John Asher graduated from Ithaca High School in 1957 and from Harvard medical school in 1966. He had been an Epidemic Intelligence Service (EIS) officer with the Center for Disease Control in Atlanta, Georgia, and in November 1968 he initiated abortion surveillance at Atlanta's Grady Memorial Hospital. He concluded that a "rational approach" to the problem of complications of illegal abortions required a combination of improved contraceptives services and wider availability of safe hospital abortions. In the early 1970s he was Chief Resident in the Department of Psychiatry, Stanford University Medical School In 1973 he was Co-organizer, Medical Relief Teams, at Wounded Knee.
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The seizure of the trading post and the surrounding settlement at Wounded Knee began on February 27. 1973 and was initiated by local Pine Ridge Reservation Indians known as the Oglala Sioux Civil Rights Organization (OSCRO) under the leadership of Pedro Bissonette.
...Movement (AIM) leaders and from various sympathizers across the nation.
For a variety of motivations, Chicanos, Blacks, and Whites all made their way to Wounded Knee in support of their Red brothers and sisters. Confronting them they found federal marshals in powder-blue jump suits with American flag shoulder patches, khaki-clad FBI agents slinging automatic weapons, walkie talkie carrying Community Relations Service (CRS) men from the Justice Department, and Bureau of Indian Affairs (BIA) police, themselves Indians working with their affiliated toughs known locally as "the goon squad." The"goons" had earned their name by their rough tactics on anyone who disagreed with the Tribal Council and its leader Richard Wilson.
Somewhere between the opposing lines were the medical people, the legal people, and the church people. The closest to a local legal person was Ramon Roubideaux from Rapid City. South Dakota, who with a staff of lawyers represented the AIM interests. The local church and medical people found themselves in a difficult position, since the Indian community itself was severely split into pro- and anti-AIM factions. The latter were led....
Inside churchmen, like the local medical personnel, were sensitized to the threat of repercussions long after the outsiders and do-gooders (like myself) were safely back in Minneapolis, San Francisco, New York, and the other urban centers from whence they had come. Thus they were reluctant to become identified with the militant Indians, though they freely admitted the corruption of the Tribal Council. Like the Reverend Adams, I, as a doctor from far away, had the advantage of acceptability based on my skills, trust as long as I delivered what I promised, and relative immunity to future revenge (except on the part of the Government — after all, I did cross state lines to get to Wounded Knee)....
I arrived in the small town of Pine Ridge, population 1500, at eleven in the morning without a single contact and with only one clue as to how to proceed. I had learned from the Frontier Airlines ticket agent in Scotts Bluff, Nebraska that there was an Indian Health Service hospital in Pine Ridge; the agent doubled as pilot for a small air ambulance charter service and had often flown sick Indians to Fitzsimmons Army Hospital in Denver: They get the best care there is. There's no problem up there at Wounded Knee. There never was. We flew this old Indian lady to Denver. The government pays for all that, don't you know. Why even the Americans (emphasis mine) around here don't get care like that. Maybe you don't see it this way,'' he said eyeing my beard, "but I don't think they want to change. It's just like in Watts. There it was colored people, but it was started by outsiders. I'm 100 percent sure Communists are behind the whole thing. But when the trouble starts they're gone." ...Being a Public Health Service graduate myself and also knowing that their hospitals are staffed with young doctors just out of medical school who are fulfilling their draft obligation in non- combat positions. I hoped to find a friendly face or two to help me get into Wounded Knee. Moreover the basic rule taught me when going on assignment as an Epidemic Intelligence Service (EIS) officer with the Center for Disease Control in Atlanta, Georgia was to include rather than exclude the local health authorities. This old lesson turned out to be extremely useful as it opened the door to the various Justice and Interior Department officials who in turn granted me initial access to Wounded Knee. The second lesson I had learned as an EIS officer was to try to establish an enduring mechanism which continues after your departure.
Once having gained entrance into Wounded Knee for myself and medical supplies, the setting up of ongoing medical relief teams became my main objective. In accomplishing it, by necessity I had to negotiate directly with all the major opposing forces and personalities at Wounded Knee, including Russell Means of AIM and Richard Wilson of the Tribal Council.... What did not become clear in my own mind until long after I left Wounded Knee and had spoken to groups in Ithaca, Washington, and in the San Francisco Bay area was the answer to that ever recurring question, "What do they really want?" Finally, after what
seemed like hundreds of conversations I was able to answer it to my own satisfaction: They want what they deserve....
The idea that medical personnel can be neutral in a confrontation is absurd. The BIA and Richard Wilson were quick to grasp this point, which explains why they reneged on the agreement I negotiated with them. However, the negotiations in and of themselves had a conciliatory effect on the general atmosphere by including two groups, the hospital and the Tribal Council, which had previously been excluded. Furthermore, the medical presence became a force to be reckoned with. Over the ensuing weeks the shuttling in and out of doctors, nurses, and paramedics provided a kind of fair witness" which said two things to the Government: 1 ) There is middle-class support for this takeover, and 2) If there is bloodshed, assuming they live to tell the tale, the medical people will tell the world what happened. The Government knows very well that the medical personnel will be believed before the politicians, the negotiators, the lawyers, and even the media people. After all, it was the pathologist in upstate New York who destroyed the official attempt to blame the deaths of the Attica hostages on the prisoners. The story that their throats had been slashed was denied by the pathologist who ascertained the cause of death to be bullets — and only the police had guns.
Unlike lawyers, doctors are not trained in the adversary mode; they tend to cooperate with other doctors in order to defeat a nonhuman adversary, namely disease. Rather than covering up or distorting truth, their efforts are aimed at discovering reality and, when possible, the true pathological mechanisms at
work. This is not to picture doctors as ever noble defenders of truth and lawyers as consistent liars, but it is important to recognize the intrinsic difference between the adversary negotiator's attempt to portray the best story or to get the best deal, and the scientist's effort to picture reality as distortion-free as possible. Nor does this mean that lawyers are more biased than doctors in a confrontation. On the contrary, doctors and other medical personnel take a clear stand merely by being there. Negotiators are not usually shot at, whereas medical personnel at Wounded Knee were pinned down more than once by Government fire.

