From the Other End of the Speculum

April 14, 1844

“Are you aware that you are in a dangerous condition?” the New York City coroner asked. *

The fever flushed Eliza’s sunken cheeks, and her hair, oily and stringy from sweat, was matted against her scalp. Perspiration glistened on her forehead. “Yes, sir,” she said. The physician who’d been attending her had given her narcotics to make her comfortable, but as the infection spread, it was impossible to find any position on the worn cot satisfying. Every part of her body ached, from the burning behind her eyes to her stiff muscles and joints. During the past two weeks, any fat reserves she’d had were depleted, and her muscles had atrophied. Her limbs felt heavy, as if stones had been placed on them, although they had never been lighter. The pain in her swollen abdomen hurt worst of all. She bent, then straightened her legs, trying to alleviate her misery. She pressed her hands against her belly, as if the pressure would make the pain subside.

Dr. Sweeney had summoned Coroner Edmund Rawson to Mrs. Bird’s boarding house because Eliza was in a “dying state.” Dr. Sweeney told him that the girl was a native of New Haven, Connecticut, who had “respectable connections.”

Rawson arrived on Sunday evening at eight o’clock, bringing with him Police Justice Merritt, to hold an antemortem examination in Eliza’s bedroom. Upon entering, they found the young woman lying on a cot in the center of a small, dimly lit room. The transom above the door provided perhaps the only ventilation from the putrid, sickeningly sweet smell of infection. Eliza had wasted to a mere skeleton, despite Dr. Sweeney’s attempts to save her. Eliciting as much information as he could and afraid she’d expire at any moment, Rawson had twenty-six-year-old Eliza make her mark on the deposition after each short series of questions. All she could manage in her fragile state was a faint X on the paper. Rawson suspected she wouldn’t survive much longer, but he made sure he had her signed testimony. Someone would pay for the condition of this girl.

Over the next eight hours, Eliza sunk lower and lower. Dr. Sweeney roused her when he could with stimulants, then Rawson continued with more questions.

“Did you have an operation performed on you for the purpose of procuring an abortion?”

“Yes.”

*
July 2, 1975

“It’s almost over,” I told Terri (as I’ll call her), the twenty-something woman on the examining room table, as I held her hands in mine. She squeezed so tight I thought my bones might break.

I stood by her side. Her tears, glistening from the fluorescent ceiling lights, slid down the side of her face, wetting her blond hair. I looked at Dr. Eames, only the top of his fuzzy gray-haired head visible. He huddled between Terri’s naked legs draped in a pastel-blue paper sheet, suctioning the unwanted pregnancy from her womb.

In my training as a medical assistant, I’d learned to disengage myself from the patients, not to let myself imagine what the patient felt during a procedure. This detachment made it tolerable for me to give wailing babies injections, to pierce a squirming child’s spaghetti vein for blood on the first try, to assist without fainting as a doctor sliced through skin with a scalpel blade. But when Terri’s legs, propped in the stirrups, began quivering involuntarily, the paper drape crackling as she trembled, my resolve broke, and I fought the urge to flee the room, never to return to a doctor’s office again.

Loosening a hand from Terri’s grip, I placed it on one knee to steady her leg. I focused on a colorful anatomical diagram of the female reproductive organs on the opposite wall. As I mentally reviewed the names of the parts—cervix, uterus, fallopian tubes, ovaries—then recited the lyrical medical terms I’d learned in school, like bilateral salpingo-oophorectomy (surgical removal of both ovaries and fallopian tubes), I regained my composure.

“It’s OK, Terri,” said Dr. Eames. “We’re almost through.”

This was my first job after interning in another medical practice. My wide-eyed wonder for the glamorous world of doctors and medicine began when I had volunteered at Planned Parenthood. There, teens and women could obtain low-cost birth control, but not abortions. For that, they had to make an appointment with a doctor. I decided then to go to medical assisting school, already knowing I wanted to work for an obstetrician-gynecologist. When I interviewed with Dr. Eames, I learned he did abortions two mornings a week, scheduled on days when expectant mothers who wanted their babies didn’t have appointments. This kept the women, some of them teenagers, who decided against bringing their pregnancies to term, from having contact with his other patients. Was it to protect the privacy of those ending their pregnancies, I wondered, or to sequester them? Because Dr. Eames terminated pregnancies in the office building of his private practice, not in an abortion clinic, his patients, most of whom were middle class white women, never had to confront protestors. Nor did I.

