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Rashes, Rights, and Wrongs in the Hospital and in the Courtroom: German Measles, Abortion, and Malpractice before Roe and Doe

Published online by Cambridge University Press:  18 August 2010

Extract

When women contracted German measles in early pregnancy, they were “entitled” to therapeutic abortion, according to one 1959 magazine. Williams Obstetrics, the standard medical textbook, advised doctors that therapeutic abortion was “justifiable” in such cases if the pregnant woman and her husband decided upon it. German measles (also known as rubella) was first recognized as a teratogen by an Australian ophthalmologist in 1941. Exposure to the disease in early pregnancy could damage the developing fetus, causing deafness, blindness, heart defects, and mental retardation in newborns as well as miscarriages, stillbirths, and infant deaths. Aware of the disease's effects, thousands of pregnant women who contracted German measles avidly sought abortions. Yet, as many learned in the 1950s and 1960s, the decision to carry a possibly affected pregnancy or have a therapeutic abortion was not clearly in their hands at all. Physicians refused to perform therapeutic abortions, their legality was uncertain, and hospital policies were designed to limit their numbers. An unknown number of women who knew they had contracted the disease and understood the implications were denied therapeutic abortions, and later gave birth to severely harmed children. Some of them sued their doctors for malpractice. Barbara Stewart and Sandra Gleitman, with their husbands, brought two early cases, Gleitman v. Cosgrove (1967) and Stewart v. Long Island College Hospital (1970 and 1972).

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References

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7. Most states now permit wrongful birth suits, though they remain subject to debate. Only three states permit wrongful life suits. These phrases are currently used in cases regarding amniocentesis and genetic testing, but have also been used in suits regarding failed contraception or sterilization. The origin of these labels is unclear. Gleitman and Stewart were not referred to as “wrongful birth” or “wrongful life” suits at the time. They appear to take off from torts for “wrongful death.” Gleitman cited Tedeschi, , “On Tort Liability for ‘Wrongful Life,’” Israel Law Review (1966): 513, 529Google Scholar. “Wrongful birth” did not appear in a similar appellate case regarding rubella and abortion until Jacobs v. Theimer, 519 S.W. 2d 846, 18 Tex. Sup. J. 222 (1975). On this type of tort, see Hensel, Wendy F., “Disability Impact of Wrongful Birth and Wrongful Life Actions,” Harvard Civil Rights and Civil Liberties Law Review 40.1 (Winter 2005): 141–96Google Scholar; Furrow, Barry R. et al., Health Law, 2nd ed., vol. 2, Practitioner Treatise Series (St. Paul, Minn.: West Group, 2000), chap. 17, 361–73Google Scholar; Weil, Elizabeth, “A Wrongful Birth?” New York Times Magazine, March 12, 2006Google Scholar.

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16. The Stewarts' attorney lost a similar case, as reported in Sanders, Marion K., “The Right Not to be Born,” Harper's 240 (April 1970): 92Google Scholar. There may have been other cases that never went anywhere in the legal system nor received public attention. I do not present the two cases in chronological order because the record is thinner for the earlier case, for which I do not have a transcript. How these patients found their attorneys is unknown. Nor do I know whether the Stewarts knew of the earlier suit brought by the Gleitmans. The news coverage of Gleitman appeared after the Stewarts filed their complaint, but it seems likely that the two attorneys knew each other or of the suits.

17. “Worst Rash of Measles,” Business Week (April 4, 1964): 98Google Scholar; quotation from Spots All Over,” Newsweek 73 (April 13, 1964): 90Google Scholar. The CDC estimated over 12,000,000 cases of rubella, 5,000 therapeutic abortions for maternal rubella, and 20,000 children born with congenital rubella syndrome as a result of the 1964–65 epidemic. See Plotkin, , “Rubella Vaccine,” 303Google Scholar, table 11–5 on 308. See also Reagan, Leslie J., Dangerous Pregnancies: Mothers, Disabilities, and Abortion in Modern America (Berkeley: University of California Press, 2009), chap. 2Google Scholar.

