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diff --git a/18616.txt b/18616.txt new file mode 100644 index 0000000..1fd706e --- /dev/null +++ b/18616.txt @@ -0,0 +1,5035 @@ +Project Gutenberg's Moral Principles and Medical Practice, by Charles Coppens + +This eBook is for the use of anyone anywhere at no cost and with +almost no restrictions whatsoever. You may copy it, give it away or +re-use it under the terms of the Project Gutenberg License included +with this eBook or online at www.gutenberg.org + + +Title: Moral Principles and Medical Practice + The Basis of Medical Jurisprudence + +Author: Charles Coppens + +Release Date: June 18, 2006 [EBook #18616] + +Language: English + +Character set encoding: ASCII + +*** START OF THIS PROJECT GUTENBERG EBOOK MORAL PRINCIPLES *** + + + + +Produced by Geoff Horton, Laura Wisewell and the Online +Distributed Proofreading Team at http://www.pgdp.net + + + + + + +------------------------------------------------------------------+ + | | + | Transcriber's Note | + | | + | In Lecture I, there are paragraphs numbered 1 to 8 but omitting | + | 4. This is as in the original, as is the inconsistent | + | hyphenation of the words "lawgiver" and "twofold". In two | + | instances, errors of punctuation have been corrected, and in one | + | case obscured words have been guessed. Full details can be found | + | in the html version of this ebook. | + | | + +------------------------------------------------------------------+ + + + + + MORAL PRINCIPLES AND + + MEDICAL PRACTICE, + + + THE BASIS OF MEDICAL JURISPRUDENCE. + + + BY + + REV. CHARLES COPPENS, S.J., + + _Professor of Medical Jurisprudence in the John A. Creighton + Medical College, Omaha, Neb., author of Text-Books on Metaphysics, + Ethics, Oratory, and Rhetoric._ + + + NEW YORK, CINCINNATI, CHICAGO: + BENZIGER BROTHERS, + _Printers to the Holy Apostolic See._ + + + + + TO + + MR. JOHN A. CREIGHTON, + + THE FOUNDER OF THIS MEDICAL COLLEGE + AND OF + ST. JOSEPH'S HOSPITAL, + AS + A SLIGHT TRIBUTE OF HONOR + FOR + HIS ENLIGHTENED PATRONAGE OF LEARNING + AND + HIS CHRISTIAN CHARITY TOWARDS HIS FELLOW-MEN, + THIS VOLUME + IS + RESPECTFULLY INSCRIBED. + + + + +=Permissu Superiorum.= + + +The undersigned, Provincial of the Missouri Province of the Society of +Jesus, in virtue of faculties granted to him by Very Rev. L. MARTIN, +General of the same Society, hereby permits the publication of a book +entitled "Moral Principles and Medical Practice," by Rev. CHARLES +COPPENS, S.J., the same having been approved by the censors appointed by +him to revise it. + + THOMAS S. FITZGERALD, S.J. + + ST. LOUIS, MO., July 2, 1897. + + + * * * * * + + +=Imprimatur.= + + MICHAEL AUGUSTINE, + _Archbishop of New York._ + + NEW YORK, July 20, 1897. + + + + +COPYRIGHT, 1897, BY BENZIGER BROTHERS. + + + + +PREFACE. + + +The science of Medicine is progressive; genius irradiates its onward +march. Few other sciences have advanced as rapidly as it has done within +the last half century. Hence it has happened that in many of its +branches text-books have not kept pace with the knowledge of its leading +minds. Such is confessedly the case in the department of Medical +Jurisprudence. This very term, Medical Jurisprudence, as now used in +colleges, is generally acknowledged to be a misnomer. There is no reason +why it should be so used. The leading medical writers and practitioners +are sound at present on the moral principles that ought to direct the +conduct of physicians. It is high time that their principles be more +generally and distinctly inculcated on the younger members, and +especially on the students of their noble profession. To promote this +object is the purpose aimed at by the author. His brief volume is not +intended to be substituted for existing text-books on Medical +Jurisprudence, but to supply some chapters imperatively demanded by +science for the thorough treatment of this important subject. + + + + +CONTENTS. + + + PAGE + LECTURE I.--INTRODUCTION--THE FOUNDATION OF JURISPRUDENCE, 11 + + " II.--CRANIOTOMY, 37 + + " III.--ABORTION, 58 + + " IV.--VIEWS OF SCIENTISTS AND SCIOLISTS, 81 + + " V.--VENEREAL EXCESSES, 104 + + " VI.--THE PHYSICIAN'S PROFESSIONAL RIGHTS AND DUTIES, 128 + + " VII.--THE NATURE OF INSANITY, 151 + + " VIII.--THE LEGAL ASPECTS OF INSANITY, 177 + + " IX.--HYPNOTISM AND THE BORDER-LAND OF SCIENCE, 197 + + + + +MORAL PRINCIPLES AND MEDICAL PRACTICE. + + + + +LECTURE I. + +INTRODUCTORY--THE FOUNDATION OF JURISPRUDENCE. + + +Gentlemen:--1. When I thoughtfully consider the subject on which I am to +address you in this course of lectures, i.e., Medical Jurisprudence, I +am deeply impressed with the dignity and the importance of the matter. + +The study of medicine is one of the noblest pursuits to which human +talent can be devoted. It is as far superior to geology, botany, +entomology, zooelogy, and a score of kindred sciences as its subject, the +body of man, the visible lord of the creation, is superior to the +subject of all other physical sciences, which do so much honor to the +power of the human mind; astronomy, which explores the vast realms of +space, traces the courses and weighs the bulks of its mighty orbs; +chemistry, which analyzes the minutest atoms of matter; physics, which +discovers the properties, and mechanics, which utilizes the powers of an +endless variety of bodies--all these noble sciences together are of less +service to man than that study which directly promotes the welfare of +his own structure, guards his very life, fosters the vigor of his youth, +promotes the physical and mental, aye, even the moral, powers of his +manhood, sustains his failing strength, restores his shattered health, +preserves the integrity of his aging faculties, and throughout his whole +career supplies those conditions without which both enjoyment and +utility of life would be impossible. + +The physician, indeed, is one of the most highly valued benefactors of +mankind. Therefore he has ever been held in honor among his fellow-men; +by barbarous tribes he is looked upon as a connecting link between the +visible and the invisible world; in the most civilized communities, from +the time of Hippocrates, the father of medicine, to the present day, he +has been held in deeper veneration than the members of almost any other +profession; even in the sacred oracles of Revelation his office is +spoken of with the highest commendation: "Honor the physician," writes +the inspired penman, "for the need thou hast of him; for the Most High +hath created him. The skill of the physician shall lift up his head, and +in the sight of great men he shall be praised. The Most High has created +medicines out of the earth, and a wise man shall not abhor them. The +virtue of these things is come to the knowledge of men, and the Most +High has given knowledge to men, that He may be honored in His wonders. +By these He shall cure and shall allay their pains, and of these the +apothecary shall make sweet confections, and shall make up ointments of +health, and of His works there shall be no end." (Ecclus. xxxiii. 1-7). + +2. It is well to remind you thus, gentlemen, at the opening of this new +year of studies, of the excellence of your intended profession; for you +cannot help seeing that a science so noble should be studied for a noble +purpose. In this age of utilitarianism, it is, alas! too common an evil +that the most excellent objects are coveted exclusively for lower +purposes. True, no one can find fault with a physician for making his +profession, no matter how exalted, a means of earning an honest +livelihood and a decent competency; but to ambition this career solely +for its pecuniary remuneration would be to degrade one of the most +sublime vocations to which man may aspire. There is unfortunately too +much of this spirit abroad in our day. There are too many who talk and +act as if the one highest and worthiest ambition of life were to make as +large a fortune in as short a time and in as easy a way as possible. If +this spirit of utilitarianism should become universal, the sad +consequence of it to our civilization would be incalculable. Fancy what +would become of the virtue of patriotism if officers and men had no +higher ambition than to make money! As a patriotic army is the strongest +defence of a nation's rights, so a mercenary army is a dreadful danger +to a people's liberty, a ready tool in the hand of a tyrant; as heroism +with consequent glory is the noble attribute of a patriot, so a +mercenary spirit is a stigma on the career of any public officer. We +find no fault with an artisan, a merchant, or a common laborer if he +estimate the value of his toil by the pecuniary advantages attached to +it; for that is the nature of such ordinary occupations, since for man +labor is the ordinary and providential condition of existence. But in +the higher professions we always look for loftier aspirations. This +distinction of rewards for different avocations is so evident that it +has passed into the very terms of our language: we speak of "wages" as +due to common laborers, of a "salary" as paid to those who render more +regular and more intellectual services; of a "fee" as appointed for +official and professional actions; and the money paid to a physician or +a lawyer is distinguished from ordinary fees by the especial name of +"honorary" or "honorarium." This term evidently implies, not only that +special honor is due to the recipients of such fees, but besides that +the services they render are too noble to be measured in money values, +and therefore the money offered is rather in the form of a tribute to a +benefactor than of pecuniary compensation for a definite amount of +service rendered. + +Wages may be measured by the time bestowed, or by the effect produced, +or by the wants of the laborer to lead a life of reasonable comfort; a +salary is measured by the period of service; but an honorary is not +dependent on time employed, or on needs of support, or on effect +produced, but it is a tribute of gratitude due to a special benefactor. +Whatever practical arrangements may be necessary or excusable in special +circumstances, this is the ideal which makes the medical profession so +honorable in society. + +3. From these and many other considerations that might be added, it is +evident, gentlemen, that in the pursuit of the distinguished career for +which you are preparing, you are expected to make yourselves the +benefactors of your fellow-men. Now, in order to do so, it will not +suffice for you to understand the nature of the various diseases which +flesh is heir to, together with the specific powers of every drug +described in works on materia medica. The knowledge of anatomy and +surgery, and of the various branches that are taught by the many +professors with whom I have the honor of being associated in the work of +your medical education, no matter how fully that knowledge be mastered, +is not sure by itself to make you benefactors to your fellow-men, unless +your conduct in the management of all your resources of science and art +be directed to procure the real welfare of your patients. Just as a +skilful politician may do more harm than good to his country if he +direct his efforts to improper ends, or make use of disgraceful means; +as a dishonest lawyer may be more potent for the perversion than the +maintenance of justice among his fellow-citizens; so likewise an able +physician may abuse the beneficent resources of his profession to +procure inferior advantages at the sacrifice of moral rights and +superior blessings. + +Your career, gentlemen, to be truly useful to others and pursued with +safety and benefit to yourselves, needs to be directed by a science +whose principles it will be my task to explain in this course of +lectures--the science of MEDICAL JURISPRUDENCE. + +It is the characteristic of science to trace results to their causes. +The science of _Jurisprudence_ investigates the causes or principles of +law. It is defined as "the study of law in connection with its +underlying principles." _Medical Jurisprudence_, in its wider sense, +comprises two departments, namely, the study of the laws regarding +medical practice, and, more, especially, the study of the principles on +which those laws are founded, and from which they derive their binding +power on the human conscience. The former department, styled _Medical +Law_, is assigned in the Prospectus of this College to a gentleman of +the legal profession. He will acquaint you with the laws of the land, +and of this State in particular, which regulate the practice of +medicine; he will explain the points on which a Doctor may come in +contact with the law courts, either as a practitioner having to account +for his own actions, under a charge of malpractice perhaps, or as an +expert summoned as a witness before a court in matters of civil contests +or criminal prosecutions. His field is wide and important, but the field +of _Medical Jurisprudence_, in its stricter or more specific sense, is +wider still and its research much deeper: it considers those principles +of reason that underlie the laws of the land, the natural rights and +duties which these laws are indeed to enforce to some extent, but which +are antecedent and superior to all human laws, being themselves founded +on the essential and eternal fitness of things. For things are not right +or wrong simply because men have chosen to make them so. You all +understand, gentlemen, that, even if we were living in a newly +discovered land, where no code of human laws had yet been adopted, nor +courts of justice established, nor civil government organized, still +even there certain acts of Doctors, as of any other men, would be right +and praiseworthy, and others wrong and worthy of condemnation; even +there Doctors and patients and their relatives would have certain rights +and duties. + +In such a land, the lecturer on Medical Law would have nothing to +explain; for there would be no human laws and law courts with which a +physician could come in contact. But the lecturer on Medical +Jurisprudence proper would have as much to explain as I have in this +country at present; because he treats of the Ethics or moral principles +of Medical Practice, he deals with what is ever the same for all men +where-ever they dwell, it being consequent on the very nature of man and +his essential relations to his Maker and his fellow-man. Unfortunately +the term "Medical Jurisprudence" has been generally misused. Dr. Ewell, +in his text-book on the subject, writes "While the term 'Medical +Jurisprudence' is a misnomer,--the collection of facts and conclusions +usually passing by that name being principally only matters of evidence, +and rarely rules of law,--still the term is so generally employed that +it would be idle to attempt to bring into use a new term, and we shall +accordingly continue the employment of that which has only the sanction +of usage to recommend it" (Ch. I). + +I prefer to use terms in their genuine meaning; for misnomers are out of +place in science, since they are misleading. Yet, to avoid all danger of +misunderstanding, I will call my subject "Moral Principles and Medical +Practice," and distinctly style it "The Basis of Medical Jurisprudence." + +On what lines will my treatment of the subject depart from the beaten +path? On the same lines on which most other improvements have been made +in the science of medicine. Science has not discovered new laws of +physical nature that did not exist before; but it has succeeded in +understanding existing laws more perfectly than before, and has shaped +its practice accordingly. So, too, the leaders of thought among +physicians, especially in English-speaking countries, now understand the +laws of moral nature--the principles of Ethics--more thoroughly than +most of their predecessors did, and they have modified their treatment +so as to conform it to these rules of morality. Hitherto Medical +Jurisprudence had regulated the conduct of practitioners by human, +positive laws, and sanctioned acts because they were not condemned by +civil courts. Now we go deeper in our studies, and appeal from human +legislation to the first principles of right and wrong, as Jurisprudence +ought to do; and, in consequence, some medical operations which used to +be tolerated, or even approved, by many in the profession are at present +absolutely and justly condemned. The learned physician these days is no +longer afraid to face the moral philosopher; there is no longer any +estrangement between Ethics and Medical Practice. Medicine, sent from +Heaven to be an angel of mercy to man, is now ever faithful to its +beneficent mission; it never more performs the task of a destroying +spirit, as--not in wantonness, but in ignorance--it did frequently +before. + +On these lines, then, of the improved understanding of first principles, +I will now proceed to develop the teachings of Medical Jurisprudence. + +The first principle that I will lay down for explanation is, that a man +is not to be held responsible for all his acts, but only for those which +he does of his own free will, which, therefore, it is in his power to do +or not to do. These are called _human_ acts, because they proceed from a +distinctively human power. A brute animal cannot perform such acts; it +can only do under given circumstances what its impulses prompt it to do; +or, when it experiences various impulses in different directions, it can +only follow its strongest impulse; as when a dog, rushing up to attack a +man, turns and runs away before his uplifted stick. When a bird sings, +it cannot help singing; but a man may sing or not sing at his choice; +his singing is a human act. When, however, under the impulse of violent +pain, a person happens involuntarily to sigh or groan or even shriek, +this indeed is the act of a man, but, inasmuch as it is physically +uncontrollable, it is not a human act. So whatever a patient may do +while under the influence of chloroform is not a human act, and he is +not morally responsible for it. His conduct under the circumstances may +denote a brave or a cowardly disposition, or it may indicate habits of +self-command or the absence of them. His prayers or curses while thus +unconscious are no doubt the effects of acquired virtues or vices; yet, +in as far as his will has no share in the present acts, they are not +free or human acts. He deserves praise or blame for his former acts, by +which he acquired such habits, but not for his unconscious acts as such. + +From this principle it follows that a physician is not responsible to +God or man for such evil consequences of his prescriptions or surgical +operations as are entirely beyond his will and therefore independent of +his control. If, however, his mistakes arise from his ignorance or want +of skill, he is blamable in as far as he is the wilful cause of such +ignorance; he should have known better; or, not knowing better, he +should not have undertaken the case for which he knew he was not +qualified. + +But it often happens that the best informed and most skilful +practitioner, even when acting with his utmost care, causes real harm to +his patients; he is the accidental, not the wilful, cause of that harm, +and therefore he is free from all responsibility in the matter. + +The practical lessons, however, which all of you must lay to heart on +this subject are: 1st. That you are in duty bound to acquire sound +knowledge and great skill in your profession; since the consequences +involved are of the greatest moment, your obligation is of a most +serious nature. 2d. That in your future practice you will be obliged on +all occasions to use all reasonable care for the benefit of your +patients. 