{"collection":"philosophy-ethics","full_text_available":true,"graph_url":"https://unchartedknowledge.5gfusion.net/v2/api/page/gutenberg_18616/graph","html_url":"https://unchartedknowledge.5gfusion.net/v2/page/gutenberg_18616","id":"gutenberg_18616","license":"Public Domain (US)","rights_basis":"gutenberg_metadata_copyright_false","source":"gutenberg","source_url":"https://www.gutenberg.org/ebooks/18616","summary":null,"tags":["Category: Health & Medicine","Category: Law & Criminology","Category: Philosophy & Ethics","Medical ethics","Medical jurisprudence"],"text":"Produced by Geoff Horton, Laura Wisewell and the Online\nDistributed Proofreading Team at http://www.pgdp.net\n\n\n\n\n\n  +------------------------------------------------------------------+\n  |                                                                  |\n  | Transcriber's Note                                               |\n  |                                                                  |\n  | In Lecture I, there are paragraphs numbered 1 to 8 but omitting  |\n  | 4. This is as in the original, as is the inconsistent            |\n  | hyphenation of the words \"lawgiver\" and \"twofold\". In two        |\n  | instances, errors of punctuation have been corrected, and in one |\n  | case obscured words have been guessed. Full details can be found |\n  | in the html version of this ebook.                               |\n  |                                                                  |\n  +------------------------------------------------------------------+\n\n\n\n\n                         MORAL PRINCIPLES AND\n\n                           MEDICAL PRACTICE,\n\n\n                  THE BASIS OF MEDICAL JURISPRUDENCE.\n\n\n                                  BY\n\n                      REV. CHARLES COPPENS, S.J.,\n\n     _Professor of Medical Jurisprudence in the John A. Creighton\n  Medical College, Omaha, Neb., author of Text-Books on Metaphysics,\n                    Ethics, Oratory, and Rhetoric._\n\n\n                    NEW YORK, CINCINNATI, CHICAGO:\n                          BENZIGER BROTHERS,\n                 _Printers to the Holy Apostolic See._\n\n\n\n\n                                  TO\n\n                        MR. JOHN A. CREIGHTON,\n\n                  THE FOUNDER OF THIS MEDICAL COLLEGE\n                                AND OF\n                        ST. JOSEPH'S HOSPITAL,\n                                  AS\n                       A SLIGHT TRIBUTE OF HONOR\n                                  FOR\n                 HIS ENLIGHTENED PATRONAGE OF LEARNING\n                                  AND\n             HIS CHRISTIAN CHARITY TOWARDS HIS FELLOW-MEN,\n                              THIS VOLUME\n                                  IS\n                        RESPECTFULLY INSCRIBED.\n\n\n\n\n=Permissu Superiorum.=\n\n\nThe undersigned, Provincial of the Missouri Province of the Society of\nJesus, in virtue of faculties granted to him by Very Rev. L. MARTIN,\nGeneral of the same Society, hereby permits the publication of a book\nentitled \"Moral Principles and Medical Practice,\" by Rev. CHARLES\nCOPPENS, S.J., the same having been approved by the censors appointed by\nhim to revise it.\n\n                THOMAS S. FITZGERALD, S.J.\n\n    ST. LOUIS, MO., July\u00a02, 1897.\n\n\n       *       *       *       *       *\n\n\n=Imprimatur.=\n\n                \u2720\u00a0MICHAEL AUGUSTINE,\n                        _Archbishop of New York._\n\n    NEW YORK, July\u00a020, 1897.\n\n\n\n\nCOPYRIGHT, 1897, BY BENZIGER BROTHERS.\n\n\n\n\nPREFACE.\n\n\nThe science of Medicine is progressive; genius irradiates its onward\nmarch. Few other sciences have advanced as rapidly as it has done within\nthe last half century. Hence it has happened that in many of its\nbranches text-books have not kept pace with the knowledge of its leading\nminds. Such is confessedly the case in the department of Medical\nJurisprudence. This very term, Medical Jurisprudence, as now used in\ncolleges, is generally acknowledged to be a misnomer. There is no reason\nwhy it should be so used. The leading medical writers and practitioners\nare sound at present on the moral principles that ought to direct the\nconduct of physicians. It is high time that their principles be more\ngenerally and distinctly inculcated on the younger members, and\nespecially on the students of their noble profession. To promote this\nobject is the purpose aimed at by the author. His brief volume is not\nintended to be substituted for existing text-books on Medical\nJurisprudence, but to supply some chapters imperatively demanded by\nscience for the thorough treatment of this important subject.\n\n\n\n\nCONTENTS.\n\n\n                                                                PAGE\n  LECTURE I.--INTRODUCTION--THE FOUNDATION OF JURISPRUDENCE,      11\n\n     \"   II.--CRANIOTOMY,                                         37\n\n     \"  III.--ABORTION,                                           58\n\n     \"   IV.--VIEWS OF SCIENTISTS AND SCIOLISTS,                  81\n\n     \"    V.--VENEREAL EXCESSES,                                 104\n\n     \"   VI.--THE PHYSICIAN'S PROFESSIONAL RIGHTS AND DUTIES,    128\n\n     \"  VII.--THE NATURE OF INSANITY,                            151\n\n     \" VIII.--THE LEGAL ASPECTS OF INSANITY,                     177\n\n     \"   IX.--HYPNOTISM AND THE BORDER-LAND OF SCIENCE,          197\n\n\n\n\nMORAL PRINCIPLES AND MEDICAL PRACTICE.\n\n\n\n\nLECTURE I.\n\nINTRODUCTORY--THE FOUNDATION OF JURISPRUDENCE.\n\n\nGentlemen:--1. When I thoughtfully consider the subject on which I am to\naddress you in this course of lectures, i.e., Medical Jurisprudence, I\nam deeply impressed with the dignity and the importance of the matter.\n\nThe study of medicine is one of the noblest pursuits to which human\ntalent can be devoted. It is as far superior to geology, botany,\nentomology, zo\u00f6logy, and a score of kindred sciences as its subject, the\nbody of man, the visible lord of the creation, is superior to the\nsubject of all other physical sciences, which do so much honor to the\npower of the human mind; astronomy, which explores the vast realms of\nspace, traces the courses and weighs the bulks of its mighty orbs;\nchemistry, which analyzes the minutest atoms of matter; physics, which\ndiscovers the properties, and mechanics, which utilizes the powers of an\nendless variety of bodies--all these noble sciences together are of less\nservice to man than that study which directly promotes the welfare of\nhis own structure, guards his very life, fosters the vigor of his youth,\npromotes the physical and mental, aye, even the moral, powers of his\nmanhood, sustains his failing strength, restores his shattered health,\npreserves the integrity of his aging faculties, and throughout his whole\ncareer supplies those conditions without which both enjoyment and\nutility of life would be impossible.\n\nThe physician, indeed, is one of the most highly valued benefactors of\nmankind. Therefore he has ever been held in honor among his fellow-men;\nby barbarous tribes he is looked upon as a connecting link between the\nvisible and the invisible world; in the most civilized communities, from\nthe time of Hippocrates, the father of medicine, to the present day, he\nhas been held in deeper veneration than the members of almost any other\nprofession; even in the sacred oracles of Revelation his office is\nspoken of with the highest commendation: \"Honor the physician,\" writes\nthe inspired penman, \"for the need thou hast of him; for the Most High\nhath created him. The skill of the physician shall lift up his head, and\nin the sight of great men he shall be praised. The Most High has created\nmedicines out of the earth, and a wise man shall not abhor them. The\nvirtue of these things is come to the knowledge of men, and the Most\nHigh has given knowledge to men, that He may be honored in His wonders.\nBy these He shall cure and shall allay their pains, and of these the\napothecary shall make sweet confections, and shall make up ointments of\nhealth, and of His works there shall be no end.\" (Ecclus. xxxiii. 1-7).\n\n2. It is well to remind you thus, gentlemen, at the opening of this new\nyear of studies, of the excellence of your intended profession; for you\ncannot help seeing that a science so noble should be studied for a noble\npurpose. In this age of utilitarianism, it is, alas! too common an evil\nthat the most excellent objects are coveted exclusively for lower\npurposes. True, no one can find fault with a physician for making his\nprofession, no matter how exalted, a means of earning an honest\nlivelihood and a decent competency; but to ambition this career solely\nfor its pecuniary remuneration would be to degrade one of the most\nsublime vocations to which man may aspire. There is unfortunately too\nmuch of this spirit abroad in our day. There are too many who talk and\nact as if the one highest and worthiest ambition of life were to make as\nlarge a fortune in as short a time and in as easy a way as possible. If\nthis spirit of utilitarianism should become universal, the sad\nconsequence of it to our civilization would be incalculable. Fancy what\nwould become of the virtue of patriotism if officers and men had no\nhigher ambition than to make money! As a patriotic army is the strongest\ndefence of a nation's rights, so a mercenary army is a dreadful danger\nto a people's liberty, a ready tool in the hand of a tyrant; as heroism\nwith consequent glory is the noble attribute of a patriot, so a\nmercenary spirit is a stigma on the career of any public officer. We\nfind no fault with an artisan, a merchant, or a common laborer if he\nestimate the value of his toil by the pecuniary advantages attached to\nit; for that is the nature of such ordinary occupations, since for man\nlabor is the ordinary and providential condition of existence. But in\nthe higher professions we always look for loftier aspirations. This\ndistinction of rewards for different avocations is so evident that it\nhas passed into the very terms of our language: we speak of \"wages\" as\ndue to common laborers, of a \"salary\" as paid to those who render more\nregular and more intellectual services; of a \"fee\" as appointed for\nofficial and professional actions; and the money paid to a physician or\na lawyer is distinguished from ordinary fees by the especial name of\n\"honorary\" or \"honorarium.\" This term evidently implies, not only that\nspecial honor is due to the recipients of such fees, but besides that\nthe services they render are too noble to be measured in money values,\nand therefore the money offered is rather in the form of a tribute to a\nbenefactor than of pecuniary compensation for a definite amount of\nservice rendered.\n\nWages may be measured by the time bestowed, or by the effect produced,\nor by the wants of the laborer to lead a life of reasonable comfort; a\nsalary is measured by the period of service; but an honorary is not\ndependent on time employed, or on needs of support, or on effect\nproduced, but it is a tribute of gratitude due to a special benefactor.\nWhatever practical arrangements may be necessary or excusable in special\ncircumstances, this is the ideal which makes the medical profession so\nhonorable in society.\n\n3. From these and many other considerations that might be added, it is\nevident, gentlemen, that in the pursuit of the distinguished career for\nwhich you are preparing, you are expected to make yourselves the\nbenefactors of your fellow-men. Now, in order to do so, it will not\nsuffice for you to understand the nature of the various diseases which\nflesh is heir to, together with the specific powers of every drug\ndescribed in works on materia medica. The knowledge of anatomy and\nsurgery, and of the various branches that are taught by the many\nprofessors with whom I have the honor of being associated in the work of\nyour medical education, no matter how fully that knowledge be mastered,\nis not sure by itself to make you benefactors to your fellow-men, unless\nyour conduct in the management of all your resources of science and art\nbe directed to procure the real welfare of your patients. Just as a\nskilful politician may do more harm than good to his country if he\ndirect his efforts to improper ends, or make use of disgraceful means;\nas a dishonest lawyer may be more potent for the perversion than the\nmaintenance of justice among his fellow-citizens; so likewise an able\nphysician may abuse the beneficent resources of his profession to\nprocure inferior advantages at the sacrifice of moral rights and\nsuperior blessings.\n\nYour career, gentlemen, to be truly useful to others and pursued with\nsafety and benefit to yourselves, needs to be directed by a science\nwhose principles it will be my task to explain in this course of\nlectures--the science of MEDICAL JURISPRUDENCE.\n\nIt is the characteristic of science to trace results to their causes.\nThe science of _Jurisprudence_ investigates the causes or principles of\nlaw. It is defined as \"the study of law in connection with its\nunderlying principles.\" _Medical Jurisprudence_, in its wider sense,\ncomprises two departments, namely, the study of the laws regarding\nmedical practice, and, more, especially, the study of the principles on\nwhich those laws are founded, and from which they derive their binding\npower on the human conscience. The former department, styled _Medical\nLaw_, is assigned in the Prospectus of this College to a gentleman of\nthe legal profession. He will acquaint you with the laws of the land,\nand of this State in particular, which regulate the practice of\nmedicine; he will explain the points on which a Doctor may come in\ncontact with the law courts, either as a practitioner having to account\nfor his own actions, under a charge of malpractice perhaps, or as an\nexpert summoned as a witness before a court in matters of civil contests\nor criminal prosecutions. His field is wide and important, but the field\nof _Medical Jurisprudence_, in its stricter or more specific sense, is\nwider still and its research much deeper: it considers those principles\nof reason that underlie the laws of the land, the natural rights and\nduties which these laws are indeed to enforce to some extent, but which\nare antecedent and superior to all human laws, being themselves founded\non the essential and eternal fitness of things. For things are not right\nor wrong simply because men have chosen to make them so. You all\nunderstand, gentlemen, that, even if we were living in a newly\ndiscovered land, where no code of human laws had yet been adopted, nor\ncourts of justice established, nor civil government organized, still\neven there certain acts of Doctors, as of any other men, would be right\nand praiseworthy, and others wrong and worthy of condemnation; even\nthere Doctors and patients and their relatives would have certain rights\nand duties.\n\nIn such a land, the lecturer on Medical Law would have nothing to\nexplain; for there would be no human laws and law courts with which a\nphysician could come in contact. But the lecturer on Medical\nJurisprudence proper would have as much to explain as I have in this\ncountry at present; because he treats of the Ethics or moral principles\nof Medical Practice, he deals with what is ever the same for all men\nwhere-ever they dwell, it being consequent on the very nature of man and\nhis essential relations to his Maker and his fellow-man. Unfortunately\nthe term \"Medical Jurisprudence\" has been generally misused. Dr.\u00a0Ewell,\nin his text-book on the subject, writes \"While the term 'Medical\nJurisprudence' is a misnomer,--the collection of facts and conclusions\nusually passing by that name being principally only matters of evidence,\nand rarely rules of law,--still the term is so generally employed that\nit would be idle to attempt to bring into use a new term, and we shall\naccordingly continue the employment of that which has only the sanction\nof usage to recommend it\" (Ch. I).\n\nI prefer to use terms in their genuine meaning; for misnomers are out of\nplace in science, since they are misleading. Yet, to avoid all danger of\nmisunderstanding, I will call my subject \"Moral Principles and Medical\nPractice,\" and distinctly style it \"The Basis of Medical Jurisprudence.\"\n\nOn what lines will my treatment of the subject depart from the beaten\npath? On the same lines on which most other improvements have been made\nin the science of medicine. Science has not discovered new laws of\nphysical nature that did not exist before; but it has succeeded in\nunderstanding existing laws more perfectly than before, and has shaped\nits practice accordingly. So, too, the leaders of thought among\nphysicians, especially in English-speaking countries, now understand the\nlaws of moral nature--the principles of Ethics--more thoroughly than\nmost of their predecessors did, and they have modified their treatment\nso as to conform it to these rules of morality. Hitherto Medical\nJurisprudence had regulated the conduct of practitioners by human,\npositive laws, and sanctioned acts because they were not condemned by\ncivil courts. Now we go deeper in our studies, and appeal from human\nlegislation to the first principles of right and wrong, as Jurisprudence\nought to do; and, in consequence, some medical operations which used to\nbe tolerated, or even approved, by many in the profession are at present\nabsolutely and justly condemned. The learned physician these days is no\nlonger afraid to face the moral philosopher; there is no longer any\nestrangement between Ethics and Medical Practice. Medicine, sent from\nHeaven to be an angel of mercy to man, is now ever faithful to its\nbeneficent mission; it never more performs the task of a destroying\nspirit, as--not in wantonness, but in ignorance--it did frequently\nbefore.\n\nOn these lines, then, of the improved understanding of first principles,\nI will now proceed to develop the teachings of Medical Jurisprudence.\n\nThe first principle that I will lay down for explanation is, that a man\nis not to be held responsible for all his acts, but only for those which\nhe does of his own free will, which, therefore, it is in his power to do\nor not to do. These are called _human_ acts, because they proceed from a\ndistinctively human power. A brute animal cannot perform such acts; it\ncan only do under given circumstances what its impulses prompt it to do;\nor, when it experiences various impulses in different directions, it can\nonly follow its strongest impulse; as when a dog, rushing up to attack a\nman, turns and runs away before his uplifted stick. When a bird sings,\nit cannot help singing; but a man may sing or not sing at his choice;\nhis singing is a human act. When, however, under the impulse of violent\npain, a person happens involuntarily to sigh or groan or even shriek,\nthis indeed is the act of a man, but, inasmuch as it is physically\nuncontrollable, it is not a human act. So whatever a patient may do\nwhile under the influence of chloroform is not a human act, and he is\nnot morally responsible for it. His conduct under the circumstances may\ndenote a brave or a cowardly disposition, or it may indicate habits of\nself-command or the absence of them. His prayers or curses while thus\nunconscious are no doubt the effects of acquired virtues or vices; yet,\nin as far as his will has no share in the present acts, they are not\nfree or human acts. He deserves praise or blame for his former acts, by\nwhich he acquired such habits, but not for his unconscious acts as such.\n\nFrom this principle it follows that a physician is not responsible to\nGod or man for such evil consequences of his prescriptions or surgical\noperations as are entirely beyond his will and therefore independent of\nhis control. If, however, his mistakes arise from his ignorance or want\nof skill, he is blamable in as far as he is the wilful cause of such\nignorance; he should have known better; or, not knowing better, he\nshould not have undertaken the case for which he knew he was not\nqualified.\n\nBut it often happens that the best informed and most skilful\npractitioner, even when acting with his utmost care, causes real harm to\nhis patients; he is the accidental, not the wilful, cause of that harm,\nand therefore he is free from all responsibility in the matter.\n\nThe practical lessons, however, which all of you must lay to heart on\nthis subject are: 1st. That you are in duty bound to acquire sound\nknowledge and great skill in your profession; since the consequences\ninvolved are of the greatest moment, your obligation is of a most\nserious nature. 2d. That in your future practice you will be obliged on\nall occasions to use all reasonable care for the benefit of your\npatients. 3d. That you cannot in conscience undertake the management of\ncases of unusual difficulty unless you possess the special knowledge\nrequired, or avail yourselves of the best counsel that can reasonably be\nobtained.\n\n5. A second principle of Ethics in medical practice, gentlemen, is this,\nthat many human acts may be highly criminal of which, however, human\nlaws and courts take no notice whatsoever. In this matter I am not\nfinding fault with human legislation. The laws of the land, considering\nthe end and the nature of civil government, need take no cognizance of\nany but overt acts; a man's heart may be a very cesspool of vice, envy,\nmalice, impurity, pride, hatred, etc., yet human law does not and ought\nnot to punish him for this, as long as his actions do not disturb the\npublic peace nor trench upon the happiness of his neighbor. Even his\nopen outward acts which injure only himself, such as gluttony,\nblasphemy, impiety, private drunkenness, self-abuse, even seduction and\nfornication, are not usually legislated against or punished in our\ncourts. Does it follow that they are innocent acts and lawful before\nGod? No man in his right senses will say so.\n\nThe goodness and the evil of human acts is not dependent on human\nlegislation alone; in many cases the moral good or evil is so intrinsic\nto the very nature of the acts that God Himself could not change the\nradical difference between them. Thus justice, obedience to lawful\nauthority, gratitude to benefactors, are essentially good; while\ninjustice, disobedience, and ingratitude are essentially evil. Our\nreason informs us of this difference; and our reason is nothing else\nthan our very nature as intelligent beings capable of knowing truth. The\nvoice of our reason or conscience is the voice of God Himself, who\nspeaks through the rational nature that He has made. Through our reason\nGod not only tells us of the difference between good and evil acts, but\nHe also commands us to do good and avoid evil;--to do certain acts\nbecause they are proper, right, orderly, suitable to the end for which\nwe are created; and to avoid other acts because they are improper,\nwrong, disorderly, unsuitable to the end of our existence. There is a\nthird class of acts, which, in themselves, are indifferent, i.e.,\nneither good nor evil, neither necessary for our end nor interfering\nwith its attainment. These we are free to do or to omit as we prefer;\nbut even these become good and even obligatory when they are commanded\nby proper authority, and they become evil when forbidden. In themselves,\nthey are indifferent acts.\n\n6. These explanations are not mere abstractions, gentlemen, or mere\nphilosophical speculations. True, my subject is philosophical; but it is\nthe philosophy of every-day life; we are dealing with live issues which\ngive rise to the gravest discussions of your medical journals; issues on\nwhich practically depend the lives of thousands of human beings every\nyear, issues which regard physicians more than any other class of men,\nand for the proper consideration of which Doctors are responsible to\ntheir conscience, to human society, and to their God. To show you how we\nare dealing with present live issues, let me give you an example of a\ncase in point. In the \"Medical Record,\" an estimable weekly, now in\nalmost the fiftieth year of its existence, there was lately carried on a\nlengthy and, in some of its parts, a learned discussion, regarding the\ntruth of the principles which I have just now explained, namely, the\nintrinsic difference between right and wrong, independently of the\nruling of law courts and of any human legislation. The subject of the\ndiscussion was the lawfulness in any case at all of performing\ncraniotomy, or of directly destroying the life of the child by any\nprocess whatever, at the time of parturition, with the intention of\nsaving the life of the mother.\n\nI will not examine this important matter in all its bearings at present;\nI mean to take it up later on in our course, and to lay before you the\nteachings of science on this subject, together with the principles on\nwhich they are based. For the present I will confine myself to the point\nwe are treating just now, namely, the existence of a higher law than\nthat of human tribunals, the superiority of the claims of natural to\nthose of legal justice. Some might think, at first sight, that this\nneeds no proof. In fact we are all convinced that human laws are often\nunjust, or, at least, very imperfect, and therefore they cannot be the\nultimate test or fixed standard of right and wrong; yet the main\nargument advanced by one of the advocates of craniotomy rests upon the\ndenial of a higher law, and the assertion of the authority of human\ntribunals as final in such matters.\n\nIn the \"Medical Record\" for July\u00a027, 1895, p.\u00a0141, this gentleman writes\nin defence of craniotomy: \"The question is a legal one _per se_ against\nwhich any conflicting view is untenable. The subdivisions under which\nthe common law takes consideration of craniotomy are answers in\nthemselves to the conclusions quoted above, under the unfortunate\nnecessity which demands the operation.\" Next he quotes the Ohio statute\nlaw, which, he remarks, was enacted in protection of physicians who are\nconfronted with this dire necessity. He is answered with much ability\nand sound learning by Dr.\u00a0Thomas J. Kearney, of New York, in the same\n\"Medical Record\" for August\u00a031, 1895, p.\u00a0320, who writes: \"Dr.\u00a0G. bases\nhis argument for the lawfulness of craniotomy in the teachings of common\nlaw, contending, at least implicitly, that it is unnecessary to seek\nfarther the desired justification. However, the basis of common law,\nthough broad, is certainly not broad enough for the consideration of\nsuch a question as the present one. His coolness rises to sublime\nheights, in thus assuming infallibility for common law, ignoring the\nvery important fact that behind it there is another and higher law,\nwhose imperative, to every one with a conscience, is ultimate. It\nevidently never occurs to him that some time could be profitably spent\nin research, with the view to discovering how often common-law maxims,\nseen to be at variance with the principles of morality, have been\nabrogated by statutory enactments. Now the maxims of common law\nrelating to craniotomy, the statutes in conformity therewith, as well as\nDr.\u00a0G.'s arguments (some of them at least), rest on a basis of pure\nunmitigated expediency; and this is certainly in direct contravention of\nthe teachings of all schools of moral science, even the utilitarian.\"\n\nDr.\u00a0Kearney's doctrine of the existence of a higher law, superior to all\nhuman law, is the doctrine that has been universally accepted, in all\nChristian lands at least, and is so to the present day. Froude explains\nit correctly when he writes: \"Our human laws are but the copies, more or\nless imperfect, of the eternal laws so far as we can read them, and\neither succeed and promote our welfare or fail and bring confusion and\ndisaster, according as the legislator's insight has detected the true\nprinciple, or has been distorted by ignorance or selfishness\" (Century\nDict., \"Law\").\n\nWhoever calmly reflects on the manner in which laws are enacted by\nlegislative bodies, under the influence of human passions and\nprejudices, often at the dictation of party leaders or of popular\nsentiment, of office-seekers or wealthy corporations, etc., will not\nmaintain for a moment that human laws and human tribunals are to be\naccepted as the supreme measure or _norma_ of right and wrong. The\ncommon law of England, which lies at the basis of our American\nlegislation, and is an integral portion of our civil government, is less\nfluctuating than our statutory law, and is in the main sound and in\nconformity with the principles of Jurisprudence. But no one will claim\ninfallibility for its enactments; the esteem we have for it is chiefly\ndue to its general accord with the requirements of the higher law.\n\n7. There is, then, a higher law, which all men are bound to obey, even\nlawgivers and rulers themselves as well as their humblest subjects, a\nlaw from which no man nor class of men can claim exemption, a law which\nthe Creator cannot fail to impose upon His rational creatures: although\nGod was free to create or not to create as He chose, since He did not\nneed anything to complete His own happiness,--yet, if He did create, He\nwas bound by His own wisdom to put order into His work; else it would\nnot be worthy of His supreme wisdom. As the poet has so tersely\nexpressed it, \"Order is Heaven's first law.\"\n\nHow admirably is this order displayed in the material universe! The more\nwe study the sciences--astronomy, biology, botany, physiology, medicine,\netc.--the more we are lost in admiration at the beautiful order we see\ndisplayed in the tiniest as well as in the vastest portions of the\ncreation. And shall man alone, the masterpiece of God in this visible\nuniverse, be allowed to be disorderly, to be a failure in the noblest\npart of his being, to make himself like to the brute or to a demon of\nmalice, to waste his choicest gifts in the indulgence of debasing\npleasure? The Creator is bound by His own wisdom to direct men to high\npurposes, worthy of their exalted intellectual nature. But how shall He\ndirect man? He compels material things to move with order to the\naccomplishment of their alloted tasks by the physical laws of matter. He\ndirects brute animals most admirably to run their appointed careers by\nthe wonderful laws of instinct, which none of them can resist at will.\nBut man He has made free; He must direct him to do worthy actions by\nmeans suitable to a free being, that is, by the enacting of the moral\nlaw.\n\nHe makes known to us what is right and wrong. He informs every one of\nus, by the voice of reason itself, that He requires us to do the right\nand avoid the wrong. He has implanted in us the sense of duty to obey\nthat law. If we do so, we lead worthy lives, we please Him, and, in His\ngoodness, He has rewards in store.\n\nBut can He be pleased with us if we thwart His designs; if we, His\nnoblest works on earth, instead of adding to the universal harmony of\nHis creation, make monsters of ourselves, moral blots upon the\nbeautiful face of His world? It were idle for Him to give us the\nknowledge of His will and then to stand by and let us disfigure His\nfairest designs; to bid us do what is right, and then let us do wrong\nwithout exacting redress or atonement. If He is wise, He must not only\nlay down the law, but He must also enforce it; He must make it our\nhighest interest to keep His law, to do the right; so that ultimately\nthose men shall be happy who have done it, and those who have thwarted\nHis designs shall be compelled to rue it. He will not deprive us of\nliberty, the fairest gift to an intelligent creature, but He will hold\nout rewards and punishments to induce us to keep the law and to avoid\nits violation. Once He has promised and threatened, His justice and His\nholiness compel Him to fulfil His threats and promises. A man can commit\nno rasher act than to ignore, defy, and violate that higher law of which\nwe are speaking, and which, if it must direct all men, especially\nrequires the respect and obedience of those into whose hands he has\nplaced at times the lives of their fellow-men, the greatest of earthly\ntreasures.\n\nI have insisted so much, gentlemen, on the existence of the higher law,\non its binding power and on the necessity of observing it, because it is\nthe foundation of my whole course of lectures. If there were no higher\nlaw, then there would be no Medical Jurisprudence, in the true sense of\nthe word. For Jurisprudence studies the principles that underlie legal\nenactments, and if there were no higher law, there would be no such\nprinciples; then the knowledge of the human law would fill the whole\nprogramme. This in fact is the contention of the defendant of craniotomy\nto whom I have referred; and he boldly applies his speculation to a\nmatter in which the physician has the most frequent opportunity to\nexhibit his fidelity to principle, or his subserviency to the\nrequirements of temporary expediency at the sacrifice of duty.\n\n8. You will find, gentlemen, as we proceed in our course, that Doctors\nhave very many occasions in which to apply the lessons of Jurisprudence\nin their medical practice. I even suspect that they need to be more\nconscientious in regard to the dictates of the higher law than any other\nclass of men, the clergy alone, perhaps, excepted. They need this not\nonly for their own good, but also for the good of their patients and of\nthe community at large. The reasons are these:\n\nA. The matters entrusted to their keeping are the most important of all\nearthly possessions; for they are life itself, and, along with life,\nhealth, the necessary condition of almost all temporal enjoyment. No\nother class of men is entrusted with more weighty earthly interests.\nHence the physician's responsibility is very great; hence the common\ngood requires that he be eminently faithful and conscientious.\n\nB. With no other class of men does the performance of duty depend more\non personal integrity, on conscientious regard for the higher law of\nmorality than with the Doctor. For the Doctor's conduct is less open to\nobservation than that of other professions. The lawyer may have many\ntemptations to act unjustly; but other lawyers are watching him, and the\ncourts of justice are at hand to check his evil practices. As to the\njudge, he is to pronounce his decisions in public and give reasons for\nhis ruling. The politician is jealously watched by his political\nopponents. The public functionary, if he is unjust in his dealings, is\nlikely sooner or later to be brought to an account. But the physician,\non very many occasions, can be morally sure that his conduct will never\nbe publicly scrutinized. Such is the nature of his ministrations, and\nsuch too is the confidence habitually reposed in his integrity, that he\nis and must be implicitly trusted in matters in which, if he happens to\nbe unworthy of his vocation, he may be guilty of the most outrageous\nwrongs.