By Frederick N. Dyer, Ph.D.
On November 7, 1855, Dr. David Humphreys Storer gave the Introductory Lecture that commenced the term of Harvard's Massachusetts Medical College where Storer was the Professor of Obstetrics and Medical Jurisprudence. The lecture was titled, 'Duties, Trials and Rewards of the Student of Midwifery,' but the last portion of the lecture also dealt with the sharp increase in induced abortion and with what David Humphreys Storer argued was a direct result, the increase in women's diseases. David Humphreys Storer's son, Dr. Horatio Robinson Storer, is credited as the founder of the 'physicians' crusade against abortion,' and Horatio repeatedly credited this lecture of his father as the stimulus for his crusade.
The Introductory Lecture was traditionally published as a pamphlet, and this was true for David Humphreys Storer's Lecture, as well. However, at the request of Dr. Henry J. Bigelow, Professor of Surgery at the Medical College, the abortion portion of the lecture was omitted from the pamphlet. Unnecessary abortion was a taboo and controversial topic in 1855, and one reason for suppression was that publication would lead to the condemnation of New England because induced abortion was prevalent. It also was believed that publication would reflect badly on the Medical College and cause fewer students to enroll, reducing the fees students paid directly to their professors.
Although the Boston Medical and Surgical Journal was typically controlled by the Medical College, its editors, William W. Morland and Francis Minot, bravely criticized the medical school faculty for suppressing the anti-abortion segment of the Introductory Address. One passage from their December 1855 editorial on the Introductory Lecture read:
'We referred to the fact that the fair proportions of this Address have been essentially diminished by an omission of certain portions. While we confess the truth of the adage that 'half a loaf is better than no bread,' we particularly dislike all processes which abstract the leaven from any compound. Deferring to the judgment of others, whose opinions we all delight to honor, Professor Storer has omitted the very paragraphs, which, in our judgment, should have been allowed to go forth as freely as they were spoken. To whom shall the community look for a verdict upon practices which disgrace our land and prevail to an extent that would hardly be credited, if not to physicians-and, chiefest among them, to medical teachers? For ourselves, we have no fear that the truth, as told by the writer of this Address, in reference to the crime of procuring abortion and the scarcely less heinous offence of preventing impregnation, would do aught but good in this, or in any, city. It would appear that sheer ignorance, in many honest people, is the spring of much of the horrible intra-uterine murder which exists among us; why not, then, enlighten this ignorance? It would be far more effectually done by some bold and manly appeal like that to which we allude, than by the private and scattered influence of honorable practitioners alone. In this case we will guarantee that vice would be all the more 'hated' the more it was revealed, and would be neither 'pitied' nor 'embraced.' The alarming extent of these evil practices is admitted; why attempt to conceal them any longer? Will not the mischief bye and bye be all the more deadly for delaying exposure and attempting relief?'
The suppressed portion of the Lecture was finally published seventeen years later in the sixth volume of the first medical journal devoted to gynecology. This was the Journal of the Gynecological Society of Boston which was started and edited by Horatio Robinson Storer. Horatio not only was responsible for the publication of the abortion portion of his father's Introductory Lecture, he probably made input to it when it was being composed in 1855. A year earlier, Horatio was providing a great deal of material to David Humphreys Storer to assist him in his new Professorship which began in November 1854. At that time, Horatio was in Edinburgh, Scotland studying with Great Britain's most famous obstetrician and gynecologist, Dr. (later Sir) James Young Simpson. Horatio was sending his father notes and copies of diagrams from Simpson's lectures at Edinburgh University. Horatio returned to Boston in June 1855 and it is probable that Horatio's assistance to his father continued, including input to the upcoming major Introductory Lecture. It is even possible that the anti-abortion portion was Horatio's idea, even his composition. If Horatio were primarily responsible for the anti-abortion portion of his father's lecture, it could account for why David Humphreys Storer allowed it to be suppressed when it was published a few weeks after delivery. Horatio later referred to this as one of the few times that his pugnacious father was to 'show the white feather.' It also could account for why David Humphreys Storer did not persist in anti-abortion efforts after the Introductory Lecture. Horatio was to actively commence his campaign against abortion in early 1857, a little more than one year following David Humphreys Storer's Introductory Lecture.