3d. That you cannot in conscience undertake the management of +cases of unusual difficulty unless you possess the special knowledge +required, or avail yourselves of the best counsel that can reasonably be +obtained. + +5. A second principle of Ethics in medical practice, gentlemen, is this, +that many human acts may be highly criminal of which, however, human +laws and courts take no notice whatsoever. In this matter I am not +finding fault with human legislation. The laws of the land, considering +the end and the nature of civil government, need take no cognizance of +any but overt acts; a man's heart may be a very cesspool of vice, envy, +malice, impurity, pride, hatred, etc., yet human law does not and ought +not to punish him for this, as long as his actions do not disturb the +public peace nor trench upon the happiness of his neighbor. Even his +open outward acts which injure only himself, such as gluttony, +blasphemy, impiety, private drunkenness, self-abuse, even seduction and +fornication, are not usually legislated against or punished in our +courts. Does it follow that they are innocent acts and lawful before +God? No man in his right senses will say so. + +The goodness and the evil of human acts is not dependent on human +legislation alone; in many cases the moral good or evil is so intrinsic +to the very nature of the acts that God Himself could not change the +radical difference between them. Thus justice, obedience to lawful +authority, gratitude to benefactors, are essentially good; while +injustice, disobedience, and ingratitude are essentially evil. Our +reason informs us of this difference; and our reason is nothing else +than our very nature as intelligent beings capable of knowing truth. The +voice of our reason or conscience is the voice of God Himself, who +speaks through the rational nature that He has made. Through our reason +God not only tells us of the difference between good and evil acts, but +He also commands us to do good and avoid evil;--to do certain acts +because they are proper, right, orderly, suitable to the end for which +we are created; and to avoid other acts because they are improper, +wrong, disorderly, unsuitable to the end of our existence. There is a +third class of acts, which, in themselves, are indifferent, i.e., +neither good nor evil, neither necessary for our end nor interfering +with its attainment. These we are free to do or to omit as we prefer; +but even these become good and even obligatory when they are commanded +by proper authority, and they become evil when forbidden. In themselves, +they are indifferent acts. + +6. These explanations are not mere abstractions, gentlemen, or mere +philosophical speculations. True, my subject is philosophical; but it is +the philosophy of every-day life; we are dealing with live issues which +give rise to the gravest discussions of your medical journals; issues on +which practically depend the lives of thousands of human beings every +year, issues which regard physicians more than any other class of men, +and for the proper consideration of which Doctors are responsible to +their conscience, to human society, and to their God. To show you how we +are dealing with present live issues, let me give you an example of a +case in point. In the "Medical Record," an estimable weekly, now in +almost the fiftieth year of its existence, there was lately carried on a +lengthy and, in some of its parts, a learned discussion, regarding the +truth of the principles which I have just now explained, namely, the +intrinsic difference between right and wrong, independently of the +ruling of law courts and of any human legislation. The subject of the +discussion was the lawfulness in any case at all of performing +craniotomy, or of directly destroying the life of the child by any +process whatever, at the time of parturition, with the intention of +saving the life of the mother. + +I will not examine this important matter in all its bearings at present; +I mean to take it up later on in our course, and to lay before you the +teachings of science on this subject, together with the principles on +which they are based. For the present I will confine myself to the point +we are treating just now, namely, the existence of a higher law than +that of human tribunals, the superiority of the claims of natural to +those of legal justice. Some might think, at first sight, that this +needs no proof. In fact we are all convinced that human laws are often +unjust, or, at least, very imperfect, and therefore they cannot be the +ultimate test or fixed standard of right and wrong; yet the main +argument advanced by one of the advocates of craniotomy rests upon the +denial of a higher law, and the assertion of the authority of human +tribunals as final in such matters. + +In the "Medical Record" for July 27, 1895, p. 141, this gentleman writes +in defence of craniotomy: "The question is a legal one _per se_ against +which any conflicting view is untenable. The subdivisions under which +the common law takes consideration of craniotomy are answers in +themselves to the conclusions quoted above, under the unfortunate +necessity which demands the operation." Next he quotes the Ohio statute +law, which, he remarks, was enacted in protection of physicians who are +confronted with this dire necessity. He is answered with much ability +and sound learning by Dr. Thomas J. Kearney, of New York, in the same +"Medical Record" for August 31, 1895, p. 320, who writes: "Dr. G. bases +his argument for the lawfulness of craniotomy in the teachings of common +law, contending, at least implicitly, that it is unnecessary to seek +farther the desired justification. However, the basis of common law, +though broad, is certainly not broad enough for the consideration of +such a question as the present one. His coolness rises to sublime +heights, in thus assuming infallibility for common law, ignoring the +very important fact that behind it there is another and higher law, +whose imperative, to every one with a conscience, is ultimate. It +evidently never occurs to him that some time could be profitably spent +in research, with the view to discovering how often common-law maxims, +seen to be at variance with the principles of morality, have been +abrogated by statutory enactments. Now the maxims of common law +relating to craniotomy, the statutes in conformity therewith, as well as +Dr. G.'s arguments (some of them at least), rest on a basis of pure +unmitigated expediency; and this is certainly in direct contravention of +the teachings of all schools of moral science, even the utilitarian." + +Dr. Kearney's doctrine of the existence of a higher law, superior to all +human law, is the doctrine that has been universally accepted, in all +Christian lands at least, and is so to the present day. Froude explains +it correctly when he writes: "Our human laws are but the copies, more or +less imperfect, of the eternal laws so far as we can read them, and +either succeed and promote our welfare or fail and bring confusion and +disaster, according as the legislator's insight has detected the true +principle, or has been distorted by ignorance or selfishness" (Century +Dict., "Law"). + +Whoever calmly reflects on the manner in which laws are enacted by +legislative bodies, under the influence of human passions and +prejudices, often at the dictation of party leaders or of popular +sentiment, of office-seekers or wealthy corporations, etc., will not +maintain for a moment that human laws and human tribunals are to be +accepted as the supreme measure or _norma_ of right and wrong. The +common law of England, which lies at the basis of our American +legislation, and is an integral portion of our civil government, is less +fluctuating than our statutory law, and is in the main sound and in +conformity with the principles of Jurisprudence. But no one will claim +infallibility for its enactments; the esteem we have for it is chiefly +due to its general accord with the requirements of the higher law. + +7. There is, then, a higher law, which all men are bound to obey, even +lawgivers and rulers themselves as well as their humblest subjects, a +law from which no man nor class of men can claim exemption, a law which +the Creator cannot fail to impose upon His rational creatures: although +God was free to create or not to create as He chose, since He did not +need anything to complete His own happiness,--yet, if He did create, He +was bound by His own wisdom to put order into His work; else it would +not be worthy of His supreme wisdom. As the poet has so tersely +expressed it, "Order is Heaven's first law." + +How admirably is this order displayed in the material universe! The more +we study the sciences--astronomy, biology, botany, physiology, medicine, +etc.--the more we are lost in admiration at the beautiful order we see +displayed in the tiniest as well as in the vastest portions of the +creation. And shall man alone, the masterpiece of God in this visible +universe, be allowed to be disorderly, to be a failure in the noblest +part of his being, to make himself like to the brute or to a demon of +malice, to waste his choicest gifts in the indulgence of debasing +pleasure? The Creator is bound by His own wisdom to direct men to high +purposes, worthy of their exalted intellectual nature. But how shall He +direct man? He compels material things to move with order to the +accomplishment of their alloted tasks by the physical laws of matter. He +directs brute animals most admirably to run their appointed careers by +the wonderful laws of instinct, which none of them can resist at will. +But man He has made free; He must direct him to do worthy actions by +means suitable to a free being, that is, by the enacting of the moral +law. + +He makes known to us what is right and wrong. He informs every one of +us, by the voice of reason itself, that He requires us to do the right +and avoid the wrong. He has implanted in us the sense of duty to obey +that law. If we do so, we lead worthy lives, we please Him, and, in His +goodness, He has rewards in store. + +But can He be pleased with us if we thwart His designs; if we, His +noblest works on earth, instead of adding to the universal harmony of +His creation, make monsters of ourselves, moral blots upon the +beautiful face of His world? It were idle for Him to give us the +knowledge of His will and then to stand by and let us disfigure His +fairest designs; to bid us do what is right, and then let us do wrong +without exacting redress or atonement. If He is wise, He must not only +lay down the law, but He must also enforce it; He must make it our +highest interest to keep His law, to do the right; so that ultimately +those men shall be happy who have done it, and those who have thwarted +His designs shall be compelled to rue it. He will not deprive us of +liberty, the fairest gift to an intelligent creature, but He will hold +out rewards and punishments to induce us to keep the law and to avoid +its violation. Once He has promised and threatened, His justice and His +holiness compel Him to fulfil His threats and promises. A man can commit +no rasher act than to ignore, defy, and violate that higher law of which +we are speaking, and which, if it must direct all men, especially +requires the respect and obedience of those into whose hands he has +placed at times the lives of their fellow-men, the greatest of earthly +treasures. + +I have insisted so much, gentlemen, on the existence of the higher law, +on its binding power and on the necessity of observing it, because it is +the foundation of my whole course of lectures. If there were no higher +law, then there would be no Medical Jurisprudence, in the true sense of +the word. For Jurisprudence studies the principles that underlie legal +enactments, and if there were no higher law, there would be no such +principles; then the knowledge of the human law would fill the whole +programme. This in fact is the contention of the defendant of craniotomy +to whom I have referred; and he boldly applies his speculation to a +matter in which the physician has the most frequent opportunity to +exhibit his fidelity to principle, or his subserviency to the +requirements of temporary expediency at the sacrifice of duty. + +8. You will find, gentlemen, as we proceed in our course, that Doctors +have very many occasions in which to apply the lessons of Jurisprudence +in their medical practice. I even suspect that they need to be more +conscientious in regard to the dictates of the higher law than any other +class of men, the clergy alone, perhaps, excepted. They need this not +only for their own good, but also for the good of their patients and of +the community at large. The reasons are these: + +A. The matters entrusted to their keeping are the most important of all +earthly possessions; for they are life itself, and, along with life, +health, the necessary condition of almost all temporal enjoyment. No +other class of men is entrusted with more weighty earthly interests. +Hence the physician's responsibility is very great; hence the common +good requires that he be eminently faithful and conscientious. + +B. With no other class of men does the performance of duty depend more +on personal integrity, on conscientious regard for the higher law of +morality than with the Doctor. For the Doctor's conduct is less open to +observation than that of other professions. The lawyer may have many +temptations to act unjustly; but other lawyers are watching him, and the +courts of justice are at hand to check his evil practices. As to the +judge, he is to pronounce his decisions in public and give reasons for +his ruling. The politician is jealously watched by his political +opponents. The public functionary, if he is unjust in his dealings, is +likely sooner or later to be brought to an account. But the physician, +on very many occasions, can be morally sure that his conduct will never +be publicly scrutinized. Such is the nature of his ministrations, and +such too is the confidence habitually reposed in his integrity, that he +is and must be implicitly trusted in matters in which, if he happens to +be unworthy of his vocation, he may be guilty of the most outrageous +wrongs. + +The highest interests of earth are in his hands. If he is not +conscientious, or if he lets himself be carried about by every wind of +modern speculations, he can readily persuade himself that a measure is +lawful because it is presently expedient, that acts can justly be +performed because the courts do not punish them; and thus he will often +violate the most sacred rights of his patients or of their relatives. +Who has more frequent opportunities than a licentious Doctor to seduce +the innocent, to pander to the passions of the guilty, to play into the +hands of greedy heirs, who may be most willing to pay him for his +services? No one can do it more safely, as far as human tribunals are +concerned. As a matter of fact, many, all over this land and other +lands, are often guilty of prostituting their noble profession to the +vilest uses. The evil becomes all the more serious when false doctrines +are insinuated, or publicly advocated, which throw doubt upon the most +sacred principles of morality. True, the sounder and by far the larger +portion of medical men protest against these false teachings by their +own conduct at least; but it very frequently happens that the honest man +is less zealous in his advocacy of what is right than is the +propagandist of bold speculations and dangerous new theories in the +spreading of what is pernicious. + +The effect thus produced upon many minds is to shake their convictions, +to say the least; and I need not tell you, gentlemen, that weak +convictions are not likely to be proof against violent and repeated +temptations. In fact, if a physician, misled by any of those many +theories which are often inculcated or at least insinuated by false +scientists, can ever convince himself, or even can begin to surmise +that, after all, there may be no such thing as a higher law before which +he is responsible for even his secret conduct, then what is to prevent +him from becoming a dangerous person to the community? If he see much +temporal gain on the one hand, and security from legal prosecution on +the other, what would keep him in the path of duty and honesty? +Especially if he can once make himself believe that, for all he knows, +he may be nothing more than a rather curiously developed lump of matter, +which is to lose forever all consciousness in death. Why should he not +get rid of any other evolved lump of matter if it stand in the way of +his present or prospective happiness? Those are dangerous men who +inculcate such theories; it were a sad day for the medical profession +and for the world at large if ever they found much countenance among +physicians. Society cannot do without the higher law; this law is to be +studied in Medical Jurisprudence. + +It is my direct object, gentlemen, to explain this law to you in its +most important bearings, and thus to lay before you the chief duties of +your profession. The principal reason why I have undertaken to deliver +this course of lectures--the chief reason, in fact, why the Creighton +University has assumed the management of this Medical College--is that +we wish to provide for the West, as far as we are able, a goodly supply +of conscientious physicians, who shall be as faithful and reliable as +they will be able and well informed; whose solid principles and sterling +integrity shall be guarantees of upright and virtuous conduct. + +That this task of mine may be successfully accomplished, I will endeavor +to answer all difficulties and objections that you may propose. I will +never consider it a want of respect to me as your professor if you will +urge your questions till I have answered them to your full satisfaction. +On the contrary, I request you to be very inquisitive; and I will be +best pleased with those who show themselves the most ready to point out +those difficulties, connected with my lectures, which seem to require +further answers and explanations. + + + + +LECTURE II. + +CRANIOTOMY. + + +Gentlemen:--In my first lecture I proved to you the existence and the +binding power of a higher law than that of human legislators, namely, of +the eternal law, which, in His wisdom, the Creator, if He created at +all, could not help enacting, and which He is bound by His wisdom and +justice to enforce upon mankind. + +We are next to consider what are the duties which that higher law +imposes upon the physician. In this present lecture I will confine +myself to one duty, that of respect for human life. + +A duty is a bond imposed on our will. God, as I remarked before, imposes +such bonds, and by them He directs free beings to lead worthy lives. As +He directs matter by irresistible physical laws, so He directs +intelligent and free beings by moral laws, that is, by laying duties or +moral bonds upon them, which they ought to obey, which He must require +them to obey, enforcing His commands by suitable rewards and +punishments. Thus He establishes and enforces the moral order. + +Now the duties He lays upon us are of three classes. First, there are +duties of reverence and honor towards Himself as our sovereign Lord and +Master. These are called the duties of Religion, the study of which does +not belong to Medical Jurisprudence. The other classes of duties regard +ourselves and our fellow-men, with these we are to deal in our lectures. + +I. Order requires that the meaner species of creatures shall exist for +the benefit of the nobler; the inert clod of earth supports vegetable +life, the vegetable kingdom supplies the wants of animal life, the brute +animal with all inferior things subserves the good of man; while man, +the master of the visible universe, himself exists directly for the +honor and glory of God. In this beautiful order of creation, man can use +all inferior things for his own benefit. + +This is what reason teaches concerning our status in this world; and +this teaching of reason is confirmed by the convictions of all nations +and all ages of mankind. The oldest page of literature that has come +down to us, namely, the first chapter of the first book of Holy Writ, +lays down this same law, and no improvement has been made in it during +all subsequent ages. Whether we regard this writing as inspired, as +Christians and Jews have always done, or only as the testimony of the +most remote antiquity, confirmed by the acceptance of all subsequent +generations, it is for every sensible man of the highest authority. + +Here is the passage: "God said, Let us make man to our image and +likeness; and let him have dominion over the fishes of the sea, and the +fowls of the air, and the beasts, and the whole earth, and every +creeping creature that creepeth upon the earth." And later on in +history, after the deluge, God more explicitly declared the order thus +established, saying to Noe and his posterity: "Every thing that moveth +and liveth shall be meat for you; even as the green herbs have I +delivered them to you." But He emphatically adds that the lives of men +are not included in this grant; they are directly reserved for His own +disposal. "At the hand of every man," He says, "will I require the life +of man." + +All things then are created for man; man is created directly for God, +and is not to be sacrificed for the advantage of a fellow-man. Thus +reason and Revelation in unison proclaim that we can use brute animals +as well as plants for our benefit, taking away their lives when it is +necessary or useful to do so for our own welfare; while no man is ever +allowed to slay his fellow-man for his own use or benefit: "At the hand +of every man will I require the life of man." + +II. The first practical application I will make of these general +principles to the conduct of physicians is this: a physician and a +student of medicine can, with a safe conscience, use any brute animal +that has not been appropriated by another man, whether it be bug or bird +or beast, to experiment upon, whatever specious arguments humane +societies may advance to the contrary. Brute animals are for the use of +man, for his food and clothing, his mental and physical improvement, and +even his reasonable recreations. Man can lawfully hunt and fish and +practise his skill at the expense of the brute creation, notwithstanding +the modern fad of sentimentalists. The teacher and the pupil can use +vivisection, and thus to some extent prolong the sufferings of the brute +subject for the sake of science, of mental improvement, and intelligent +observation. But is not this cruelty? and has a man a right to be cruel? +No man has a right to be cruel; cruelty is a vice, it is degrading to +man's noble nature. But vivisection practised for scientific purposes is +not cruel. Cruelty implies the _wanton_ infliction of pain: there are +people who delight in seeing a victim tortured; this is cruelty or +savagery, and is a disgrace to man. Even to inflict pain without +benefit is cruel and wrong; but not when it is inflicted on the brute +creation for the benefit of man, unless the pain should be very great +and the benefit very small. Certainly it is right to cultivate habits of +kindness even to animals; but this matter must not be carried to excess. + +The teaching of humane societies condemning all vivisection is due to +the exaggeration of a good sentiment and to ignorance of first +principles. For they suppose that sufferings inflicted on brute animals +are a violation of their rights. Now we maintain that brute animals have +no rights in the true sense of the word. To prove this thesis we must +explain what a right is and how men get to have rights. A _right_ is a +moral claim to a thing, which claim other persons are obliged to +respect. Since every man has a destiny appointed for him by his Creator, +and which he is to work out by his own acts, he must have the means +given him to do so. For to assign a person a task and not to give him +the means of accomplishing it would be absurd. Therefore the Creator +wants him to have those means, and forbids every one to deprive him of +those means. Here is the foundation of rights. Every man, in virtue of +the Creator's will, has certain advantages or claims to advantages +assigned him which no other man may infringe. Those advantages and +claims constitute his rights, guaranteed him by the Creator; and all +other men have the _duty_ imposed on them to respect those rights. Thus +rights and duties are seen to be correlative and inseparable; the rights +lodged in one man beget duties in other men. The same Creator that +assigns rights to one man lays upon all others duties to respect those +rights, that thus every free being may have the means of working out its +Heaven-appointed destiny. + +Thus it is apparent that rights and duties suppose free beings, persons; +now an irrational animal is not a person; it is not a free being, having +a destiny to work out by its free acts; it is therefore incapable of +having duties. Duties are matters of conscience; therefore they cannot +belong