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The Worst of Times

Underground abortions: a patient, doctor, abortionist, and
tell their stories

Abortion is one of the most explosive topics of our times. In her quest to make sense of it all, Pittsburgh lawyer Patricia G. Miller spent two years interviewing abortion survivors, practitioners, coroners, cops, and children of women who died--all ordinary people who happened to live during a time when abortion was illegal. Here are four firsthand accounts of their experiences, each of which sheds a "bright, painful light" on an issue that won't go away.


In 1957 I was living in Pittsburgh. I had graduated from high school a little more than a year earlier--the first person in my family ever to do so--and was working as a secretary. We were West Virginians. I was one of thirteen children, and we were what are known as "country people."

When I first set foot in the door of my high school, I vowed that I would graduate, even though no one in my family had ever done that. I was not going to get pregnant before I got an education and I was absolutely not going to live the kind of poverty-stricken life I watched my mother and older sisters live.

I graduated from high school still a virgin, so I felt I had a good chance of surviving the trap all the women in my family had fallen into. When I was nineteen or twenty, I met a sophisticated older man. Ray was twenty-five years older than I was. He had been married and had children older than I was. In addition to his maturity and sophistication, he had, by my standards, a great deal of money. With him, I embarked on my first sexual experience.

In those days there was really no birth control--at least so far as I knew. Ray told me that if you douched every time after you had sex, you wouldn't get pregnant. What did I know? I did what he told me. Now we know that douching is one of the most dangerous things in the world to do after having sex. It doesn't get rid of the sperm, it just washes it into places where it's more likely to meet the egg.

At that time, I had no attitudes, religious or otherwise, about abortion. In fact, I don't know that I had ever even heard the word growing up. I never was aware that this was an option people had. When I was in high school, I was aware of pregnancies before marriage, but the couple always just got married. It never occurred to me that people could do anything else.

Then I had that morning so many women face--when you look in the mirror and say, "Oh, my God!" You spend your time running to the bathroom, hoping against hope to see that magic spot of blood, but it doesn't happen. Finally, you reluctantly admit that it just isn't going to.

Ray said, "Of course you have to have an abortion." The only thing I'd ever heard about abortion was listening to my mother talk about jumping off kitchen tables, failing down flights of stairs, and taking hot baths--or maybe cold baths. I never really knew that there was any other way to have an abortion. Ray said, "Oh no, it's not like that. There are other ways." Ray was very--what shall I say?--well-connected. Many of his close friends were gangsters and people who lived outside the law. Ray said he knew of a good person to go to, and the reason he was good was because that's where all the gangsters took their girlfriends and their wives. Anyone involved in organized crime seemed to do nothing but the best, so this abortionist was sure to be "the best money can buy." It certainly made sense to me.

Ray made all the arrangements and told me that he and another man would pick me up and we would drive to Youngstown, Ohio. At the appointed time, at night, Ray and his friend Lloyd picked me up. I had met Lloyd before. He was a convicted murderer. I don't know how he had killed, but he'd served his time. He was out of jail, working as a bookie.

That late-night car trip to Ohio happened many years ago, but I can see it as vividly as if it was yesterday. I sat in the front seat of this shiny new big black Chrysler Imperial with Ray in a black cashmere coat on one side of me and Lloyd, the murderer-turned-bookie, sporting an elegant camel's-hair coat, on the other. All the way to Ohio, the two men talked exclusively to each other, mostly about sports or gambling. I sat silent between them, feeling like I was no bigger than a candle flame in the dark. I felt almost nonexistent, like I was in some other world. The trip had a strange quality of unreality about it.

I was beyond fear--truly beyond it, I was so terrified I couldn't move or speak or even think. I just huddled there in the front seat. I didn't know where I was going or what was going to be done to me. I had no idea. Was someone going to cut my head off or cut my belly open? Either was equally possible in my mind.