\n\nThe highest interests of earth are in his hands. If he is not\nconscientious, or if he lets himself be carried about by every wind of\nmodern speculations, he can readily persuade himself that a measure is\nlawful because it is presently expedient, that acts can justly be\nperformed because the courts do not punish them; and thus he will often\nviolate the most sacred rights of his patients or of their relatives.\nWho has more frequent opportunities than a licentious Doctor to seduce\nthe innocent, to pander to the passions of the guilty, to play into the\nhands of greedy heirs, who may be most willing to pay him for his\nservices? No one can do it more safely, as far as human tribunals are\nconcerned. As a matter of fact, many, all over this land and other\nlands, are often guilty of prostituting their noble profession to the\nvilest uses. The evil becomes all the more serious when false doctrines\nare insinuated, or publicly advocated, which throw doubt upon the most\nsacred principles of morality. True, the sounder and by far the larger\nportion of medical men protest against these false teachings by their\nown conduct at least; but it very frequently happens that the honest man\nis less zealous in his advocacy of what is right than is the\npropagandist of bold speculations and dangerous new theories in the\nspreading of what is pernicious.\n\nThe effect thus produced upon many minds is to shake their convictions,\nto say the least; and I need not tell you, gentlemen, that weak\nconvictions are not likely to be proof against violent and repeated\ntemptations. In fact, if a physician, misled by any of those many\ntheories which are often inculcated or at least insinuated by false\nscientists, can ever convince himself, or even can begin to surmise\nthat, after all, there may be no such thing as a higher law before which\nhe is responsible for even his secret conduct, then what is to prevent\nhim from becoming a dangerous person to the community? If he see much\ntemporal gain on the one hand, and security from legal prosecution on\nthe other, what would keep him in the path of duty and honesty?\nEspecially if he can once make himself believe that, for all he knows,\nhe may be nothing more than a rather curiously developed lump of matter,\nwhich is to lose forever all consciousness in death. Why should he not\nget rid of any other evolved lump of matter if it stand in the way of\nhis present or prospective happiness? Those are dangerous men who\ninculcate such theories; it were a sad day for the medical profession\nand for the world at large if ever they found much countenance among\nphysicians. Society cannot do without the higher law; this law is to be\nstudied in Medical Jurisprudence.\n\nIt is my direct object, gentlemen, to explain this law to you in its\nmost important bearings, and thus to lay before you the chief duties of\nyour profession. The principal reason why I have undertaken to deliver\nthis course of lectures--the chief reason, in fact, why the Creighton\nUniversity has assumed the management of this Medical College--is that\nwe wish to provide for the West, as far as we are able, a goodly supply\nof conscientious physicians, who shall be as faithful and reliable as\nthey will be able and well informed; whose solid principles and sterling\nintegrity shall be guarantees of upright and virtuous conduct.\n\nThat this task of mine may be successfully accomplished, I will endeavor\nto answer all difficulties and objections that you may propose. I will\nnever consider it a want of respect to me as your professor if you will\nurge your questions till I have answered them to your full satisfaction.\nOn the contrary, I request you to be very inquisitive; and I will be\nbest pleased with those who show themselves the most ready to point out\nthose difficulties, connected with my lectures, which seem to require\nfurther answers and explanations.\n\n\n\n\nLECTURE II.\n\nCRANIOTOMY.\n\n\nGentlemen:--In my first lecture I proved to you the existence and the\nbinding power of a higher law than that of human legislators, namely, of\nthe eternal law, which, in His wisdom, the Creator, if He created at\nall, could not help enacting, and which He is bound by His wisdom and\njustice to enforce upon mankind.\n\nWe are next to consider what are the duties which that higher law\nimposes upon the physician. In this present lecture I will confine\nmyself to one duty, that of respect for human life.\n\nA duty is a bond imposed on our will. God, as I remarked before, imposes\nsuch bonds, and by them He directs free beings to lead worthy lives. As\nHe directs matter by irresistible physical laws, so He directs\nintelligent and free beings by moral laws, that is, by laying duties or\nmoral bonds upon them, which they ought to obey, which He must require\nthem to obey, enforcing His commands by suitable rewards and\npunishments. Thus He establishes and enforces the moral order.\n\nNow the duties He lays upon us are of three classes. First, there are\nduties of reverence and honor towards Himself as our sovereign Lord and\nMaster. These are called the duties of Religion, the study of which does\nnot belong to Medical Jurisprudence. The other classes of duties regard\nourselves and our fellow-men, with these we are to deal in our lectures.\n\nI. Order requires that the meaner species of creatures shall exist for\nthe benefit of the nobler; the inert clod of earth supports vegetable\nlife, the vegetable kingdom supplies the wants of animal life, the brute\nanimal with all inferior things subserves the good of man; while man,\nthe master of the visible universe, himself exists directly for the\nhonor and glory of God. In this beautiful order of creation, man can use\nall inferior things for his own benefit.\n\nThis is what reason teaches concerning our status in this world; and\nthis teaching of reason is confirmed by the convictions of all nations\nand all ages of mankind. The oldest page of literature that has come\ndown to us, namely, the first chapter of the first book of Holy Writ,\nlays down this same law, and no improvement has been made in it during\nall subsequent ages. Whether we regard this writing as inspired, as\nChristians and Jews have always done, or only as the testimony of the\nmost remote antiquity, confirmed by the acceptance of all subsequent\ngenerations, it is for every sensible man of the highest authority.\n\nHere is the passage: \"God said, Let us make man to our image and\nlikeness; and let him have dominion over the fishes of the sea, and the\nfowls of the air, and the beasts, and the whole earth, and every\ncreeping creature that creepeth upon the earth.\" And later on in\nhistory, after the deluge, God more explicitly declared the order thus\nestablished, saying to Noe and his posterity: \"Every thing that moveth\nand liveth shall be meat for you; even as the green herbs have I\ndelivered them to you.\" But He emphatically adds that the lives of men\nare not included in this grant; they are directly reserved for His own\ndisposal. \"At the hand of every man,\" He says, \"will I require the life\nof man.\"\n\nAll things then are created for man; man is created directly for God,\nand is not to be sacrificed for the advantage of a fellow-man. Thus\nreason and Revelation in unison proclaim that we can use brute animals\nas well as plants for our benefit, taking away their lives when it is\nnecessary or useful to do so for our own welfare; while no man is ever\nallowed to slay his fellow-man for his own use or benefit: \"At the hand\nof every man will I require the life of man.\"\n\nII. The first practical application I will make of these general\nprinciples to the conduct of physicians is this: a physician and a\nstudent of medicine can, with a safe conscience, use any brute animal\nthat has not been appropriated by another man, whether it be bug or bird\nor beast, to experiment upon, whatever specious arguments humane\nsocieties may advance to the contrary. Brute animals are for the use of\nman, for his food and clothing, his mental and physical improvement, and\neven his reasonable recreations. Man can lawfully hunt and fish and\npractise his skill at the expense of the brute creation, notwithstanding\nthe modern fad of sentimentalists. The teacher and the pupil can use\nvivisection, and thus to some extent prolong the sufferings of the brute\nsubject for the sake of science, of mental improvement, and intelligent\nobservation. But is not this cruelty? and has a man a right to be cruel?\nNo man has a right to be cruel; cruelty is a vice, it is degrading to\nman's noble nature. But vivisection practised for scientific purposes is\nnot cruel. Cruelty implies the _wanton_ infliction of pain: there are\npeople who delight in seeing a victim tortured; this is cruelty or\nsavagery, and is a disgrace to man. Even to inflict pain without\nbenefit is cruel and wrong; but not when it is inflicted on the brute\ncreation for the benefit of man, unless the pain should be very great\nand the benefit very small. Certainly it is right to cultivate habits of\nkindness even to animals; but this matter must not be carried to excess.\n\nThe teaching of humane societies condemning all vivisection is due to\nthe exaggeration of a good sentiment and to ignorance of first\nprinciples. For they suppose that sufferings inflicted on brute animals\nare a violation of their rights. Now we maintain that brute animals have\nno rights in the true sense of the word. To prove this thesis we must\nexplain what a right is and how men get to have rights. A _right_ is a\nmoral claim to a thing, which claim other persons are obliged to\nrespect. Since every man has a destiny appointed for him by his Creator,\nand which he is to work out by his own acts, he must have the means\ngiven him to do so. For to assign a person a task and not to give him\nthe means of accomplishing it would be absurd. Therefore the Creator\nwants him to have those means, and forbids every one to deprive him of\nthose means. Here is the foundation of rights. Every man, in virtue of\nthe Creator's will, has certain advantages or claims to advantages\nassigned him which no other man may infringe. Those advantages and\nclaims constitute his rights, guaranteed him by the Creator; and all\nother men have the _duty_ imposed on them to respect those rights. Thus\nrights and duties are seen to be correlative and inseparable; the rights\nlodged in one man beget duties in other men. The same Creator that\nassigns rights to one man lays upon all others duties to respect those\nrights, that thus every free being may have the means of working out its\nHeaven-appointed destiny.\n\nThus it is apparent that rights and duties suppose free beings, persons;\nnow an irrational animal is not a person; it is not a free being, having\na destiny to work out by its free acts; it is therefore incapable of\nhaving duties. Duties are matters of conscience; therefore they cannot\nbelong to the brute animal; for it has no conscience. And, since rights\nare given to creatures because of the duties incumbent on them, brute\nanimals are incapable of having rights. When a brute animal has served\nman's purpose, it has reached its destiny.\n\nIII. But it is entirely different with man: there is what we may call an\ninfinite distance between man and brute. Every man is created directly\nfor the honor and service not of other men, but of God Himself: by\nserving God man must work out his own destiny--eternal happiness. In\nthis respect all men are equal, having the same essence or nature and\nthe same destiny. The poor child has as much right to attain eternal\nhappiness as the rich child, the infant as much as the gray-bearded\nsire. Every one is only at the beginning of an endless existence, of\nwhich he is to determine the nature by his own free acts. In this\ninfinite destiny lies the infinite superiority of man over the brute\ncreation.\n\nThat all men are equal in their essential rights is the dictate of\ncommon-sense and of sound philosophy. This truth may not flatter kings\nand princes; but it is the charter of human rights, founded deeper and\nbroader in nature and on the Creator's will than any other claim of\nmankind. As order requires the subordination of lower natures to higher,\nso it requires equality of essential rights among beings of the same\nnature. Now all men are of the same nature, hence they have all the same\nessential rights.\n\nIf any people on earth must stand by these principles, certainly the\nAmerican people must do so; for we have put them as the\nfoundation-stones of our civil liberty. There is more wisdom than many,\neven of its admirers, imagine in the preamble to our Declaration of\nIndependence; upon it we are to base the most important rights and\nduties which belong to Jurisprudence. The words of the preamble read as\nfollows: \"We hold these truths as self-evident, that all men are created\nequal; that they are endowed by their Creator with certain inalienable\nrights; that among these are life, liberty, and the pursuit of\nhappiness.\" I feel convinced, gentlemen, and I will take it for granted\nhenceforth, unless you bring objections to the contrary, that you all\nagree with me on this important point that _every man has a natural\nright to his life, a right which all other men are solemnly bound to\nrespect_. It is his chief earthly right. It is called an _inalienable_\nright; by which term the fathers of our liberty meant a right which\nunder no circumstances can be lawfully disregarded. A man who takes it\nupon himself to deprive another of life commits two grievous wrongs: one\ntowards his victim, whose most important right he violates, and one\ntowards God, who has a right to the life and service of His creatures.\n\"Thou shalt not kill\" is a precept as deeply engraven on the human heart\nby reason itself as it was on the stone tables of the Ten Commandments\nby Revelation.\n\nSo far we have chiefly considered murder as a violation of man's right\nto his life. We must now turn our attention to God's right, which the\nmurderer violates. It may indeed happen that a man willingly resigns\nhis right to live, that he is tired of life, and longs and implores for\nsome one to take it away. Can you then do it? You cannot. His life does\nnot belong to him alone, but to God also, and to God principally; if you\ndestroy it, you violate God's right, and you will have to settle with\nHim. God wills this man to live and serve Him, if it were only by\npatient endurance of his sufferings.\n\nFor a man may be much ennobled and perfected by the practice of patience\nunder pain and agony. Some of the noblest characters of history are most\nglorious for such endurance. The suicide rejects this greatness; he robs\nGod of service and glory, he rebels against his Creator. Even Plato of\nold understood the baseness of suicide, when he wrote in his dialogue\ncalled \"Ph\u00e6don\" that a man in this world is like a soldier stationed on\nguard; he must hold his post as long as his commander requires it; to\ndesert it is cowardice and treachery; thus, he says, suicide is a\ngrievous crime.\n\nThis being so, can a Doctor, or any other man, ever presume to\ncontribute his share to the shortening of a person's life by aiding him\nto commit suicide? We must emphatically say No, even though the patient\nshould desire death: the Doctor cannot, in any case, lend his\nassistance to violate the right and the law of the Creator: \"Thou shalt\nnot kill.\"\n\nI have no doubt, gentlemen, that some of you have been saying to\nyourselves, Why does the lecturer insist so long upon a point which is\nso clear? Of course, none of us doubts that we can in no case aid a\npatient to commit suicide. My reason for thus insisting on this matter\nis that here again we are dealing with a living issue. There are to-day\nphysicians and others who deny this truth, not in their secret practice\nonly, but, of late, to justify their conduct, they have boldly\nformulated the thesis that present apparent expediency can lawfully be\npreferred to any higher consideration. Here is the fact. At a\nMedico-Legal Congress, held in the summer of 1895, Dr.\u00a0Bach, one of its\nleading lights, openly maintained it as his opinion that \"Physicians\nhave the moral right to end life when the disease is incurable, painful,\nand agonizing.\"\n\nWhat his arguments were in support of his startling proposition, I have\nnot been able to learn. But I know that a cry of horror and indignation\nhas gone up from many a heart. Many have protested in print; but unless,\non an occasion like this, moralists raise their voice against it with\nall the influence which sound principles command, the saying of\nDr.\u00a0Bach may at least shake the convictions of the rising generation of\nphysicians. The only argument for Dr. Bach's assertion that I can\nimagine--and it is one proceeding from the heart rather than the\nhead--is that it is cruel to let a poor man suffer when there is no\nlonger hope of recovery. It is not the Physician that makes him suffer;\nit is God who controls the case, and God is never cruel.\n\nHe knows His own business, and forbids you to thwart His designs. If the\nsufferer be virtuous, God has an eternity to reward his patient\nendurance; if guilty, the Lord often punishes in this world that He may\nspare in the next. Let Him have His way, if you are wise; His command to\nall is clear, \"Thou shalt not kill.\"\n\nOne rash utterance, like that of Dr.\u00a0Bach, can do an incalculable amount\nof harm. Why, gentlemen, just think what consequences must follow if his\nprinciple were, admitted! For the only reason that could give it any\nplausibility would be that the patient's life is become useless and\ninsupportable. If that were a reason for taking human life away, then it\nwould follow that, whenever a man considers his life as useless and no\nlonger supportable, he could end it, he could commit suicide. That\nreasoning would practically justify almost all suicides. For, when\npeople kill themselves, it is, in almost all cases, because they\nconsider their lives useless and insupportable. Whether it results from\nphysical or from moral causes that they consider their life a burden,\ncannot, it seems to me, make any material difference; grief, shame,\ndespair are as terrible sufferings as bodily pains. If, then, we accept\nDr.\u00a0Bach's principle, we must be prepared for all its baneful\nconsequences.\n\nIV. But are there no exceptions to the general law, \"Thou shalt not\nkill\"? Are there no cases in which it is allowed to take another's life?\nWhat about justifiable homicide? There are three cases of this nature,\ngentlemen; namely, self-defence, capital punishment inflicted by the\nstate, and active warfare. With only one of these can a physician, as\nsuch be concerned or think himself concerned. He is not a public hangman\nexecuting a sentence of a criminal court; nor is he acting as a soldier\nproceeding by public authority against a public foe. As to the plea of\nself-defence, it must be correctly understood, lest he usurp a power\nwhich neither human nor divine law has conferred upon him.\n\n1. _Self-defence._ It is a dictate of common-sense, already quoted by\nCicero as a universally received maxim of Jurisprudence in his day, that\nit is justifiable to repel violence by violence, even if the death of\nour unjust assailant should result. In such a case, let us consider what\nreally takes place. A ruffian attempts to take away my life; I have a\nright to my life. I may, therefore, protect it against him; and, for\nthat purpose, I may use all lawful means. A lawful means is one that\nviolates no law, one that I may use without giving any one reasonable\nground of complaint. Suppose I have no other means to protect my life\nthan by shooting my aggressor; has he a right to complain of my conduct\nif I try to do so? No, because he forces me to the act; he forces me to\nchoose between my life and his. Good order is not violated if I prefer\nmy own life: well-ordered charity begins at home. But is not God's right\nviolated? It is; for God has a right to my life and to that of my\nassailant. The ruffian who compels me to shoot him is to blame for\nbringing both our lives into danger; he is responsible for it to God.\nBut the Creator will not blame me for defending my life by the only\nmeans in my power, and that when compelled by an unjust assailant, who\ncannot reasonably find fault with my conduct.\n\nBut it may be objected that no evil act may be done to procure a good\nresult, that a good end does not justify a bad means. That is a correct\nprinciple, and we will consider it carefully some other day. But my act\nof necessary self-defence is not evil, and therefore needs no\njustification; for the means I employ are, under the circumstances,\nwell-ordered and lawful means, which violate no one's rights, as has\njust been shown. Of course the harm I do to the aggressor is just only\nin as far as it is strictly necessary to defend the inalienable right I\nhave to life or limb or very valuable property. Hence I must keep within\nthe just limits of self-defence. To shoot an assailant, when I am in no\nserious danger, or when I can free myself some other way, or when I act\nthrough malice, would not be self-defence, but unjustifiable violence on\nmy part.\n\n2. The principles that make it lawful for a man to defend his own life\nwith violence against an unjust assailant will also justify a parent in\nthus defending his children, a guardian his wards; and in fact any one\nmay forcibly defend any other human being against unjust violence. A\nparent or guardian not only can, but he is in duty bound to, defend\nthose under his charge by all lawful means. Similarly the physician\nwould be obliged to defend his patient by the exercise of his profession\nin his behalf.\n\nNow the only case in which the need of medical treatment against unjust\naggression could become a matter for discussion in Jurisprudence is the\ncase of a mother with child. Is the child under those circumstances\nreally an unjust aggressor? Let us study that important case with the\nclosest attention. Let all the rays of light we have gathered so far be\nfocussed on this particular point. Can a physician ever be justified in\ndestroying the life of a child, before or during its birth, by\ncraniotomy or in any other manner, in order to save its mother's life,\non the plea that the child is an unjust assailant of the life of its\nmother? Put the case in a definite shape before you. Here is a mother in\nthe pangs of parturition. An organic defect, no matter in what shape or\nform, prevents deliverance by the ordinary channels. All that medical\nskill can do to assist nature has been done. The case is desperate.\nOther physicians have been called in for consultation, as the civil law\nrequires before it will tolerate extreme measures. All agree that, if no\nsurgical operation is performed, both mother and child must die. There\nare the C\u00e6sarian section, the Porro operation, laparotomy,\nsymphysiotomy, all approved by science and the moral law. But we will\nsuppose an extreme case; namely, the circumstances are so unfavorable\nfor any of these operations--whether owing to want of skill in the\nDoctors present, or for any other reason--that none can safely be\nattempted; any of them would be fatal to the mother.\n\nIn this extreme case of necessity, can the Doctor break the cranium of\nthe living child, or in any way destroy its life with a view to save the\nmother? If three consulting physicians agree that this is the only way\nto save her, he will not be molested by the law courts for performing\nthe murderous operation. But will the law of nature and of nature's God\napprove or allow his conduct? This is the precise question under our\nconsideration. We have seen that the infant, a true human being, has a\nright to live, as well as its mother. \"All men are created equal, and\nhave an equal right to life,\" declares the first principle of our\nliberty. The Creator, too, as reason teaches, has a clear right to the\nchild's life; that child may answer a very special purpose of\nProvidence. But whether it will or not, God is the supreme and the only\nMaster of life and death, and He has laid down the strict prohibition,\n\"Thou shalt not kill.\"\n\nNow comes the plea of self-defence against an unjust aggressor. If the\nchild is such, if it _unjustly_ attacks its mother's life, then she can\ndestroy it to save herself, and her physician can aid the innocent\nagainst the guilty party. But can it be proved that the infant is an\nunjust aggressor in the case? There can be no intentional or _formal_\nguilt in the little innocent babe. But can we argue that the actual\nsituation of the child is an unjust act, unconsciously done, yet\n_materially_ unjust, unlawful? Thus, if a madman would rush at me with a\nsharp sword, evidently intent on killing me, he may be called an unjust\naggressor; though, being a raving maniac, he does not know what crime he\nis committing, and is _formally_ innocent of murderous intent.\n_Materially_ considered, the act is unjust, and I can defend myself\nlawfully as against any other unjust assailant. Such is the common\nteaching of moralists. But can the innocent babe be classed in the same\ncategory with the raving maniac? Why should it? It is doing nothing; it\nis merely passive in the whole process of parturition.\n\nWill any one object that the infant has no right to be there at all? Who\nput it there? The only human agents in the matter were its parents. The\nmother is more accountable for the unfortunate situation than the child.\nCertainly you could not, to save the child, directly kill the mother,\ntreating her as an unjust assailant of her child's life? Still less can\nyou treat the infant as an unjust assailant of its mother's life.\n\nThe plea of self-defence against unjust aggression being thus ruled out\nof court in all such cases, and no other plea remaining for the\ncraniotomist, we have established, on the clearest principles of Ethics\nand Jurisprudence, that it is never allowed directly to kill a child as\na means to save its mother's life. It would be a bad means, morally\nevil; and no moral evil can ever be done that good may come of it; the\nend cannot justify an evil means. In theory all good men agree with us\nthat the end can never justify the means. But in practice it seems to be\ndifferent with some of the medical profession. Of late, however, the\npractice of craniotomy and all equivalent operations upon living\nsubjects has gone almost entirely out of fashion among the better class\nof physicians.\n\nAllow me, gentlemen, to conclude this lecture with the reading of two\nextracts from articles of medical writers on the present state of\ncraniotomy in their profession. You will find them in accord with the\nconclusions at which we have arrived by reasoning upon the principles of\nJurisprudence.\n\nDr.\u00a0W.\u00a0H. Parish writes (\"Am. Eccles. Review,\" November, 1893, p.\u00a0364):\n\"The operations of craniotomy and embryotomy are to-day of relatively\ninfrequent occurrence, and many obstetricians of large experience have\nnever performed them. Advanced obstetricians advocate the performance of\nthe Cesarian section or its modification--the Porro operation--in\npreference to craniotomy, because nearly all the children are saved,\nand the unavoidable mortality among mothers is not much higher than that\nwhich attends craniotomy. Of one hundred women on whom Cesarian section\nis performed under _favorable conditions_ and with _attainable_ skill,\nabout ninety-five mothers should recover and fully the same number of\nchildren. Of one hundred craniotomies, ninety-five mothers or possibly a\nlarger number will recover, and of course none of the children. The\nproblem resolves itself into this: Which shall we choose--Cesarian\nsection with one hundred and ninety living beings as the result, or\ncraniotomy with about ninety-five living beings?\"\n\nEven if a liberal deduction be made for unfavorable circumstances and\ndeficient skill, the results, gentlemen, will still leave a wide margin\nin favor of Cesarian section. My second extract is from an article of\nDr.\u00a0M. O'Hara, and it is supported by the very highest authorities (ib.\np.\u00a0361): \"Recently [August\u00a01, 1893] the British Medical Association, the\nmost authoritative medical body in Great Britain, at its sixty-first\nannual meeting, held at Newcastle-upon-Tyne, definitely discussed the\nsubject before us. In the address delivered at the opening of the\nsection of Obstetric Medicine and Gynecology, an assertion was put forth\nwhich I regard as very remarkable, my recollection not taking in any\nsimilar pronouncement made in any like representative medical body. The\nauthoritative value of this statement, accepted as undisputed by the\nmembers of the association, which counts about fifteen thousand\npractitioners, need not be emphasized.\n\n\"Dr.\u00a0James Murphy ('British Medical Journal,' August\u00a026, 1893), of the\nUniversity of Durham, made the presidential address. He first alluded to\nthe perfection to which the forceps had reached for pelves narrowed at\nthe brim, and the means of correcting faulty position of the f\u0153tus\nduring labor. He then stated: 'In cases of great deformity of the\npelvis, it has long been the ambition of the obstetrician, where it has\nbeen impossible to deliver a living child _per vias naturales_, to find\nsome means by which that child could be born alive with comparative\nsafety to the mother; and that time has now arrived. It is not for me to\ndecide,' he says, 'whether the modern Cesarian section, Porro's\noperation, symphysiotomy, ischiopubotomy, or other operation is the\nsafest or most suitable, nor yet is there sufficient material for this\nquestion to be decided; but when such splendid and successful results\nhave been achieved by Porro, Leopold, Saenger, and by our own Murdoch\nCameron, I say it deliberately and with whatever authority I possess,\nand I urge it with all the force I can master, that we are not now\njustified in destroying a living child; and while there may be some\nthings I look back upon with pleasure in my professional career, that\nwhich gives me the greatest satisfaction is that I have never done a\ncraniotomy on a living child.'\"\n\nYou will please notice, gentlemen, that when this distinguished Doctor\nsaid, \"We are not _now_ justified in destroying a living child,\" he was\nspeaking from a medical standpoint, and meant to say that such\ndestruction is now scientifically unjustifiable, is a blunder in\nsurgery. From a moral point of view it is not only now, but it was\nalways, unjustifiable to slay a child as a means to save the mother's\nlife; a good end cannot justify an evil means, is a truth that cannot be\ntoo emphatically inculcated. This is one of the most important subjects\non which Medical Jurisprudence has been improved, and most of its\ntext-books are deficient. The improvement is explained with much\nscientific detail in an address of the President, Samuel C. Busey, M.D.,\nbefore the Washington Obstetrical and Gynecological Society (\"Am.\nJournal of Obstetrics and Diseases of Women and Children,\" vol.\u00a0xvii.\nn.\u00a02).\n\n\n\n\nLECTURE III.\n\nABORTION.\n\n\nAbortion, gentlemen, is the theme of my present lecture.\n\nI. An important point to be determined is the precise time when the\nhuman embryo is first animated by its own specific principle of life,\nits human soul. It is interesting to read what various conjectures have\nbeen ventured on this subject by the learned of former ages. They were\ntotally at sea. Though gifted with keen minds, they had not the proper\ndata to reason from. And yet some of those sages made very shrewd\nguesses. For instance, as early as the fourth century of our era,\nSt.\u00a0Gregory of Nyssa taught the true doctrine, which modern science has\nnow universally accepted. He taught that the rational soul is created by\nAlmighty God and infused into the embryo at the very moment of\nconception. Still, as St. Gregory could not prove the certainty of his\ndoctrine, it was opposed by the majority of the learned.\n\nThe Schoolmen of the Middle Ages, while condemning abortion from the\ntime of conception, preferred the opinion of Aristotle, that the\nrational soul is not infused till the f\u0153tus is sufficiently developed to\nreceive it. The embryo lived first, they taught, with a vegetable life;\nafter a few days an animal soul replaced the vegetative principle; the\nhuman soul was not infused into the tiny body till the fortieth day for\na male, and the eightieth day for a female child. All this sounds very\nfoolish now; and yet we should not sneer at their ignorance; had we\nlived in their times, we could probably have done no better than they.\n\nIt was not till 1620 that Fienus, a physician of Louvain, in Belgium,\npublished the first book of modern times that came near the truth. He\nmaintained that the human soul was created and infused into the embryo\nthree days after conception. Nearly forty years later, in 1658, a\nreligious priest, called Florentinius, wrote a book in which he taught\nthat, for all we know, the soul may be intellectual or human from the\nfirst moment of conception; and the Pope's physician Zachias soon after\nmaintained the thesis as a certainty that the human embryo has from the\nvery beginning a human soul.\n\nGreat writers applauded Fienus and his successors; universities favored\ntheir views; the Benedictines, the Dominicans, and the Jesuits supported\nthem. Modern science claims to have proved beyond all doubt that the\nsame soul animates the man that animated the f\u0153tus from the very moment\nof conception. The \"Medical Jurisprudence\" of Wharton and Still\u00e9 quotes\nDr.\u00a0Hodge of the Pennsylvania University as follows (p.\u00a011): \"In a most\nmysterious manner brought into existence, how wonderful its formation!\nImperfect in the first instance, nay, even invisible to the naked eye,\nthe embryo is nevertheless endowed, at once, with the principles of\nvitality; and although retained in the system of its mother, it has, in\na strict sense, an independent existence. It immediately manifests all\nthe phenomena of _organic_ life; it forms its own fluids and circulates\nthem; it is nourished and developed; and, very rapidly from being a\n_rudis indigestaque moles_, apparently an inorganic drop of fluid, its\norgans are generated and its form perfected. It daily gains strength and\ngrows; and, while still within the organ of its mother, manifests some\nof the phenomena of animal life, especially as regards mobility. After\nthe fourth month its motions are perceptible to the mother, and in a\nshort period can be perceived by other individuals on close\ninvestigation.