to the brute animal; for it has no conscience. And, since rights +are given to creatures because of the duties incumbent on them, brute +animals are incapable of having rights. When a brute animal has served +man's purpose, it has reached its destiny. + +III. But it is entirely different with man: there is what we may call an +infinite distance between man and brute. Every man is created directly +for the honor and service not of other men, but of God Himself: by +serving God man must work out his own destiny--eternal happiness. In +this respect all men are equal, having the same essence or nature and +the same destiny. The poor child has as much right to attain eternal +happiness as the rich child, the infant as much as the gray-bearded +sire. Every one is only at the beginning of an endless existence, of +which he is to determine the nature by his own free acts. In this +infinite destiny lies the infinite superiority of man over the brute +creation. + +That all men are equal in their essential rights is the dictate of +common-sense and of sound philosophy. This truth may not flatter kings +and princes; but it is the charter of human rights, founded deeper and +broader in nature and on the Creator's will than any other claim of +mankind. As order requires the subordination of lower natures to higher, +so it requires equality of essential rights among beings of the same +nature. Now all men are of the same nature, hence they have all the same +essential rights. + +If any people on earth must stand by these principles, certainly the +American people must do so; for we have put them as the +foundation-stones of our civil liberty. There is more wisdom than many, +even of its admirers, imagine in the preamble to our Declaration of +Independence; upon it we are to base the most important rights and +duties which belong to Jurisprudence. The words of the preamble read as +follows: "We hold these truths as self-evident, that all men are created +equal; that they are endowed by their Creator with certain inalienable +rights; that among these are life, liberty, and the pursuit of +happiness." I feel convinced, gentlemen, and I will take it for granted +henceforth, unless you bring objections to the contrary, that you all +agree with me on this important point that _every man has a natural +right to his life, a right which all other men are solemnly bound to +respect_. It is his chief earthly right. It is called an _inalienable_ +right; by which term the fathers of our liberty meant a right which +under no circumstances can be lawfully disregarded. A man who takes it +upon himself to deprive another of life commits two grievous wrongs: one +towards his victim, whose most important right he violates, and one +towards God, who has a right to the life and service of His creatures. +"Thou shalt not kill" is a precept as deeply engraven on the human heart +by reason itself as it was on the stone tables of the Ten Commandments +by Revelation. + +So far we have chiefly considered murder as a violation of man's right +to his life. We must now turn our attention to God's right, which the +murderer violates. It may indeed happen that a man willingly resigns +his right to live, that he is tired of life, and longs and implores for +some one to take it away. Can you then do it? You cannot. His life does +not belong to him alone, but to God also, and to God principally; if you +destroy it, you violate God's right, and you will have to settle with +Him. God wills this man to live and serve Him, if it were only by +patient endurance of his sufferings. + +For a man may be much ennobled and perfected by the practice of patience +under pain and agony. Some of the noblest characters of history are most +glorious for such endurance. The suicide rejects this greatness; he robs +God of service and glory, he rebels against his Creator. Even Plato of +old understood the baseness of suicide, when he wrote in his dialogue +called "Phaedon" that a man in this world is like a soldier stationed on +guard; he must hold his post as long as his commander requires it; to +desert it is cowardice and treachery; thus, he says, suicide is a +grievous crime. + +This being so, can a Doctor, or any other man, ever presume to +contribute his share to the shortening of a person's life by aiding him +to commit suicide? We must emphatically say No, even though the patient +should desire death: the Doctor cannot, in any case, lend his +assistance to violate the right and the law of the Creator: "Thou shalt +not kill." + +I have no doubt, gentlemen, that some of you have been saying to +yourselves, Why does the lecturer insist so long upon a point which is +so clear? Of course, none of us doubts that we can in no case aid a +patient to commit suicide. My reason for thus insisting on this matter +is that here again we are dealing with a living issue. There are to-day +physicians and others who deny this truth, not in their secret practice +only, but, of late, to justify their conduct, they have boldly +formulated the thesis that present apparent expediency can lawfully be +preferred to any higher consideration. Here is the fact. At a +Medico-Legal Congress, held in the summer of 1895, Dr. Bach, one of its +leading lights, openly maintained it as his opinion that "Physicians +have the moral right to end life when the disease is incurable, painful, +and agonizing." + +What his arguments were in support of his startling proposition, I have +not been able to learn. But I know that a cry of horror and indignation +has gone up from many a heart. Many have protested in print; but unless, +on an occasion like this, moralists raise their voice against it with +all the influence which sound principles command, the saying of +Dr. Bach may at least shake the convictions of the rising generation of +physicians. The only argument for Dr. Bach's assertion that I can +imagine--and it is one proceeding from the heart rather than the +head--is that it is cruel to let a poor man suffer when there is no +longer hope of recovery. It is not the Physician that makes him suffer; +it is God who controls the case, and God is never cruel. + +He knows His own business, and forbids you to thwart His designs. If the +sufferer be virtuous, God has an eternity to reward his patient +endurance; if guilty, the Lord often punishes in this world that He may +spare in the next. Let Him have His way, if you are wise; His command to +all is clear, "Thou shalt not kill." + +One rash utterance, like that of Dr. Bach, can do an incalculable amount +of harm. Why, gentlemen, just think what consequences must follow if his +principle were, admitted! For the only reason that could give it any +plausibility would be that the patient's life is become useless and +insupportable. If that were a reason for taking human life away, then it +would follow that, whenever a man considers his life as useless and no +longer supportable, he could end it, he could commit suicide. That +reasoning would practically justify almost all suicides. For, when +people kill themselves, it is, in almost all cases, because they +consider their lives useless and insupportable. Whether it results from +physical or from moral causes that they consider their life a burden, +cannot, it seems to me, make any material difference; grief, shame, +despair are as terrible sufferings as bodily pains. If, then, we accept +Dr. Bach's principle, we must be prepared for all its baneful +consequences. + +IV. But are there no exceptions to the general law, "Thou shalt not +kill"? Are there no cases in which it is allowed to take another's life? +What about justifiable homicide? There are three cases of this nature, +gentlemen; namely, self-defence, capital punishment inflicted by the +state, and active warfare. With only one of these can a physician, as +such be concerned or think himself concerned. He is not a public hangman +executing a sentence of a criminal court; nor is he acting as a soldier +proceeding by public authority against a public foe. As to the plea of +self-defence, it must be correctly understood, lest he usurp a power +which neither human nor divine law has conferred upon him. + +1. _Self-defence._ It is a dictate of common-sense, already quoted by +Cicero as a universally received maxim of Jurisprudence in his day, that +it is justifiable to repel violence by violence, even if the death of +our unjust assailant should result. In such a case, let us consider what +really takes place. A ruffian attempts to take away my life; I have a +right to my life. I may, therefore, protect it against him; and, for +that purpose, I may use all lawful means. A lawful means is one that +violates no law, one that I may use without giving any one reasonable +ground of complaint. Suppose I have no other means to protect my life +than by shooting my aggressor; has he a right to complain of my conduct +if I try to do so? No, because he forces me to the act; he forces me to +choose between my life and his. Good order is not violated if I prefer +my own life: well-ordered charity begins at home. But is not God's right +violated? It is; for God has a right to my life and to that of my +assailant. The ruffian who compels me to shoot him is to blame for +bringing both our lives into danger; he is responsible for it to God. +But the Creator will not blame me for defending my life by the only +means in my power, and that when compelled by an unjust assailant, who +cannot reasonably find fault with my conduct. + +But it may be objected that no evil act may be done to procure a good +result, that a good end does not justify a bad means. That is a correct +principle, and we will consider it carefully some other day. But my act +of necessary self-defence is not evil, and therefore needs no +justification; for the means I employ are, under the circumstances, +well-ordered and lawful means, which violate no one's rights, as has +just been shown. Of course the harm I do to the aggressor is just only +in as far as it is strictly necessary to defend the inalienable right I +have to life or limb or very valuable property. Hence I must keep within +the just limits of self-defence. To shoot an assailant, when I am in no +serious danger, or when I can free myself some other way, or when I act +through malice, would not be self-defence, but unjustifiable violence on +my part. + +2. The principles that make it lawful for a man to defend his own life +with violence against an unjust assailant will also justify a parent in +thus defending his children, a guardian his wards; and in fact any one +may forcibly defend any other human being against unjust violence. A +parent or guardian not only can, but he is in duty bound to, defend +those under his charge by all lawful means. Similarly the physician +would be obliged to defend his patient by the exercise of his profession +in his behalf. + +Now the only case in which the need of medical treatment against unjust +aggression could become a matter for discussion in Jurisprudence is the +case of a mother with child. Is the child under those circumstances +really an unjust aggressor? Let us study that important case with the +closest attention. Let all the rays of light we have gathered so far be +focussed on this particular point. Can a physician ever be justified in +destroying the life of a child, before or during its birth, by +craniotomy or in any other manner, in order to save its mother's life, +on the plea that the child is an unjust assailant of the life of its +mother? Put the case in a definite shape before you. Here is a mother in +the pangs of parturition. An organic defect, no matter in what shape or +form, prevents deliverance by the ordinary channels. All that medical +skill can do to assist nature has been done. The case is desperate. +Other physicians have been called in for consultation, as the civil law +requires before it will tolerate extreme measures. All agree that, if no +surgical operation is performed, both mother and child must die. There +are the Caesarian section, the Porro operation, laparotomy, +symphysiotomy, all approved by science and the moral law. But we will +suppose an extreme case; namely, the circumstances are so unfavorable +for any of these operations--whether owing to want of skill in the +Doctors present, or for any other reason--that none can safely be +attempted; any of them would be fatal to the mother. + +In this extreme case of necessity, can the Doctor break the cranium of +the living child, or in any way destroy its life with a view to save the +mother? If three consulting physicians agree that this is the only way +to save her, he will not be molested by the law courts for performing +the murderous operation. But will the law of nature and of nature's God +approve or allow his conduct? This is the precise question under our +consideration. We have seen that the infant, a true human being, has a +right to live, as well as its mother. "All men are created equal, and +have an equal right to life," declares the first principle of our +liberty. The Creator, too, as reason teaches, has a clear right to the +child's life; that child may answer a very special purpose of +Providence. But whether it will or not, God is the supreme and the only +Master of life and death, and He has laid down the strict prohibition, +"Thou shalt not kill." + +Now comes the plea of self-defence against an unjust aggressor. If the +child is such, if it _unjustly_ attacks its mother's life, then she can +destroy it to save herself, and her physician can aid the innocent +against the guilty party. But can it be proved that the infant is an +unjust aggressor in the case? There can be no intentional or _formal_ +guilt in the little innocent babe. But can we argue that the actual +situation of the child is an unjust act, unconsciously done, yet +_materially_ unjust, unlawful? Thus, if a madman would rush at me with a +sharp sword, evidently intent on killing me, he may be called an unjust +aggressor; though, being a raving maniac, he does not know what crime he +is committing, and is _formally_ innocent of murderous intent. +_Materially_ considered, the act is unjust, and I can defend myself +lawfully as against any other unjust assailant. Such is the common +teaching of moralists. But can the innocent babe be classed in the same +category with the raving maniac? Why should it? It is doing nothing; it +is merely passive in the whole process of parturition. + +Will any one object that the infant has no right to be there at all? Who +put it there? The only human agents in the matter were its parents. The +mother is more accountable for the unfortunate situation than the child. +Certainly you could not, to save the child, directly kill the mother, +treating her as an unjust assailant of her child's life? Still less can +you treat the infant as an unjust assailant of its mother's life. + +The plea of self-defence against unjust aggression being thus ruled out +of court in all such cases, and no other plea remaining for the +craniotomist, we have established, on the clearest principles of Ethics +and Jurisprudence, that it is never allowed directly to kill a child as +a means to save its mother's life. It would be a bad means, morally +evil; and no moral evil can ever be done that good may come of it; the +end cannot justify an evil means. In theory all good men agree with us +that the end can never justify the means. But in practice it seems to be +different with some of the medical profession. Of late, however, the +practice of craniotomy and all equivalent operations upon living +subjects has gone almost entirely out of fashion among the better class +of physicians. + +Allow me, gentlemen, to conclude this lecture with the reading of two +extracts from articles of medical writers on the present state of +craniotomy in their profession. You will find them in accord with the +conclusions at which we have arrived by reasoning upon the principles of +Jurisprudence. + +Dr. W. H. Parish writes ("Am. Eccles. Review," November, 1893, p. 364): +"The operations of craniotomy and embryotomy are to-day of relatively +infrequent occurrence, and many obstetricians of large experience have +never performed them. Advanced obstetricians advocate the performance of +the Cesarian section or its modification--the Porro operation--in +preference to craniotomy, because nearly all the children are saved, +and the unavoidable mortality among mothers is not much higher than that +which attends craniotomy. Of one hundred women on whom Cesarian section +is performed under _favorable conditions_ and with _attainable_ skill, +about ninety-five mothers should recover and fully the same number of +children. Of one hundred craniotomies, ninety-five mothers or possibly a +larger number will recover, and of course none of the children. The +problem resolves itself into this: Which shall we choose--Cesarian +section with one hundred and ninety living beings as the result, or +craniotomy with about ninety-five living beings?" + +Even if a liberal deduction be made for unfavorable circumstances and +deficient skill, the results, gentlemen, will still leave a wide margin +in favor of Cesarian section. My second extract is from an article of +Dr. M. O'Hara, and it is supported by the very highest authorities (ib. +p. 361): "Recently [August 1, 1893] the British Medical Association, the +most authoritative medical body in Great Britain, at its sixty-first +annual meeting, held at Newcastle-upon-Tyne, definitely discussed the +subject before us. In the address delivered at the opening of the +section of Obstetric Medicine and Gynecology, an assertion was put forth +which I regard as very remarkable, my recollection not taking in any +similar pronouncement made in any like representative medical body. The +authoritative value of this statement, accepted as undisputed by the +members of the association, which counts about fifteen thousand +practitioners, need not be emphasized. + +"Dr. James Murphy ('British Medical Journal,' August 26, 1893), of the +University of Durham, made the presidential address. He first alluded to +the perfection to which the forceps had reached for pelves narrowed at +the brim, and the means of correcting faulty position of the foetus +during labor. He then stated: 'In cases of great deformity of the +pelvis, it has long been the ambition of the obstetrician, where it has +been impossible to deliver a living child _per vias naturales_, to find +some means by which that child could be born alive with comparative +safety to the mother; and that time has now arrived. It is not for me to +decide,' he says, 'whether the modern Cesarian section, Porro's +operation, symphysiotomy, ischiopubotomy, or other operation is the +safest or most suitable, nor yet is there sufficient material for this +question to be decided; but when such splendid and successful results +have been achieved by Porro, Leopold, Saenger, and by our own Murdoch +Cameron, I say it deliberately and with whatever authority I possess, +and I urge it with all the force I can master, that we are not now +justified in destroying a living child; and while there may be some +things I look back upon with pleasure in my professional career, that +which gives me the greatest satisfaction is that I have never done a +craniotomy on a living child.'" + +You will please notice, gentlemen, that when this distinguished Doctor +said, "We are not _now_ justified in destroying a living child," he was +speaking from a medical standpoint, and meant to say that such +destruction is now scientifically unjustifiable, is a blunder in +surgery. From a moral point of view it is not only now, but it was +always, unjustifiable to slay a child as a means to save the mother's +life; a good end cannot justify an evil means, is a truth that cannot be +too emphatically inculcated. This is one of the most important subjects +on which Medical Jurisprudence has been improved, and most of its +text-books are deficient. The improvement is explained with much +scientific detail in an address of the President, Samuel C. Busey, M.D., +before the Washington Obstetrical and Gynecological Society ("Am. +Journal of Obstetrics and Diseases of Women and Children," vol. xvii. +n. 2). + + + + +LECTURE III. + +ABORTION. + + +Abortion, gentlemen, is the theme of my present lecture. + +I. An important point to be determined is the precise time when the +human embryo is first animated by its own specific principle of life, +its human soul. It is interesting to read what various conjectures have +been ventured on this subject by the learned of former ages. They were +totally at sea. Though gifted with keen minds, they had not the proper +data to reason from. And yet some of those sages made very shrewd +guesses. For instance, as early as the fourth century of our era, +St. Gregory of Nyssa taught the true doctrine, which modern science has +now universally accepted. He taught that the rational soul is created by +Almighty God and infused into the embryo at the very moment of +conception. Still, as St. Gregory could not prove the certainty of his +doctrine, it was opposed by the majority of the learned. + +The Schoolmen of the Middle Ages, while condemning abortion from the +time of conception, preferred the opinion of Aristotle, that the +rational soul is not infused till the foetus is sufficiently developed to +receive it. The embryo lived first, they taught, with a vegetable life; +after a few days an animal soul replaced the vegetative principle; the +human soul was not infused into the tiny body till the fortieth day for +a male, and the eightieth day for a female child. All this sounds very +foolish now; and yet we should not sneer at their ignorance; had we +lived in their times, we could probably have done no better than they. + +It was not till 1620 that Fienus, a physician of Louvain, in Belgium, +published the first book of modern times that came near the truth. He +maintained that the human soul was created and infused into the embryo +three days after conception. Nearly forty years later, in 1658, a +religious priest, called Florentinius, wrote a book in which he taught +that, for all we know, the soul may be intellectual or human from the +first moment of conception; and the Pope's physician Zachias soon after +maintained the thesis as a certainty that the human embryo has from the +very beginning a human soul. + +Great writers applauded Fienus and his successors; universities