In the 21st century,
the premier pro-life issue of our time is abortion. Abortion has always been
with us, although feminists sometimes exaggerate the extent of its practice up
to the 19th century. Elective abortion using herbs, or instruments
was not a safe a procedure. Even
physicians who performed abortions for medical reasons did so with some
trepidation[1],
and only when the woman’s life or health was in imminent jeopardy.[2]
Craniotomy, however, was also a means of killing the unborn that has been
legally sanctioned for millennia. Craniotomy was the operation that
obstetricians used to deal with obstructed labour. Obstructed labour was
usually caused by pelvic deformities that were the result of nutritional
deficiencies.[3]
Whenever there was too great a
difference between the size of the pelvis and the size of the fetal head,
physicians would often perform this operation. They would use a sharp tool such as a perforator or a pair
of obstetric scissors
to pierce the head, then evacuate the brain and collapse the skull. If the head
was inaccessible, then the child would be eviscerated or body parts would be
amputated. Sometimes the
operation was performed on a dead fetus. But much of the time, it was done on
children who were still alive.[4]
Anglo-American physicians strongly detested this procedure. American
Obstetrician Charles Meigs wrote “Perhaps there is nothing to be met with in
the very troublesome and anxious profession of an obstetrician, that is more
painful to his feelings, than the management of a case of labour, in which it
is required to mutilate the child, in order to extract it from the maternal
organs.” [5] Sometimes
practitioners would try to have someone else do the procedure.[6] In
order to assuage their conscience, some physicians waited for the baby to die.[7] But
Hugh L. Hodge warned students in his textbook that if craniotomy was required,
there should be no delay. [8]
Physicians tried to develop techniques to avoid having to perform this
operation. Where possible, they used forceps or version. If they knew
the pregnant mother had a small pelvis from a previous delivery, they might try
to bring on premature labour in the seventh or eighth month, when the fetus was
smaller.
The C-section seems like an
obvious solution to this problem, but doctors were usually very
reluctant to perform them. There was virtually no infection control in
the early 19th century as doctors were either ignorant of germ
theory, or had an imperfect understanding of it. When the pelvic diameter was
less than two inches, they had no choice but to perform the operation, as there
was insufficient room to use sharp instruments and extract pieces of the
mutilated baby. C-sections were truly the measure of last resort, as most Anglo-American women who underwent
c-sections died in this period.[9]
American obstetricians understood
that the fetus was a human being from his conception, or thereabouts.[10] But they also considered the fetus to be almost inert. The first American obstetrics textbook published in 1807 by Samuel
Bard claimed that an infant emerged from a “vegetable life” when it was born,
that the unborn were more plant than animal.[11] Echoing
these same sentiments, Gunning S. Bedford wrote in 1861 that “the infant before birth may be regarded as enjoying an existence purely
vegetative.”[12]
In the same vein, Hugh L. Hodge wrote in 1864 “the foetal life is essentially vegetable
or organic.”[13] Once the child was born, he was said to enter
“animal life.”
America’s most famous obstetrician in the period, William P. Dewees, opposed
this discourse regarding the unborn child, as he thought it underestimated the
child’s value. He feared this devaluation of the child would lead to greater
recourse to destructive means. [14] He wrote:
“In a moral point of view, the turpitude of destroying the life of
the foetus by design, call it vegetable, or animal, as you please, will be the
same; nor must we permit ourselves to undervalue it, or be seduced to destroy
it wantonly, by employing terms which have no definite meaning; or , if they
have a definite meaning, the destruction of the principle called life must, in
a moral light, be viewed as a crime.”[15]
Gradually, Dewees did adopt a more pro-life view, coming to prefer
c-sections over craniotomy,[16]
though not in all cases.[17]
In spite of this belief about the
unborn, most American physicians favoured the
criminalization of abortion. A fetus was a human being, who deserved to
be legally protected. But between the woman and the fetus, the woman was the more important human being.
[18] Obstetrician Charles
D. Meigs expressed the consensus of the medical establishment when he wrote:
“The child has no fixed claims whatever, if they come to conflict
with the rights of its more important parent.”[19]
And it is for this reason that
craniotomy was perceived to be an acceptable solution to obstructed labour.
