+------------------------------------------------------------------+ | | | Transcriber's Note | | | | In Lecture I, there are paragraphs numbered 1 to 8 but omitting | | 4. This is as in the original, as is the inconsistent | | hyphenation of the words "lawgiver" and "twofold". In two | | instances, errors of punctuation have been corrected, and in one | | case obscured words have been guessed. Full details can be found | | in the html version of this ebook. | | | +------------------------------------------------------------------+

 MORAL PRINCIPLES AND

 MEDICAL PRACTICE, THE BASIS OF MEDICAL JURISPRUDENCE. 

 BY

 REV. CHARLES COPPENS, S. J. , _Professor of Medical Jurisprudence in the John A. Creighton Medical College, Omaha, Neb. , author of Text-Books on Metaphysics, Ethics, Oratory, and Rhetoric. _

 NEW YORK, CINCINNATI, CHICAGO: BENZIGER BROTHERS, _Printers to the Holy Apostolic See. _

 TO

 MR. JOHN A. CREIGHTON, THE FOUNDER OF THIS MEDICAL COLLEGE AND OF ST. JOSEPH'S HOSPITAL, AS A SLIGHT TRIBUTE OF HONOR FOR HIS ENLIGHTENED PATRONAGE OF LEARNING AND HIS CHRISTIAN CHARITY TOWARDS HIS FELLOW-MEN, THIS VOLUME IS RESPECTFULLY INSCRIBED. 

=Permissu Superiorum. =

The undersigned, Provincial of the Missouri Province of the Society ofJesus, in virtue of faculties granted to him by Very Rev. L. MARTIN, General of the same Society, hereby permits the publication of a bookentitled "Moral Principles and Medical Practice, " by Rev. CHARLESCOPPENS, S. J. , the same having been approved by the censors appointed byhim to revise it. 

 THOMAS S. FITZGERALD, S. J. 

 ST. LOUIS, MO. , July 2, 1897. 

 * * * * *

=Imprimatur. =

 ✠ MICHAEL AUGUSTINE, _Archbishop of New York. _

 NEW YORK, July 20, 1897. 

COPYRIGHT, 1897, BY BENZIGER BROTHERS. 

PREFACE. 

The science of Medicine is progressive; genius irradiates its onwardmarch. Few other sciences have advanced as rapidly as it has done withinthe last half century. Hence it has happened that in many of itsbranches text-books have not kept pace with the knowledge of its leadingminds. Such is confessedly the case in the department of MedicalJurisprudence. This very term, Medical Jurisprudence, as now used incolleges, is generally acknowledged to be a misnomer. There is no reasonwhy it should be so used. The leading medical writers and practitionersare sound at present on the moral principles that ought to direct theconduct of physicians. It is high time that their principles be moregenerally and distinctly inculcated on the younger members, andespecially on the students of their noble profession. To promote thisobject is the purpose aimed at by the author. His brief volume is notintended to be substituted for existing text-books on MedicalJurisprudence, but to supply some chapters imperatively demanded byscience for the thorough treatment of this important subject. 

CONTENTS. 

 PAGE LECTURE I. --INTRODUCTION--THE FOUNDATION OF JURISPRUDENCE, 11

 " II. --CRANIOTOMY, 37

 " III. --ABORTION, 58

 " IV. --VIEWS OF SCIENTISTS AND SCIOLISTS, 81

 " V. --VENEREAL EXCESSES, 104

 " VI. --THE PHYSICIAN'S PROFESSIONAL RIGHTS AND DUTIES, 128

 " VII. --THE NATURE OF INSANITY, 151

 " VIII. --THE LEGAL ASPECTS OF INSANITY, 177

 " IX. --HYPNOTISM AND THE BORDER-LAND OF SCIENCE, 197

MORAL PRINCIPLES AND MEDICAL PRACTICE. 

LECTURE I. 

INTRODUCTORY--THE FOUNDATION OF JURISPRUDENCE. 

Gentlemen:--1. When I thoughtfully consider the subject on which I am toaddress you in this course of lectures, i. E. , Medical Jurisprudence, Iam deeply impressed with the dignity and the importance of the matter. 