favored +their views; the Benedictines, the Dominicans, and the Jesuits supported +them. Modern science claims to have proved beyond all doubt that the +same soul animates the man that animated the foetus from the very moment +of conception. The "Medical Jurisprudence" of Wharton and Stille quotes +Dr. Hodge of the Pennsylvania University as follows (p. 11): "In a most +mysterious manner brought into existence, how wonderful its formation! +Imperfect in the first instance, nay, even invisible to the naked eye, +the embryo is nevertheless endowed, at once, with the principles of +vitality; and although retained in the system of its mother, it has, in +a strict sense, an independent existence. It immediately manifests all +the phenomena of _organic_ life; it forms its own fluids and circulates +them; it is nourished and developed; and, very rapidly from being a +_rudis indigestaque moles_, apparently an inorganic drop of fluid, its +organs are generated and its form perfected. It daily gains strength and +grows; and, while still within the organ of its mother, manifests some +of the phenomena of animal life, especially as regards mobility. After +the fourth month its motions are perceptible to the mother, and in a +short period can be perceived by other individuals on close +investigation. + +"The usual impression," the authors add, "and one which is probably +still maintained by the mass of the community, is that the embryo is +perfected at the period of quickening--say the one hundred and twelfth +or one hundred and twentieth day. When the mother first perceives +motion, is considered the period when the foetus becomes animated--when +it receives its spiritual nature into union with its corporeal. + +"These and similar suppositions are, as has been already shown, contrary +to all fact, and, if it were not for the high authorities--medical, +legal, and theological--in opposition, we might add, to common-sense." + +At present, gentlemen, there seems to be no longer any authority to the +contrary. But many people, and some Doctors, seem to be several +generations behind the times; for they still act and reason as if in the +first weeks of pregnancy no immortal or human soul were in question. + +Physicians worthy of their noble profession should strive to remove such +gross and mischievous ignorance. In many of the United States the law +casts its protection around an unborn infant from its first stage of +ascertainable existence; no matter whether "quickening" has taken place +or not, and consequently no matter what may be the stage of gestation, +an indictment lies for its wilful destruction (Wharton and Stille, +p. 861). "Where there has been as yet no judicial settlement of the +immediate question, it may be reasonably contended that to make the +criminality of the offence depend upon the fact of quickening is as +repugnant to sound morals as it is to enlightened physiology" (ib.). +"That it is inconsistent with the analogies of the law is shown by the +fact that an infant, born even at the extreme limit of gestation after +its father's death, is capable of taking by descent, and being appointed +executor" (ib.). Dr. Hodge adds this sensible remark: "It is _then_ only +[at conception] the father can in any way exert an influence over his +offspring; it is _then_ only the female germ is in direct union with the +mother--the connection afterwards is indirect and imperfect" (ib.). The +fact, therefore, is now scientifically established that the embryo from +the first moment of conception or fecundation is a human being, having a +human immortal soul. + +II. Now we come to the direct study of abortion. Abortion, or +miscarriage, strictly means the expulsion of the foetus before it is +viable, i.e., before it is sufficiently developed to continue its life +outside of the maternal womb. The period of arrival at viability is +usually after the twenty-eighth week of gestation. When birth occurs +later than that period, and yet before the full term of nine months, it +is called _premature birth_, which is altogether different from +abortion; for it may save the life of the child, which abortion always +destroys. "Premature labor is frequently induced in legitimate medical +practice, for the purpose of avoiding the risks which in some cases +attend parturition at term.... The average number of children saved by +this means is rather more than one-half of the cases operated upon," say +Wharton and Stille ("Parturition," p. 96). But they caution the +physician against too ready recourse to this treatment; for, they add +very truly, "The sympathetic phenomena of pregnancy are often more +alarming in appearance than in reality, and will rarely justify any +interference with the natural progress of gestation. In all cases the +physician should consult with one or more of his colleagues before +inducing premature labor; in this manner his humane intentions will not +expose him, in case of failure, to reproach, suspicion, or prosecution." + +The first time my attention was practically called to the case of a +child in danger of dying before the time of delivery occurred over +twenty years ago, when the mother of a highly respected family, then in +my spiritual charge, was wasting away with consumption during her state +of pregnancy. You know that we Catholics are very solicitous that +infants shall not die without Baptism, because we believe that heaven +is not promised to the unbaptized. I therefore directed the lady's +husband to consult their family physician on the prospects of the case, +and take timely precautions, so that, if death should come on the mother +before her delivery, the infant might be reached at once and be baptized +before it expired. The physician, a learned and conscientious +practitioner, answered that we should not be solicitous; for that Nature +had so provided that mothers in such cases rarely die before the child +is born. He was right. The child was born and baptized; the mother died +a few hours later; the little one lived several weeks before it went to +join the angels in heaven. I learned from that occurrence the lesson +which Wharton and Stille inculcate that "the phenomena of pregnancy are +often far more alarming in appearance than in reality, and we are rarely +justified in interfering with the natural progress of gestation." + +To return to our subject. Abortion, or miscarriage, is often, as you +know, gentlemen, the result of natural causes beyond human control; at +other times it is brought on by unintentional imprudence on the part of +the mother or her attendants. It is the duty of the family physician, +when occasions offer, to instruct his pregnant patients and other +persons concerned on the dangers to be avoided. A good Doctor should be +to his patients what a father is to his children; very important matters +are confided to him, and therefore grave responsibilities rest on his +conscience. + +III. We are now ready to consider the chief question of this lecture, +namely, whether there can be any cases in which a physician is justified +in bringing about an abortion, or in prescribing a treatment from which +he knows an abortion is likely to result. + +1. It is evident that, if he acts with due prudence, and yet, from some +cause which he did not foresee and could not have been foreseen, his +treatment brings about a miscarriage, he cannot justly be held +accountable for what he could not help. + +2. But what if he foresees that a drug or treatment, which, he thinks, +is needed for the mother's health, may perhaps bring on a miscarriage? +Can he still administer that drug or prescribe that treatment? Notice +the question carefully. It is not supposed that he wants to bring on the +miscarriage. He does not; he will do all he can to prevent it. Nor will +his treatment or drug directly destroy the life or the organism of the +embryo; but it is intended to affect favorably the system of the mother, +and it is applied to her own organism. Still the Doctor knows that the +prescription may indirectly bring about abortion. Can he prescribe the +drug or treatment from which he knows the death of the foetus may +indirectly result, the direct purpose being to remove an ailment of the +mother's? + +There is a sound moral principle bearing on such cases; it is +universally admitted in Ethics and Jurisprudence, and its application is +so extensive that it well deserves careful study. It is this: "He who +wilfully puts a cause is answerable for the effect of that cause," +_causa causae est causa causati_. Therefore, if the effect is evil, he is +answerable for that evil. This, however, supposes that he could foresee +the danger of such evil effect. + +That evil effect is said to be _indirectly_ willed; for it follows from +a cause which is _directly_ willed. If, then, you should give a dose to +a pregnant mother which is intended to stop her fever or other ailment, +but may also bring on abortion, the stopping of her fever is directly +intended, and the abortion is said to be indirectly intended or willed. +Those are the received terms in moral science. It were more correct to +say that the abortion in this case is an effect not intended at all, but +only _permitted_. That, then, which is permitted to result from our +acts is said to be indirectly willed. + +Are we then always responsible for evil effects permitted or indirectly +willed? The principle laid down seems to say so. But then that principle +admits of important exceptions. If we could never do an act from which +we know evil consequences may follow, then we could scarcely do anything +of importance; a young man could certainly not become a physician at +all, for he is almost certain to injure some of his patients in the +course of his professional life. But if we had no Doctors, such a loss +would be a much greater evil to mankind than their occasional mistakes. +Here then we seem to be in a dilemma, with evil on both sides of us. And +then we are reminded of that other principle of which we spoke before, +that we may never do evil at all that good may come of it. What shall we +do? The solution is this: we should never _do_ evil, but we are often +justified in _permitting_ evil to happen; in other words, we can never +will evil _directly_, but we can often will it _indirectly_: we can do +what is right in itself, even though we know or fear that evil will +also result from our good act. + +This conduct requires four conditions: 1. That we do not wish the evil +itself, but make all reasonable effort to avoid it. 2. That the +immediate effect we wish to produce is good in itself. 3. That the good +effect intended is at least as important as the evil effect permitted. +4. That the evil is not made a means used to obtain the good effect. + +Now let us apply these principles to the case in hand. + +1. If the medicine is necessary to save the mother's life, and it is not +certain to bring on abortion, though it is likely to do so, then the +good effect is greater and more immediate or direct than the bad effect; +then give the medicine to save the mother, and permit the probable death +of the child. + +2. If the medicine is not necessary to save the mother's life, though +very useful, for the sake of such an advantage, you cannot justly expose +the child's life to serious danger. + +3. But if the danger it is exposed to is not serious but slight, and the +remedy, though not necessary, is expected to be very useful to the +mother, you may then administer the medicine; for a slight risk need not +prevent a prudent man from striving to obtain very good results. + +4. But what if the drug is necessary to save the mother, and as +dangerous to the child as it is beneficial to her; can you then give the +medicine with the moral certainty that it will save her and kill her +child? When we know principles clearly we can apply them boldly. I +answer then with this important distinction: you can give such medicine +as will act on her system, her organs, in a manner to save her life, and +you may permit the sad effects which will indirectly affect the child; +but you cannot injure the child directly as a means to benefit her +indirectly; that would be using a bad means to obtain a good end. + +Suppose, then, what is said to be a real case of occasional recurrence +in obstetrical practice, namely, that a pregnant mother is seized with +violent and unceasing attacks of vomiting, so that she must die if the +vomiting be not stopped; and you, as well as the consulting physician +called in, can discover no means of relieving the vomiting except by +procuring an abortion, by relieving the womb of its living burden. +Abortion is then the means used to stop the vomiting. Are you justified +in using that means? Abortion is the dislodging of the child from the +only place where it can live and where nature has placed it for that +purpose. Therefore abortion directly kills the child, as truly as +plunging a man under water kills the man. Can you thus kill the child to +save the mother? You _cannot_. Neither in this case nor in any other +case can you do evil that good may come of it. + +You notice, gentlemen, that I lay great stress on, this principle that +_the end can never justify the means_. It is an evident principle, which +all civilized nations acknowledge. Its opposite, that the end justifies +the means, is so odious that the practice of it is a black stamp of +ignominy on any man or any set of men that would be guilty of it. The +Catholic Church has, all through her course of existence, taught the +maxim that the end cannot justify the means. She has impressed it on the +laws and hearts of all Christian peoples. She inculcates it in the +teachings of all her theologians and moral philosophers and in all her +channels of education. And since we Jesuits are among her leading +educators and writers, we have maintained that thesis in thousands of +printed volumes, as firmly as I am maintaining it before you to-day. No +Jesuit ever, nor any Catholic theologian or philosopher, has taught the +contrary. And yet even such pretentious works as the "Encyclopaedia +Britannica" have carried all over the earth the slander that we teach +the opposite maxim, that the end does justify the means, and the odious +term _Jesuitry_ has been coined to embody that slander. + +Is it not strange then, very strange, that they who thus falsely accuse +us are often the very men who will procure an abortion to save the +mother's life, who will do wrong that good may come of it? And you find +such men maintaining the lawfulness of abortion on the plea that the +operation, whether licit or not, is a necessary means to obtain a good +end. + +IV. Gentlemen, if once you grant that grave reasons would justify +abortion, there is no telling where you will stop in your career of +crime. To-day, for instance, you are called to attend a mother, who, you +think, must die if you do not bring on a miscarriage. You are urged to +do it by herself and her husband, and perhaps by other physicians. There +are money considerations too, and the possible loss of practice. Will +you yield to the temptation? The next day you are visited by a most +respectable lady; but she has been unfaithful to her marriage vow. The +consequences of her fall are becoming evident. If her husband finds out +her condition, he may wreak a terrible vengeance. Her situation is +sadder than that of the sick mother of the preceding day. You can easily +remove the proof of her guilt, we will suppose, and spare a world of +woes. Will you withstand the temptation? The third day comes a young +lady, a daughter of an excellent family; bright prospects lie before +her; her parents' lives and happiness are wrapped up in that girl. But +in an evil hour she has been led astray. Now she is with child. She +begs, she implores you to save her from ruin, and her parents from +despair. If you do not help her, some other Doctor or a quack will do +it; but you could do it so much better. If you should have yielded on +the two former occasions, if you have already stained your heart with +innocent blood, will you now refuse? Where are you going to draw the +line? + +The passions of men are insatiate, even in modern society; the more you +yield to them, the stronger grows their craving. Let me illustrate my +meaning by a fact that happened a few years ago in Russia. It is just to +our point. During a severe winter, a farmer, having his wife and +children with him on a wagon, was driving through a wild forest. All was +still as death except the howling of wolves in the distance. The howling +came nearer and nearer. After a while a pack of hungry wolves was seen +following in the track of the wagon. The farmer drove on faster, but +they gained on him. It was a desperate race to keep out of their reach. +At last they are just back of the wagon. What can be done? The next +moment the wolves may jump on the uncovered vehicle. The children, +horrified, crouch near their trembling mother. Suddenly the father, +driven to despair, seizes one of the little children and flings it among +the pack of wolves, hoping that by yielding them one he may save the +rest. The hungry beasts stop a few moments to fight over their prey. But +soon they are in hot pursuit again, fiercer because they have tasted +blood. A second child is thrown to them, and after a while a third and a +fourth. + +Human society, gentlemen, in this matter of sacrificing foetal life is as +insatiable as a pack of hungry wolves. Woe to any one of you if he +begins to yield to its cravings; there is no telling where he will stop. +In proof of my statement, let me read to you an extract from a lecture +on Obstetrics, delivered by Doctor Hodge, of Philadelphia, to the +medical students of the University of Pennsylvania: "We blush while we +record the fact, that, in this country, in our cities and towns, in this +city where literature, science, morality, and Christianity are supposed +to have so much influence; where all the domestic and social virtues are +reported as being in full and delightful exercise; even here +individuals, male and female, exist who are continually imbruing their +hands and consciences in the blood of unborn infants; yea, even medical +men are to be found who, for some trifling pecuniary recompense, will +poison the fountains of life, or forcibly induce labor, to the certain +destruction of the foetus and not infrequently of the parent. + +"So low, gentlemen, is the moral sense of the community on this subject, +so ignorant are the greater number of individuals, that even mothers, in +many instances, shrink not from the commission of this crime, but will +voluntarily destroy their own progeny, in violation of every natural +sentiment and in opposition to the laws of God and man. Perhaps there +are few individuals in extensive practice who have not had frequent +applications made to them by the fathers and mothers of unborn infants +(respectable and polite in their general appearance and manners) to +destroy the fruit of illicit pleasure, under the vain hope of preserving +their reputation by this unnatural and guilty sacrifice. + +"Married women, also, from the fear of labor, from indisposition to have +the care, the expense, or the trouble of children, or some other motive +equally trifling and degrading, have solicited that the embryo should be +destroyed by their medical attendant. And when such individuals are +informed of the nature of the transaction, there is an expression of +real or pretended surprise that any one should deem that act improper, +much more guilty; nay, in spite even of the solemn warnings of the +physician, they will resort to the debased and murderous charlatan, who, +for a piece of silver, will annihilate the life of the foetus, and +endanger even that of its ignorant or guilty mother. + +"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. + + + + +LECTURE VII. + +THE NATURE OF INSANITY. + + +The subject of the present lecture, gentlemen, is "Insanity." + +I. This subject belongs to a course of Medical Jurisprudence, because a +physician who treats patients for insanity is liable, from time to time, +to be cited before a court of law either as a witness or as an expert. +His conduct in such cases is to be guided by the principles of natural +and legal justice. + +Various important cases at law turn upon the question of a person's +soundness of mind; and frequently the medical expert has it in his power +to furnish the court with more reliable information in this matter than +any one else. At one time, the validity of a last will may be contested, +and the possession of a fortune by one party or another may hinge on the +question whether the testator at the time of making his will was in +sufficient possession of his mental powers to perform an act of so much +consequence. + +At another time, interested parties may plead for or against the +validity of a sale or other bargain made by a person of doubtful +competency of mind; or a life-insurance company may be interested in +ascertaining the mental condition of an applicant for membership; or it +may be questioned whether the payment of an insurance policy is due to +the family of a suicide, the doubt depending for solution on the sound +or unsound condition of his mind at the moment of the fatal act. Again, +there may be a real or pretended doubt whether a certain property-owner +is so far demented as to be unfit to manage his estate; or whether he +needs a guardian to take care of his person; or it may even seem +necessary to confine him in a lunatic asylum. There may be objections +raised to the mental soundness of a witness in a civil or a criminal +suit; or, finally, a criminal prosecution will depend mainly on the +sanity or insanity of the culprit at the moment when the crime was +committed; as was the case with a Prendergast and a Guiteau. + +You see, then, gentlemen, that important interests are dependent on the +thorough and correct understanding of this matter; and therefore much +responsibility rests upon the experts consulted in such cases: property, +honor, liberty, nay, even life itself may be at stake. + +That cases involving an insane condition of mind must be of frequent +occurrence, both in the medical and in the legal professions, is +apparent from the large and rapidly increasing amount of lunacy in our +modern civilization. Wharton and Stille's "Medical Jurisprudence" states +(sec. 770, note) that in 1850 there was in Great