ACTA HISTORY
Acta fifty years ago Excerpts from articles on abortion, women’s fertile period and how the estrogenic hormones reflect the endometrial cycle
Acta Obstet Gynecol Scand 1992; 71: 577-579
Overview: 1942
Women’s wish for abortion: complex motives
Nineteen forty-two was another gloomy year of the second World War, with all of the Scandinavian countries except Sweden directly involved, one way or another. Communication across the borders was severely hampered, and one might expect that nonmartial scientific activity would also be at ebb. To judge by the contents of Acta Obstetricia et Gynecologica Scandinavica, this was not the case. Volume XXII had four fasciculi with a total of 400 pages, the articles being written by Swedish authors in eleven cases, Danish in seven and Finnish in one. Articles from Norway were notably absent, but I have previously mentioned that Finn B0e had a contribution in the last fasciculus of volume XXI, which belonged to the previous year but was printed in 1942 due to publication delay (1). The Finnish article and five of those from Sweden were written in German, twelve in English and one in French. The latter, ‘La pytlite gravidique’ was a study by Folke Holtz, Stockholm (2). Interestingly, the same author had another article, ‘Manual removal of retained placenta and placental fragments’ in English in the same volume (3). What made him choose one and the other language for different topics is a matter for conjecture. Browsing through the pages from 1942, I find that much of the content matter is worthy of being revived, if only to show that some themes will always recur while others reflect a certain period of time and are therefore true mirrors of history. Abortion (4,5) and acute poliomyelitis during pregnancy (6) may serve as examples.
Fasciculus 2 was wholly devoted to the theme of abortion, consisting of two articles, in which Gunnar Inghe (4) and Gustav Jonsson (5) analysed the same case material from Sabbatsberg Hospital in Stockholm from different angles. They had personally interviewed 787 women who had had abortions in the years 1935 to 1937, before they were discharged from the hospital. As the interview was wholly voluntary, the case material represented only 55% of the hospital’s abortion patients. During the period of investigation, there were about 20 abortion deaths, which the authors considered ‘a small number’. Induced abortion in those days was on the whole illegal in Sweden. A 1935 report from an official Abortion committee had put forth possible reasons for the rising number of abortions. This was followed by a debate on the feasibility of legal abortion on social indications. However, for the purpose of the present study, the main distinction between spontaneous and criminal abortion was fever. As the researchers could hardly expect to get honest answers about the nature of the abortion, questions on this point were mainly indirect. In their estimate, spontaneous abortions comprised less than one fifth of the cases. R o hundred and eighty-nine (37%) did admit to induction attempts and also described the methods used. To quote the authors; ‘As a rule, they began with exercises, washing clothes, turning rooms or some such, continued with hot baths, vaginal douches and remedies per os, finally to resort to attempts with probe or @ Acta Obstet Gynecol Scand 71 (1992)
578
Acta history
spray .... The hot baths often consisted of hipbaths and were combined with exercises and vaginal douching. Mustard baths were sometimes taken. Of particular interest was the large number of patients using remedies per 0s (49% [of those who gave information])’. The remedies were laxatives, colocynth, castor oil, aloes, bitter water, Karlsbad pills, Leo pills and others. Quinine and alcohol were also common. Some had used doctors’ prescriptions and taken agomensin and selinol, often ingesting several remedies in large doses at the same time. ‘It is probable that many quite simply took what happened to be in the medicine chest at the time’. Concerning douches, probes and actual operations, the information was clearly deficient, as the patients had promised not to say anything (which some of them admitted). In ten cases a doctor had performed an operation. There were evidently three midwives among the helpers, in a few cases professional abortionists, but more often persons ‘with no thought of profit’. As a matter of fact, none of the women had paid more than 50 Swedish crowns. Some had used knitting needles, or other kinds of probes, on themselves. Gunnar Inghe studied the frequency of abortions versus births with regard to the married state, and concluded that pregnancies ended with abortion on average six times as often among the unmarried as among married women. Looking at age-specific figures, he found that there were relatively more febrile abortions among the older multiparous women than among the primigravidae. He also looked at the occupation of the women and found that waitresses, scullery-maids, hairdressers and possibly shop assistants, had a higher abortion frequency than other wage earners. In case some of his readers should be surprised at these findings, he explained that ‘restaurant staff, hairdressers and shop assistants come into contact with a large number of people in a quite different way than do factory workers, for example, or domestic servants. And it is from these very callings that prostitutes have, from olden times, been notoriously recruited to a particularly high degree’. Gustav Jonsson studied the women’s motives for wanting an abortion, by asking about their attitude towards the male partner, the attitude of their parents, their knowledge about the risks of the procedure and what they knew about public aid (which at that time comprised child welfare for the unmarried, and small financial contributions called ’maternity relief and ‘parish relief‘). In the long list of motives, ‘poor financial position’ dominated both for the unmarried and married women, with ‘dis-
grace of being an unmarried mother’ as a clear number two for the unmarried ones. In the current abortion debate of 1992, which is most vociferous in the U.S.A. and Ireland, but occasionally flares up in a country like Norway, history may teach us a lesson. I have recapitulated stories on the theme from Helsinki (7) and Oslo (8) sixty years ago in this column and made brief mention of Per Kolstad’s abortion treatise which was published in Acta in 1957 (9). Those who want to make a historical review will certainly find more.
