"This low estimate of the importance of foetal life is by no means restricted to the ignorant or to the lower classes of society. Educated, refined, and fashionable women, yea, in many instances, women whose lives are in other respects without reproach—mothers who are devoted with an ardent and self-denying affection to the children who already constitute the family—are perfectly indifferent concerning the foetus in utero. They seem not to realize that the being within them is indeed animate, that it is in verity a human being, body and spirit; that it is of importance; that its value is inestimable, having reference to this world and the next. Hence they in every way neglect its interests. They eat and drink, they walk and ride; they will practise no self-restraint, but will indulge every caprice, every passion, utterly regardless of the unseen, unloved embryo....

"These facts are horrible, but they are too frequent and too true; often, very often, must all the eloquence and all the authority of the practitioner be employed; often he must as it were grasp the conscience of his weak and erring patient, and let her know, in language not to be misunderstood, that she is responsible to her Creator for the life of the being within her." (Wharton and Stille's Med. Jur., Parturition, p. 92.)

Dr. Walter Channing, of Massachusetts, refers to the difficulty of obtaining a conviction for abortion, and adds: "I believe there has never been one in this State, this moral State by eminence, and perhaps in none is this crime more rife." ("Boston Med. and Surg. Journal," April, 1859, p. 135).

V. We have, then, proved, gentlemen, two important and pregnant principles: 1. That we can never directly procure abortion, and 2, that we can procure it indirectly in extreme cases; or rather that we can take such extreme measures in pressing danger as may likely result in abortion against our will.

While these principles are clear and undoubted, there are cases in which the right application of them is beset with great difficulties. These often occur in connection with what is called ectopic or extra-uterine gestation, namely, when the nascent human form lodges in some recess not intended by nature for its abode. Of late years, Dr. Velpeau, of Paris; Dr. Tait, of Birmingham, and many other eminent physicians have shown that cases of ectopic gestation are more numerous than had been supposed; one practitioner reports that he had attended fifty cases, another eighty-five.

1. We will first suppose the case of an interior growth occurring, the nature of which cannot be determined. It may be only a tumor, yet it may be the growth of a living foetus. If no immediate crisis is feared, you will wait, of course, for further developments. If it proves to be a child, you will attempt no operation till it becomes viable at least. But suppose that fatal consequences are apprehended before the presence of a human being can be ascertained by the beating of the heart; suppose that delay would endanger the mother's life; and yet if you undertake to cut out the tumor, you may find it to contain foetal life. In such urgent danger, can you lawfully perform the operation? Let us apply our principles. You mean to operate on a tumor affecting one of the mother's organs. The consequences this may have for the child are not directly willed, but permitted. The four conditions mentioned before are hereby verified, under which the evil result, the death of the possible foetus, may be lawfully permitted; namely: (a) You do not wish its death; (b) What you intend directly, the operation on the mother's organism, is good in itself; (c) The good effect intended, her safety, to which she has an undoubted right, overbalances the evil effect, the possible death of the child, whose right to life is doubtful, since its very existence is doubtful; now, a certain right must take precedence of a doubtful right of the same species; (d) The evil is not made the means to obtain the good effect (see "Am. Eccl. Rev.," Nov., 1893, p. 353). This last condition would not be verified if it were proposed, not to cut out the cyst, but to destroy its contents by an electric current. Then, it would seem, the foetus itself, if there be one, would be directly attacked.

2. The case would present greater difficulties if the growth in question were known to contain a living foetus. Such a case is discussed in all its details, with remarkable philosophical acumen, and in the light of copious information furnished by prominent members of the medical profession, in the pages of the "American Ecclesiastical Review" for November, 1893, pages 331-360. The participants in this interesting discussion are writers who enjoy a world-wide reputation for keenness of intellect and soundness of doctrine in philosophical and theological learning. They are not at all agreed as to the practical conclusion arrived at, and even those who agree to the same conclusion do so for different reasons. Three of them agree that in the case of a cyst known to contain a living embryo, when a rupture most probably fatal to mother and child is imminent, the abdominal section might be performed lawfully, the cyst opened and the child baptized before its certain death. Two of these justify this conclusion on the principle that the death of the child is then permitted only or indirectly intended; one maintains that the killing of the embryo is then directly procured, but he considers that an embryo in a place not intended for it by nature is where it has no right to be, and therefore may be treated as an unjust aggressor upon the mother's life. At least one of the disputants condemns the operation as absolutely unlawful.

Gentlemen, when such authorities disagree, I would not presume to attempt a theoretic decision. But then we have this other principle practically to guide us, that in matters so very doubtful we need not condemn those who differ from our view, as long as they feel convinced that they are acting wisely and prudently. In Jurisprudence, reason must be our guide when it affords us evidence of the truth. But when our reason offers arguments on both sides of the question, so that we can arrive at no certain conclusion, then we act prudently by invoking the authority of wiser minds who make moral questions a speciality, and we are perfectly safe if we follow the best authority obtainable.

A Catholic physician has here a special advantage: for he has in cases of great difficulty the decisions of Roman tribunals, composed of most learned men, and renowned for the thoroughness of their investigations and the prudence of their verdicts, to serve him as guides and vouchers for his conduct. Although these tribunals claim no infallibility, yet they offer all the advantages that we look for, with regard to civil matters, in the decisions of our Supreme Court. These Roman courts have uniformly decided against any operation tending directly to the death of an innocent child ("Am. Eccl. Rev.," Nov., 1893, pp. 352, 353; Feb., 1895, p. 171).

Non-Catholics are, of course, not obliged to obey such pronouncements; yet, even for them, it cannot be injurious, but rather very useful, to know the views of so competent a court on matters of the most vital interest in their learned profession. This is the reason why the "Medical Record" has published of late so many articles on the teachings of Catholic authorities with regard to craniotomy and abortion (see vol. xlvii. nos. 5, 9, 25; vol. xlviii. nos. 1, 2, 3, 4).



LECTURE IV.

VIEWS OF SCIENTISTS AND SCIOLISTS.

In my former lectures, gentlemen, I explained to you the principles condemnatory of craniotomy and abortion, viewing these chiefly from the standpoint of the ethical philosopher and the jurist. Not being a physician myself, I think it proper, on matters of so much importance, to quote here freely from a lecture delivered on this subject by a late professional gynecologist, an old experienced practitioner, who was for many years a professor of obstetrics in the St. Louis Medical College. I quote him with the more pleasure because of my personal acquaintance with him, and of the universal esteem for ability and integrity in which he was held by the medical profession.

Dr. L. Charles Boisliniere, to whom I refer, had by his scientific acquirements and his successful practice, during forty years of his life, become, to a great extent, identified with the progress of the science of obstetrics in this country; and a few months before his late demise, he had published a useful work on "Obstetric Accidents, Emergencies, and Operations."

In 1892 he read, before the St. Louis Obstetrical and Gynecological Society, a lecture on the moral aspects of craniotomy and abortion, of which a considerable portion is very much to our present purpose. The Doctor herein clearly demonstrates that, in this matter at least, Ethics and Medical Science are to-day perfectly concordant. He says:

"The operation of craniotomy is a very old one. The ancients entertained the belief that, in difficult labors, the unborn child was an unjust aggressor against the mother, and must, therefore, be sacrificed to save her life.

"Hippocrates, Celsus, Avicenna, and the Arabian School invented a number of vulnerating instruments to enter and crush the child's cranium. With the advance of the obstetric art, more conservative measures were gradually adopted, such as the forceps, version, induction of premature labor, and, finally, Cesarean section.

"Cesarean section is reported to have been performed by Nicola de Falcon in the year 1491. Nufer, in 1500, and Rousset, in 1581, performed it a great many times, always successfully; so that, Scipio Murunia affirms, it was as common in France during that epoch as blood-letting was in Italy, where at that time patients were bled for almost every disease. However, a reaction soon followed, headed by Guillemau and Ambrose Pare, who had failed in their attempts at Cesarean section. In our days a marked change of opinion on this interesting and delicate question is rapidly taking place.

"With these advances in view, the question now is:

"Are we ever justified in killing an unborn child in order to save the mother's life?

"This is a burning question, and the sooner and more satisfactorily it is settled, the greater will be the peace to the medical mind and conscience.

"In answer to the question, I, at the outset, reply No, and claim that, under no conditions or circumstances, is it ever allowable to destroy the life of the child in order to increase the mother's chances of living. And the day may arrive when, by the law of the land, the act will be considered criminal and punished as such. In support of this opinion, and to illustrate this position, allow me to take a purely ethical and medico-legal view of the subject, and to relate to you a parallel case, as also the decision arrived at by the Lord Chief Justice of England, Judge Coleridge, than whom there is not a greater jurist living.

"The case is that of the British yacht 'Mignonette.' On July 5, 1884, the prisoners Dudley and Stevens, with one Brookes and the deceased, an English boy between 17 and 18 years of age, part of the crew of the 'Mignonette,' were cast away in a storm at sea 1,600 miles from the Cape of Good Hope, and were compelled to take to an open boat.

"They had no supply of water, no supply of food, and subsisted for twenty days on two pounds of turnips and a small turtle they had caught. They managed to collect a little rain-water in their oil-skin capes.