When a woman came in for an abortion, Dr. Eames counseled her and explained the procedure. On that first visit, when I initially met Terri, I assisted as he inserted a laminaria, a compacted piece of seaweed from the Sea of Japan that looked like an algae-green houseplant spike with a string, into the neck of her cervix. Overnight, the laminaria dilated the opening somewhat, as it swelled like a tampon from the mucosa in the surrounding tissues. This dilation caused less physical trauma and slightly less pain when Dr. Eames performed the abortion the next day.

I had no way of knowing then the impact these procedures—and the women who had them—would leave on me, especially this first abortion. Terri was surely more frightened than I, but I was scared, too. When her legs started shaking, I swore to myself right then that I would never miss taking a birth control pill. Terri’s ordeal was one neither of us would forget.

*

Eliza Munson found the strength to tell Coroner Rawson that her abortion took place the previous December, when she was six weeks pregnant. A woman named Madame Restell of Greenwich Street performed the abortion. Eliza’s boyfriend, James Fraser, had seen an ad in the newspaper and accompanied her to the abortionist’s house. The couple explained to Madame Restell that Eliza needed assistance with her condition. James paid for the procedure—$19—then Madame Restell took Eliza into a room and shut the door.

In the diffuse glow of the flickering oil lamp, Eliza took off her winter cloak and bonnet, but Madame Restell instructed her to remove just her knee-length chemise from under her long bell-shaped skirt, then to lie on the floor. What thoughts went through Eliza’s mind as she lay there? How could she not be frightened? Did she have second thoughts? Did she know how it would hurt? Was she wishing she had someone’s hand to hold?

Restell knelt and reached her bare, unwashed hands up Eliza’s skirts. Eliza couldn’t see what Madame Restell was doing, so she didn’t know whether the woman used her fingers or an instrument, or both. But Eliza could feel the pain. Without any pain medicine, Restell forced something inside her womb. Eliza surely cried out.

*

After pulling out the exam table extension, I lifted and lowered Terri’s shaking legs from the stirrups to straighten them and adjusted the paper drape blanketing her legs. Dr. Eames stood from his stool and removed his surgical gloves, snapping them off and into the waste can, infusing the sterile air momentarily with the smell of latex and powder. As if choreographed, he stepped over to Terri’s side while I moved out of her sight to cover the clear jar reflecting her terminated pregnancy. From a stainless steel cabinet, I pulled out a sage-colored surgical towel, then I draped it over the container—like a flag over a casket. Dr. Eames patted Terri’s arm, told her she had done well, and asked if she had any questions. She sniffled a no and wiped her tears with the Kleenex I had given her. I wondered if the glare from the ceiling lights bothered her eyes. Dr. Eames told her I would explain the post-op care and would schedule her follow-up appointment for a week from today. He gave her arm a quick squeeze, turned and nodded to me, then left the room.

I placed a sanitary pad between Terri’s legs and asked, “Do you feel ready to sit up? Or do you want to lie here a few minutes?”

“No. I can get up.”

I gripped Terri’s arm and put my free hand on her back, feeling the damp warmth of her skin. She rocked slightly to the side and lifted from the waist to sit up. Her body still quivered, a nervous reaction from the procedure and the medications Dr. Eames had injected into her vein several minutes before he began: Valium to relax her and Demerol for the pain.

*

After Madame Restell finished the procedure, she had Eliza stay in her care the rest of the day and night, but she didn’t see a need for Eliza to be confined to her bed. She could rise and move about when she felt like it. The next day, Eliza took the train back to her hometown of New Haven.

But she eventually returned to New York City to work at her sewing trade, because people in New Haven were talking. The gossip about her condition and the solution to her problem had become known. “I did not wish to remain there to mortify my friends,” she told Coroner Rawson. She rented a room in Manhattan from Mrs. Susan Devlin, and Eliza lived there until she became ill in mid-April 1844. She claimed she had never been right since the abortion last December, and she’d had two heavy periods, which she called “floodings.” Hoping to receive a remedy for her ailment, she sought help from Mrs. Bird, a nurse, at 18 Oliver Street.