The study of medicine is one of the noblest pursuits to which humantalent can be devoted. It is as far superior to geology, botany, entomology, zoölogy, and a score of kindred sciences as its subject, thebody of man, the visible lord of the creation, is superior to thesubject of all other physical sciences, which do so much honor to thepower of the human mind; astronomy, which explores the vast realms ofspace, traces the courses and weighs the bulks of its mighty orbs;chemistry, which analyzes the minutest atoms of matter; physics, whichdiscovers the properties, and mechanics, which utilizes the powers of anendless variety of bodies--all these noble sciences together are of lessservice to man than that study which directly promotes the welfare ofhis own structure, guards his very life, fosters the vigor of his youth, promotes the physical and mental, aye, even the moral, powers of hismanhood, sustains his failing strength, restores his shattered health, preserves the integrity of his aging faculties, and throughout his wholecareer supplies those conditions without which both enjoyment andutility of life would be impossible. 

The physician, indeed, is one of the most highly valued benefactors ofmankind. Therefore he has ever been held in honor among his fellow-men;by barbarous tribes he is looked upon as a connecting link between thevisible and the invisible world; in the most civilized communities, fromthe time of Hippocrates, the father of medicine, to the present day, hehas been held in deeper veneration than the members of almost any otherprofession; even in the sacred oracles of Revelation his office isspoken of with the highest commendation: "Honor the physician, " writesthe inspired penman, "for the need thou hast of him; for the Most Highhath created him. The skill of the physician shall lift up his head, andin the sight of great men he shall be praised. The Most High has createdmedicines out of the earth, and a wise man shall not abhor them. Thevirtue of these things is come to the knowledge of men, and the MostHigh has given knowledge to men, that He may be honored in His wonders. By these He shall cure and shall allay their pains, and of these theapothecary shall make sweet confections, and shall make up ointments ofhealth, and of His works there shall be no end. " (Ecclus. Xxxiii. 1-7). 

2. It is well to remind you thus, gentlemen, at the opening of this newyear of studies, of the excellence of your intended profession; for youcannot help seeing that a science so noble should be studied for a noblepurpose. In this age of utilitarianism, it is, alas! too common an evilthat the most excellent objects are coveted exclusively for lowerpurposes. True, no one can find fault with a physician for making hisprofession, no matter how exalted, a means of earning an honestlivelihood and a decent competency; but to ambition this career solelyfor its pecuniary remuneration would be to degrade one of the mostsublime vocations to which man may aspire. There is unfortunately toomuch of this spirit abroad in our day. There are too many who talk andact as if the one highest and worthiest ambition of life were to make aslarge a fortune in as short a time and in as easy a way as possible. Ifthis spirit of utilitarianism should become universal, the sadconsequence of it to our civilization would be incalculable. Fancy whatwould become of the virtue of patriotism if officers and men had nohigher ambition than to make money! As a patriotic army is the strongestdefence of a nation's rights, so a mercenary army is a dreadful dangerto a people's liberty, a ready tool in the hand of a tyrant; as heroismwith consequent glory is the noble attribute of a patriot, so amercenary spirit is a stigma on the career of any public officer. Wefind no fault with an artisan, a merchant, or a common laborer if heestimate the value of his toil by the pecuniary advantages attached toit; for that is the nature of such ordinary occupations, since for manlabor is the ordinary and providential condition of existence. But inthe higher professions we always look for loftier aspirations. Thisdistinction of rewards for different avocations is so evident that ithas passed into the very terms of our language: we speak of "wages" asdue to common laborers, of a "salary" as paid to those who render moreregular and more intellectual services; of a "fee" as appointed forofficial and professional actions; and the money paid to a physician ora lawyer is distinguished from ordinary fees by the especial name of"honorary" or "honorarium. " This term evidently implies, not only thatspecial honor is due to the recipients of such fees, but besides thatthe services they render are too noble to be measured in money values, and therefore the money offered is rather in the form of a tribute to abenefactor than of pecuniary compensation for a definite amount ofservice rendered. 

Wages may be measured by the time bestowed, or by the effect produced, or by the wants of the laborer to lead a life of reasonable comfort; asalary is measured by the period of service; but an honorary is notdependent on time employed, or on needs of support, or on effectproduced, but it is a tribute of gratitude due to a special benefactor. Whatever practical arrangements may be necessary or excusable in specialcircumstances, this is the ideal which makes the medical profession sohonorable in society. 