\n\n\"The usual impression,\" the authors add, \"and one which is probably\nstill maintained by the mass of the community, is that the embryo is\nperfected at the period of quickening--say the one hundred and twelfth\nor one hundred and twentieth day. When the mother first perceives\nmotion, is considered the period when the f\u0153tus becomes animated--when\nit receives its spiritual nature into union with its corporeal.\n\n\"These and similar suppositions are, as has been already shown, contrary\nto all fact, and, if it were not for the high authorities--medical,\nlegal, and theological--in opposition, we might add, to common-sense.\"\n\nAt present, gentlemen, there seems to be no longer any authority to the\ncontrary. But many people, and some Doctors, seem to be several\ngenerations behind the times; for they still act and reason as if in the\nfirst weeks of pregnancy no immortal or human soul were in question.\n\nPhysicians worthy of their noble profession should strive to remove such\ngross and mischievous ignorance. In many of the United States the law\ncasts its protection around an unborn infant from its first stage of\nascertainable existence; no matter whether \"quickening\" has taken place\nor not, and consequently no matter what may be the stage of gestation,\nan indictment lies for its wilful destruction (Wharton and Still\u00e9,\np.\u00a0861). \"Where there has been as yet no judicial settlement of the\nimmediate question, it may be reasonably contended that to make the\ncriminality of the offence depend upon the fact of quickening is as\nrepugnant to sound morals as it is to enlightened physiology\" (ib.).\n\"That it is inconsistent with the analogies of the law is shown by the\nfact that an infant, born even at the extreme limit of gestation after\nits father's death, is capable of taking by descent, and being appointed\nexecutor\" (ib.). Dr.\u00a0Hodge adds this sensible remark: \"It is _then_ only\n[at conception] the father can in any way exert an influence over his\noffspring; it is _then_ only the female germ is in direct union with the\nmother--the connection afterwards is indirect and imperfect\" (ib.). The\nfact, therefore, is now scientifically established that the embryo from\nthe first moment of conception or fecundation is a human being, having a\nhuman immortal soul.\n\nII. Now we come to the direct study of abortion. Abortion, or\nmiscarriage, strictly means the expulsion of the f\u0153tus before it is\nviable, i.e., before it is sufficiently developed to continue its life\noutside of the maternal womb. The period of arrival at viability is\nusually after the twenty-eighth week of gestation. When birth occurs\nlater than that period, and yet before the full term of nine months, it\nis called _premature birth_, which is altogether different from\nabortion; for it may save the life of the child, which abortion always\ndestroys. \"Premature labor is frequently induced in legitimate medical\npractice, for the purpose of avoiding the risks which in some cases\nattend parturition at term.... The average number of children saved by\nthis means is rather more than one-half of the cases operated upon,\" say\nWharton and Still\u00e9 (\"Parturition,\" p.\u00a096). But they caution the\nphysician against too ready recourse to this treatment; for, they add\nvery truly, \"The sympathetic phenomena of pregnancy are often more\nalarming in appearance than in reality, and will rarely justify any\ninterference with the natural progress of gestation. In all cases the\nphysician should consult with one or more of his colleagues before\ninducing premature labor; in this manner his humane intentions will not\nexpose him, in case of failure, to reproach, suspicion, or prosecution.\"\n\nThe first time my attention was practically called to the case of a\nchild in danger of dying before the time of delivery occurred over\ntwenty years ago, when the mother of a highly respected family, then in\nmy spiritual charge, was wasting away with consumption during her state\nof pregnancy. You know that we Catholics are very solicitous that\ninfants shall not die without Baptism, because we believe that heaven\nis not promised to the unbaptized. I therefore directed the lady's\nhusband to consult their family physician on the prospects of the case,\nand take timely precautions, so that, if death should come on the mother\nbefore her delivery, the infant might be reached at once and be baptized\nbefore it expired. The physician, a learned and conscientious\npractitioner, answered that we should not be solicitous; for that Nature\nhad so provided that mothers in such cases rarely die before the child\nis born. He was right. The child was born and baptized; the mother died\na few hours later; the little one lived several weeks before it went to\njoin the angels in heaven. I learned from that occurrence the lesson\nwhich Wharton and Still\u00e9 inculcate that \"the phenomena of pregnancy are\noften far more alarming in appearance than in reality, and we are rarely\njustified in interfering with the natural progress of gestation.\"\n\nTo return to our subject. Abortion, or miscarriage, is often, as you\nknow, gentlemen, the result of natural causes beyond human control; at\nother times it is brought on by unintentional imprudence on the part of\nthe mother or her attendants. It is the duty of the family physician,\nwhen occasions offer, to instruct his pregnant patients and other\npersons concerned on the dangers to be avoided. A good Doctor should be\nto his patients what a father is to his children; very important matters\nare confided to him, and therefore grave responsibilities rest on his\nconscience.\n\nIII. We are now ready to consider the chief question of this lecture,\nnamely, whether there can be any cases in which a physician is justified\nin bringing about an abortion, or in prescribing a treatment from which\nhe knows an abortion is likely to result.\n\n1. It is evident that, if he acts with due prudence, and yet, from some\ncause which he did not foresee and could not have been foreseen, his\ntreatment brings about a miscarriage, he cannot justly be held\naccountable for what he could not help.\n\n2. But what if he foresees that a drug or treatment, which, he thinks,\nis needed for the mother's health, may perhaps bring on a miscarriage?\nCan he still administer that drug or prescribe that treatment? Notice\nthe question carefully. It is not supposed that he wants to bring on the\nmiscarriage. He does not; he will do all he can to prevent it. Nor will\nhis treatment or drug directly destroy the life or the organism of the\nembryo; but it is intended to affect favorably the system of the mother,\nand it is applied to her own organism. Still the Doctor knows that the\nprescription may indirectly bring about abortion. Can he prescribe the\ndrug or treatment from which he knows the death of the f\u0153tus may\nindirectly result, the direct purpose being to remove an ailment of the\nmother's?\n\nThere is a sound moral principle bearing on such cases; it is\nuniversally admitted in Ethics and Jurisprudence, and its application is\nso extensive that it well deserves careful study. It is this: \"He who\nwilfully puts a cause is answerable for the effect of that cause,\"\n_causa caus\u00e6 est causa causati_. Therefore, if the effect is evil, he is\nanswerable for that evil. This, however, supposes that he could foresee\nthe danger of such evil effect.\n\nThat evil effect is said to be _indirectly_ willed; for it follows from\na cause which is _directly_ willed. If, then, you should give a dose to\na pregnant mother which is intended to stop her fever or other ailment,\nbut may also bring on abortion, the stopping of her fever is directly\nintended, and the abortion is said to be indirectly intended or willed.\nThose are the received terms in moral science. It were more correct to\nsay that the abortion in this case is an effect not intended at all, but\nonly _permitted_. That, then, which is permitted to result from our\nacts is said to be indirectly willed.\n\nAre we then always responsible for evil effects permitted or indirectly\nwilled? The principle laid down seems to say so. But then that principle\nadmits of important exceptions. If we could never do an act from which\nwe know evil consequences may follow, then we could scarcely do anything\nof importance; a young man could certainly not become a physician at\nall, for he is almost certain to injure some of his patients in the\ncourse of his professional life. But if we had no Doctors, such a loss\nwould be a much greater evil to mankind than their occasional mistakes.\nHere then we seem to be in a dilemma, with evil on both sides of us. And\nthen we are reminded of that other principle of which we spoke before,\nthat we may never do evil at all that good may come of it. What shall we\ndo? The solution is this: we should never _do_ evil, but we are often\njustified in _permitting_ evil to happen; in other words, we can never\nwill evil _directly_, but we can often will it _indirectly_: we can do\nwhat is right in itself, even though we know or fear that evil will\nalso result from our good act.\n\nThis conduct requires four conditions: 1. That we do not wish the evil\nitself, but make all reasonable effort to avoid it. 2. That the\nimmediate effect we wish to produce is good in itself. 3. That the good\neffect intended is at least as important as the evil effect permitted.\n4. That the evil is not made a means used to obtain the good effect.\n\nNow let us apply these principles to the case in hand.\n\n1. If the medicine is necessary to save the mother's life, and it is not\ncertain to bring on abortion, though it is likely to do so, then the\ngood effect is greater and more immediate or direct than the bad effect;\nthen give the medicine to save the mother, and permit the probable death\nof the child.\n\n2. If the medicine is not necessary to save the mother's life, though\nvery useful, for the sake of such an advantage, you cannot justly expose\nthe child's life to serious danger.\n\n3. But if the danger it is exposed to is not serious but slight, and the\nremedy, though not necessary, is expected to be very useful to the\nmother, you may then administer the medicine; for a slight risk need not\nprevent a prudent man from striving to obtain very good results.\n\n4. But what if the drug is necessary to save the mother, and as\ndangerous to the child as it is beneficial to her; can you then give the\nmedicine with the moral certainty that it will save her and kill her\nchild? When we know principles clearly we can apply them boldly. I\nanswer then with this important distinction: you can give such medicine\nas will act on her system, her organs, in a manner to save her life, and\nyou may permit the sad effects which will indirectly affect the child;\nbut you cannot injure the child directly as a means to benefit her\nindirectly; that would be using a bad means to obtain a good end.\n\nSuppose, then, what is said to be a real case of occasional recurrence\nin obstetrical practice, namely, that a pregnant mother is seized with\nviolent and unceasing attacks of vomiting, so that she must die if the\nvomiting be not stopped; and you, as well as the consulting physician\ncalled in, can discover no means of relieving the vomiting except by\nprocuring an abortion, by relieving the womb of its living burden.\nAbortion is then the means used to stop the vomiting. Are you justified\nin using that means? Abortion is the dislodging of the child from the\nonly place where it can live and where nature has placed it for that\npurpose. Therefore abortion directly kills the child, as truly as\nplunging a man under water kills the man. Can you thus kill the child to\nsave the mother? You _cannot_. Neither in this case nor in any other\ncase can you do evil that good may come of it.\n\nYou notice, gentlemen, that I lay great stress on, this principle that\n_the end can never justify the means_. It is an evident principle, which\nall civilized nations acknowledge. Its opposite, that the end justifies\nthe means, is so odious that the practice of it is a black stamp of\nignominy on any man or any set of men that would be guilty of it. The\nCatholic Church has, all through her course of existence, taught the\nmaxim that the end cannot justify the means. She has impressed it on the\nlaws and hearts of all Christian peoples. She inculcates it in the\nteachings of all her theologians and moral philosophers and in all her\nchannels of education. And since we Jesuits are among her leading\neducators and writers, we have maintained that thesis in thousands of\nprinted volumes, as firmly as I am maintaining it before you to-day. No\nJesuit ever, nor any Catholic theologian or philosopher, has taught the\ncontrary. And yet even such pretentious works as the \"Encyclop\u00e6dia\nBritannica\" have carried all over the earth the slander that we teach\nthe opposite maxim, that the end does justify the means, and the odious\nterm _Jesuitry_ has been coined to embody that slander.\n\nIs it not strange then, very strange, that they who thus falsely accuse\nus are often the very men who will procure an abortion to save the\nmother's life, who will do wrong that good may come of it? And you find\nsuch men maintaining the lawfulness of abortion on the plea that the\noperation, whether licit or not, is a necessary means to obtain a good\nend.\n\nIV. Gentlemen, if once you grant that grave reasons would justify\nabortion, there is no telling where you will stop in your career of\ncrime. To-day, for instance, you are called to attend a mother, who, you\nthink, must die if you do not bring on a miscarriage. You are urged to\ndo it by herself and her husband, and perhaps by other physicians. There\nare money considerations too, and the possible loss of practice. Will\nyou yield to the temptation? The next day you are visited by a most\nrespectable lady; but she has been unfaithful to her marriage vow. The\nconsequences of her fall are becoming evident. If her husband finds out\nher condition, he may wreak a terrible vengeance. Her situation is\nsadder than that of the sick mother of the preceding day. You can easily\nremove the proof of her guilt, we will suppose, and spare a world of\nwoes. Will you withstand the temptation? The third day comes a young\nlady, a daughter of an excellent family; bright prospects lie before\nher; her parents' lives and happiness are wrapped up in that girl. But\nin an evil hour she has been led astray. Now she is with child. She\nbegs, she implores you to save her from ruin, and her parents from\ndespair. If you do not help her, some other Doctor or a quack will do\nit; but you could do it so much better. If you should have yielded on\nthe two former occasions, if you have already stained your heart with\ninnocent blood, will you now refuse? Where are you going to draw the\nline?\n\nThe passions of men are insatiate, even in modern society; the more you\nyield to them, the stronger grows their craving. Let me illustrate my\nmeaning by a fact that happened a few years ago in Russia. It is just to\nour point. During a severe winter, a farmer, having his wife and\nchildren with him on a wagon, was driving through a wild forest. All was\nstill as death except the howling of wolves in the distance. The howling\ncame nearer and nearer. After a while a pack of hungry wolves was seen\nfollowing in the track of the wagon. The farmer drove on faster, but\nthey gained on him. It was a desperate race to keep out of their reach.\nAt last they are just back of the wagon. What can be done? The next\nmoment the wolves may jump on the uncovered vehicle. The children,\nhorrified, crouch near their trembling mother. Suddenly the father,\ndriven to despair, seizes one of the little children and flings it among\nthe pack of wolves, hoping that by yielding them one he may save the\nrest. The hungry beasts stop a few moments to fight over their prey. But\nsoon they are in hot pursuit again, fiercer because they have tasted\nblood. A second child is thrown to them, and after a while a third and a\nfourth.\n\nHuman society, gentlemen, in this matter of sacrificing f\u0153tal life is as\ninsatiable as a pack of hungry wolves. Woe to any one of you if he\nbegins to yield to its cravings; there is no telling where he will stop.\nIn proof of my statement, let me read to you an extract from a lecture\non Obstetrics, delivered by Doctor Hodge, of Philadelphia, to the\nmedical students of the University of Pennsylvania: \"We blush while we\nrecord the fact, that, in this country, in our cities and towns, in this\ncity where literature, science, morality, and Christianity are supposed\nto have so much influence; where all the domestic and social virtues are\nreported as being in full and delightful exercise; even here\nindividuals, male and female, exist who are continually imbruing their\nhands and consciences in the blood of unborn infants; yea, even medical\nmen are to be found who, for some trifling pecuniary recompense, will\npoison the fountains of life, or forcibly induce labor, to the certain\ndestruction of the f\u0153tus and not infrequently of the parent.\n\n\"So low, gentlemen, is the moral sense of the community on this subject,\nso ignorant are the greater number of individuals, that even mothers, in\nmany instances, shrink not from the commission of this crime, but will\nvoluntarily destroy their own progeny, in violation of every natural\nsentiment and in opposition to the laws of God and man. Perhaps there\nare few individuals in extensive practice who have not had frequent\napplications made to them by the fathers and mothers of unborn infants\n(respectable and polite in their general appearance and manners) to\ndestroy the fruit of illicit pleasure, under the vain hope of preserving\ntheir reputation by this unnatural and guilty sacrifice.\n\n\"Married women, also, from the fear of labor, from indisposition to have\nthe care, the expense, or the trouble of children, or some other motive\nequally trifling and degrading, have solicited that the embryo should be\ndestroyed by their medical attendant. And when such individuals are\ninformed of the nature of the transaction, there is an expression of\nreal or pretended surprise that any one should deem that act improper,\nmuch more guilty; nay, in spite even of the solemn warnings of the\nphysician, they will resort to the debased and murderous charlatan, who,\nfor a piece of silver, will annihilate the life of the f\u0153tus, and\nendanger even that of its ignorant or guilty mother.\n\n\"This low estimate of the importance of f\u0153tal life is by no means\nrestricted to the ignorant or to the lower classes of society. Educated,\nrefined, and fashionable women, yea, in many instances, women whose\nlives are in other respects without reproach--mothers who are devoted\nwith an ardent and self-denying affection to the children who already\nconstitute the family--are perfectly indifferent concerning the f\u0153tus\n_in utero_. They seem not to realize that the being within them is\nindeed _animate_, that it is in verity a _human_ being, body and spirit;\nthat it is of importance; that its value is inestimable, having\nreference to this world and the next. Hence they in every way neglect\nits interests. They eat and drink, they walk and ride; they will\npractise no self-restraint, but will indulge every caprice, every\npassion, utterly regardless of the unseen, unloved embryo....\n\n\"These facts are horrible, but they are too frequent and too true;\noften, very often, must all the eloquence and all the authority of the\npractitioner be employed; often he must as it were grasp the conscience\nof his weak and erring patient, and let her know, in language not to be\nmisunderstood, that she is responsible to her Creator for the life of\nthe being within her.\" (Wharton and Still\u00e9's Med. Jur., Parturition,\np.\u00a092.)\n\nDr.\u00a0Walter Channing, of Massachusetts, refers to the difficulty of\nobtaining a conviction for abortion, and adds: \"I believe there has\nnever been one in this State, this moral State by eminence, and perhaps\nin none is this crime more rife.\" (\"Boston Med. and Surg. Journal,\"\nApril, 1859, p.\u00a0135).\n\nV. We have, then, proved, gentlemen, two important and pregnant\nprinciples: 1. That we can never directly procure abortion, and 2, that\nwe can procure it indirectly in extreme cases; or rather that we can\ntake such extreme measures in pressing danger as may likely result in\nabortion against our will.\n\nWhile these principles are clear and undoubted, there are cases in which\nthe right application of them is beset with great difficulties. These\noften occur in connection with what is called _ectopic_ or\n_extra-uterine gestation_, namely, when the nascent human form lodges in\nsome recess not intended by nature for its abode. Of late years,\nDr.\u00a0Velpeau, of Paris; Dr. Tait, of Birmingham, and many other eminent\nphysicians have shown that cases of ectopic gestation are more numerous\nthan had been supposed; one practitioner reports that he had attended\nfifty cases, another eighty-five.\n\n1. We will first suppose the case of an interior growth occurring, the\nnature of which cannot be determined. It may be only a tumor, yet it may\nbe the growth of a living f\u0153tus. If no immediate crisis is feared, you\nwill wait, of course, for further developments. If it proves to be a\nchild, you will attempt no operation till it becomes viable at least.\nBut suppose that fatal consequences are apprehended before the presence\nof a human being can be ascertained by the beating of the heart; suppose\nthat delay would endanger the mother's life; and yet if you undertake to\ncut out the tumor, you may find it to contain f\u0153tal life. In such urgent\ndanger, can you lawfully perform the operation? Let us apply our\nprinciples. You mean to operate on a tumor affecting one of the mother's\norgans. The consequences this may have for the child are not directly\nwilled, but permitted. The four conditions mentioned before are hereby\nverified, under which the evil result, the death of the possible f\u0153tus,\nmay be lawfully permitted; namely: (_a_) You do not wish its death;\n(_b_) What you intend directly, the operation on the mother's organism,\nis good in itself; (_c_) The good effect intended, her safety, to which\nshe has an undoubted right, overbalances the evil effect, the possible\ndeath of the child, whose right to life is doubtful, since its very\nexistence is doubtful; now, a certain right must take precedence of a\ndoubtful right of the same species; (_d_) The evil is not made the means\nto obtain the good effect (see \"Am. Eccl. Rev.,\" Nov., 1893, p.\u00a0353).\nThis last condition would not be verified if it were proposed, not to\ncut out the cyst, but to destroy its contents by an electric current.\nThen, it would seem, the f\u0153tus itself, if there be one, would be\ndirectly attacked.\n\n2. The case would present greater difficulties if the growth in question\nwere _known_ to contain a living f\u0153tus. Such a case is discussed in all\nits details, with remarkable philosophical acumen, and in the light of\ncopious information furnished by prominent members of the medical\nprofession, in the pages of the \"American Ecclesiastical Review\" for\nNovember, 1893, pages 331-360. The participants in this interesting\ndiscussion are writers who enjoy a world-wide reputation for keenness of\nintellect and soundness of doctrine in philosophical and theological\nlearning. They are not at all agreed as to the practical conclusion\narrived at, and even those who agree to the same conclusion do so for\ndifferent reasons. Three of them agree that in the case of a cyst known\nto contain a living embryo, when a rupture most probably fatal to mother\nand child is imminent, the abdominal section might be performed\nlawfully, the cyst opened and the child baptized before its certain\ndeath. Two of these justify this conclusion on the principle that the\ndeath of the child is then permitted only or indirectly intended; one\nmaintains that the killing of the embryo is then directly procured, but\nhe considers that an embryo in a place not intended for it by nature is\nwhere it has no right to be, and therefore may be treated as an unjust\naggressor upon the mother's life. At least one of the disputants\ncondemns the operation as absolutely unlawful.\n\nGentlemen, when such authorities disagree, I would not presume to\nattempt a theoretic decision. But then we have this other principle\npractically to guide us, that in matters so very doubtful we need not\ncondemn those who differ from our view, as long as they feel convinced\nthat they are acting wisely and prudently. In Jurisprudence, reason must\nbe our guide when it affords us evidence of the truth. But when our\nreason offers arguments on both sides of the question, so that we can\narrive at no certain conclusion, then we act prudently by invoking the\nauthority of wiser minds who make moral questions a speciality, and we\nare perfectly safe if we follow the best authority obtainable.\n\nA Catholic physician has here a special advantage: for he has in cases\nof great difficulty the decisions of Roman tribunals, composed of most\nlearned men, and renowned for the thoroughness of their investigations\nand the prudence of their verdicts, to serve him as guides and vouchers\nfor his conduct. Although these tribunals claim no infallibility, yet\nthey offer all the advantages that we look for, with regard to civil\nmatters, in the decisions of our Supreme Court. These Roman courts have\nuniformly decided against any operation tending directly to the death of\nan innocent child (\"Am. Eccl. Rev.,\" Nov., 1893, pp.\u00a0352, 353; Feb.,\n1895, p.\u00a0171).\n\nNon-Catholics are, of course, not obliged to obey such pronouncements;\nyet, even for them, it cannot be injurious, but rather very useful, to\nknow the views of so competent a court on matters of the most vital\ninterest in their learned profession. This is the reason why the\n\"Medical Record\" has published of late so many articles on the teachings\nof Catholic authorities with regard to craniotomy and abortion (see vol.\nxlvii. nos. 5, 9, 25; vol. xlviii. nos. 1, 2, 3, 4).\n\n\n\n\nLECTURE IV.\n\nVIEWS OF SCIENTISTS AND SCIOLISTS.\n\n\nIn my former lectures, gentlemen, I explained to you the principles\ncondemnatory of craniotomy and abortion, viewing these chiefly from the\nstandpoint of the ethical philosopher and the jurist. Not being a\nphysician myself, I think it proper, on matters of so much importance,\nto quote here freely from a lecture delivered on this subject by a late\nprofessional gynecologist, an old experienced practitioner, who was for\nmany years a professor of obstetrics in the St.\u00a0Louis Medical College. I\nquote him with the more pleasure because of my personal acquaintance\nwith him, and of the universal esteem for ability and integrity in which\nhe was held by the medical profession.\n\nDr.\u00a0L. Charles Boislini\u00e8re, to whom I refer, had by his scientific\nacquirements and his successful practice, during forty years of his\nlife, become, to a great extent, identified with the progress of the\nscience of obstetrics in this country; and a few months before his late\ndemise, he had published a useful work on \"Obstetric Accidents,\nEmergencies, and Operations.\"\n\nIn 1892 he read, before the St.\u00a0Louis Obstetrical and Gynecological\nSociety, a lecture on the moral aspects of craniotomy and abortion, of\nwhich a considerable portion is very much to our present purpose. The\nDoctor herein clearly demonstrates that, in this matter at least, Ethics\nand Medical Science are to-day perfectly concordant. He says:\n\n\"The operation of craniotomy is a very old one. The ancients entertained\nthe belief that, in difficult labors, the unborn child was an unjust\naggressor against the mother, and must, therefore, be sacrificed to save\nher life.\n\n\"Hippocrates, Celsus, Avicenna, and the Arabian School invented a number\nof vulnerating instruments to enter and crush the child's cranium. With\nthe advance of the obstetric art, more conservative measures were\ngradually adopted, such as the forceps, version, induction of premature\nlabor, and, finally, Cesarean section.\n\n\"Cesarean section is reported to have been performed by Nicola de Falcon\nin the year 1491. Nufer, in 1500, and Rousset, in 1581, performed it a\ngreat many times, always successfully; so that, Scipio Murunia affirms,\nit was as common in France during that epoch as blood-letting was in\nItaly, where at that time patients were bled for almost every disease.\nHowever, a reaction soon followed, headed by Guillemau and Ambrose Pare,\nwho had failed in their attempts at Cesarean section. In our days a\nmarked change of opinion on this interesting and delicate question is\nrapidly taking place.\n\n\"With these advances in view, the question now is:\n\n\"_Are we ever justified in killing an unborn child in order to save the\nmother's life?_\n\n\"This is a burning question, and the sooner and more satisfactorily it\nis settled, the greater will be the peace to the medical mind and\nconscience.\n\n\"In answer to the question, I, at the outset, reply _No_, and claim\nthat, under no conditions or circumstances, is it ever allowable to\ndestroy the life of the child in order to increase the mother's chances\nof living. And the day may arrive when, by the law of the land, the act\nwill be considered criminal and punished as such. In support of this\nopinion, and to illustrate this position, allow me to take a purely\nethical and medico-legal view of the subject, and to relate to you a\nparallel case, as also the decision arrived at by the Lord Chief Justice\nof England, Judge Coleridge, than whom there is not a greater jurist\nliving.\n\n\"The case is that of the British yacht 'Mignonette.' On July\u00a05, 1884,\nthe prisoners Dudley and Stevens, with one Brookes and the deceased, an\nEnglish boy between 17 and 18 years of age, part of the crew of the\n'Mignonette,' were cast away in a storm at sea 1,600\u00a0miles from the Cape\nof Good Hope, and were compelled to take to an open boat.\n\n\"They had no supply of water, no supply of food, and subsisted for\ntwenty days on two pounds of turnips and a small turtle they had caught.\nThey managed to collect a little rain-water in their oil-skin capes.\n\n\"On the eighteenth day, having been without food for seventeen days and\nwithout water for five days, the prisoners suggested that some one\nshould be sacrificed to save the rest. Brookes dissented, and the boy,\nto whom they referred, was not consulted. On that day Dudley and Stevens\nspoke of their having families, and of their lives being more valuable\nthan that of the boy. The boy was lying in the bottom of the boat, quite\nhelpless, extremely weak and unable to make any resistance; nor did he\nassent to be killed to save the others. Dudley, with the assent of\nStevens, went to the boy and, telling him that his time had come, put a\nknife into his throat and killed him. They fed upon his flesh for four\ndays. On the fourth day the boat was picked up by a passing vessel, and\nthe sailors were rescued, still alive but in a state of extreme\nprostration.\n\n\"The prisoners were carried to the port of Falmouth and committed for\ntrial, the charge being murder. Their excuse was that, if they had not\nkilled the boy and fed upon his flesh, there being no sail in sight,\nthey would have died of starvation before being rescued. They said that\nthere was no chance of saving their lives, except by killing some one\nfor the others to eat. The prisoners were committed for murder and\nsentenced to death, but appealed to the mercy of the court, pleading\nignorance. It was found by the verdict that the boy was incapable of\nresistance, and authorities were then quoted to prove that, in order to\nsave your own life, you have the right to take the life of an unjust\naggressor in self-defence--a principle the truth of which is universally\nadmitted.\n\n\"But the evidence clearly showed that the defenceless boy was not an\nunjust aggressor against their lives, and, consequently, their only plea\nwas that of expediency.\n\n\"In a chapter in which he deals with the exception created by necessity,\nLord Hale, quoted by Justice Coleridge, thus expresses himself:\n\n\"'If a man be desperately assaulted and in peril of death, and cannot\notherwise escape, except by killing an innocent person then present, the\nact will not acquit him of the crime and punishment of murder; for he\nought rather to die himself than to kill an innocent.'\n\n\"In the case of two men on a plank at sea, which can only support one,\nthe right of one occupant to throw the other overboard to save his own\nlife, and in the instance of sailors, to save themselves, throwing\npassengers in the sea, are equally condemned by Lord Coleridge as\nunjustifiable homicide. So that under no circumstances is it allowable\nto kill an innocent aggressor to save your own life. I say _innocent_\naggressor; but it is allowed, in self-defence, to kill, if necessary, an\n_unjust_ aggressor against your life.\n\n\"This case is exactly analogous to that of the child lying helpless in\nits mother's womb. She causes its death by her consent to the act of her\nagent, the physician in attendance.\n\n\"Remark that Brookes, one of the sailors, dissented to the killing of\nthe sailor-boy. This may happen in consultation, when one of the\nconsultants does not admit the right to kill an unborn child. Please\nalso remember that the sailor-boy lay helpless at the bottom of the\nboat when his assailants killed him to save their own lives.\n\n\"The child is not an unjust aggressor against the mother. It is placed\nin the womb without its consent and is defenceless. It is the mother who\nis, as it were, the aggressor from the obstacles caused by a deformed\npelvis, tumors, etc.; and she has not the right to ask or consent to the\nkilling of the child who does not attack her.\n\n\"Therefore, I repeat that the two cases are analogous; and if, as\nremarked by Justice Coleridge, murder was committed in the first\ninstance, so is murder committed in the analogue. So, we see, the\nprincipal points of the opinion enunciated by the learned judge, and the\nprinciples therein laid down, can, with equal force, be applied to the\nnon-justification of craniotomy, by which the life of a defenceless\nchild is sacrificed to save the mother.