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The Abortionist on the Circuit of Fear

Before Roe, terminating a pregnancy meant confronting a nightmare of quacks and butchers, knitting needles and wire coat hangers. The exceptions were people like Dr. X, “the stars of the underground abortion circuit.”

by

The Abortionist on the Circuit of Fear
August 18, 1966

The abortionist is the man hunted by the police and a million desperate women a year.

No city can be without him. Few are.

In almost every town there are quacks and butchers with minimal training. Taxi drivers and pharmacists who improvise. Neighbors whose tools are knitting needles, wire coat hangers, and crude catheters.

Scattered across the country and in the larger cities there are a handful of qualified doctors who because of money or ideals or other circumstances have tried to meet the frantic demand for the abortions the hospitals won’t perform.

These men are the stars of the underground abortion circuit. Women travel to Pennsylvania, Florida, Baltimore, or Washington because of the reduced risk to their lives these men represent. Women pass these doctors’ names along as a gesture of friendship and social amenity. Their names appear on experience-tested and approved lists circulated among college girls. The lists also contain tips like whether or not to let the doctor’s receptionist know why you are calling, whether or not to plan to stay overnight, what the best deals on fees are, and usually end by advising the girls — for her emotional well-being — not to go to the abortionist alone.

These lists are often used as the basis for a non-profit referral service. One 21-year-old girl from Long Island has steered 15 friends and friends of friends three times removed to abortionists in the last year. She has received as many as four calls in one week from girls around the country who did not want to become another statistic among the roughly 5000 who are known to die from illegal abortions each year or to risk sterilization at the hands of an incompetent bungler.

The qualified abortionists who make these lists would be respected members of the medical profession in Sweden or Japan or Hungary.

Nathan Rappaport is part of this medical nether world. He has been performing illegal abortions for almost 40 years. An alumnus of City College, a graduate with honors from the University of Arkansas Medical School, with advanced training at the University of Pennsylvania, he spent nine of the past 15 year in jail. He lost his medical license, his home, his wife, and his children. He has been publicly humiliated and exorcised. Ignored on the street by doctors and people he served in his office. And frequently blackmailed.

$1000 a Month

Two patrolmen in a community where he worked in pay-offs. Surgical nurses, doctors, and various hospital personnel have been paid not to report to authorities abortion patients who needed hospital facilities.

It was because he refused to pay off a couple of hold-up men who kept making repeat visits that the gangsters tipped the police and he was arrested for the first time, in 1950. When he was arrested again, in Florida, the police, always glad to be of service, gave his instruments to another abortionist who was paying off at a higher rate.

On parole since May from his last two-year sentence, Rappaport is living in a no-color green room in a hotel on West 73rd Street. At 66 he is a round man. Round face, round glasses, a pleasantly rounded body.

In a short-sleeved sport shirt that stayed crisp despite the steam-bath atmosphere of the room, he sat before a small kitchen table piled high with a collection of printed materials, a tape recorder, and long sheets of yellow steno paper covered with an ink scrawl. He is in the process of writing his second book.

The Whole Story

The new book will be called “Man’s Inhumanity to Women.” The title tells the whole story. Men made the abortion laws, women suffer because of them.

“If the women had had any hand in shaping the statutes that were put on the books a hundred years ago we would probably have abortion practically on demand the way they do in many European countries,” he said.

Although his first book “The Abortionist” was published by Doubleday under the alias of Dr. X, Rappaport has decided to bring the new book out under his own name now that he is going to fight actively for more liberal abortion laws.

The laws in 42 states now specifically limit abortions to those cases in which it is necessary to save a life. No provision for abortions for health reasons is stated in the New York penal code.

These laws, which are mainly monuments to political fear, will not be changed in the legislatures, Dr. Rappaport believes. He plans to battle through the courts.

The Legendary Dr. S.

He is currently organizing abortionists, including the legendary Dr. S. of Pennsylvania, who was recently arrested. Rappaport hopes that either through appealing his own case or that of some other doctor to work his way up to the Supreme Court. He is looking for some abortees or sympathizers who would be willing to adopt some of the tactics of the civil-rights movement and join him in battle.

Speaking of his plans, his experience, the books he had read, or the fourth estate, Nathan Rappaport seems an articulate, warm, comfortable man who would be very much in control of most situations.

“You surely must wonder,” he said during the interview, “why I can’t behave like so many other doctors you’ve known. Even in these sordid surroundings you sense that I am above all a doctor. Why can’t I act like a reasonable, intellectual, and professional man?

“The answer on the simplest level is that I am not a reasonable man. The reasonable man adapts himself to the world. The unreasonable man persists in trying to adapt the world to himself.

Almost 40 years ago I helped organize planned parenthood clinics. This type of medical practice was looked up on askance then. I felt then, as I do now, that the needs of my patients in their pursuit of happiness and love was of primary importance to me, their physician, and that the wonder of conception, its regulation, postponement, or interruption is wholly a medical problem. It is not the sphere of influence or interpretation of the moralists, religionists, faddists, legalists, or anybody else.