Britain one lunatic to +about one thousand persons; only thirty years later the Lunacy +Commission of Great Britain reported one lunatic to 357 persons in +England and Wales, that is, nearly three times as many. In New York +there is one to 384 persons. It appears certain that its increase of +late is out of all proportion to the increase of population; and even +though I see reasons to distrust somewhat the figures quoted for +England, enough is known to create serious alarm regarding the fruits of +modern manners and customs on the minds of thousands. This fact makes +the matter of insanity very important for the medical and the legal +student. + +II. Still it must be noted that the responsibility of deciding cases of +lunacy does not rest chiefly with the medical expert. In cases of +doubtful insanity the decision is to be given not by the Doctor but by +the court of justice. Except on very special occasions, as when a +physician is appointed on a committee or commission of inquiry, he +appears before a court either as an ordinary witness, stating what +facts have fallen under his personal observation; or as an expert, +explaining the received opinion of medical men with regard to cases of a +certain class. Even though he feels convinced that the culprit or the +patient is as mad as a March hare, the physician cannot expect that his +statement to that effect will be received as decisive. It is for the +judge to instruct the jury what kind or degree of insanity will excuse a +culprit from legal punishment, or will disqualify a person from +testifying as a witness, or from being a party to a civil contract in +certain cases; and it is for the jury to decide whether, in the case in +hand, the fact of such insanity exists or not. In criminal cases, the +jury pronounces on the double question, whether the accused did the act +charged to him, and whether he has been juridically proved to have been +accountable for the act under the laws as expounded by the judge. + +1. To come to a decision on this double question, the jury might need to +hear the facts stated which the physician has personally observed, and +of which he is summoned to be a sworn witness. In such a situation all +that is required of the Doctor is that he shall give a most faithful +and intelligent account of the facts. + +It would disgrace his standing in society if any fault could be found +with his testimony; and, as a sworn witness, he is bound in conscience, +like any other witness, to state the truth, the whole truth, and nothing +but the truth. This is always the case when the purpose of the inquiry +is the discovery of the sane or insane condition of a person's mind. But +if the inquiry concerns the performance of the guilty act, the +commission of the crime, many States of the Union, as explained before, +consider the Doctor's professional secrets as privileged, just like +those of the lawyer and the clergyman; i.e., the Doctor must not use +against his patient any knowledge he has become possessed of while +acting as his medical adviser. + +2. When the physician appears before a court or commission as an expert, +he is expected to give the views of the medical profession upon +hypothetical cases resembling the one under examination, and the +scientific reasons and authorities on which those views are advanced. + +3. But here a considerable difficulty presents itself; it is so serious +that, owing to it, the weight of the medical expert's testimony with +judge and jury is often much less than could reasonably be desired. The +difficulty is to ascertain what really are the views of the medical +profession on any given subject. Of course no individual Doctors can +put themselves up as representing the convictions of the medical +profession, nor can they always appeal to the unanimous agreement of +their leading men. Leading physicians, unfortunately, are far from +entertaining concordant views on many most vital questions. It is this +want of agreement that has made the testimony of experts so powerless to +sway the minds of judge and jury. + +The medical profession has no organization through which it can +pronounce judgment. In fact, many of its most conspicuous members have +adopted principles at variance with the deepest convictions of mankind +generally; such, for instance, are the followers of Darwin, Huxley, +Maudsley, and similar agnostic and materialistic leaders of modern +thought. + +4. What still further diminishes the credit of medical experts is the +fact that, both in civil and criminal trials, they are summoned either +by the defence or by the prosecution, and are thus naturally selected, +not on account of their thorough knowledge, but on account of their +peculiar views known beforehand to the parties citing them. Thus their +testimony is likely to be partial to either side, and is distrusted; at +least it fails to command perfect confidence. The only way in which the +prejudices thus created against the physician can be overcome is by his +acquiring thorough knowledge of his specialty, and showing himself on +all occasions to be as honorable and faithful as he is evidently +experienced and intelligent. + +5. The medical profession could be brought to be much more useful to +society for the discovery of insanity if we could have here something +like what exists in some parts of Germany. "The practice obtains there +of requiring the medical faculty of each judicial district to appoint a +special committee, to which questions of this kind are referred. This +committee is examined directly by the court, and gives testimony +somewhat in the same way, and with the same effect, as would a +common-law court when reporting its judgment in a feigned issue from +chancery, or as would assessors called upon under the canon law to +state, in proceedings under the law, what is the secular law of the land +on the pending question" (Wharton and Stille, sec. 274). + +The matter of introducing some such practice into this country has been +agitated of late, and may by and by lead to beneficial results. +Dr. Shrady has taken steps to promote this object by striving to have a +law enacted by the New York legislature providing for the regulation of +expert medical testimony in jury trials. According to his plan, once +such a commission has been established, the court is to send the +medical issue to these experts, just as it sends other issues to special +juries to be decided. The regular petit jury will then decide only upon +the facts constituting the crime. + +This would do away with special pleas of insanity before a jury that +knows little or nothing about the nature of the disease, and whose +sympathies may readily be worked upon by shrewd lawyers to render a +verdict of acquittal. + +As things are now, the medical expert, summoned to testify in a case of +contested sanity or insanity of mind, ought to rise above minor +considerations, and promote the cause of justice, by giving all the +valuable information that his profession enables him to acquire on the +very difficult subject of mental unsoundness. + +6. For this purpose, he must be skilled in three departments of science. + +(_a_) In _law_--sufficiently to understand what are considered by the +courts as characteristic marks of an insane mind, and what amount of +sanity the courts require to hold a culprit responsible for his crime or +a contract valid in its effects. + +(_b_) In _psychology_--to such an extent that the expert witness can +speak analytically and correctly as to the properties and actions of the +human mind. + +(_c_) In _medicine_--so far as concerns the treatment of the insane, and +the understanding of their peculiarities, so as to reason from them by +induction to the real condition of the client's or patient's mind. + +But the main requisite for an expert witness is to understand clearly in +what insanity properly consists, and how far it ought to excuse an +insane man from bearing the consequences of his acts. + +III. This two-fold knowledge is obtained by the psychological study of +insanity, on which study we are now to enter, and it is the principal +point in this whole matter. + +Insanity means a want of soundness; he is insane whose mind is not +sound, but is deranged, and therefore, like a machine out of order, it +cannot properly perform its specific task, namely, to know the truth of +things. An insane man cannot judge rightly. + +1. Insanity takes various forms, which may be reduced to two kinds, with +the doubtful addition of a third kind, namely, moral insanity, of which +we shall speak in our next lecture. + +The first kind consists in the total want or gross torpor of mental +activity. When there is a total, or nearly total, eclipse of the +intellect, the disease is called _idiocy_, the state of an idiot. When +there is an abnormally low grade of the reasoning power, it is styled +_imbecility_. The failure or decay of reason in old age is called +_dotage_. + +The second kind of insanity is called _illusional_ or _delusional_. In +it the intellect is not impotent; on the contrary, it is often unusually +active; but its action is abnormal, its conclusions are false. Not that +it reasons illogically or draws conclusions which are not contained in +the premises. Very keen logicians may be demented. Their unsoundness +arises from the fact that they reason from false premises; and they get +their false premises from their diseased imaginations, whose vagaries +they take for realities. + +2. Here a difficulty presents itself, which we must explain at once, +namely, how can there be unsoundness of mind at all? Is not the +intellect of man a simple power, and his soul a simple being? How can a +simple being become deranged? Can that which has no parts become +disarranged, disorganized? I answer, the soul is a simple being, its +intellect is a spiritual faculty; and therefore we never say that the +_soul_ is insane, nor should we say that the _intellect_ is insane or +diseased; but we say that the _mind_ is deranged or insane; the mind +comprises more than the intellect; it designates the intellect together +with those lower powers that supply the materials for our thought, the +chief of which is the imagination. Now the imagination is an organic +faculty: it works in and by a bodily organism, which is the brain. +Therefore, when the brain is not in a normal condition, the action of +the imagination may be disordered. And the intellect or understanding of +the spiritual soul is so closely united in its action and its very being +with the organic body that the two ever act conjointly, like the two +wheels of a vehicle. If one wheel breaks down, the other is thrown out +of gear. Thus it is readily understood that mental unsoundness is an +affection of the brain, a bodily disease, which may often be relieved +and even cured by bodily remedies, by the use of drugs or wholesome +food, healthy exercise, fresh air, and all that benefits the nervous +system. + +Pathologically considered, the nerves may be too excited or too sluggish +and torpid; and we have as the result two subdivisions of mental +insanity--_mania_ and _melancholia_. The differences between these two +are very striking; as they proceed from opposite causes they produce +opposite effects, and, therefore, they betray themselves by very +different manifestations; but in one point the two agree, and with this +point precisely we are concerned, because in it lies the essence of +mental insanity, namely, that both produce a disordered action of the +imagination. + +3. The manner in which the imagination co-operates in mental action is +this. It presents to the intellect the materials from which that power +forms its ideas. When we see, feel, hear, taste, or smell anything by +our bodily senses, our imagination takes note of the object perceived by +forming a brain-picture of it which is called a _phantasm_. I do not +mean to say that it forms a photographic picture of the object; for +there can be no photographing taste or smell or feeling; but it forms an +image of some kind which it presents to the intellect. This power at +once proceeds to form, not a brain-picture, but an intellectual or +abstract image of the object presented. For instance, you see this book, +and at once you, in some mysterious way which has never yet been +explained, impress some image of it on your brain. That you do so is +clear from the fact that the image remains when the book is withdrawn. +That material image or brain-picture is the _phantasm_. It is not an +_idea_, though it is often improperly so called. But your intellect +forms to itself an idea of a book; that is, you know what is meant by a +book. You distinguish between the mere form of a book and the book +itself. Your idea of a book is a universal idea, which stands for any +book, no matter of what shape or size. Every phantasm, or brain-picture, +is a representation which presents its object as having a definite shape +or size, while your idea of a book ignores any shape or size. And yet, +when your intellect conceives a book, your imagination will picture some +particular form of book. If your brain became so affected by disease as +to be unfit for the formation and retention of the proper phantasms, +then your intellect either would not work at all or it would work +abnormally; your mind would then be insane. + +4. Now, in an infant the brain is still too soft and imperfect to form +the proper phantasms from which the intellect is to elaborate its ideas. +A false school of psychology would say that the infant's brain cannot +yet _ideate_; but that is incorrect language. No brain can ideate or +form ideas; an idea is an intellectual or mind image, not a brain image; +it is an abstract and universal image, and matter cannot represent but +what is concrete and individual. Only a simple and spiritual being, the +rational soul, can form ideas. Nevertheless our soul, in its present +state of substantial union with our body, is extrinsically dependent on +the body; to form ideas it needs to have the sensible object presented +to it by a phantasm or brain-picture. Now, a child born blind and deaf, +and thus having its mind, as it were, cut off from communication with +the outer world, could scarcely form the necessary phantasms, because +the clogged senses could not supply proper materials for them; such a +child would, therefore, be apt to remain idiotic. And even in children +whose outer senses are sound the brain or the nervous system may be too +imperfect to allow of its forming proper phantasms. In this torpor of +the mind then consists the first kind of mental unsoundness, that of +_idiocy_, or its milder form _imbecility_. In old age, and in peculiar +diseases, the worn-out system may return to a second childhood, then +called _dementia_ or _dotage_. The existence of such species of insanity +is not difficult to discover. + +5. The second and more common form of insanity, and that which it is +often difficult to discover and pronounce upon with certainty, is that +which I have called _delusional_ or _illusional_. Its characteristic +trait, its very essence, lies in this, that the insane man mistakes what +he imagines for what is real; and he cannot be made to distinguish +between imagination and reality, though the difference is obvious to an +intellect in its normal state. + +In this connection, it is well to point out a distinction, not always +observed, but useful to explain the workings of an insane mind, between +_illusions_, _hallucinations_, and _delusions_. + +(_a_) An _illusion_ is properly a deception arising from a mistake in +sense-perception; as when a half-drunken man sees two posts where there +is only one. He has a picture of the post in each eye, and his brain is +too much disturbed to refer the two pictures to the same object. In this +case the cause of the mistake is subjective. A _mirage_ offers another +instance of a sense-illusion; but in it the cause is objective. + +(_b_) A _hallucination_ is a creation of the fancy mistaken for a +reality. The deception may be but momentary, as when Macbeth is stealing +on tiptoe to the chamber of his guest to murder him. His mind is +disturbed by the imagination of the horrid deed he is about to +perpetrate. He thinks he sees a dagger in the air, and he says: "Is this +a dagger that I see before me, its handle towards my hand? Come, let me +clutch thee. I hold thee not, and yet I see thee still; and on thy +dudgeon gouts of blood, which was not so before." But Macbeth, upon a +moment's reflection, sees it is all imagination. "There's no such +thing," he exclaims. He is not insane, though deceived for a while. + +(_c_) A _delusion_, on the contrary, is a permanent deception, whether +it results from an illusion or a hallucination, it matters not; as a +fact, it almost always originates in hallucinations. The deluded man +clings to his imaginings; you cannot talk them out of his head. Such is +the case of an inebriate who suffers from _mania a potu_, or "the +horrors;" he sees snakes and demons, he thinks, and persists in his +error. Such also is a fixed idea not arrived at by faulty reasoning, but +come unbidden and proof against all reasoning and evidence. Thus an +insane man may be convinced, solely by his imagination, that he is +poisoned or pursued or conspired against. + +6. This delusion constitutes the essence of mental insanity, which +therefore is often called delusional insanity. It may be chronic, i.e., +of long continuance, or it may be temporary, acute. For the time being, +the effects are the same. Perhaps any man may, at times, be for a moment +thrown off his guard, and mistake a fancy for a reality; this does not +constitute lunacy. But when the error is so firmly held in the mind's +grasp that nothing can dislodge it thence, then the mind is deranged in +its special sphere of action, which consists in knowing the real from +the unreal; the mind is then insane. + +You notice, gentlemen, that I speak of the mind as grasping the error, +and I suppose it to do so independently of the free will's command. But +when the error is voluntary; when a man clings to it simply because he +loves it; when he hugs a delusion to his heart, this shows not mental +but moral obliquity; it is not insanity but self-deception, and it is by +no means of rare occurrence. In a well-reasoned article on "The +Metaphysics of Insanity," written by Mr. James M. Wilcox and printed in +the "American Catholic Quarterly Review" for January, 1878, some very +severe and no less true strictures are made upon the readiness of a vast +multitude of people to practise this wilful self-deception. "Self," he +writes (p. 54), "is the prolific origin of such errors; and so indulgent +are we to its faults that we try secretly to hide them even from our own +eyes, mostly with success; and where success is not perfect, we make a +second effort to hide the imperfection. Repeated efforts of this kind, +from which we but half turn away, are crowned in the end, and we soon +forget what successful hypocrites we have been. Our numerous passions, +the complexities of our desires, the tenacity of their grasp, and the +pleasant gentleness of its touch explain an infinity of temptations +followed by wilful successes in blindness, all of which are nothing less +than guilty acts of self-deception." + +7. It oftens happens in real insanity that mental derangement manifests +itself upon one error or one group of errors only, while for all the +rest the patient appears to be quite rational. Such a man is called a +_monomaniac_. But he is truly an insane man; for the essence of insanity +is in him. It is usually found that a monomaniac will, sooner or later, +exhibit signs of mental unsoundness on other matters as well; and even +while he has given no such signs, it still remains true that a mind +cannot be trusted, but has something radically unsound about it, if it +is really unhinged at any point at all. + +But then you must be very careful not to confound monomania with +eccentricity. The distinction is as important as it is real. +_Eccentricity_ is a conscious aberration from the common course of life; +it consists in peculiarities in reasoning, words, and actions, which are +wilfully indulged, in defiance of popular sentiment. The eccentric man +knows that he is eccentric; he is willing to be so, and to take the +consequences; but he is not insane. + +As this matter is of frequent occurrence before the courts of justice, +and the validity of last wills in particular often depends on the view +that judges and expert witnesses take of it, I think it well to refer +the earnest student for further information to Wharton's and Stille's +"Medical Jurisprudence," in the volume on "Mental Unsoundness and +Psychological Law;" in particular to secs. 29, 38, 39, 40. + +8. We must now return to the consideration of the manner in which the +disturbance of the brain may affect the mind. The brain is a storehouse +of records of things formerly noted there by the imagination, either as +the results of sense perception or of arbitrary combinations of +phantasms; it is a library of facts and fancies. And these are not +single, but grouped together, so that when one is stirred it will arouse +others as well. When the brain is affected, whether by an acute or a +chronic derangement, its images may become so disordered that records of +mere imaginations get mixed up with records of real perceptions in +inextricable confusion. You may have had occasion to notice the process +in the case of a man who is becoming intoxicated and then passes on to +_mania_ or _delirium tremens_: he gradually proceeds to mix up +brain-pictures with realities, and after a while he speaks and acts like +a very crazy man. He is in a kind of dream; his imaginations are wild +and disconnected, his language is incoherent. + +The delirium arising from violent fevers, for instance from typhoid +fever, is very similar to that arising from the excessive use of +intoxicants and narcotics; similar in these respects; that the mania is +only temporary, and that the exciting cause is not altogether unknown. + +The _bacilli_ of the infection, like the alcohol, the opium, the +morphine, or other drugs, are accountable for the disordered action of +the brain. But I do not pretend to know, nor do medical writers +generally pretend to understand, _how_ the poison, or whatever causes +the disease, gets to affect the brain. Does it do so directly, or by +means of the