\n\n\"Notice also that two of the perpetrators of the deed claimed that they\nhad families, and that their lives were more valuable than that of the\nmurdered boy. By craniotomists this reason or excuse is frequently given\nwith much sentimentality to justify the killing of the child. The child,\nthey say, has no social value, the mother is the idol of her husband,\nthe pride of the household, often an ornament to society, the mother of\nliving or possible children. Therefore, her life is more valuable than\nthat of the unborn child. But who is to be the judge of the value of\nlife? Were not Scipio Africanus, Manlius, was not C\u00e6sar, from whom the\nvery name of the operation, delivered by section from their mother's\nwomb? The operation was familiarly known to Shakespeare, who tells us:\n\n    'Macduff was from his mother's womb untimely ripped.'\n\n\"There can never be a necessity for killing--except an unjust aggressor\nand in self-defence--unless the killing can be justified by some\nrecognized excuse admitted by the law. In the case of the murdered\nsailor-boy, there was not such an excuse, unless the killing was\njustified by what has been called necessity. But, as stated above, there\nnever is an excuse for killing an innocent aggressor, and the temptation\nto the act and its expediency is not what the law has ever called\nnecessity. Nor is this to be regretted; for if in this case the\ntemptation to murder and the expediency of the deed had been held by law\nas absolute defence of the deed, there would have been no guilt in the\ncase. Happily this is not so. The plea of necessity once admitted might\nbe made the legal cloak for unbridled passions and atrocious crimes,\nsuch as the producing of abortion, etc.\n\n\"As in the case of this young sailor, so in the killing of an unborn\nchild, no such excuse can be pleaded; the unborn child cannot be the\naggressor, no more so than the defenceless sailor-boy was.\n\n\"To preserve one's life is, generally speaking, a duty: but it may be\nthe plainest duty, the highest duty, to sacrifice one's life. War is\nfull of such instances in which it is not man's duty to live, but to\ndie. The Greek and Latin authors contain many examples in which the duty\nof dying for others is laid down in most glowing and eloquent language.\n\n\"'_Dulce et decorum est pro patria mori_,' says Horace. Such was heathen\nethics, and it is enough in a Christian country to teach that there is\nnot always an absolute and unqualified necessity to preserve one's life.\n\n\"Thus, as a parallel case, is the situation of a woman in a difficult\nlabor, when her life and that of her unborn child are in extreme danger.\nIn this instance, it is the mother's duty to die rather than to consent\nto the killing of her child.\n\n\"In a subject of such delicacy and importance I have avoided all\nargument based upon the doctrines of any particular religion, and\nconsidered the subject upon its purely ethical and scientific basis. I\nam aware that I am taking a position quite at variance with that\noccupied by many men influenced by former teachings and prejudices.\n\n\"I respect the honest convictions of those opposed to the opinions\npresented in this paper. But it is hoped that thoughtful physicians will\nsoon reconsider their views and adopt a more just and humane method of\ndealing with the rights of a living unborn child.\n\n\"As a hopeful sign, it is to be noticed that a gradual change is taking\nplace in the opinions of the profession as to the propriety of\nperforming craniotomy. Busey says: 'To state the issue plainly, the\naverment must be made that no conscientious physician would deliberately\nand wilfully kill a f\u0153tus, if he believed that the act was a violation\nof the commandment \"Thou shalt not kill.\"' It has been well said by\nBarnes, the ablest and most conservative defender of craniotomy, that\n'it is not simply a question for medicine to decide. Religion and the\ncivil law claim a preponderating voice. In the whole range of the\npractice of medicine, there arises no situation of equal solemnity.'\n\n\"Having thus far considered the subject from a purely ethical\nstandpoint, I shall now present its scientific and practical aspect.\n\n\"Parvin says that the improved Cesarean section has given in Germany\nresults so satisfactory that, possibly, the day is at hand when\ncraniotomy upon the living f\u0153tus will be very rarely performed, if done\nat all. Kinkead, a high English authority, states: 'To reduce the bulk\nof the child, or to extract it afterward through a pelvis of two and\none-half or less conjugate diameter, is an operation of extreme\ndifficulty, lengthy, requiring a very great experience, as far as the\nmother is concerned, requiring an amount of manual dexterity rarely to\nbe acquired outside of a large city. While, on the other hand, the\nCesarean section is an easy operation, capable of successful performance\nby any surgeon of ordinary skill.'\n\n\"Tait remarks that he 'feels certain that the decision of the profession\nwill be, before long, to give up the performance of such operations as\nare destructive to the child, in favor of an operation that saves it,\nand subjects the mother to little more risk. The operation of Cesarean\nsection, or the Porro amputation of the pregnant womb, will\nrevolutionize the obstetric art, and in two years we shall hear no more\nof craniotomy; for the improved method will save more lives, and is far\neasier of performance. It is the easiest operation in abdominal surgery,\nand every country practitioner ought to be able, and always prepared, to\ndo it.' So said Lawson Tait in 1888.\n\n\"I could quote many other authorities, showing the change that is taking\nplace in the profession upon this important question. It is established\nby the consensus of professional opinion that craniotomy has been\nfrequently performed in cases where delivery could have been safely\naccomplished by the forceps, turning, and even by the unaided power of\nnature (Busey); and there is no case known to him where a woman, on whom\na section had been successfully performed, has refused to submit to its\nrepetition in subsequent pregnancies. In Belgium the Cesarean section\nhas been performed seven times on the same woman, and in Philadelphia\nthree times. Doctor Bretoneaux, of Tours, has performed it six times on\nthe same woman; and this woman his wife. 'The brutal epoch of craniotomy\nhas certainly passed. The legitimate aspiration and tendency of science\nis to eliminate craniotomy on the living and viable child from obstetric\npractice.'--Barnes' words as quoted by Busey. Tyler Smith is in perfect\naccordance with Barnes. Barnes again writes: 'For the Cesarean section\ntwo very powerful arguments may be advanced. First, that the child is\nnot sacrificed. Second, that the mother has a reasonable prospect of\nbeing saved.'\n\n\"Late reports of the Dublin Rotunda Hospital show that, in 3,631 cases\nof labor, craniotomy was performed only four times, and in three of\nthese, positive diagnosis of the child's death was ascertained before\nthe operation. In one of these cases the diagnosis was doubtful.\n\n\"More Madden, a celebrated obstetrician of forty years' experience,\nnever performed it once.\n\n\"'The brilliant achievements in abdominal surgery give assurance that\nthe Cesarean section is not only a legitimate operation, but one almost\nfree from danger; also, that the tragic scenes heretofore witnessed in\ncertain cases, in which the destruction of the child was resorted to,\nmay be relegated to history (A.\u00a0P. Clarke).'\"\n\nFurther on, Dr.\u00a0Boislini\u00e8re speaks more directly of abortion. He says:\n\n\"The principle once admitted that you are not justifiable in killing an\ninnocent aggressor except in self-defence, equally prohibits any\ninterference with early gestation.\n\n\"From the moment of conception the child is living. It grows, and what\ngrows has life. '_Homo est qui homo futurus_,' says an ancient and high\nauthority.\n\n\"Therefore, f\u0153ticide is not permissible at any stage of utero-gestation.\n\n\"The killing of the defenceless f\u0153tus is sometimes done in cases of\nuncontrollable vomiting of pregnancy, in cases of tubal or abdominal\ngestation, and the killing of the f\u0153tus is done by electricity,\ninjections of morphine in the amniotic sac, the puncturing of that sac,\netc.\n\n\"This practice is too lightly adopted by thoughtless or conscienceless\nphysicians. This practice is much on the increase. I once heard a known\nobstetrician of the old school say: 'I would as lief kill, if necessary,\nan unborn child as a rat.' So much for the estimate he put on the value\nof human life! _O tempora! O mores!_\n\n\"Is it not time that this wanton 'massacre of the innocents' should\ncease?\n\n\"Without wishing to load this paper with elaborate statistics, I shall\nfurnish the latest arrived at in the two operations of craniotomy and\nCesarean section.\n\n\"In the combined reports of the clinics of Berlin, Halle, and Dresden,\nthe maternal mortality in craniotomy was 5.8\u00a0per\u00a0cent--of course, one\nhundred per\u00a0cent of the children lost.\n\n\"In Cesarean section the maternal mortality was eight or eleven\nper\u00a0cent; children's mortality, thirteen per\u00a0cent.\n\n\"Caruso, the latest and most reliable statistician, not an optimist,\nsums up the results from the different clinics, and comes to the\nconclusion that craniotomy shows ninety-three and one one-hundredth\nmothers recover, Cesarean section eighty-nine and four one-hundredths.\n\n\"Caruso, therefore, concludes that craniotomy on the living child is to\nbe superseded by Cesarean section. He says, therefore, that the mother\nhas three chances out of four, and her child nine out of ten, for life.\n\n\"Leopold, as stated above, shows a much better result, viz.: ninety-five\nmothers saved out of one hundred by Cesarean section, a result equal\nthat obtained in craniotomy.\"\n\nYou notice, gentlemen, that the eminent physician whom I have been\nquoting speaks with much indignation of the killing of the embryo, when\nhe calls it a \"massacre of the innocents.\" By this odious term we\nusually denote the massacre of the babes at Bethlehem, ordered by the\ninfamous Herod to defend himself against the future aggression, as he\nimagined, of the new-born King of the Jews. A craniotomist would, no\ndoubt, feel insulted at being compared with Herod. And yet, if we\nexamine the matter closely, we shall find that the two massacres,\nHerod's and the craniotomist's, could only be defended by the same plea,\nthat of necessity. \"Necessity knows no law,\" writes Dr.\u00a0Galloway, in his\ndefence of craniotomy, to which I referred in a former lecture. \"The\nsame law,\" he writes in the \"Medical Record\" for July\u00a027, 1895, \"which\nlies at the basis of Jurisprudence in this respect justifies the\nsacrifice of the life of one person when actually necessary for the\npreservation of the life of another, when the two are reduced to such\nextremity that one or the other must die. This is the _necessitas non\nhabet legem_.\"\n\nDid not Herod look on the matter just in that light? Expecting Christ to\nbe, not a spiritual, but a temporal ruler, as the Jewish nation supposed\nat the time, he looked upon it as a case of necessity to sacrifice the\nlives of the innocents for his own preservation. \"Necessity knows no\nlaw\" was his principle. True, many had to die on that occasion to save\none; but then he was a king. Anyhow, their death was necessary, and\n_necessitas non habet legem_; that settles it: Herod must not be blamed,\non that principle. It is not even certain that, cruel as he was, he\nwould have confessed, with the modern obstetrician, \"I would as lief, if\nit were necessary, kill an unborn child as a rat.\"\n\nSuch sentiments, revolting as they are, and a disgrace to civilization,\nare the natural outcome of rash speculations about the first principles\nof morality.\n\nThe principle \"_Necessitas non habet legem_\" has indeed a true and\nharmless meaning when properly understood; it means that no law is\nviolated when a man does what he is physically necessitated to do, and\nthat no law can compel him to do more than he can do. Thus a disabled\nsoldier cannot be compelled to march on with his regiment; necessity\ncompels him to remain behind. In this sense the principle quoted is a\ntruism; hence its universal acceptance. Applying the same principle in a\nwider sense, moralists agree that human law-givers do not, and in\nordinary circumstances cannot, impose obligations the fulfilment of\nwhich requires extraordinary virtue. Even God Himself does not usually\nexact of men the performance of positive heroic acts. But no such plea\ncan be urged to justify acts which God forbids by the natural law.[1]\nWhen necessity is used as a synonym for a \"very strong reason,\" as it\nis in the plea of the craniotomist, then it is utterly false that very\nstrong reasons for doing an act cannot be set aside by a divine law to\nthe contrary; what is wrong in itself can never become right, even\nthough the strongest arguments could be adduced in its favor. It would\nbe doing wrong that good may come of it, or making the end justify the\nmeans. Such principles may be found in the code of tyrants and\ncriminals, but should not be looked for in the code of Medical\nJurisprudence.\n\n  [1] See this point more fully treated in the Author's \"Moral\n  Philosophy,\" Book. I. c. ii., \"The Morality of Human Acts.\"\n\nThere is but one plea left, I believe, on which, of late years, it is\nsometimes attempted to justify the murder of little children. It is the\nplea of some evolutionists who maintain that the infant has not yet a\ntrue human soul. I should not deign to consider this theory if it were\nnot that I find it seriously treated by a contributor to the \"Medical\nRecord,\" in an article which, on September\u00a04, 1895, concluded a long\ndiscussion on craniotomy published in that learned periodical.\n\nThe writer of this article asserts: \"Procuring the death of the f\u0153tus to\nsave the life of the mother is, I am sure, to be defended on ethical\ngrounds.\" And here is the way he attempts to defend it: \"We may safely\nassume,\" he argues, \"that the theory of evolution is the best working\nhypothesis in every branch of natural science. We are learning through\nHerbert Spencer and all late writers on ethics and politics, that the\nsame principle will best explain the facts\" (p.\u00a0395).\n\nI do not deny that a certain school of scientists is trying to rewrite\nall history and all Ethics and Jurisprudence. But the writer strangely\nmisstates the case when he says that \"all great writers on ethics and\npolitics\" agree with Mr.\u00a0Spencer. Besides a multitude of others, Lord\nSalisbury for one, has clearly shown of late that the school of agnostic\nevolutionists is coming to grief; it has had its short day, and it is\nnow setting below the horizon of ignominy and subsequent oblivion. The\nwriter of the article in question does not attempt to prove the\nevolution theory; therefore I need not stop to disprove it. But he makes\nthe following application of it to our subject--an application so\nshocking to humanity and so revolting to common sense that, if it is\nlogical, it is by itself sufficient to refute the whole theory of\nMr.\u00a0Spencer and his school.\n\nHe argues that, if that theory be admitted, it must necessarily follow\nthat, while the human embryo is from the first alive, it is not a human\nbeing until it has developed and differentiated to such a point as\ncorresponds to that point at the birth of the race where the animal\nbecomes a man. \"I am sure,\" he adds, \"I do not know when that occurred\nin the past, and I do not know at what point it occurs in the\nindividual.... In inquiring for that distinct feature which\ndistinguishes the man from the animal, I find none but mentality. If we\nwait for distinct mentality to appear in the development of the\nindividual, it would be some time after birth.\"\n\nAccording to this reasoning a child is not known to be a human being\ntill some time after its birth. And this is not uttered by some\nspeculative philosopher in his closet, but by a medical practitioner on\nhis daily rounds, tools in hand, as it were, to carry out his theory and\nbreak the skulls of any and all luckless babes that may come in his way\nin the exercise of what he calls his legitimate practice. How long after\nbirth the child remains without becoming a human being, he does not\npretend to know; they remain non-human till they manifest mental action.\nTill then, not being human, he assigns them no human rights--no rights\nat all which we are conscientiously obliged to respect. Herod may have\nbeen right after all when he appointed the term of two years old and\nunder as the limit of the butchery at Bethlehem. The writer pretends to\nlessen the horror inspired by his theory by referring to some\nrestrictions of canon law. But what do he and his like care about canon\nlaw? He would be the first to scout the idea of letting canon law limit\nhis freedom of action and speculation.\n\nWhat would be the real results in practical life if we were to accept as\nrules of conduct these rash theories of agnostic philosophers and\ninfidel scientists? Justly does the writer proceed to say: \"I am well\naware that the idea arouses antagonism and inflammatory denunciation in\nsome minds.\" Certainly it does. He adds: \"That it [the idea] will prove\nto be the true one, however, depends only on the truth of the general\ntheory of development.\" If this be the logical consequence of evolution,\nor Darwinism, as he calls it, then all the worse for Darwinism. Society\ncannot get along on a theory that begets such principles of action; the\nmore so since, in Spencer's and in Darwin's system, the human soul, even\nin grown persons, is only a material modification of the body and\nperishes with it in death. Hence there would be no responsibility after\ndeath. On this theory the physician is only a lump of very curiously\nevolved matter; he, too, like the embryo, is without an immortal soul,\nis not a free being, and therefore is incapable of having rights or\nduties.\n\nBefore we remodel our codes of Ethics and Jurisprudence by the admission\ninto them of such destructive and revolutionary principles, we shall at\nleast be allowed to challenge these aggressors and ask solid proof of\ntheir rash innovations. We may address to them the wise words uttered\nagainst similar speculators by one of the most logical of modern\nreasoners, the illustrious Cardinal Newman. \"Why may not my first\nprinciples contest the prize with yours? they have been longer in the\nworld, they have lasted longer, they have done harder work, they have\nseen rougher service. You sit in your easy-chairs, you dogmatize in your\nlecture-rooms, you wield your pens: it all looks well on paper; you\nwrite exceedingly well; there never was an age in which there was better\nwriting, logical, nervous, eloquent, and pure,--go and carry it out in\nthe world. Take your first principles, of which you are so proud, into\nthe crowded streets of our cities, into the formidable classes which\nmake up the bulk of our population: try to work society by them. You\nthink you can; I say you cannot; at least you have not as yet, it is to\nbe seen if you can.... My principles, which I believe to be eternal,\nhave at least lasted eighteen hundred years; let yours last as many\nmonths.... These principles have been the life of nations; they have\nshown they could be carried out; let any single nation carry out yours\"\n(\"Present Position of Catholics in England.\" p.\u00a0293).\n\nGentlemen, let no one trifle with the principles of Ethics and\nJurisprudence; human society cannot get along without them. Morality is\nthe heart of civilization: its principles are the life-blood, which it\nsends forth to feed and warm and strengthen and beautify all the organs\nof its earthly frame. A flesh-wound may be healed, a bone may be set, it\nmay knit and grow vigorous again; but you must not puncture the heart,\nnor attempt to change the natural channels of the circulating blood,\nunder the penalty of having a corpse on your hands. So you must respect\nthe eternal laws that direct the current of man's moral actions, the\nprinciples of Ethics and Jurisprudence.\n\n\n\n\nLECTURE V.\n\nVENEREAL EXCESSES.\n\n\nIn the opening lecture of this course, I remarked to you, gentlemen,\nthat the scope of Medical Jurisprudence is much wider than that of\nMedical Law. It embraces many subjects of which human laws take no\ncognizance, and in particular such vicious actions as do not violate the\nrights of others, but are injurious to those only who practise them.\nThey undermine the health and shorten the lives of the guilty parties,\nand bring in their train diseases the most destructive and often the\nmost incurable. It is the physician's beneficent task to lessen the\nweaknesses and sufferings of the body, and to prolong human life in\nwell-preserved vigor to a green old age. It is not the least important\npart of his valuable services to provide for the sound and vigorous\npropagation of the human race to future generations. Of this propagation\nof our race, of the laws which govern it, and of the criminal abuses by\nwhich these laws are violated, I am to treat in this present lecture. My\nsubject is \"Venereal Excesses.\"\n\nI. If a physician's purpose were only to make money, his task would then\nbe to multiply diseases and infirmities; he would then be as great a\ncurse to mankind as he is really intended to be a blessing; and an\nimmense blessing he will be to his fellow-men if he studies to remove\neven the remote causes of diseases and untimely deaths. He can do so in\na variety of ways and not the least by providing against sexual excesses\nand abuses. These are a copious fountain of ill to humanity. A host of\ndiseases, such as tuberculosis, diabetes, cardial and nervous\naffections, epilepsy, hysteria, general debility, weaknesses of sight,\nlanguor and general worthlessness, hypochondria, weakness and total loss\nof reason, and, in married life, impotence and sterility are some of the\neffects of venereal excesses. Any excitement of the sexual passion\nbefore the body has received its full development is more or less\ninjurious to its welfare; and all excesses or unnatural indulgence of it\nat any period of life is pregnant with deplorable consequences. Now,\nsuch evil practices are too much overlooked by many physicians; yet it\nis certain that thousands of patients might, by timely warning on these\nmatters, be saved from unspeakable mental and physical sufferings. To\ngive sensible and intelligible directions on a subject as delicate as it\nis important in medical practice, it will be necessary to enter into\nsome scientific details.\n\nThe passion which prompts to sexual intercourse is altogether natural in\nitself, and, as such, intended by the Creator to be indulged in at the\nright time and in the proper manner. It is the stimulus which He has\nprovided for the propagation of the human race. If the stimulus is\nstrong at times, this too is a special effect of His wisdom; because\nwithout a powerful prompting of this kind, most men would shirk the\nburden of married life, just as very many would not care to toil if they\nhad no hunger and thirst and other bodily wants to satisfy.\n\nBut though all these cravings are useful and even indispensable to\nmankind, all of them need the regulation of reason. When they are\nindulged immoderately or in unnatural ways, they become most copious\nsources of bodily diseases, of mental disorders, and moral degradation.\nEvery one knows how the passion of drink, when abused, proves the\nruination of millions; excessive eating, too, injures the systems of\ncountless people. But no animal passion is more liable to become\ndisorderly, none needs more firm control and habitual watchfulness, than\nthe passion of lust. Reason dictates that it should be indulged for no\nother purpose than that for which the Creator has made it, namely,\nmarital intercourse. I say _marital_ and not merely sexual intercourse;\nfor outside of married life all nations have always condemned its\nindulgence.\n\nBesides, it is only in the married state that the children, which are\nthe fruit of such intercourse, can be properly educated. To generate a\nrace of young barbarians is certainly not the purpose of the sexual\nrelations. Children must not be begotten unless they can be properly\nraised, in a manner worthy of their noble destiny. Now, it is only in\nthe married state, in the family or domestic society, that they can be\nthus educated. They need the tender hand of a mother to supply their\nmaterial wants; they need the manly care of a devoted father to provide\nthe necessaries of life, his firm hand to break their wanton wills, and\nhis wise direction to set them well on the road to temporal and eternal\nhappiness. Therefore, no one has the right to beget or to bear children\nexcept in marital life. Now, the sexual passion is to be exercised only\nin connection with its proper object, the procreation of children and\nthe fostering of such mutual love between husband and wife as is\nconducive to domestic happiness. Therefore this passion is to be kept\nunder careful and rational constraint. This the law of morality\nrequires; all nations have ever exacted that this passion shall be\nsubject to established rules; no free-love has ever been tolerated where\nthere was the least pretence to civilization, and I do not know that it\nwas ever permitted even among barbarians.\n\nEven the distant approach that Mormonism made towards free-love has been\nabsolutely condemned and repressed by the common-sense of the American\npeople, as incompatible with civilization. In fact, all history\ntestifies that the true civilization of any race or country rises or\nfalls with the restraints imposed on the passion of lust; no polygamous\nnation has ever been more than half-civilized. The greatness of Rome and\nGreece decayed when the laws of social purity declined; and in our own\nday the immorality of what is called \"the social evil\" is the darkest\nstain on modern civilization.\n\nAnd what we say of civilization or social soundness, the soundness of\nthe body politic, applies in a great measure to individual soundness,\nthe health of every person's mind and body. Personal purity promotes\nhealth and vigor, it lends beauty to form, gives a keen edge to the\nintellect, adds energy and brings success to manhood, and prepares for\nenduring and honored old age. Venereal excesses, on the contrary,\nundermine the vigor of the constitution, bring on a host of bodily\ninfirmities, exhaust the system before the proper time, debauch and\ndegrade the mind and will, and prepare their victims for an early grave\nor a decrepit old age.\n\nII. But how can a passion so ardent be properly restrained? In\nparticular, what can a physician do to prevent the manifold injuries\nwhich, if not properly controlled, it will bring to his patients? These\nare practical questions directly to our purpose.\n\nThe first requisite for all effective action is to have correct\nknowledge and strong convictions on a subject. No one will check a\npassion with firmness if he have a lingering doubt as to whether, after\nall, he is strictly bound to restrain it. As a man's mind matures, at\nleast if his mind be upright and not distorted by the strain of a ruling\npassion, he understands more and more thoroughly that his perfection\nconsists and his highest interests lie in obeying at all times the law\nof reason, in maintaining his specific dignity of a rational being, and\nnot allowing himself to be controlled by passion, the ruling power of\nbrute animals. Besides, he becomes aware in various ways of the evil\nresults of immoral practices, and he sees many reasons to keep his\npassions in check. But young people have neither such experience nor\nsuch information, and they are not always wise enough to understand the\nimperative dictates of self-restraint. And yet it is often in early\nyears, while body and mind are in the period of development, that the\nmost serious injury is done to the constitution and to the character by\nthe indulgence of carnal pleasures. Habits are then engendered which\nbecome a real slavery; so that later in life when there arises a sincere\ndesire to stop such disgraceful practices, there is a feeling of\nimpotence to resist temptations which by one's own fault have become a\nsecond nature.\n\nWhat then can be done with the young? They must early and\nauthoritatively be told of the wrong, the sin of base self-indulgence,\nand of every practice that leads to it. If a beginning of immorality is\ndiscovered in a child, it must be plainly told and emphatically warned\nof the serious consequences involved. The child's mother is, as a rule,\nthe best guide and director in infancy. Later on, the Doctor has\nfrequent chances to do so; it comes from him with better grace than from\nothers; and his warning is likely to be minded, because it is clear that\nhe knows and ought to know what he is talking about with regard to\nbodily consequences. Yet it is always a matter of delicacy; and great\ncare should be taken lest, while pointing out the evil, there be also a\nstimulus added to a prurient curiosity.\n\nMuch good sense is required in any given case to decide whether more\ngood or more evil is likely to result from the warning; in doubt of\nsuccess, it is better to leave the matter alone.\n\n    \"Where ignorance is bliss\n     'Tis folly to be wise.\"\n\nThe safest way of repressing the passion of lust is the provision that\nan all-wise Providence supplies in Religion, in which God\nauthoritatively forbids all immoral action and even all immoral coveting\nor desire. Positive dogmatic teaching on this subject is required,\nespecially with the young. You cannot argue with them on this matter as\nyou can with grown people. That is one reason why religious teaching\nshould permeate early education. The Decalogue should be the back-bone\nof a child's training: and it should be proposed on the authority of\nGod, and explained so as to check not only sinful acts, but also\ncovetings, prurient curiosity, improper reading, immodest looks and\nthoughts, in a word, whatever paves the way to the walks of sin. The\ngreatest of teachers has Himself laid down the law in this matter: it\nmust be proposed as coming from His divine lips, as it did: \"I say to\nyou that whosoever shall look on a woman to lust after her has already\ncommitted adultery with her in his heart\" (St.\u00a0Matt. v.\u00a028). The lesson\nis enforced by these words of the great Apostle: \"Neither fornicators,\nnor adulterers, nor the effeminate ... shall possess the kingdom of God\"\n(1\u00a0Cor. vi.\u00a09, 10).\n\nTrue, the child will not realize the full import of such lessons; but he\nwill understand it in due time; and already in early years he will be\nwarned against indulging his nascent passions. It is well that the\nconscience should be early awakened in this matter; for the more this\npassion is indulged, the more it craves for further indulgence till it\nbecomes almost uncontrollable.\n\nIII. No possible evil to any individual man or woman can result from the\nfirm control that one may acquire over the passion of lust. On the\ncontrary, if it should be controlled all through life, this would only\nadd to a man's strength of mind, firmness of will, soundness of body,\nand length of life. For in the school of morality, in which every\nPhysician should be educated, the leading principle is: \"Contraries are\ncured by contraries,\" \"_Contraria contrariis curantur_.\" On this\nprinciple, lust is most efficiently controlled by aiming, at least in\nyouth, at total abstinence from its indulgence. You know that, in the\nCatholic Church, priests and religious lead a single life, and pledge\nthemselves for life to practise the most perfect control of the sexual\npassion. What do you think is the result of their total abstinence on\nthis point with regard to their length of days? As a rule their life is\nmuch longer, in normal circumstances, than that of the other learned\nprofessions. Here are a few proofs. In France, during the twenty years\nfrom 1823 to 1843, 750 priests died in the diocese of Paris. Of these\nonly 200 were under sixty years old; there were 554 between sixty and\nseventy years old, 448 over seventy, and 177 over eighty. Again, of 202\nCarmelite nuns who died in a large convent of Paris, Dr.\u00a0Descuret, the\nattending physician, states that 82 had lived over seventy years, 23\nover eighty years. Most Trappists and Carthusians die of scarcely any\nother sickness than old age. All young people who aspire to the clerical\nor religious profession learn from their early years the holiness and\nthe loveliness of purity. Our Church effects this result by placing\nbefore their youthful imaginations the most perfect of patterns of\nvirtue, the infant Saviour, the virgin Mother, the boy saints Aloysius\nand Stanislaus, the maidens Agatha and Cecilia, and a whole phalanx of\nChristian heroes and heroines.\n\nI dwell the more willingly on this subject, gentlemen, because, besides\nprotecting modesty in your young patients generally, it may fall to the\nlot of some of you, in the course of your professional careers, to be\nattending physicians to religious houses; and you will then appreciate\nthe delicacy of the flowers of virtue that bloom beneath the shadow of\nthe sanctuary. Certainly even there you may happen to find isolated\ncases of infidelity to duty; for human nature is not angelic nature; but\nin such abodes it comes near to it, at least for the vast majority.\n\nIV. On the other hand, what sad havoc does not the sexual passion play\nwhere it is precociously developed and wantonly indulged. Dr.\u00a0H.\nFournier, one of the most eminent physicians of Paris, says: \"There is\nnot a vice more fatal to the conservation of man than masturbation.