Dr. James Sweeney attended Eliza, treating her at Mrs. Bird’s. “She had violent uterine hemorrhage at that time,” he informed the coroner. Sweeney had packed her with cotton and treated her with “two drachmas of powdered Secale Cornutum,” a compound made from ergot, which would help the blood loss and constrict the uterine muscle fibers. When he visited Eliza later in the afternoon, the hemorrhaging had subsided. Upon examination, “I found something in the neck of the uterus and protruding a little from its mouth,” he said, “which to the feel appeared to be a portion of the placenta.”

Eliza’s back and abdominal pain continued. Dr. Sweeney tried to alleviate her suffering. At first, he did not administer any opiates because he was afraid the drugs would interfere with her uterine contractions and the expulsion of the remaining placenta. At various times, however, he ultimately gave her laudanum, nitrous aether, and castor oil, even though it was three or four days before the placenta completed its expulsion. The placenta, Sweeney reported, “was in a putrid condition, from which I inferred that it was detached from the uterus for some time and had lost its vitality.”

Dr. Sweeney knew Eliza was dying. Even after the placenta detached, she complained of abdominal pain. He catheterized her, but only a tablespoon or two of urine dripped out; he administered an injection, “which operated freely on her bowels.” The next day Eliza still had abdominal tenderness, so Dr. Sweeney applied leeches. Then he gave her calomel, a common treatment for gastrointestinal problems, and opium. The bleeding from the leeches relieved some of her pain, and she began feeling better. But within days, Eliza relapsed. “There was distension [sic] of the bowels and the pain returned,” said Dr. Sweeney. “I prepared a turpentine injection [to treat intestinal parasites], which was administered and a large blister was applied under the umbilicus…” After he caused her skin to blister by giving her a second degree burn, he drained the wound. Physicians believed that an imbalance in the four humors—blood, phlegm, and black and yellow bile—caused disease. Bleeding, purging, puking, blistering, poulticing, and applying toxic ointments were typical treatments to restore balance.

When Eliza didn’t improve, Sweeney called in a colleague, Dr. Olliff, for his opinion. Dr. Olliff concurred that Eliza was dying. Sweeney told Eliza that she was in a “dangerous situation,” and he applied more leeches and created two more large blisters. On another visit, Dr. Sweeney brought with him another colleague, Dr. Colwell, who “proposed moistening a segar [sic] and passing it up the rectum, and withdraw[ing] it [quickly] in order to reduce the flatulence, which was done without producing any effect.” When Dr. Sweeney again emphasized to Eliza that she was in a dangerous condition, she confessed that she’d had an operation performed by Madame Restell.

When Coroner Rawson heard the story, he issued a subpoena for the abortionist.

*

Some twenty years after working in Dr. Eames’s office, I had changed careers, becoming a professional genealogist. I happened upon Eliza’s case in the New York City coroner’s files, where she reeled me into the lives of women, not unlike my patient Terri, who endured the trauma of deciding to terminate a pregnancy and then the physical ordeal. I understood what Eliza suffered. When I stood by the sides of women who’d had abortions, I was the one who held their hands, trying to comfort them through a procedure that left permanent emotional scars. I was the one handing them tissues to dry their tears. I was the one reassuring them that everything would be fine—as if I could know that.

*

Eliza, like all women then, had few, if any, dependable methods of preventing pregnancy other than abstinence. The rhythm method gained popularity slowly in the 1840s and 1850s. More common for birth control was vaginal douching with warm water and an astringent such as tannin, powdered opium, prussic acid, iodine, or strychnine, all considered spermicides. There were also no reliable means for determining whether a woman was pregnant until quickening, or fetal movement. Unable to distinguish between an early pregnancy or a missed period, physicians and women often treated a late period as an “obstruction,” thereby terminating—intentionally or unintentionally—a potential pregnancy. Most people did not see this practice as either morally or legally wrong.

Women commonly resorted to using botanical and chemical abortifacients. Eliza had ingested oil of Tansy, a poisonous flowering herb, on at least one occasion to produce a miscarriage, but without success. Ergot, a fungus that grows on rye, was known to cause uterine contractions, thereby forcing a miscarriage. Women obtained these remedies from chemists, doctors, and midwives. Early nineteenth-century statutes made abortion a crime only when poisons or “instruments,” such as a hat pin, knitting needle, or wire to separate the fetus and placenta from the womb, were used after quickening. In order for Madame Restell to reach inside Eliza’s uterus, she almost certainly used an instrument. Even with Eliza’s knees bent close to her chest, Madame Restell’s finger likely wouldn’t have been long enough to reach through the vaginal canal and into the neck of the cervix, a little more than an inch long, to then penetrate the uterus and dislodge the fetus and placenta. Her finger also would have been too large to insert into the tightly closed cervical os (opening) without using extreme force.

