatrists with a rich proving ground for their specialty. According to a number of essayists, psychiatrists did rise to the aid of their colleagues by providing the ex- pert basis for medical decisionmaking and medical control that would have otherwise been lacking. As the biology of both disease pathology and pregnancy became less mystified and less remote because of medical- technological advances, psychiatrists stepped in, forestalling the possible empowerment of the pregnant patient. Psychiatrists constructed and drew on the unconscious as an entity which was only accessible to, and could only be decoded by, the expert. One physician observed, "If we have learned anything in psychiatry, we have learned to respect the un- conscious far more than the conscious and we have learned not to take [abortion requests] at face value."63 Another demonstrated how this ob- servation worked in practice. "An example is a woman who comes in seemingly with an unambivalent wish to be aborted which, upon inter- view, turns out to be an unconscious attempt on her part to punish her husband."64 Such a discovery, as the basis of diagnosis, could only be available to the physician.

PREGNANCY REDEFINED
This physician and many of his colleagues were, in part, responding to the new pressure from many women in their offices initiating requests for legal, therapeutic abortions. They were also responding hm a new defi- nition of pregnancy itself which emerged following the decline of med- ical indications for the interruption of pregnancy and alongside the vali- dation of the psychiatric perspective.

Pregnancy became, at this time, a state inhering to the woman-as-cus- todian, but the pregnant woman and fetus no longer presented an inte- grated system. In the postwar period, pregnancy was no longer viewed as an "added burden" or an "increased load," or a potentially destructive agent. It remained, under the proper circumstances only, a fundamental expression of womanhood, inexorable and transcendent, but something dramatic had happened to the essence of pregnancy. After medical doc- tors determined that there were no longer any medical contraindications to pregnancy, pregnancy ceased to be a physical issue. Physicians now ar- gued that "for most conditions, the natural history of the disease is not influenced deleteriously by an intercurrent pregnancy. Convertly, neither is the course of pregnancy seriously affected by a complicating medical condition."65

Neither did physicians consider pregnancy a psychological issue. One argued: "Statistical analysis shows that childbearing has only a small influ- ence on the mental disorders of women and that the majority of individ-

uals predisposed to mental disorder go through childbirth unscathed."66 Regarding psychological treatment, medical doctors were confident that "the presence of pregnancy does not interfere with the treatment of psy- chiatric disease or make it less effective; in fact, we do not hesitate to ad- minister electric shock therapy with curare while the patient is preg- nant."67 Summing up the position of many, two obstetricians wrote, "As far as a complicating disease is concerned, the expectant mother presents a problem not greatly different fiom that of a non-pregnant sister with the same disease, and . . . hthermore, so far as her pregnancy is con- cerned, she is not greatly different fiom other pregnant women."68

In essence, pregnancy was most centrally a moral issue, but the moral ground had shitied. As the fetus was constructed as a little person, med- ical doctors constructed the pregnant woman's body as a safe reproduc- tive container. The woman, along with her physician, had the moral duty, to sustain the container as fit.69 One obstetrician explained the suitability of women for this role. "Woman is a uterus surrounded by a supporting organism and a directing personality."70 Completely effaced, the woman-as-uterus simply housed the child. The most perfect iconic expression of this refocusing burst upon the consciousness of the general public in this country in the pages of Lij magazine in April 1965. There were displayed the amazing photographs of Linnert Nilsson, a Swedish photographer, who had spent seven years working with surgeons in five Stockholm hospitals, to capture images of the fetus in utero at many stages of its development.71 The photographs demonstrated two startling conceptual innovations. First, in Nilsson's pictures, each fiame is filled entirely by a fetus in the uterine environment, but no woman, no moth- er, no hint that the fetus is in relation to any other living entity The fe- tus is ultraprivileged and apparently ultraindependent. The images sug- gest that if there is a woman involved in this "life before birth," she oc- cupies another space, if not another universe, entirely. Second, the pic- tures aim to capture, most importantly, the human-ness of the "baby." Nilsson selected to focus on the eyes, the faces, the hands and feet, to stimulate the viewers' sense of sympathy and identity with the fetus. The photographer intends to portray the thirty-seven-day-old, one-half-inch fetus as baby. The embryo with a human face demands a morally nour- ishing environment. Providing that had become the pregnant woman's job and the meaning of pregnancy.

It is important to note here a shocking irony regardmg this pictorial event. Tiny, inconspicuous text accompanying the photographs indicates that almost all of the photographs were images of embryos that had been "surgically removed for a variety of reasons." The text doesn't indicate from what or whom they had been "removed." So without any clues about this fact attached to any individual picture, indeed, it was the case that these fetuses were independent, if dead.

