Dr. Bill Roy: "Contraception: Did you know?"

CONTRACEPTION: "DID YOU KNOW?"

BY DR. BILL ROY, CONGRESSMAN, KANSAS 2ND DISTRICT, 1970 - 1974

We entered the Sixties one nation and exited the Sixties very much another nation, nearly entirely for the better. Somewhat buried among dramatic changes were less noted changes in abortion attitudes and new state abortion laws. Abortion was not in the news each day like the Vietnam War and civil rights, but nevertheless were a subject of study and debate.

Needless to say, this burning ember burst into flame a bit later, with the reading of Roe v Wade, the January, 1973 Supreme Court decision that decriminalized early abortions and limited restrictive state laws in the second three months of pregnancy. Shortly thereafter, the Republican Party gained decades of ascendancy in federal elections by exhibiting various forms of mostly symbolic opposition to abortion.

Meanwhile, back at the office, we were doing lots of Pap smears for early diagnosis of cervical cancer, and prescribing birth control pills which had become available in 1961. The baby boom was slowing down; Jane and I had contributed six children, all boys except five, to the boomer generation from 1949 to 1959. So had many of our friends.

Folks were thinking differently. I found myself spending after-office hours counseling Catholic wives and husbands about contraception. For the first time they were thinking more in terms of a half dozen rather than a dozen children, and about recreational sex as well as procreational sex.

Because I was sensitive to Catholic views on abortion, I was careful to tell them intrauterine devices and oral contraceptives on occasion may cause very early abortions. So while they may have come in after hearing about new contraceptives, many chose the old barrier contraceptives, condoms and diaphragms.

Of course--or did you know?--it was unlawful to prescribe contraceptives to anyone in Connecticut at that time. And legislators did not change that; judges did. The Supreme Court ruled in Griswold v Connecticut in 1965 that the Connecticut law was unconstitutional because the United States Constitution provides a “right of marital privacy.”

Those who oppose abortion will tell you this was the beginning of a slippery slope, because the right of privacy later was used by the court in Roe v Wade. They point out the court admitted that “right was not mentioned explicitly in the Constitution.”

Anyway, after 1965 states could not prohibit the prescribing and sale of contraceptives. And, after 1972, when the court struck down a Massachusetts law (Eisenstadt v Baird), states could not prohibit the sale of contraceptives to unmarried men and women.

Paradoxically, unwanted pregnancies were believed to be increasing in number. Some termed them epidemic. But 100 year old state abortion laws prevailed.

So what happened? Many women, unable or not wanting to marry, illustrated the resiliency of the human spirit and had the babies and cared for them with love and care. Illegitimacy did increase 100 percent from the mid-Fifties to the mid-Sixties--and never stopped increasing to today’s 37 percent of all births.

Contemporary studies showed one-third to one-half of teen-age marriages had pregnant brides. And more than one-half of these marriages ended within 18 months.

As far as I know, everyone in private practice in Topeka “helped out” with private adoptions. There weren’t many rules, so we each had our own.

First of all, we waited for the mother to request help placing her baby. Even in this context, we felt our first duty was to the baby. Then, we further played God and told a lucky infertile couple whom we knew and believed would be good parents, we had a baby for them.

Meanwhile, studies and articles in popular magazines were appearing condemning American abortion laws and practices. In California, 223 of 1,063 of 1966 maternal deaths were the result of abortions. Nearly one-quarter who died were Mexican American and another quarter Negro.

The authors estimated there were 100,000 criminal abortions that year, consistent with the generally accepted figure of 1,000,000 in the country.

As a result of the clamor, in 1967 Colorado implemented a new abortion law, and shortly thereafter, Governor Ronald Wilson Reagan signed the nation’s most liberal abortion law in California.

Kansas was soon to follow.

Dr. Roy may be reached at wirroy@aol.com

Dr. Bill Roy: "A Needless Human Trauma ... after the fact"

A NEEDLESS HUMAN TRAUMA ... AFTER THE FACT

by Dr. Bill Roy,

Kansas Congressman, 2nd District, 1970 - 74

As portrayed in the TV show MASH, Hawkeye and Trapper John were meatball surgeons in a Mobile Army Surgical Hospital during the Korean Conflict, some of the same years I was resident physician at City of Detroit Receiving Hospital.

The two hospitals were so similar I never had any trouble identifying with their efforts to deal with injuries and death resulting from human mayhem, or with the irreverent humor they mustered to relieve tensions inherent in their jobs.

Receiving was never directly under fire (although a resident was killed by gunfire during the 1942 Detroit riots) and had a more steady flow of emergencies--although we peaked on weekends, and Christmas and New Years Eve, when families got together. And, any potential for intramural violence was dampened by two armed City of Detroit policemen in a cage right in the center of the admitting area.

Perhaps the greatest difference was the MASH unit did not have to deal with women whose lives were in jeopardy because of induced abortions.

Receiving was a 400 bed hospital that received nearly all emergencies from a metropolitan area of two million people. As I recall--and all figures will not be exact after 55 years--we had 13 emergency rooms with two to six gurneys in each, a capacity for treating about 50 patients at any one time.

To care for several hundred emergencies each day, we had a large, skilled nursing crew and four to eight interns. And four resident physicians--one surgical resident, one internal medicine resident, one psychiatric resident and one obstetrics and gynecology resident in or near the ER at all times.

Why psychiatric? Heroin was big then, and many people were irrational, comatose or dead on arrival from overdoses. And, as always, alcohol, and delirium tremens (DTs). These conditions sometimes made it darn near impossible to evaluate associated medical and surgical conditions.

The full-time OB-Gyn resident’s numerically biggest job was caring for women who had had the infamous back-alley abortions. We saw scores of them.

Their ambulance ticket to Receiving Hospital was usually heavy bleeding from an incomplete abortion, or from injuries ranging from potassium permanganate burns to perforated vaginas to torn cervices and uteruses.

Most “incompletes” were cared for on the gurney by removing retained, often infected tissue with a ring or ovum forceps. That and oxytocins usually stopped the heavy bleeding.

Blood and antibiotics were often necessary. If the uterus was intact, the tissue removed and the patient stabilized, they were transferred to one of several area hospitals for further observation and treatment, or sent home with instructions. Only the very sickest and nearly bled out were admitted.

Some women, not many, but some each year, were dead on arrival or expired shortly after arriving, almost always of hemorrhage. To this day, I can see a plump, blonde girl of 15 who lay marble-white on a gurney after an would-be abortionist had inserted a coat hanger that perforated her uterus and uterine vessels. Her parents cried at her side.

The adhesions that followed abortion and venereal disease resulted in many ectopic (extra-uterine, often tubal) pregnancies. On two occasions, we had four cases on the way to the ER. In all, we had more ectopics at Receiving than reported for the entire city of Baltimore. They were great first surgical cases for us, just as gun shot wounds were for first-year general surgical residents.

After Receiving, we had seen it all, from unattended obstructed labors with dying or dead babies to advanced, untreated cancer. Most of us moved on to gentle practices in nice places like Topeka where our previous experience served us well.

But, just as I suspect of Hawkeye and Trapper, we didn’t forget the needless human trauma we could only treat after the fact. For the most part, we put it out of mind. It made for better mental health.

And, while we would have liked to modify or eliminate the causes of injuries we treated, we hardly expected an opportunity. But, if opportunity knocked, we were experientially more motivated to act. In my way, I did.

Dr. Roy may be reached at wirroy@aol.com