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19. Transcript of Stewart 284.

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21. For examples, see Schauffler, Goodrich C., M.D., “Tell Me Doctor,” Ladies Home Journal 79 (March 1962), 12, 14Google Scholar; The Agony of Mothers about Their Unborn,” Life 58.22 (July 4, 1965), 2931Google Scholar. See Reagan, Dangerous Pregnancies, chap. 2.

22. Transcript of Stewart 204.

23. Ibid., 195; Robert E. Hall, “New York Abortion Law Survey,” American Journal of Obstetrics and Gynecology (hereafter cited as AJOG ) 93.8 (December 15, 1965): 1182–83.

24. Dr. Louis Z. Cooper in Transcript of Stewart, 8–83.

25. Transcript of Stewart, 149, 150, quotation on 151.

26. Transcript of Stewart, 298, quotation on 306.

27. See Plaintiffs' Exhibit 4 in Ibid., 693.

28. The complaint was first served on March 19, 1965. Brief of Plaintiff-Appellant, Rosalyn Stewart in Rosalyn Stewart v. Long Island College Hospital, 30 NY2d 695 (1970), 1–4, quotation on 4, New York Court of Appeals Cases and Briefs, New York State Library.

29. Barbara Stewart in Transcript of Stewart, 156, “upset” and “irritable” on 157. See also Brief of Plaintiff-Appellant, Rosalyn Stewart, 1–4.

30. Reagan, When Abortion Was a Crime, chap. 6; Rickie Solinger, “A Complete Disaster': Abortion and the Politics of Hospital Abortion Committees, 1950–1970,” Feminist Studies 19.2 (Summer 1993): 241–68.

31. Dr. Robert Gordon in Transcript of Stewart, quotation on 369, on calling Dr. Cohen at Kings, but not Dr. Domsky, 358–59.

32. Dr. Vincent Tricomi, Transcript of Stewart, 463, 467. Attorney Grutman's questions concerning whether some patients would be “rich enough” to have gone to a specialist for diagnosis on 474–75.

33. Analysis of 1950–1960 data found that therapeutic abortion rates fell after the creation of therapeutic abortion boards.Hall, Robert E., “Therapeutic Abortion, Sterilization, and Contraception,” AJOG 91.4 (Febrauary 15, 1965): 518–20CrossRefGoogle ScholarPubMed. See also Tietze, Christopher, “Thera- peutic Abortions in New York City, 1943–1947,” AJOG 60.1 (May 1950): 146, 147Google Scholar. Further analysis of New York City data for 1943–1962 showed decreasing numbers of therapeutic abortions overall and that the downward trend was greatest among Puerto Ricans and lowest among whites. Rates of (illegal) abortion-related deaths were much higher among Puerto Rican and nonwhite women.Gold, Edwin M., et al., “Therapeutic Abortions in New York City: A 20-Year Review,” American Journal of Public Health 55.7 (July 1965): quotations on 966, 968–69, 971Google ScholarPubMed.

34. The staff at this hospital was willing to perform abortions for low-income women, which made it unusual. That such a large number considered and approved these cases may have been politically prudent rather than a method of restricting access. Nonetheless, a private paying patient only needed the approval of one physician. Inter-Departmental Communication from Department of Professional and Vocational Standards, Division of Investigation to Board of Medical Examiners, 19 August 1965, p. 1, folder 822, Abortion Investigative Files, 1925–1969, State Board of Medical Examiner Records, Department of Consumer Affairs, California State Archives, Sacramento, California.

35. Reagan, When Abortion Was a Crime, chaps. 3, 4, 6.

36. Reagan, Leslie J., “Engendering the Dread Disease: Women, Men, and Cancer,” American Journal of Public Health 87.11 (November 1997): 1781-1782CrossRefGoogle ScholarPubMed; Marks, Lara, Sexual Chemistry: A History of the Contraceptive Pill (New Haven: Yale University Press, 2001), 196Google Scholar.