Drawing on the innovative notions of pregnancy and pregnant wom- en, psychiatrists were prepared to explain the behavior of the growing number of women asking medical doctors for abortions in the postwar years. Their explanations created a broad category of women who were, by definition, in the absence of traditional medical problems, morally and psychologically unsuited for childbearing and certainly for motherhood because they were unwilling to serve as pregnancy vessels. Where there was an unhappily pregnant woman, there was a defective vessel. Many medical doctors agreed that an abortion could be performed on such a woman, but the procedure would not help as the problem was not the pregnancy. The problem was called a "psychiatric disorder" involving the woman's denial of her destiny and "amendable to treatment" as such.72 But the tone of the diagnosis, like the tone so ofien used to judge women on one grounds or another in these years, dripped with moral rectitude and condemnation. One psychiatrist identified the request for abortion "as proof [of the petitioner's] inability and failure to live through the des- tiny of being a wornan."73 Another, already cited, named motherhood as woman's "main role on earth." Arguing that abortion inevitably damaged women, he claimed that "despite protests to the contrary [and] . . . despite other sublimated types of activities," pregnancy and motherhood were "still their primary role."74 Going a step further, a psychiatrically oriented New York obstetrician insisted that most women experiencing unwanted pregnancies-whether or not they sought abortions-were "immature, psychoneurotic, or under emotional stress," not the victims of contraceptive failures.75

Again, consistent with the generally misogynistic and moralistic judg- ments exyerts offered at this time, there was a broad consensus among many essayists in the medical journals and elsewhere that unwdingness to provide a safe environment for the fetus revealed a deeply rooted history of mental illness. One medcal doctor found that "the patient, who all her life has disllked being female, found herself in conflict with men, and feared motherhood may be particularly abortion-prone. . . ." He cited the work of another specialist who identified two types of women likely to refuse pregnancy for psychological reasons: (1) "The basically immature woman who cannot accept the outstanding responsibhty of mature ferni- ninity, namely becoming a mother"; and (2) "The independent, h-ustrated woman who has been conditioned to and yearns for the rewards of the male world and feels that maternity, the greatest reward of the female world, is much less satisfymein fact, highly unsatisfymg."76

A physician who responded to such a woman's expressed desire to vi- olate her destiny was, according to many, in serious error. One highly experienced author-psychiatrist placed women who chose abortion on a sullied moral plane when he asserted that he had "never seen a patient who has not had guilt feelings about a previous . . . abortion."77 Others felt that because the pregnancy itself was not the source of difficulty, an abortion did not solve a woman's problems but could create serious problems for her. For example,

[Abortion] coupled with ideas of gdt, self-deprecation, some recurrent preoccupation centering around the abortion and the general theme of "I let them kill my baby" might well disturb a poorly integrated personality even to psychotic proportions. Feel- ings of love, admiration and respect for the male partner . . . may well be distorted in the aborted woman to ideas of disgust, hate, and disrespect; "He gave me a baby then took it away." The unconscious motivation and even the flow of emotions during the readjustments to a normal sexual nonpregnancy cycle may result in deeply engrained feelings of hostility toward the husband. Abortions we may say can produce psychotic cicatrix7$

Indeed, husbands were ofien defined as the worst victims of abortion. A psychiatrist described what he had observed were its most common psychiatric sequelae:

Psychiatrists see patients who accuse themselves . . . of being murderesses and then who go into very pronounced depressive reactions. We see patients who deliberately afier- wards punish themselves or their husbands by forcing vasectomy upon them, or in oth- er wayssometimes unconsciously, but very frequently on conscious levels deliberately castrating their husbands-usually emotionally, but occasionally, even in act~ality.7~

Another physician argued that abortions were beside the point be- cause "women who are physically vulnerable" will eventually and in- evitably deteriorate. The pregnancy was beside the point, as well: "It seems to matter little with regard to hture mental health whether the pregnancy is terminated or not. Those who are going to react adversely will do so irrespective of the procedure."m Conversely, a psychiatrist in Birmingham, England, cited the work of his colleagues as a warning to abortion-prone doctors: "Pregnancy appears to have a protective effect against the manifestations of mental disorder . . . many psychotics and neurotics show quiescence of their symptoms during pregnancy itseK"81 In this case, hardly an "added burden," pregnancy becomes a variant of electric shock therapy

In sum, the rise of hospital abortion committees and the redefinition

of pregnancy in the postwar years reflected and intensified a broad cul- tural interest in reaffirming and reasserting rnale authority over women. The method of achieving rnale control described here was a typically in- sidious example of this effort, because the language created by the new insights about the nature of pregnancy required that pregnant women be disempowered. That is, the new "moral" essence of pregnancy was built upon a presupposition of judgment and control. When physicians de- fined pregnancy as a moral issue and counseled women to cooperate in sustaining themselves as moral and fit containers for fetuses, they de- manded that pregnant girls and women cooperate in accepting the terms of their own oppression. Resistance had become a moral issue and, in effect, an immoral act.

