How did illegal abortions spur the push for medical licensing in the 19th Century

John T. Hoffman Governor of New York vetoed the medical licensing law

In 1872, American physicians were not licensed anywhere in the United States. Medicine was completely unregulated, and anyone could claim to be a physician. Most American physicians could be classified as either regular, homeopaths, or eclectics. These three medical sects were in brutal competition with each other. Regulars were part of a medical sect that could trace its roots to ancient Rome. Homeopaths and eclectics were part of medical sects founded in the 18th and early 19th centuries. Regular medical practice's ineffectiveness encouraged people to explore new medical ideas that led to distinct medical sects. These new medical groups found willing patients who were understandably skeptical of traditional medicine.

These three sects were operating in an environment unencumbered by any meaningful regulation. Over the next thirty years, that would change dramatically. While regular physicians were predisposed to advocating for some type of medical licensing, state legislatures had expressed little interest in creating any medical licensing. Up until that point, nothing had occurred to galvanize widespread support for medical licensing until the summer of 1872.

A Tragic Death

In late August 1872 in New York City, a young pregnant woman named Alice Augusta Bowlsby read an advertisement in the newspaper for a Dr. Ascher. The advertisement stated that Dr. Ascher could help “[l]adies in trouble, guaranteed immediate relief, sure and safe; no fee required until perfectly satisfied; elegant rooms and nursing provided.” Bowlsby went to Ascher’s office, where he performed an abortion. Bowlsby died from Ascher’s botched abortion, and her tragic death provided an opportunity for New York’s organized Regulars to open the debate for medical licensing.

Bowlsby’s death captured the attention of the New York Times and the New York Herald because the details of her death were incredibly salacious. After Bowlsby died, Ascher attempted to hide the woman’s death by shipping her body in a ramshackle trunk to Chicago by train. After an alert railroad employee searched the trunk, police authorities were quickly contacted and conducted an autopsy on the body. The coroner determined that the young woman died from several “severe lacerations” that “had been sustained in the attempt to affect an abortion.” The police quickly ascertained the identity of the young women and tracked down Jacob Rosenzweig, a 39-year-old Polish physician. The police learned that Rosenzweig practiced in New York City under the name Dr. Ascher.

The Times relentlessly reported on the Bowlsby case because it was not only a headline-grabber, but it allowed the newspaper to batter one of its chief rivals, the New York Herald. The Times had a golden opportunity to accuse the Herald of enabling abortionists and hypocrisy. Soon after Bowlsby’s death, the Herald ran an editorial condemning abortionists. However, the Herald’s editorial staff failed to notice that Rosenweig’s alias, Dr. Ascher, still advertised in the Herald's classified section. Naturally, the Times was overjoyed at the chance to castigate the Herald. While the Times may have had difficulty containing its glee, a quick scan of the New York Times classified section reveals that it, too, ran numerous advertisements for dubious doctors.

The Bowlsby case was not the first abortion case to get publicity in 1871 in New York City. The New York City police had previously arrested two other physicians, Dr. Michael Wolff and Dr. Thomas Lookup Evans, for performing abortions that year. Both cases garnered media interest in New York City, but they led to any broader medical community action. Dr. Michael Wolff was convicted of second-degree manslaughter after the death of one of his patients. In that case, the presiding judge, Gunning Bedford, sentenced Wolff to seven years in prison and began a New York City campaign to stamp out an abortion. Bedford also presided over the trial of the other abortionist, Lookup Evans. Evans was charged with performing an abortion that killed twins. The Times refused to describe Evans’ alleged crime in the newspaper because it was of such a “revolting character” that it was completely “unfit for publication.”

Establishing Medical Licensing

Judge Bedford spoke to the New York Academy of Medicine members on September 30th at the start of the Bowlsby case. These prominent abortion cases convinced Bedford that New York City was “living in an atmosphere of abortion.” He stated that the authorities would “strain every nerve until these traffickers in human life are exterminated and driven from existence.” Aside from prosecuting abortionists under the law, Bedford argued that the legislature should change the penalty for abortion or abortion-related deaths from second-degree manslaughter to first-degree murder. If convicted of first-degree murder, doctors could be executed for botched abortions. At the same meeting, members of the New York Academy of Medicine passed a resolution promising to “promote public health and public morals” and pledged to support “any legislative or other measures” advocated by law enforcement officials to “remove the pestilence of criminal abortion.”

Bowlsby’s “Trunk Murder” and Bedford’s campaign merged and convinced members within the medical community that it was time they eliminated abortionists from their ranks. Abortionists undermined doctors' already questionable reputations and lowered the profession's standing in the public’s eyes. In step with Bedford’s proposal ratcheting up the abortion laws, members of the New York medical community argued that doctors had to be regulated by the state to stem the city's tide of tragic abortion cases. Prominent Regular physicians wanted to stigmatize physicians who performed abortions with medical licensing. Regular physicians began to argue that medical licensing was the only effective way to stop abortionists from plying their trade.

Lobbying Physicians

“Medical and legal members” of the New York Medico-Legal Society had drafted “An Act to Protect the People against Quackery and Crime” two years earlier, but it received little or legislative support. Soon after the Bowlsby case, Stephen Rogers, M.D., a member of the Medical Society of the State of New York and the President of the New York Medico-Legal Society, believed that it was critical for the New York medical community to stamp out abortion and focused the Medico-Legal Society on that mission. Not surprisingly, he believed that a medical licensing law was the best way to do it. Rogers’s primary goals as the society's president weree to pass medical licensing and new severe abortion law. The Times reported on January 12, the Medico-Society proposed a “bill against quacks” that authorized the creation of county medical societies. These county societies would each appoint five censors who would examine “resident practitioners.” The proposed bill permitted prosecuting any unlicensed physicians “for obtaining money under pretenses.” After the Medico-Legal Society approved the draft bill, it agreed to print copies of the bill for distribution around the state.

Rogers, along with other members of the Regular sect, accepted that the state’s failure to regulate physicians permitted abortionists to prosper. An East River Medical Association of New York report discussing abortion argued that “the unrestricted practice of medicine was the main cause for the existence of professional abortionists.” The report contended that only medical licensing could eliminate abortion. While Rogers concluded that strengthening the penalties for criminal abortion was important, he argued that only medical licensing had the power to stop abortions. Along with most Regular physicians, Rogers believed that most abortionists could not meet even minimum medical licensing requirements. Even if a licensing board did give an abortionist a license, the state’s Regulars contended that a strong licensing board should be granted the power to revoke licenses for unprofessional behavior, such as performing abortions.

Roger ended up lobbying numerous regular and irregular medical organizations including the New York County Medical Society, the Medical Society of New York, the New York State Medical Society, the New York chapter of the American Institute of Homeopathy. While many individual physicians opposed licensing, Rogers was able to garner support from a number of these organizations. The support of these institutions lent credibility to licensing efforts and the New York House and Senate to pass these medical licensing laws.

Conclusion

Ultimately, Governor John Thompson Hoffman vetoed the medical licensing bill, but this was one of the earliest and most successful efforts to establish medical licensing in the United States. The medical community's efforts to pass medical licensing did not occur in a vacuum. Physicians throughout the United States were remarkably well connected. Organizations such as the American Medical Association served as a hub for the national community. State and local organizations across the country quickly became aware of New York's medical community's attempt to enact medical licensing. In other states, medical groups would quickly follow the lead of their New York brethren. Unlike the New York physicians, they started to become successful in their efforts to pass medical licensing medical legislation. Similar to the physicians in New York, they tied licensing to other unrelated public health measures such as stronger anti-abortion laws or sanitary legislation.

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