How long b woman’s fertile period? Stig Samuelsson, working in Professor Axel Westman’s department in Lund, analysed the ages at menarche and menopause of all the women treated in the gynecological department during the years 1937-1939 (10). He found that in South Sweden, menarche began at an average of 15.0 years, with a standard error of the mean of the 746 observations of 0.03 years. Similarly, age at menopause was 48.6 plus/minus 0.13 years (671 observations). Women who had borne children, had menopause on average 1.4 years later than nulliparae. There was a negative correlation between menarche and menopause: the earlier the menarche, the later came the menopause. The menarcheal age of 15 years corresponded closely with that of most other investigations from Japan, North America and Europe, the exceptions being 16.6 and 16.2 years in two German studies from before and around the turn of the century, and 13.5 for Jews in New York City as the extremes. Without discussing possible methodological weaknesses of the quoted study, it is worth mentioning that the age at menarche in Norway fifty years later is 13.3 years. To answer the question in the heading, the fertile period ranged from 25 to 40 years, depending on the woman’s age at menarche and the number of births she had had. Finally, it is interesting to note that authors who made use of statistical methods fifty years ago, Samuelsson being one, presented all the definitions and mathematical formulas to avoid any misunderstanding about the derivation of their figures.
More light on the menstrual cycle Mirjam Furuhjelm ( l l ) , whose thesis on the excretion of estrogens and androgens in the urine of women had been published in Acta two years earlier (recounted in this column in No. 5, 1990, 12) followed this up by asking five healthy women to collect their whole urine output from the beginning of one menstruation until the end of the next one. In
Acta history
addition, she obtained specimens of the endometrium up to four times in the same cycles, to ascertain that its transformation from proliferative to secretory pattern corresponded to the estrogen peak. She claimed that no such correlative study had been published previously. Presenting the results, she clearly established the relationship she had set out to find. It was a pioneer study. In a manner of speaking, the five volunteers who collected urine and subjected themselves to the unpleasantness of having their endometria repeatedly sampled, were also pioneers. In contradistinction to present-day demand for anonymity (12), their names were freely printed on the graphic curves. In two cases, the first names were represented only by the initials M and G. To remove any doubt about their identities, you need only look up Table I where they were identified by their first names, to find that they were in fact Maria Andersson, Mia Larsson, Gudrun Jonsson, in addition to Sofia LovCn and Stina Lofberg. If they are still among the living numbers I hope they (and the author, who is) will forgive me for once again printing their names, for posterity. Per Bergsj@
References I . Bae F. A case of ovarian pregnancy. Acta Obstet Gynecol Scand 1942; 21: 427-32. Recounted in: Bergs@ P. Acta fifty years ago. Description of an ovarian pregnancy. and a tribute to its author. Acta Obstet Gynecol Scand 1992; 71: 3-5. 2. Holtz F. La pyelite grdvidique. Acta Obstet Gynecol Scand 1942; 22: 235-56.