When we got to Youngstown, Lloyd drove to a very rundown part of town. The houses all had a ramshackle look about them. We pulled up behind a rundown old house. It was frame and looked like it hadn't been painted in at least 25 years. The two men sat in the car, and I went up to the door by myself. I supposed I was expected, so no introduction was necessary.

An old black man with springy white hair opened the door. I found myself standing in a small room with a wooden kitchen table in the middle. Although the table needed a new paint job too, it had seen a paint brush more recently than the exterior of the house.

My fear drove me into what must have been an altered state of consciousness. I didn't ever lose consciousness, but I have very little memory of what happened next. To this day, I cannot recall what that old man did to me. He was the abortionist. No one else came into the room. The last thing I remember was climbing up onto the kitchen table. I don't remember anything else until it was over. The next thing I remembered was the old man looking at me and saying, "Now, you are going to have a lot of pain, but you are going to be all right. Just take some aspirin. Don't worry about it, and don't go to a doctor." When I came out of the house, Ray and Lloyd were waiting in the car. We drove back to Pittsburgh. At that point I felt fine--no pain or bleeding or anything.

The next day the pain started. The cramps were terrible--unlike anything I had ever experienced. Aspirin did nothing for the pain, but I didn't call a doctor. After about two days of severe cramping, I began to hemorrhage and did miscarry. I remember going into the bathroom and having blood and clots just pour out of me. The blood was very dark, almost black. There was blood all over the bathroom floor. It was frightening.

When I began hemorrhaging, my roommate, who knew about the abortion, said, "I've got to tell your mother. We got to call a doctor." I refused. She was scared, and frankly, so was I, but I had been told not to call a doctor. I was afraid that a doctor would call the police and I would go to jail. My roommate kept arguing that they wouldn't put me in jail, but I was sure they would. Not only had I done something illegal, but I had been driven there by a gangster. How much more illegal could it get? Besides, I figured that even if the police didn't put me in jail, gangsters might do something even worse to me if I told. It was much better--and safer--to just keep my mouth shut.

Ray came to see me once or twice. I can remember him bending over the bed looking at me. I kept hoping he would just pick me up and take me to an emergency room. He didn't, though.

My roommate and I just toughed it out without involving anyone. The pain and the bleeding gradually subsided, and after ten days I was able to drag myself back to work. Everyone had been told I had the flu, and I looked the part. I had lost weight to the point where I was sallow and scrawny-looking. I was weak, and it was an effort to drag myself through the day.

About three weeks after I had gone back to work, and more than a month after the abortion, I began to have a new and ominous symptom--a discharge. It was very different from the hemorrhaging, although it was almost as heavy. Instead of dark red blood, it was pale pink fluid with a putrid odor. The smell, which seemed to pervade my whole body and not just the discharge itself, was so bad it made me gag.

My roommate again begged me to go to the doctor, and I was willing because it seemed to be a different medical problem, one for which I might not get arrested. However, it took me another two weeks to get up enough nerve to call a doctor, so by the time I actually got medical attention, it was five or six weeks after the abortion.

I found the doctor in the Yellow Pages. I didn't know him or anything. Of course, I didn't tell him about the abortion. Because I had, to him at least, a bafflingly innocuous medical history that did not match the severity of my symptoms, he decided to hospitalize me. Although that made me somewhat fearful, I was really too sick to offer much resistance. After lab tests ruled out a venereal disease as the cause of my symptoms, he informed me that he was going to do a [dilatation and curettage] because I had a severe infection of unknown cause.

After the D and C, the doctor came in, and I'll never forget this. He leaned over my bed, looked into my eyes, and said, "Young lady, why didn't you tell me you had had an abortion?" I looked back at him and said, "Because I thought you would put me in jail!" He patted my hand--he was very kind--and said, "No, no. We'll take care of you. It's all right. No one will hurt you. It's over now, and everything will be all right." Well, I started to cry, and I just lay there crying, and he stood there patting my hand, telling me not to worry. He was really a wonderful human being, and for the first time I felt that things really might be all right after all.