alteration it causes in the whole nervous system or in the +blood? We do not know; nor does it matter for the purposes of Medical +Jurisprudence. + +IV. The questions with which the courts of justice, the lawyers, and the +expert witnesses are concerned are these: Is the man really insane? Or +was he insane at a given time when he performed a certain civil or +criminal act? Is he now, or was he then, so far controlled by his mental +unsoundness as to be incapable of acting like a rational being +accountable for his actions? Even if he is now, or was then, a +monomaniac, can the deed in question be traceable to his monomania as to +its real cause? + +1. When we know that a man is suffering from a fever, or has been +drinking to excess, or has been addicted to the use of morphine, opium, +cocaine or to similar deplorable practices, it is then easy enough to +conclude from this that he is not in his right senses; knowing the +cause, we can fairly estimate the effect. But in many cases of +delusional insanity the cause is hidden; neither pulse nor other medical +test betrays it. Whether the mind is sane or not is then to be found out +from the man's words and actions; and these may be affected for a +purpose: he may play the fool to escape punishment. + +2. Phrenologists have pretended that the peculiarities of a person's +mind could be known by the conformation of his brain, and even by the +elevations and depressions of the skull. But brain and skull do not +always correspond with sufficient closeness; and besides, Sir William +Hamilton has shown conclusively, I believe, that phrenology is quackery; +its principles are not scientific and its observations not reliable. He +points out, among other errors, that while women as a class are more +religiously inclined than men, what phrenologists call the bump of +reverence, an important element in religious sentiment, is generally +more developed in men than in women, and is often most conspicuous in +reckless criminals. + +Nor is it at all certain that a lunatic's brain, if it could be examined +with a microscope while he is alive, would exhibit the marks of any +disorder to the eye of the observer. It is stated by Dr. Storer that +the results show that "insanity may exist without structural changes of +the brain, and that structural changes in the brain may exist without +insanity." Dr. Bell, of the Somerville Asylum, says that "the autopsies +of the insane generally present no lesion of the brain." Dr. Bucknil +maintains that "the brains of the insane appear to be certainly not more +liable than those of others to various incidental affections." Nor has +the microscope discovered in the demented any exudation or addition to +the stroma of the brain, or any change in size, shape, or proportional +number of its cells. Dr. Storer concludes: "It is thus seen not merely +that there is no direct correspondence between the exterior of the skull +and mental integrity, any more than between the exterior of the skull +and the shape and consistence of its contents" (Wharton and Stille, +"Mental Unsoundness," sec. 323). In the cases of insanity among women, +the causes are largely to be found in derangement of their productive +organs, and are to be met by special local treatment (ib.). + +It does happen, however, at times, that the brain itself is diseased, +_idiopathically_ diseased, as it is technically called; but at other +times it is merely affected by _sympathy_ with some other organ that is +physically deranged. A physical cause there is for all mental insanity, +and that physical cause determines its kind of mania or melancholia, its +duration, its chances of a perfect cure. But what that cause is in a +given case is often very hard if not impossible to determine. Besides +natural and inherited predispositions--some taint of derangement in the +family, often betrayed by fits of epilepsy, hysterics, etc.--exciting +causes are usually traceable. Every form of disease may bring on +sympathetic affection of the brain when the circumstances for such +affection are favorable. + +But while affirming that the disease usually arises in the body, and +even frequently in parts far removed from the brain, we must not deny +nor ignore the fact that intellectual and protracted worry, or sudden +and violent grief, can also be the direct cause of disturbance in the +brain. For the brain is the organ not of the imagination alone, which is +put to an unhealthy strain by excessive mental labor, but probably also +of the passions, whose emotions when excessive may cause even permanent +lesion. Hence mental insanity may and does often arise from ill-subdued +passions. + +The knowledge of all this may enable the physician to remove the +exciting cause or to mitigate its influence; it may also aid expert +witnesses, judges, lawyers, and jurymen to ascertain the main fact with +which the courts are concerned, namely, the presence or absence of +mental insanity at the time of a given civil or criminal action. + +V. Supposing then that, in the case before the court, the fact of +insanity is established, the next question of Jurisprudence to determine +is this: How far and why ought such unsoundness of mind to exclude +responsibility for deliberate acts? + +It is a clear principle of reason that no man can justly be blamed or +punished for doing what he cannot help doing; now an insane man cannot +help judging wrong at times; he cannot then justly be blamed for acting +on his mistaken judgments. If he invincibly judges an act to be morally +good whereas it is morally bad, no matter how criminal the act may +be--say the killing of his own father or child--if he commits the deed +with the full conviction that he is doing right, he cannot be blamed or +punished for committing that awful crime. + +The principle then is clear that an insane man is not to be held +responsible to God or man for his insane acts. For the root and reason +of our responsibility for an act lies in the fact that we do the deed of +our own free choice; knowing its moral nature, being masters of our own +free will, so that, if we do one act in preference to another, we +wilfully take upon ourselves the consequences of this preference as far +as we can know or suspect them. + +If we do what we are firmly convinced is right, just, worthy of a man, +we deserve praise; if we do what we are convinced or suspect is wrong, +unjust, unworthy of a man, we deserve blame and punishment. But an +insane man may do the most unjust act, and yet feel invincibly convinced +that it is just; he cannot then be held responsible for doing it, +because the root of responsibility is then wanting. + +I do not, however, maintain that one who is insane on any one point is +thereby made irresponsible for all his actions. If he does what he +thinks to be wrong, he acts against the dictates of his conscience, he +deserves punishment from God; and if he violates a just law of the land, +and it can be proved that his deed proceeded from a bad will, he may be +punished by the civil courts as well, even though he is insane on other +points. For instance, if a young man were to have a crazy notion that +his father disliked him, that he is often in various ways unjust to him, +and if, in consequence of this insane conviction, he were to attempt his +father's life, he should be punished for the criminal act; because, even +according to the way he views the matter, he could not be justified in +killing his father for such a reason. It were different if he insanely +imagined that his father was in the act of killing him, and that he +could not escape death but by killing his father first; for then he +could plead the right of self-defence against an unjust aggressor, as he +foolishly imagines his father to be. + +The conclusion then from all this explanation is that an insane man +should not be held responsible for a deed which he insanely thinks to be +right; but he is responsible for all his other acts. + +In our next lecture we shall consider more fully the treatment of the +insane by the civil and criminal tribunals. + + + + +LECTURE VIII. + +THE LEGAL ASPECTS OF INSANITY. + + +In our last lecture, gentlemen, we considered the nature and causes of +delusional insanity. We saw that its essence lies in mistaking +imaginations for realities with a firmness of conviction which no +argument to the contrary can shake. The reasoning of the insane man may +be logically faultless, we said, but he reasons from false premises +supplied to him by the phantasms of a diseased imagination. The cause of +the disease I showed to lie in an abnormal action of the brain, which is +the storehouse of the phantasms or brain-pictures. And this abnormal +action may itself proceed either from a local lesion of the brain, or +from a sympathetic affection due to indisposition in other parts of the +human body. I finished by examining the responsibility of an insane man +for his actions, and arrived at this practical conclusion, that a victim +of delusional insanity should not be held responsible for any acts which +he insanely thinks right, but should be held responsible for all his +other human acts. + +I. This teaching of psychological and ethical science is to-day the +received rule of action followed by the courts of justice in England and +the United States. Sound philosophy and positive law are in perfect +agreement on this subject. But it was not so a hundred years ago. It is +wonderful to us now how strange and erroneous were the views of insanity +formerly entertained by English jurists. For instance, when, in 1723, +Arnold was tried for shooting at Lord Onslow, the instruction given to +the court was that, for one to be exempt from punishment in such a case, +"it must be a man that is totally deprived of his understanding and does +not know what he is doing, no more than an infant, than a brute or a +wild beast." On such a theory, very few lunatics indeed would be +acquitted; few ever are so totally demented. + +The first jurist that pointed out the true test of insanity was Lord +Erskine, who, in 1800, when Hudfield was tried for shooting at the king, +delivered a celebrated speech, in which he maintained that the real test +of insanity was in delusion: if delusion existed the man was insane; +else, he was not insane. The deluded man, he said, might reason with +admirable logic from his false principles; he was nevertheless demented +if he mistook his imaginations for realities, and did so irresistibly +and persistently. + +Erskine's test has been, from that time on, followed in the courts of +England. But you will notice, on careful consideration, gentlemen, that +while the principle is correct so far as it goes, it does not go far +enough to cover all cases of disputed responsibility. It will apply, +indeed, to all cases of total insanity, that is, when the delusion +existing in a lunatic's mind affects a variety of subjects; then his +premises are never reliable, and therefore he cannot be held accountable +for any of his acts. + +But what if his insanity is partial only, if he is a monomaniac, +deranged on one point and sound in mind on all other matters? This was +not clearly understood till about the middle of the present century. In +order to secure uniform views and action on this important matter, the +British Parliament, in 1843, proposed various questions to the judges, +with a request that they would agree upon and report answers. This +investigation, and in fact the whole history of English legislation on +insanity, is briefly and yet clearly explained in an article of Rev. +Walter Hill, S.J., which appeared in the "American Catholic Quarterly +Review" for January, 1880. The first question was: What was the law +respecting the crime of one who is partially deluded but not insane in +other respects, when he commits what he knows to be a crime in order to +redress some wrong or obtain some public benefit? The answer was that +such a one, even though insane, is to be punished for the crime which he +knew he was committing. + +To another of those questions the judges answered, that a person +partially insane was to be treated _as if the facts were just what he +imagined them to be_, as if his delusions were realities. His conduct +was to be judged by his own premises. This was accepted as law by +England, and is the law now both there and here, and, I suppose, +throughout the civilized world. Now, these are exactly the conclusions +about an insane man's responsibility which we had arrived at before, +reasoning from psychological and ethical first principles. + +It is therefore for the consequences of an insane delusion only that a +man is not responsible before the inward court of conscience and the +outward courts of justice. + +But the case is altogether different when the error is not the result of +insane delusion. When a man, sane or partially insane, has reasoned +himself into a false opinion or conviction, not the result of his +insanity, that the crime he is going to commit is justifiable, such +conviction being his own free act does not exempt him from punishment. +This was the precise point on which turned the celebrated case of +Guiteau, the murderer of President Garfield. His trial before the +Supreme Court, District of Columbia, December, 1882, was one of the most +interesting that have ever occurred in this country or elsewhere in +connection with the plea of insanity. In his very able and exhaustive +instructions to the jury on that occasion, Judge Cox states the rule +that is to guide the jury in these words: "It has been argued with great +force on the part of the defendant that there are a great many things in +his conduct which could never be expected of a sane man, and which are +only explainable on the theory of insanity. The very extravagance of his +expectations in connection with this deed--that he would be protected by +the men he was to benefit, would be applauded by the whole country when +his motives were made known--has been dwelt upon as the strongest +evidence of unsoundness. Whether this and other strange things in his +career are really indicative of partial insanity, or can be accounted +for by ignorance of men, exaggerated egotism, or perverted moral sense, +might be a question of difficulty. And difficulties of this kind you +might find very perplexing if you were compelled to determine the +question of insanity generally, without any rule for your guidance. + +"But the only safe rule for you is to direct your reflections to the one +question which is the test of criminal responsibility, and which has +been so often repeated to you, viz., whether, whatever may have been the +prisoner's singularities and eccentricities, he possessed the mental +capacity, at the time the act was committed, to know that it was wrong, +or was deprived of that capacity by mental disease." + +What furnished the clearest proof, gentlemen, that Guiteau's opinion +concerning the expediency of killing the President resulted not from an +insane delusion but from his own reasoning is contained in a paper which +he had himself drawn up to justify the murder. + +It is an address to the American people, published on June 16, in which +he says: "I conceived the idea of removing the President four weeks ago; +not a soul knew my purpose. I conceived the idea myself and kept it to +myself. I read the newspapers carefully, for and against the +Administration, and gradually the conviction dawned on me that the +President's removal was a political necessity, because he proved a +traitor to the men that made him, and thereby imperilled the life of +the Republic." Again he says: "Ingratitude is the basest of crimes. That +the President under the manipulation of the Secretary of State has been +guilty of the basest ingratitude to the Stalwarts, admits of no denial. +The express purpose of the President has been to crush Senator Grant and +Senator Conkling, and thereby open the way for his renomination in 1884. +In the President's madness he has wrecked the once grand old Republican +Party, and _for this he dies_.--This is not murder. It is a political +necessity. It will make my friend, Arthur, President, and save the +Republic," etc. + +When instructing the jury, Judge Cox told them clearly that, if they +found, from all the testimony presented, that the culprit had been led +to commit the murder by an insane delusion, they were to acquit him; but +that reasoning one's self into an opinion or conviction was not acting +upon an insane delusion. "When men reason," he said, "the law requires +them to reason correctly, as far as their practical duties are +concerned. When they have the capacity to distinguish between right and +wrong, they are bound to do it. Opinions, properly so called, that is, +beliefs resulting from reasoning, reflection, or examination of +evidence, afford no protection against the penal consequences of +crime." On this precise point of the question then the verdict was to +depend. + +But to understand this matter thoroughly there remains one more +important point to notice in the instructions of Judge Cox. It relates +to the question on whom rests the burden of proof regarding the +existence of insanity in the culprit. Is the prosecution bound to prove +that insanity did not influence the crime? Or is the defence to prove +that it did? And, in case neither party can prove its point to a +certainty, so that the jury remains in doubt as to the existence or the +influence of insanity in the crime, is the doubt to weigh in favor of +the culprit or against him? The judge, after a careful exposition of the +conflicting views on this subject by different courts, and after +weighing their respective claims, favors the opinion which holds that +"the sanity of the accused is just as much a part of the case of the +prosecution as the homicide itself, and just as much an element in the +crime of murder, the only difference being that, as the law presumes +every one to be sane, it is not necessary for the government to produce +affirmative proof of the sanity; but that, if the jury have a reasonable +doubt of the sanity, they are just as much bound to acquit as if they +entertain a reasonable doubt of the commission of the homicide by the +accused." + +But the jury, enlightened by the lucid instructions of the court, were +convinced that Guiteau had not been led to commit the murder by an +insane delusion, but by his own reasoning and his own free will, and +that, therefore, he was to bear the consequences of his own deliberate +choice. Their verdict was "guilty," and the political crank was hanged. + +II. We have now done with the study of mental or delusional insanity; it +remains for us to speak of moral insanity. Of late years, the legal and +medical professions have been much divided upon the question whether +there exists a disease which may properly be called moral, emotional, or +affective insanity, and which can justly be pleaded as an excuse from +legal responsibility. + +Dr. Pritchard, and later on, Dr. Maudsley, with very many followers, +have maintained the existence of such a disease, and have claimed that, +even when it is not accompanied by any delusion, it ought, nevertheless, +to free a man from all punishment for crimes committed under its +influence. Moral insanity consists, they say, in a perversion of the +will, which by this disease is deprived of its liberty, so that the +morally insane man does what he knows to be wrong, but cannot help +doing it. And they claim that therefore he cannot be blamed nor punished +for the crime he thus commits, although he commits it knowingly and +willingly. + +But I absolutely deny that such a state of insanity is possible. It is +against those clear principles of psychology and ethics which are not +only speculatively evident, but practically necessary to maintain the +fabric of human society. I do not deny that there exists an emotional +insanity of another kind, which I will explain further on, but not an +insanity of the will, as they understand it, which would excuse a man +from the consequences of his wilful acts. Upon this subject Dr. Chipley +justly remarks: "If one is born with all the emotional endowments of our +nature, but destitute of understanding, his irresponsibility is +unquestionable. The same is true when the faculties of the understanding +are perverted, impaired, or destroyed by disease. + +"In every aspect in which man's accountability is viewed, we arrive at +the same point that its sole basis is the existence and soundness of the +intellectual powers. Those wonderful endowments which so eminently +distinguish man from other animals, which enable him to discriminate +between good and evil, right and wrong, and to choose the one and avoid +the other; or in the language of Judge Robertson, he is accountable +because he has the light of reason 'to guide him in the pathway of duty, +and a _free_ and _rational_ presiding will to enable him to keep that +way in defiance of all passion and temptation.' + +"If then accountability is a structure erected solely on the +intellectual power, must it not remain unshaken so long as its +foundation is sound and unbroken? Is it not illogical to set out with +the fundamental proposition, that man is made responsible for his acts +only because he is gifted with an understanding and then arrive at the +conclusion that he may become irresponsible without the impairment or +disease of any of its powers?" (Wharton and Stille, "Mental +Unsoundness," p. 170.) + +Gentlemen, let me give you a specimen of the false reasoning used in +support of their theory by those who believe in the insanity of the +will. "It would be as rational," says one of their leading writers in +this country, "to punish a schoolboy whose antics and grimaces, the +result of chorea [St. Vitus' dance], are a source of laughter and +distraction to his schoolmates, as to inflict punishment upon the insane +criminal who, knowing the difference between right and wrong, has it not +in his power to execute that which his judgment dictates. One is under +the dominant influence of insanity of the _muscles_, the other is under +the influence of insanity of the _will_. To punish one would be as cruel +as to punish the other." This is indeed a very illogical argument. The +reason why we do not blame the boy is because his will is not in it; he +moves against his will. The reason why we blame the other is because his +will is in it; he does what he wills to do. + +The