“Buried with Doctor’s Certificate”: Reading the Uses and Abuses of Bodies in a Medical School Thesis

[gblockquote source=’Marie K. Formad, “Some Notes on Criminal Abortion,” thesis submitted to Woman’s Medical College of Pennsylvania, 1886.’]Case I. May 27 1885. A. R. age 25 White, single. First pregnancy. Operation had been performed on her ten days before death. (The criminality of abortion was fully established by the confession of the diceased [sic], which however had been kept secret and the body buried with the doctors certificate of gastritis. The operator was sentenced to seven years imprisonment.) Body disinterred by the Coroner five days after death.

Case II. May 28, 1885. J. G. German, age 25, married, had three children all living, never aborted before. Had operation performed on herself by a professional abortionist on May 10^th. Died May 23^rd Buried with doctors’ certificate of heart disease.[/gblockquote]

In 1886, Marie K. Formad graduated from the Woman’s Medical College of Pennsylvania, entering the small but rapidly growing body of American women holding the degree of Doctor of Medicine. Along with Dr. Formad, the 31 other members of the class of 1886 demonstrated clearly the progress of women’s medical education in the thirty years since the Female Medical College granted its first seven degrees to the inaugural class of 1851.¹ In those early days, only two years after Elizabeth Blackwell earned her hard-won MD from Geneva Medical College, for a woman to pursue a medical education in the United States had been a truly radical and lonely course. By Dr. Formad’s day, the narrow path had become markedly wider.

Formad’s thesis is an interesting document — not least because it begins with an apology for being not quite a thesis. “Not desiring to spend much time in the composition of an elaborate essay to the detriment of my general medical studies,” Formad wrote, “I decided to submit the notes contained in the following pages as my inaugural thesis.”² The “notes” consisted of Formad’s observations at the autopsies of six women who died in Philadelphia during the year in which Formad studied with her preceptor (and father) Henry F. Formad, coroner’s physician for the city. “They relate,” she explained, “to cases of criminal abortion.”

[gblockquote]Case III. Nov. 1^st 1885. S. L. White age 30. Three children, all living. Never had any previous abortion. Abortion had been performed on her instrumentally eight days previous to death. Case reported to coroner by a physician who had been called in consultation. Autopsy 20 hrs. after death.

Case IV. Nov. 6^th 1885. L. S. White, age 26. Single. Has had children and is said to have aborted before, but this is not definitely established. Abortion performed ten days previous to death. Buried with certificate of gastritis. Body disinterred by coroner. Autopsy seven days after death.[/gblockquote]

The structure of Formad’s thesis is simple: sixteen pages of autopsy notes describing in intimate, monotonous detail the postmortem appearance of corruption in the bodies of the six abortion victims, bookended by short essays on the two different meanings of the word “abortion” in current use.

To begin the thesis, Formad reflected on the distressing prevalence of the business of criminal or “forced” abortion, even in the city of brotherly love. The hideous results of this practice, which “[m]any are disposed to consider … as beneficial and a necessary evil,” become only too clear in the following pages, where even the detached and clinical language of purulence, ecchymosis, and ante-mortem hemorrhage cannot obscure the suffering her observations described.

Formad followed up these gruesome scenes with recommendations for the detection of a “forced” abortion and a brief study of the phenomenon of “spontaneous abortion” — what we would call miscarriage. “In order to study intelligently criminal abortion,” she reasoned, “it is necessary to be familiar with all the phases of spontaneous abortions.”

It is hardly remarkable that Formad chose to write about abortion, or that her writing evinced outrage and disapproval at the “unnatural” end to which her subjects’ pregnancies had come. The relevance of the subject in the 1880s was undeniable, and while it is easy to assume that female physicians, themselves so acutely aware of the perils and social pressures that led fellow women to seek abortions, would show support for the practice, this was not always the case. Historian Leslie Reagan has shown that in fact, women in Formad’s position were more likely to side with the medical establishment in condemning the “quackish” abortionists who operated outside of both the law and medical orthodoxy.³

Caught between a rock and a hard place, many women attempting to defend their right to call themselves physicians chose to distance themselves from those “irregular” practitioners — particularly midwives — who were most closely associated with the dangerous and legally suspect practice of abortion.