I finally did recover from the abortion and the infection, but it was a very slow process. Actually I never got back to where I had been, because the infection left such severe scarring that I was never able to get pregnant after that.

I had no mixed feelings about having an abortion. I desperately wanted that abortion. I was not taught, and I did not believe, that abortion was morally wrong, but I did feel that I was a bad person because I had committed a criminal act. Abortion was against the law and I had broken the law. That made me a bad person, because in my mind there was no such thing as "good criminals" and "bad criminals."

It took me years to get over that feeling. I had always felt so alone--like I was the only woman who had this dirty secret. Finding out that there were so many of us made me feel less like a criminal. My guilt went away completely, I think, when abortion became legal. It wasn't that I did something "wrong," it's that I did what I did at the "wrong" point in the history of this country.


I graduated from medical school in 1954. During my medical training, I saw women being treated for septic abortion, and as a resident I took care of lots of them. I have no idea what the real abortion numbers were in those days, but I'm pretty sure we just saw and identified as "abortion patients" the tip of the iceberg--women where something went wrong and they had no private doctor. I suspect that no more than one in five abortions was actually listed as an abortion, maybe even less.

The women on the wards were generally more seriously ill than the private patients. Now, that may be due to their generally inferior health status. They didn't have the advantages of good nutrition and hygiene. They didn't get regular health care or any kind of maintenance care. They also tended to be black, and the private patients tended to be white, but this was probably typical of the times. However, it didn't mean that white women got better abortions. They all got lousy abortions.

The technique of the criminal abortionist wasn't limited to a catheter or coat hanger. Many of them injected some kind of caustic substance--bleach or something like that--into the uterus. The uterus would contract to get rid of the irritant, but there was a high risk of complications.

Potassium permanganate [a dark purple salt] was another common choice. The abortionist dissolved some of the crystals in water and inserted the solution into the uterus through a syringe or catheter. On the street, women heard that potassium permanganate would work, but they didn't get all the details of how to use it, and we would see women who would just insert the crystals into the vagina.

By the time these women got to the hospital, they would have terrible burns or even actual holes in the vaginal lining, because the crystals had simply eaten away the tissue. The irony is that placed in the vagina, potassium permanganate didn't abort the pregnancy, but it sure did a lot of damage to the vagina.

The complications we typically saw on the ward were severe pelvic inflammation and infection, with pelvic abscesses which had to be drained. Many women got an ilius, or shutdown of their intestines. They had to have a nasal-gastic tube so we could just keep their intestines quiet until they started to function again.

They would also get a generalized peritonitis. Some patients died of "uremia"--at least that's what would be written on the death certificate again leading statisticians to miss the abortion connection. Uremia is an extremely severe infection with septic shock and kidney shutdown.

Hemorrhage was sometimes a complication, although often these women died at the time of the abortion, before they ever got to a hospital. With a perforation in certain parts of the uterus, where the blood supply is concentrated, it would take only a few hours--a day at most--for the woman to bleed to death. If it isn't that part of the uterus, perforation could take several days to cause death.

With illegal abortion, there were lots of ways to die. The lucky ones made it through. The not-so-lucky ones died fairly horrible deaths.

In the 1950s and early '60s, in spite of that always-full hospital ward, no one talked about abortion as a public health problem. It was just a fact of life, and you dealt with it the best way you could--taking care of the complications. It was the women's rights movement and not public health concerns that made abortion legal.

I remember that when I first went into private practice in 1961, if a woman wanted her tubes tied, she had to get her husband's written permission. I thought that was way out of line. Her body didn't belong to her husband! Besides, she didn't have to sign for his vasectomy. But that's how it was.

For as long as I can remember, I have been in favor of making abortion legal, because I always thought that a woman ought to have the right to control her body.