“I don’t want to be forced by them to be a judge when a woman pleads with me for an abortion. I am a doctor who has been trained to answer the cry of distress. My task is to ease the agony of an anguished mind. And, if I cannot persuade the woman to have the child, I want to at least save her body from the mutilation and torture of an operation without the anesthetics the charlatans do not know how to, or dare not, use.

“My refusing to perform the abortion wouldn’t prevent it. A woman determined to have an abortion will find someone to do it or do it herself,” Rappaport said.

Jackson Heights

This man who has ended his medical career as a criminal began it as a law-abiding doctor in Jackson Heights.

“I always believed that competent abortions were essential, but when I first opened my office in 1926 I never thought I could go outside the law to commit them. I sent all my abortion patients to another doctor.

“Two years after I was in practice a relative begged me to perform one and I finally did it on the kitchen table. Then the Depression came. More and more women asked me for abortions because they could not afford to feed another mouth. The collections from my practice had dwindled to almost nothing. There was pressure from my family to take the abortion money. By 1933 I had let the druggist and other doctors know I was available and made abortion my specialty.

“I tried to quit after I got out of prison the first time and just to do something related to medicine. But, with my license revoked and my jail record, I couldn’t get a job anywhere in the world. I was even turned down for a position as a medical aide in Cambodia,” he said.

Over the years of practice on the fringes of the medical world, the fees for his services rose from the $25 of the Depression to an average of $300.

“Like all doctors from time immemorial, I adjusted fees according to the patient’s ability to pay. I have done many abortions free or for very little money, but when I got an affluent patient I charged extra, not a little, but a lot. The rich patients helped pay the graft which is part of the overhead of the business,” Rappaport said.

Even with an average fee of $300, his rates were low. The going price for an illegal abortion these days is about $500 and along Park and Fifth Avenues it can run into the thousands.

In the case of therapeutic abortions performed in hospitals it is common practice, according to Rappaport, to pay a couple of hundred dollars to each of two psychiatrists so they will testify before the board approving the abortions for the hospital. The magic words that can get the legal abortion are, “this woman will take her life if she has to have the baby.”

Sometimes the boards will stretch and bend the interpreta­tion of the abortion law either for humanitarian reasons or, as Rappaport charges, because one or more board members have gotten a little something to remember the applicant by.

Despite the monetary persua­sions that may be used, avail­able statistics report only 8000 legal hospital-approved abortions of the more than a million that take place each year. There were four times as many legal abortions 25 years ago. While the practice of medicine has advanced in almost all other areas it has gone backward in its approach to abortions. Now that doctors have learned how to bring women with almost any illness including kidney disease and cancer successfully through a pregnancy, most of the real medical reasons for legal hospi­tal abortions and the convenient pretexts have been eliminated. More than 25,000 of the women who have been shut out of the hospitals have found their way to Nathan Rappaport’s office in the years since he made his critical choice.

Over 65 per cent of them were married women.

First Talk

Some were minors. Their par­ents usually came with them. The shared experience often develop­ed a great bond between the parents and child. In some cases it was the first time they really talked to one another.

There were women trying to rid themselves of the guilt of carrying the wrong man’s child or the child of a marriage that was about to break up. There were victims of the worn-out mother syndrome and of rape. Young girls ignorant of contraceptive devices and sophisticated women who, whatever their emotional or psychological reasons, failed to use them. Women too poor to afford another child and women too rich to be bothered.

“Most of those who came to me,” Rappaport said, acted like the guiltiest of criminals; in their own minds they must have been. Yet, much of the guilt is imposed on them by a society that forces them to skulk down dark alleys looking for a doctor and condemns as criminal what is accepted as common in other countries.

“Their decision to come to me was usually an agonizing one. Who then was I to hand down a flat judgment telling them it’s worse to destroy a baby before it’s born than to let it live life as an unwanted, often unloved and neglected child? Or to tell these women they should have their babies and give them up at the time maternal feelings are the strongest, when, especially if Negro, the child can spend its life in an institution waiting to be adopted.

“Once the women got to my office some were unable to face the operation and fled. Filled with old wives’ tales and horror stories, many feared they were about to die. Those who went through with it often were so terrified no amount of assurance I could give them during the preliminary interview did any good.

“I could empathize with their fear. I still faint in the dentist’s chair every time he injects novocaine into my jaw, my way of dying a coward’s thousand deaths.

“Of those I operated on, the least frightened were teenagers. Perhaps because they have not heard enough to be terrorized.

“The bravest to come my way were the Oriental women who submitted to abortions with or without anesthesia, without flinching, their control a marvel to behold.

“But the most casual patient I ever had was a dancer in the Rockettes. She sauntered in for her abortion, rose blithely from the table when it was over, and did a little dance, still dizzy from the anesthesia. A moment later, while my back was turned, she took out a cigarette and lit it. Her lungs were still full of resid­ual ether fumes. Why an explosion did not occur I still don’t understand.”

