Horatio Robinson Storer , M.D. and the Physicians’ Crusade Against Abortion

1. Horatio Robinson Storer, M.D. and the Physicians’ Crusade Against Abortion Frederick N. Dyer, Ph.D. Research Solutions, Inc. Columbus, Georgia

2. Presented February 25, 2012 at the Educational Meeting of the American Association of Pro-Life Obstetricians and Gynecologists at the Four Points by Sheraton Hotel, Washington D.C.

3. Goals of this presentation: • Identify Dr. Storer’s major contributions to gynecology and gynecological surgery. • Describe Dr. Storer’s key role in starting the “Physicians’ Crusade Against Abortion.” • Discuss how the “Physicians’ Crusade Against Abortion” has greatly influenced who is alive today in the U.S.

4. Who was Horatio Robinson Storer?

5. Who was Horatio Robinson Storer? • Born in Boston February 27, 1830. Died in Newport, R.I. September 18 , 1922. • Harvard University: A.B. 1850; A.M. & M.D. 1853; LL.B. 1868. • Studied a year with Edinburgh’s Dr. (later Sir) James Young Simpson. • Began medical practice in Boston in 1855 with emphasis on obstetrics and gynecology

6. Who was Horatio Robinson Storer? • Physician to the Boston Lying-in Hospital, St. Joseph’s (Catholic) Home, & St. Elizabeth’s Hospital for Women. • Professor of Obstetrics & Medical Jurisprudence at the Berkshire Medical College, Pittsfield, Massachusetts. • Prize Essayist & Secretary American Medical Association 1865, & Vice-President 1868.

7. Father was David Humphreys Storer, M.D. • Obstetrics professor and later Dean of Harvard Medical School. • Better known for his widely acclaimed “Report on the Fishes of Massachusetts,” published in August 1839. • As will be seen, contributed to the physicians’ crusade against abortion.

8. Anesthesia Pioneer • Horatio observed many of the earliest uses of ether during surgery, though not the first by John Collins Warren on October 16, 1846. • Worshipped chloroform discoverer, James Young Simpson of Scotland. • Storer’s limited and later full advocacy of chloroform anesthesia angered Boston etherites. • Advocated anesthesia for childbirth. • Storer saw this leading to fewer abortions by women who often chose abortion to avoid childbirth pain.

9. Dr. Storer’s contributions to gynecology and gynecological surgery • Storer1863: “Immediately on entering practice, it became evident to me that the great field for advance in obstetric therapeutics was the interior of the uterus,—an opinion that was daily strengthened during the intimate relations to which I was admitted by Prof. Simpson in 1854.” • At that time (1853), women suffered or died with problems that could have been found and easily treated if they had digital examinations.

10. Dr. Storer’s contributions to gynecology and gynecological surgery • “During the sixteen years since we graduated in medicine we have never once prescribed for a married woman with any, the slightest, pelvic symptoms,—and this is what perhaps no other living man can say,—without a careful digital examination; and while in a small proportion of cases we have found so healthful a local condition that we were able to dismiss the pelvic region from all participation in treatment, in scores upon scores of other cases, where not the slightest suspicion had existed on the part of the patient that there was here any cause for anxiety, we have detected the grave, effective, and real exciting cause of the distant or apparently constitutional disorder previously recognized.”

11. Dr. Storer’s contributions to gynecology and gynecological surgery • The first physician in America to give a complete collegiate course (60 lectures) upon the Diseases of Women as distinct from Midwifery. • One of the earliest successful hysterectomies. • Invented gynecological instruments and procedures.

12. One of the earliest successful hysterectomies. • On September 23, 1865, Horatio successfully performed an operation for the removal of the uterus and ovaries. His case was only the 6th successful hysterectomy out of a worldwide total of 24 such operations. • The exposed tumor was found to almost completely fill the abdomen and the abdominal mass was “continuous with another also of large size, and of very irregular outline, completely filling the cavity of the pelvis.” The great weight of the mass, later determined to be thirty-seven pounds was more than twice as heavy as any previously removed.

13. Invented the clamp shield. • Horatio described his new clamp shield. It provided a much stronger clamp on the uterine pedicle and which shielded “tissues beneath and around it from being lacerated.” It also served to lift “the uterus, so as to bring as much as possible of the cervix within its grasp,” and “lessens the number of ligatures necessary to be subsequently applied.” Numerous reports of Horatio’s and others’ surgery would credit this clamp shield for successful outcomes.

14. Invented the clamp shield.

15. Invented the “Boston speculum.” • Horatio viewed his new speculum as such a valuable advance that he published its description. The key feature was that the “duckbill” blades of the speculum could be reversed “by a slight touch of the finger” and the instrument then became a retractor. “If it is as appropriate for an inventor as for a naturalist to attach to a novelty its specific name, I would request that my instrument should be known as the Boston speculum, as I am anxious to do what little I can for the credit of my native city.”