3. From these and many other considerations that might be added, it isevident, gentlemen, that in the pursuit of the distinguished career forwhich you are preparing, you are expected to make yourselves thebenefactors of your fellow-men. Now, in order to do so, it will notsuffice for you to understand the nature of the various diseases whichflesh is heir to, together with the specific powers of every drugdescribed in works on materia medica. The knowledge of anatomy andsurgery, and of the various branches that are taught by the manyprofessors with whom I have the honor of being associated in the work ofyour medical education, no matter how fully that knowledge be mastered, is not sure by itself to make you benefactors to your fellow-men, unlessyour conduct in the management of all your resources of science and artbe directed to procure the real welfare of your patients. Just as askilful politician may do more harm than good to his country if hedirect his efforts to improper ends, or make use of disgraceful means;as a dishonest lawyer may be more potent for the perversion than themaintenance of justice among his fellow-citizens; so likewise an ablephysician may abuse the beneficent resources of his profession toprocure inferior advantages at the sacrifice of moral rights andsuperior blessings. 

Your career, gentlemen, to be truly useful to others and pursued withsafety and benefit to yourselves, needs to be directed by a sciencewhose principles it will be my task to explain in this course oflectures--the science of MEDICAL JURISPRUDENCE. 

It is the characteristic of science to trace results to their causes. The science of _Jurisprudence_ investigates the causes or principles oflaw. It is defined as "the study of law in connection with itsunderlying principles. " _Medical Jurisprudence_, in its wider sense, comprises two departments, namely, the study of the laws regardingmedical practice, and, more, especially, the study of the principles onwhich those laws are founded, and from which they derive their bindingpower on the human conscience. The former department, styled _MedicalLaw_, is assigned in the Prospectus of this College to a gentleman ofthe legal profession. He will acquaint you with the laws of the land, and of this State in particular, which regulate the practice ofmedicine; he will explain the points on which a Doctor may come incontact with the law courts, either as a practitioner having to accountfor his own actions, under a charge of malpractice perhaps, or as anexpert summoned as a witness before a court in matters of civil contestsor criminal prosecutions. His field is wide and important, but the fieldof _Medical Jurisprudence_, in its stricter or more specific sense, iswider still and its research much deeper: it considers those principlesof reason that underlie the laws of the land, the natural rights andduties which these laws are indeed to enforce to some extent, but whichare antecedent and superior to all human laws, being themselves foundedon the essential and eternal fitness of things. For things are not rightor wrong simply because men have chosen to make them so. You allunderstand, gentlemen, that, even if we were living in a newlydiscovered land, where no code of human laws had yet been adopted, norcourts of justice established, nor civil government organized, stilleven there certain acts of Doctors, as of any other men, would be rightand praiseworthy, and others wrong and worthy of condemnation; eventhere Doctors and patients and their relatives would have certain rightsand duties. 

In such a land, the lecturer on Medical Law would have nothing toexplain; for there would be no human laws and law courts with which aphysician could come in contact. But the lecturer on MedicalJurisprudence proper would have as much to explain as I have in thiscountry at present; because he treats of the Ethics or moral principlesof Medical Practice, he deals with what is ever the same for all menwhere-ever they dwell, it being consequent on the very nature of man andhis essential relations to his Maker and his fellow-man. Unfortunatelythe term "Medical Jurisprudence" has been generally misused. Dr.  Ewell, in his text-book on the subject, writes "While the term 'MedicalJurisprudence' is a misnomer, --the collection of facts and conclusionsusually passing by that name being principally only matters of evidence, and rarely rules of law, --still the term is so generally employed thatit would be idle to attempt to bring into use a new term, and we shallaccordingly continue the employment of that which has only the sanctionof usage to recommend it" (Ch. I). 

I prefer to use terms in their genuine meaning; for misnomers are out ofplace in science, since they are misleading. Yet, to avoid all danger ofmisunderstanding, I will call my subject "Moral Principles and MedicalPractice, " and distinctly style it "The Basis of Medical Jurisprudence. "