Whether original with David Humphreys Storer and the inspiration for Horatio's 'physicians' crusade' (as Horatio repeatedly claimed in later writing), or whether more-or-less authored by Horatio, the anti-abortion segment of this Introductory Lecture is a landmark event in the successful 'physicians' campaign against abortion.' Within a few decades this campaign against abortion led to passage of laws in almost every state and territory protecting the unborn from conception. The effect was to reduce abortion among married Protestant women (abortion was rare among Catholic women). Given the exponential increase in subsequent generations of descendents of the additional 'Storer survivors of pregnancy,' it is probable that a majority of Protestant Americans can thank the 'physicians' campaign,' and its Father-and-Son founders, for one or more of their ancestors.
The following is the abortion portion of David Humphreys' Introductory Lecture printed as, 'Two Frequent Causes of Uterine Disease,' in the March 1872 issue of Horatio's Journal of the Gynecological Society of Boston:
'I should feel that I had been guilty of an unpardonable neglect were I to omit to glance at a subject the importance of which, each succeeding year, has been more forcibly impressed upon my mind. I had hoped that, long ere this, some one of the strong men of the profession,-strong in the affections of the community, strong in the confidence of his brethren,-would have spoken, trumpet-tongued, against an existing, and universally acknowledged evil. I have waited in vain. The lecturer is silent, the press is silent, and the enormity, unrebuked, stalks at midday throughout the length and breadth of the land. It is time that this silence should be broken. It is time that men should speak. It is no presumption in the humblest individual to point out a much-needed reformation, however others may doubt the expediency of his course, if he thinks by thus doing he shall awaken in any mind the slightest attention to the subject; particularly if he sincerely believes that anything which can be found to be wrong can be rectified, that anything which ought to be done can be done sooner or later, whether it affects an individual, a community, or a race.
'Within the past few years one of the most striking changes which has been observed in the phases of disease has occurred in the affections peculiar to the female. All physicians are familiar with the fact, not only that the different seasons produce peculiar derangements, but also that those derangements differ in a greater or less degree as the natural causes vary, and that the further removed from a state of health any individual may be, the more liable that individual is to suffer from periodical influences; that at these different periods one set of organs suffers disproportionately to others; that in winter and spring the thoracic organs are most frequently deranged; that in summer and autumn the digestive apparatus is the seat of disease; and that each organ of the body is most affected when any of its important functions are unnaturally excited, either by being called into action too frequently or by that action being too long continued. These are well-established laws, intelligible to all; but when the diseases of an important organ are rapidly becoming more and more frequently observed, pervading every class of society, noticeable among those surrounded by the luxuries of wealth as well as in the beggar at our door, affecting those who have heretofore enjoyed the most perfect health as well as those whose constitutions had ever been infirm,-and no apparent cause exists for these sudden and alarming inroads,-the question naturally arises, how can this be explained? Why is it that the females of the present day suffer so much more from uterine diseases than those of the previous generations? If an answer to this inquiry does not instantaneously rise to the lips of every medical man, however limited may be his experience, his powers of observation must be exceedingly defective. The same natural laws exist which have ever existed; by them the same derangements are produced,-these are unavoidable; and that the same amount of disease should be observed in a given number of individuals, as was formerly noticed, ought to be expected-no more. Assuming this proposition to be self-evident, unnatural causes are exerting a fearful influence. An immense amount of disease exists which is unnecessary, which might be prevented. Various reasons have been assigned by different authorities for this alarming increase, each of which, while it explains a few isolated cases, leaves by far the larger number unaccounted for; from which it would appear that there is a great unwillingness, on the part of the profession, to dwell upon, or even to refer to, one of the principal causes of this class of derangements. But why should this be? Why should we shrink from the performance of any duty, however unpleasant or ungrateful to our feelings it may be, if we think that it is demanded of us? If we know it is clearly a duty, it should be performed. We may, it is too true, be misunderstood; we may be misinterpreted. But this should not prevent us from the full, free expression of our convictions. A true man fears, can fear, nothing.
'The most inattentive observer must be surprised when he remarks the comparative smallness of the families of the present day. Formerly, it was by no means an uncommon circumstance for parents to estimate their wealth by the number of their children; to be willing to suffer any privation, to endure any hardship, in order to rear and educate a numerous progeny. Now, a large family of children is a rare spectacle, and if any can be pointed at consisting of what was once a not unfrequent number, the principals are considered by many as proper subjects to occupy apartments in an insane hospital. Fashion, which controls everything, is the regulator here. The absurd, the preposterous desire so universally cherished among the different circles of society, each to appear as nearly equal in externals to the others as is possible to be done; the extravagance necessary to be indulged by an inferior grade in order to imitate the modes of living of a higher one, are the great remote causes of existing opinions, of existing acts.