579
3. Holtz F.Manual removal of retained placenta and placental fragments. Clinical study of 737 cases. Acta Obstet Gynecol Scand 1942; 22: 62-101. 4. Inghe G. Social conditions and complex motives of the abortion patients. I. The social conditions of the abortion patients. Acta Obstet Gynecol Scand 1942; 22: 123-74. 5. Jonsson G. Social conditions and complex motives of the abortion patients. 11. The social-psychological background to the woman’s wish for abortion. Acta Obstet Gynecol Scand 1942; 22: 175-203. 6. Hansen JL. Acute anterior poliomyelitis during pregnancy. A case and a survey. Acta Obstet Gynecol Scand 1942; 22: 324-46. 7. Chydenius JJ. Uber die operative Behandlung der diffusen Abortperitonitiden. Acta Obstet Gynecol Scand 1930; 10: 1-31. Recounted in: Bergsja P. Acta sixty years ago. Evaluation of radical treatment of abortion peritonitis. Acta Obstet Gynecol Scand 1990; 69: 101. 8. Bergs@ P. Acta sixty years ago. On abortions in Oslo, fistulas in Helsinki, elderly primiparas in Stockholm, and more. Acta Obstet Gynecol Scand 1991;70: 101-2. 9. Kolstad P. Therapeutic abortion. A clinical study based upon 968 cases from a Norwegian hospital, 1940-53. Acta Obstet Gynecol Scand 1957; 36 Suppl 6: 1-72. Mentioned in: Bergsja P, Trope C, Iversen T. Obituary: Per Kolstad, 31 August 1925-14. August 1091. Acta Obstet Gynecol Scand 1992; 71: 494-5. 10. Samuelsson S. Menarche, Menopause und Reproduktionszeit des Weibes. Acta Obstet Gynecol Scand 1942; 22: 33-61. 11. Furuhjelm M. The relationship between the peaks in the excretion of estrogenic substances and the phases of the endometrial cycle in normal women. Acta Obstet Gynecol Scand 1942: 22: 221-34. 12. Bergs@ P. Acta fifty years ago. Introducing the volume; and describing a study on the excretion of estrogens and androgens in women. Acta Obstet Gynecol Scand 1990; 69: 369-70.
0 Acta Obstet Gynecol Scand 71 (1992)
Acta fifty years ago Excerpts from articles on abortion, women’s fertile period and how the estrogenic hormones reflect the endometrial cycle
Acta Obstet Gynecol Scand 1992; 71: 577-579
Overview: 1942
Women’s wish for abortion: complex motives
Nineteen forty-two was another gloomy year of the second World War, with all of the Scandinavian countries except Sweden directly involved, one way or another. Communication across the borders was severely hampered, and one might expect that nonmartial scientific activity would also be at ebb. To judge by the contents of Acta Obstetricia et Gynecologica Scandinavica, this was not the case. Volume XXII had four fasciculi with a total of 400 pages, the articles being written by Swedish authors in eleven cases, Danish in seven and Finnish in one. Articles from Norway were notably absent, but I have previously mentioned that Finn B0e had a contribution in the last fasciculus of volume XXI, which belonged to the previous year but was printed in 1942 due to publication delay (1). The Finnish article and five of those from Sweden were written in German, twelve in English and one in French. The latter, ‘La pytlite gravidique’ was a study by Folke Holtz, Stockholm (2). Interestingly, the same author had another article, ‘Manual removal of retained placenta and placental fragments’ in English in the same volume (3). What made him choose one and the other language for different topics is a matter for conjecture. Browsing through the pages from 1942, I find that much of the content matter is worthy of being revived, if only to show that some themes will always recur while others reflect a certain period of time and are therefore true mirrors of history. Abortion (4,5) and acute poliomyelitis during pregnancy (6) may serve as examples.