But craniotomy was supposed to be used as a last
resort. The physicians who taught its use in lectures and textbooks were the
top practitioners in their field. They had many techniques at their disposal,
and many years experience to perfect their art. Lesser practitioners were not
so well-versed in obstetrics. And so they were more prone to practice
craniotomy as a shortcut in dealing with difficult labours. These elite
obstetricians decried this state of affairs.[20]
Many seemed to have their own stories and experiences with unnecessary and/or
botched craniotomies.[21]
Improvements in medicine made craniotomies less common, but they were
practiced well into the early decades of the twentieth century. Even today, in
certain remote parts of the world, they are still practiced where birth
attendants do not have access to hospitals.[22]
We can see in the discourse about
craniotomy the rudiments of the contemporary abortion debate. The unborn are
human beings who deserve consideration, but when the mother’s interests are at
stake, they can be sacrificed as they are not as important as the mother,
because they exist in a vegetative state.
William Dewees was a strong voice against the devaluation of the unborn. He
spent many pages of his textbook refuting the beliefs of 18th century British obstetrician
William Osborn, who more than any other Anglo-American practitioner, held the
fetus in low esteem, saying that it was basically inert and did not feel any
pain during craniotomy. Dewees writes of Osborn:
“He declares the struggle of an infant in utero would be an evidence of
pain and of course of its possessing " sensation ;" and that if this
struggle did take place even in articulo mortis, it is highly probable
that the mother would be sensible of it — now, what is the fact upon this
subject? Why that we have been repeatedly informed by mothers, that they
were apprehensive their children were dead, because after a severe struggle or
kind of fluttering, which has been described of longer or shorter duration,
they had felt their children no more — every accoucheur can bear witness to
such statements from mothers.”
 |
| From Henry Miller's 1854 textbook on obstetrics |
[1]
Walter Channing, “Effects of Criminal Abortion,” Boston Medical and Surgical
Journal LX, no. 7 (March 17, 1859): 136. https://play.google.com/books/reader?id=EQEHAAAAcAAJ&hl=en_CA&pg=GBS.PA134.
[2]
Among the more common reasons to produce abortion in the early 19th
century were: hyperemesis gravidarum (causing severe vomiting) William
Dewees, A Treatise on the Diseases of Females (H.C. Carey & I. Lea,
1826), 135; Walter Channing, “Effects of Criminal Abortion,” Boston Medical and
Surgical Journal LX, no. 7 (March 17, 1859): 141; retroversion of the uterus: Gunning
S. Bedford, The Principles and Practice of Obstetrics (Samuel S. &
William Wood, 1861), 234; William P. Dewees, “Observations on the Retroversion
of the Uterus,” in Essays on Various Subjects Connected with Midwifery
(Philadelphia: H.C. Carey & I. Lea, 1823), 287; and convulsions: Charles D. Meigs, The
Philadelphia Practice of Midwifery (J. Kay, jun. & brother; Pittsburgh,
J. I. Kay & Company, 1838), 280-281; Channing, The Effects of Criminal
Abortion, 141. Many more examples of these medical exceptions could be cited.
[3]
These pelvic deformities were typically caused by rickets, a disease caused by
the lack of Vitamin D. Although American-born women typically did not develop
rickets, immigrants such as the Irish, were prone to this problem due to their
extreme poverty. Other causes of obstructed labour included tumours in the
birth canal and hydrocephalus, which caused a build-up of fluid in the child’s
skull.
[4]
It is important to remember that statistics on craniotomy do not make a
distinction as to which procedures were done on live children.
[5]
Charles D. Meigs, The
Philadelphia Practice of Midwifery (J. Kay, jun. & brother; Pittsburgh,
J. I. Kay & Company, 1838), 317.
[6]
Charles D. Meigs, Obstetrics: The Science and the Art (Blanchard and
Lea, 1852), 567.
[7]
Thomas Cock, A Manual of Obstetrics (Wood, 1853), 232.
[8]
Hugh Lenox Hodge, The Principles and Practice of Obstetrics: Illustrated
with One Hundred and Fifty-Nine Lithographic Figures from Original
Photographs : And with Numerous Wood-Cuts (Henry C. Lea, 1864), 398, https://play.google.com/books/reader?id=gj9GAQAAMAAJ&hl=en_CA&pg=GBS.PP1.
[9]
In Britain, most women who underwent
the operation died, while in France, a bare majority survived, according to
Baudelocque. See footnote by John W. Francis in Thomas Denman, An
Introduction to the Practice of Midwifery, ed. John W. Francis (New-York :