"On the eighteenth day, having been without food for seventeen days and without water for five days, the prisoners suggested that some one should be sacrificed to save the rest. Brookes dissented, and the boy, to whom they referred, was not consulted. On that day Dudley and Stevens spoke of their having families, and of their lives being more valuable than that of the boy. The boy was lying in the bottom of the boat, quite helpless, extremely weak and unable to make any resistance; nor did he assent to be killed to save the others. Dudley, with the assent of Stevens, went to the boy and, telling him that his time had come, put a knife into his throat and killed him. They fed upon his flesh for four days. On the fourth day the boat was picked up by a passing vessel, and the sailors were rescued, still alive but in a state of extreme prostration.

"The prisoners were carried to the port of Falmouth and committed for trial, the charge being murder. Their excuse was that, if they had not killed the boy and fed upon his flesh, there being no sail in sight, they would have died of starvation before being rescued. They said that there was no chance of saving their lives, except by killing some one for the others to eat. The prisoners were committed for murder and sentenced to death, but appealed to the mercy of the court, pleading ignorance. It was found by the verdict that the boy was incapable of resistance, and authorities were then quoted to prove that, in order to save your own life, you have the right to take the life of an unjust aggressor in self-defence—a principle the truth of which is universally admitted.

"But the evidence clearly showed that the defenceless boy was not an unjust aggressor against their lives, and, consequently, their only plea was that of expediency.

"In a chapter in which he deals with the exception created by necessity, Lord Hale, quoted by Justice Coleridge, thus expresses himself:

"'If a man be desperately assaulted and in peril of death, and cannot otherwise escape, except by killing an innocent person then present, the act will not acquit him of the crime and punishment of murder; for he ought rather to die himself than to kill an innocent.'

"In the case of two men on a plank at sea, which can only support one, the right of one occupant to throw the other overboard to save his own life, and in the instance of sailors, to save themselves, throwing passengers in the sea, are equally condemned by Lord Coleridge as unjustifiable homicide. So that under no circumstances is it allowable to kill an innocent aggressor to save your own life. I say innocent aggressor; but it is allowed, in self-defence, to kill, if necessary, an unjust aggressor against your life.

"This case is exactly analogous to that of the child lying helpless in its mother's womb. She causes its death by her consent to the act of her agent, the physician in attendance.

"Remark that Brookes, one of the sailors, dissented to the killing of the sailor-boy. This may happen in consultation, when one of the consultants does not admit the right to kill an unborn child. Please also remember that the sailor-boy lay helpless at the bottom of the boat when his assailants killed him to save their own lives.

"The child is not an unjust aggressor against the mother. It is placed in the womb without its consent and is defenceless. It is the mother who is, as it were, the aggressor from the obstacles caused by a deformed pelvis, tumors, etc.; and she has not the right to ask or consent to the killing of the child who does not attack her.

"Therefore, I repeat that the two cases are analogous; and if, as remarked by Justice Coleridge, murder was committed in the first instance, so is murder committed in the analogue. So, we see, the principal points of the opinion enunciated by the learned judge, and the principles therein laid down, can, with equal force, be applied to the non-justification of craniotomy, by which the life of a defenceless child is sacrificed to save the mother.

"Notice also that two of the perpetrators of the deed claimed that they had families, and that their lives were more valuable than that of the murdered boy. By craniotomists this reason or excuse is frequently given with much sentimentality to justify the killing of the child. The child, they say, has no social value, the mother is the idol of her husband, the pride of the household, often an ornament to society, the mother of living or possible children. Therefore, her life is more valuable than that of the unborn child. But who is to be the judge of the value of life? Were not Scipio Africanus, Manlius, was not Caesar, from whom the very name of the operation, delivered by section from their mother's womb? The operation was familiarly known to Shakespeare, who tells us:

'Macduff was from his mother's womb untimely ripped.'

"There can never be a necessity for killing—except an unjust aggressor and in self-defence—unless the killing can be justified by some recognized excuse admitted by the law. In the case of the murdered sailor-boy, there was not such an excuse, unless the killing was justified by what has been called necessity. But, as stated above, there never is an excuse for killing an innocent aggressor, and the temptation to the act and its expediency is not what the law has ever called necessity. Nor is this to be regretted; for if in this case the temptation to murder and the expediency of the deed had been held by law as absolute defence of the deed, there would have been no guilt in the case. Happily this is not so. The plea of necessity once admitted might be made the legal cloak for unbridled passions and atrocious crimes, such as the producing of abortion, etc.

"As in the case of this young sailor, so in the killing of an unborn child, no such excuse can be pleaded; the unborn child cannot be the aggressor, no more so than the defenceless sailor-boy was.

"To preserve one's life is, generally speaking, a duty: but it may be the plainest duty, the highest duty, to sacrifice one's life. War is full of such instances in which it is not man's duty to live, but to die. The Greek and Latin authors contain many examples in which the duty of dying for others is laid down in most glowing and eloquent language.

"'Dulce et decorum est pro patria mori,' says Horace. Such was heathen ethics, and it is enough in a Christian country to teach that there is not always an absolute and unqualified necessity to preserve one's life.

"Thus, as a parallel case, is the situation of a woman in a difficult labor, when her life and that of her unborn child are in extreme danger. In this instance, it is the mother's duty to die rather than to consent to the killing of her child.

"In a subject of such delicacy and importance I have avoided all argument based upon the doctrines of any particular religion, and considered the subject upon its purely ethical and scientific basis. I am aware that I am taking a position quite at variance with that occupied by many men influenced by former teachings and prejudices.

"I respect the honest convictions of those opposed to the opinions presented in this paper. But it is hoped that thoughtful physicians will soon reconsider their views and adopt a more just and humane method of dealing with the rights of a living unborn child.

"As a hopeful sign, it is to be noticed that a gradual change is taking place in the opinions of the profession as to the propriety of performing craniotomy. Busey says: 'To state the issue plainly, the averment must be made that no conscientious physician would deliberately and wilfully kill a foetus, if he believed that the act was a violation of the commandment "Thou shalt not kill."' It has been well said by Barnes, the ablest and most conservative defender of craniotomy, that 'it is not simply a question for medicine to decide. Religion and the civil law claim a preponderating voice. In the whole range of the practice of medicine, there arises no situation of equal solemnity.'

"Having thus far considered the subject from a purely ethical standpoint, I shall now present its scientific and practical aspect.

"Parvin says that the improved Cesarean section has given in Germany results so satisfactory that, possibly, the day is at hand when craniotomy upon the living foetus will be very rarely performed, if done at all. Kinkead, a high English authority, states: 'To reduce the bulk of the child, or to extract it afterward through a pelvis of two and one-half or less conjugate diameter, is an operation of extreme difficulty, lengthy, requiring a very great experience, as far as the mother is concerned, requiring an amount of manual dexterity rarely to be acquired outside of a large city. While, on the other hand, the Cesarean section is an easy operation, capable of successful performance by any surgeon of ordinary skill.'

"Tait remarks that he 'feels certain that the decision of the profession will be, before long, to give up the performance of such operations as are destructive to the child, in favor of an operation that saves it, and subjects the mother to little more risk. The operation of Cesarean section, or the Porro amputation of the pregnant womb, will revolutionize the obstetric art, and in two years we shall hear no more of craniotomy; for the improved method will save more lives, and is far easier of performance. It is the easiest operation in abdominal surgery, and every country practitioner ought to be able, and always prepared, to do it.' So said Lawson Tait in 1888.

"I could quote many other authorities, showing the change that is taking place in the profession upon this important question. It is established by the consensus of professional opinion that craniotomy has been frequently performed in cases where delivery could have been safely accomplished by the forceps, turning, and even by the unaided power of nature (Busey); and there is no case known to him where a woman, on whom a section had been successfully performed, has refused to submit to its repetition in subsequent pregnancies. In Belgium the Cesarean section has been performed seven times on the same woman, and in Philadelphia three times. Doctor Bretoneaux, of Tours, has performed it six times on the same woman; and this woman his wife. 'The brutal epoch of craniotomy has certainly passed. The legitimate aspiration and tendency of science is to eliminate craniotomy on the living and viable child from obstetric practice.'—Barnes' words as quoted by Busey. Tyler Smith is in perfect accordance with Barnes. Barnes again writes: 'For the Cesarean section two very powerful arguments may be advanced. First, that the child is not sacrificed. Second, that the mother has a reasonable prospect of being saved.'

"Late reports of the Dublin Rotunda Hospital show that, in 3,631 cases of labor, craniotomy was performed only four times, and in three of these, positive diagnosis of the child's death was ascertained before the operation. In one of these cases the diagnosis was doubtful.

"More Madden, a celebrated obstetrician of forty years' experience, never performed it once.

"'The brilliant achievements in abdominal surgery give assurance that the Cesarean section is not only a legitimate operation, but one almost free from danger; also, that the tragic scenes heretofore witnessed in certain cases, in which the destruction of the child was resorted to, may be relegated to history (A. P. Clarke).'"

Further on, Dr. Boisliniere speaks more directly of abortion. He says:

"The principle once admitted that you are not justifiable in killing an innocent aggressor except in self-defence, equally prohibits any interference with early gestation.