These women, whose bond was the life they didn’t want or couldn’t have growing inside them, arrived at Nathan Rappa­port’s office like the trains from New York to Washington sched­uled every hour on the hour. He tried to limit the appointments to five a day, but on some week­ends they arrived in droves. Rap­paport has done as many as 27 abortions in one day, and knows of another abortionist who has done 50.

“The actual abortion,” he said, “took me anywhere from five to 20 minutes; depending on how much fetal tissue had to be re­moved and how readily it could be reached. Occasionally an op­eration would last for an hour or longer.”

For women less than three months pregnant he used the standard abortion technique which is known as dilation and curettage or “D and C.” The operation is performed with a small rake-shaped metal instrument used to scrape the walls of the womb.

Too Dangerous

This method is generally considered too dangerous if used after three months because as the womb enlarges, its musculature thins, making perforation and internal hemorrhaging more likely.

Pregnancies over three months were refused in the early years of Rappaport’s practice. Then he began to use a method which is new to this country but was known in Eastern Europe for some time. The technique involves injecting a salt solution through the abdomen into the amniotic sac enclosing the fetus. Within 24 hours this induces labor and a miscarriage.

Rappaport believes this is an even safer method than the D and C because instruments do not have to be introduced into the body for any length of time.

Unexpected Problems

He always used anesthesia, although it sometimes cause unexpected problems.

“I gave the wife of a young intern sodium pentathol, which also acts as a kind of truth serum. When she came out of the anesthesia she asked if her husband could sit with her in the recovery room. I permitted him to go in and he hovered solicitously by her bed. Leaning over to kiss his wife he said, ‘Darling, I’m so sorry you had to go through all this.’

“She, still under the effects of the anesthesia, blurted out that she didn’t know what he was so worried about because it wasn’t his kid, anyway.

“I didn’t wait to hear his an­swer. I fled back into my office and told my nurse to call me when they left.

“Women who use alcohol or drugs in any amount and don’t tell me when I ask them in the preliminary interview also caused me problems. They often get a high from the anesthesia. They used to fly all over the table with me chasing them, instruments in hand. In most of these cases it was impossible to operate.

Calculate Risk

“Operating on a person outside a hospital is always a calculated risk, no matter how good the technique,”Rappaport said. “In any surgery complication can arise. In a hospital you’re much better prepared for them. You have immediate access to blood banks, additional professional help, and consultations, and almost all the necessary equip­ment and drugs.”

It is because of the ever pres­ent risk which increases as the skill of the abortionist decreases that Rappaport wants even the best of illegal abortionists put out of business by hospitals given the freedom to deal realistically with abortions and the determined women who insist on having them.

Ideally, he would like to do away with all laws limiting hospital abortions because he considers these laws no more relevant or necessary to a medical problem than laws dictating tonsillectomies.

Practically, he wants the laws in this country liberalized at least to the Swedish or Danish level. And maybe even to see abortions covered by Blue Cross.

In addition to granting abortions for medical reasons such as a threat to the mental or physical health or life of the woman he wants them granted for eugenic reasons.

Mental Deficiencies

Eugenic abortions would include cases in which there are serious mental deficiencies in the parents or the probability of a congenital disease of malformation in the unborn infant. The Sherri Finkbine abortion was granted on eugenic grounds, but she had to travel to Sweden to get the abortion after learning that the Thalidomide she had taken produced monstrously deformed children.

Little Argument

Rappaport also believes there should be little argument about granting abortions on humanitarian grounds to victims of rape or incest, or to girls less than 15 years old. Abortions for general health reasons such as too many chil­dren or children too close to­gether should be permitted, he said.

There are two other general grounds on which he feels abor­tion should be allowed. One is for social reasons — when a woman feels that bearing a child would have disastrous effects on her life because of the stigma society places on the unwed mother and the illegitimate child.

The other is for psychological reasons, when the woman is emotionally unfit to be a mother, does not want the child, or when there seem to be indications that a child raised by the woman will suffer because of her attitude.

“I want to make it absolutely clear,”‘ Rappaport said, “that in no instance would I ever recom­mend an abortion unless the mother herself wanted it. That would be running Hitler a close second. It would not matter how deformed or how psychotic the baby would prove to be, if the mother wanted to give birth, that would be her choice.”

No Deterrent

He does not believe liberalizing the laws will encourage abortions or that the present laws deter them.

“The complicated reasons that drive a woman or a rebellious girl to become pregnant and then to not want her child have absolutely nothing to do with the existence or nonexistence of laws,” he said.

Yet, punitive laws remain on the books.

These laws sentence at least 5000 women a year to death. Degrade others by forcing them to search from pharmacist to laundrywoman to hotel clerk for the abortionists. And make getting a competent abortion the lucky break of the few who have money or who are tipped by the underground referral service to doctors like Nathan Rappaport.

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