Thursday, June 23, 2011

Anniversary: Well, all surgery has risks, right?

Cora A. Burke was a 20-year-old who had been widowed about five months. She had a four-year-old son and lived in her own home along with her child and her parents. She'd recently become engaged. She'd been in good health up until the events that began to unfold on June 21, 1899.

In May of 1899, Cora told Mrs. Martha Johnson that she was about six weeks pregnant and wanted to find a good doctor to perform an abortion. Mrs. Johnson introduced Cora to Dr. R. J. Alcorn who had been practicing medicine in Kootenai County, Idaho, for a short time. Dr. Alcorn was living in the boarding house Mrs. Johnson operated with Mr. E.J. Abbey. Finding a doctor to perform an illegal abortion was common prior to legalization.

Cora went to Dr. Alcorn's room about two days after they were introduced. Mr. Abbey listened from an adjoining room, and heard Cora say that the instrument Dr. Alcorn was using was hurting her.

On the night of Tuesday, June 21, Dr. Alcorn asked Mr. T.J. Rundell to help him carry a table into his office, which was at the back of a drug store in the town of Harrison. Rundell's curiosity was piqued, and he asked Alcorn if he was going to "dissect a stiff." Alcorn told him no, he was going to perform an operation on somebody from across the river.

Rundell decided to snoop, so he returned at 10:00 PM and saw Cora go through the drug store into Alcorn's office. Rundell then slipped around to the back of the building, where he could peer into Alcorn's office around an ill-hung window blind. The following is what Rundell says he observed.
  • Alcorn stood beside the chair where Cora was sitting, supporting her head with one hand. He had a small vial containing a dark liquid, and was holding a cloth to Cora's face. Cora seemed to fall into a deep sleep, whereupon Alcorn picked her up and lay her on the table.
  • Alcorn removed Cora's undergarments and positioned her for the surgery. He examined her internally, inserted a speculum, then inserted a probe about a foot long into her body, causing a flow of blood which he blotted up with a cloth. From time to time, Alcorn applied the cloth to Cora's face again. The entire procedure took about an hour and a half.
  • Cora was awakened, and Alcorn helped her to set her clothing to rights and sent her on her way.
At about 4 PM the next day, Alcorn was called to tend to Cora, who was in a lot of pain. He examined her and found her uterus to be inflamed and bleeding. He prescribed ergot, to be given one-half teaspoon each half-hour for three doses, then every hour afterward for 18 hours. Cora's mother asked Alcorn about her daughter's condition. Alcorn told her, "She caught a bad cold. She does not flow enough when she has her monthlies. I will give her something to make her flow."

Over the ensuing days, Alcorn visited Cora five times, the last time about two hours before she died on Friday afternoon, June 23. Her feet and hands were cold, her fingers blue, her lips purple. Alcorn told Cora's mother that she was doing well and would be up soon. Alcorn immediately took a train to Washington state, returning about 10:00 on the following Sunday morning. The next day he again left the state, this time going to Montana, where he was arrested and returned to Kootenai county.

While Cora was ill, she passed a lot of blood and clots. Mrs. Knight, who visited Cora during her illness, testified, "I helped dress her after she was dead. Her clothing and bedclothing were saturated with blood. A quilt was doubled up under her four thicknesses, and it was clear through the quilt. It was clots of blood. I observed an odor in connection with it. There was too great a quantity to have come from the ordinary menstruation. Much greater in quantity."

At about 6:00 PM on the 21st, William Ketchum called Alcorn to visit Mrs. Ketchum, but Alcorn told him, "Well, I don't know. I am expecting a miscarriage here any minute. I can go over there, and come back, if it does not make any difference to them." So he went to Ketchum's home to attend to Mrs. Ketchum.

Kootenai County sheriff F. H. Bradbury testified, "He told me that he never had anything to do with this girl, Cora Burke; that he began in the daytime an operation on a man for stricture, and did not complete it; and that he took him in the back room of the drug store and completed the operation in the evening. He gave me this statement after I had warned him not to make any statement to me. This was on the train between here and Missoula."

Alcorn testified on is own behalf, saying that Cora had attempted to do an abortion on herself with "a hair dart," which had punctured the wall of her uterus and broken off, leaving about 1 1/2 inches. Rundell said that he'd used a speculum and piston syringe to remove the foreign body from Cora's uterus.

The physicians called as expert witnesses on the case all agreed that Cora died of septicemia or blood poisoning. They also agreed that ergot itself would be enough to cause an abortion.
Alcorn's defense also raised the possibility that Cora hadn't actually been pregnant, but the court concluded that Cora had believed herself to be pregnant, had sought an abortion, and had undergone a procedure intended to cause an abortion, which was enough to demonstrate the intent of the defendant to kill a fetus, especially in the light of Alcorn's statement that he was expecting a patient to miscarry.

Alcorn was charged with murder, convicted of manslaughter, in Cora's death.

I have no information on overall maternal mortality, or abortion mortality, in the 19th century. I imagine it can't be too much different from maternal and abortion mortality at the very beginning of the 20th Century.

Note, please, that with overall public issues such as doctors not using proper aseptic techniques, lack of access to blood transfusions and antibiotics, and overall poor health to begin with, there was likely little difference between the performance of a legal abortion and illegal practice, and the aftercare for either type of abortion was probably equally unlikely to do the woman much, if any, good.

For more on this era, see Abortion Deaths in the 19th Century.

For more on pre-legalization abortion, see The Bad Old Days of Abortion

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