will being a spiritual power can no more be diseased than can the +intellect. But as the imagination, an organic power, can be disorganized +by an affection of the brain, and by delusion deceive the intellect, +thus producing mental insanity, similarly I fully admit that a man's +passions, which are also organic powers, common to us and to brute +animals, can become disordered by bodily disease; and the passions, when +excited, will strive to drag along the consent of the will, as we all +experience. A man whose passions are abnormally influenced by bodily +disease, so that he is constantly inclined to act very unreasonably, may +well be called morally insane. Such a state of insanity is not a rare +occurrence, and there is no objection to denominate it emotional, +affective, or moral insanity. + +But in such a disease the will remains free; if a man does what he knows +to be wrong and criminal, he then sees reasons for not doing it; and in +this lies the root of his liberty. For seeing himself drawn in one +direction by one motive and in another by another motive, he is not +determined in his choice but by the act of his free will. A merely +organic faculty must be determined by the stronger attraction, as is the +case with brutes; but a spiritual faculty, as our will is, acts freely +in choosing between two opposing motives of action. This is the +philosophical or psychological explanation: and I am well pleased to +find that here again, as in the matter of mental insanity, the courts of +England and the leading courts of the United States follow the sound +teachings of philosophy. + +The nearest advance I know of, that has been made towards the +recognition of this moral insanity as a total bar to responsibility, was +made in 1864 by the court of appeals in Kentucky, and again in 1869 +under the same presiding Judge Robertson. But Chief Justice Williams +rebukes this strange ruling in most emphatic language. He says: "In all +the vague, uncertain, intangible, and undefined theories of the most +impractical metaphysician in psychology or moral insanity, no court of +last resort in England or America, so far as has been brought to our +knowledge, ever before announced such a startling, irresponsible, and +dangerous proposition of law, as that laid down in the inferior court. +For, if this be law, then no longer is there any responsibility for +homicide, unless it be perpetrated in calm, cool, considerate condition +of mind. + +"What is this proposition if compressed into a single sentence? that, if +his intellect was unimpaired and he knew it was forbidden both by human +and moral laws; yet if at the _instant_ of the act his will was +subordinated by any uncontrollable passion or emotion causing him to do +the act, it was moral insanity, and they ought to find for the +plaintiff?... If so, then the more violent the passion and desperate the +deed, the more secure from punishment will be the perpetrator of +homicide or other crimes.... The doctrine of moral insanity, ever +dangerous as it is to the citizen's life, and pregnant as it is with +evils to society, has but little or no application to this case. Too +uncertain and intangible for the practical consideration of juries, and +unsafe in the hands of even the most learned and astute jurist, it +should never be resorted to for exemption from responsibility save on +the most irrefragable evidence, developing unquestionable testimony of +that morbid or diseased condition of the affections or passions, so as +to control and overpower or subordinate the will before the act +complained of" (ib., p. 172). + +You will notice, gentlemen, that Chief Justice Williams does not deny +the existence of every kind of moral insanity. As I explained before, +not the will but the passions may really be diseased or insane, and they +may prompt the lunatic to commit very unreasonable and even criminal +acts. When the impulse of a passion is violent, so that a man is carried +along by it before he has had time to reflect on the criminal nature of +his act, or at least before he could do so calmly and deliberately, the +courts readily recognize such passion as a partial excuse: murder thus +committed in a moment of strong provocation becomes manslaughter, not +murder in the proper sense of the word. It is not justifiable; but yet +it is far less criminal and less severely punished than when committed +in cold blood, or, as the law terms it, with malice prepense or +aforethought. This practice of our courts is right and highly +reasonable, because on such occasions the will of the culprit is partly +overpowered, or deprived of freedom. + +It is a matter of much discussion among jurists whether a passion can +ever be so violent as to overpower the will _absolutely_, so as to +deprive it of all freedom at the moment. If it can, then the culprit +should be totally acquitted for doing what he could not help doing. In +several States of the Union, such an invincible impulse has been +recognized by the courts of justice, and men have been acquitted for +acting on what was supposed to be an invincible impulse to commit crime; +the courts considered this as an extreme form of moral insanity. + +I have shown above that on sound principles of philosophy the will can +never be compelled to do wrong; at most it could be said that, in the +cases just referred to, the will was not in the act. Now this, I +suppose, is the case in hydrophobia or _rabies_, in which terrible +disease the biting of the sufferer appears to be spasmodic, not +voluntary. It is very doubtful whether such excuse can be substantiated +in what is called moral insanity. + +The courts of England and the leading authorities in the United States +have never departed from this correct rule, that a man is accountable, +to some extent at least, for whatever he does willingly and without the +influence of delusion. + +Moral insanity thus understood, as a derangement of the passions +lessening a man's full mastery of himself, but not destroying it +altogether, assumes various forms. There are kleptomania, or an +abnormal impulse to steal; pyromania, an impulse to set things on fire; +dipsomania, or an abnormal fondness for intoxicants; nymphomania, or the +tyranny of lustful passions; homicidal mania, or a craving to commit +murder; etc. In all these the nature of the disease is the same, it +would appear. The imagination seizes the pleasure vividly, yet, it is +claimed, without delusion: and the passion, owing to organic disorder, +is abnormally excitable. The organic derangement is supposed to be in +the brain. For the human brain, a masterpiece of the Creator's wisdom, +is now generally believed to consist of various portions which are the +organs of the passions, of motive power and the phantasms, erroneously +called ideation. Hence it is easy to understand how it may happen that +one portion is diseased while the other parts are in a normal condition. +And on the other hand it thus appears very probable also that a brain +partially diseased is liable to be soon affected in the other parts as +well. Hence we may suspect that moral insanity is likely to bring on +delusional insanity, and _vice versa_. In fact, I find that a medical +expert of note, who had for many years taught that moral insanity was +quite a distinct disease and separate from mental insanity, has in his +old age changed his mind to some extent on this subject. "Of late +years," says Dr. Bauduy, of St. Louis, in his learned work on "Diseases +of the Nervous System," "I have believed, notwithstanding the doctrine +of Pritchard, that a careful study of moral insanity will enable us to +detect some evidence, although, it must be confessed, often very feeble, +of mental weakening. Even the classic cases of Pritchard," he adds, "who +first defined the so-called moral insanity, when carefully examined, +will confirm this statement" (p. 227). Usually, as the same Dr. Bauduy +explains, those who are morally insane are at least on the high road to +mental insanity (p. 228). Moral insanity is known to exist when there is +a sudden change of character which can have no other source than bodily +disease; as when a most honest man becomes of a sudden an habitual +thief, a decent man openly profane, a miser becomes extravagantly +liberal, an affectionate father a very tyrant to his children, without +any traceable causes for such transformation. The disease is made more +manifest if such a sudden change is preceded by certain physical +conditions, such as epilepsy, hereditary taint, suicidal attempts, "the +insane temperament," as it is called, and other influences which are to +be taken into consideration. + +If ever you be summoned, gentlemen, to testify or pronounce on a +person's insane condition, let me give you one piece of advice which may +spare you much unpleasantness: be unusually cautious of what you say. +If you appear as an expert or a witness, and you make a mistake +unfavorable to the patient, he will be your enemy for life; even he may +at times recover damages for libel. If he is really crazy, he may be all +the more dangerous. Do your duty, of course, as an honest man must +always do; but do it very prudently. + +Dr. Bauduy is very emphatic on the assertion that moral insanity is not +moral depravity. He is perfectly right; yet we must not forget that +moral depravity is often screened before the courts by the plea of +insanity. When a man of bad antecedents commits a crime, and is known to +have been sane just before and after the deed, he ought not to be +excused on the plea that he may have been insane at the moment when he +committed the act; there is no reason for such a plea. And with the +victims of kleptomania, dipsomania, and other moral manias, it is well +known that a sound whipping will often stop the nuisance. The rod for +the juvenile offender, and the whipping-post for adults, would cure many +a moral leper and be a strong protection for society at large, +especially if applied before bad habits freely indulged have demoralized +the person beyond the usual limits. All of us have our passions; they +are an essential part of our nature and even an indispensable part. But +they should be controlled by reason and will, whereas they are often +indulged with guilty weakness. They are much strengthened by indulgence, +especially in those predisposed to certain vices by hereditary +transmission. No doubt some children have worse passions to contend +against than others. It is still worse if, at the same time, their +surroundings are unfavorable to virtue; and this is a constant source of +increase to the criminal classes. + +Wise statesmen will study the ways in which temptations to vice may be +diminished; but it is mistaken mercy and dangerous to the community to +spare the guilty when once they have committed criminal acts. If ever +the principle were admitted in our courts of justice that the possible +existence of mental insanity ought to protect a culprit from punishment, +crime would soon increase tenfold both in the sane and in the insane. +Both classes must be kept impressed with the conviction that the law +rules supreme and will not tolerate the destruction of public safety. +Your profession, gentlemen, in this matter as in many others, by its +sound views on Jurisprudence and Ethics, is one of the strongest +bulwarks of the common good. + + + + +LECTURE IX. + +HYPNOTISM AND THE BORDER-LAND OF SCIENCE. + + +In this last lecture of our course I propose to make a brief excursion +with you into the border-land of science, a region chiefly occupied by +imposture and superstition. To show there is such a territory, we have +only to name a few of its inhabitants, such as mesmerism, animal +magnetism, odylism, hypnotism, mind-reading, faith-cures, clairvoyance, +spiritism, including table-rapping, spirit-rapping, most of which have +been used in connection with medicine. I do not maintain that all of +these are mere vagaries, empty shadows, without the least reality, mere +ghosts and hobgoblins, mere phantoms of the heat-oppressed brain, or +cunning devices of impostors to deceive a gullible crowd of the ignorant +public. Yet most of these are such beyond a doubt, and as such are +totally unworthy of our attention. + +Medicine is a science; it deals with undoubted facts and certain +principles, and with theories in so far as they are supported by +well-ascertained realities. The border-land of which I speak presents +to our investigation few certain facts. It is chiefly the domain of +imposture. Charlatans and showmen and medical quacks call things facts +that are not facts. Among all the inhabitants of the shadowy region that +I have enumerated, there is only one considered to-day by the science of +medicine as worthy of its attention. It is hypnotism. As its first +origin is connected with the history of mesmerism, and the latter, +though itself a phantom, has been used as the chief patron of all other +phantoms, I will premise a few words about mesmerism itself. + +I. Mesmer was born about 1733, studied in Vienna and there became a +doctor of medicine in 1766. Soon after, he began to speculate upon the +curative powers of the magnet, and claimed to have discovered the +existence of a force in man similar to magnetism and the source of +strong influence on the human body. + +In 1775 he published an account of the medical powers of this animal +magnetism, which from his name was afterward called _mesmerism_. Paris +was then the centre of attraction for scientific discoverers and +pretenders. Thither Mesmer betook himself and there he soon created a +lively sensation by the exhibition of mesmeric trances, some of which +were accompanied by clairvoyance--that is, the power of seeing objects +concealed from the eyes. He was also supposed to work some inexplicable +cures. + +The secret of his art he could not be induced to reveal even for the sum +of 340,000 livres, which was offered him in compensation. People began +to doubt whether he had a real secret, or whether he was a rank +impostor. A royal commission was appointed to examine into the matter. +Our Benjamin Franklin, then in Paris, was one of the commissioners. +Their report was unfavorable. They found no proof of the existence of a +fluid such as animal magnetism, and thought that all that was not +imposture could be accounted for by the power of imagination. In a +secret report they pointed out very strongly the dangers likely to arise +from this unhealthy stimulus to the imagination. Their verdict does +honor to their learning and their common-sense. Mesmer left Paris, and +he died in obscurity in 1815. + +But his pretended discovery did not die with him. It was a mine of +resources to charlatans and impostors generally. There were strange +effects produced, and at the sight of the inexplicable men lose their +wits. The gullible public wondered, restless minds experimented, and +many pondered thoughtfully on facts, most of which were not facts at +all. But after eliminating all the elements of imposture and +exaggeration there seemed to remain a residue of phenomena that were +strange and unaccountable. + + +II. THEORY OF HYPNOTISM. + +About 1840 the vaunted claims of the many clairvoyants were exposed +before the French Academy of Medicine, which passed a resolution +rejecting mesmerism altogether as unworthy of notice on the part of +scientific men. The theory of a mesmeric fluid, until then the only one +advanced, had evidently to be abandoned. Science with all its tests +could find no such cause of the results produced. But in 1842 an English +physician, Dr. James Braid, hit upon a more plausible theory. He +conjectured that the actions of the mesmeric subject could be explained +without a fluid by the suggestion of phantasms to him on the part of the +mesmerizer. Dr. Carpenter, then a great authority, defended his theory; +but the medical branch of the British Association disdained to consider +the matter. Dr. Braid thought the mesmeric trance was only a state of +somnambulism artificially brought about, and he coined the word +_hypnotism_ to indicate the artificial sleep. Other attempts to promote +the cause of hypnotism were made in the United States and other lands, +but no very definite or scientific results were reached until 1878, when +the celebrated Prof. Charcot and others made its nature and +possibilities the subject of a thorough study and abundant +experimentation at the Paris hospital of La Salpetriere and in other +places. At present it is admitted by distinguished medical scientists +that hypnotism is a reality, capable of being utilized for important +purposes. Many effects have been demonstrated to be produced by it as +real as any ordinary phenomena of nature. But on the explanation of +their causes there hangs still a cloud of obscurity. + +The Paris School of Doctors attribute the effects to physical causes, +chief among which are diseases of the nerves. Those of Nancy trace the +phenomena to a psychical source, namely, to suggestion--that is, action +on the subject through his imagination excited by words, signs, or in +any other manner. This appears to be, in the main, the theory of +Dr. Braid vindicated by modern science. Probably enough, both schools +are right in their way, the suggestions not taking effect except where +nervous affections have prepared the way. The beneficial results claimed +for hypnotism by the scientific men who have made its study a specialty +are chiefly as follows: + + +III. BENEFITS OF HYPNOTISM. + +1. It acts as a temporary sedative, quieting the excited nerves of the +patient. It was thus employed, for instance, on an old woman who was +near her death, and who had not been able to make necessary preparations +for that important event, being beside herself with nervous agitation. +She obtained by this means a calm condition for some seven or eight +hours. Hypnotism was for her like the visit of a good angel from heaven. + +2. It is used as an anaesthetic in place of chloroform, which in many +cases cannot be applied without great danger to health, or even life. +Thus perfect insensibility may be procured and long continued, allowing +sometimes of the performance of protracted surgical operations that +would otherwise be almost impossible. + +3. At other times it is employed as a mere pain-killer without depriving +the patient of consciousness, so that the hurt is felt indeed, but not +attended with keen suffering. + +4. It is claimed that the skilful application of hypnotism can at times +not only alleviate the pain of an injury, but even cure nervous +affections more or less permanently, removing, for instance, the defect +of stammering. + +5. There are not wanting cases in which even moral improvements are +claimed to be produced, at least in the removing of bad habits, such as +drunkenness. If hypnotism can cure intoxication permanently, or even for +a season, it deserves to be encouraged. Yet even then it must be used +with great caution, for there may be very evil consequences resulting +from its use. To realize fully the dangers and the evils attendant upon +hypnotism you must understand the three stages through which the patient +is made to pass--those of lethargy, catalepsy, and somnambulism. + + +IV. DANGEROUS TREATMENT. + +Each of these is a disease in itself, and thus it is seen at once that a +treatment which employs diseases as its means of cure must be of a +dangerous kind. After the patient has been hypnotized by any of the +various processes--the chief are mesmeric passes of the hypnotizer's +hands, his eyes fixed into the eyes of his subject, or the latter's on +an object so held as to strain his eyes--the first stage of hypnotism is +obtained, that of lethargy. In the lethargic state, the subject appears +to be sunk in a deep sleep; his body is perfectly helpless; the limbs +hang down slackly, and when raised fall heavily into the same position. +In this condition all the striated or voluntary muscles react on +mechanical excitement. Without an accurate knowledge of anatomy, much +harm may be done by the experiment. + +The second stage is that of catalepsy, certainly not a healthy condition +to be in. Its grand feature is a plastic immobility by which the subject +maintains all the attitudes given to his body and limbs, but with this +peculiarity, that the limbs and features act in unison. Join the hands +of the patient as if in devout prayer, and his countenance assumes a +devout expression; clench his fist, and anger is depicted in his +features. + +The third stage is that of somnambulism. The skin is now insensible to +pain, but excessive keenness is manifested in the sight, hearing, smell, +and muscular sense. Here the impostor can play off his pretended +clairvoyance or second sight; for the subject will discover objects +hidden from sight by the sense of smell and other senses affected with +abnormal power. The somnambulist will now exhibit the utmost sensibility +to suggestions made to him by the hypnotizer, so that he seems to be +almost entirely controlled by the influence of the latter's will. This +is what chiefly favored the early theory that a mesmeric fluid emanated +from the mesmerizer by means of which he could act in his subject as he +pleased. The experiment by suggestions seems to succeed best with +hysterical patients, which fact confirms the morbid character of the +hypnotic trance. + + +V. FIELD FOR A SCIENTIST. + +If any distinguished scientist or Doctor who can afford it wishes to +make a special study of hypnotism, which is still so imperfectly +understood, he may render a valuable service to humanity, and in +particular to the science of medicine. But if any ordinary physician +asked my advice about devoting attention to this pursuit. I would +emphatically tell him, "Leave it alone: you are not likely to derive +real benefit from it, and you are very likely to inspire your clients +with distrust of you when they see you deal with matters which have +deserved a bad name on account of the charlatanism and the superstitious +abuses usually connected with them." This is not my opinion alone, but +also that of distinguished writers on the subject. + + +VI. OBJECTIONS TO HYPNOTISM. + +When there is question of hypnotic seances or exhibitions such as are +designed to feed the morbid cravings of the public for what is +mysterious and sensational, I would call special attention to the +following objections against such practices. + +1. Medical