Fasciculus 2 was wholly devoted to the theme of abortion, consisting of two articles, in which Gunnar Inghe (4) and Gustav Jonsson (5) analysed the same case material from Sabbatsberg Hospital in Stockholm from different angles. They had personally interviewed 787 women who had had abortions in the years 1935 to 1937, before they were discharged from the hospital. As the interview was wholly voluntary, the case material represented only 55% of the hospital’s abortion patients. During the period of investigation, there were about 20 abortion deaths, which the authors considered ‘a small number’. Induced abortion in those days was on the whole illegal in Sweden. A 1935 report from an official Abortion committee had put forth possible reasons for the rising number of abortions. This was followed by a debate on the feasibility of legal abortion on social indications. However, for the purpose of the present study, the main distinction between spontaneous and criminal abortion was fever. As the researchers could hardly expect to get honest answers about the nature of the abortion, questions on this point were mainly indirect. In their estimate, spontaneous abortions comprised less than one fifth of the cases. R o hundred and eighty-nine (37%) did admit to induction attempts and also described the methods used. To quote the authors; ‘As a rule, they began with exercises, washing clothes, turning rooms or some such, continued with hot baths, vaginal douches and remedies per os, finally to resort to attempts with probe or @ Acta Obstet Gynecol Scand 71 (1992)
578
Acta history
spray .... The hot baths often consisted of hipbaths and were combined with exercises and vaginal douching. Mustard baths were sometimes taken. Of particular interest was the large number of patients using remedies per 0s (49% [of those who gave information])’. The remedies were laxatives, colocynth, castor oil, aloes, bitter water, Karlsbad pills, Leo pills and others. Quinine and alcohol were also common. Some had used doctors’ prescriptions and taken agomensin and selinol, often ingesting several remedies in large doses at the same time. ‘It is probable that many quite simply took what happened to be in the medicine chest at the time’. Concerning douches, probes and actual operations, the information was clearly deficient, as the patients had promised not to say anything (which some of them admitted). In ten cases a doctor had performed an operation. There were evidently three midwives among the helpers, in a few cases professional abortionists, but more often persons ‘with no thought of profit’. As a matter of fact, none of the women had paid more than 50 Swedish crowns. Some had used knitting needles, or other kinds of probes, on themselves. Gunnar Inghe studied the frequency of abortions versus births with regard to the married state, and concluded that pregnancies ended with abortion on average six times as often among the unmarried as among married women. Looking at age-specific figures, he found that there were relatively more febrile abortions among the older multiparous women than among the primigravidae. He also looked at the occupation of the women and found that waitresses, scullery-maids, hairdressers and possibly shop assistants, had a higher abortion frequency than other wage earners. In case some of his readers should be surprised at these findings, he explained that ‘restaurant staff, hairdressers and shop assistants come into contact with a large number of people in a quite different way than do factory workers, for example, or domestic servants. And it is from these very callings that prostitutes have, from olden times, been notoriously recruited to a particularly high degree’. Gustav Jonsson studied the women’s motives for wanting an abortion, by asking about their attitude towards the male partner, the attitude of their parents, their knowledge about the risks of the procedure and what they knew about public aid (which at that time comprised child welfare for the unmarried, and small financial contributions called ’maternity relief and ‘parish relief‘). In the long list of motives, ‘poor financial position’ dominated both for the unmarried and married women, with ‘dis-
grace of being an unmarried mother’ as a clear number two for the unmarried ones. In the current abortion debate of 1992, which is most vociferous in the U.S.A. and Ireland, but occasionally flares up in a country like Norway, history may teach us a lesson. I have recapitulated stories on the theme from Helsinki (7) and Oslo (8) sixty years ago in this column and made brief mention of Per Kolstad’s abortion treatise which was published in Acta in 1957 (9). Those who want to make a historical review will certainly find more.
How long b woman’s fertile period? Stig Samuelsson, working in Professor Axel Westman’s department in Lund, analysed the ages at menarche and menopause of all the women treated in the gynecological department during the years 1937-1939 (10). He found that in South Sweden, menarche began at an average of 15.0 years, with a standard error of the mean of the 746 observations of 0.03 years. Similarly, age at menopause was 48.6 plus/minus 0.13 years (671 observations). Women who had borne children, had menopause on average 1.4 years later than nulliparae. There was a negative correlation between menarche and menopause: the earlier the menarche, the later came the menopause. The menarcheal age of 15 years corresponded closely with that of most other investigations from Japan, North America and Europe, the exceptions being 16.6 and 16.2 years in two German studies from before and around the turn of the century, and 13.5 for Jews in New York City as the extremes. Without discussing possible methodological weaknesses of the quoted study, it is worth mentioning that the age at menarche in Norway fifty years later is 13.3 years. To answer the question in the heading, the fertile period ranged from 25 to 40 years, depending on the woman’s age at menarche and the number of births she had had. Finally, it is interesting to note that authors who made use of statistical methods fifty years ago, Samuelsson being one, presented all the definitions and mathematical formulas to avoid any misunderstanding about the derivation of their figures.