I can't remember when I did my first abortion, because it was such a long time ago. I would guess it was in the early to mid-fifties. Most of my referrals came from doctors or nurses who knew me. At first I was always reluctant. I'd say to them, "Can't you get someone else to do it?" They would usually say that they couldn't get anyone else or they wanted me because they knew me and trusted me or because I was a good nurse or something like that. I always ended helping them out.

Abortions are easy to do, and it doesn't take long to do a good one. I took less than five minutes: completely done, clean, and out. Usually the woman wouldn't be at my house for longer than 15 minutes total.

I always used a catheter, but sometimes I took it out and other times I left it in. Mostly I left it in because you get better results that way. Catheters were easy to get. Different doctors would sometimes give them to me. I would also go to the drugstore and buy them. The pharmacist would sort of jokingly bawl me out for buying so many, but he always sold them to me. The catheters I used were thicker than a broom straw and not as thick as a drinking straw. They were made of red rubber and were about 12 inches long. Sometimes they were just plain, but sometimes they came in little sterile individual packets. That was nice. I liked it when I could get them like that. When they didn't come in the sterile packets, I sterilized them myself by boiling them in water with Clorox.

In addition to the catheters, I had to have a speculum and a light so I could look in and see what was going on. I've heard of people who did abortions in the back seats of cars. I can't imagine that. You wouldn't be able to see, and it sure wouldn't be very clean. With all the abortions I did, I had the woman lying on the bed. I had good light and good conditions. You simply have to be able to see what you are doing.

I was never willing to do an abortion beyond the first two months or so. It could be done later, but it was more complicated and more dangerous for the patient, and I just never wanted to get involved with that.

I didn't give the women antibiotics because I couldn't get those without a prescription, so I would tell each woman to get them from the doctor who sent her to me. Sometimes I never knew who the referring doctor was because the doctor didn't want me to know he was sending people to me. It's like they all wanted me to be out there doing good abortions so they could send their patients to me, while at the same time they didn't want to get themselves "involved." Although I guess I understand that, in some ways it doesn't seem very fair.

I never had a medical problem that occurred right there, like a perforation or something, and only one woman ever got an infection afterward. I probably did one or two abortions a week for ten or twelve years altogether. I certainly did hundreds, but probably not more than a thousand, if that many. I always did the abortions in my bedroom, and contrary to what the police said, my bedroom was neat and clean. So was the rest of my house.

My fees varied depending on the person. My regular charge was a $150 dollars, but I did lot for $25 or $30 dollars, and I did plenty for nothing. When you live in a community like mine, you see a lot of poor people who really need help.

I felt so horrible when I was arrested and my name was in the paper. It was years before I was willing to leave the house. I felt so ashamed. It wasn't doing abortions that I was ashamed of, it was being arrested. In my mind, the only people who are arrested are criminals, and suddenly, overnight, instead of being a nurse, mother, and productive member of society, I had become a criminal. It was awful. I did not feel good about myself, and I just withdrew from the world.

I never worked as a nurse again, and I never did another abortion either. I went into a deep depression and refused to leave my house. The longer I stayed home, the worse it got and the more depressed I got. I just kept retreating inward. I'm still depressed. I don't understand why one person can be so inhuman to another. I never did anything to those two people [who arrested me]. Why did they do that to me?


I'm a retired city detective. In 1966 I was one of two undercover city detectives who arrested Fay. Someone gave us the tip that Fay was doing abortions, and they were able to give us enough information, like her address and such, that we could make an appointment. I made the telephone call. I told her I had a girl in trouble and I needed an abortion. She was very up-front about everything, and it was very candid. She told me what it would cost. As I remember, it was a $150 dollars, but that might not be right. She gave us a specific time to come and asked if I needed directions. I didn't.