"From the moment of conception the child is living. It grows, and what grows has life. 'Homo est qui homo futurus,' says an ancient and high authority.

"Therefore, foeticide is not permissible at any stage of utero-gestation.

"The killing of the defenceless foetus is sometimes done in cases of uncontrollable vomiting of pregnancy, in cases of tubal or abdominal gestation, and the killing of the foetus is done by electricity, injections of morphine in the amniotic sac, the puncturing of that sac, etc.

"This practice is too lightly adopted by thoughtless or conscienceless physicians. This practice is much on the increase. I once heard a known obstetrician of the old school say: 'I would as lief kill, if necessary, an unborn child as a rat.' So much for the estimate he put on the value of human life! O tempora! O mores!

"Is it not time that this wanton 'massacre of the innocents' should cease?

"Without wishing to load this paper with elaborate statistics, I shall furnish the latest arrived at in the two operations of craniotomy and Cesarean section.

"In the combined reports of the clinics of Berlin, Halle, and Dresden, the maternal mortality in craniotomy was 5.8 per cent—of course, one hundred per cent of the children lost.

"In Cesarean section the maternal mortality was eight or eleven per cent; children's mortality, thirteen per cent.

"Caruso, the latest and most reliable statistician, not an optimist, sums up the results from the different clinics, and comes to the conclusion that craniotomy shows ninety-three and one one-hundredth mothers recover, Cesarean section eighty-nine and four one-hundredths.

"Caruso, therefore, concludes that craniotomy on the living child is to be superseded by Cesarean section. He says, therefore, that the mother has three chances out of four, and her child nine out of ten, for life.

"Leopold, as stated above, shows a much better result, viz.: ninety-five mothers saved out of one hundred by Cesarean section, a result equal that obtained in craniotomy."

You notice, gentlemen, that the eminent physician whom I have been quoting speaks with much indignation of the killing of the embryo, when he calls it a "massacre of the innocents." By this odious term we usually denote the massacre of the babes at Bethlehem, ordered by the infamous Herod to defend himself against the future aggression, as he imagined, of the new-born King of the Jews. A craniotomist would, no doubt, feel insulted at being compared with Herod. And yet, if we examine the matter closely, we shall find that the two massacres, Herod's and the craniotomist's, could only be defended by the same plea, that of necessity. "Necessity knows no law," writes Dr. Galloway, in his defence of craniotomy, to which I referred in a former lecture. "The same law," he writes in the "Medical Record" for July 27, 1895, "which lies at the basis of Jurisprudence in this respect justifies the sacrifice of the life of one person when actually necessary for the preservation of the life of another, when the two are reduced to such extremity that one or the other must die. This is the necessitas non habet legem."

Did not Herod look on the matter just in that light? Expecting Christ to be, not a spiritual, but a temporal ruler, as the Jewish nation supposed at the time, he looked upon it as a case of necessity to sacrifice the lives of the innocents for his own preservation. "Necessity knows no law" was his principle. True, many had to die on that occasion to save one; but then he was a king. Anyhow, their death was necessary, and necessitas non habet legem; that settles it: Herod must not be blamed, on that principle. It is not even certain that, cruel as he was, he would have confessed, with the modern obstetrician, "I would as lief, if it were necessary, kill an unborn child as a rat."

Such sentiments, revolting as they are, and a disgrace to civilization, are the natural outcome of rash speculations about the first principles of morality.

The principle "Necessitas non habet legem" has indeed a true and harmless meaning when properly understood; it means that no law is violated when a man does what he is physically necessitated to do, and that no law can compel him to do more than he can do. Thus a disabled soldier cannot be compelled to march on with his regiment; necessity compels him to remain behind. In this sense the principle quoted is a truism; hence its universal acceptance. Applying the same principle in a wider sense, moralists agree that human law-givers do not, and in ordinary circumstances cannot, impose obligations the fulfilment of which requires extraordinary virtue. Even God Himself does not usually exact of men the performance of positive heroic acts. But no such plea can be urged to justify acts which God forbids by the natural law.[1] When necessity is used as a synonym for a "very strong reason," as it is in the plea of the craniotomist, then it is utterly false that very strong reasons for doing an act cannot be set aside by a divine law to the contrary; what is wrong in itself can never become right, even though the strongest arguments could be adduced in its favor. It would be doing wrong that good may come of it, or making the end justify the means. Such principles may be found in the code of tyrants and criminals, but should not be looked for in the code of Medical Jurisprudence.

[1] See this point more fully treated in the Author's "Moral Philosophy," Book. I. c. ii., "The Morality of Human Acts."

There is but one plea left, I believe, on which, of late years, it is sometimes attempted to justify the murder of little children. It is the plea of some evolutionists who maintain that the infant has not yet a true human soul. I should not deign to consider this theory if it were not that I find it seriously treated by a contributor to the "Medical Record," in an article which, on September 4, 1895, concluded a long discussion on craniotomy published in that learned periodical.

The writer of this article asserts: "Procuring the death of the foetus to save the life of the mother is, I am sure, to be defended on ethical grounds." And here is the way he attempts to defend it: "We may safely assume," he argues, "that the theory of evolution is the best working hypothesis in every branch of natural science. We are learning through Herbert Spencer and all late writers on ethics and politics, that the same principle will best explain the facts" (p. 395).

I do not deny that a certain school of scientists is trying to rewrite all history and all Ethics and Jurisprudence. But the writer strangely misstates the case when he says that "all great writers on ethics and politics" agree with Mr. Spencer. Besides a multitude of others, Lord Salisbury for one, has clearly shown of late that the school of agnostic evolutionists is coming to grief; it has had its short day, and it is now setting below the horizon of ignominy and subsequent oblivion. The writer of the article in question does not attempt to prove the evolution theory; therefore I need not stop to disprove it. But he makes the following application of it to our subject—an application so shocking to humanity and so revolting to common sense that, if it is logical, it is by itself sufficient to refute the whole theory of Mr. Spencer and his school.

He argues that, if that theory be admitted, it must necessarily follow that, while the human embryo is from the first alive, it is not a human being until it has developed and differentiated to such a point as corresponds to that point at the birth of the race where the animal becomes a man. "I am sure," he adds, "I do not know when that occurred in the past, and I do not know at what point it occurs in the individual.... In inquiring for that distinct feature which distinguishes the man from the animal, I find none but mentality. If we wait for distinct mentality to appear in the development of the individual, it would be some time after birth."

According to this reasoning a child is not known to be a human being till some time after its birth. And this is not uttered by some speculative philosopher in his closet, but by a medical practitioner on his daily rounds, tools in hand, as it were, to carry out his theory and break the skulls of any and all luckless babes that may come in his way in the exercise of what he calls his legitimate practice. How long after birth the child remains without becoming a human being, he does not pretend to know; they remain non-human till they manifest mental action. Till then, not being human, he assigns them no human rights—no rights at all which we are conscientiously obliged to respect. Herod may have been right after all when he appointed the term of two years old and under as the limit of the butchery at Bethlehem. The writer pretends to lessen the horror inspired by his theory by referring to some restrictions of canon law. But what do he and his like care about canon law? He would be the first to scout the idea of letting canon law limit his freedom of action and speculation.

What would be the real results in practical life if we were to accept as rules of conduct these rash theories of agnostic philosophers and infidel scientists? Justly does the writer proceed to say: "I am well aware that the idea arouses antagonism and inflammatory denunciation in some minds." Certainly it does. He adds: "That it [the idea] will prove to be the true one, however, depends only on the truth of the general theory of development." If this be the logical consequence of evolution, or Darwinism, as he calls it, then all the worse for Darwinism. Society cannot get along on a theory that begets such principles of action; the more so since, in Spencer's and in Darwin's system, the human soul, even in grown persons, is only a material modification of the body and perishes with it in death. Hence there would be no responsibility after death. On this theory the physician is only a lump of very curiously evolved matter; he, too, like the embryo, is without an immortal soul, is not a free being, and therefore is incapable of having rights or duties.

Before we remodel our codes of Ethics and Jurisprudence by the admission into them of such destructive and revolutionary principles, we shall at least be allowed to challenge these aggressors and ask solid proof of their rash innovations. We may address to them the wise words uttered against similar speculators by one of the most logical of modern reasoners, the illustrious Cardinal Newman. "Why may not my first principles contest the prize with yours? they have been longer in the world, they have lasted longer, they have done harder work, they have seen rougher service. You sit in your easy-chairs, you dogmatize in your lecture-rooms, you wield your pens: it all looks well on paper; you write exceedingly well; there never was an age in which there was better writing, logical, nervous, eloquent, and pure,—go and carry it out in the world. Take your first principles, of which you are so proud, into the crowded streets of our cities, into the formidable classes which make up the bulk of our population: try to work society by them. You think you can; I say you cannot; at least you have not as yet, it is to be seen if you can.... My principles, which I believe to be eternal, have at least lasted eighteen hundred years; let yours last as many months.... These principles have been the life of nations; they have shown they could be carried out; let any single nation carry out yours" ("Present Position of Catholics in England." p. 293).