WOMEN THREATEN SUICIDE

Well-known to unhappily pregnant women in the postwar era, however, was one method of resistance that sometimes cut through the language of morality: the threat of suicide. This condition alone raised the specter for medical doctors of a reintegrated mind, body, and pregnancy. A pregnant woman's threat of suicide suggested that the woman might destroy the reproductive container which gave definition to her very existence.82 Women recognized early that they could get their medical doctors' atten- tion by making such a threat,83 but many physicians found it easier to be- lieve that a woman was using her pregnancy rather than throwing away her destiny. Thus, physicians proceeded very cautiously in thls area. One wrote that "a mere threat of suicide or even an abortive attempt at sui- cide is not in itself regarded as a medical indcation for therapeutic abor- tion; it may be nothing more than an effort to blackmail the surgeon into performing the operation."84 An obstetrician at Columbia-Presbyterian Medical Center in New York explained his position:

I have been very much disturbed by the use of the indication of reactive depression with suicidal tendency. In cardiac disease you at least have an occasional death to validate the indication. I have not in my experience ever run across a suicide in pregnancy in a pa- tient who was suffering fiom anxiety depression. . . .I think that one of the honest rea- sons for the reduction in the number of therapeutic abortions in the last ten yeae is that the obstetricians are concerned with the subte&ges that are being employed, otherwise they might be willing to be much more lenientg5

The abortion board at one hospital had been in operation for three years by 1960 and had adjudicated a number of requests from allegedly suicidal women. Lewis E. Save1 and Irving K. Perlmutter gave examples

demonstrating how the committee members were able to idenutjr which of the petitioners should be denied permission. "One [woman] was a 40year-old gravida v, para iv, who threatened suicide. The opinion was that such feelings were often verbalized by many women having an undesired pregnancy." This petitioner was denied an abortion. Two additional peti- tioners were similarly inclined but in both cases, "the psychiatric situation was judged too superficial to warrant intervention."w Another exemplary case described "a girl of twenty [who] was referred to a gynecologist at a large teaching hospital. Sts psychiatrists saw her to pass final approval [for the abortion]. When they rejected her . . . it was their opinion that while 'allowing the pregnancy to continue will undoubtedly cause hr- ther deterioration in her schizophrenic process, we do not think she will

kill herself. "'87

The survey reported in the Stanford Law Review provides an excellent

example of a suicidal pregnant woman who physicians were willing to

believe deserved an abortion. An unprecedented 80 percent of reporting

hospitals agreed to sanction abortion in this hypothetical case.

Mrs. C. is 32 yean old and is the mother ofchildrrn, aged 7, 4, and 3. Following the birth ojher

last child, she had what was diagnosed as a postpattum deprrssion in whuh she became completely

withdrawn. She was hospitalized in a state hospital for 6 months during which time she had electro-

shock therapy with some improvement. She has remained under psychiatric care since then but she

still becomes depressed very easily and talks jrrely about committing suicide, saying that her family

will be better ofwithout the burden ofher care.

Four weeks ago it was diagnosed that she was approximately 4 weeks'pregtiant. The news 4this

precipitated a severe emotional crisis. This has been manqested by vomiting, spellr of uncontrollable

crying lasting for hours at a time, at which time the patient locked henelj in her room. She

threatened suicide several times in the lastfour weeks, saying that she could never be a "pod

mother" and that she was a "useless member $society."

Last night Mrs. C. was found unconscious on theJwr ojher living mom. There was an empty bot- tle, which should have contained approximately eighteen sleeping pills, in her bedroom. She was taken to the hospital and has apparently responded to vigorous therapyfor her barbiturate overdose.

Mrs. C.'s case evoked near-consensus because this woman demonstrated her commitment to destroy the reproductive container she had become. Only in the case of such a demonstration could the moral dimension be eclipsed and the condition of pregnancy assume its previous status as an "added burden" or a destructive agent.