\"\nThis unfortunate habit is sometimes acquired by very little boys and\ngirls. Foolish or vicious nurses may bring it on by handling young\nchildren most indelicately. This is one of the many reasons why none but\nvirtuous servants and nurses should be employed by wise parents and\nphysicians. In later years, children often learn this degrading and most\ninjurious vice from their depraved companions, some of whom seem even to\nregard the practice of it as a manly accomplishment. When habitually\nindulged in, it produces on the health and the strength of the\nconstitution effects the most deplorable. Even the intellect is liable\nto become thereby enfeebled, a want of virility is exhibited both in the\nbody and in the mind of its victims; then follows a loss of ambition and\nself-control. \"When this morbid passion gets control of a person,\"\nwrites an experienced practitioner in medicine, \"it is as though an\nunclean spirit had entered, subdued the will, weakened the moral forces,\nenfeebled the intellectual faculties, lessened the power to resist\ntemptation, and overcome every obstacle opposed to its gratification.\nEven while the intellect is still clear, and the sense of wrong keen,\nthe individual is a slave to this morbid impulse.\" Though the baneful\neffects may not always affect the physical health of the victim, the\nunfortunate practice very often engenders in boys and girls tendencies\nwhich in later years lead to all the miseries conspicuous in houses of\ndebauch and infamy. But I need not dwell on consequences that belong to\npathology rather than to Jurisprudence.\n\nV. Confining myself to my sphere of what is morally right or wrong, I\nmust be permitted to point out some gross violations of duty in some\nmembers of your honored profession. There are physicians so reckless of\nconsequences and of principles alike as to advise at times the practice\nof illicit sexual intercourse. Let them beware; they are doing a very\nunwise and guilty act. Even if an immoral practice should save a human\nlife, it may not be indulged, on the principle which must be by this\ntime very familiar to your ears, that the end does not justify the\nmeans. And besides no good result can be expected from what is contrary\nto the law of nature and of nature's God. It was to punish sins of the\nflesh that the Deluge was sent, which destroyed nearly the whole human\nrace. \"All flesh had corrupted its way,\" says the sacred historian. It\nwas to punish unlawful indulgence of lust that Sodom and Gomorrha were\ndestroyed by fire from heaven; and the memory of these guilty cities is\npreserved in the very name of Sodomy. Onan, as the same sacred volume\nrelates (Gen. xxxviii), performed the marriage act in a manner to\nfrustrate it of its legitimate purpose, the generation of children, and\nthe Lord slew him; and his sin is to this very day branded with his name\nand called Onanism. And yet in Christian lands physicians are found who\nwill at times dare to recommend such practices to their patients.\n\nOn the occasions mentioned, God punished the guilty miraculously; but\nthat is not His usual way. He has so contrived our natures that sins\ncommitted against His laws in our bodies ordinarily bring a part of\ntheir punishment in their train, not the less certain because slower in\nits operation than a miracle would be. All the venereal diseases are\nthere to act as earthy ministers of Heaven's justice, anticipating, and\noften mercifully averting, the punishments of the future world.\n\nVI. Besides private and secret tortures of body and mind, a public and\nmost deplorable calamity has descended of late on our own vigorous young\nnation, as well as on some older lands, threatening in the not distant\nfuture the extinction of many of its most esteemed families and of what\nwas, not long ago, a vigorous stock. The following article by Dr.\u00a0Walter\nLindley, Professor of Gynecology in the University of Southern\nCalifornia, will explain the matter better than my words could do. It\nwas read in Los Angeles at a meeting of the Southern Californian Medical\nSociety in June, 1895, and is printed in the \"N.\u00a0Y. Medical Journal\" of\nAugust\u00a017 of the same year (pp.\u00a0211 and following). It is headed\n\"American Sterility;\" I will quote freely from it:\n\n\"The obstetrician finds his vocation disappearing among the American\nwomen from the face of the earth.\n\n\"It is a fact that the American family with more than one or two\nchildren is the exception. From the records of six generations of\nfamilies in some New England towns, it was found that the families\ncomprising the first generation had on an average between eight and ten\nchildren; the next three generations averaged about seven to each\nfamily; the fifth generation less than three to each family. The\ngeneration now on the stage is not doing so well as that. In\nMassachusetts the average family numbers less than three persons. In\n1885 the census of Massachusetts disclosed that 71.28\u00a0per\u00a0cent of the\nwomen of that State were childless. The census of 1885 in the State of\nNew York shows that twenty-five per\u00a0cent of the women of that State are\nchildless, fifty per\u00a0cent average less than one child, and seventy-five\nper\u00a0cent average only a trifle over one child.\n\n\"Southern California has fully as dark a record as New England--that is,\nin the family where the man and wife are American-born. It goes without\nsaying that the medical profession in this country is composed to a\ngreat extent of typical progressive Americans, and I ask you to make\nmental statistics of the children in the families of the physicians in\nSouthern California, and you will find very few of them containing more\nthan two.\n\n\"Had the Rev. T.\u00a0R. Malthus lived in the United States to-day, he would\nnever have argued about the danger of over-population, as he did in his\ninteresting volume on 'The Principles of Population.'\"\n\nAfter quoting the views of Plato, Aristotle, and Lycurgus, Dr.\u00a0Lindley\ncontinues: \"In Southern California there are, it is true, many children,\nbut the average American family is very small.\n\n\"As I sat writing this an evening or two ago, I jotted down the names of\ntwenty-five families of my acquaintance in Los Angeles, taking them as\nfast as I thought of them. The list was composed entirely of\nprofessional and business men ranging in age from thirty-five to fifty.\nAll had been married quite a number of years. The result of my\nmemorandum was that in these twenty-five families there were but\neighteen children. These families were wholly unselected, and are about\nthe average Protestant American families outside the rank of laborers.\n\n\"What are the causes of this small proportion of children? Disease,\npreventives of conception, and abortion form the trinity of\nresponsibility in this grave condition. It is true that the first cause\n(disease) results in many women being barren, but I believe that you\nwill agree with me that the last two causes, preventives of conception\nand abortion, are the two chief causes.\n\n\"The A.\u00a0P.\u00a0A. might find food for thought by investigating the\ninfrequency of criminal abortion in Catholic families in the United\nStates. It is the Protestant or agnostic American who too often uses one\nof the preventives of conception.\" (Here the Doctor refers to a\nfoot-note in which he says: \"I write this opinion as a Protestant, and\nshould be glad to learn that it is not well founded.\") He continues:\n\"If, through inadvertence, pregnancy should occur, then an abortion is\nin order. Disease and poverty and war and accident all work together to\nkeep down the population, but we are overcoming these. Plagues and\npestilences are rare. The number who die of starvation in California is\nvery small, while war has played but a small part. Through the diffusion\nof the laws of sanitation, improved dietary, and advanced therapeutics,\nthe longevity of man is increasing, but the American woman's aversion to\nchild-bearing is blighting our civilization, and can be well named the\ntwentieth-century curse. In this aversion the woman frequently echoes\nthe wish of the husband.\n\n\"A large proportion of the American young women who marry do so with the\ndetermination that they will have no children. They are abetted in this\nnotion by many elderly women. The cure for this terrible sentiment is\neducation. The home, the press, the schoolroom, and the pulpit should\nbe centres for reviving the ancient idea of the nobility of motherhood.\nThe physician should not underestimate his influence.\n\n\"By constantly bearing in mind the danger of the present tendencies, he\ncan do much to change the current. Let us hope that we shall again see\nthe day when thoughtful motherhood shall be considered the highest\nfunction of womanhood, and to shirk this natural duty will be deemed a\ndisgrace.\"\n\nGentlemen, it would be easy to prove that this testimony of Dr.\u00a0Lindley\nis not that of an exceptional witness, or a piece of special pleading;\nbut it is the acknowledged conviction of the medical profession\ngenerally, confirmed by the last United States Census, and in fact not\nquestioned, to my knowledge, by any weighty authority. As early as 1857,\nDr.\u00a0H.\u00a0B. Storer, an eminent physician of Boston, startled the community\nby publishing two books on this subject, entitled: \"Criminal Abortion.\nWhy not?--A Book for Every Woman\"; \"Is it I?--A Book for Every Man.\"\nSoon after, Rev. John Todd, a Protestant minister of Pittsfield,\nMassachusetts, published a work styled \"Serpents in the Dove's Nest,\"\nall which works and a multitude of others tell the same tale of woe\nregarding the increase of child-destroying crimes in New England,\nchiefly among the old stock peculiarly called Americans. Dr.\u00a0Nathan\nAllen, of Lowell, Massachusetts, in his treatises, \"Changes in the New\nEngland Population\" and \"The New England Family,\" gives overwhelming\ntestimony. \"Harper's Magazine\" (quoted by the \"Catholic World\" for\nApril, 1869) remarks: \"We are shocked at the destruction of human life\non the banks of the Ganges, but here in the heart of Christendom\nf\u0153ticide and infanticide are extensively practised under the most\naggravating circumstances.\" We Catholics are not personally interested\nin this matter; but the good of our fellow-men and chiefly our\nfellow-countrymen calls for the earnest exertion of us all to stop this\ndreadful evil. All the works I have referred to exempt Catholics from\nthe blame pronounced; the \"Harper's Magazine\" article referred to\nexpressly says: \"It should be stated that believers in the Roman\nCatholic faith never resort to any such practices; the strictly\nAmericans are almost alone guilty of such crimes.\" This matter is fully\nexplained in a recent work called \"Catholic and Protestant Countries\nCompared,\" by Rev. Alfred Young, C.P., ch. xxxii.\n\nVII. Now, gentlemen, I am very much afraid that while physicians as a\nbody abhor all such murders and openly condemn them, many do not show\nmuch repugnance to allow, and even sometimes to suggest, such onanistic\nintercourse among married people as shall prevent the possibility of\nconception. For instance, if it happens that a young mother suffers much\nin her first confinement, at once the suggestion is made that a second\nparturition may prove fatal. From that moment regular intercourse is\ndreaded. Either onanism is habitually practised, or the husband becomes\na frequent visitor to dens of infamy, where to where to save his wife's\nhealth, he encourages a traffic that leads multitudes of wretched girls\nto a premature and miserable death. Every one despises those outcasts of\nsociety; but are not the men who patronize them just as guilty? Probably\nenough, if the imprudent suggestion about dangers of a second\nchild-bearing had not been made by the Doctor, the young wife might have\nbecome the happy mother of a numerous family of healthy children. For we\nmust trust in Divine Providence. If a husband and wife do their\nconscientious duty, there is a God that provides for them and their\nfamily more liberally than for the birds of the air and the lilies of\nthe field. And if He should so dispose that the worst should befall,\nwell, such temporal clangers and sufferings as attend child-bearing are\nthe lot of woman-kind, just as the dangers and hardships of the\nbattlefield, the mine, the factory, the forest, and the prairie are the\nlot of the men.\n\nThe man who shirks his duty to family or country is a coward; women, as\na rule, are brave enough in their own line of duty, and patiently submit\nto God's sentence pronounced in Paradise, \"I will multiply thy sorrows\nand thy conceptions, in sorrow shalt thou bring forth children\" (Gen.\niii.\u00a016), just as they have to submit to the words immediately\nfollowing: \"Thou shalt be under thy husband's power, and he shall have\ndominion over thee.\"\n\nCertainly, the husband of a delicate woman ought to spare her strength\nand restrain his passion, but not at the sacrifice of morality; and\nDoctors ought to be very careful not to cause false or exaggerated\nalarms, and thus make themselves to some extent responsible for untold\nmoral evils. They should remember that, as a rule, the raising of a\nfamily is the principal purpose of a married life. The happiness and\nvirtue of the parties concerned depend chiefly on the faithful\nperformance of this duty. How sad is the lot of those--and they are\nmany--who undertook in early years of married life to prescribe a narrow\nlimit to the number of their children; they had one or two, and they\nwould have no more, and for this purpose criminally thwarted the\npurposes of nature. Then comes death and snatches away their solitary\nconsolation: and they spend their old age childless and loveless, in\nmutual upbraidings and unavailing regrets.\n\nHow different is the lot of those aged couples--and they were many of\nyore, and are yet in various nations--who are like patriarchs amid their\ncrowds of children and grandchildren and great-grandchildren, dwelling\nin mutual love and as if in a moral paradise where all domestic virtues\nbloom!\n\nVIII. True, such families are usually the outcome of moderately early\nmarriages; and many Doctors nowadays disapprove of such unions as an\nevil. A moral evil they certainly are not; and the physical evils\nsometimes attending them must, I think, be traceable to a variety of\ncauses; for such evils are certainly not inseparable from early\nmarriages. As to their moral advantages, Mr.\u00a0Wm. E.\u00a0H. Lecky, in his\n\"History of European Morals,\" writes of the Irish people in particular:\n\"The nearly universal custom of early marriages among the Irish\npeasantry has alone rendered possible that high standard of female\nchastity, that intense and jealous sensitiveness respecting female\nhonor, for which, among many failings and some vices, the Irish race\nhave long been pre-eminent in Europe\" (v. i. p.\u00a0146). And that he does\nnot confine his statement to female chastity is evident from what he\nadds farther on: \"There is no fact in Irish history more singular than\nthe complete and, I believe, unparalleled absence among the Irish\npriesthood of those moral scandals which in every Continental country\noccasionally prove the danger of vows of celibacy. The unsuspected\npurity of the Irish priesthood in this respect is the more remarkable,\nbecause, the government of the country being Protestant, there is no\nspecial inquisitorial legislation to insure it, because of the almost\nunbounded influence of the clergy over their parishioners, and also\nbecause, if any just cause of suspicion existed, in the fierce\nsectarianism of Irish public opinion it would assuredly be magnified.\nConsiderations of climate are quite inadequate to explain this fact; but\nthe chief cause is, I think, sufficiently obvious. The habit of marrying\nat the first development of the passions has produced among the Irish\npeasantry, from whom the priests for the most part spring, an extremely\nstrong feeling of the iniquity of irregular sexual indulgence, which\nretains its power even over those who are bound to perpetual celibacy\"\n(p.\u00a0147). No one will say, I believe, that the custom of early marriages\nin Ireland has any injurious effects on the health of either parents or\nchildren. Nor need it necessarily have such effects on those of our\nAmerican young men and women who lead regular lives and are not\nenfeebled by unnatural vices or demoralized by dainty food and luxurious\nmanners.\n\nA wise physician has many proper ways of providing for the health and\nstrength of both parents and children without advocating practices which\nare a snare for innocence. Let him insist with all his patients on the\ncultivation of healthful habits for the family and the individual;\nwholesome and not over-delicate food; moderation in eating and drinking;\nregular and manly exercise, especially in the open air; early hours for\nretiring and rising. But, above all--and this is directly to our present\npurpose--let him show the greatest regard for the laws of morality, the\nmain support of individual and social happiness. His views upon such\nmatters, manifested alike in his conduct and his conversation, but\nespecially in his management of cases involving the application of moral\nprinciples, will go far to influence the community in which he moves.\nHis task is to be a blessing to his fellow-men, a source of happiness\nand security to individuals and to society.\n\n\n\n\nLECTURE VI.\n\nTHE PHYSICIAN'S PROFESSIONAL RIGHTS AND DUTIES.\n\n\nGentlemen, so far I have explained the duties which the physician has in\ncommon with all other men, and which arise directly from the natural law\nindependently of any civil legislation. The natural law requires the\nDoctor to respect the life of the unborn child, thus forbidding\ncraniotomy and abortion. It also obliges him to protect his patients\nfrom the baneful effects of venereal excesses. Over these matters human\nlaw has no control, except that it may and ought to punish such overt\nacts as violate the rights of individuals, or seriously endanger the\npublic welfare.\n\nWe shall now consider the physician's natural rights and duties in\nregard to matters which civil and criminal legislation justly undertake\nto regulate. One of the chief functions of civil authority is to provide\nfor the observance of contracts. Now, the physician in his professional\nservices acts under a double contract, a contract with the state and a\ncontract with his individual patients. By accepting his diploma of M.D.\nfrom the college faculty, and indirectly from the civil authority, he\nmakes at least an implicit contract with the state, by which he receives\ncertain rights conditioned on his performance of certain duties. In\noffering his services to the public, he also makes an implicit contract\nwith his patients by which he obliges himself to render them his\nprofessional services with ordinary skill and diligence on condition of\nreceiving from them the usual compensation.\n\nI. The chief rights conferred on him by the state are these:\n\n1. Protection against all improper interference with his professional\nministrations.\n\n2. Protection for his professional career by the exclusion of\nunauthorized practitioners.\n\n3. Immunity from responsibility for evil consequences that may result\nwithout his fault from his medical or surgical treatment of patients.\n\n4. Enforcement of his right to receive due compensation for his\nprofessional services.\n\nThese rights are not granted him arbitrarily by the state; they are\nfounded in natural justice, but made definite and enforced by human\nlegislation. Take, for an example, his right to receive due\ncompensation for his services. This right was not recognized by the old\nRoman law in the case of advocates and physicians, nor by the common law\nof England until the passing of the Medical Act in 1858. Surgeons and\napothecaries could receive remuneration for their services, but not\nphysicians. These were presumed to attend their patients for an\n_honorarium_ or honorary, that is, a present given as a token of honor.\n\nCertainly, if Doctors by common agreement waived their right to all\ncompensation, or agreed to be satisfied with any gift the patient might\nchoose to bestow, they would be entitled to honor for their generosity;\nbut they are not obliged to such conduct on the principles of natural\njustice. For by nature all men are equal, and therefore one is not\nobliged, under ordinary circumstances, to work for the good of another.\nIf he renders a service to a neighbor, equity or equality requires that\nthe neighbor shall do a proportionate good to him in return. Thus the\nequality of men is the basis of their right to compensation for services\nrendered. The physician's right to his fee is therefore a natural right,\nand on his patient rests the natural duty of paying it. Not to pay the\nDoctor's bill is as unjust as any other manner of stealing.\n\nAs to the amount of compensation to which the Doctor is justly entitled,\nEwell's \"Medical Jurisprudence\" remarks: \"By the law of this country,\nall branches of the profession may recover at law a reasonable\ncompensation for their services, the amount of which, unless settled by\nlaw, is a question for the jury; in settling which the eminence of the\npractitioner, the delicacy and difficulty of the operation or of the\ncase, as well as the time and care expended, are to be considered. There\nis no limitation by the common law as to the amount of such fees,\nprovided the charges are reasonable. The existence of an epidemic does\nnot, however, authorize the charge of an exorbitant fee.\n\n\"A medical man can also recover for the services rendered by his\nassistants or students, even though the assistant is unregistered; it is\nnot necessary that there should be any agreed specified price, but he\nwill be allowed what is usual or reasonable.\n\n\"It is not the part of the physician's business, ordinarily, to supply\nthe patient with drugs; if he does so he has a right to compensation\ntherefor. If the agreement is \"No cure, no pay,\" he cannot, however,\neven recover for medicines supplied, if the cure is not effected. His\nright to recover for professional services does not depend upon his\neffecting a cure, or upon his service being successful, unless there is\na special agreement to that effect; but it does depend upon the skill,\ndiligence, and attention bestowed\" (pp.\u00a03 and 4).\n\nFurther details on this point belong more properly to the lecturer on\nMedical Law. We are now concerned with the principles underlying special\nlegislation. The main principle regulating all compensation is that\nthere shall be a sort of equality between the services rendered and the\nfee paid for them. Ignorant people sometimes find fault with the amount\ncharged as a Doctor's fee. There may, of course, be abuses by excess;\nbut men have no right to complain that a Doctor will ask as much for a\nbrief visit as a common laborer can earn in a day. This need not seem\nunfair if it be remembered that the physician had to prepare, during\nmany years of primary, intermediate, and professional studies, before he\ncould acquire the knowledge necessary to write a brief prescription.\nBesides, it may be that his few minutes' visit is the only one that day;\nand yet he has a right to live in decent comfort on his profession\ntogether with those who depend on him for support.\n\nWe must, however, remember, on the other hand, that excessive fees are\nnothing else than theft; for theft consists in getting possession of\nanother's property without just title. The following rules of Dr.\u00a0Ewell\nare sensible and fair:\n\n\"The number of visits required must depend upon the circumstances of\neach particular case, and the physician is regarded by the law as the\nbest and proper judge of the necessity of frequent visits; and, in the\nabsence of proof to the contrary, it will be presumed that all\nprofessional visits made were deemed necessary and were properly made.\n\n\"There must not be too many consultations. The physician called in for\nconsultation or to perform an operation may recover his fees from the\npatient, notwithstanding that the attending physician summoned him for\nhis own benefit, and had arranged with the patient that he himself would\npay.\" (This, of course, does not mean that the practitioner has a right\nthus to shift the burden of pay from his own shoulders.) \"Where a\nmedical man has attended as a friend, he cannot charge for his visit.\nWhere a tariff of fees has been prepared and agreed to by the physicians\nof any locality, they are bound by it legally as far as the public are\nconcerned (that is to say, they cannot charge more than the tariff\nrates), and morally as far as they themselves are concerned\" (p.\u00a05).\n\nIn these rules Dr.\u00a0Ewell regards chiefly what conduct the courts of\njustice will sustain. It is evident that the Doctor is never entitled to\nrun up his bill without any benefit to his patient; where there is no\nservice rendered at all, there can be no claim to compensation. Still it\nis not necessary that actual benefit has resulted to the patient; it\nsuffices for the claim to the fee that measures have been taken with a\nview to such benefit. Even when no physical advantage can reasonably be\nhoped for from the visit, the consolation it affords the patient and his\nfriends may render those who are to bear the expense fully willing that\nit should be often repeated and, of course, charged on the bill.\nProvided care be taken that they understand the situation, no injustice\nis done them. \"_Scienti et consentienti non fit injuria_\" is a good\nmoral maxim.\n\nII. We have said that the rights conferred on the physician by the state\nare conditioned on his performing certain duties. He owes the same\nduties to his patients in virtue of the contract, explicit or implicit,\nthat he makes with them by taking the case in hand. Under ordinary\ncircumstances, neither the state nor the patients can oblige him to\nexercise his profession at all; but, if once he has taken a case in\nhand, he can be justly held not to abandon it till he has given his\npatient a fair opportunity of providing another attendant; even the fear\nof contagion cannot release him from that serious obligation.\n\nThe duties arising from the physician's twofold contract, with the\nstate and with his patients, are chiefly as follows:\n\n1. He must acquire and maintain sufficient knowledge of his profession\nfor all such cases as are likely to come in his way. No Doctor has the\nright to attempt the management of a case of which he has not at least\nordinary knowledge. In matters of special difficulty, he is obliged to\nuse special prudence or ask for special consultation. The courts justly\nhold him responsible for any serious injury resulting from gross\nignorance; in such cases they will condemn him for malpractice. I would\nhere remark that, in an age in which the science of medicine is making\nsuch rapid progress, every Doctor is in duty bound to keep up with the\nimprovements made in general practice, and in his own specialty if he\nhas one.\n\n2. A second duty is that of proper diligence in treating every single\ncase. Many a patient suffers injury to health or even loses his life in\nconsequence of a Doctor's neglect. Gross negligence is an offence that\nmakes him punishable by the court, if it results in serious injury. But\neven if such injury cannot be juridically proved, or has been\naccidentally averted, the moral wrong remains and is to be settled with\nthe all-seeing Judge. Still, in ordinary ailments, no one is obliged to\ntake more than ordinary trouble.\n\n3. A third duty of the physician is to use only safe means in medical\nand surgical practice. He has no right to expose his patient to needless\ndanger. What is to be thought of the use of such remedies as will either\nkill or cure? They cannot be used as long as safer remedies are\navailable and capable of effecting a cure; for neither Doctor nor\npatient has a right to expose a human life to unnecessary risk. But when\nno safer remedies are going to effect a cure, then prudence itself\ndictates the employment of the only means to success. In such a case,\nhowever, the patient, or his parents or guardian, should, as a rule, be\ninformed of the impending danger, so that they may give or refuse their\nconsent if they please. For, next to God, the right to that life belongs\nto them rather than to the physician. The same duty of consulting their\nwishes exists when not life but the possible loss of a limb is at stake,\nor the bearing of uncommon sufferings. Moralists teach that a man is not\nobliged in conscience to submit to an extraordinarily painful or\nrevolting operation even to save his life. Certainly, when the natural\nlaw leaves him at liberty, the physician cannot compel him to submit to\nhis dictation; all he can do is to obtain his consent by moral\npersuasion.\n\n4. As a consequence from the Doctor's duty to use only safe means it\nfollows that he cannot experiment on his patients by the use of\ntreatment of which he does not know the full power for good or evil. Nor\nis he excused from responsibility in this matter by the fact that the\nexperiment thus made on one patient may be very useful to many others.\nHis contract is with the one now under treatment, who is not willing, as\na rule to be experimented upon for the benefit of others. And even if\nthe patient should be willing, the Doctor cannot lawfully expose him to\ngrievous danger unless it be the only hope of preserving his life. This\nfollows from the principle explained before, that human life belongs\nchiefly to God and not to man exclusively.\n\n5. There are various kinds of medical treatment to which we can scarcely\nhave recourse without exposing ourselves to serious evil consequences.\nSuch is the use of cocaine, morphine, and even in special cases of\nalcohol. The drugs in themselves are useful, but they often lead to evil\nresults. Now in the use of all such drugs as are apt to be beneficial in\none way and injurious in another, we must ever be guided by the rules\nformerly explained concerning evil indirectly willed, or rather\npermitted to result, while good results are directly willed or intended.\nIf the Doctor is satisfied that a dose of morphine or an application of\ncocaine will do more good than harm, he can, of course, prescribe or\napply it. Still in such matters he must remember that the good effect is\nbut temporary, while its pernicious consequences, especially when habits\nare thus contracted, are likely to be permanent and cumulative. Besides,\nthe good results affect the body only, the evil often affect body and\nsoul. Many a wreck in health and morals has been caused by imprudent\nrecourse to dangerous treatment, where a little more patience and wisdom\nwould have been equally efficient in curing the bodily ailment, without\nany deleterious consequences. If once a patient becomes a slave to the\nmorphine or cocaine habit, the only cure is to cut off all the supply of\nthe drug either at once or, at any rate, by daily diminution. To leave\nhim free control of the poison is to co-operate in his self-destruction.\n\n6. The sixth duty of a Doctor is of a different kind. There exists a\ntacit or implicit contract between him and his patients that he shall\nkeep their secrets of which he becomes possessed in his professional\ncapacity. It is always wrong wantonly to betray the secrets of others;\nbut the Doctor is bound by a special duty to keep his professional\nsecrets; and it is doubly wrong and disgraceful in him to make them\nknown. For instance, if he has treated a case of sickness brought on by\nsinful excesses of any kind, he is forbidden by the natural law to talk\nabout it to such as have no special right to know the facts. Parents and\nguardians are usually entitled to be informed of their children's and\ntheir wards' wrong-doings, that they may take proper measures to prevent\nfurther evil. Besides, the Doctor is properly in their service; he is\npaid by them, and, therefore, his contract is with them rather than with\nthe children. He can, therefore, prudently inform them of what is wrong,\nbut he cannot inform others.\n\nIt is a debated question in Medical Jurisprudence whether the Doctor's\nprofessional knowledge of criminal acts should be privileged before the\ncourts, so that he should not be forced to testify to a crime that he\nhas learned from his patients while acting as their medical adviser.\nDr.\u00a0Ewell speaks thus on the subject (p.\u00a02): \"The medical witness should\nremember that, by the common law, a medical man has no privilege to\navoid giving in evidence any statement made to him by a patient; but\nwhen called upon to do so in a court of justice, he is bound to disclose\nevery communication, however private and confidential, which has been\nmade to him by a patient while attending him in a professional\ncapacity. By statute, however, in some of the United States,\ncommunications made by a patient to a physician when necessary to the\ntreatment of a case are privileged; and the physician is either\nexpressly forbidden or not obliged to reveal them. Such statutes exist\nin Arkansas, California, Indiana, Iowa, Ohio, Michigan, Minnesota,\nMissouri, Montana, New York, and Wisconsin. The seal upon the\nphysician's lips is not even taken away by the patient's death. Such\ncommunications, however, must be of a lawful character and not against\nmorality or public policy; hence, a consultation as to the means of\nprocuring an abortion on another is not privileged, nor would be any\nsimilar conference held for the purpose of devising a crime or evading\nits consequences.\n\n\"A report of a medical official of an insurance company on the health of\na party proposing to insure his life is not privileged from production;\nnor is the report of a surgeon of a railroad company as to the injuries\nsustained by a passenger in an accident, unless such report has been\nobtained with a view to impending litigation.\"\n\nThe practical rule for a Doctor's conscience on the subject of secrecy\nis, that he must keep his professional secrets with great fidelity, and\nnot reveal them except in as far as he is compelled to do so by a court\nof justice acting within its legal power or competency. If so compelled,\nhe can safely speak out; for his duty to his patient is understood to be\ndependent on his obedience to lawful authority.\n\nAs to the question of Jurisprudence whether the courts _ought_ to treat\nthe physician's official secrets as privileged, in the same way as they\ndo a lawyer's secrets, this will depend on the further question whether\nthe same reasons militate for the one as for the other. The lawyer's\nprivilege is due to the anxiety of the state not to condemn an innocent\nman nor a guilty man beyond his deserts. To avert such evil, the accused\nparty needs the assistance of a legal adviser who can guide him safely\nthrough the mazes and technicalities of the law, and, even should he be\nguilty, who can protect him against exaggerated charges and ward off\nunmerited degrees of punishment. Now, this can scarcely be accomplished\nunless the attorney for the defence learn from his client the entire\ntruth of the facts. But the client could not safely give such\ninformation to his lawyer if the latter's professional secrets were not\nheld sacred by the court of justice.