37. Dr. Robert A. MacKenzie in discussion of Dannreuther, Walter T., “Therapeutic Abortion in a General Hospital,” AJOG 52 (July 1946): 64CrossRefGoogle ScholarPubMed; Reagan, , When Abortion Was a Crime, 178Google Scholar.

38. Transcript of Stewart, 171, 172. See also pages 478–79.

39. Transcript of Stewart, 282, 155; Sanders, , “The Right Not to Be Born,” 92.Google Scholar

40. Tragic Pregnancy,” Good Housekeeping 162 (January 1966), 12, 15, 20, 22, 26Google Scholar; Reagan, Dangerous Pregnancies, chap. 2.

41. Transcript of Stewart 487–504;Tietze, , “Therapeutic Abortions in New York City,” 147Google Scholar; Gold, , “Therapeutic Abortions in New York City,” 966Google Scholar.

42. Hall, “Therapeutic Abortion.”

43. See Gamble, Vanessa Northington, “Under the Shadow of Tuskegee: African Americans and Health Care,” American Journal of Public Health 87.11 (November 1997): 1774CrossRefGoogle ScholarPubMed; Fee, Elizabeth, “Sin Versus Science: Venereal Disease in Twentieth-Century Baltimore,” in AIDS: The Burdens of History, ed. Fee, Elizabeth and Fox, Daniel M. (Berkeley: University of California Press, 1988), 125–28Google Scholar; Roberts, Dorothy, Killing the Black Body: Race, Reproduction, and the Meaning of Liberty (New York: Vintage Books, 1997)Google Scholar.

44. The Stewarts were represented by Norman Roy Grutman, a personal injury attorney, who became quite successful.Margolick, David, “Roy Grutman is Dead at 63,” New York Times (hereafter NYT ) June 28, 1994Google Scholar.

45. Transcript of Stewart, 436–37.

46. Furthermore, this research was published in the nation's leading medical journal by New York physicians.Rashless German Measles,” Science News Letter 63.44 (Febrauary 7, 1953) reported on research byGoogle ScholarKrugman, Saul et al. in JAMA (January 24, 1953)Google Scholar. See also Avery, G. B. et al., “Rubella Syndrome After Inapparent Maternal Illness,” in Rubella Symposium in American Journal of Diseases of Children 110.4 (December 1965): 444–46Google ScholarPubMed.

47. Sanders, , “The Right Not to Be Born,” 92Google Scholar; Adams, Val, “Hospital Loses Suit in Refusal to Perform Abortion,” NYT, December 5, 1968, 32Google Scholar.

48. On intersectionality and the law's inability to see how racial and gender discrimination can operate simultaneously, see Crenshaw, Kimberle, “Demarginalizing the Intersection of Race and Sex: A Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory and Antiracist Politics,” University of Chicago Legal Forum 30 (1989): 139–67Google Scholar; Williams, Patricia J., Alchemy of Race and Rights (Cambridge: Harvard University Press, 1992)Google Scholar.

49. Sanders, , “The Right Not to Be Born,” 92.Google Scholar

50. Ibid., 99. The Harper's article ended with the last quotation and reported that in his appeals brief, attorney Grutman used the “elegant quotation” from Berrill's, N. J.The Person in the Womb (New York: Dodd, Mead and Co., 1968)Google Scholar. On the “jungle,” see Hall, Stuart, “The Spectacle of the ‘Other,’” in Representation: Cultural Representations and Signifying Practices, ed. Hall, Stuart (London: Sage Publications, 1997), 223–79Google Scholar; Jullilly Kohler-Hausman, “Militarizing the Police: Officer Jon Burge, the ‘Vietnamese Treatment,’ and Vigilantism in the ‘Urban Jungle,’” unpublished paper, October 2007, in author's possession.

51. Gleitman v. Cosgrove.

52. 1958 controversy reported in Lader, Lawrence, Politics, Power, and the Church: The Catholic Crisis and Its Challenge to American Pluralism (New York: MacMillan Publishing Co., 1987), 73–4Google Scholar.