On what lines will my treatment of the subject depart from the beatenpath? On the same lines on which most other improvements have been madein the science of medicine. Science has not discovered new laws ofphysical nature that did not exist before; but it has succeeded inunderstanding existing laws more perfectly than before, and has shapedits practice accordingly. So, too, the leaders of thought amongphysicians, especially in English-speaking countries, now understand thelaws of moral nature--the principles of Ethics--more thoroughly thanmost of their predecessors did, and they have modified their treatmentso as to conform it to these rules of morality. Hitherto MedicalJurisprudence had regulated the conduct of practitioners by human, positive laws, and sanctioned acts because they were not condemned bycivil courts. Now we go deeper in our studies, and appeal from humanlegislation to the first principles of right and wrong, as Jurisprudenceought to do; and, in consequence, some medical operations which used tobe tolerated, or even approved, by many in the profession are at presentabsolutely and justly condemned. The learned physician these days is nolonger afraid to face the moral philosopher; there is no longer anyestrangement between Ethics and Medical Practice. Medicine, sent fromHeaven to be an angel of mercy to man, is now ever faithful to itsbeneficent mission; it never more performs the task of a destroyingspirit, as--not in wantonness, but in ignorance--it did frequentlybefore. 

On these lines, then, of the improved understanding of first principles, I will now proceed to develop the teachings of Medical Jurisprudence. 

The first principle that I will lay down for explanation is, that a manis not to be held responsible for all his acts, but only for those whichhe does of his own free will, which, therefore, it is in his power to door not to do. These are called _human_ acts, because they proceed from adistinctively human power. A brute animal cannot perform such acts; itcan only do under given circumstances what its impulses prompt it to do;or, when it experiences various impulses in different directions, it canonly follow its strongest impulse; as when a dog, rushing up to attack aman, turns and runs away before his uplifted stick. When a bird sings, it cannot help singing; but a man may sing or not sing at his choice;his singing is a human act. When, however, under the impulse of violentpain, a person happens involuntarily to sigh or groan or even shriek, this indeed is the act of a man, but, inasmuch as it is physicallyuncontrollable, it is not a human act. So whatever a patient may dowhile under the influence of chloroform is not a human act, and he isnot morally responsible for it. His conduct under the circumstances maydenote a brave or a cowardly disposition, or it may indicate habits ofself-command or the absence of them. His prayers or curses while thusunconscious are no doubt the effects of acquired virtues or vices; yet, in as far as his will has no share in the present acts, they are notfree or human acts. He deserves praise or blame for his former acts, bywhich he acquired such habits, but not for his unconscious acts as such. 

From this principle it follows that a physician is not responsible toGod or man for such evil consequences of his prescriptions or surgicaloperations as are entirely beyond his will and therefore independent ofhis control. If, however, his mistakes arise from his ignorance or wantof skill, he is blamable in as far as he is the wilful cause of suchignorance; he should have known better; or, not knowing better, heshould not have undertaken the case for which he knew he was notqualified. 

But it often happens that the best informed and most skilfulpractitioner, even when acting with his utmost care, causes real harm tohis patients; he is the accidental, not the wilful, cause of that harm, and therefore he is free from all responsibility in the matter. 

The practical lessons, however, which all of you must lay to heart onthis subject are: 1st. That you are in duty bound to acquire soundknowledge and great skill in your profession; since the consequencesinvolved are of the greatest moment, your obligation is of a mostserious nature. 2d. That in your future practice you will be obliged onall occasions to use all reasonable care for the benefit of yourpatients. 3d. That you cannot in conscience undertake the management ofcases of unusual difficulty unless you possess the special knowledgerequired, or avail yourselves of the best counsel that can reasonably beobtained. 

5. A second principle of Ethics in medical practice, gentlemen, is this, that many human acts may be highly criminal of which, however, humanlaws and courts take no notice whatsoever. In this matter I am notfinding fault with human legislation. The laws of the land, consideringthe end and the nature of civil government, need take no cognizance ofany but overt acts; a man's heart may be a very cesspool of vice, envy, malice, impurity, pride, hatred, etc. , yet human law does not and oughtnot to punish him for this, as long as his actions do not disturb thepublic peace nor trench upon the happiness of his neighbor. Even hisopen outward acts which injure only himself, such as gluttony, blasphemy, impiety, private drunkenness, self-abuse, even seduction andfornication, are not usually legislated against or punished in ourcourts. Does it follow that they are innocent acts and lawful beforeGod? No man in his right senses will say so. 