authorities maintain that it requires at least as much +knowledge of therapeutics to use hypnotism safely as it does for the +general practice of medicine, and requires of a physician who engages in +it a more thorough mastery of his profession than many other branches of +the healing art, and therefore that it is as objectionable to allow +non-professionals to deal with hypnotism as it would be to allow medical +practice promiscuously to all persons without a Doctor's diploma. In +fact, in Russia, Prussia, and Denmark none but licensed physicians can +lawfully practise hypnotism. Aside from a variety of accidents which may +result to the subject hypnotized from the ignorance of physiology in the +hypnotizer, there is this general injury sustained, that even strong +subjects frequently experimented upon contract a disposition to be +readily thrown into any of the three morbid states of the mesmeric +trance. All these states are real diseases and are allied to hysteria, +epilepsy, and a whole family of nervous troubles, any one of which is +sufficient to make a patient very miserable for life, and even to lead +him to an early grave. + +2. The moralist has still stronger objections against the use of +hypnotism, except when it is used as a means to most important results. +He maintains that one of the greatest evils that can befall a man is the +weakening of his will-power; this leaves him a victim to the cravings of +his lower appetites. Now the frequent surrender of one's will to the +control of another is said (very reasonably, it would seem) to bring on +a weakening of the will or self-control. We see this exemplified in the +habitual drunkard. He loses will-power to such an extent that he can +scarcely keep his most solemn promises or withstand the slightest +temptations. There is a very serious question asked by the moralist upon +another resemblance of an hypnotic subject to a drunkard. He asks +whether any man has a right for the amusement perhaps of the curious +lookers-on to forfeit for awhile his manhood, or the highest privilege +of his manhood--his powers of intellect and free-will. He admits that we +do so daily in our sleep. But then he argues that sleep is a necessity +of our nature directly intended by the Creator, a normal part of human +life. Besides it is a necessary means for the renewal of our strength, +and on the plea of necessity the moralist may admit the use of hypnotism +when it is needed for the cure of bodily diseases. But for the mere +amusement of spectators he maintains that it is wrong for a man thus to +resign his human dignity, as it would be wrong for him to get drunk for +the amusement of lookers-on. Still, in this latter case the evil would +be greater, for in drunkenness there is contained a lower degradation, +inasmuch as the baser passions are then left without all control, and +are apt to become exceedingly vile in their licentious condition. The +hypnotic subject has at least the mind and will of the hypnotizer to +direct him. Here, however, appears the need of another caution, namely, +that the hypnotizer should be known to be a virtuous man; else the evil +that he can do to his subject, as is readily seen, may be even worse +than that resulting from a fit of drunkenness. And as men who occupy +even respectable positions may yet be vile at heart, it is very +desirable for prudence' sake to have no one hypnotized in private +without the presence of a parent, close relative, or some other party, +who will see to it that nothing improper be suggested during the trance. +For the scenes gone through during the hypnotic state, though not +remembered by the subject upon his return to consciousness, are apt to +recur to him afterwards like a dream, showing that they have left traces +behind them. + +3. Legal writers and lawyers have serious charges against hypnotism. +This practice, they maintain, if publicly exhibited to old and young, +begets dangerous cravings for sensational experiments. Turning away +men's attention from the sober realities and duties of social life, it +prompts them to pursue the unnatural and abnormal. It was this craving +that in less enlightened ages led men to the superstitious practice of +astrology and witchcraft. At present it leads to such vagaries and +unchristian and often immoral practices as are connected with spiritism, +faith-cures, mind-reading, and similar foolish or criminal or at least +dangerous experimentations which dive into the dark recesses found in +the border-land of the preternatural. The atmosphere of that region is +morally unhealthy and should be barred off by the guardians of public +morals. + +The most common objection of legal writers is directed against the +various crimes to which hypnotism is apt to lead men of criminal +propensities. They point to the statements of Dr. Luys, a respectable +authority on hypnotism, who says: "A patient under the influence of +hypnotism can be made to swallow poison, to inhale noxious gases. He can +be led to make a manual gift of property, even to sign a promissory note +or bill, or any kind of contract." Indeed, how can notaries or witnesses +suspect any fraud when even the Doctor needs all his experience and all +his skill to avoid falling into error? In criminal matters a man under +suggestion can bring false accusations and earnestly maintain that he +has taken part in some horrible crime. + + +VII. FURTHER EXPLANATION OF HYPNOTISM. + +After considering the objections to the use, or rather abuse, of +hypnotism, I may add some further explanation of hypnotism itself--of +its nature so far as it is known to science. Science has ascertained the +reality of the phenomena and facts--not single facts only, scattered +here and there, but groups of facts uniformly obedient to certain laws +of nature. It has not yet discovered the exact cause or causes of all +these phenomena, but it gives plausible explanations of them, both in +the physical theory of the Paris School and in the psychical theory of +the Nancy School of Physicians. Science has discarded the original +theory of a mesmeric fluid as the cause of these phenomena, just as it +has discarded the formerly supposed fluids of electricity and magnetism. +Of electricity the "Century Dictionary" says: "A name denoting the cause +of an important class of phenomena of attraction and repulsion, chemical +decomposition, and so on, or, collectively, these phenomena +themselves." The true nature of electricity is as yet not all +understood, but it is not, as it was formerly supposed to be, of the +nature of a fluid. Similarly we may define hypnotism as the collection +of peculiar phenomena of a trance or sleep artificially induced, or the +induced trance or sleep itself. + +The true cause of these phenomena is not yet understood, but there is no +apparent reason for attributing them to a special fluid; they seem to be +peculiar ways of acting, belonging to man's physical powers when his +nerves are in an abnormal condition. By laying down these definite +statements we gain the advantage that we isolate hypnotism from the +frauds and empty shades, from the ghosts and hobgoblins with which it +used to be associated in the border-region which we have undertaken to +explore. Science deals with well-ascertained facts. Now of mesmerism, +animal magnetism, and its kindred, odylism, we have seen that we have no +reliable facts. We have done with those unsubstantial shades. But of +hypnotism we have well-known facts, and we have shown it to be placed on +a scientific basis. + + +VIII. SCIENCE DREADS ERROR. + +Of clairvoyance, mind-reading, palmistry, spiritual science cures we +have no certain facts, but we have many impostures connected with them. +If ever we get real and undoubted facts proved to be connected with +them, we ought to examine them with care. Science is not afraid of any +portion of nature; all it dreads is ignorance, and what is worse, error. +Error with regard to facts may be committed in two ways--by admitting as +facts what are not facts, and by denying facts. Now, there are facts +certain and well ascertained, numerous and widely known, connected with +some other portions of the border-land of science that we have not yet +looked into, though I have mentioned their names. He who would assert +that spiritism, table-turning, spirit-rapping, and so on are mere idle +talk, sheer impostures, is not well read in the literature of the +present day. By denying all reality to these phenomena he strays as far +from the truth as if he allowed himself to believe mere fabrications. +They are not impositions, but they are worse; they are superstitions. By +superstitions I mean here the practice of producing results which cannot +possibly proceed from the powers of nature, and which could not without +absurdity be attributed to the interference of the Creator or His good +angels. + +Some persons strenuously object to introducing any reference to God into +scientific works. Science consists in tracing known effects to their +true causes. If there were no God, He could not be a true cause and it +would be unscientific to introduce His agency. But if there is a God and +He acts in the world which He has made, we must take His actions into +account when we study His works. Some say, "I do not believe in a God." +That may be, but that does not prove that there is no God. Belief is a +man's wilful and fine acceptance of what is proposed to him on the +authority of some one else. Students have most of their knowledge on the +authority of their professors and other men of learning. If a medical +student would say, "I do not believe in microbes nor in contagion by +disease germs," that would not kill the germs nor protect him against +contagion. Nor would it show his superior wisdom, but rather his +extravagant conceit and ignorance. So with those who believe not in God. + +There are others who believe not in the existence of devils or fallen +angels. That is not so bad; but yet they must remember that their +refusal to believe in devils does not prove that there are none. The +greatest enemies of science are those who blindly maintain false +statements and false principles of knowledge. Let us look for the truth +in every investigation. Even Huxley, in the midst of his attacks on +dogmatic religion, protests also against dogmatic infidelity. Science, +he says, is as little atheistic as it is materialistic. All this must be +remembered chiefly when we undertake to explore, as we are now doing, +the unknown region which we have called the border-land of science. +There we find many strange phenomena, and we are trying to discover +their true nature and true causes. If we can explain some of them by +natural causes, as by the powers of the imagination when it is in an +abnormal or hypnotic state, very well, let us explain them. But let us +not rashly conclude that all other phenomena can be thus explained. Do +not reason this way, as some writers have done: "Some effects," they +say, "were formerly attributed to witchcraft or deviltry and can now be +explained by hypnotism. Therefore all other mysterious effects can also +be thus explained. Therefore there is not and never was such a thing as +witchcraft or deviltry. So, too, some events often reputed miraculous +can be explained by natural causes, therefore no miracle has ever +happened." That is the reasoning of rash and ignorant men, and not of +scientific minds. It does not follow from the fact that God usually +works by natural causes, that He cannot on special occasions and for +very important reasons show His hand, as it were, and act so manifestly +against the course of nature as to show us that it is He who is at work +and He wants us to mind Him. History furnishes many instances of this +kind. + + +IX. CREDENTIALS OF CHRIST. + +Least of all have Christians a right to deny this, and we must remember +that the civilized world is Christian, almost entirely. Christians +believe in the reliability of the Bible, and in it we are constantly +informed of countless miracles in various ages. If all these accounts +are false, then Christianity is a vast imposture. Christ appealed to +them as to His credentials in His mission to the world. "If you do not +believe Me," He said, "believe My works, for they give testimony of Me. +The blind see; the lame walk; the dead are raised to life." If He spoke +falsely, He was a deceiver; if He worked those marvels by hypnotism, or +any other natural cause, He was an impostor. There is no middle way. +Either by working true miracles He proved Himself to be what He claimed +to be, the Son of God, or He was the most bold and detestable impostor +that has ever appeared on earth. This no Christian can suppose, this no +historian would admit; therefore, we must grant that He worked miracles, +and miracles are realities to be taken into account by the writers of +history, and scientific workers must not sneer at them. + + +X. DEVILTRY. + +Scientific men in their investigations need not expect to come into +contact with miracles; but they may and do find in the border-land of +science facts which reveal the agency of intellectual beings distinct +from men, and too vulgar in their manifestation to be confounded with +God or His blessed angels. Such agents in the book of the Scriptures are +called devils, and intercourse with them is styled superstition, seeking +their assistance is magic or witchcraft, and consulting them is +divination or fortune-telling. All these practices are directly and +strictly forbidden in the Scriptures, and yet they are commonly enough +in use in our own day to procure effects that gratify the curiosity of +such, especially, as have no settled belief in supernatural religion. + +Some of these effects are connected with bodily cures and thus are of +interest to physicians. For instance, spiritualistic mediums, whether +connecting their practices with magnetism or not, though entirely +ignorant of medicine, are at times able to state the exact bodily +indisposition of sick persons living at a great distance, put into +communication with them by holding some object belonging to them. They +will indicate the seat of the disorder, its nature and progress, its +complications. They propose simple and efficacious remedies, using not +infrequently technical terms which are certainly unknown to them before. +They manifest the thoughts of others, reveal family secrets, answer +questions put in languages of which they know nothing. To deny facts +attested by thousands of witnesses of various nations belonging to +various religious denominations or professing no religion whatever, is +not the spirit of science. It it estimated that 100,000 spiritist books +and pamphlets are sold yearly in the United States alone. It is certain +that much, very much imposture is mixed up with many undeniable facts, +but that does not dispose of the real facts mixed up with the +impostures. Tyndall once caught an ill-starred spiritualistic impostor +at his juggling. He concluded that all other spiritists were impostors. +The world now laughs at him for his foolish reasoning. + +Of course, I do not suppose that spiritism is mainly employed in such +matters as would directly interest the physician. It has grown into a +system of religion and morals, very peculiar and at variance with the +Christian religion, a system rather resembling the religion of Buddha, +with its reincarnations and transmigrations of souls while struggling +after eternal after-progress. This is fully and clearly explained in an +article on "Spiritism in its True Character" in the English publication +called "The Month," for September, 1892. But with this phase of it we +are not now concerned. As to the facts, it is enough to remark that +spiritists claim a following of 20,000,000. Suppose there are only +one-half that number. 10,000,000 people are not readily deceived about +matters of their daily observation, for their meetings or seances +consist chiefly of those manifestations which others call impostures. + +Their adherents are chiefly among the educated classes, I believe. +Certainly they include multitudes of doctors, lawyers, professors, +scientists, magistrates, clergymen, close students, keen intellects, +even such men as Alfred Russell Wallace, Profs. Morgan, Marley, Challis, +William Carpenter, and Edward Cox. If one has still lingering doubts on +this matter let him read the four learned articles written by my +predecessor in this chair of Medical Jurisprudence, Rev. James F. +Hoeffer, S.J., the former president of Creighton University. They are +found in the "American Catholic Quarterly Review" for 1882 and 1883. + +What must we think of the nature of spiritism, with its spirit-rappings, +table-turning, spirit-apparitions, and so on? Can such of the facts as +are not impostures and realities be explained by the laws of nature, the +powers of material agents and of men? All that could possibly be done by +the most skilled scientists, by the most determined materialists who +believe neither in God nor demon, as well as by the most conscientious +Christians, has only served to demonstrate to perfect evidence that +effects are produced which can no more be attributed to natural agency +than speech and design can be attributed to a piece of wood. One +principle of science throws much light on the nature of all those +performances, namely, that every effect must have a proportionate cause. +When the effect shows knowledge and design, the cause must be +intelligent. Now many of these marvels evidently show knowledge and +design; therefore the cause is certainly intelligent. + +A table cannot understand and answer questions; it cannot move at a +person's bidding. A medium cannot speak in a language he has never +learned, nor know the secret ailment of a patient far away, nor +prescribe the proper remedies without knowledge of medicine. Therefore +these effects, when they really exist, are due to intelligent agents, +agents distinct from the persons visibly present; invisible agents, +therefore, spirits of another world. + +Who are these agents? God and His good angels cannot work these wretched +marvels, the food of a morbid curiosity, nor could they put themselves +at the disposal of impious men to be marched out as monkeys on the +stage. The spirits which are made to appear at the seances are degraded +spirits. Spiritualists themselves tell us they are lying spirits. Those +lying spirits say they are the souls of the departed, but who can +believe their testimony if they are lying spirits, as they are +acknowledged to be? This whole combination of imposture and superstition +is simply the revival in a modern dress of a very ancient deception of +mankind by playing on men's craving for the marvellous. Many imagine +these are recent discoveries, peculiar to this age of progress. Why? +This spirit-writing is and has been for centuries extensively practised +in benighted pagan China, while even Africans and Hindoos are great +adepts at table-turning. It is simply the revival of ancient witchcraft, +which Simon Magus practised in St. Peter's time; which flourished in +Ephesus while St. Paul was preaching the Gospel there. It is more +ancient still. These were the abominations for which God commissioned +the Jews in Moses' time to exterminate the Canaanites and the other +inhabitants of the Promised Land. In the Book of Moses called +Deuteronomy, or Second Law, admitted as divine by Catholics, +Protestants, and Jews alike, we have this fact very emphatically +proclaimed by the Lord. He says: "When thou art come into the land which +the Lord thy God shall give thee, beware lest thou have a mind to +imitate the abominations of those nations; neither let there be found +among you any one that ... consulteth soothsayers, or observeth dreams +and omens, neither let there be any wizard, nor charmer, nor any one +that consulteth pythonic spirits, or fortune-tellers, or that seeketh +the truth from the dead." + +Is not this just what spiritualists pretend to do? Many may call it only +trifling and play. The Lord does not. The Scriptures continue: "For the +Lord abhorreth all these things, and for these abominations He will +destroy them at thy coming." I certainly do not mean to say that all +that passes for spiritualism is thus downright deviltry to-day, nor was +it so in pagan times. Much imposture was mixed with it. The oracles of +the pagan gods and goddesses were not all the work of the pythonic +spirits. Much was craft of the priests of idols; and yet all were +abominations before the Lord, on account of the share that Satan took +in the deceptions. + +What must be the attitude of the scientific man towards all such +matters? It should be an attitude of hostility and opposition. Science +should frown down all imposture and superstition. Medicine in +particular, intended to be one of the choicest blessings of God to man, +should not degrade its noble profession by pandering to a vulgar greed +for morbid excitement. Not only will you personally keep aloof from all +that is allied to quackery and imposture, but in after-life your +powerful influence for good will be most efficient in guarding others +against such evils, and even perhaps in withdrawing from such +associations those who have already got entangled in dangerous snares. +At all events the enlightened views you shall have formed to yourselves +on all such impostures and impieties will be a power for good in the +social circle in which your mental superiority and your moral integrity +will make you safe guides for your fellow-men. + + +PRINTED BY BENZIGER BROTHERS, NEW YORK + + + + + +End of the Project Gutenberg EBook of Moral Principles and Medical Practice, by +Charles Coppens + +*** END OF THIS PROJECT GUTENBERG EBOOK MORAL PRINCIPLES *** + +***** This file should be named 18616.txt or 18616.zip ***** +This and all associated files of various formats will be found in: + http://www.gutenberg.org/1/8/6/1/18616/ + +Produced by Geoff Horton, Laura Wisewell and the Online +Distributed Proofreading Team at http://www.pgdp.net + + +Updated editions will replace the previous one--the old editions +will be renamed. + +Creating the works from public domain print editions means that no +one owns a United States copyright in these works, so the Foundation +(and you!) can copy and distribute it in the United States without +permission and without paying copyright royalties. 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