\n\nCan the same reasons or equivalent ones be urged in behalf of the\nphysician? I do not see that they can. And I notice besides that, if he\nbe excused from testifying against his patients, all their servants and\nattendants would seem to be entitled to the same privilege. Many\npersons, I think, labor here under a confusion of ideas; a Doctor is as\nsacredly bound to keep his patients' secrets as a lawyer is in regard to\nhis clients, but it does not follow that the law cannot grant a\nprivilege to the one and refuse the same to the other, for reasons which\nrequire it in the case of the lawyer and not in that of the Doctor.\n\nIII. Besides the rights and duties which arise for the physician from\nhis contracts with the state and with his patients, there are other\nclaims on his conscience, which proceed from his character as a man, a\nChristian, and a gentleman.\n\n1. _As a man_, he is a member of the human family, not a stranger\ndwelling amid an alien race, but a brother among brothers. He cannot\nsay, as did the first murderer, Cain, \"Am I my brother's keeper?\" But\nrather he must carry out the behest of the great Father of the human\nfamily: \"God has given to each one care of his neighbor.\"\n\nThe maxim of Freemasons is that every member of that secret society must\ncome to the assistance of every brother-mason in distress. But the law\nof nature and of nature's God is wider and nobler; it requires every man\nto assist every fellow-man in grievous need. The rich glutton at whose\ndoor lay Lazarus dying of want was bound, not by any human but by the\nhigher law, to assist him; and it was for ignoring this duty that the\nsoul was buried in hell, as the gentlest of teachers expresses it.\n\n(_a_) As physicians, as men, you will have duties to the poor, who\ncannot pay you for your services; they are your fellow-men. Their bill\nwill be paid in due time. He is their security who has said: \"Whatsoever\nyou have done to the least of these, you have done it unto Me.\" He may\npay you in temporal blessings, or in still higher favors, if you do it\nfor His sake; but pay He will, and that most liberally: \"I will repay,\"\nsays the Lord. The rule of charity for physicians is that they should\nwillingly render to the poor for the love of God those professional\nservices which they are wont to render to the rich for pecuniary\ncompensation. While thus treating a poor patient they should be as\ncareful and diligent as they would be for temporal reward; what is done\nfor God should not be done in a slovenly fashion.\n\n(_b_) In this connection of regard for the poor, allow me also to call\nyour attention, gentlemen, to a point which students of medicine are apt\nto forget at times, and yet which both God and the world require you\never to bear in mind: it is the respect which every man owes to the\nmortal remains of a departed brother. I do not know that a people has\never been found, even among barbarians, who did not honor the bodies of\ntheir dead. For the good of humanity, dead bodies may at times be\nsubjected to the dissecting-knife, but never to wanton indignities.\nReason tells you to do by others as you wish to be done by, and\nRevelation adds its teaching about a future resurrection and\nglorification of that body of which the Apostle says that \"it is sown in\ndishonor, but it shall rise in glory.\" Be men of science, but be not\nhuman ghouls. There is such a thing as retribution. But lately a former\nmillionaire died in a poorhouse and left his body as a cadaver for\nmedical students. We cannot afford to ignore the mysterious ways of\nDivine Justice. Ever handle human remains in a humane manner; and as\nsoon as they have answered the purpose of science, see that they be\ndecently interred, if possible.\n\n2. There are other duties that you owe not as men but _as Christians_.\nAll of us enjoy the blessings of Christian civilization, even those who\nare not Christians themselves. We are dealt with by others on Christian\nprinciples, and we ought to treat others in the same spirit. What duties\ndoes this impose?\n\n(_a_) When your patients are in real danger of death, let them have a\ngood chance to prepare properly for their all-important passage into\neternity. Give them fair warning of their situation. Doctors and\nrelations are often afraid of alarming the patients and thus injuring\ntheir health. But those who attend Catholic patients at least soon find\nout by experience that the graces and consolations of the Last\nSacraments usually bring a peace of mind that benefits even the bodily\nhealth. In any case, the interests of the future life are too important\nto be ignored.\n\n(_b_) For the same reason, the physician should not prescribe such doses\nof morphine or other an\u00e6sthetics as will render the patient unconscious\nat a time when he ought to be preparing to meet his Judge. This would be\nnot kindness but cruelty. A little suffering more in this life may save\nmuch suffering in the next. If a Catholic priest, on being called to a\npatient's bedside, finds that the family's physician has been so\ninconsiderate, he cannot help protesting against employing such a man in\nCatholic families.\n\n(_c_) If you attend a woman in childbirth, you may be asked by a\nChristian mother not to let her child die without Baptism. The vast\nmajority of Christians believe that this sacrament is necessary to\nobtain supernatural happiness. The ceremony is easily performed: no\nharm can come of it, but immeasurable good for eternity. It should\nproperly be performed by the clergy. But if this cannot be done, any\nman, woman, or child, even one not a Christian himself, can administer\nthe sacrament. Every Doctor in a Christian land should understand how to\ndo it, and do it with unerring accuracy. It were a disgrace for him to\nbe ignorant of what even an ordinary child is expected to know. The\nceremony is so simple; and yet, being an institution of Christ, no man\ncan modify it to suit his notions; if what is done is not just what\nChrist appointed to be done, it will be of no avail. Notice, therefore,\ncarefully every detail. You will take a little water, say a cupful, real\nwater--cold or lukewarm, that matters not--you will slowly pour it on\nthe head of the child, and, _while you do so_, you will say, \"I baptize\nthee in the name of the Father, and of the Son, and of the Holy Ghost.\"\nThat is all. Notice, you must say the words while the water is being\npoured on the child. For \"I baptize\" means \"I wash\"; pour, therefore, or\nwash while you say, \"I wash.\" Should you hereafter wish to refresh your\nmemories on this matter, you can do so by consulting the \"Century\nDictionary,\" which explains Baptism, and in particular Catholic Baptism,\nas \"consisting essentially in the application of water to the person\nbaptized by one having the intention of conferring the sacrament, and\nwho pronounces at the same time the words, 'I baptize thee in the name\nof the Father, and of the Son, and of the Holy Ghost.'\" If a cup of\nwater given to the thirsty brings a blessing, how much more the giving\nof the water of salvation! Should it happen that the child is in danger\nof dying before delivery, it should be baptized in the womb provided it\nbe at all possible to cause the water to reach or wash its body,\nprojected upon it by any instrument whatever; but the water should flow\nover the body, not merely over the cyst enclosing it, for the cyst is no\npart of the child. Even if but an arm or other minor portion of the body\nis washed, the baptism is probably valid. If any doubt about the valid\nadministration is left, the infant after delivery should be carefully\nbaptized _under condition_, as it is called; that is, with the condition\nadded that, if the former ceremony was validly conferred, there is no\nintention of giving a second baptism. For that would not be right; since\nthe sacrament cannot be validly received more than once; it is a sacred\ninitiation, but it were mockery to initiate one that is already\ninitiated.\n\nShould a physician be present when a pregnant woman has recently\nexpired, and the child may still be living in the womb, it will be an\neasy and important task to perform the Cesarean section as soon as\npossible, and baptize the little one before it dies. In all this there\nis no money, but what is far more precious, the securing of eternal\nhappiness. I add with great pleasure that many physicians are wont to\ncomply with all these instructions most carefully, and even to instruct\nmidwives and nurses in the best manner of rendering such services.\n\n3. Lastly, we must consider the duties which a Doctor owes to others and\nto himself _as a gentleman_. It may not be easy to define what is meant\nby \"a gentleman,\" and yet to some extent we all know it; we recognize a\ngentleman when we meet one, we pay him sincere homage in our hearts. We\nreadily allow him to influence us and to guide us. We esteem him\ninstinctively as a superior being, as we distinguish a precious stone\nfrom a common pebble; so we value a gentleman for precious qualities\nexhibited in the beauty of his conduct. His conduct ever exhibits two\ncharacteristic marks: a proper degree of dignity or respect for self,\nand a proper degree of politeness or respect for others. Self-respect\nwill not allow him to do anything which is considered vulgar,\nunmannerly, gross, rude, or selfish; he will avoid the two extremes, of\nself-neglect on the one hand and self-display on the other. His respect\nfor others will make him treat all around him so as to make them feel\ncomfortable in his presence; he will avoid whatever gives pain or causes\nembarrassment to even the lowest member of society.\n\nGentlemanliness has much to do with every one's success in life, and in\nparticular with a Doctor's success. It is especially when sick that we\nare sensitive to everything displeasing in the conduct of others. It is\nnot then the bold thinker or the extensive reader that is the acceptable\nvisitor to the sick-room; but the gentlemanly consoler who always says\nthe right thing at the right time, whose very eye expresses and whose\ncountenance reflects the thought and sentiment most appropriate on the\noccasion.\n\nThere are most able physicians who are not gentlemen, and there are in\nthe medical profession gentlemen who are rather poor physicians; but as\na rule, I believe, the gentleman will thrive where the genius will\nstarve. It is more or less the same in other professions. I know learned\nlawyers to-day who are far from prosperous, while men ten times their\ninferiors in learning are getting rich. I remember a most skilful\nphysician, now no more on earth, who was a very genius in the science of\nmedicine; but he was so filthy in his habits, he would so\nunceremoniously chew tobacco at all times, that many dreaded his\nvisits, and would sooner have a man of less ability but gentler manners\nas their family physician.\n\nGentlemen, habits good and bad cannot be put on and off like a\ndress-coat; they are lasting qualities, the growth of years, the result\nof constant practice and self-denial or self-neglect. And, as I wish you\nsuccess in life, allow me to conclude this lecture by recommending to\nyou the assiduous cultivation of gentlemanly habits. Cultivate them now,\nwhile you are preparing for future labors. You wrong yourselves, and you\ninsult your companions and your professors, when you neglect in their\npresence the conventionalities of polite society.\n\nUniting the external decorum of a gentleman with a thorough knowledge of\nyour profession, and with what is still more important, the virtues of a\nconscientious man and a sincere Christian; ever true to the sound\nprinciples of morality which I have endeavored to explain and to\ninculcate in these lectures: you will be an honor to yourselves, an\nornament to your noble profession, the glory and joy of your Alma Mater,\na blessing to the community in which Providence will cast your lot as\nthe dispensers of health and happiness and length of days to your\nfellow-men.\n\n\n\n\nLECTURE VII.\n\nTHE NATURE OF INSANITY.\n\n\nThe subject of the present lecture, gentlemen, is \"Insanity.\"\n\nI. This subject belongs to a course of Medical Jurisprudence, because a\nphysician who treats patients for insanity is liable, from time to time,\nto be cited before a court of law either as a witness or as an expert.\nHis conduct in such cases is to be guided by the principles of natural\nand legal justice.\n\nVarious important cases at law turn upon the question of a person's\nsoundness of mind; and frequently the medical expert has it in his power\nto furnish the court with more reliable information in this matter than\nany one else. At one time, the validity of a last will may be contested,\nand the possession of a fortune by one party or another may hinge on the\nquestion whether the testator at the time of making his will was in\nsufficient possession of his mental powers to perform an act of so much\nconsequence.\n\nAt another time, interested parties may plead for or against the\nvalidity of a sale or other bargain made by a person of doubtful\ncompetency of mind; or a life-insurance company may be interested in\nascertaining the mental condition of an applicant for membership; or it\nmay be questioned whether the payment of an insurance policy is due to\nthe family of a suicide, the doubt depending for solution on the sound\nor unsound condition of his mind at the moment of the fatal act. Again,\nthere may be a real or pretended doubt whether a certain property-owner\nis so far demented as to be unfit to manage his estate; or whether he\nneeds a guardian to take care of his person; or it may even seem\nnecessary to confine him in a lunatic asylum. There may be objections\nraised to the mental soundness of a witness in a civil or a criminal\nsuit; or, finally, a criminal prosecution will depend mainly on the\nsanity or insanity of the culprit at the moment when the crime was\ncommitted; as was the case with a Prendergast and a Guiteau.\n\nYou see, then, gentlemen, that important interests are dependent on the\nthorough and correct understanding of this matter; and therefore much\nresponsibility rests upon the experts consulted in such cases: property,\nhonor, liberty, nay, even life itself may be at stake.\n\nThat cases involving an insane condition of mind must be of frequent\noccurrence, both in the medical and in the legal professions, is\napparent from the large and rapidly increasing amount of lunacy in our\nmodern civilization. Wharton and Still\u00e9's \"Medical Jurisprudence\" states\n(sec.\u00a0770, note) that in 1850 there was in Great Britain one lunatic to\nabout one thousand persons; only thirty years later the Lunacy\nCommission of Great Britain reported one lunatic to 357 persons in\nEngland and Wales, that is, nearly three times as many. In New York\nthere is one to 384 persons. It appears certain that its increase of\nlate is out of all proportion to the increase of population; and even\nthough I see reasons to distrust somewhat the figures quoted for\nEngland, enough is known to create serious alarm regarding the fruits of\nmodern manners and customs on the minds of thousands. This fact makes\nthe matter of insanity very important for the medical and the legal\nstudent.\n\nII. Still it must be noted that the responsibility of deciding cases of\nlunacy does not rest chiefly with the medical expert. In cases of\ndoubtful insanity the decision is to be given not by the Doctor but by\nthe court of justice. Except on very special occasions, as when a\nphysician is appointed on a committee or commission of inquiry, he\nappears before a court either as an ordinary witness, stating what\nfacts have fallen under his personal observation; or as an expert,\nexplaining the received opinion of medical men with regard to cases of a\ncertain class. Even though he feels convinced that the culprit or the\npatient is as mad as a March hare, the physician cannot expect that his\nstatement to that effect will be received as decisive. It is for the\njudge to instruct the jury what kind or degree of insanity will excuse a\nculprit from legal punishment, or will disqualify a person from\ntestifying as a witness, or from being a party to a civil contract in\ncertain cases; and it is for the jury to decide whether, in the case in\nhand, the fact of such insanity exists or not. In criminal cases, the\njury pronounces on the double question, whether the accused did the act\ncharged to him, and whether he has been juridically proved to have been\naccountable for the act under the laws as expounded by the judge.\n\n1. To come to a decision on this double question, the jury might need to\nhear the facts stated which the physician has personally observed, and\nof which he is summoned to be a sworn witness. In such a situation all\nthat is required of the Doctor is that he shall give a most faithful\nand intelligent account of the facts.\n\nIt would disgrace his standing in society if any fault could be found\nwith his testimony; and, as a sworn witness, he is bound in conscience,\nlike any other witness, to state the truth, the whole truth, and nothing\nbut the truth. This is always the case when the purpose of the inquiry\nis the discovery of the sane or insane condition of a person's mind. But\nif the inquiry concerns the performance of the guilty act, the\ncommission of the crime, many States of the Union, as explained before,\nconsider the Doctor's professional secrets as privileged, just like\nthose of the lawyer and the clergyman; i.e., the Doctor must not use\nagainst his patient any knowledge he has become possessed of while\nacting as his medical adviser.\n\n2. When the physician appears before a court or commission as an expert,\nhe is expected to give the views of the medical profession upon\nhypothetical cases resembling the one under examination, and the\nscientific reasons and authorities on which those views are advanced.\n\n3. But here a considerable difficulty presents itself; it is so serious\nthat, owing to it, the weight of the medical expert's testimony with\njudge and jury is often much less than could reasonably be desired. The\ndifficulty is to ascertain what really are the views of the medical\nprofession on any given subject. Of course no individual Doctors can\nput themselves up as representing the convictions of the medical\nprofession, nor can they always appeal to the unanimous agreement of\ntheir leading men. Leading physicians, unfortunately, are far from\nentertaining concordant views on many most vital questions. It is this\nwant of agreement that has made the testimony of experts so powerless to\nsway the minds of judge and jury.\n\nThe medical profession has no organization through which it can\npronounce judgment. In fact, many of its most conspicuous members have\nadopted principles at variance with the deepest convictions of mankind\ngenerally; such, for instance, are the followers of Darwin, Huxley,\nMaudsley, and similar agnostic and materialistic leaders of modern\nthought.\n\n4. What still further diminishes the credit of medical experts is the\nfact that, both in civil and criminal trials, they are summoned either\nby the defence or by the prosecution, and are thus naturally selected,\nnot on account of their thorough knowledge, but on account of their\npeculiar views known beforehand to the parties citing them. Thus their\ntestimony is likely to be partial to either side, and is distrusted; at\nleast it fails to command perfect confidence. The only way in which the\nprejudices thus created against the physician can be overcome is by his\nacquiring thorough knowledge of his specialty, and showing himself on\nall occasions to be as honorable and faithful as he is evidently\nexperienced and intelligent.\n\n5. The medical profession could be brought to be much more useful to\nsociety for the discovery of insanity if we could have here something\nlike what exists in some parts of Germany. \"The practice obtains there\nof requiring the medical faculty of each judicial district to appoint a\nspecial committee, to which questions of this kind are referred. This\ncommittee is examined directly by the court, and gives testimony\nsomewhat in the same way, and with the same effect, as would a\ncommon-law court when reporting its judgment in a feigned issue from\nchancery, or as would assessors called upon under the canon law to\nstate, in proceedings under the law, what is the secular law of the land\non the pending question\" (Wharton and Still\u00e9, sec.\u00a0274).\n\nThe matter of introducing some such practice into this country has been\nagitated of late, and may by and by lead to beneficial results.\nDr.\u00a0Shrady has taken steps to promote this object by striving to have a\nlaw enacted by the New York legislature providing for the regulation of\nexpert medical testimony in jury trials. According to his plan, once\nsuch a commission has been established, the court is to send the\nmedical issue to these experts, just as it sends other issues to special\njuries to be decided. The regular petit jury will then decide only upon\nthe facts constituting the crime.\n\nThis would do away with special pleas of insanity before a jury that\nknows little or nothing about the nature of the disease, and whose\nsympathies may readily be worked upon by shrewd lawyers to render a\nverdict of acquittal.\n\nAs things are now, the medical expert, summoned to testify in a case of\ncontested sanity or insanity of mind, ought to rise above minor\nconsiderations, and promote the cause of justice, by giving all the\nvaluable information that his profession enables him to acquire on the\nvery difficult subject of mental unsoundness.\n\n6. For this purpose, he must be skilled in three departments of science.\n\n(_a_) In _law_--sufficiently to understand what are considered by the\ncourts as characteristic marks of an insane mind, and what amount of\nsanity the courts require to hold a culprit responsible for his crime or\na contract valid in its effects.\n\n(_b_) In _psychology_--to such an extent that the expert witness can\nspeak analytically and correctly as to the properties and actions of the\nhuman mind.\n\n(_c_) In _medicine_--so far as concerns the treatment of the insane, and\nthe understanding of their peculiarities, so as to reason from them by\ninduction to the real condition of the client's or patient's mind.\n\nBut the main requisite for an expert witness is to understand clearly in\nwhat insanity properly consists, and how far it ought to excuse an\ninsane man from bearing the consequences of his acts.\n\nIII. This two-fold knowledge is obtained by the psychological study of\ninsanity, on which study we are now to enter, and it is the principal\npoint in this whole matter.\n\nInsanity means a want of soundness; he is insane whose mind is not\nsound, but is deranged, and therefore, like a machine out of order, it\ncannot properly perform its specific task, namely, to know the truth of\nthings. An insane man cannot judge rightly.\n\n1. Insanity takes various forms, which may be reduced to two kinds, with\nthe doubtful addition of a third kind, namely, moral insanity, of which\nwe shall speak in our next lecture.\n\nThe first kind consists in the total want or gross torpor of mental\nactivity. When there is a total, or nearly total, eclipse of the\nintellect, the disease is called _idiocy_, the state of an idiot. When\nthere is an abnormally low grade of the reasoning power, it is styled\n_imbecility_. The failure or decay of reason in old age is called\n_dotage_.\n\nThe second kind of insanity is called _illusional_ or _delusional_. In\nit the intellect is not impotent; on the contrary, it is often unusually\nactive; but its action is abnormal, its conclusions are false. Not that\nit reasons illogically or draws conclusions which are not contained in\nthe premises. Very keen logicians may be demented. Their unsoundness\narises from the fact that they reason from false premises; and they get\ntheir false premises from their diseased imaginations, whose vagaries\nthey take for realities.\n\n2. Here a difficulty presents itself, which we must explain at once,\nnamely, how can there be unsoundness of mind at all? Is not the\nintellect of man a simple power, and his soul a simple being? How can a\nsimple being become deranged? Can that which has no parts become\ndisarranged, disorganized? I answer, the soul is a simple being, its\nintellect is a spiritual faculty; and therefore we never say that the\n_soul_ is insane, nor should we say that the _intellect_ is insane or\ndiseased; but we say that the _mind_ is deranged or insane; the mind\ncomprises more than the intellect; it designates the intellect together\nwith those lower powers that supply the materials for our thought, the\nchief of which is the imagination. Now the imagination is an organic\nfaculty: it works in and by a bodily organism, which is the brain.\nTherefore, when the brain is not in a normal condition, the action of\nthe imagination may be disordered. And the intellect or understanding of\nthe spiritual soul is so closely united in its action and its very being\nwith the organic body that the two ever act conjointly, like the two\nwheels of a vehicle. If one wheel breaks down, the other is thrown out\nof gear. Thus it is readily understood that mental unsoundness is an\naffection of the brain, a bodily disease, which may often be relieved\nand even cured by bodily remedies, by the use of drugs or wholesome\nfood, healthy exercise, fresh air, and all that benefits the nervous\nsystem.\n\nPathologically considered, the nerves may be too excited or too sluggish\nand torpid; and we have as the result two subdivisions of mental\ninsanity--_mania_ and _melancholia_. The differences between these two\nare very striking; as they proceed from opposite causes they produce\nopposite effects, and, therefore, they betray themselves by very\ndifferent manifestations; but in one point the two agree, and with this\npoint precisely we are concerned, because in it lies the essence of\nmental insanity, namely, that both produce a disordered action of the\nimagination.\n\n3. The manner in which the imagination co-operates in mental action is\nthis. It presents to the intellect the materials from which that power\nforms its ideas. When we see, feel, hear, taste, or smell anything by\nour bodily senses, our imagination takes note of the object perceived by\nforming a brain-picture of it which is called a _phantasm_. I do not\nmean to say that it forms a photographic picture of the object; for\nthere can be no photographing taste or smell or feeling; but it forms an\nimage of some kind which it presents to the intellect. This power at\nonce proceeds to form, not a brain-picture, but an intellectual or\nabstract image of the object presented. For instance, you see this book,\nand at once you, in some mysterious way which has never yet been\nexplained, impress some image of it on your brain. That you do so is\nclear from the fact that the image remains when the book is withdrawn.\nThat material image or brain-picture is the _phantasm_. It is not an\n_idea_, though it is often improperly so called. But your intellect\nforms to itself an idea of a book; that is, you know what is meant by a\nbook. You distinguish between the mere form of a book and the book\nitself. Your idea of a book is a universal idea, which stands for any\nbook, no matter of what shape or size. Every phantasm, or brain-picture,\nis a representation which presents its object as having a definite shape\nor size, while your idea of a book ignores any shape or size. And yet,\nwhen your intellect conceives a book, your imagination will picture some\nparticular form of book. If your brain became so affected by disease as\nto be unfit for the formation and retention of the proper phantasms,\nthen your intellect either would not work at all or it would work\nabnormally; your mind would then be insane.\n\n4. Now, in an infant the brain is still too soft and imperfect to form\nthe proper phantasms from which the intellect is to elaborate its ideas.\nA false school of psychology would say that the infant's brain cannot\nyet _ideate_; but that is incorrect language. No brain can ideate or\nform ideas; an idea is an intellectual or mind image, not a brain image;\nit is an abstract and universal image, and matter cannot represent but\nwhat is concrete and individual. Only a simple and spiritual being, the\nrational soul, can form ideas. Nevertheless our soul, in its present\nstate of substantial union with our body, is extrinsically dependent on\nthe body; to form ideas it needs to have the sensible object presented\nto it by a phantasm or brain-picture. Now, a child born blind and deaf,\nand thus having its mind, as it were, cut off from communication with\nthe outer world, could scarcely form the necessary phantasms, because\nthe clogged senses could not supply proper materials for them; such a\nchild would, therefore, be apt to remain idiotic. And even in children\nwhose outer senses are sound the brain or the nervous system may be too\nimperfect to allow of its forming proper phantasms. In this torpor of\nthe mind then consists the first kind of mental unsoundness, that of\n_idiocy_, or its milder form _imbecility_. In old age, and in peculiar\ndiseases, the worn-out system may return to a second childhood, then\ncalled _dementia_ or _dotage_. The existence of such species of insanity\nis not difficult to discover.\n\n5. The second and more common form of insanity, and that which it is\noften difficult to discover and pronounce upon with certainty, is that\nwhich I have called _delusional_ or _illusional_. Its characteristic\ntrait, its very essence, lies in this, that the insane man mistakes what\nhe imagines for what is real; and he cannot be made to distinguish\nbetween imagination and reality, though the difference is obvious to an\nintellect in its normal state.\n\nIn this connection, it is well to point out a distinction, not always\nobserved, but useful to explain the workings of an insane mind, between\n_illusions_, _hallucinations_, and _delusions_.\n\n(_a_) An _illusion_ is properly a deception arising from a mistake in\nsense-perception; as when a half-drunken man sees two posts where there\nis only one. He has a picture of the post in each eye, and his brain is\ntoo much disturbed to refer the two pictures to the same object. In this\ncase the cause of the mistake is subjective. A _mirage_ offers another\ninstance of a sense-illusion; but in it the cause is objective.\n\n(_b_) A _hallucination_ is a creation of the fancy mistaken for a\nreality. The deception may be but momentary, as when Macbeth is stealing\non tiptoe to the chamber of his guest to murder him. His mind is\ndisturbed by the imagination of the horrid deed he is about to\nperpetrate. He thinks he sees a dagger in the air, and he says: \"Is this\na dagger that I see before me, its handle towards my hand? Come, let me\nclutch thee. I hold thee not, and yet I see thee still; and on thy\ndudgeon gouts of blood, which was not so before.\" But Macbeth, upon a\nmoment's reflection, sees it is all imagination. \"There's no such\nthing,\" he exclaims. He is not insane, though deceived for a while.\n\n(_c_) A _delusion_, on the contrary, is a permanent deception, whether\nit results from an illusion or a hallucination, it matters not; as a\nfact, it almost always originates in hallucinations. The deluded man\nclings to his imaginings; you cannot talk them out of his head. Such is\nthe case of an inebriate who suffers from _mania a potu_, or \"the\nhorrors;\" he sees snakes and demons, he thinks, and persists in his\nerror. Such also is a fixed idea not arrived at by faulty reasoning, but\ncome unbidden and proof against all reasoning and evidence. Thus an\ninsane man may be convinced, solely by his imagination, that he is\npoisoned or pursued or conspired against.\n\n6. This delusion constitutes the essence of mental insanity, which\ntherefore is often called delusional insanity. It may be chronic, i.e.,\nof long continuance, or it may be temporary, acute. For the time being,\nthe effects are the same. Perhaps any man may, at times, be for a moment\nthrown off his guard, and mistake a fancy for a reality; this does not\nconstitute lunacy. But when the error is so firmly held in the mind's\ngrasp that nothing can dislodge it thence, then the mind is deranged in\nits special sphere of action, which consists in knowing the real from\nthe unreal; the mind is then insane.\n\nYou notice, gentlemen, that I speak of the mind as grasping the error,\nand I suppose it to do so independently of the free will's command. But\nwhen the error is voluntary; when a man clings to it simply because he\nloves it; when he hugs a delusion to his heart, this shows not mental\nbut moral obliquity; it is not insanity but self-deception, and it is by\nno means of rare occurrence. In a well-reasoned article on \"The\nMetaphysics of Insanity,\" written by Mr.\u00a0James M. Wilcox and printed in\nthe \"American Catholic Quarterly Review\" for January, 1878, some very\nsevere and no less true strictures are made upon the readiness of a vast\nmultitude of people to practise this wilful self-deception. \"Self,\" he\nwrites (p.\u00a054), \"is the prolific origin of such errors; and so indulgent\nare we to its faults that we try secretly to hide them even from our own\neyes, mostly with success; and where success is not perfect, we make a\nsecond effort to hide the imperfection. Repeated efforts of this kind,\nfrom which we but half turn away, are crowned in the end, and we soon\nforget what successful hypocrites we have been. Our numerous passions,\nthe complexities of our desires, the tenacity of their grasp, and the\npleasant gentleness of its touch explain an infinity of temptations\nfollowed by wilful successes in blindness, all of which are nothing less\nthan guilty acts of self-deception.\"\n\n7. It oftens happens in real insanity that mental derangement manifests\nitself upon one error or one group of errors only, while for all the\nrest the patient appears to be quite rational. Such a man is called a\n_monomaniac_. But he is truly an insane man; for the essence of insanity\nis in him. It is usually found that a monomaniac will, sooner or later,\nexhibit signs of mental unsoundness on other matters as well; and even\nwhile he has given no such signs, it still remains true that a mind\ncannot be trusted, but has something radically unsound about it, if it\nis really unhinged at any point at all.