'The fashionable young bride, accustomed to adulation, is reluctant to forego at once the excitement of society; she is too often unwilling to feel that she 'has taken the veil'-that she has consecrated her affections to one being-and that his approval and his devotion should keep her heart ever full to overflowing; but wishing still to enjoy the immunities of unmarried life-to be as free, as unshackled as ever-she will not endure the seclusion and deprivations necessarily connected with the pregnant condition, but resorts to means, readily procurable, to destroy the life within her, apparently unconscious that she is not only committing a crime in the sight of the law, but also a sin in the sight of her Maker.
'The mother, too, while she acknowledges the happiness she enjoys in the possession of her children, and looks upon them as the most valuable blessings she can possess, not unfrequently is willing, anxious, to pursue a similar course to produce a similar result. Unfortunate, perhaps pecuniarily unable to have her family provided for in the manner in which they have been accustomed to live, her pride will not allow her to see those already dependent upon her, appearing less 'respectable,' to use a word thus applied in common parlance, as she thinks must be a necessary consequence upon the introduction of every addition to the circle; or learning from others that woman was born for higher and nobler purposes than the propagation of her species, that it is unreasonable that so large a portion of her life should be yielded to its drudgery, or, imagining, from some misinterpreted remark her physician may have carelessly made, that it would really be dangerous for her again to be called upon to give birth to a mature child, and even that it would certainly cause her death, she persuades herself into the belief that it is not morally wrong, that it is really her duty, to destroy her unborn child.
'I do not presume to stand here as a moralist. I would attempt only to point out a few of the duties obligatory upon the physician, as such. I should, however, be faithless to the noble profession which occupies my every thought; I should be unworthy the confidence or esteem of my brethren did I refrain, while referring to this subject, to enter my solemn protest against the existing vice; to express, emphatically, the universal sentiment of horror and indignation entertained among the upright men of the profession in this community. Of horror, that the female can so completely unsex herself, that her sensibilities can be so entirely blunted, that any conceivable circumstances can compel her to welcome such degradation! Of indignation, that men can be found so regardless of their own characters, so perfectly indifferent respecting those of their cotemporaries [sic], as to lend their services in such unholy transactions.
'To save the life of the mother we may be called upon to destroy the foetus in utero, but here alone can it be justifiable. The generally prevailing opinion that although it may be wrong to procure an abortion after the child has presented unmistakable signs of life, it is excusable previous to that period, is unintelligible to the conscientious physician. The moment an embryo enters the uterus a microscopic speck, it is the germ of a human being, and it is as morally wrong to endeavor to destroy that germ as to be guilty of the crime of infanticide. But there are many who will pretend not to be convinced on this point, whatever arguments may be adduced; they choose to think for themselves, and of the morality of the subject they feel they can judge for themselves. Upon such, should be urged the unavoidable injury to their physical condition, the serious inroads upon their health which inevitably follow, if they do not always accompany, these forbidden procedures; they should be entreated to hesitate in their career before their systems are undermined; they should be made to comprehend that their well-being depends upon a proper observance of certain natural laws, which are readily understood, and which are as exacting as they are intelligible; that each organ has a law of its own, if I may be allowed thus to speak, controlling the performance of its functions,-a law which cannot be broken with impunity. The Lawgiver is inexorable.