DOCTORS THREATENSTERILIZATION
The other way that physicians ftequently revealed their commitment to the new construction of women's bodies as reproductive containers was in their association of therapeutic abortion with simultaneous steriliza- tion. As one chronicler of this era put it:

Patientr actually had little or no contact with the operating physicians and often learned, only well after the fact, that the abortion had included sterilization. Because abortion pa- tients were viewed as "psychotic," "hysterical" "depressed," "neurotic," or "guilt-laden," the symptoms associated with what psychiatrists . . . term the "post-abortion hangover," the patient was considered to be in an unfit mental state to evaluate her own treatment. Early supporters of the psychiatric route believed that the abortive woman not only lost her baby, but rejected her own womanhood as well. The belief in woman-as-childbearer, a paramount flnction, undergirded the entire therapeutic stmcture.88

The prevalence of sterilization was widely featured in the obstetrical and psychiatric literature of the day, specifically in cases involving what one prominent expert called the "tainted indvidual."s9 One group of ob- stetricians found that "some women desiring an abortion were required to have a simultaneous sterilization operation as a condition of approval of the abortion in from one-third to two-thirds of [those] teaching hospitals [studied] in dfferent regions of the country. In all, 53.6 percent of teach- ing hospitals made this a requirement for some of their patients."% Another physician reported his finding of a 40 percent concomitant steriliza- tion rate in all U.S. hospitals in the 1940s and 1950~.~l

A Chicago study of 209 aborted patients showed that medcal doctors at the Lying-In Hos- pital in that city determined, "In the majority of cases when therapeutic abortion is indicated, the patient's medical condtion warrants the preven- tion of future gestations"; 69.4 percent of these women were sterilized.92

Some physicians justified simultaneous sterilization on the grounds that any woman ill enough to warrant abortion should never awn be preg- r1ant.~3 Others shared this position but shifted the emphasis on to the medcal doctor's dilemma: "A serious effort is made to control [by steril- ization] the need for dealing with the same problem in the same patient twice."94 A California psychiatrist described what he felt was a strong trend among medical doctors, "penahzing" by sterilization the patient who "needs" a therapeutic abortion. He explained the practice this way: "Often, the surgeon's stipulation for sterihzation may reflect his reluctance to perform the abortion, his misunderstanding of its necessity, and his re- sentment of the psychiatric indications."95 Another commentator felt that some physicians in this era resented sexual women more than they resent- ed psychiatry: "The abortion committee [at one hospital] evaluated dl patients in terms of recommendations for sterilization. Medical grounds for this 'final solution' to 'promiscuous' abortions were forcefully debated by individual members and typically included the physician's evaluation of

the woman's condition and moral character."% The widespread use of sterilization, whatever the expressed justification, seems to suggest that many physicians in the postwar era were willing to use the sterilization option to cap the defective reproductive container. In one small mid- western hospital, four requests for therapeutic abortion were presented to the committee one year. None was approved. Among them was this case: "Approval of both therapeutic abortion and sterilization was re- quested for a 36-year-old gravida iv, para ii for arrested pulmonary tu- berculosis, thyrotoxicosis, and emotional instability. Despite the consul- tants' recommendations the committee did not approve the abortion, but did approve postpartum sterilization."97

One physician, unhappy about the coupling of sterilization and thera- peutic abortion in U.S. hospitals, observed that this practice actually drove women to illegal abortionists to escape the likelihood that a legal abortion would entail the permanent loss of their fertihty. He added, "I would like to point that out, because the package [therapeutic abortion- sterilization] is so fiequent I therefore consider them fortunate to have been illegally rather than therapeutically aborted, and thus spared steril- ization."98 This aspect of the discussion foreshadowed, of course, the le- gal institutionalization, in our time, of the link between abortion and sterilization, via the Hyde Amendment.

THE LIMITS OF ABORTION COMMITTEES
The literature reviewed in this essay makes it clear that some influential medical doctors in the postwar era derived professional strength and ide- ological coherence from abortion committees and fiom a new, disem- bodied detinition of pregnancy. But by the middle of the 1960s, it was also clear that the same factors which had pushed physicians into a de- fensive posture in the early postwar years continued to exert considerable pressures on the profession. These and additional factors combined to fa- cilitate the eclipse of medical authority over the abortion decision much sooner than many practitioners had predicted.

Over time, the committees themselves could not sustain the image of professional unity and scientific purpose, even if an individual hospital could issue abortion decisions with one voice. Harold Rosen, a promi- nent medical doctor interested in abortion reform, noted widespread in- consistencies between hospital abortion committees in the mid-1960s which hurt the credibility of the profession.

Not infrequently, for instance, the abortion board of one hospital, but not another, may rehse to accept a recommendation for intermption; on nine separate occasions during the past seven years, patients who have been seen in consultation in one hospital have af- terwards been therapeutically aborted at adjacent hospitals with, at times, almost the same visiting staff.

At the heart of this apparent capriciousness was a continuing inability among physicians to agree on indications, even medical indcations. If physicians do not wish to force a specific woman to carry a specific pregnancy to term, and if that woman is actually suffering from some severe physical disease then, but only then, the pathological process, provided it falls within certain categories, is in cer- tain hospitals and by certain physicians and hospital boards considered sufficient indica- tion for intermption. In others, it is not. .. .99

In addition, Rosen noted that the medical profession continued to be rent by the abortion issue as the direct result of both medical progress in managing pregnancy and "undeclared nonmedical factors," specifically the pressure of the legal threat against physicians and restrictive legislative statutes. These factors persisted in conditioning the abortion decisions of medical doctors despite attempts to neutrhze them and despite the fact that they were rarely, if ever, in fact prosecuted for performing therapeu- tic abortions in hospitals.