The goodness and the evil of human acts is not dependent on humanlegislation alone; in many cases the moral good or evil is so intrinsicto the very nature of the acts that God Himself could not change theradical difference between them. Thus justice, obedience to lawfulauthority, gratitude to benefactors, are essentially good; whileinjustice, disobedience, and ingratitude are essentially evil. Ourreason informs us of this difference; and our reason is nothing elsethan our very nature as intelligent beings capable of knowing truth. Thevoice of our reason or conscience is the voice of God Himself, whospeaks through the rational nature that He has made. Through our reasonGod not only tells us of the difference between good and evil acts, butHe also commands us to do good and avoid evil;--to do certain actsbecause they are proper, right, orderly, suitable to the end for whichwe are created; and to avoid other acts because they are improper, wrong, disorderly, unsuitable to the end of our existence. There is athird class of acts, which, in themselves, are indifferent, i. E. , neither good nor evil, neither necessary for our end nor interferingwith its attainment. These we are free to do or to omit as we prefer;but even these become good and even obligatory when they are commandedby proper authority, and they become evil when forbidden. In themselves, they are indifferent acts. 

6. These explanations are not mere abstractions, gentlemen, or merephilosophical speculations. True, my subject is philosophical; but it isthe philosophy of every-day life; we are dealing with live issues whichgive rise to the gravest discussions of your medical journals; issues onwhich practically depend the lives of thousands of human beings everyyear, issues which regard physicians more than any other class of men, and for the proper consideration of which Doctors are responsible totheir conscience, to human society, and to their God. To show you how weare dealing with present live issues, let me give you an example of acase in point. In the "Medical Record, " an estimable weekly, now inalmost the fiftieth year of its existence, there was lately carried on alengthy and, in some of its parts, a learned discussion, regarding thetruth of the principles which I have just now explained, namely, theintrinsic difference between right and wrong, independently of theruling of law courts and of any human legislation. The subject of thediscussion was the lawfulness in any case at all of performingcraniotomy, or of directly destroying the life of the child by anyprocess whatever, at the time of parturition, with the intention ofsaving the life of the mother. 

I will not examine this important matter in all its bearings at present;I mean to take it up later on in our course, and to lay before you theteachings of science on this subject, together with the principles onwhich they are based. For the present I will confine myself to the pointwe are treating just now, namely, the existence of a higher law thanthat of human tribunals, the superiority of the claims of natural tothose of legal justice. Some might think, at first sight, that thisneeds no proof. In fact we are all convinced that human laws are oftenunjust, or, at least, very imperfect, and therefore they cannot be theultimate test or fixed standard of right and wrong; yet the mainargument advanced by one of the advocates of craniotomy rests upon thedenial of a higher law, and the assertion of the authority of humantribunals as final in such matters. 

In the "Medical Record" for July 27, 1895, p.  141, this gentleman writesin defence of craniotomy: "The question is a legal one _per se_ againstwhich any conflicting view is untenable. The subdivisions under whichthe common law takes consideration of craniotomy are answers inthemselves to the conclusions quoted above, under the unfortunatenecessity which demands the operation. " Next he quotes the Ohio statutelaw, which, he remarks, was enacted in protection of physicians who areconfronted with this dire necessity. He is answered with much abilityand sound learning by Dr.  Thomas J. Kearney, of New York, in the same"Medical Record" for August 31, 1895, p.  320, who writes: "Dr.  G. Baseshis argument for the lawfulness of craniotomy in the teachings of commonlaw, contending, at least implicitly, that it is unnecessary to seekfarther the desired justification. However, the basis of common law, though broad, is certainly not broad enough for the consideration ofsuch a question as the present one. His coolness rises to sublimeheights, in thus assuming infallibility for common law, ignoring thevery important fact that behind it there is another and higher law, whose imperative, to every one with a conscience, is ultimate. Itevidently never occurs to him that some time could be profitably spentin research, with the view to discovering how often common-law maxims, seen to be at variance with the principles of morality, have beenabrogated by statutory enactments. Now the maxims of common lawrelating to craniotomy, the statutes in conformity therewith, as well asDr.  G. 's arguments (some of them at least), rest on a basis of pureunmitigated expediency; and this is certainly in direct contravention ofthe teachings of all schools of moral science, even the utilitarian. "

Dr.  Kearney's doctrine of the existence of a higher law, superior to allhuman law, is the doctrine that has been universally accepted, in allChristian lands at least, and is so to the present day. Froude explainsit correctly when he writes: "Our human laws are but the copies, more orless imperfect, of the eternal laws so far as we can read them, andeither succeed and promote our welfare or fail and bring confusion anddisaster, according as the legislator's insight has detected the trueprinciple, or has been distorted by ignorance or selfishness" (CenturyDict. , "Law"). 