Gentlemen, let no one trifle with the principles of Ethics and Jurisprudence; human society cannot get along without them. Morality is the heart of civilization: its principles are the life-blood, which it sends forth to feed and warm and strengthen and beautify all the organs of its earthly frame. A flesh-wound may be healed, a bone may be set, it may knit and grow vigorous again; but you must not puncture the heart, nor attempt to change the natural channels of the circulating blood, under the penalty of having a corpse on your hands. So you must respect the eternal laws that direct the current of man's moral actions, the principles of Ethics and Jurisprudence.



LECTURE V.

VENEREAL EXCESSES.

In the opening lecture of this course, I remarked to you, gentlemen, that the scope of Medical Jurisprudence is much wider than that of Medical Law. It embraces many subjects of which human laws take no cognizance, and in particular such vicious actions as do not violate the rights of others, but are injurious to those only who practise them. They undermine the health and shorten the lives of the guilty parties, and bring in their train diseases the most destructive and often the most incurable. It is the physician's beneficent task to lessen the weaknesses and sufferings of the body, and to prolong human life in well-preserved vigor to a green old age. It is not the least important part of his valuable services to provide for the sound and vigorous propagation of the human race to future generations. Of this propagation of our race, of the laws which govern it, and of the criminal abuses by which these laws are violated, I am to treat in this present lecture. My subject is "Venereal Excesses."

I. If a physician's purpose were only to make money, his task would then be to multiply diseases and infirmities; he would then be as great a curse to mankind as he is really intended to be a blessing; and an immense blessing he will be to his fellow-men if he studies to remove even the remote causes of diseases and untimely deaths. He can do so in a variety of ways and not the least by providing against sexual excesses and abuses. These are a copious fountain of ill to humanity. A host of diseases, such as tuberculosis, diabetes, cardial and nervous affections, epilepsy, hysteria, general debility, weaknesses of sight, languor and general worthlessness, hypochondria, weakness and total loss of reason, and, in married life, impotence and sterility are some of the effects of venereal excesses. Any excitement of the sexual passion before the body has received its full development is more or less injurious to its welfare; and all excesses or unnatural indulgence of it at any period of life is pregnant with deplorable consequences. Now, such evil practices are too much overlooked by many physicians; yet it is certain that thousands of patients might, by timely warning on these matters, be saved from unspeakable mental and physical sufferings. To give sensible and intelligible directions on a subject as delicate as it is important in medical practice, it will be necessary to enter into some scientific details.

The passion which prompts to sexual intercourse is altogether natural in itself, and, as such, intended by the Creator to be indulged in at the right time and in the proper manner. It is the stimulus which He has provided for the propagation of the human race. If the stimulus is strong at times, this too is a special effect of His wisdom; because without a powerful prompting of this kind, most men would shirk the burden of married life, just as very many would not care to toil if they had no hunger and thirst and other bodily wants to satisfy.

But though all these cravings are useful and even indispensable to mankind, all of them need the regulation of reason. When they are indulged immoderately or in unnatural ways, they become most copious sources of bodily diseases, of mental disorders, and moral degradation. Every one knows how the passion of drink, when abused, proves the ruination of millions; excessive eating, too, injures the systems of countless people. But no animal passion is more liable to become disorderly, none needs more firm control and habitual watchfulness, than the passion of lust. Reason dictates that it should be indulged for no other purpose than that for which the Creator has made it, namely, marital intercourse. I say marital and not merely sexual intercourse; for outside of married life all nations have always condemned its indulgence.

Besides, it is only in the married state that the children, which are the fruit of such intercourse, can be properly educated. To generate a race of young barbarians is certainly not the purpose of the sexual relations. Children must not be begotten unless they can be properly raised, in a manner worthy of their noble destiny. Now, it is only in the married state, in the family or domestic society, that they can be thus educated. They need the tender hand of a mother to supply their material wants; they need the manly care of a devoted father to provide the necessaries of life, his firm hand to break their wanton wills, and his wise direction to set them well on the road to temporal and eternal happiness. Therefore, no one has the right to beget or to bear children except in marital life. Now, the sexual passion is to be exercised only in connection with its proper object, the procreation of children and the fostering of such mutual love between husband and wife as is conducive to domestic happiness. Therefore this passion is to be kept under careful and rational constraint. This the law of morality requires; all nations have ever exacted that this passion shall be subject to established rules; no free-love has ever been tolerated where there was the least pretence to civilization, and I do not know that it was ever permitted even among barbarians.

Even the distant approach that Mormonism made towards free-love has been absolutely condemned and repressed by the common-sense of the American people, as incompatible with civilization. In fact, all history testifies that the true civilization of any race or country rises or falls with the restraints imposed on the passion of lust; no polygamous nation has ever been more than half-civilized. The greatness of Rome and Greece decayed when the laws of social purity declined; and in our own day the immorality of what is called "the social evil" is the darkest stain on modern civilization.

And what we say of civilization or social soundness, the soundness of the body politic, applies in a great measure to individual soundness, the health of every person's mind and body. Personal purity promotes health and vigor, it lends beauty to form, gives a keen edge to the intellect, adds energy and brings success to manhood, and prepares for enduring and honored old age. Venereal excesses, on the contrary, undermine the vigor of the constitution, bring on a host of bodily infirmities, exhaust the system before the proper time, debauch and degrade the mind and will, and prepare their victims for an early grave or a decrepit old age.

II. But how can a passion so ardent be properly restrained? In particular, what can a physician do to prevent the manifold injuries which, if not properly controlled, it will bring to his patients? These are practical questions directly to our purpose.

The first requisite for all effective action is to have correct knowledge and strong convictions on a subject. No one will check a passion with firmness if he have a lingering doubt as to whether, after all, he is strictly bound to restrain it. As a man's mind matures, at least if his mind be upright and not distorted by the strain of a ruling passion, he understands more and more thoroughly that his perfection consists and his highest interests lie in obeying at all times the law of reason, in maintaining his specific dignity of a rational being, and not allowing himself to be controlled by passion, the ruling power of brute animals. Besides, he becomes aware in various ways of the evil results of immoral practices, and he sees many reasons to keep his passions in check. But young people have neither such experience nor such information, and they are not always wise enough to understand the imperative dictates of self-restraint. And yet it is often in early years, while body and mind are in the period of development, that the most serious injury is done to the constitution and to the character by the indulgence of carnal pleasures. Habits are then engendered which become a real slavery; so that later in life when there arises a sincere desire to stop such disgraceful practices, there is a feeling of impotence to resist temptations which by one's own fault have become a second nature.

What then can be done with the young? They must early and authoritatively be told of the wrong, the sin of base self-indulgence, and of every practice that leads to it. If a beginning of immorality is discovered in a child, it must be plainly told and emphatically warned of the serious consequences involved. The child's mother is, as a rule, the best guide and director in infancy. Later on, the Doctor has frequent chances to do so; it comes from him with better grace than from others; and his warning is likely to be minded, because it is clear that he knows and ought to know what he is talking about with regard to bodily consequences. Yet it is always a matter of delicacy; and great care should be taken lest, while pointing out the evil, there be also a stimulus added to a prurient curiosity.

Much good sense is required in any given case to decide whether more good or more evil is likely to result from the warning; in doubt of success, it is better to leave the matter alone.

"Where ignorance is bliss 'Tis folly to be wise."

The safest way of repressing the passion of lust is the provision that an all-wise Providence supplies in Religion, in which God authoritatively forbids all immoral action and even all immoral coveting or desire. Positive dogmatic teaching on this subject is required, especially with the young. You cannot argue with them on this matter as you can with grown people. That is one reason why religious teaching should permeate early education. The Decalogue should be the back-bone of a child's training: and it should be proposed on the authority of God, and explained so as to check not only sinful acts, but also covetings, prurient curiosity, improper reading, immodest looks and thoughts, in a word, whatever paves the way to the walks of sin. The greatest of teachers has Himself laid down the law in this matter: it must be proposed as coming from His divine lips, as it did: "I say to you that whosoever shall look on a woman to lust after her has already committed adultery with her in his heart" (St. Matt. v. 28). The lesson is enforced by these words of the great Apostle: "Neither fornicators, nor adulterers, nor the effeminate ... shall possess the kingdom of God" (1 Cor. vi. 9, 10).

True, the child will not realize the full import of such lessons; but he will understand it in due time; and already in early years he will be warned against indulging his nascent passions. It is well that the conscience should be early awakened in this matter; for the more this passion is indulged, the more it craves for further indulgence till it becomes almost uncontrollable.