--John D. Asher

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Epidemiology of Induced Abortion
by John D. Asher '67

My interest in induced abortion was based largely on hospital experiences during my obstetrics and gynecology rotation in the spring of 1966 at the Boston Hospital for Women. Of course I was not unaware of the existence of the problem, and, in fact, once spent a long spring afternoon in Paris trying to convince the girlfriend of a friend (it's always "of a friend") not to undergo this dangerous procedure. I was only a pre-medical student at the
time and thus very firmly convinced of the dangers and risks she would suffer. My pleas were to no avail and for one thousand new French francs she was relieved of her burden.
The agony of the unwanted pregnancy has been shared by many. My French friend had faced a dilemma which lurks beneath the surface on every American college campus today. Some are forced to confront the situation directly and must marry under duress, give up the unwanted child, or undergo the incalculable strain of an often dangerous criminal act. Others only hear about the problem or occasionally entertain theoretical worries about it.
I did not really come to grips with the issue until last spring, when, in a six-week period, I experienced three quite different and unusual cases. The first was a young college girl who was operated on as a surgical emergency because of apparent intra-abdominal hemorrhage with no history of trauma. I happened to be asked to scrub on this case. Upon opening the abdomen we were confronted with ....a rare complication of incomplete abortion known as chorioadenoma destruens first described in 1942.... the patient eventually recovered.
The history of this case was slowly revealed long after the physical examination and treatment had been completed. It was a classic story: The bewildered boy friend; boy and girl both still studying and not ready to marry; no use of contraceptives; a friend who knew a doctor; a plane trip to Oklahoma City with boy friend; regular patients waiting in the doctor's office; radio blaring rock'n roll as anesthesia substitute, fainting . . . then six weeks later sudden hemorrhage.
Both "kids" were from upper middle class backgrounds. Although the parents knew nothing — about them, about the pregnancy, about the trip to Oklahoma, or even why their daughter was in the hospital with intra-abdominal hemorrhage — the necessary one thousand dollars was readily obtainable.
The majority of women in this country, faced with an unwanted pregnancy, may not be in such a fortunate economic position, so that even this avenue of escape, unsavory though it may be, is closed off to them.
In the second case the history was crucial and the abortion came as a result. The patient was a young Negro woman who had three children and a devoted husband. One year pre- viously she had been stricken with a cerebral tuberculoma and as a result was almost completely blind. In the interval of less than one year since losing her vision she had learned braille and was again able to take care of her household and family. However, she had also become pregnant. Thus, she requested therapeutic abortion as well as sterilization because of the health and economic strains any further pregnancies would impose upon her and her family. Her request was considered from every aspect with utmost care and discussed fully with both patient and husband before being acted upon.
The third case was also an application for therapeutic abortion but more complex. She was a middle-aged mother with teenage children whose husband was incapacitated for life in a nursing home. While visiting him daily she developed a friendship with a man whose wife was a paraplegic in the same nursing home. The friendship continued, became more serious, and the woman found herself pregnant. She requested therapeutic abortion. The students were asked their opinion, and we wrestled with the pros and cons just as the staff had to do. The resident who was the woman's doctor felt very strongly that his patient could not stand the strain and humiliation of a pregnancy before her friends and high school children. He felt that she would under no circumstances carry through the pregnancy. The question was what was to be the role and responsibility of the physicians to whom she had come for help.
In these three cases we faced the dual problem of criminal and therapeutic abortion and the triple factors of social, economic and health considerations. In this country abortion is a term so charged with emotional connotations that it is no longer in respectable medical usage. The near fatal complications of a criminal abortion in a single college girl, the plight of a pregnant wife recovering from crippling TB and the middle-aged mother stricken with the "disease" represent the full spectrum of the abortion problem in the United States today. Until this year, not for economic, not for social and only circuitously for health reasons was an abortion permitted in any of the fifty states....
Dr. Asher is now completing his internship in surgery at the Boston City Hospital (Harvard Service). In support of this study-travel program, he gratefully acknowledges the help of the Milbank Foundation through its faculty
fellowship to Dr. David C. Poskanzer, and also the Harvard Medical School.
Extracted from Epidemiology of Induced Abortion, John D. Asher, Harvard Medical Alumni Bulletin Vol. 42 Winter 1968 No. 3