By Eliza’s day in the 1840s, abortion was on the rise. It was no secret that single and married women from all classes, but especially middle and upper class women, used abortion as a means of family limitation or to treat an unwanted pregnancy. In newspapers across the country, chemists, midwives, and physicians advertised “menstrual regulators” in the form of “pills guaranteed in every case where the monthly periods have become irregular.” Warnings that these pills “would undoubtedly…produce miscarriage” did not escape anyone’s attention. Prescriptive literature, such as The Married Woman’s Private Medical Companion, published in 1854, offered advice on “when proper and necessary to effect miscarriage.”

One physician of the day remarked, “Ladies boast to each other of the impunity with which they have aborted, as they do of their expenditures, of their dress, of their success in society. There is a fashion in this.” For many bourgeois women, it became common practice to abort “pregnancies that occurred during the first few years of marriage, pleading that polite society considered early pregnancies déclassé.” A Michigan physician reported in the Detroit Review of Medicine and Pharmacy in 1873 that abortions were so common in America that it was rare for a married woman of childbearing age not to have had one or more abortions.

*

Coroner Rawson needed Eliza to identify Madame Restell. When summoned, however, Restell refused to cooperate, so he issued a warrant for her arrest. The officers found Madame Restell in bed and brought her to the house on Oliver Street where Eliza lay dying. To assist in their line-up, the officers directed two other women who boarded in the Restell household to dress themselves like Restell and to fashion their hair like hers. Restell wore her black hair parted down the middle, smooth against her head and pulled back into a bun at the crown of her head. Long spiral curls dangled on the sides in front of her ears.

When the three women arrived in Eliza’s room, they stood before her.

“Do you know the women present in this room?” Coroner Rawson asked Eliza.

She raised her head, giving each an earnest look. In the glittering light, she probably squinted to see. Then she pointed. “I know that one. I believe it is Madame Restell.” Eliza sunk back on her pillow.

Rawson continued his questioning. “Is the woman present, the one that operated on you, for the purpose of producing abortion and, if so, which one was it?”

Eliza pointed at the same woman. “That one seems to be the one. I never saw her but once before in a house in Greenwich Street.”

Rawson looked at Madame Restell, then directed another question at Eliza. “What business did you have with this woman when you saw her in Greenwich Street?”

“I went there to have her produce an abortion upon me.”

“And what induced you to come to Mrs. Bird?”

“I was out of health.” Eliza’s words faded under her breath. “I thought I would come and see what ailed me.” Then she spoke no more.

Death relieved Eliza Ann Munson of her suffering around four in the morning on April 15, 1844.

*

In Eliza’s time, rarely was it solely a woman’s decision to terminate her pregnancy without regard for her husband or lover. In almost all cases reported in the press, medical journals, and court records of the time, men, like Eliza’s boyfriend James Fraser, either encouraged women to seek abortions or helped women secure them.

Yet it wasn’t religious or moral reform groups who eventually swayed lawmakers, nor was the life of the unborn child a foremost issue. Rather, the laws changed in part because white Protestant Americans feared being out bred and out numbered by the arrival of thousands of European immigrants throughout the nineteenth century. At the same time, an increasing number of middle- and upper-class white Protestant married women sought abortions to limit their family sizes. It was the American Medical Association that lobbied for legislation to curb deliberately procured miscarriages. One by one, states passed harsh laws during the late nineteenth century, making abortion at any stage during gestation a criminal offense and holding the woman and the abortionist accountable. These laws remained unchanged for nearly 100 years until the Supreme Court overturned them in the famous Roe v. Wade case of 1973, which gave women an unconditional right to terminate a pregnancy in the first or second trimester of pregnancy. Pregnancy in the third trimester could also be terminated, but only if the life or health of the mother was at risk.

*

“Can…can I see it?” Terri asked me, then blew her nose.