Whoever calmly reflects on the manner in which laws are enacted bylegislative bodies, under the influence of human passions andprejudices, often at the dictation of party leaders or of popularsentiment, of office-seekers or wealthy corporations, etc. , will notmaintain for a moment that human laws and human tribunals are to beaccepted as the supreme measure or _norma_ of right and wrong. Thecommon law of England, which lies at the basis of our Americanlegislation, and is an integral portion of our civil government, is lessfluctuating than our statutory law, and is in the main sound and inconformity with the principles of Jurisprudence. But no one will claiminfallibility for its enactments; the esteem we have for it is chieflydue to its general accord with the requirements of the higher law. 

7. There is, then, a higher law, which all men are bound to obey, evenlawgivers and rulers themselves as well as their humblest subjects, alaw from which no man nor class of men can claim exemption, a law whichthe Creator cannot fail to impose upon His rational creatures: althoughGod was free to create or not to create as He chose, since He did notneed anything to complete His own happiness, --yet, if He did create, Hewas bound by His own wisdom to put order into His work; else it wouldnot be worthy of His supreme wisdom. As the poet has so terselyexpressed it, "Order is Heaven's first law. "

How admirably is this order displayed in the material universe! The morewe study the sciences--astronomy, biology, botany, physiology, medicine, etc. --the more we are lost in admiration at the beautiful order we seedisplayed in the tiniest as well as in the vastest portions of thecreation. And shall man alone, the masterpiece of God in this visibleuniverse, be allowed to be disorderly, to be a failure in the noblestpart of his being, to make himself like to the brute or to a demon ofmalice, to waste his choicest gifts in the indulgence of debasingpleasure? The Creator is bound by His own wisdom to direct men to highpurposes, worthy of their exalted intellectual nature. But how shall Hedirect man? He compels material things to move with order to theaccomplishment of their alloted tasks by the physical laws of matter. Hedirects brute animals most admirably to run their appointed careers bythe wonderful laws of instinct, which none of them can resist at will. But man He has made free; He must direct him to do worthy actions bymeans suitable to a free being, that is, by the enacting of the morallaw. 

He makes known to us what is right and wrong. He informs every one ofus, by the voice of reason itself, that He requires us to do the rightand avoid the wrong. He has implanted in us the sense of duty to obeythat law. If we do so, we lead worthy lives, we please Him, and, in Hisgoodness, He has rewards in store. 

But can He be pleased with us if we thwart His designs; if we, Hisnoblest works on earth, instead of adding to the universal harmony ofHis creation, make monsters of ourselves, moral blots upon thebeautiful face of His world? It were idle for Him to give us theknowledge of His will and then to stand by and let us disfigure Hisfairest designs; to bid us do what is right, and then let us do wrongwithout exacting redress or atonement. If He is wise, He must not onlylay down the law, but He must also enforce it; He must make it ourhighest interest to keep His law, to do the right; so that ultimatelythose men shall be happy who have done it, and those who have thwartedHis designs shall be compelled to rue it. He will not deprive us ofliberty, the fairest gift to an intelligent creature, but He will holdout rewards and punishments to induce us to keep the law and to avoidits violation. Once He has promised and threatened, His justice and Hisholiness compel Him to fulfil His threats and promises. A man can commitno rasher act than to ignore, defy, and violate that higher law of whichwe are speaking, and which, if it must direct all men, especiallyrequires the respect and obedience of those into whose hands he hasplaced at times the lives of their fellow-men, the greatest of earthlytreasures. 

I have insisted so much, gentlemen, on the existence of the higher law, on its binding power and on the necessity of observing it, because it isthe foundation of my whole course of lectures. If there were no higherlaw, then there would be no Medical Jurisprudence, in the true sense ofthe word. For Jurisprudence studies the principles that underlie legalenactments, and if there were no higher law, there would be no suchprinciples; then the knowledge of the human law would fill the wholeprogramme. This in fact is the contention of the defendant of craniotomyto whom I have referred; and he boldly applies his speculation to amatter in which the physician has the most frequent opportunity toexhibit his fidelity to principle, or his subserviency to therequirements of temporary expediency at the sacrifice of duty. 