What makes Formad’s thesis interesting from the perspective of women’s history — and perhaps troubling — is its utilitarian approach to the problem of abortion, and its explicit use of the bodies of women Formad considered victims of misused medicine to achieve entry into the medical profession. So often, both historically and in our current moment, discussions of abortion are conducted on a theoretical plane, as expansive questions of morality, policy, and philosophy guide the rhetoric on both sides.

Yet Formad’s study is inescapably material and personal: it is built out of the bodies of six women. Women with names (though Formad included only initials in her report), faces, and in some cases families, women with whose bodies Formad spent significant time, examining in close detail the physical traces of the violence done to them by the profession to which she herself aspired. Formad’s writing betrayed no special sympathy for these women; on the contrary, her attitude towards them resembles that of a scientist toward specimens or tools, and their role in her thesis is clear — they are the raw material of medical inquiry, to be transmuted through Formad’s writing into a medical degree.

[gblockquote]Case V. Dec. 3^rd 1885. C. J. S. White age 23. First pregnancy. Married six weeks before death which took place Dec. second. Abortion performed eleven days previously with consent of her husband in order to avoid confinement before the elapse of the legitimate time after marriage.

Case VI. Dec. 29^th 1885. A. B. White age 24 married, had one child, no previous abortions. Had abortion performed on herself Dec. 15^th; but getting very ill called in a physician Dec. 17^th, who treated her until Dec. 29^th when she died. Coroners autopsy six hours after death.[/gblockquote]

It is tempting to see Formad’s rhetorical use of her autopsy subjects as a kind of postmortem violence in itself, exploiting the victims of medical failures to appeal to the very medical establishment which had led the campaign against abortion for the past thirty years. Yet such a critique fails to capture some of the difficult complexities of the moment Formad occupied. It misses the hard-won value of clinical experience for female medical students, and the legitimacy of Formad’s concerns about the dangerous application of medicine to “force” abortions in women fearful of censure, suffering, or even death in the course of natural labor. Such a reading must also account for the humanizing influence of the brief patient histories with which Formad begins each case study, introducing the name, the age, the family, and the last days of each woman’s life.

Texts like Formad’s thesis, which contribute to the history of abortion from new and complicated perspectives other than those of male doctor and female patient, defy easy categorization and understanding. “Some Notes on Criminal Abortion” encompasses in thirty-eight pages the disgust and condemnation that underpinned the campaign against abortion, alongside the anxiety and stubborn confidence that characterized women’s struggle for medical recognition, and the profound human suffering at the heart of the political and moral debates over abortion’s rightful legal status.

In 2017, as we survey a political future that promises to attack, condemn, and restrict abortion wherever it is found, reading these complexities becomes an essential task for those who wish to understand the weight of the history we are all carrying on our shoulders — and for those who hope to clear a path to a better and safer future.

Notes

1. When it opened in 1850, the nation’s first major medical school for women was called the Female Medical College of Pennsylvania. In 1867, the name was changed to the Woman’s Medical College of Pennsylvania. In 1870, the school went co-ed, and became simply the Medical College of Pennsylvania (MCP) until it was absorbed first by Hahnemann Medical School in 1993 and eventually by Drexel University College of Medicine in 2003. Return to text.
2. Marie K. Formad, “Some Notes on Criminal Abortion,” Woman’s Medical College of Pennsylvania, 1886. WMC/MCP Medical Students, Records (1850-1981), Acc. 72, Legacy Center Archives and Special Collections, Drexel University College of Medicine. Return to text.
3. Leslie J. Reagan, “Linking Midwives and Abortion in the Progressive Era,” Bulletin of the History of Medicine 69, iss. 4 (1995): 569-598. Return to text.

---

Featured image caption: The woman’s surgical ward at the Presbyterian Hospital in New York. (Jane Hodson/National Library of Medicine | Public domain)