I wasn’t sure whether I was supposed to show her the collection jar or not. Dr. Eames hadn’t told me this might happen.

“It’s only blood and fluid,” I told her. The vacuum aspiration abortions Dr. Eames performed in the office were done in the first twelve weeks of pregnancy. He’d been doing them regularly since Roe v. Wade had legalized abortions two years earlier. After Dr. Eames had inserted the duckbilled speculum to open Terri’s vaginal canal and removed the laminaria, he introduced into the neck of her uterus a rubber tube called a “cannula” and turned on the 180-watt rotary pump. As the vacuum suction unit hummed and whirred like a small electric fan, he moved the tube forward and back inside the womb, suctioning the tissue. He removed the tube to scrape the inside of the uterine wall with a curette, an instrument similar to an iced-tea spoon with a hollowed loop at the end. He inserted the cannula a final time to eliminate any remaining tissue. The suction unit contained two clear, polycarbonate jars, each capable of holding two liters of fluid, although rarely did the procedure fill the receiving receptacle more than a quarter full. One canister held tap water, which the unit circulated into the other jar to mix with the uterine tissue. The whole procedure took less than fifteen minutes, although to Terri, it surely felt much longer. Suctioning and scraping the uterine cavity caused intense cramping. The tears streaking her face weren’t only from the emotional pain.

I decided to show Terri the jar, and I would later realize that some women needed to see it, although I didn’t understand why. What were they expecting to see? A baby suspended in liquid? How could that make them feel better? Terri sighed with relief when she saw what I had told her was true. There was no fetus to see. Just murky red water with a few clots of blood resting at the bottom. She dabbed at fresh tears brimming her eyes and murmured “Thank you.” I nodded and averted my eyes, staring blindly at the linoleum floor. I didn’t know what to say, nor how to comfort her, or even if I could. Holding her hand during the procedure seemed natural; now I felt awkward. Should I hug her? I wondered. Is that appropriate? Or wanted? I replaced the towel over the jar, and, picking it up, I cradled the container in the crook of my arm. I left the room to give her privacy, gently pulling the door closed behind me.

*

Had Eliza Munson wanted to look? I wondered. No one stood by her side. No one held her hand. No one gave her a tissue to wipe away her tears while she underwent the most traumatizing experience of her life. Her abortion occurred in the days before the discovery of the germ theory and sterile practices, before anesthesia or routine administration of pain killers, before antibiotics might have controlled her infection and saved her life. How many other women like her suffered the same fate before surgical procedures became safe?

*

Madame Restell was an assumed name. She was born in England as Ann Trow in 1811. Ann and her first husband and infant daughter came to America in the early 1830s. Not long after their arrival, her husband died, and Ann supported herself and her daughter as a seamstress. Toward the end of the decade, in 1839, after marrying a second time and after returning from a trip to England, she began advertising her fertility control services in the spring. In one of her first ads placed in the New York Sun, she claimed that she was introduced to the specialty “by the celebrated midwife and female physician, Mrs. Restell, the grandmother of the advertiser.”

As Madame Restell’s New York City practice grew, her fees increased, and as her fees increased, Restell moved to more fashionable parts of the city, eventually purchasing a mansion at the corner of 52nd Street and Fifth Avenue. Her clientele consisted of a broad spectrum of women, but she catered to the social elite, most of whom were married. Her newspaper advertisements were targeted “To Married Ladies,” which sometimes brought as many as twenty women a day. Madame Restell had a reputation for complete discretion. The authorities rarely bothered her because she often threatened to reveal the names of her wealthy and well-known clients.

In Eliza’s deathbed testimony, she told the coroner she’d had an abortion in December 1843 performed by Madame Restell. When Coroner Rawson began the inquest, however, the all-male jury heard a different version of the events, as did everyone in New York City. For five days running, the New York Herald printed transcripts of the inquest testimonies, often taking up a full column on page two and sometimes the front page. Eight people testified, from Eliza’s sister to her landlady, as well as a brother and a cousin of James Fraser (Eliza’a boyfriend), and two doctors. Witnesses revealed that Eliza didn’t have just one abortion by Madame Restell, but a second one a few months later by Mrs. Bird.