III. No possible evil to any individual man or woman can result from the firm control that one may acquire over the passion of lust. On the contrary, if it should be controlled all through life, this would only add to a man's strength of mind, firmness of will, soundness of body, and length of life. For in the school of morality, in which every Physician should be educated, the leading principle is: "Contraries are cured by contraries," "Contraria contrariis curantur." On this principle, lust is most efficiently controlled by aiming, at least in youth, at total abstinence from its indulgence. You know that, in the Catholic Church, priests and religious lead a single life, and pledge themselves for life to practise the most perfect control of the sexual passion. What do you think is the result of their total abstinence on this point with regard to their length of days? As a rule their life is much longer, in normal circumstances, than that of the other learned professions. Here are a few proofs. In France, during the twenty years from 1823 to 1843, 750 priests died in the diocese of Paris. Of these only 200 were under sixty years old; there were 554 between sixty and seventy years old, 448 over seventy, and 177 over eighty. Again, of 202 Carmelite nuns who died in a large convent of Paris, Dr. Descuret, the attending physician, states that 82 had lived over seventy years, 23 over eighty years. Most Trappists and Carthusians die of scarcely any other sickness than old age. All young people who aspire to the clerical or religious profession learn from their early years the holiness and the loveliness of purity. Our Church effects this result by placing before their youthful imaginations the most perfect of patterns of virtue, the infant Saviour, the virgin Mother, the boy saints Aloysius and Stanislaus, the maidens Agatha and Cecilia, and a whole phalanx of Christian heroes and heroines.

I dwell the more willingly on this subject, gentlemen, because, besides protecting modesty in your young patients generally, it may fall to the lot of some of you, in the course of your professional careers, to be attending physicians to religious houses; and you will then appreciate the delicacy of the flowers of virtue that bloom beneath the shadow of the sanctuary. Certainly even there you may happen to find isolated cases of infidelity to duty; for human nature is not angelic nature; but in such abodes it comes near to it, at least for the vast majority.

IV. On the other hand, what sad havoc does not the sexual passion play where it is precociously developed and wantonly indulged. Dr. H. Fournier, one of the most eminent physicians of Paris, says: "There is not a vice more fatal to the conservation of man than masturbation." This unfortunate habit is sometimes acquired by very little boys and girls. Foolish or vicious nurses may bring it on by handling young children most indelicately. This is one of the many reasons why none but virtuous servants and nurses should be employed by wise parents and physicians. In later years, children often learn this degrading and most injurious vice from their depraved companions, some of whom seem even to regard the practice of it as a manly accomplishment. When habitually indulged in, it produces on the health and the strength of the constitution effects the most deplorable. Even the intellect is liable to become thereby enfeebled, a want of virility is exhibited both in the body and in the mind of its victims; then follows a loss of ambition and self-control. "When this morbid passion gets control of a person," writes an experienced practitioner in medicine, "it is as though an unclean spirit had entered, subdued the will, weakened the moral forces, enfeebled the intellectual faculties, lessened the power to resist temptation, and overcome every obstacle opposed to its gratification. Even while the intellect is still clear, and the sense of wrong keen, the individual is a slave to this morbid impulse." Though the baneful effects may not always affect the physical health of the victim, the unfortunate practice very often engenders in boys and girls tendencies which in later years lead to all the miseries conspicuous in houses of debauch and infamy. But I need not dwell on consequences that belong to pathology rather than to Jurisprudence.

V. Confining myself to my sphere of what is morally right or wrong, I must be permitted to point out some gross violations of duty in some members of your honored profession. There are physicians so reckless of consequences and of principles alike as to advise at times the practice of illicit sexual intercourse. Let them beware; they are doing a very unwise and guilty act. Even if an immoral practice should save a human life, it may not be indulged, on the principle which must be by this time very familiar to your ears, that the end does not justify the means. And besides no good result can be expected from what is contrary to the law of nature and of nature's God. It was to punish sins of the flesh that the Deluge was sent, which destroyed nearly the whole human race. "All flesh had corrupted its way," says the sacred historian. It was to punish unlawful indulgence of lust that Sodom and Gomorrha were destroyed by fire from heaven; and the memory of these guilty cities is preserved in the very name of Sodomy. Onan, as the same sacred volume relates (Gen. xxxviii), performed the marriage act in a manner to frustrate it of its legitimate purpose, the generation of children, and the Lord slew him; and his sin is to this very day branded with his name and called Onanism. And yet in Christian lands physicians are found who will at times dare to recommend such practices to their patients.

On the occasions mentioned, God punished the guilty miraculously; but that is not His usual way. He has so contrived our natures that sins committed against His laws in our bodies ordinarily bring a part of their punishment in their train, not the less certain because slower in its operation than a miracle would be. All the venereal diseases are there to act as earthy ministers of Heaven's justice, anticipating, and often mercifully averting, the punishments of the future world.

VI. Besides private and secret tortures of body and mind, a public and most deplorable calamity has descended of late on our own vigorous young nation, as well as on some older lands, threatening in the not distant future the extinction of many of its most esteemed families and of what was, not long ago, a vigorous stock. The following article by Dr. Walter Lindley, Professor of Gynecology in the University of Southern California, will explain the matter better than my words could do. It was read in Los Angeles at a meeting of the Southern Californian Medical Society in June, 1895, and is printed in the "N. Y. Medical Journal" of August 17 of the same year (pp. 211 and following). It is headed "American Sterility;" I will quote freely from it:

"The obstetrician finds his vocation disappearing among the American women from the face of the earth.

"It is a fact that the American family with more than one or two children is the exception. From the records of six generations of families in some New England towns, it was found that the families comprising the first generation had on an average between eight and ten children; the next three generations averaged about seven to each family; the fifth generation less than three to each family. The generation now on the stage is not doing so well as that. In Massachusetts the average family numbers less than three persons. In 1885 the census of Massachusetts disclosed that 71.28 per cent of the women of that State were childless. The census of 1885 in the State of New York shows that twenty-five per cent of the women of that State are childless, fifty per cent average less than one child, and seventy-five per cent average only a trifle over one child.

"Southern California has fully as dark a record as New England—that is, in the family where the man and wife are American-born. It goes without saying that the medical profession in this country is composed to a great extent of typical progressive Americans, and I ask you to make mental statistics of the children in the families of the physicians in Southern California, and you will find very few of them containing more than two.

"Had the Rev. T. R. Malthus lived in the United States to-day, he would never have argued about the danger of over-population, as he did in his interesting volume on 'The Principles of Population.'"

After quoting the views of Plato, Aristotle, and Lycurgus, Dr. Lindley continues: "In Southern California there are, it is true, many children, but the average American family is very small.

"As I sat writing this an evening or two ago, I jotted down the names of twenty-five families of my acquaintance in Los Angeles, taking them as fast as I thought of them. The list was composed entirely of professional and business men ranging in age from thirty-five to fifty. All had been married quite a number of years. The result of my memorandum was that in these twenty-five families there were but eighteen children. These families were wholly unselected, and are about the average Protestant American families outside the rank of laborers.

"What are the causes of this small proportion of children? Disease, preventives of conception, and abortion form the trinity of responsibility in this grave condition. It is true that the first cause (disease) results in many women being barren, but I believe that you will agree with me that the last two causes, preventives of conception and abortion, are the two chief causes.

"The A. P. A. might find food for thought by investigating the infrequency of criminal abortion in Catholic families in the United States. It is the Protestant or agnostic American who too often uses one of the preventives of conception." (Here the Doctor refers to a foot-note in which he says: "I write this opinion as a Protestant, and should be glad to learn that it is not well founded.") He continues: "If, through inadvertence, pregnancy should occur, then an abortion is in order. Disease and poverty and war and accident all work together to keep down the population, but we are overcoming these. Plagues and pestilences are rare. The number who die of starvation in California is very small, while war has played but a small part. Through the diffusion of the laws of sanitation, improved dietary, and advanced therapeutics, the longevity of man is increasing, but the American woman's aversion to child-bearing is blighting our civilization, and can be well named the twentieth-century curse. In this aversion the woman frequently echoes the wish of the husband.

"A large proportion of the American young women who marry do so with the determination that they will have no children. They are abetted in this notion by many elderly women. The cure for this terrible sentiment is education. The home, the press, the schoolroom, and the pulpit should be centres for reviving the ancient idea of the nobility of motherhood. The physician should not underestimate his influence.

"By constantly bearing in mind the danger of the present tendencies, he can do much to change the current. Let us hope that we shall again see the day when thoughtful motherhood shall be considered the highest function of womanhood, and to shirk this natural duty will be deemed a disgrace."

Gentlemen, it would be easy to prove that this testimony of Dr. Lindley is not that of an exceptional witness, or a piece of special pleading; but it is the acknowledged conviction of the medical profession generally, confirmed by the last United States Census, and in fact not questioned, to my knowledge, by any weighty authority. As early as 1857, Dr. H. B. Storer, an eminent physician of Boston, startled the community by publishing two books on this subject, entitled: "Criminal Abortion. Why not?—A Book for Every Woman"; "Is it I?—A Book for Every Man." Soon after, Rev. John Todd, a Protestant minister of Pittsfield, Massachusetts, published a work styled "Serpents in the Dove's Nest," all which works and a multitude of others tell the same tale of woe regarding the increase of child-destroying crimes in New England, chiefly among the old stock peculiarly called Americans. Dr. Nathan Allen, of Lowell, Massachusetts, in his treatises, "Changes in the New England Population" and "The New England Family," gives overwhelming testimony. "Harper's Magazine" (quoted by the "Catholic World" for April, 1869) remarks: "We are shocked at the destruction of human life on the banks of the Ganges, but here in the heart of Christendom foeticide and infanticide are extensively practised under the most aggravating circumstances." We Catholics are not personally interested in this matter; but the good of our fellow-men and chiefly our fellow-countrymen calls for the earnest exertion of us all to stop this dreadful evil. All the works I have referred to exempt Catholics from the blame pronounced; the "Harper's Magazine" article referred to expressly says: "It should be stated that believers in the Roman Catholic faith never resort to any such practices; the strictly Americans are almost alone guilty of such crimes." This matter is fully explained in a recent work called "Catholic and Protestant Countries Compared," by Rev. Alfred Young, C.P., ch. xxxii.