More light on the menstrual cycle Mirjam Furuhjelm ( l l ) , whose thesis on the excretion of estrogens and androgens in the urine of women had been published in Acta two years earlier (recounted in this column in No. 5, 1990, 12) followed this up by asking five healthy women to collect their whole urine output from the beginning of one menstruation until the end of the next one. In
Acta history
addition, she obtained specimens of the endometrium up to four times in the same cycles, to ascertain that its transformation from proliferative to secretory pattern corresponded to the estrogen peak. She claimed that no such correlative study had been published previously. Presenting the results, she clearly established the relationship she had set out to find. It was a pioneer study. In a manner of speaking, the five volunteers who collected urine and subjected themselves to the unpleasantness of having their endometria repeatedly sampled, were also pioneers. In contradistinction to present-day demand for anonymity (12), their names were freely printed on the graphic curves. In two cases, the first names were represented only by the initials M and G. To remove any doubt about their identities, you need only look up Table I where they were identified by their first names, to find that they were in fact Maria Andersson, Mia Larsson, Gudrun Jonsson, in addition to Sofia LovCn and Stina Lofberg. If they are still among the living numbers I hope they (and the author, who is) will forgive me for once again printing their names, for posterity. Per Bergsj@
References I . Bae F. A case of ovarian pregnancy. Acta Obstet Gynecol Scand 1942; 21: 427-32. Recounted in: Bergs@ P. Acta fifty years ago. Description of an ovarian pregnancy. and a tribute to its author. Acta Obstet Gynecol Scand 1992; 71: 3-5. 2. Holtz F. La pyelite grdvidique. Acta Obstet Gynecol Scand 1942; 22: 235-56.
579
3. Holtz F.Manual removal of retained placenta and placental fragments. Clinical study of 737 cases. Acta Obstet Gynecol Scand 1942; 22: 62-101. 4. Inghe G. Social conditions and complex motives of the abortion patients. I. The social conditions of the abortion patients. Acta Obstet Gynecol Scand 1942; 22: 123-74. 5. Jonsson G. Social conditions and complex motives of the abortion patients. 11. The social-psychological background to the woman’s wish for abortion. Acta Obstet Gynecol Scand 1942; 22: 175-203. 6. Hansen JL. Acute anterior poliomyelitis during pregnancy. A case and a survey. Acta Obstet Gynecol Scand 1942; 22: 324-46. 7. Chydenius JJ. Uber die operative Behandlung der diffusen Abortperitonitiden. Acta Obstet Gynecol Scand 1930; 10: 1-31. Recounted in: Bergsja P. Acta sixty years ago. Evaluation of radical treatment of abortion peritonitis. Acta Obstet Gynecol Scand 1990; 69: 101. 8. Bergs@ P. Acta sixty years ago. On abortions in Oslo, fistulas in Helsinki, elderly primiparas in Stockholm, and more. Acta Obstet Gynecol Scand 1991;70: 101-2. 9. Kolstad P. Therapeutic abortion. A clinical study based upon 968 cases from a Norwegian hospital, 1940-53. Acta Obstet Gynecol Scand 1957; 36 Suppl 6: 1-72. Mentioned in: Bergsja P, Trope C, Iversen T. Obituary: Per Kolstad, 31 August 1925-14. August 1091. Acta Obstet Gynecol Scand 1992; 71: 494-5. 10. Samuelsson S. Menarche, Menopause und Reproduktionszeit des Weibes. Acta Obstet Gynecol Scand 1942; 22: 33-61. 11. Furuhjelm M. The relationship between the peaks in the excretion of estrogenic substances and the phases of the endometrial cycle in normal women. Acta Obstet Gynecol Scand 1942: 22: 221-34. 12. Bergs@ P. Acta fifty years ago. Introducing the volume; and describing a study on the excretion of estrogens and androgens in women. Acta Obstet Gynecol Scand 1990; 69: 369-70.
0 Acta Obstet Gynecol Scand 71 (1992)