'A law of the organ of which we have been speaking, requires that a certain specified time shall be occupied in perfecting its most important work; this period is fixed, uniform, universal. In a state of perfect health deviation may be said to be unknown. When any irregularity is noticed it may be traced almost invariably to some unnatural cause. When the entire limit is reached, when the foetus has become perfectly developed, the system of the mother, gradually being prepared for the approaching event, is able to bear the momentous change unimpaired. The unfortunate cases are exceedingly rare; they are the exceptions to the rule. When, however, from any accidental cause the organ is called upon to perform a duty for which it is unprepared, a greater or less degree of injury must be produced; and when any rude attempt is deliberately made to effect this object, infinitely greater is the probability of there being increased detriment and irretrievable harm; for in addition to the circumstance I have referred to, of the unpreparedness of the organ for the attempted change, are the unavoidable local lesions; and that cause, even more important than these (say what men may to the contrary), the deep, heart-felt depression which must weigh upon the spirit of the evil-doer. Hundreds of lives are unquestionably yearly lost by the innumerable methods which are resorted to to produce premature delivery, and thousands of females who escape the grave may date, from these operations, the origin of many exhausting, painful, incurable diseases. The laws of the land, with all their penalties annexed, can do but little to abolish the crime. Compulsory measures may meet individual cases, and cause a temporary respite in a limited circle, but in order to produce an effect co-extensive with the transgression, that course should be pursued, the lenity of which proves its sincerity. Reason should be dealt with; moral suasion should be used, and no one can exert a greater influence than the physician; for no one is compelled like him to witness the misery, to see the distress which is acknowledged by the sufferer to have been thus produced, to hear the disclosures as they reluctantly fall from the lips of the dying penitent. We can do much-we can do all. If our profession will feel and act as one man; if they cannot all regard the subject in the same light as I have, as respects its morality, but will look at it merely as a cause of physical suffering to the mother; if they will upon all proper occasions freely express their convictions of its injurious effects, of its present danger, of its detrimental consequences,-a triumphant result must follow. Years, a half century perhaps, may elapse before such a reaction shall have been produced, but, slow although it would be, it would be certain. Like all other crimes it might be occasionally perpetrated. To preserve a previously unsullied character, to prevent a deep and damning stain upon a family's reputation, it would be clandestinely resorted to, but the virtuous mother would no longer be found sacrificing her offspring.
'In this connection I would for a moment refer to a subject which seems entirely to have escaped the notice of the medical writer, and yet it is one which must often force itself upon the mind of the physician, not merely as a prominent ground for variations in tables relating to population, but also as being a no inconsiderable cause of uterine disease. I allude to the means so extensively employed to prevent impregnation. Although there exists a large number of individuals whose conscientious scruples would prevent them from deliberately producing an abortion, very many of these consider that it is perfectly right to use all practicable means to avoid conception. To such an extent is this feeling carried, that it is a very common occurrence for the physician to be told that children need not be conceived, and by such persons they are not conceived; frequently to these individuals no children are ever born. This procedure is continually gaining strength, and is to a great extent based upon the same causes as those which prompt others to free themselves of the product of conception. The question of its morality I leave for others to argue, and only cursorily look at it as a cause of disease. The physiologist well knows that the functions of no organ can be interfered with without suffering being induced; that as an organ may be destroyed by excessive action, so may it become atrophied by disuse; that it requires a natural incentive, a peculiar, an appropriate stimulus to preserve its healthful condition; that a function may lie dormant for years, for life, may never be called into action, and yet the integrity of the organ may not apparently be affected,-but should it once be excited; the application of any cause which shall interfere with its perfect performance must be detrimental; and that if, when the system is perfectly developed, and the union of the sexes exists, the uterus is not allowed to be excited by the stimulus provided for that purpose, and for that purpose only, it cannot but suffer. An unusual determination of blood to the organ uniformly takes place at the moment referred to; if the sexual desire is gratified, the function naturally performed, this local plethora is relieved, and the organ is left sound. If, however, the operations of nature are interrupted, different results must follow. The interior of the organ, debarred from its appropriate excitement, executes imperfectly its function, the congestion is not readily removed, and, increased by every repetition of the unnatural intercourse, gradually passes into a state of confirmed hypertrophy. Without sufficient data to warrant me in stating positively the fact, I would, nevertheless, venture the belief that numberless cases of induration, and finally of organic disease, must be the inevitable consequences.
'I need not state that I have been induced to touch upon these most ungrateful topics from a sense of their vast importance; from a feeling that they have not received the attention they deserve from the profession at large; from the hope that even my feeble voice might not be raised entirely in vain; conscious that should any of my brethren fail to entertain similar views, they will appreciate my motives, and at least respect the expression of my opinions.'
AFTERWORD: Recent research showing that premature termination of pregnancy increases women's risk of breast cancer, shows the perspicacity and wisdom of David Humphreys Storer and Horatio Robinson Storer in the middle of the nineteenth century when they emphasized the health risks of induced abortion, even when the abortion itself was survived without incident.
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