VII. Now, gentlemen, I am very much afraid that while physicians as a body abhor all such murders and openly condemn them, many do not show much repugnance to allow, and even sometimes to suggest, such onanistic intercourse among married people as shall prevent the possibility of conception. For instance, if it happens that a young mother suffers much in her first confinement, at once the suggestion is made that a second parturition may prove fatal. From that moment regular intercourse is dreaded. Either onanism is habitually practised, or the husband becomes a frequent visitor to dens of infamy, where to where to save his wife's health, he encourages a traffic that leads multitudes of wretched girls to a premature and miserable death. Every one despises those outcasts of society; but are not the men who patronize them just as guilty? Probably enough, if the imprudent suggestion about dangers of a second child-bearing had not been made by the Doctor, the young wife might have become the happy mother of a numerous family of healthy children. For we must trust in Divine Providence. If a husband and wife do their conscientious duty, there is a God that provides for them and their family more liberally than for the birds of the air and the lilies of the field. And if He should so dispose that the worst should befall, well, such temporal clangers and sufferings as attend child-bearing are the lot of woman-kind, just as the dangers and hardships of the battlefield, the mine, the factory, the forest, and the prairie are the lot of the men.

The man who shirks his duty to family or country is a coward; women, as a rule, are brave enough in their own line of duty, and patiently submit to God's sentence pronounced in Paradise, "I will multiply thy sorrows and thy conceptions, in sorrow shalt thou bring forth children" (Gen. iii. 16), just as they have to submit to the words immediately following: "Thou shalt be under thy husband's power, and he shall have dominion over thee."

Certainly, the husband of a delicate woman ought to spare her strength and restrain his passion, but not at the sacrifice of morality; and Doctors ought to be very careful not to cause false or exaggerated alarms, and thus make themselves to some extent responsible for untold moral evils. They should remember that, as a rule, the raising of a family is the principal purpose of a married life. The happiness and virtue of the parties concerned depend chiefly on the faithful performance of this duty. How sad is the lot of those—and they are many—who undertook in early years of married life to prescribe a narrow limit to the number of their children; they had one or two, and they would have no more, and for this purpose criminally thwarted the purposes of nature. Then comes death and snatches away their solitary consolation: and they spend their old age childless and loveless, in mutual upbraidings and unavailing regrets.

How different is the lot of those aged couples—and they were many of yore, and are yet in various nations—who are like patriarchs amid their crowds of children and grandchildren and great-grandchildren, dwelling in mutual love and as if in a moral paradise where all domestic virtues bloom!

VIII. True, such families are usually the outcome of moderately early marriages; and many Doctors nowadays disapprove of such unions as an evil. A moral evil they certainly are not; and the physical evils sometimes attending them must, I think, be traceable to a variety of causes; for such evils are certainly not inseparable from early marriages. As to their moral advantages, Mr. Wm. E. H. Lecky, in his "History of European Morals," writes of the Irish people in particular: "The nearly universal custom of early marriages among the Irish peasantry has alone rendered possible that high standard of female chastity, that intense and jealous sensitiveness respecting female honor, for which, among many failings and some vices, the Irish race have long been pre-eminent in Europe" (v. i. p. 146). And that he does not confine his statement to female chastity is evident from what he adds farther on: "There is no fact in Irish history more singular than the complete and, I believe, unparalleled absence among the Irish priesthood of those moral scandals which in every Continental country occasionally prove the danger of vows of celibacy. The unsuspected purity of the Irish priesthood in this respect is the more remarkable, because, the government of the country being Protestant, there is no special inquisitorial legislation to insure it, because of the almost unbounded influence of the clergy over their parishioners, and also because, if any just cause of suspicion existed, in the fierce sectarianism of Irish public opinion it would assuredly be magnified. Considerations of climate are quite inadequate to explain this fact; but the chief cause is, I think, sufficiently obvious. The habit of marrying at the first development of the passions has produced among the Irish peasantry, from whom the priests for the most part spring, an extremely strong feeling of the iniquity of irregular sexual indulgence, which retains its power even over those who are bound to perpetual celibacy" (p. 147). No one will say, I believe, that the custom of early marriages in Ireland has any injurious effects on the health of either parents or children. Nor need it necessarily have such effects on those of our American young men and women who lead regular lives and are not enfeebled by unnatural vices or demoralized by dainty food and luxurious manners.

A wise physician has many proper ways of providing for the health and strength of both parents and children without advocating practices which are a snare for innocence. Let him insist with all his patients on the cultivation of healthful habits for the family and the individual; wholesome and not over-delicate food; moderation in eating and drinking; regular and manly exercise, especially in the open air; early hours for retiring and rising. But, above all—and this is directly to our present purpose—let him show the greatest regard for the laws of morality, the main support of individual and social happiness. His views upon such matters, manifested alike in his conduct and his conversation, but especially in his management of cases involving the application of moral principles, will go far to influence the community in which he moves. His task is to be a blessing to his fellow-men, a source of happiness and security to individuals and to society.



LECTURE VI.

THE PHYSICIAN'S PROFESSIONAL RIGHTS AND DUTIES.

Gentlemen, so far I have explained the duties which the physician has in common with all other men, and which arise directly from the natural law independently of any civil legislation. The natural law requires the Doctor to respect the life of the unborn child, thus forbidding craniotomy and abortion. It also obliges him to protect his patients from the baneful effects of venereal excesses. Over these matters human law has no control, except that it may and ought to punish such overt acts as violate the rights of individuals, or seriously endanger the public welfare.

We shall now consider the physician's natural rights and duties in regard to matters which civil and criminal legislation justly undertake to regulate. One of the chief functions of civil authority is to provide for the observance of contracts. Now, the physician in his professional services acts under a double contract, a contract with the state and a contract with his individual patients. By accepting his diploma of M.D. from the college faculty, and indirectly from the civil authority, he makes at least an implicit contract with the state, by which he receives certain rights conditioned on his performance of certain duties. In offering his services to the public, he also makes an implicit contract with his patients by which he obliges himself to render them his professional services with ordinary skill and diligence on condition of receiving from them the usual compensation.

I. The chief rights conferred on him by the state are these:

1. Protection against all improper interference with his professional ministrations.

2. Protection for his professional career by the exclusion of unauthorized practitioners.

3. Immunity from responsibility for evil consequences that may result without his fault from his medical or surgical treatment of patients.

4. Enforcement of his right to receive due compensation for his professional services.

These rights are not granted him arbitrarily by the state; they are founded in natural justice, but made definite and enforced by human legislation. Take, for an example, his right to receive due compensation for his services. This right was not recognized by the old Roman law in the case of advocates and physicians, nor by the common law of England until the passing of the Medical Act in 1858. Surgeons and apothecaries could receive remuneration for their services, but not physicians. These were presumed to attend their patients for an honorarium or honorary, that is, a present given as a token of honor.

Certainly, if Doctors by common agreement waived their right to all compensation, or agreed to be satisfied with any gift the patient might choose to bestow, they would be entitled to honor for their generosity; but they are not obliged to such conduct on the principles of natural justice. For by nature all men are equal, and therefore one is not obliged, under ordinary circumstances, to work for the good of another. If he renders a service to a neighbor, equity or equality requires that the neighbor shall do a proportionate good to him in return. Thus the equality of men is the basis of their right to compensation for services rendered. The physician's right to his fee is therefore a natural right, and on his patient rests the natural duty of paying it. Not to pay the Doctor's bill is as unjust as any other manner of stealing.

As to the amount of compensation to which the Doctor is justly entitled, Ewell's "Medical Jurisprudence" remarks: "By the law of this country, all branches of the profession may recover at law a reasonable compensation for their services, the amount of which, unless settled by law, is a question for the jury; in settling which the eminence of the practitioner, the delicacy and difficulty of the operation or of the case, as well as the time and care expended, are to be considered. There is no limitation by the common law as to the amount of such fees, provided the charges are reasonable. The existence of an epidemic does not, however, authorize the charge of an exorbitant fee.

"A medical man can also recover for the services rendered by his assistants or students, even though the assistant is unregistered; it is not necessary that there should be any agreed specified price, but he will be allowed what is usual or reasonable.

"It is not the part of the physician's business, ordinarily, to supply the patient with drugs; if he does so he has a right to compensation therefor. If the agreement is "No cure, no pay," he cannot, however, even recover for medicines supplied, if the cure is not effected. His right to recover for professional services does not depend upon his effecting a cure, or upon his service being successful, unless there is a special agreement to that effect; but it does depend upon the skill, diligence, and attention bestowed" (pp. 3 and 4).