Other factors which exerted increasing pressure in the abortion arena include first, of course, women's growing insistence on breaking the link between law and medicine, so that women themselves could take the power to decide who was a mother and to decide when a woman was a mother. After the rubella epidemic and the thalidomide episode of the early 1960s, women also began to insist on a led, publicly sanctioned right to decide who was a child. The sensationally and intrusively re- ported plight of Sherri Finkbine in 1962 raised, above all, the specter of the pregnant woman's right to reject a fetus deeply damaged by thalido- rnide.100

Additional pressures whlch struck at medcal authority came fbm the flowering of the quality of life (or "life-style") ethic among the middle- class in the United States which undermined the acceptabihty of the sim- ple life/death dichotomy that the law mandated must govern abortion decisions. Also, in the 1960s as social criticism seeped back into rnain- stream public discourse, some physicians began to accept and use a defin- ition of the purpose of medicine-in this case, of indications for abortion, which placed unhappily pregnant women in desperate social and eco- nomic contexts.101 Physicians were also involved in and influenced by the reemergence in this era of a holistic approach toward diagnostics and

treatment which reflected and promoted the other two emergent trends of the 1960s. One contemporary commentator applied these trends to the abortion issue in this way:

Distinctions between physical and mental health are meaningless in terms of modem medical thinking. Health cannot be divorced &om socio-economic facton which influence people's lives since health is a product of these conditions. In applying criteria for abortion based on maternal health, the question should be the extent to which the preg- nancy threatens the general well-being of the patient.102

Of equal or greater importance to all these pressures undermining medical authority in the abortion arena by the mid-1960s was wide- spread concern and fear among whites in the United States about the "population explosion," rising welfare costs, the civil rights movement, and the "sexual revolution." Critics of these social, political, and cultural phenomena tended to target women's bodies and their reproductive ca- pacity as a source of danger to the fabric of U.S. society Demedicdzing and decriminalizing the abortion decision became one way to diminish the damage women's bodies could do.lo3

CONCLUSION This essay leaves unexplored many issues that would shed additional light on the concerns and strategies of medical doctors sitting on hospital abor- tion committees in the postwar era. These include physicians' attitudes toward abortion and women of various races, ethnicities, and classes. Much research is needed in this area. The essay does not explore medical doctors' attitudes toward and relationships with illegal abortionists, a sub- ject well worth pursuing.1o4 Also left unexplored are the sources and complex nature of physicians' changing amtudes toward abortion in the 1960s and 1970s. Pregnant women themselves have not been given voice in thls essay. But the subjects of this study, a highly visible segment of the medical community, have been given voice here in order to allow us to consider what was at issue for many physicians in the immediate pre-Roe v. Wade decades. What is most striking in the literature reviewed for this essay is that, with the exception of the few articles prepared by Catholic medical doctors, the physicians who wrote on the abortion issue were not pri- marily concerned with the issue of when life begins.105 They were, how- ever, very concerned with what they took to be their role in the postwar cultural mandate to protect and preserve the links between sexuahty, femininity, marriage, and maternity. They were also deeply concerned

about their professional dignity and about devising strategies to protect and preserve the power, the prerogatives, and the legal standing of the medical profession.

An important strategy of many physicians in this era was to draw on the vulnerability of pregnant women to construct a definition of preg- nancy that effaced the personhood of the individual pregnant woman. Ths definition created a safe place for the fetus and also for the physician forced by law to adjudicate the extremely personal decisions of women, many of whom were resisting effacement. The subordination of the pregnant woman to the fetus revitalized medical participation in the abortion decision because the medical doctor was now required to make sure that the woman stayed moral, that is, served her fetus correctly. These postwar ideas demonstrate the relationship between scientific ad- vances and ideological positions regarding women, pregnant women, pregnancy, and fetuses. Physicians have often presented these positions as scientdic, providing "evidence" for antichoice proponents. It seems clear today that if abortion decisions were again assigned by law to medical doctors, unhappily pregnant women seeking abortions would again con- hnt a defensive profession, masking as scientists for this purpose, but constrained to practice ideological medicine. Perhaps the most dficult task for prochoice advocates today, and the most crucial, is to insist with even more vitality that they occupy the moral ground. Pregnancy is not, by definition, the moral duty of girls and women; rather, granting this population reproductive fieedom is the moral duty of society.

NOTES

All these cases are drawn from Herbert L. Packer and Ralph J. Gampell, "Therapeutic Abor- tion: A Problem in Law and Medicine, Sfanford Law Review 11 (May 1959): 417-55.