The female police officer was new on the job, but I had known her for years because she lived in my neighborhood. Before we went in I said, "Now, Mary, whatever you do, don't let her put anything in you." Well, Mary laughed and told me she sure wouldn't. It seems that Mary had had a hysterectomy, and so she didn't have a uterus anymore, which meant that as soon as Fay examined her, she would realize that Mary knew she wasn't pregnant. Then Fay would figure out we were undercover cops, and it would all be over.

We entered into a living room, where I was told to sit and wait. Mary was ushered into the next room, which turned out to be a bedroom. There wasn't a door between the rooms. just a kind of drape hanging over the doorway.

The plan was that as soon as Mary handed Fay the money, she was to yell and I was to come in and make the arrest. I don't know how long I sat, except that it was too long. It should have just been few seconds, but the minutes dragged by. I sat there getting more and more nervous and wondering what had gone wrong. It's true that it was Mary's first job, but I didn't think anything could go wrong with our plan. Finally Mary yelled and I went flying in. Mary was partially undressed, lying on her back on the bed. Fay had already inserted an instrument that I later learned was called a speculum. That was the first step before she actually did the abortion. In one more instant, Fay would have looked into Mary's vagina and seen that she had no uterus at all.

I arrested Fay while Mary put her clothes back on. I looked around the room. Fay had a piece of coat hanger she was planning to use on Mary. The only "equipment" I remember seeing was the coat hanger and the speculum--you know, a kind of thing real doctors use. She had probably stolen it from some hospital. The instruments were wrapped in an old newspaper. The room was an ordinary bedroom. It wasn't particularly clean. There were clothes and stuff laying around.

All of these abortionists fit the same mold. It didn't matter whether they worked out of houses or the back seats of cars. It was the same dirty routine. The house was usually run-down. The room was dirty. The abortion was usually done on a bed or a kitchen table, sometimes on the floor. The instruments were wrapped in newspaper. They weren't sterilized. They weren't even washed from one client to another. It was just filth. The abortionists were black and white, men and women. Color or sex didn't matter. What drew them to it was the money. It was terrible.


Usually, in the black community, there were midwives who did abortions. A lot of them were nurses or at least had some nurses training. Many of them knew anatomy and physiology. They had often developed an abortion practice. People knew them and liked them. Even the doctors knew them and liked them. Many times these midwives would call us before they did an abortion. Then we would follow up on the patient afterward. This practice was universal in the black community, but I don't know what it was like in the white community.

The doctor certainly came to rely on these competent midwife-abortionists and to refer patients to them. They charged reasonable prices. They had set up their own facilities where they did the abortions. These places were usually clean and reasonably well-equipped, although nothing like it would have been if it were legal and aboveboard. When you have to hide and sneak around, then naturally there's a lot of stuff you can't do that you would otherwise do.

One of the best midwife-abortionists was a woman named Fay, who did the most abortions in our community. She would often send the woman directly to me or to another doctor after her abortion so that we could give the woman antibiotics. She was very well-trained. Of course, she was never trained during her formal nursing career in how to do an abortion, but she did know anatomy. And sometimes your best training is experience. After you do 200 to 300 abortions, you get pretty good.

Fay didn't select her clientele just on the basis of money like some did. A lot of the women who came to Fay had three or four children, all by different men. Some were on welfare or didn't have much money. For them, Fay cut her prices, maybe charging no more than thirty dollars. With a good Fay out there, there was almost no reason for a doctor to take a chance and do an abortion himself.

Fay functioned in our community for about twenty years, and there were a lot of other Fays and people like her in other communities all over Pittsburgh. I have no doubt that there were back-alley abortionists--people with little training and little experience--but the Fays I knew weren't like that at all.

Adapted from The Worst of Times: Illegal Abortion-Survivors, Practitioners, Coroners, Cops, and Children of Women Who Died Talk about Its Horror, by Patricia G. Miller. Copyright (c) 1993 by Patricia G. Miller. An Aaron Asher Book. Reprinted by arrangement with HarperCollins Publishers Inc.