G. & C. & H. Carvill, 1829), 498, http://archive.org/details/56711100R.nlm.nih.gov.
[10] Theodric Romeyn Beck, Elements of
Medical Jurisprudence (John Anderson et al., 1825), 79; Gunning S. Bedford, The Principles
and Practice of Obstetrics (Samuel S. & William Wood, 1861), 176-177; William Dewees, A
Compendious System of Midwifery: Chiefly Designed to Facilitate the Inquiries
of Those Who May Be Pursuing This Branch of Study. Illustrated by Occasional
Cases (John Miller, 1825), 108; Robley
Dunglison, Human Physiology, vol. II (Lea and Blanchard, 1841), 484; Hugh Lenox Hodge, The
Principles and Practice of Obstetrics: Illustrated with One Hundred and
Fifty-Nine Lithographic Figures from Original Photographs : And with Numerous
Wood-Cuts (Henry C. Lea, 1864), 78, https://play.google.com/books/reader?id=gj9GAQAAMAAJ&hl=en_CA&pg=GBS.PP1; Stephen Tracy, The Mother and
Her Offspring (Harper & Bros., 1860), 74; Stephen West Williams, A Catechism of Medical
Jurisprudence: Being Principally a Compendium of the Opinions of the Best
Writers Upon the Subject : With a Preliminary Discourse Upon the Importance of
the Study of Forensic Medicine : Designed for Physicians, Attornies, Coroners,
and Jurymen (J.H. Butler, 1835),
79.
[11]
Samuel Bard, A Compendium of the Theory and Practice of Midwifery (New
York: Collins and Co., 1807), 205. https://collections.nlm.nih.gov/bookviewer?PID=nlm:nlmuid-2542028R-bk#page/4/mode/2up.
[12]
Gunning S. Bedford, Clinical Lectures on the Diseases of Women and Children
(S.S. & W. Wood, 1855), 451.
[13]
Hugh Lenox Hodge, The Principles and Practice of Obstetrics: Illustrated
with One Hundred and Fifty-Nine Lithographic Figures from Original
Photographs : And with Numerous Wood-Cuts (Henry C. Lea, 1864), 399. https://play.google.com/books/reader?id=gj9GAQAAMAAJ&hl=en_CA&pg=GBS.PP1.
[14]
William Dewees, A Compendious System of Midwifery ... Illustrated by
Occasional Cases. With Fourteen Engravings (Philadelphia, 1843), 532.
[15]
William Dewees, A Compendious System of Midwifery ... Illustrated by
Occasional Cases. With Fourteen Engravings (Philadelphia, 1843), 533.
[16]
William Dewees, A Compendious System of Midwifery ... Illustrated by
Occasional Cases. With Fourteen Engravings (Philadelphia, 1843), 550.
[17]
William Dewees, A Compendious System of Midwifery, 304.
[18]
Gunning S. Bedford, The Principles and Practice of Obstetrics (Samuel S.
& William Wood, 1861), 279; Hugh
Lenox Hodge, The Principles and Practice of Obstetrics: Illustrated with One
Hundred and Fifty-Nine Lithographic Figures from Original Photographs : And
with Numerous Wood-Cuts (Henry C. Lea, 1864), 298; Henry Miller, “A Theoretical and Practical Treatise on Human
Parturition,” 1849, 374; Thomas Cock, A Manual of
Obstetrics (Wood, 1853), 137. David H. Tucker, Elements of the
Principles and Practice of Midwifery (Lindsay and Blakiston, 1848), 376.
[19]
Charles D. Meigs, Obstetrics: The Science and the Art (Blanchard and
Lea, 1852), 563.
[20]
Samuel Bard, A Compendium of the Theory and Practice of Midwifery (New
York: Collins and Co., 1807), 9; William Dewees, A Compendious
System of Midwifery ... Illustrated by Occasional Cases. With Fourteen
Engravings (Philadelphia, 1843),
XV; William Dewees, A Compendious System of Midwifery: Chiefly Designed
to Facilitate the Inquiries of Those Who May Be Pursuing This Branch of Study.
Illustrated by Occasional Cases (John Miller, 1825), 578. Thomas Denman, An Introduction to
the Practice of Midwifery, ed. John W. Francis (New-York : G. & C.
& H. Carvill, 1829), 697
[footnote by John W. Francis]; Gunning
S. Bedford, The Principles and Practice of Obstetrics (Samuel S. &
William Wood, 1861), 630, 658.
[21]
Gunning S. Bedford, The Principles and Practice of Obstetrics (Samuel S.
& William Wood, 1861), 659; William Dewees, A Compendious
System of Midwifery ... Illustrated by Occasional Cases. With Fourteen
Engravings (Philadelphia, 1843),
558; also see Judith Walzer Leavitt, Brought to Bed: Childbearing in
America, 1750-1950, 30th Anniversary Edition (Oxford University Press,
2016), 44-45.
[22]
For example, see this web page from Médecins sans frontieres: https://medicalguidelines.msf.org/viewport/ONC/english/9-7-embryotomy-51417976.html
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