Ibid., 418.

In fact, for many postwar commentators, a woman fulfilled her destiny as mother not via pregnancy but in the proper postnatal care of her child. This is especially evident in the prevailing treatment of white unwed mothers in these years, particularly in the definition of this population as not-mothers and in the coercively applied prescription that these girls and women should relin- quish their babies for adoption on an every-case basis. See Rickie Solinger, "Fbce and 'Value': Black and White Illegitimate Babies in the U.S.A., 1945-1965," Gender and History 4 (Autumn 1992): 343-63.

See, for example, Quinten Scherman, "Therapeutic Abortion," Obstetrics and Gynecology 11 (March 1958): 323-35. This article and others cited in this essay contradict Rosalind Petchesky's observation that a 1970 American Medical Association statement calling for the liberalization of abortion laws demonstrated that "after a century of strictly moral opposition to abortion on practi- cally any ground, the AMA was now conceding that abortion for 'medically necessary' reasons was legitimate." See Rosalind Pollack Petchesky, Abortion and Woman's Choice: The State, Sexuality, and

Reproductive Freedom, rev. ed. (Boston: Northeastern University Press, 1990), 124.

J.G. Moore and J.H. Randall, "Trends in Therapeutic Abortion: A Review of 137 Cases," American Journal of Obstetrics and Gynecology 63 (January 1952): 28-40.

Scherman, 323.

Mary S. Calderone, ed., Therapeutic Abortion in the United States (New York: Harper & Bros., 1958), 84. Kristin Luker argues that the ratio of hospital, therapeutic abortions to deliveries be- tween 1926 and 1960 did not seem to have changed: "Abortions became neither easier nor hard- er to obtain over time." See Kristin Luker, Abortion and the Politics ofMotherhood (Berkeley: Uni- venity of California Preu, 1984), 46. Most of the articles cited in the present essay suggest that between about 1945 and 1965, rates of hospital abortions dedined in relation to births.

Edwin M. Gold et al., "Therapeutic Abortions in New York City: A Twenty-Year Review," Amen'utn Journal ofhblu Health 55 (July 1965): 964-72.

Lawrence Lader, Abortion (Indianapolis: Bobbs-Merrill, 1966), 26-27.

See Mary S. Calderone, ed., Abortion in the United States (New York: Harper &Bros., 1958), 86-88.

1 1. Scherman, 325.

12. Luker, 66.

13. See Calderone, Therapeutic Abortion in the United States, chap. 9.

Moore and Randall, 28.

Keith P. Russell, "Changing Indications for Therapeutic Abortion: Twenty Years' Experi- ence at Los Angeles Community Hospital," Journal of the American Medical Association 151 (10 Jan. 1953): 108.

Myrna Loth and H. Close Heneltine, "Therapeutic Abortion at the Chicago Lying-In Hos- pital," American Journal of Obstetrics and Gynecology 72 (August1956): 304-1 1.

Harry A. Pearse and Harold A. Ott, "Hospital Control of Sterilization and Therapeutic Abortion," Ameriutn Journal of Obstetricc and Gynecology 60 (August 1950): 285.

Scherman, 323.

Roy J. Heffeman and William Lynch, "What Is the Status of Therapeutic Abortion in Mod- em Obstetrics?" American Journal of Obstetrics and Gynecology 66 (August 1953): 335.

Harold Rosen, "The Psychiatric Implications of Abortion: A Case Study in Hypocrisy," in Abortion and the Lnu,ed. David T. Smith (Cleveland: The Pres of Case Western Reserve Uni- versity, 1967). 105.

"Comment," by W.O. Johnson, in Pearse and Ott, 299.

Heffeman and Lynch; Moore and Randall, 39; H.A. Stephenson, "Therapeutic Abortion," Obstetrics and Gynecology 4 (1958): 578. Also see the New York Times, 22 June 1965, which com- pares the rates of psychiatric indications for aboflon in a Bum0 hospital in 1943 (13 percent) and 1963 (87.5 percent).

See, for example, Moore and Randall, 34.

See, for example, D.I. Arbuse and J. Schechtman, American Practitioner 1 (October 1950): 1069.

"Comment," by G.K. Folger, in Pearse and Ott, 299-300.

Scherman, 330-31.

Edwin M. Schur, Crimes without Vim'ms: Deviant Behmior and Public Policy (Englewood Cli6, N.J.: Prentice-Hall, 1965). 16.

Sidney Bolter, Response to Robert L. Marcus's Editorial. Ameriurn Journal of Psychiatry 119 (February 1963): 798.

Alex Barno, "Criminal Abortion Deaths, Illegitimate Pregnancy Deaths, and Suicide in Preg- nancy: Minnesota 1950-1965," Ameriutn Journal of Obstettics and Cy~cology 98 (June 1967): 361.