53. Brief for Defendants-Respondents in Gleitman v. Cosgrove, Superior Court of New Jersey, Appellate Division, A-559–65 (1966), 6; New Jersey State Law Library, Law Division, Trenton, New Jersey.

54. Gordon, Robert in Transcript of Stewart, 361.Google Scholar

55. Brief on behalf of Plaintiffs-Appellants in Gleitman v. Cosgrove, 2–4, 6, 8; New Jersey State Law Library.

56. Brief for Defendants-Respondents in Gleitman v. Cosgrove, 4–5.

57. Brief on Behalf of Plaintiffs-Appellants in Gleitman v. Cosgrove, 6.

58. For a summary of the international discussion, see Lundstrom, Rolf, Rubella During Pregnancy: A Follow-Up Study of Children Born after an Epidemic of Rubella in Sweden, 1951, with Additional Investigations on Prophylaxis and Treatment of Maternal Rubella (Uppsala, Sweden: Appelbergy Boktryckeri, 1962), 8083Google ScholarPubMed.

59. Greenberg, Morris and Pellitteri, Ottavio, “Frequency of Defects in Infants Whose Mothers had Rubella During Pregnancy,” JAMA (December 12, 1957): 675.Google Scholar

60. Ibid., 678.

61. Ibid. On the idea of risk in medicine, see Thomas Schlich and Ulrich Trohler, eds., The Risks of Medical Innovation: Risk Perception and Assessment in Historical Context (London and New York: Routledge, 2006).

62. Rubella in Pregnancy,” Medical Journal of Australia 11.17 (December 24, 1959): 609.Google Scholar

63. Coffey, Victoria P. and Jessop, W. J. E., “Rubella and Incidence of Congenital Abnormalities,” The Irish Medical Journal of Medical Science 6.397 (January 1959): 5.Google Scholar

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65. Pernick, Martin S., The Black Stork: Eugenics and the Death of “Defective” Babies in American Medicine and Motion Pictures since 1915 (New York: Oxford University Press, 1996)Google Scholar; Trent, Inventing the Feeble Mind. Furthermore, blindness and deafness both were often equated with mental retardation.Burch, Susan, Signs of Resistance: American Deaf Cultural History, 1900 to World War II (New York and London: New York University Press, 2002), 134–37Google Scholar; Moor, Pauline M., “Blind Children with Developmental Problems,” Children 18.1 (January-February 1961), 9Google Scholar.

66. Brief on behalf of Plaintiffs-Appellants in Gleitman v. Cosgrove, 2–4.

67. Brief for Defendants-Respondents in Gleitman v. Cosgrove, 8.

68. On Dr. Samuel Cosgrove and the Margaret Hague Hospital, see Reagan, , When Abortion Was a Crime, 179–80Google Scholar. Although it was a municipal hospital, Margaret Hague Hospital's hostile Catholic-based stance toward abortion continued after Roe v. Wade. See Lader, , Politics, Power, and the Church, 75Google Scholar. On the Catholic Church's interventions in medical practice around birth control, see Garrow, Liberty and Sexuality, chapters 1–2; on Catholic and Protestant views in the early twentieth century, see Kennedy, David M., Birth Control in America: The Career of Margaret Sanger (New Haven, Conn.: Yale University Press, 1970), 144–71Google Scholar.

69. Cosgrove, S. A. and Carter, Patricia A., “A Consideration of Therapeutic Abortion,” AJOG 48 (September 1944): 299305CrossRefGoogle Scholar. First quote on 304, “abortion-murder” on 305, Russians on 308–9, table comparing abortion rates on 305. Emphasis in original. See Reagan, , When Abortion Was a Crime, 173–81Google Scholar.