16. Invented the “Boston speculum.”

17. Pocketing the ovarian pedicle • In September, 1867, an ovarian tumor of “some two years’ standing” and weighing forty-three pounds was removed from a 41-year-old woman. The clamp shield was applied to the pedicle and the ovary and its tumor separated from the pedicle with scissors. Horatio performed the surgery and for the first time “pocketed the pedicle.” • The closing of the incision and the “pocketing” were described as follows:

18. Pocketing the ovarian pedicle • The walls of the primary incision were united by twenty sutures of iron wire; the extremity of the pedicle being brought between the inner lips of the wound, at its lower angle, and there ‘pocketed;’ this being effected by passing three of the stitches through itself and both inner edges of the abdominal wound, and then bringing the external edges closely together; the raw surface of the pedicle being in apposition to the raw surfaces of the wound, and yet covered over fairly and completely by the line of superficial union.

19. Pocketing the ovarian pedicle • 24 years later, Horatio’s former student and close friend, Dr. Henry Orlando Marcy, was to write Horatio about the “discovery” of the procedure at Johns Hopkins in 1891.

20. Vaginal eversion of the female rectum • Horatio’s first published description of vaginal eversion of the rectum was in the May 1868 American Journal of Obstetrics. The technique involved insertion of the finger into the vagina, then the rectum is “everted through its sphincter like the finger of a glove.” Horatio indicated that he had practiced this for “many years” and shown it to a great many physicians present at his operations and examinations. Horatio suspected that although original with himself, it may have been “but the rediscovery of something already well known.” • Storer claimed this facilitated diagnosis and treatment of hemorrhoids and other rectal disease.

21. Started first society and journal devoted to gynecology

22. Started first society and journal devoted to gynecology • 7 volumes of the Journal of the Gynaecological Society of Boston were published from 1869 to 1872 (Storer’s extended illness ended journal). • It included: • Proceedings of the GynaecologicalSociety of Boston. • Original articles, including publication of his father’s suppressed 1855 abortion section. • Editorial Notes where Storer • Discussed Harvard Medical School deficiencies, • Decried excessive nuisances like the Revere Copper Company and the Brighton slaughter-houses, • Castigated abortion and abortionists.

23. Abortion was common in the middle of the 19th century. • You may find it surprising that abortion was common in the middle of the 19th century. • November 6, 1839. Hugh Lenox Hodge, M.D.’s Introductory Lecture: “this crime, this mode of committing murder, is prevalent among the most intelligent, refined, moral, and Christian communities” • March 1844. Gunning Bedford, M.D. “It, indeed, seems too monstrous for belief that such gross violations of the laws both of God and man should be suffered in the very heart of a community professing to be Christian.”

24. Abortion was common in the middle of the 19th century. • May 1844 . Boston Medical and Surgical Journal editorial: “In the city of Boston. There are men … celebrated … for their success in exterminating foetal life. • June 1850. David Meredith Reese, M.D. editorial: “We cannot refer such a hecatomb of human offspring to natural causes.”

25. Abortion common in middle of 19th • January 1851. John P. Leonard, “Quackery and Abortion”: “This kind of charlatanism is rife,” ALSO: “Besides these bills of mortality, the records of criminal courts will furnish sufficient proof that this crime is every day becoming more prevalent.” • November 1855. David Humphreys Storer’s Introductory Lecture: “The lecturer is silent, the press is silent, and the enormity, unrebuked, stalks at midday throughout the length and breadth of the land. “* • *David’s abortion comments were not published with the rest of his speech. Horatio published them in his journal in March 1872.

26. Abortion common in middle of 19th • December 1855 Boston Medical and Surgical Journal editorial protesting the suppression of David Storer’s abortion remarks:“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?”

27. Abortion common in middle of 19th • March 1857 letter to Horatio from C.W. LeBoutillier, M.D. of Minnesota: “The practice of producing abortion is frequently resorted to in our vicinity.” • April 1857 letter to Horatio from Wm. Henry Brisbane, M.D. of Wisconsin: “It is my present intention to endeavor to get a law paper by our legislature to meet the case, much too common, of administering drugs & injections either to prevent conception or destroy the embryo.”

28. Abortion common in middle of 19th • Storer’s 1857 Suffolk [Boston] District Medical Society Report on Criminal Abortion included: • “In no less than fifteen instances during the past half-year has the Chairman been called to treat the confessed results, near or remote, of criminal abortion; and, of these patients, all without exception were married and respectable women.”

29. Abortion common in middle of 19th • From Horatio’s November 1859 article, “The Duty of the Profession.” • One basis for physician guilt was their current “apathy and silence” on the subject of abortion, despite the fact that “thousands and hundreds of thousand of lives are thus directly at stake, and are annually sacrificed.”