“Mrs. Bird” was also an alias. Her real name was Margaret Dawson. Like Madame Restell and other abortionists of the day, she advertised her services in the classifieds of newspapers. Bird claimed she had trained “at several celebrated hospitals in Germany.” Abortion in the mid-nineteenth century had become a booming commercialized business and one of the nation’s first medical specialties. With no laws to the contrary, anyone could hang out a shingle and style themselves a midwife or a physician, trained or not.

After Eliza’s first abortion in December, she became pregnant again, seeking another abortion the following March or April. But why hadn’t Eliza returned to seek help from Madame Restell? Why had she pointed a finger at her and not at Mrs. Bird? Were fear and scandal part of Eliza’s motivation to keep the secret, even on her deathbed? Frustrating as it is, Eliza’s reasons were buried with her.

The doctor who conducted the postmortem exam on Eliza’s body determined the cause of death was from blood loss and peritonitis, the spread of infection to the lining of the abdominal cavity. Mrs. Bird was indicted and found guilty of procuring an abortion on Eliza Ann Munson, which led to injuries resulting in her death. The crime was a misdemeanor, and she was sentenced to spend six months in the city prison and to pay a $250 fine.

And what of James Fraser, Eliza’s lover? Where was he during all this?

Conveniently, he had disappeared.

*

I found Dr. Eames in the supply room, rooting for something in a cabinet. I held the jar, my hands under the draped surgical towel.

“What do I do with this?”

He glanced over his shoulder to see what I was talking about. “Pour it down the sink and rinse out the container.”

His directive stunned me. I was amazed I hadn’t dropped the jar. Was he serious?

He found whatever he looked for, and as he passed by me to leave the room, he nodded toward the sink. “Over there.”

I didn’t know what I had expected. A ceremony? A soprano to sing “Amazing Grace” perhaps? A priest to administer last rites? Something? Anything?

I stood where Dr. Eames left me, for how long, I couldn’t say. The insides of my own thighs quivered now. Despite the coolness of the room, I could feel sweat seep through my favorite uniform top, the patterned one with pink and purple petunias against a white background. My hands felt jittery, as if I’d had too much caffeine, and the warmth that had radiated against my palms from the jar’s interior began to chill.

I sucked in a breath and, not knowing what else to do, I moved to the sink and quickly poured the cylinder’s contents down the drain, flecks of blood and tissue splashing against the sides of the stainless steel basin.

*

A century and a half after Eliza Munson’s death, she found in me someone who had an inkling of what she’d gone through, someone who wouldn’t let her life—or her death—be forgotten, because Terri and countless other women whose hands I’d held had never left me. I was the one in Dr. Eames’s office to whom these women turned for comfort, for empathy, for understanding, a person Eliza never had by her side. But what reassurance could I have given her? The women I attended in 1975—some of them teenagers, others in their twenties and thirties, some single, others married, some not ready for children, others not wanting more—always thanked me for the kindness I showed them and for not judging them. I never asked their reasons for terminating a pregnancy, although most volunteered their stories. Was it absolution they sought, or was it simply a need to share their decision with another woman? Over time, I suppose, I became better at anticipating what they needed from me: a smile, shared sadness, distraction, pure professionalism, or maybe even a laugh. But they never knew how I had to numb myself to the flow of their tears. They never knew how inadequate I felt in the role they expected of me, a strong, empathetic caregiver. I hadn’t been prepared for that part of my job. How could I have been? I was only 18.

 

 

*  Dialog and details come from the New York City coroner’s files and/or newspaper accounts, and conversations with a modern-day physician.

 

 

Sharon DeBartolo Carmack, MFA, is a Certified Genealogist and the author of You Can Write Your Family History. Her work has appeared in numerous genealogical journals, as well as Brevity, Creative Nonfiction, Hippocampus Magazine, and Steinbeck Review, to name a few. She is an assistant editor for Brevity, a contributing editor for Family Tree Magazine, and serves on the editorial board of Steinbeck Review. She can be reached through her website www.NonfictionHelp.com.


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One Response to From the Other End of the Speculum

  1. Desmond Walls Allen on May 16, 2012 at 5:58 pm

    How incredibly sad! We think of ourselves as enlightened today, but there are a world of folks still out there who insist a woman’s right to use birth control should be subject to constraints – moral, fiscal, or religious. Sharon’s poignant narrative should be required reading for those who imagine they can legislate morality. Both stories are well told here.

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