Allan J. Rosenberg and Emmanuel Silver, "Suicide, Psychiatrists, and Therapeutic Abor- tions," California Medicine 102 (June 1965): 410; also see R.B. McGraw, "Legal Aspects of Termi- nation of Pregnancy on Psychiatric Grounds," New York State Journal of Medicine 56 (15 May 1956): 1605. This article carries a long case tustory of a woman referred for abortion on psychi- atric grounds. The final vote of the abortion committee was five to five.

Sidney Bolter, "The Psychlatrists Role in Therapeutic Abortion: The Unwitting Accom- plice," American Journal of Psychiatry 119 (October 1962): 312.

Rosen, "Psychiatric Indications of Abortion," 90.

Ibid., 77, 80.

Lewis E. Savel, "Adjudication of Therapeutic Abortion and Sterilization," in Therapeutic Abortion and Sterilization, ed. Edmund W. Overstreet (New York: Harper &Row, 1964). Alan Guttmacher gives his own description of the Mt. Sinai committee in several places, including Calderone, Abortion in the United States, 92-93, 139; and Alan F. Guttmacher, "Therapeutic Abortion: The Doctor's Dilemma," Journal ofMt. Sinai Hospital 21 (1954): 111.

James M. Ingram et al., "Intemption of Pregnancy for Psychiatric Indications-A Suggested Method of Control," Obstetrics and Gynecology 29 (February 1967): 255.

"Laws Regulating Abortion," Journal ofthe Indiana Medical Association 40 (July 1947): 16.

Pearse and Ott, 290, 299.

Packer and Gampell, 429.

See, for example, Ingram et al., 255.

See, especially, The Abortionist, by Dr. X as told to Lucy Freeman (Garden City, N.Y.: Dou- bleday, 1962). Elsewhere, "Dr. X," a convicted abortionist, testified, "In spite of the fact that there were 353 doctors whom I had sewed for many years, when the time came for those men to come forward and share the responsibhty with me, there was not one in the whole group that offered to do so. . . . So actually it was the profession that convicted me, in spite of the fact that they were the very ones who had used my senices." See Calderone, Abortion in the United States,

62. Also see Zad Leavy and Jerome M. Kummer, "Criminal Abortion: Human Hardship and Unyielding Laws," Southern California Law Review 35 (Winter 1965): 125. Other firsthand state- ments about the relahonship between illegal practitioners and refemng physicians can be found in Dr. Ruth Bametfs They Weep on My Doorstep (Beaverton, Ore.: HALO Publishers, 1969).

Carole Joffe, "'Portraib of Three Physicians of Conscience': Abortion before Legahation in the United States," Journal ofthe History ofSexuality 2 (July 1991): 46-67.

See, for example, Lader, 26.

Pearse and Ott, 299.

Lews E. Savel and Irving K. Perlmutter, "Therapeutic Abortion and Sterilization Commit- tees: A Three-Year Expenence," American Journal oJ Obstetrits and Gynecology 80 (December 1960): 1198, 1194.

W. Joseph May, "Therapeuhc Abortion in North Carolina," North Carolina Medical Journal 23 (December 1962): 548.

See, for example, Ingram et al., 252; also Packer and Gampell, who report that 75 percent of participating hospitals felt that their abortion decisions regularly violated the law, 430. Also of in- terest is Jack Star, "One Million Abortions a Year: The Growing Tragedy of Abortion," Look, 19 Oct. 1965. Star quotes Robert E. Hall of the Department of Obstetrics and Gynecology at Co- lumbia University's College of Physicians and Surgeons to the effect that hospital abortion boards could not do their job and stay within the law. Hall went on to give examples demonstrating that this was so.

Pearse and Ott, 297.

In England, physicians called their abortion committees "tribunals." See, for example, J.V. O'Sullivan and L. Fairfield, "The Case against Termination on Psychiatric Grounds," Mental Health 20 (August 1961): 97.

Arnold S. Levine, "The Problem of Psychiatric Disturbances in Relation to Therapeutic Abortion," Journal ofthe Albert Einstein Medical Center 6 (1958): 76.

Nicholas J. Eastman, "Obstetric Forward," in Therapeutic Abortion, ed. Harold Rosen (New York: Julian Press, 1954), xx.

Bolter, 315.

Packer and Gampell, 430.

Levine, 76.

Moore and Randall. 36.

Scherman, 323.

See, for example, Richard Kluger, Simple Justiu (New York: Fbndom House, 1975); Alfred

C. Kinsey, Wardell B. Pomeroy, and Clyde W. Martin, Sexual Behavior in the Human Male (Philadelphia: W.B. Saunden, 1948); Alfred C. Kinsey, Warden B. Pomeroy, and Clyde E. Martin, Sexual Behovior in the Human Female (Philadelphia: W.B. Saunden, 1953).