70. Cosgrove and Carter boasted that Margaret Hague had the lowest therapeutic abortion to delivery ratio, 1:16,750 and Hopkins the highest with a ratio of 1 therapeutic abortion to 35 deliveries.Cosgrove, and Carter, , “A Consideration of Therapeutic Abortion,” Table I, p. 305Google Scholar. S. A. Cosgrove reported that in the eleven years after that article “no abortion has been performed in the hospital which I until recently directed,” in Therapeutic Abortion,” Journal of the Michigan State Medical Society 55 (July 1956): 798Google Scholar. In response to Robert Cosgrove's remark, the Gleitmans' attorney pointed out that therapeutic abortions were done in New Jersey, they were legal, and Jersey City was in New Jersey. The doctors had a duty to inform their patient of the consequences of German measles during pregnancy and to alert her to the possibility of therapeutic abortion at other hospitals. Brief on Behalf of Plaintiffs-Appellants in Gleitman v. Cosgrove, R. Cosgrove quote on 18, argument concerning the duty of physicians to inform their patients on 10–14.

71. Brief on Behalf of Plaintiffs-Appellants in Gleitman v. Cosgrove, 11, 4.

72. Mrs. Kent in Abortion, ABC News, June 5, 1969, print at Wisconsin State Historical Society, Madison, Wisconsin.

73. Watson, , “How to Have a Perfect Baby,” 75.Google Scholar

74. In 1962, 55.13% believed abortion should be legal in this case; by 1969, 62.32% believed it should be legal. Gallup Brain, online data base, Gallup Organization.

75. Williams Obstetrics 786.

76. A 1967 nation-wide survey of 40,000 physicians found that 49.1% of Catholic doctors and 93.3% of non-Catholic doctors supported liberalizing the abortion law. By 1969, 64% of Americans, and 60% of Catholics agreed that abortion was not a decision for the law to make. April 1967 report in Modern Medicine cited in Kerby, Phil, “Abortion: Laws and Attitudes,” The Nation 204 (June 12, 1967): 755Google Scholar; Cisler, Lucinda, “Unfinished Business: Birth Control and Women's Liberation,” in Sisterhood is Powerful: An Anthology of Writings from the Women's Liberation Movement, ed. Morgan, Robin (New York: Vintage Books, 1970), 310–11Google Scholar; Changing Morality: The Two Americas, A Time-Louis Harris Poll,” Time 93 (June 6, 1969): 27Google Scholar; Petchesky, Abortion and Woman's Choice, chap. 3.

77. Transcript of Stewart, 99–100.

78. Ibid., 101.

79. I deliberately mention race here because who was considered deserving-as children, mothers, and citizens-was structured by race. Respectability and a person deserving respect were attributes also read through demeanor, dress, hairstyle, and cleanliness, all gendered, all classed, and all the responsibility of a mother to her daughter. At the moment of this case, African-Americans vocally demanded equal rights as citizens and the welfare rights movement made demands for poor mothers of color, especially black single mothers. See Kornbluh, Felicia, The Battle for Welfare Rights: Politics and Poverty in Modern America (Philadelphia: University of Pennsylvania Press, 2007)Google Scholar; Solinger, Rickie, Beggars and Choosers: How the Politics of Choice Shapes Adoption, Abortion, and Welfare in the United States (New York: Hill and Wang, 2001), chap. 5Google Scholar.

80. Dr. Louis Z. Cooper testimony and presentation of Rosalyn Stewart in Transcript of Stewart, 99–110, quotations on 107, 108–9.Trent, , Inventing the Feeble Mind, 254–55Google Scholar. Report of Stewart on a waiting list in Sanders, , “The Right Not to be Born,” 94Google Scholar; Robert F. Kennedy toured Willowbrook in 1965. See Rivera, Geraldo, Willowbrook: a report on how it is and why it doesn't have to be that way (New York: Random House, 1972)Google Scholar; Museum of DisABILITY History, media timeline, <www.museumofdisability.org> (accessed July 25, 2007);“A Push to Preserve Willowbrook's Legacy,” Staten Island Advance, March 19, 2006Google Scholar; Rothman, Sheila M. and Rothman, David, The Willowbrook Wars: Bringing the Mentally Disabled Into the Community (Edison, N.J.: Aldine Transaction, 2005)Google Scholar.

81. For Exhibits, see Transcript of Stewart, iv, 587–710.