Further details on this point belong more properly to the lecturer on Medical Law. We are now concerned with the principles underlying special legislation. The main principle regulating all compensation is that there shall be a sort of equality between the services rendered and the fee paid for them. Ignorant people sometimes find fault with the amount charged as a Doctor's fee. There may, of course, be abuses by excess; but men have no right to complain that a Doctor will ask as much for a brief visit as a common laborer can earn in a day. This need not seem unfair if it be remembered that the physician had to prepare, during many years of primary, intermediate, and professional studies, before he could acquire the knowledge necessary to write a brief prescription. Besides, it may be that his few minutes' visit is the only one that day; and yet he has a right to live in decent comfort on his profession together with those who depend on him for support.

We must, however, remember, on the other hand, that excessive fees are nothing else than theft; for theft consists in getting possession of another's property without just title. The following rules of Dr. Ewell are sensible and fair:

"The number of visits required must depend upon the circumstances of each particular case, and the physician is regarded by the law as the best and proper judge of the necessity of frequent visits; and, in the absence of proof to the contrary, it will be presumed that all professional visits made were deemed necessary and were properly made.

"There must not be too many consultations. The physician called in for consultation or to perform an operation may recover his fees from the patient, notwithstanding that the attending physician summoned him for his own benefit, and had arranged with the patient that he himself would pay." (This, of course, does not mean that the practitioner has a right thus to shift the burden of pay from his own shoulders.) "Where a medical man has attended as a friend, he cannot charge for his visit. Where a tariff of fees has been prepared and agreed to by the physicians of any locality, they are bound by it legally as far as the public are concerned (that is to say, they cannot charge more than the tariff rates), and morally as far as they themselves are concerned" (p. 5).

In these rules Dr. Ewell regards chiefly what conduct the courts of justice will sustain. It is evident that the Doctor is never entitled to run up his bill without any benefit to his patient; where there is no service rendered at all, there can be no claim to compensation. Still it is not necessary that actual benefit has resulted to the patient; it suffices for the claim to the fee that measures have been taken with a view to such benefit. Even when no physical advantage can reasonably be hoped for from the visit, the consolation it affords the patient and his friends may render those who are to bear the expense fully willing that it should be often repeated and, of course, charged on the bill. Provided care be taken that they understand the situation, no injustice is done them. "Scienti et consentienti non fit injuria" is a good moral maxim.

II. We have said that the rights conferred on the physician by the state are conditioned on his performing certain duties. He owes the same duties to his patients in virtue of the contract, explicit or implicit, that he makes with them by taking the case in hand. Under ordinary circumstances, neither the state nor the patients can oblige him to exercise his profession at all; but, if once he has taken a case in hand, he can be justly held not to abandon it till he has given his patient a fair opportunity of providing another attendant; even the fear of contagion cannot release him from that serious obligation.

The duties arising from the physician's twofold contract, with the state and with his patients, are chiefly as follows:

1. He must acquire and maintain sufficient knowledge of his profession for all such cases as are likely to come in his way. No Doctor has the right to attempt the management of a case of which he has not at least ordinary knowledge. In matters of special difficulty, he is obliged to use special prudence or ask for special consultation. The courts justly hold him responsible for any serious injury resulting from gross ignorance; in such cases they will condemn him for malpractice. I would here remark that, in an age in which the science of medicine is making such rapid progress, every Doctor is in duty bound to keep up with the improvements made in general practice, and in his own specialty if he has one.

2. A second duty is that of proper diligence in treating every single case. Many a patient suffers injury to health or even loses his life in consequence of a Doctor's neglect. Gross negligence is an offence that makes him punishable by the court, if it results in serious injury. But even if such injury cannot be juridically proved, or has been accidentally averted, the moral wrong remains and is to be settled with the all-seeing Judge. Still, in ordinary ailments, no one is obliged to take more than ordinary trouble.

3. A third duty of the physician is to use only safe means in medical and surgical practice. He has no right to expose his patient to needless danger. What is to be thought of the use of such remedies as will either kill or cure? They cannot be used as long as safer remedies are available and capable of effecting a cure; for neither Doctor nor patient has a right to expose a human life to unnecessary risk. But when no safer remedies are going to effect a cure, then prudence itself dictates the employment of the only means to success. In such a case, however, the patient, or his parents or guardian, should, as a rule, be informed of the impending danger, so that they may give or refuse their consent if they please. For, next to God, the right to that life belongs to them rather than to the physician. The same duty of consulting their wishes exists when not life but the possible loss of a limb is at stake, or the bearing of uncommon sufferings. Moralists teach that a man is not obliged in conscience to submit to an extraordinarily painful or revolting operation even to save his life. Certainly, when the natural law leaves him at liberty, the physician cannot compel him to submit to his dictation; all he can do is to obtain his consent by moral persuasion.

4. As a consequence from the Doctor's duty to use only safe means it follows that he cannot experiment on his patients by the use of treatment of which he does not know the full power for good or evil. Nor is he excused from responsibility in this matter by the fact that the experiment thus made on one patient may be very useful to many others. His contract is with the one now under treatment, who is not willing, as a rule to be experimented upon for the benefit of others. And even if the patient should be willing, the Doctor cannot lawfully expose him to grievous danger unless it be the only hope of preserving his life. This follows from the principle explained before, that human life belongs chiefly to God and not to man exclusively.

5. There are various kinds of medical treatment to which we can scarcely have recourse without exposing ourselves to serious evil consequences. Such is the use of cocaine, morphine, and even in special cases of alcohol. The drugs in themselves are useful, but they often lead to evil results. Now in the use of all such drugs as are apt to be beneficial in one way and injurious in another, we must ever be guided by the rules formerly explained concerning evil indirectly willed, or rather permitted to result, while good results are directly willed or intended. If the Doctor is satisfied that a dose of morphine or an application of cocaine will do more good than harm, he can, of course, prescribe or apply it. Still in such matters he must remember that the good effect is but temporary, while its pernicious consequences, especially when habits are thus contracted, are likely to be permanent and cumulative. Besides, the good results affect the body only, the evil often affect body and soul. Many a wreck in health and morals has been caused by imprudent recourse to dangerous treatment, where a little more patience and wisdom would have been equally efficient in curing the bodily ailment, without any deleterious consequences. If once a patient becomes a slave to the morphine or cocaine habit, the only cure is to cut off all the supply of the drug either at once or, at any rate, by daily diminution. To leave him free control of the poison is to co-operate in his self-destruction.

6. The sixth duty of a Doctor is of a different kind. There exists a tacit or implicit contract between him and his patients that he shall keep their secrets of which he becomes possessed in his professional capacity. It is always wrong wantonly to betray the secrets of others; but the Doctor is bound by a special duty to keep his professional secrets; and it is doubly wrong and disgraceful in him to make them known. For instance, if he has treated a case of sickness brought on by sinful excesses of any kind, he is forbidden by the natural law to talk about it to such as have no special right to know the facts. Parents and guardians are usually entitled to be informed of their children's and their wards' wrong-doings, that they may take proper measures to prevent further evil. Besides, the Doctor is properly in their service; he is paid by them, and, therefore, his contract is with them rather than with the children. He can, therefore, prudently inform them of what is wrong, but he cannot inform others.

It is a debated question in Medical Jurisprudence whether the Doctor's professional knowledge of criminal acts should be privileged before the courts, so that he should not be forced to testify to a crime that he has learned from his patients while acting as their medical adviser. Dr. Ewell speaks thus on the subject (p. 2): "The medical witness should remember that, by the common law, a medical man has no privilege to avoid giving in evidence any statement made to him by a patient; but when called upon to do so in a court of justice, he is bound to disclose every communication, however private and confidential, which has been made to him by a patient while attending him in a professional capacity. By statute, however, in some of the United States, communications made by a patient to a physician when necessary to the treatment of a case are privileged; and the physician is either expressly forbidden or not obliged to reveal them. Such statutes exist in Arkansas, California, Indiana, Iowa, Ohio, Michigan, Minnesota, Missouri, Montana, New York, and Wisconsin. The seal upon the physician's lips is not even taken away by the patient's death. Such communications, however, must be of a lawful character and not against morality or public policy; hence, a consultation as to the means of procuring an abortion on another is not privileged, nor would be any similar conference held for the purpose of devising a crime or evading its consequences.

"A report of a medical official of an insurance company on the health of a party proposing to insure his life is not privileged from production; nor is the report of a surgeon of a railroad company as to the injuries sustained by a passenger in an accident, unless such report has been obtained with a view to impending litigation."

The practical rule for a Doctor's conscience on the subject of secrecy is, that he must keep his professional secrets with great fidelity, and not reveal them except in as far as he is compelled to do so by a court of justice acting within its legal power or competency. If so compelled, he can safely speak out; for his duty to his patient is understood to be dependent on his obedience to lawful authority.

As to the question of Jurisprudence whether the courts ought to treat the physician's official secrets as privileged, in the same way as they do a lawyer's secrets, this will depend on the further question whether the same reasons militate for the one as for the other. The lawyer's privilege is due to the anxiety of the state not to condemn an innocent man nor a guilty man beyond his deserts. To avert such evil, the accused party needs the assistance of a legal adviser who can guide him safely through the mazes and technicalities of the law, and, even should he be guilty, who can protect him against exaggerated charges and ward off unmerited degrees of punishment. Now, this can scarcely be accomplished unless the attorney for the defence learn from his client the entire truth of the facts. But the client could not safely give such information to his lawyer if the latter's professional secrets were not held sacred by the court of justice.