30. Abortion common in middle of 19th • Augustus Kinsley Gardner, M.D., January 1960. • “We look with a shudder upon the poor ignorant Hindoo woman, who from the very love of her child, agonizes her mother’s heart, when in the fervor of her religious enthusiasm she sacrifices her beloved offspring at the feet of Juggernaut or in the turbid waves of the sacred Ganges, yet we have not a pang, nor even a word of reprobation, for the human sacrifices of the unborn thousands annually immolated in the city of New York before the blood-worshipped Moloch of fashion.”

31. Abortion common in middle of 19th • Edwin Moses Hale in his 1867 pamphlet, “The Great Crime of the Nineteenth Century,” claimed “two-thirds of the number of conceptions occurring in the United States, and many other civilized countries, are destroyed criminally.”

32. Storer’skey role in creating stringent legislation protecting the unborn • 1857: Requested the American Medical Association create a Committee on Criminal Abortion. They agreed and he was made Chairman. • 1859: Published nine articles on abortion for physicians in the North-American Medico-Chirurgical Review. • 1859: Prepared Committee’s Report on Criminal Abortion and the Resolutions that were presented at the Annual AMA meeting in Louisville. • 1860: Prepared Memorial sent to state legislatures requesting improvement of laws pertaining to abortion. • 1860: Prepared Address sent to State Medical Societies requesting their cooperation in seeking improved laws.

33. Storer’s articles in the North-American Medico-Chirurgical Review • “Criminal Abortion,” (January 1859) • “Its Frequency, and the Causes Thereof,” (March 1859) • “Its Victims,” (May 1859) • “Its Proofs,” (May 1859) • “Its Perpetrators,” (May 1859) • “Its Innocent Abettors,” (July 1859) • “Its Obstacles to Conviction,” (September 1859) • “Can It be at all Controlled by Law?” (November 1859) • “The Duty of the Profession,” (November 1859) • Articles published in 1860 as the book, Criminal Abortion in America.

34. Storer’s articles in the North-American Medico-Chirurgical Review • The final paragraph of Storer’s first North-American Medico-Chirurgical Review article read: • “And now words fail. Of the mother, by consent or by her own hand, imbrued with her infant’s blood; of the equally guilty father, who counsels or allows the crime; of the wretches who by their wholesale murders far out-Herod Burke and Hare; of the public sentiment which palliates, pardons, and would even praise this so common violation of all law, human and divine, of all instinct, of all reason, all pity, all mercy, all love,—we leave those to speak who can. “

35. Storer’s articles in the North-American Medico-Chirurgical Review • Reading “Of the Mother…” in 1994 made me realize that Storer was strongly pro-life and that he definitely needed a biography. It is unfortunate that James Mohr did not include “Of the Mother…” in his 1978 Abortion in America. It would have reduced the need for Joseph Dellapenna’s 2006 Dispelling the Myths of Abortion History. • Storer repeated “Of the Mother…” in 3 later books. “Of the Mother…” also was frequently repeated by other physicians and even by a judge in later articles and books.

36. 1859 Report of the AMA Committee on Criminal Abortion • The Report began: “The heinous guilt of criminal abortion, however viewed by the community, is everywhere acknowledged by medical men. Its frequency—among all classes of society, rich and poor, single and married—most physicians have been led to suspect; very many, from their own experience of its deplorable results, have known.” Additional evidence of abortion’s frequency were “comparisons of the present with our past rates of increase in population, the size of our families, the statistics of our foetal deaths, by themselves considered, and relatively to the births and to the general mortality.”

37. 1859 Report of the AMA Committee on Criminal Abortion • Horatio then moved to the reasons for the large number of abortions. These included the “wide-spread popular ignorance of the true character of the crime,” the innocent abetment of abortion by physicians who “are frequently supposed careless of foetal life,” and “the grave defects of our laws, both common and statute, as regards the independent and actual existence of the child before birth, as a living being.” As “[a]bundant proof upon each of these points,” Horatio called attention to his nine articles in the North-American Medico-Chirurgical Review.

38. 1859 Report of the AMA Committee on Criminal Abortion • The Report then moved to the duties of physicians. “The case is here of life or death—” he continued, “the life or death of thousands—and it depends, almost wholly, upon ourselves.” He called on physicians to enlighten the public about fetal development, to avoid any appearance of negligence “of the sanctity of foetal life,” and to establish an “obstetric code; which ... would tend to prevent such unnecessary and unjustifiable destruction of human life.”

39. 1859 Report of the AMA Committee on Criminal Abortion • He then turned to the deficient laws on abortion and called on physicians “as citizens” to improve them. “If the evidence upon this point is especially of a medical character,” he continued, “it is our duty to proffer our aid, and in so important a matter to urge it.”