\n\nBut then you must be very careful not to confound monomania with\neccentricity. The distinction is as important as it is real.\n_Eccentricity_ is a conscious aberration from the common course of life;\nit consists in peculiarities in reasoning, words, and actions, which are\nwilfully indulged, in defiance of popular sentiment. The eccentric man\nknows that he is eccentric; he is willing to be so, and to take the\nconsequences; but he is not insane.\n\nAs this matter is of frequent occurrence before the courts of justice,\nand the validity of last wills in particular often depends on the view\nthat judges and expert witnesses take of it, I think it well to refer\nthe earnest student for further information to Wharton's and Still\u00e9's\n\"Medical Jurisprudence,\" in the volume on \"Mental Unsoundness and\nPsychological Law;\" in particular to secs.\u00a029, 38, 39, 40.\n\n8. We must now return to the consideration of the manner in which the\ndisturbance of the brain may affect the mind. The brain is a storehouse\nof records of things formerly noted there by the imagination, either as\nthe results of sense perception or of arbitrary combinations of\nphantasms; it is a library of facts and fancies. And these are not\nsingle, but grouped together, so that when one is stirred it will arouse\nothers as well. When the brain is affected, whether by an acute or a\nchronic derangement, its images may become so disordered that records of\nmere imaginations get mixed up with records of real perceptions in\ninextricable confusion. You may have had occasion to notice the process\nin the case of a man who is becoming intoxicated and then passes on to\n_mania_ or _delirium tremens_: he gradually proceeds to mix up\nbrain-pictures with realities, and after a while he speaks and acts like\na very crazy man. He is in a kind of dream; his imaginations are wild\nand disconnected, his language is incoherent.\n\nThe delirium arising from violent fevers, for instance from typhoid\nfever, is very similar to that arising from the excessive use of\nintoxicants and narcotics; similar in these respects; that the mania is\nonly temporary, and that the exciting cause is not altogether unknown.\n\nThe _bacilli_ of the infection, like the alcohol, the opium, the\nmorphine, or other drugs, are accountable for the disordered action of\nthe brain. But I do not pretend to know, nor do medical writers\ngenerally pretend to understand, _how_ the poison, or whatever causes\nthe disease, gets to affect the brain. Does it do so directly, or by\nmeans of the alteration it causes in the whole nervous system or in the\nblood? We do not know; nor does it matter for the purposes of Medical\nJurisprudence.\n\nIV. The questions with which the courts of justice, the lawyers, and the\nexpert witnesses are concerned are these: Is the man really insane? Or\nwas he insane at a given time when he performed a certain civil or\ncriminal act? Is he now, or was he then, so far controlled by his mental\nunsoundness as to be incapable of acting like a rational being\naccountable for his actions? Even if he is now, or was then, a\nmonomaniac, can the deed in question be traceable to his monomania as to\nits real cause?\n\n1. When we know that a man is suffering from a fever, or has been\ndrinking to excess, or has been addicted to the use of morphine, opium,\ncocaine or to similar deplorable practices, it is then easy enough to\nconclude from this that he is not in his right senses; knowing the\ncause, we can fairly estimate the effect. But in many cases of\ndelusional insanity the cause is hidden; neither pulse nor other medical\ntest betrays it. Whether the mind is sane or not is then to be found out\nfrom the man's words and actions; and these may be affected for a\npurpose: he may play the fool to escape punishment.\n\n2. Phrenologists have pretended that the peculiarities of a person's\nmind could be known by the conformation of his brain, and even by the\nelevations and depressions of the skull. But brain and skull do not\nalways correspond with sufficient closeness; and besides, Sir William\nHamilton has shown conclusively, I believe, that phrenology is quackery;\nits principles are not scientific and its observations not reliable. He\npoints out, among other errors, that while women as a class are more\nreligiously inclined than men, what phrenologists call the bump of\nreverence, an important element in religious sentiment, is generally\nmore developed in men than in women, and is often most conspicuous in\nreckless criminals.\n\nNor is it at all certain that a lunatic's brain, if it could be examined\nwith a microscope while he is alive, would exhibit the marks of any\ndisorder to the eye of the observer. It is stated by Dr.\u00a0Storer that\nthe results show that \"insanity may exist without structural changes of\nthe brain, and that structural changes in the brain may exist without\ninsanity.\" Dr.\u00a0Bell, of the Somerville Asylum, says that \"the autopsies\nof the insane generally present no lesion of the brain.\" Dr.\u00a0Bucknil\nmaintains that \"the brains of the insane appear to be certainly not more\nliable than those of others to various incidental affections.\" Nor has\nthe microscope discovered in the demented any exudation or addition to\nthe stroma of the brain, or any change in size, shape, or proportional\nnumber of its cells. Dr.\u00a0Storer concludes: \"It is thus seen not merely\nthat there is no direct correspondence between the exterior of the skull\nand mental integrity, any more than between the exterior of the skull\nand the shape and consistence of its contents\" (Wharton and Still\u00e9,\n\"Mental Unsoundness,\" sec.\u00a0323). In the cases of insanity among women,\nthe causes are largely to be found in derangement of their productive\norgans, and are to be met by special local treatment (ib.).\n\nIt does happen, however, at times, that the brain itself is diseased,\n_idiopathically_ diseased, as it is technically called; but at other\ntimes it is merely affected by _sympathy_ with some other organ that is\nphysically deranged. A physical cause there is for all mental insanity,\nand that physical cause determines its kind of mania or melancholia, its\nduration, its chances of a perfect cure. But what that cause is in a\ngiven case is often very hard if not impossible to determine. Besides\nnatural and inherited predispositions--some taint of derangement in the\nfamily, often betrayed by fits of epilepsy, hysterics, etc.--exciting\ncauses are usually traceable. Every form of disease may bring on\nsympathetic affection of the brain when the circumstances for such\naffection are favorable.\n\nBut while affirming that the disease usually arises in the body, and\neven frequently in parts far removed from the brain, we must not deny\nnor ignore the fact that intellectual and protracted worry, or sudden\nand violent grief, can also be the direct cause of disturbance in the\nbrain. For the brain is the organ not of the imagination alone, which is\nput to an unhealthy strain by excessive mental labor, but probably also\nof the passions, whose emotions when excessive may cause even permanent\nlesion. Hence mental insanity may and does often arise from ill-subdued\npassions.\n\nThe knowledge of all this may enable the physician to remove the\nexciting cause or to mitigate its influence; it may also aid expert\nwitnesses, judges, lawyers, and jurymen to ascertain the main fact with\nwhich the courts are concerned, namely, the presence or absence of\nmental insanity at the time of a given civil or criminal action.\n\nV. Supposing then that, in the case before the court, the fact of\ninsanity is established, the next question of Jurisprudence to determine\nis this: How far and why ought such unsoundness of mind to exclude\nresponsibility for deliberate acts?\n\nIt is a clear principle of reason that no man can justly be blamed or\npunished for doing what he cannot help doing; now an insane man cannot\nhelp judging wrong at times; he cannot then justly be blamed for acting\non his mistaken judgments. If he invincibly judges an act to be morally\ngood whereas it is morally bad, no matter how criminal the act may\nbe--say the killing of his own father or child--if he commits the deed\nwith the full conviction that he is doing right, he cannot be blamed or\npunished for committing that awful crime.\n\nThe principle then is clear that an insane man is not to be held\nresponsible to God or man for his insane acts. For the root and reason\nof our responsibility for an act lies in the fact that we do the deed of\nour own free choice; knowing its moral nature, being masters of our own\nfree will, so that, if we do one act in preference to another, we\nwilfully take upon ourselves the consequences of this preference as far\nas we can know or suspect them.\n\nIf we do what we are firmly convinced is right, just, worthy of a man,\nwe deserve praise; if we do what we are convinced or suspect is wrong,\nunjust, unworthy of a man, we deserve blame and punishment. But an\ninsane man may do the most unjust act, and yet feel invincibly convinced\nthat it is just; he cannot then be held responsible for doing it,\nbecause the root of responsibility is then wanting.\n\nI do not, however, maintain that one who is insane on any one point is\nthereby made irresponsible for all his actions. If he does what he\nthinks to be wrong, he acts against the dictates of his conscience, he\ndeserves punishment from God; and if he violates a just law of the land,\nand it can be proved that his deed proceeded from a bad will, he may be\npunished by the civil courts as well, even though he is insane on other\npoints. For instance, if a young man were to have a crazy notion that\nhis father disliked him, that he is often in various ways unjust to him,\nand if, in consequence of this insane conviction, he were to attempt his\nfather's life, he should be punished for the criminal act; because, even\naccording to the way he views the matter, he could not be justified in\nkilling his father for such a reason. It were different if he insanely\nimagined that his father was in the act of killing him, and that he\ncould not escape death but by killing his father first; for then he\ncould plead the right of self-defence against an unjust aggressor, as he\nfoolishly imagines his father to be.\n\nThe conclusion then from all this explanation is that an insane man\nshould not be held responsible for a deed which he insanely thinks to be\nright; but he is responsible for all his other acts.\n\nIn our next lecture we shall consider more fully the treatment of the\ninsane by the civil and criminal tribunals.\n\n\n\n\nLECTURE VIII.\n\nTHE LEGAL ASPECTS OF INSANITY.\n\n\nIn our last lecture, gentlemen, we considered the nature and causes of\ndelusional insanity. We saw that its essence lies in mistaking\nimaginations for realities with a firmness of conviction which no\nargument to the contrary can shake. The reasoning of the insane man may\nbe logically faultless, we said, but he reasons from false premises\nsupplied to him by the phantasms of a diseased imagination. The cause of\nthe disease I showed to lie in an abnormal action of the brain, which is\nthe storehouse of the phantasms or brain-pictures. And this abnormal\naction may itself proceed either from a local lesion of the brain, or\nfrom a sympathetic affection due to indisposition in other parts of the\nhuman body. I finished by examining the responsibility of an insane man\nfor his actions, and arrived at this practical conclusion, that a victim\nof delusional insanity should not be held responsible for any acts which\nhe insanely thinks right, but should be held responsible for all his\nother human acts.\n\nI. This teaching of psychological and ethical science is to-day the\nreceived rule of action followed by the courts of justice in England and\nthe United States. Sound philosophy and positive law are in perfect\nagreement on this subject. But it was not so a hundred years ago. It is\nwonderful to us now how strange and erroneous were the views of insanity\nformerly entertained by English jurists. For instance, when, in 1723,\nArnold was tried for shooting at Lord Onslow, the instruction given to\nthe court was that, for one to be exempt from punishment in such a case,\n\"it must be a man that is totally deprived of his understanding and does\nnot know what he is doing, no more than an infant, than a brute or a\nwild beast.\" On such a theory, very few lunatics indeed would be\nacquitted; few ever are so totally demented.\n\nThe first jurist that pointed out the true test of insanity was Lord\nErskine, who, in 1800, when Hudfield was tried for shooting at the king,\ndelivered a celebrated speech, in which he maintained that the real test\nof insanity was in delusion: if delusion existed the man was insane;\nelse, he was not insane. The deluded man, he said, might reason with\nadmirable logic from his false principles; he was nevertheless demented\nif he mistook his imaginations for realities, and did so irresistibly\nand persistently.\n\nErskine's test has been, from that time on, followed in the courts of\nEngland. But you will notice, on careful consideration, gentlemen, that\nwhile the principle is correct so far as it goes, it does not go far\nenough to cover all cases of disputed responsibility. It will apply,\nindeed, to all cases of total insanity, that is, when the delusion\nexisting in a lunatic's mind affects a variety of subjects; then his\npremises are never reliable, and therefore he cannot be held accountable\nfor any of his acts.\n\nBut what if his insanity is partial only, if he is a monomaniac,\nderanged on one point and sound in mind on all other matters? This was\nnot clearly understood till about the middle of the present century. In\norder to secure uniform views and action on this important matter, the\nBritish Parliament, in 1843, proposed various questions to the judges,\nwith a request that they would agree upon and report answers. This\ninvestigation, and in fact the whole history of English legislation on\ninsanity, is briefly and yet clearly explained in an article of Rev.\nWalter Hill, S.J., which appeared in the \"American Catholic Quarterly\nReview\" for January, 1880. The first question was: What was the law\nrespecting the crime of one who is partially deluded but not insane in\nother respects, when he commits what he knows to be a crime in order to\nredress some wrong or obtain some public benefit? The answer was that\nsuch a one, even though insane, is to be punished for the crime which he\nknew he was committing.\n\nTo another of those questions the judges answered, that a person\npartially insane was to be treated _as if the facts were just what he\nimagined them to be_, as if his delusions were realities. His conduct\nwas to be judged by his own premises. This was accepted as law by\nEngland, and is the law now both there and here, and, I suppose,\nthroughout the civilized world. Now, these are exactly the conclusions\nabout an insane man's responsibility which we had arrived at before,\nreasoning from psychological and ethical first principles.\n\nIt is therefore for the consequences of an insane delusion only that a\nman is not responsible before the inward court of conscience and the\noutward courts of justice.\n\nBut the case is altogether different when the error is not the result of\ninsane delusion. When a man, sane or partially insane, has reasoned\nhimself into a false opinion or conviction, not the result of his\ninsanity, that the crime he is going to commit is justifiable, such\nconviction being his own free act does not exempt him from punishment.\nThis was the precise point on which turned the celebrated case of\nGuiteau, the murderer of President Garfield. His trial before the\nSupreme Court, District of Columbia, December, 1882, was one of the most\ninteresting that have ever occurred in this country or elsewhere in\nconnection with the plea of insanity. In his very able and exhaustive\ninstructions to the jury on that occasion, Judge Cox states the rule\nthat is to guide the jury in these words: \"It has been argued with great\nforce on the part of the defendant that there are a great many things in\nhis conduct which could never be expected of a sane man, and which are\nonly explainable on the theory of insanity. The very extravagance of his\nexpectations in connection with this deed--that he would be protected by\nthe men he was to benefit, would be applauded by the whole country when\nhis motives were made known--has been dwelt upon as the strongest\nevidence of unsoundness. Whether this and other strange things in his\ncareer are really indicative of partial insanity, or can be accounted\nfor by ignorance of men, exaggerated egotism, or perverted moral sense,\nmight be a question of difficulty. And difficulties of this kind you\nmight find very perplexing if you were compelled to determine the\nquestion of insanity generally, without any rule for your guidance.\n\n\"But the only safe rule for you is to direct your reflections to the one\nquestion which is the test of criminal responsibility, and which has\nbeen so often repeated to you, viz., whether, whatever may have been the\nprisoner's singularities and eccentricities, he possessed the mental\ncapacity, at the time the act was committed, to know that it was wrong,\nor was deprived of that capacity by mental disease.\"\n\nWhat furnished the clearest proof, gentlemen, that Guiteau's opinion\nconcerning the expediency of killing the President resulted not from an\ninsane delusion but from his own reasoning is contained in a paper which\nhe had himself drawn up to justify the murder.\n\nIt is an address to the American people, published on June\u00a016, in which\nhe says: \"I conceived the idea of removing the President four weeks ago;\nnot a soul knew my purpose. I conceived the idea myself and kept it to\nmyself. I read the newspapers carefully, for and against the\nAdministration, and gradually the conviction dawned on me that the\nPresident's removal was a political necessity, because he proved a\ntraitor to the men that made him, and thereby imperilled the life of\nthe Republic.\" Again he says: \"Ingratitude is the basest of crimes. That\nthe President under the manipulation of the Secretary of State has been\nguilty of the basest ingratitude to the Stalwarts, admits of no denial.\nThe express purpose of the President has been to crush Senator Grant and\nSenator Conkling, and thereby open the way for his renomination in 1884.\nIn the President's madness he has wrecked the once grand old Republican\nParty, and _for this he dies_.--This is not murder. It is a political\nnecessity. It will make my friend, Arthur, President, and save the\nRepublic,\" etc.\n\nWhen instructing the jury, Judge Cox told them clearly that, if they\nfound, from all the testimony presented, that the culprit had been led\nto commit the murder by an insane delusion, they were to acquit him; but\nthat reasoning one's self into an opinion or conviction was not acting\nupon an insane delusion. \"When men reason,\" he said, \"the law requires\nthem to reason correctly, as far as their practical duties are\nconcerned. When they have the capacity to distinguish between right and\nwrong, they are bound to do it. Opinions, properly so called, that is,\nbeliefs resulting from reasoning, reflection, or examination of\nevidence, afford no protection against the penal consequences of\ncrime.\" On this precise point of the question then the verdict was to\ndepend.\n\nBut to understand this matter thoroughly there remains one more\nimportant point to notice in the instructions of Judge Cox. It relates\nto the question on whom rests the burden of proof regarding the\nexistence of insanity in the culprit. Is the prosecution bound to prove\nthat insanity did not influence the crime? Or is the defence to prove\nthat it did? And, in case neither party can prove its point to a\ncertainty, so that the jury remains in doubt as to the existence or the\ninfluence of insanity in the crime, is the doubt to weigh in favor of\nthe culprit or against him? The judge, after a careful exposition of the\nconflicting views on this subject by different courts, and after\nweighing their respective claims, favors the opinion which holds that\n\"the sanity of the accused is just as much a part of the case of the\nprosecution as the homicide itself, and just as much an element in the\ncrime of murder, the only difference being that, as the law presumes\nevery one to be sane, it is not necessary for the government to produce\naffirmative proof of the sanity; but that, if the jury have a reasonable\ndoubt of the sanity, they are just as much bound to acquit as if they\nentertain a reasonable doubt of the commission of the homicide by the\naccused.\"\n\nBut the jury, enlightened by the lucid instructions of the court, were\nconvinced that Guiteau had not been led to commit the murder by an\ninsane delusion, but by his own reasoning and his own free will, and\nthat, therefore, he was to bear the consequences of his own deliberate\nchoice. Their verdict was \"guilty,\" and the political crank was hanged.\n\nII. We have now done with the study of mental or delusional insanity; it\nremains for us to speak of moral insanity. Of late years, the legal and\nmedical professions have been much divided upon the question whether\nthere exists a disease which may properly be called moral, emotional, or\naffective insanity, and which can justly be pleaded as an excuse from\nlegal responsibility.\n\nDr.\u00a0Pritchard, and later on, Dr.\u00a0Maudsley, with very many followers,\nhave maintained the existence of such a disease, and have claimed that,\neven when it is not accompanied by any delusion, it ought, nevertheless,\nto free a man from all punishment for crimes committed under its\ninfluence. Moral insanity consists, they say, in a perversion of the\nwill, which by this disease is deprived of its liberty, so that the\nmorally insane man does what he knows to be wrong, but cannot help\ndoing it. And they claim that therefore he cannot be blamed nor punished\nfor the crime he thus commits, although he commits it knowingly and\nwillingly.\n\nBut I absolutely deny that such a state of insanity is possible. It is\nagainst those clear principles of psychology and ethics which are not\nonly speculatively evident, but practically necessary to maintain the\nfabric of human society. I do not deny that there exists an emotional\ninsanity of another kind, which I will explain further on, but not an\ninsanity of the will, as they understand it, which would excuse a man\nfrom the consequences of his wilful acts. Upon this subject Dr.\u00a0Chipley\njustly remarks: \"If one is born with all the emotional endowments of our\nnature, but destitute of understanding, his irresponsibility is\nunquestionable. The same is true when the faculties of the understanding\nare perverted, impaired, or destroyed by disease.\n\n\"In every aspect in which man's accountability is viewed, we arrive at\nthe same point that its sole basis is the existence and soundness of the\nintellectual powers. Those wonderful endowments which so eminently\ndistinguish man from other animals, which enable him to discriminate\nbetween good and evil, right and wrong, and to choose the one and avoid\nthe other; or in the language of Judge Robertson, he is accountable\nbecause he has the light of reason 'to guide him in the pathway of duty,\nand a _free_ and _rational_ presiding will to enable him to keep that\nway in defiance of all passion and temptation.'\n\n\"If then accountability is a structure erected solely on the\nintellectual power, must it not remain unshaken so long as its\nfoundation is sound and unbroken? Is it not illogical to set out with\nthe fundamental proposition, that man is made responsible for his acts\nonly because he is gifted with an understanding and then arrive at the\nconclusion that he may become irresponsible without the impairment or\ndisease of any of its powers?\" (Wharton and Still\u00e9, \"Mental\nUnsoundness,\" p.\u00a0170.)\n\nGentlemen, let me give you a specimen of the false reasoning used in\nsupport of their theory by those who believe in the insanity of the\nwill. \"It would be as rational,\" says one of their leading writers in\nthis country, \"to punish a schoolboy whose antics and grimaces, the\nresult of chorea [St.\u00a0Vitus' dance], are a source of laughter and\ndistraction to his schoolmates, as to inflict punishment upon the insane\ncriminal who, knowing the difference between right and wrong, has it not\nin his power to execute that which his judgment dictates. One is under\nthe dominant influence of insanity of the _muscles_, the other is under\nthe influence of insanity of the _will_. To punish one would be as cruel\nas to punish the other.\" This is indeed a very illogical argument. The\nreason why we do not blame the boy is because his will is not in it; he\nmoves against his will. The reason why we blame the other is because his\nwill is in it; he does what he wills to do.\n\nThe will being a spiritual power can no more be diseased than can the\nintellect. But as the imagination, an organic power, can be disorganized\nby an affection of the brain, and by delusion deceive the intellect,\nthus producing mental insanity, similarly I fully admit that a man's\npassions, which are also organic powers, common to us and to brute\nanimals, can become disordered by bodily disease; and the passions, when\nexcited, will strive to drag along the consent of the will, as we all\nexperience. A man whose passions are abnormally influenced by bodily\ndisease, so that he is constantly inclined to act very unreasonably, may\nwell be called morally insane. Such a state of insanity is not a rare\noccurrence, and there is no objection to denominate it emotional,\naffective, or moral insanity.\n\nBut in such a disease the will remains free; if a man does what he knows\nto be wrong and criminal, he then sees reasons for not doing it; and in\nthis lies the root of his liberty. For seeing himself drawn in one\ndirection by one motive and in another by another motive, he is not\ndetermined in his choice but by the act of his free will. A merely\norganic faculty must be determined by the stronger attraction, as is the\ncase with brutes; but a spiritual faculty, as our will is, acts freely\nin choosing between two opposing motives of action. This is the\nphilosophical or psychological explanation: and I am well pleased to\nfind that here again, as in the matter of mental insanity, the courts of\nEngland and the leading courts of the United States follow the sound\nteachings of philosophy.\n\nThe nearest advance I know of, that has been made towards the\nrecognition of this moral insanity as a total bar to responsibility, was\nmade in 1864 by the court of appeals in Kentucky, and again in 1869\nunder the same presiding Judge Robertson. But Chief Justice Williams\nrebukes this strange ruling in most emphatic language. He says: \"In all\nthe vague, uncertain, intangible, and undefined theories of the most\nimpractical metaphysician in psychology or moral insanity, no court of\nlast resort in England or America, so far as has been brought to our\nknowledge, ever before announced such a startling, irresponsible, and\ndangerous proposition of law, as that laid down in the inferior court.\nFor, if this be law, then no longer is there any responsibility for\nhomicide, unless it be perpetrated in calm, cool, considerate condition\nof mind.\n\n\"What is this proposition if compressed into a single sentence? that, if\nhis intellect was unimpaired and he knew it was forbidden both by human\nand moral laws; yet if at the _instant_ of the act his will was\nsubordinated by any uncontrollable passion or emotion causing him to do\nthe act, it was moral insanity, and they ought to find for the\nplaintiff?... If so, then the more violent the passion and desperate the\ndeed, the more secure from punishment will be the perpetrator of\nhomicide or other crimes.... The doctrine of moral insanity, ever\ndangerous as it is to the citizen's life, and pregnant as it is with\nevils to society, has but little or no application to this case. Too\nuncertain and intangible for the practical consideration of juries, and\nunsafe in the hands of even the most learned and astute jurist, it\nshould never be resorted to for exemption from responsibility save on\nthe most irrefragable evidence, developing unquestionable testimony of\nthat morbid or diseased condition of the affections or passions, so as\nto control and overpower or subordinate the will before the act\ncomplained of\" (ib., p.\u00a0172).\n\nYou will notice, gentlemen, that Chief Justice Williams does not deny\nthe existence of every kind of moral insanity. As I explained before,\nnot the will but the passions may really be diseased or insane, and they\nmay prompt the lunatic to commit very unreasonable and even criminal\nacts. When the impulse of a passion is violent, so that a man is carried\nalong by it before he has had time to reflect on the criminal nature of\nhis act, or at least before he could do so calmly and deliberately, the\ncourts readily recognize such passion as a partial excuse: murder thus\ncommitted in a moment of strong provocation becomes manslaughter, not\nmurder in the proper sense of the word. It is not justifiable; but yet\nit is far less criminal and less severely punished than when committed\nin cold blood, or, as the law terms it, with malice prepense or\naforethought. This practice of our courts is right and highly\nreasonable, because on such occasions the will of the culprit is partly\noverpowered, or deprived of freedom.\n\nIt is a matter of much discussion among jurists whether a passion can\never be so violent as to overpower the will _absolutely_, so as to\ndeprive it of all freedom at the moment. If it can, then the culprit\nshould be totally acquitted for doing what he could not help doing. In\nseveral States of the Union, such an invincible impulse has been\nrecognized by the courts of justice, and men have been acquitted for\nacting on what was supposed to be an invincible impulse to commit crime;\nthe courts considered this as an extreme form of moral insanity.\n\nI have shown above that on sound principles of philosophy the will can\nnever be compelled to do wrong; at most it could be said that, in the\ncases just referred to, the will was not in the act. Now this, I\nsuppose, is the case in hydrophobia or _rabies_, in which terrible\ndisease the biting of the sufferer appears to be spasmodic, not\nvoluntary. It is very doubtful whether such excuse can be substantiated\nin what is called moral insanity.\n\nThe courts of England and the leading authorities in the United States\nhave never departed from this correct rule, that a man is accountable,\nto some extent at least, for whatever he does willingly and without the\ninfluence of delusion.\n\nMoral insanity thus understood, as a derangement of the passions\nlessening a man's full mastery of himself, but not destroying it\naltogether, assumes various forms. There are kleptomania, or an\nabnormal impulse to steal; pyromania, an impulse to set things on fire;\ndipsomania, or an abnormal fondness for intoxicants; nymphomania, or the\ntyranny of lustful passions; homicidal mania, or a craving to commit\nmurder; etc. In all these the nature of the disease is the same, it\nwould appear. The imagination seizes the pleasure vividly, yet, it is\nclaimed, without delusion: and the passion, owing to organic disorder,\nis abnormally excitable. The organic derangement is supposed to be in\nthe brain. For the human brain, a masterpiece of the Creator's wisdom,\nis now generally believed to consist of various portions which are the\norgans of the passions, of motive power and the phantasms, erroneously\ncalled ideation. Hence it is easy to understand how it may happen that\none portion is diseased while the other parts are in a normal condition.\nAnd on the other hand it thus appears very probable also that a brain\npartially diseased is liable to be soon affected in the other parts as\nwell. Hence we may suspect that moral insanity is likely to bring on\ndelusional insanity, and _vice versa_. In fact, I find that a medical\nexpert of note, who had for many years taught that moral insanity was\nquite a distinct disease and separate from mental insanity, has in his\nold age changed his mind to some extent on this subject. \"Of late\nyears,\" says Dr.\u00a0Bauduy, of St.\u00a0Louis, in his learned work on \"Diseases\nof the Nervous System,\" \"I have believed, notwithstanding the doctrine\nof Pritchard, that a careful study of moral insanity will enable us to\ndetect some evidence, although, it must be confessed, often very feeble,\nof mental weakening. Even the classic cases of Pritchard,\" he adds, \"who\nfirst defined the so-called moral insanity, when carefully examined,\nwill confirm this statement\" (p.\u00a0227). Usually, as the same Dr.\u00a0Bauduy\nexplains, those who are morally insane are at least on the high road to\nmental insanity (p.\u00a0228). Moral insanity is known to exist when there is\na sudden change of character which can have no other source than bodily\ndisease; as when a most honest man becomes of a sudden an habitual\nthief, a decent man openly profane, a miser becomes extravagantly\nliberal, an affectionate father a very tyrant to his children, without\nany traceable causes for such transformation. The disease is made more\nmanifest if such a sudden change is preceded by certain physical\nconditions, such as epilepsy, hereditary taint, suicidal attempts, \"the\ninsane temperament,\" as it is called, and other influences which are to\nbe taken into consideration.\n\nIf ever you be summoned, gentlemen, to testify or pronounce on a\nperson's insane condition, let me give you one piece of advice which may\nspare you much unpleasantness: be unusually cautious of what you say.\nIf you appear as an expert or a witness, and you make a mistake\nunfavorable to the patient, he will be your enemy for life; even he may\nat times recover damages for libel. If he is really crazy, he may be all\nthe more dangerous. Do your duty, of course, as an honest man must\nalways do; but do it very prudently.\n\nDr.