John Johnson, "Termination of Pregnancy on Psychiatric Grounds," Medical Gynecology and Sodology 2 (1 966): 2.

Lader, 27.

Charles C. Dahlberg, "Abortion," in Smal Eehavior and the Low,ed. Ralph Slovenko (Spring- field, Ill.: Charles Thomas Publishers, 1965). 384.

60. Calderone, Abortion in the United States, 93.

See, for example, Ingram et al., and Pearse and Ott.

Lader, 28.

Bolter, 315.

"Discussion," in Abortion Obtained and Denied: Research Perspectives, ed. Sidney H. Newman, Mildred B. Beck, and Sarah Lewit (New York: Population Council, 1971), 77.

Gold et al., 969.

J.A. Harrington, "Psychiatric Indications for the Termination of Pregnancy," Prdtioner 185 (November 1960): 654-58.

Moore and Randall, 34.

Heffeman and Lynch, 335.

It is difTicult to tell, in this regard, whether the physician was the mother's assistant, or the other way around.

70. Calderone, Abortion in the United States, 118.

"The Drama of Life before Birth," Life, 30 Apr. 1965, 54.

Harrington, 658.

Theodore Linz, "Reflections of the Psychiatrist," in Tkerapeutic Abodon.

Bolter, 314-15.

Hans Lehfeldt, "WW Exposure to Unwanted Pregnancy," Amen'an Journal of Obstdricc and Gynecology 78 (September 1959): 665; also see the statement of Iago Goldston defining the desire for abortion in a "so-called adult woman" as an indication of "a sick penon and a sick situation . . . which could be relieved, or ameliorated [by the abortion] hke cutting off a gangrenous foot" (Cal- derone, Abortion in the United States, 118-19).

H. Flanders Dunbar, Psychiatry in the Medical Spen'alties (New York: McGraw-Hill, 1959), 279, 281.

Bolter, 314.

F.G. Ebaugh and K.D. Heuser, "Psychiatric Aspects of Therapeutic Abortion," Postgraduate Medin'ne 2 (1947): 325.

79. Calderone, Abortion in the United States, 129.

Johnson, 3.

Harrington, 655.

See, for example, Jacob H. Friedman, "The Vagarity of Psychatric Indications for Therapeu- tic Abortion," American Journal ofPsychotherapy 16 (April 1962): 251.

See, for example, Nanette Davis, From Cn'me to Choice: The Transformation of Abortion in Amen'a (Westport, Conn.: Greenwood Press, 1985), 72.

S. Leon Israel, "Editorials: Therapeutic Abortion," Postgraduate Mediane 33 (June 1963): 619-20.

85. Calderone, Abortion it: the Um'ted States,108.

Save1 and Perlmutter, 1194.

Dahlberg, 384.

Davis, 73.

Frederick S. Taussig, Abortion, Spontaneous and Induced: Medical and S0c1'al Aspeds (St. Louis, Mo.: C.V. Mosby Co., 1936), 79.

Johan W. Eliot et al., "The Obstetrician's View," in Abortion in a Changing World, ed. Robert

E. Hall (New York: Columbia University Press, 1970), 1: 93.

Kenneth R. Niswander, "Medical Abortion Practices in the United States," in Abortion and the LAW, 57.

Loth and Hesseltine, 306; see also Peane and Ott.

See, for example, Moore and Randall, 37.

Savel, 18.

Alexander Simon, "Psychiatric Indications for Therapeutic Abortion and Stenlization," in Therapeutic Abortion and Sterilization, 78. Also see Dahlberg, 383.

Davis, 77-78.

Pearse and Ott, 296.

98. Calderone, Abortion in the United States, 131.

Rosen, "Psychiatric Implications of Abortion," 77, 80.

See the New York Times, 25 July 1962 to 27 Aug. 1962.

See, for example, "Discussion by Charles S. Stevenson," in Barno, 364.

Kenneth J. Ryan, "Humane Abortion Laws and the Health Needs of Society," in Abortion and the Law, 68.

103. See Rickie Solinger, Wake Up Little Susie: Single Pregnancy and Race before Roe v. Wade (New York: Routledge, 1992).

See Davis, 89-90. This subject is one focus of a study I am currently rnakmg of trials in the postwar era involving women who were incarcerated for performing illegal abortions (Solinger, The Abortionist [The Free Press, forthcoming]).

See The Abortion Problem (Baltimore, Md.: Williams & Wdkins, 1944) for a comprehensive collection of medical docton' concerns in this era, few of which focus on the issue of the incep- tion of life.

Comments
  • Recommend Us