40. The 1859 Report of the AMA Committee on Criminal Abortion concluded: The Committee would advise that this body, representing, as it does, the physicians of the land, publicly express its abhorrence of the unnatural and now rapidly increasing crime of abortion; that it avow its true nature, as no simple offence against public morality and decency, no mere misdemeanor, no attempt upon the life of the mother, but the wanton and murderous destruction of her child; and that while it would in no wise transcend its legitimate province or invade the precincts of the law, the Association recommend, by memorial, to the governors and legislatures of the several States, and, as representing the federal district, to the President and Congress, a careful examination and revision of the statutory and of so much of the common law, as relates to this crime.

41. Resolutions of the Committee on Criminal Abortion • “Resolved, That while physicians have long been united in condemning the act of producing abortion, at every period of gestation, except as necessary for preserving the life of either mother or child, it has become the duty of this Association, in view of the prevalence and increasing frequency of the crime, publicly to enter an earnest and solemn protest against such unwarrantable destruction of human life.

42. Resolutions of theCommittee on Criminal Abortion • “Resolved, That in pursuance of the grand and noble calling we profess, the saving of human lives, and of the sacred responsibilities thereby devolving upon us, the Association present this subject to the attention of the several legislative assemblies of the Union, with the prayer that the laws by which the crime of procuring abortion is attempted to be controlled may be revised, and that such other action may be taken in the premises as they in their wisdom may deem necessary.

43. Resolutions of theCommittee on Criminal Abortion • “Resolved, That the Association request the zealous co-operation of the various State Medical Societies in pressing this subject upon the legislatures of their respective States, and that the President and Secretaries of the Association are hereby authorized to carry out, by memorial, these resolutions.”

44. AMA Report and Resolutions • Horatio was too ill to travel to Louisville . • Louisville 3 May 59 • Dear Dr • I have ordered the paper sent to you daily during our associate existence. You will see that your report was read and the resolutions unanimously adopted. Your report was highly spoken of, not a dissenting voice in any direction. I am sorry my dear Dr to hear from Dr Townsend the cause of your not being with us. I do hope my dear yoke fellow (though I am not the oldest ox) that your illness will be of short duration, and that a little relaxation will restore you to your wanted measure of health and professional ability.. Yours truly • ThosW Blatchford

45. AMA Report and Resolutions • Louisville 5 May 1859 • My Dear Dr • I cannot tell you the number of Gentlemen who have spoken to me about your Report since I read it nor can I begin to tell you the high encomiums, bestowed upon it without a single drawback. I thought you would like to know it. To know that our labors are appreciated by our brethren when those labors have been bestowed in the cause of humanity is a precious cordial for one's soul in this old and thankless world. • … • Yours very sincerely • Thos W Blatchford

46. 1860 Memorial Requesting Improvement of Laws • “To the Governor and Legislature of the State of __________ the Memorial of the American Medical Association, an Organization representing the Medical Profession of the United States.” The Memorial then indicated that criminal abortion was “the intentional destruction of a child within its parent; and physicians are now agreed, from actual and various proof, that the child is alive from the moment of conception.” It described the high and increasing rate of criminal abortion that led to the deaths of “hundreds of thousands” and “the serious injury thereby inflicted upon the public morals.”

47. 1860 Memorial Requesting Improvement of Laws • “Public sentiment and the natural sense of duty instinctive to parents proving insufficient to check the crime, it would seem that an appeal should be made to the law and to its framers.” The various problems with existing statutes were then briefly described including the inconsistency of the Common Law that “fails to recognize the unborn child as criminally affected, whilst its existence for all civil purposes is nevertheless fully acknowledged.”

48. 1860 Memorial Requesting Improvement of Laws • The Memorial then referred to the “duty of the American Medical Association ... publicly to enter an earnest and solemn protest against such unwarrantable destruction of human life.” “The duty would be but half fulfilled did we not call upon those who alone can check and control the crime, early to give this matter their serious attention.” It concluded:

49. 1860 Memorial Requesting Improvement of Laws • “The Association would in no wise transcend its office, but that office is here so plain that it has full confidence in the result. We therefore enter its earnest prayer, that the subject of Criminal Abortion in the state of _____________, and the laws in force on the subject in said State may be referred to an appropriate Committee, with directions to report what legislative action may be necessary in the premises.” • Horatio’s 9 North-American Medico-Chirurgical Reviewarticles were enclosed with the Memorial.

50. 1860 Address Sent to State Medical Societies • The Address consisted of the three Resolutions on Criminal Abortion plus the following: • In pursuance of our instructions, a memorial, of which a copy is herewith enclosed, has been transmitted to the Governor and Legislature of the State of _______________, and it now has become our duty earnestly to request of the body you represent, such early and hearty action in furtherance of the memorial of the Association, as may insure its full success against the common, though unnatural crime it aims to check.