Can the same reasons or equivalent ones be urged in behalf of the physician? I do not see that they can. And I notice besides that, if he be excused from testifying against his patients, all their servants and attendants would seem to be entitled to the same privilege. Many persons, I think, labor here under a confusion of ideas; a Doctor is as sacredly bound to keep his patients' secrets as a lawyer is in regard to his clients, but it does not follow that the law cannot grant a privilege to the one and refuse the same to the other, for reasons which require it in the case of the lawyer and not in that of the Doctor.

III. Besides the rights and duties which arise for the physician from his contracts with the state and with his patients, there are other claims on his conscience, which proceed from his character as a man, a Christian, and a gentleman.

1. As a man, he is a member of the human family, not a stranger dwelling amid an alien race, but a brother among brothers. He cannot say, as did the first murderer, Cain, "Am I my brother's keeper?" But rather he must carry out the behest of the great Father of the human family: "God has given to each one care of his neighbor."

The maxim of Freemasons is that every member of that secret society must come to the assistance of every brother-mason in distress. But the law of nature and of nature's God is wider and nobler; it requires every man to assist every fellow-man in grievous need. The rich glutton at whose door lay Lazarus dying of want was bound, not by any human but by the higher law, to assist him; and it was for ignoring this duty that the soul was buried in hell, as the gentlest of teachers expresses it.

(a) As physicians, as men, you will have duties to the poor, who cannot pay you for your services; they are your fellow-men. Their bill will be paid in due time. He is their security who has said: "Whatsoever you have done to the least of these, you have done it unto Me." He may pay you in temporal blessings, or in still higher favors, if you do it for His sake; but pay He will, and that most liberally: "I will repay," says the Lord. The rule of charity for physicians is that they should willingly render to the poor for the love of God those professional services which they are wont to render to the rich for pecuniary compensation. While thus treating a poor patient they should be as careful and diligent as they would be for temporal reward; what is done for God should not be done in a slovenly fashion.

(b) In this connection of regard for the poor, allow me also to call your attention, gentlemen, to a point which students of medicine are apt to forget at times, and yet which both God and the world require you ever to bear in mind: it is the respect which every man owes to the mortal remains of a departed brother. I do not know that a people has ever been found, even among barbarians, who did not honor the bodies of their dead. For the good of humanity, dead bodies may at times be subjected to the dissecting-knife, but never to wanton indignities. Reason tells you to do by others as you wish to be done by, and Revelation adds its teaching about a future resurrection and glorification of that body of which the Apostle says that "it is sown in dishonor, but it shall rise in glory." Be men of science, but be not human ghouls. There is such a thing as retribution. But lately a former millionaire died in a poorhouse and left his body as a cadaver for medical students. We cannot afford to ignore the mysterious ways of Divine Justice. Ever handle human remains in a humane manner; and as soon as they have answered the purpose of science, see that they be decently interred, if possible.

2. There are other duties that you owe not as men but as Christians. All of us enjoy the blessings of Christian civilization, even those who are not Christians themselves. We are dealt with by others on Christian principles, and we ought to treat others in the same spirit. What duties does this impose?

(a) When your patients are in real danger of death, let them have a good chance to prepare properly for their all-important passage into eternity. Give them fair warning of their situation. Doctors and relations are often afraid of alarming the patients and thus injuring their health. But those who attend Catholic patients at least soon find out by experience that the graces and consolations of the Last Sacraments usually bring a peace of mind that benefits even the bodily health. In any case, the interests of the future life are too important to be ignored.

(b) For the same reason, the physician should not prescribe such doses of morphine or other anaesthetics as will render the patient unconscious at a time when he ought to be preparing to meet his Judge. This would be not kindness but cruelty. A little suffering more in this life may save much suffering in the next. If a Catholic priest, on being called to a patient's bedside, finds that the family's physician has been so inconsiderate, he cannot help protesting against employing such a man in Catholic families.

(c) If you attend a woman in childbirth, you may be asked by a Christian mother not to let her child die without Baptism. The vast majority of Christians believe that this sacrament is necessary to obtain supernatural happiness. The ceremony is easily performed: no harm can come of it, but immeasurable good for eternity. It should properly be performed by the clergy. But if this cannot be done, any man, woman, or child, even one not a Christian himself, can administer the sacrament. Every Doctor in a Christian land should understand how to do it, and do it with unerring accuracy. It were a disgrace for him to be ignorant of what even an ordinary child is expected to know. The ceremony is so simple; and yet, being an institution of Christ, no man can modify it to suit his notions; if what is done is not just what Christ appointed to be done, it will be of no avail. Notice, therefore, carefully every detail. You will take a little water, say a cupful, real water—cold or lukewarm, that matters not—you will slowly pour it on the head of the child, and, while you do so, you will say, "I baptize thee in the name of the Father, and of the Son, and of the Holy Ghost." That is all. Notice, you must say the words while the water is being poured on the child. For "I baptize" means "I wash"; pour, therefore, or wash while you say, "I wash." Should you hereafter wish to refresh your memories on this matter, you can do so by consulting the "Century Dictionary," which explains Baptism, and in particular Catholic Baptism, as "consisting essentially in the application of water to the person baptized by one having the intention of conferring the sacrament, and who pronounces at the same time the words, 'I baptize thee in the name of the Father, and of the Son, and of the Holy Ghost.'" If a cup of water given to the thirsty brings a blessing, how much more the giving of the water of salvation! Should it happen that the child is in danger of dying before delivery, it should be baptized in the womb provided it be at all possible to cause the water to reach or wash its body, projected upon it by any instrument whatever; but the water should flow over the body, not merely over the cyst enclosing it, for the cyst is no part of the child. Even if but an arm or other minor portion of the body is washed, the baptism is probably valid. If any doubt about the valid administration is left, the infant after delivery should be carefully baptized under condition, as it is called; that is, with the condition added that, if the former ceremony was validly conferred, there is no intention of giving a second baptism. For that would not be right; since the sacrament cannot be validly received more than once; it is a sacred initiation, but it were mockery to initiate one that is already initiated.

Should a physician be present when a pregnant woman has recently expired, and the child may still be living in the womb, it will be an easy and important task to perform the Cesarean section as soon as possible, and baptize the little one before it dies. In all this there is no money, but what is far more precious, the securing of eternal happiness. I add with great pleasure that many physicians are wont to comply with all these instructions most carefully, and even to instruct midwives and nurses in the best manner of rendering such services.

3. Lastly, we must consider the duties which a Doctor owes to others and to himself as a gentleman. It may not be easy to define what is meant by "a gentleman," and yet to some extent we all know it; we recognize a gentleman when we meet one, we pay him sincere homage in our hearts. We readily allow him to influence us and to guide us. We esteem him instinctively as a superior being, as we distinguish a precious stone from a common pebble; so we value a gentleman for precious qualities exhibited in the beauty of his conduct. His conduct ever exhibits two characteristic marks: a proper degree of dignity or respect for self, and a proper degree of politeness or respect for others. Self-respect will not allow him to do anything which is considered vulgar, unmannerly, gross, rude, or selfish; he will avoid the two extremes, of self-neglect on the one hand and self-display on the other. His respect for others will make him treat all around him so as to make them feel comfortable in his presence; he will avoid whatever gives pain or causes embarrassment to even the lowest member of society.

Gentlemanliness has much to do with every one's success in life, and in particular with a Doctor's success. It is especially when sick that we are sensitive to everything displeasing in the conduct of others. It is not then the bold thinker or the extensive reader that is the acceptable visitor to the sick-room; but the gentlemanly consoler who always says the right thing at the right time, whose very eye expresses and whose countenance reflects the thought and sentiment most appropriate on the occasion.

There are most able physicians who are not gentlemen, and there are in the medical profession gentlemen who are rather poor physicians; but as a rule, I believe, the gentleman will thrive where the genius will starve. It is more or less the same in other professions. I know learned lawyers to-day who are far from prosperous, while men ten times their inferiors in learning are getting rich. I remember a most skilful physician, now no more on earth, who was a very genius in the science of medicine; but he was so filthy in his habits, he would so unceremoniously chew tobacco at all times, that many dreaded his visits, and would sooner have a man of less ability but gentler manners as their family physician.

Gentlemen, habits good and bad cannot be put on and off like a dress-coat; they are lasting qualities, the growth of years, the result of constant practice and self-denial or self-neglect. And, as I wish you success in life, allow me to conclude this lecture by recommending to you the assiduous cultivation of gentlemanly habits. Cultivate them now, while you are preparing for future labors. You wrong yourselves, and you insult your companions and your professors, when you neglect in their presence the conventionalities of polite society.

Uniting the external decorum of a gentleman with a thorough knowledge of your profession, and with what is still more important, the virtues of a conscientious man and a sincere Christian; ever true to the sound principles of morality which I have endeavored to explain and to inculcate in these lectures: you will be an honor to yourselves, an ornament to your noble profession, the glory and joy of your Alma Mater, a blessing to the community in which Providence will cast your lot as the dispensers of health and happiness and length of days to your fellow-men.