\u00a0Bauduy is very emphatic on the assertion that moral insanity is not\nmoral depravity. He is perfectly right; yet we must not forget that\nmoral depravity is often screened before the courts by the plea of\ninsanity. When a man of bad antecedents commits a crime, and is known to\nhave been sane just before and after the deed, he ought not to be\nexcused on the plea that he may have been insane at the moment when he\ncommitted the act; there is no reason for such a plea. And with the\nvictims of kleptomania, dipsomania, and other moral manias, it is well\nknown that a sound whipping will often stop the nuisance. The rod for\nthe juvenile offender, and the whipping-post for adults, would cure many\na moral leper and be a strong protection for society at large,\nespecially if applied before bad habits freely indulged have demoralized\nthe person beyond the usual limits. All of us have our passions; they\nare an essential part of our nature and even an indispensable part. But\nthey should be controlled by reason and will, whereas they are often\nindulged with guilty weakness. They are much strengthened by indulgence,\nespecially in those predisposed to certain vices by hereditary\ntransmission. No doubt some children have worse passions to contend\nagainst than others. It is still worse if, at the same time, their\nsurroundings are unfavorable to virtue; and this is a constant source of\nincrease to the criminal classes.\n\nWise statesmen will study the ways in which temptations to vice may be\ndiminished; but it is mistaken mercy and dangerous to the community to\nspare the guilty when once they have committed criminal acts. If ever\nthe principle were admitted in our courts of justice that the possible\nexistence of mental insanity ought to protect a culprit from punishment,\ncrime would soon increase tenfold both in the sane and in the insane.\nBoth classes must be kept impressed with the conviction that the law\nrules supreme and will not tolerate the destruction of public safety.\nYour profession, gentlemen, in this matter as in many others, by its\nsound views on Jurisprudence and Ethics, is one of the strongest\nbulwarks of the common good.\n\n\n\n\nLECTURE IX.\n\nHYPNOTISM AND THE BORDER-LAND OF SCIENCE.\n\n\nIn this last lecture of our course I propose to make a brief excursion\nwith you into the border-land of science, a region chiefly occupied by\nimposture and superstition. To show there is such a territory, we have\nonly to name a few of its inhabitants, such as mesmerism, animal\nmagnetism, odylism, hypnotism, mind-reading, faith-cures, clairvoyance,\nspiritism, including table-rapping, spirit-rapping, most of which have\nbeen used in connection with medicine. I do not maintain that all of\nthese are mere vagaries, empty shadows, without the least reality, mere\nghosts and hobgoblins, mere phantoms of the heat-oppressed brain, or\ncunning devices of impostors to deceive a gullible crowd of the ignorant\npublic. Yet most of these are such beyond a doubt, and as such are\ntotally unworthy of our attention.\n\nMedicine is a science; it deals with undoubted facts and certain\nprinciples, and with theories in so far as they are supported by\nwell-ascertained realities. The border-land of which I speak presents\nto our investigation few certain facts. It is chiefly the domain of\nimposture. Charlatans and showmen and medical quacks call things facts\nthat are not facts. Among all the inhabitants of the shadowy region that\nI have enumerated, there is only one considered to-day by the science of\nmedicine as worthy of its attention. It is hypnotism. As its first\norigin is connected with the history of mesmerism, and the latter,\nthough itself a phantom, has been used as the chief patron of all other\nphantoms, I will premise a few words about mesmerism itself.\n\nI. Mesmer was born about 1733, studied in Vienna and there became a\ndoctor of medicine in 1766. Soon after, he began to speculate upon the\ncurative powers of the magnet, and claimed to have discovered the\nexistence of a force in man similar to magnetism and the source of\nstrong influence on the human body.\n\nIn 1775 he published an account of the medical powers of this animal\nmagnetism, which from his name was afterward called _mesmerism_. Paris\nwas then the centre of attraction for scientific discoverers and\npretenders. Thither Mesmer betook himself and there he soon created a\nlively sensation by the exhibition of mesmeric trances, some of which\nwere accompanied by clairvoyance--that is, the power of seeing objects\nconcealed from the eyes. He was also supposed to work some inexplicable\ncures.\n\nThe secret of his art he could not be induced to reveal even for the sum\nof 340,000\u00a0livres, which was offered him in compensation. People began\nto doubt whether he had a real secret, or whether he was a rank\nimpostor. A royal commission was appointed to examine into the matter.\nOur Benjamin Franklin, then in Paris, was one of the commissioners.\nTheir report was unfavorable. They found no proof of the existence of a\nfluid such as animal magnetism, and thought that all that was not\nimposture could be accounted for by the power of imagination. In a\nsecret report they pointed out very strongly the dangers likely to arise\nfrom this unhealthy stimulus to the imagination. Their verdict does\nhonor to their learning and their common-sense. Mesmer left Paris, and\nhe died in obscurity in 1815.\n\nBut his pretended discovery did not die with him. It was a mine of\nresources to charlatans and impostors generally. There were strange\neffects produced, and at the sight of the inexplicable men lose their\nwits. The gullible public wondered, restless minds experimented, and\nmany pondered thoughtfully on facts, most of which were not facts at\nall. But after eliminating all the elements of imposture and\nexaggeration there seemed to remain a residue of phenomena that were\nstrange and unaccountable.\n\n\nII. THEORY OF HYPNOTISM.\n\nAbout 1840 the vaunted claims of the many clairvoyants were exposed\nbefore the French Academy of Medicine, which passed a resolution\nrejecting mesmerism altogether as unworthy of notice on the part of\nscientific men. The theory of a mesmeric fluid, until then the only one\nadvanced, had evidently to be abandoned. Science with all its tests\ncould find no such cause of the results produced. But in 1842 an English\nphysician, Dr.\u00a0James Braid, hit upon a more plausible theory. He\nconjectured that the actions of the mesmeric subject could be explained\nwithout a fluid by the suggestion of phantasms to him on the part of the\nmesmerizer. Dr.\u00a0Carpenter, then a great authority, defended his theory;\nbut the medical branch of the British Association disdained to consider\nthe matter. Dr.\u00a0Braid thought the mesmeric trance was only a state of\nsomnambulism artificially brought about, and he coined the word\n_hypnotism_ to indicate the artificial sleep. Other attempts to promote\nthe cause of hypnotism were made in the United States and other lands,\nbut no very definite or scientific results were reached until 1878, when\nthe celebrated Prof. Charcot and others made its nature and\npossibilities the subject of a thorough study and abundant\nexperimentation at the Paris hospital of La Salp\u00e9tri\u00e8re and in other\nplaces. At present it is admitted by distinguished medical scientists\nthat hypnotism is a reality, capable of being utilized for important\npurposes. Many effects have been demonstrated to be produced by it as\nreal as any ordinary phenomena of nature. But on the explanation of\ntheir causes there hangs still a cloud of obscurity.\n\nThe Paris School of Doctors attribute the effects to physical causes,\nchief among which are diseases of the nerves. Those of Nancy trace the\nphenomena to a psychical source, namely, to suggestion--that is, action\non the subject through his imagination excited by words, signs, or in\nany other manner. This appears to be, in the main, the theory of\nDr.\u00a0Braid vindicated by modern science. Probably enough, both schools\nare right in their way, the suggestions not taking effect except where\nnervous affections have prepared the way. The beneficial results claimed\nfor hypnotism by the scientific men who have made its study a specialty\nare chiefly as follows:\n\n\nIII. BENEFITS OF HYPNOTISM.\n\n1. It acts as a temporary sedative, quieting the excited nerves of the\npatient. It was thus employed, for instance, on an old woman who was\nnear her death, and who had not been able to make necessary preparations\nfor that important event, being beside herself with nervous agitation.\nShe obtained by this means a calm condition for some seven or eight\nhours. Hypnotism was for her like the visit of a good angel from heaven.\n\n2. It is used as an an\u00e6sthetic in place of chloroform, which in many\ncases cannot be applied without great danger to health, or even life.\nThus perfect insensibility may be procured and long continued, allowing\nsometimes of the performance of protracted surgical operations that\nwould otherwise be almost impossible.\n\n3. At other times it is employed as a mere pain-killer without depriving\nthe patient of consciousness, so that the hurt is felt indeed, but not\nattended with keen suffering.\n\n4. It is claimed that the skilful application of hypnotism can at times\nnot only alleviate the pain of an injury, but even cure nervous\naffections more or less permanently, removing, for instance, the defect\nof stammering.\n\n5. There are not wanting cases in which even moral improvements are\nclaimed to be produced, at least in the removing of bad habits, such as\ndrunkenness. If hypnotism can cure intoxication permanently, or even for\na season, it deserves to be encouraged. Yet even then it must be used\nwith great caution, for there may be very evil consequences resulting\nfrom its use. To realize fully the dangers and the evils attendant upon\nhypnotism you must understand the three stages through which the patient\nis made to pass--those of lethargy, catalepsy, and somnambulism.\n\n\nIV. DANGEROUS TREATMENT.\n\nEach of these is a disease in itself, and thus it is seen at once that a\ntreatment which employs diseases as its means of cure must be of a\ndangerous kind. After the patient has been hypnotized by any of the\nvarious processes--the chief are mesmeric passes of the hypnotizer's\nhands, his eyes fixed into the eyes of his subject, or the latter's on\nan object so held as to strain his eyes--the first stage of hypnotism is\nobtained, that of lethargy. In the lethargic state, the subject appears\nto be sunk in a deep sleep; his body is perfectly helpless; the limbs\nhang down slackly, and when raised fall heavily into the same position.\nIn this condition all the striated or voluntary muscles react on\nmechanical excitement. Without an accurate knowledge of anatomy, much\nharm may be done by the experiment.\n\nThe second stage is that of catalepsy, certainly not a healthy condition\nto be in. Its grand feature is a plastic immobility by which the subject\nmaintains all the attitudes given to his body and limbs, but with this\npeculiarity, that the limbs and features act in unison. Join the hands\nof the patient as if in devout prayer, and his countenance assumes a\ndevout expression; clench his fist, and anger is depicted in his\nfeatures.\n\nThe third stage is that of somnambulism. The skin is now insensible to\npain, but excessive keenness is manifested in the sight, hearing, smell,\nand muscular sense. Here the impostor can play off his pretended\nclairvoyance or second sight; for the subject will discover objects\nhidden from sight by the sense of smell and other senses affected with\nabnormal power. The somnambulist will now exhibit the utmost sensibility\nto suggestions made to him by the hypnotizer, so that he seems to be\nalmost entirely controlled by the influence of the latter's will. This\nis what chiefly favored the early theory that a mesmeric fluid emanated\nfrom the mesmerizer by means of which he could act in his subject as he\npleased. The experiment by suggestions seems to succeed best with\nhysterical patients, which fact confirms the morbid character of the\nhypnotic trance.\n\n\nV. FIELD FOR A SCIENTIST.\n\nIf any distinguished scientist or Doctor who can afford it wishes to\nmake a special study of hypnotism, which is still so imperfectly\nunderstood, he may render a valuable service to humanity, and in\nparticular to the science of medicine. But if any ordinary physician\nasked my advice about devoting attention to this pursuit. I would\nemphatically tell him, \"Leave it alone: you are not likely to derive\nreal benefit from it, and you are very likely to inspire your clients\nwith distrust of you when they see you deal with matters which have\ndeserved a bad name on account of the charlatanism and the superstitious\nabuses usually connected with them.\" This is not my opinion alone, but\nalso that of distinguished writers on the subject.\n\n\nVI. OBJECTIONS TO HYPNOTISM.\n\nWhen there is question of hypnotic s\u00e9ances or exhibitions such as are\ndesigned to feed the morbid cravings of the public for what is\nmysterious and sensational, I would call special attention to the\nfollowing objections against such practices.\n\n1. Medical authorities maintain that it requires at least as much\nknowledge of therapeutics to use hypnotism safely as it does for the\ngeneral practice of medicine, and requires of a physician who engages in\nit a more thorough mastery of his profession than many other branches of\nthe healing art, and therefore that it is as objectionable to allow\nnon-professionals to deal with hypnotism as it would be to allow medical\npractice promiscuously to all persons without a Doctor's diploma. In\nfact, in Russia, Prussia, and Denmark none but licensed physicians can\nlawfully practise hypnotism. Aside from a variety of accidents which may\nresult to the subject hypnotized from the ignorance of physiology in the\nhypnotizer, there is this general injury sustained, that even strong\nsubjects frequently experimented upon contract a disposition to be\nreadily thrown into any of the three morbid states of the mesmeric\ntrance. All these states are real diseases and are allied to hysteria,\nepilepsy, and a whole family of nervous troubles, any one of which is\nsufficient to make a patient very miserable for life, and even to lead\nhim to an early grave.\n\n2. The moralist has still stronger objections against the use of\nhypnotism, except when it is used as a means to most important results.\nHe maintains that one of the greatest evils that can befall a man is the\nweakening of his will-power; this leaves him a victim to the cravings of\nhis lower appetites. Now the frequent surrender of one's will to the\ncontrol of another is said (very reasonably, it would seem) to bring on\na weakening of the will or self-control. We see this exemplified in the\nhabitual drunkard. He loses will-power to such an extent that he can\nscarcely keep his most solemn promises or withstand the slightest\ntemptations. There is a very serious question asked by the moralist upon\nanother resemblance of an hypnotic subject to a drunkard. He asks\nwhether any man has a right for the amusement perhaps of the curious\nlookers-on to forfeit for awhile his manhood, or the highest privilege\nof his manhood--his powers of intellect and free-will. He admits that we\ndo so daily in our sleep. But then he argues that sleep is a necessity\nof our nature directly intended by the Creator, a normal part of human\nlife. Besides it is a necessary means for the renewal of our strength,\nand on the plea of necessity the moralist may admit the use of hypnotism\nwhen it is needed for the cure of bodily diseases. But for the mere\namusement of spectators he maintains that it is wrong for a man thus to\nresign his human dignity, as it would be wrong for him to get drunk for\nthe amusement of lookers-on. Still, in this latter case the evil would\nbe greater, for in drunkenness there is contained a lower degradation,\ninasmuch as the baser passions are then left without all control, and\nare apt to become exceedingly vile in their licentious condition. The\nhypnotic subject has at least the mind and will of the hypnotizer to\ndirect him. Here, however, appears the need of another caution, namely,\nthat the hypnotizer should be known to be a virtuous man; else the evil\nthat he can do to his subject, as is readily seen, may be even worse\nthan that resulting from a fit of drunkenness. And as men who occupy\neven respectable positions may yet be vile at heart, it is very\ndesirable for prudence' sake to have no one hypnotized in private\nwithout the presence of a parent, close relative, or some other party,\nwho will see to it that nothing improper be suggested during the trance.\nFor the scenes gone through during the hypnotic state, though not\nremembered by the subject upon his return to consciousness, are apt to\nrecur to him afterwards like a dream, showing that they have left traces\nbehind them.\n\n3. Legal writers and lawyers have serious charges against hypnotism.\nThis practice, they maintain, if publicly exhibited to old and young,\nbegets dangerous cravings for sensational experiments. Turning away\nmen's attention from the sober realities and duties of social life, it\nprompts them to pursue the unnatural and abnormal. It was this craving\nthat in less enlightened ages led men to the superstitious practice of\nastrology and witchcraft. At present it leads to such vagaries and\nunchristian and often immoral practices as are connected with spiritism,\nfaith-cures, mind-reading, and similar foolish or criminal or at least\ndangerous experimentations which dive into the dark recesses found in\nthe border-land of the preternatural. The atmosphere of that region is\nmorally unhealthy and should be barred off by the guardians of public\nmorals.\n\nThe most common objection of legal writers is directed against the\nvarious crimes to which hypnotism is apt to lead men of criminal\npropensities. They point to the statements of Dr.\u00a0Luys, a respectable\nauthority on hypnotism, who says: \"A patient under the influence of\nhypnotism can be made to swallow poison, to inhale noxious gases. He can\nbe led to make a manual gift of property, even to sign a promissory note\nor bill, or any kind of contract.\" Indeed, how can notaries or witnesses\nsuspect any fraud when even the Doctor needs all his experience and all\nhis skill to avoid falling into error? In criminal matters a man under\nsuggestion can bring false accusations and earnestly maintain that he\nhas taken part in some horrible crime.\n\n\nVII. FURTHER EXPLANATION OF HYPNOTISM.\n\nAfter considering the objections to the use, or rather abuse, of\nhypnotism, I may add some further explanation of hypnotism itself--of\nits nature so far as it is known to science. Science has ascertained the\nreality of the phenomena and facts--not single facts only, scattered\nhere and there, but groups of facts uniformly obedient to certain laws\nof nature. It has not yet discovered the exact cause or causes of all\nthese phenomena, but it gives plausible explanations of them, both in\nthe physical theory of the Paris School and in the psychical theory of\nthe Nancy School of Physicians. Science has discarded the original\ntheory of a mesmeric fluid as the cause of these phenomena, just as it\nhas discarded the formerly supposed fluids of electricity and magnetism.\nOf electricity the \"Century Dictionary\" says: \"A name denoting the cause\nof an important class of phenomena of attraction and repulsion, chemical\ndecomposition, and so on, or, collectively, these phenomena\nthemselves.\" The true nature of electricity is as yet not all\nunderstood, but it is not, as it was formerly supposed to be, of the\nnature of a fluid. Similarly we may define hypnotism as the collection\nof peculiar phenomena of a trance or sleep artificially induced, or the\ninduced trance or sleep itself.\n\nThe true cause of these phenomena is not yet understood, but there is no\napparent reason for attributing them to a special fluid; they seem to be\npeculiar ways of acting, belonging to man's physical powers when his\nnerves are in an abnormal condition. By laying down these definite\nstatements we gain the advantage that we isolate hypnotism from the\nfrauds and empty shades, from the ghosts and hobgoblins with which it\nused to be associated in the border-region which we have undertaken to\nexplore. Science deals with well-ascertained facts. Now of mesmerism,\nanimal magnetism, and its kindred, odylism, we have seen that we have no\nreliable facts. We have done with those unsubstantial shades. But of\nhypnotism we have well-known facts, and we have shown it to be placed on\na scientific basis.\n\n\nVIII. SCIENCE DREADS ERROR.\n\nOf clairvoyance, mind-reading, palmistry, spiritual science cures we\nhave no certain facts, but we have many impostures connected with them.\nIf ever we get real and undoubted facts proved to be connected with\nthem, we ought to examine them with care. Science is not afraid of any\nportion of nature; all it dreads is ignorance, and what is worse, error.\nError with regard to facts may be committed in two ways--by admitting as\nfacts what are not facts, and by denying facts. Now, there are facts\ncertain and well ascertained, numerous and widely known, connected with\nsome other portions of the border-land of science that we have not yet\nlooked into, though I have mentioned their names. He who would assert\nthat spiritism, table-turning, spirit-rapping, and so on are mere idle\ntalk, sheer impostures, is not well read in the literature of the\npresent day. By denying all reality to these phenomena he strays as far\nfrom the truth as if he allowed himself to believe mere fabrications.\nThey are not impositions, but they are worse; they are superstitions. By\nsuperstitions I mean here the practice of producing results which cannot\npossibly proceed from the powers of nature, and which could not without\nabsurdity be attributed to the interference of the Creator or His good\nangels.\n\nSome persons strenuously object to introducing any reference to God into\nscientific works. Science consists in tracing known effects to their\ntrue causes. If there were no God, He could not be a true cause and it\nwould be unscientific to introduce His agency. But if there is a God and\nHe acts in the world which He has made, we must take His actions into\naccount when we study His works. Some say, \"I do not believe in a God.\"\nThat may be, but that does not prove that there is no God. Belief is a\nman's wilful and fine acceptance of what is proposed to him on the\nauthority of some one else. Students have most of their knowledge on the\nauthority of their professors and other men of learning. If a medical\nstudent would say, \"I do not believe in microbes nor in contagion by\ndisease germs,\" that would not kill the germs nor protect him against\ncontagion. Nor would it show his superior wisdom, but rather his\nextravagant conceit and ignorance. So with those who believe not in God.\n\nThere are others who believe not in the existence of devils or fallen\nangels. That is not so bad; but yet they must remember that their\nrefusal to believe in devils does not prove that there are none. The\ngreatest enemies of science are those who blindly maintain false\nstatements and false principles of knowledge. Let us look for the truth\nin every investigation. Even Huxley, in the midst of his attacks on\ndogmatic religion, protests also against dogmatic infidelity. Science,\nhe says, is as little atheistic as it is materialistic. All this must be\nremembered chiefly when we undertake to explore, as we are now doing,\nthe unknown region which we have called the border-land of science.\nThere we find many strange phenomena, and we are trying to discover\ntheir true nature and true causes. If we can explain some of them by\nnatural causes, as by the powers of the imagination when it is in an\nabnormal or hypnotic state, very well, let us explain them. But let us\nnot rashly conclude that all other phenomena can be thus explained. Do\nnot reason this way, as some writers have done: \"Some effects,\" they\nsay, \"were formerly attributed to witchcraft or deviltry and can now be\nexplained by hypnotism. Therefore all other mysterious effects can also\nbe thus explained. Therefore there is not and never was such a thing as\nwitchcraft or deviltry. So, too, some events often reputed miraculous\ncan be explained by natural causes, therefore no miracle has ever\nhappened.\" That is the reasoning of rash and ignorant men, and not of\nscientific minds. It does not follow from the fact that God usually\nworks by natural causes, that He cannot on special occasions and for\nvery important reasons show His hand, as it were, and act so manifestly\nagainst the course of nature as to show us that it is He who is at work\nand He wants us to mind Him. History furnishes many instances of this\nkind.\n\n\nIX. CREDENTIALS OF CHRIST.\n\nLeast of all have Christians a right to deny this, and we must remember\nthat the civilized world is Christian, almost entirely. Christians\nbelieve in the reliability of the Bible, and in it we are constantly\ninformed of countless miracles in various ages. If all these accounts\nare false, then Christianity is a vast imposture. Christ appealed to\nthem as to His credentials in His mission to the world. \"If you do not\nbelieve Me,\" He said, \"believe My works, for they give testimony of Me.\nThe blind see; the lame walk; the dead are raised to life.\" If He spoke\nfalsely, He was a deceiver; if He worked those marvels by hypnotism, or\nany other natural cause, He was an impostor. There is no middle way.\nEither by working true miracles He proved Himself to be what He claimed\nto be, the Son of God, or He was the most bold and detestable impostor\nthat has ever appeared on earth. This no Christian can suppose, this no\nhistorian would admit; therefore, we must grant that He worked miracles,\nand miracles are realities to be taken into account by the writers of\nhistory, and scientific workers must not sneer at them.\n\n\nX. DEVILTRY.\n\nScientific men in their investigations need not expect to come into\ncontact with miracles; but they may and do find in the border-land of\nscience facts which reveal the agency of intellectual beings distinct\nfrom men, and too vulgar in their manifestation to be confounded with\nGod or His blessed angels. Such agents in the book of the Scriptures are\ncalled devils, and intercourse with them is styled superstition, seeking\ntheir assistance is magic or witchcraft, and consulting them is\ndivination or fortune-telling. All these practices are directly and\nstrictly forbidden in the Scriptures, and yet they are commonly enough\nin use in our own day to procure effects that gratify the curiosity of\nsuch, especially, as have no settled belief in supernatural religion.\n\nSome of these effects are connected with bodily cures and thus are of\ninterest to physicians. For instance, spiritualistic mediums, whether\nconnecting their practices with magnetism or not, though entirely\nignorant of medicine, are at times able to state the exact bodily\nindisposition of sick persons living at a great distance, put into\ncommunication with them by holding some object belonging to them. They\nwill indicate the seat of the disorder, its nature and progress, its\ncomplications. They propose simple and efficacious remedies, using not\ninfrequently technical terms which are certainly unknown to them before.\nThey manifest the thoughts of others, reveal family secrets, answer\nquestions put in languages of which they know nothing. To deny facts\nattested by thousands of witnesses of various nations belonging to\nvarious religious denominations or professing no religion whatever, is\nnot the spirit of science. It it estimated that 100,000 spiritist books\nand pamphlets are sold yearly in the United States alone. It is certain\nthat much, very much imposture is mixed up with many undeniable facts,\nbut that does not dispose of the real facts mixed up with the\nimpostures. Tyndall once caught an ill-starred spiritualistic impostor\nat his juggling. He concluded that all other spiritists were impostors.\nThe world now laughs at him for his foolish reasoning.\n\nOf course, I do not suppose that spiritism is mainly employed in such\nmatters as would directly interest the physician. It has grown into a\nsystem of religion and morals, very peculiar and at variance with the\nChristian religion, a system rather resembling the religion of Buddha,\nwith its reincarnations and transmigrations of souls while struggling\nafter eternal after-progress. This is fully and clearly explained in an\narticle on \"Spiritism in its True Character\" in the English publication\ncalled \"The Month,\" for September, 1892. But with this phase of it we\nare not now concerned. As to the facts, it is enough to remark that\nspiritists claim a following of 20,000,000. Suppose there are only\none-half that number. 10,000,000 people are not readily deceived about\nmatters of their daily observation, for their meetings or s\u00e9ances\nconsist chiefly of those manifestations which others call impostures.\n\nTheir adherents are chiefly among the educated classes, I believe.\nCertainly they include multitudes of doctors, lawyers, professors,\nscientists, magistrates, clergymen, close students, keen intellects,\neven such men as Alfred Russell Wallace, Profs. Morgan, Marley, Challis,\nWilliam Carpenter, and Edward Cox. If one has still lingering doubts on\nthis matter let him read the four learned articles written by my\npredecessor in this chair of Medical Jurisprudence, Rev. James F.\nHoeffer, S.J., the former president of Creighton University. They are\nfound in the \"American Catholic Quarterly Review\" for 1882 and 1883.\n\nWhat must we think of the nature of spiritism, with its spirit-rappings,\ntable-turning, spirit-apparitions, and so on? Can such of the facts as\nare not impostures and realities be explained by the laws of nature, the\npowers of material agents and of men? All that could possibly be done by\nthe most skilled scientists, by the most determined materialists who\nbelieve neither in God nor demon, as well as by the most conscientious\nChristians, has only served to demonstrate to perfect evidence that\neffects are produced which can no more be attributed to natural agency\nthan speech and design can be attributed to a piece of wood. One\nprinciple of science throws much light on the nature of all those\nperformances, namely, that every effect must have a proportionate cause.\nWhen the effect shows knowledge and design, the cause must be\nintelligent. Now many of these marvels evidently show knowledge and\ndesign; therefore the cause is certainly intelligent.\n\nA table cannot understand and answer questions; it cannot move at a\nperson's bidding. A medium cannot speak in a language he has never\nlearned, nor know the secret ailment of a patient far away, nor\nprescribe the proper remedies without knowledge of medicine. Therefore\nthese effects, when they really exist, are due to intelligent agents,\nagents distinct from the persons visibly present; invisible agents,\ntherefore, spirits of another world.\n\nWho are these agents? God and His good angels cannot work these wretched\nmarvels, the food of a morbid curiosity, nor could they put themselves\nat the disposal of impious men to be marched out as monkeys on the\nstage. The spirits which are made to appear at the s\u00e9ances are degraded\nspirits. Spiritualists themselves tell us they are lying spirits. Those\nlying spirits say they are the souls of the departed, but who can\nbelieve their testimony if they are lying spirits, as they are\nacknowledged to be? This whole combination of imposture and superstition\nis simply the revival in a modern dress of a very ancient deception of\nmankind by playing on men's craving for the marvellous. Many imagine\nthese are recent discoveries, peculiar to this age of progress. Why?\nThis spirit-writing is and has been for centuries extensively practised\nin benighted pagan China, while even Africans and Hindoos are great\nadepts at table-turning. It is simply the revival of ancient witchcraft,\nwhich Simon Magus practised in St.\u00a0Peter's time; which flourished in\nEphesus while St.\u00a0Paul was preaching the Gospel there. It is more\nancient still. These were the abominations for which God commissioned\nthe Jews in Moses' time to exterminate the Canaanites and the other\ninhabitants of the Promised Land. In the Book of Moses called\nDeuteronomy, or Second Law, admitted as divine by Catholics,\nProtestants, and Jews alike, we have this fact very emphatically\nproclaimed by the Lord. He says: \"When thou art come into the land which\nthe Lord thy God shall give thee, beware lest thou have a mind to\nimitate the abominations of those nations; neither let there be found\namong you any one that ... consulteth soothsayers, or observeth dreams\nand omens, neither let there be any wizard, nor charmer, nor any one\nthat consulteth pythonic spirits, or fortune-tellers, or that seeketh\nthe truth from the dead.\"\n\nIs not this just what spiritualists pretend to do? Many may call it only\ntrifling and play. The Lord does not. The Scriptures continue: \"For the\nLord abhorreth all these things, and for these abominations He will\ndestroy them at thy coming.\" I certainly do not mean to say that all\nthat passes for spiritualism is thus downright deviltry to-day, nor was\nit so in pagan times. Much imposture was mixed with it. The oracles of\nthe pagan gods and goddesses were not all the work of the pythonic\nspirits. Much was craft of the priests of idols; and yet all were\nabominations before the Lord, on account of the share that Satan took\nin the deceptions.\n\nWhat must be the attitude of the scientific man towards all such\nmatters? It should be an attitude of hostility and opposition. Science\nshould frown down all imposture and superstition. Medicine in\nparticular, intended to be one of the choicest blessings of God to man,\nshould not degrade its noble profession by pandering to a vulgar greed\nfor morbid excitement. Not only will you personally keep aloof from all\nthat is allied to quackery and imposture, but in after-life your\npowerful influence for good will be most efficient in guarding others\nagainst such evils, and even perhaps in withdrawing from such\nassociations those who have already got entangled in dangerous snares.\nAt all events the enlightened views you shall have formed to yourselves\non all such impostures and impieties will be a power for good in the\nsocial circle in which your mental superiority and your moral integrity\nwill make you safe guides for your fellow-men.\n\n\nPRINTED BY BENZIGER BROTHERS, NEW YORK","title":"Moral Principles and Medical Practice: The Basis of Medical Jurisprudence","tradition":"philosophy-ethics","translated_text":null,"word_count":47018}