8. You will find, gentlemen, as we proceed in our course, that Doctorshave very many occasions in which to apply the lessons of Jurisprudencein their medical practice. I even suspect that they need to be moreconscientious in regard to the dictates of the higher law than any otherclass of men, the clergy alone, perhaps, excepted. They need this notonly for their own good, but also for the good of their patients and ofthe community at large. The reasons are these:

A. The matters entrusted to their keeping are the most important of allearthly possessions; for they are life itself, and, along with life, health, the necessary condition of almost all temporal enjoyment. Noother class of men is entrusted with more weighty earthly interests. Hence the physician's responsibility is very great; hence the commongood requires that he be eminently faithful and conscientious. 

B. With no other class of men does the performance of duty depend moreon personal integrity, on conscientious regard for the higher law ofmorality than with the Doctor. For the Doctor's conduct is less open toobservation than that of other professions. The lawyer may have manytemptations to act unjustly; but other lawyers are watching him, and thecourts of justice are at hand to check his evil practices. As to thejudge, he is to pronounce his decisions in public and give reasons forhis ruling. The politician is jealously watched by his politicalopponents. The public functionary, if he is unjust in his dealings, islikely sooner or later to be brought to an account. But the physician, on very many occasions, can be morally sure that his conduct will neverbe publicly scrutinized. Such is the nature of his ministrations, andsuch too is the confidence habitually reposed in his integrity, that heis and must be implicitly trusted in matters in which, if he happens tobe unworthy of his vocation, he may be guilty of the most outrageouswrongs. 

The highest interests of earth are in his hands. If he is notconscientious, or if he lets himself be carried about by every wind ofmodern speculations, he can readily persuade himself that a measure islawful because it is presently expedient, that acts can justly beperformed because the courts do not punish them; and thus he will oftenviolate the most sacred rights of his patients or of their relatives. Who has more frequent opportunities than a licentious Doctor to seducethe innocent, to pander to the passions of the guilty, to play into thehands of greedy heirs, who may be most willing to pay him for hisservices? No one can do it more safely, as far as human tribunals areconcerned. As a matter of fact, many, all over this land and otherlands, are often guilty of prostituting their noble profession to thevilest uses. The evil becomes all the more serious when false doctrinesare insinuated, or publicly advocated, which throw doubt upon the mostsacred principles of morality. True, the sounder and by far the largerportion of medical men protest against these false teachings by theirown conduct at least; but it very frequently happens that the honest manis less zealous in his advocacy of what is right than is thepropagandist of bold speculations and dangerous new theories in thespreading of what is pernicious. 

The effect thus produced upon many minds is to shake their convictions, to say the least; and I need not tell you, gentlemen, that weakconvictions are not likely to be proof against violent and repeatedtemptations. In fact, if a physician, misled by any of those manytheories which are often inculcated or at least insinuated by falsescientists, can ever convince himself, or even can begin to surmisethat, after all, there may be no such thing as a higher law before whichhe is responsible for even his secret conduct, then what is to preventhim from becoming a dangerous person to the community? If he see muchtemporal gain on the one hand, and security from legal prosecution onthe other, what would keep him in the path of duty and honesty?Especially if he can once make himself believe that, for all he knows, he may be nothing more than a rather curiously developed lump of matter, which is to lose forever all consciousness in death. Why should he notget rid of any other evolved lump of matter if it stand in the way ofhis present or prospective happiness? Those are dangerous men whoinculcate such theories; it were a sad day for the medical professionand for the world at large if ever they found much countenance amongphysicians. Society cannot do without the higher law; this law is to bestudied in Medical Jurisprudence. 

It is my direct object, gentlemen, to explain this law to you in itsmost important bearings, and thus to lay before you the chief duties ofyour profession. The principal reason why I have undertaken to deliverthis course of lectures--the chief reason, in fact, why the CreightonUniversity has assumed the management of this Medical College--is thatwe wish to provide for the West, as far as we are able, a goodly supplyof conscientious physicians, who shall be as faithful and reliable asthey will be able and well informed; whose solid principles and sterlingintegrity shall be guarantees of upright and virtuous conduct. 

That this task of mine may be successfully accomplished, I will endeavorto answer all difficulties and objections that you may propose. I willnever consider it a want of respect to me as your professor if you willurge your questions till I have answered them to your full satisfaction. On the contrary, I request you to be very inquisitive; and I will bebest pleased with those who show themselves the most ready to point outthose difficulties, connected with my lectures, which seem to requirefurther answers and explanations. 

LECTURE II. 

CRANIOTOMY. 

Gentlemen:--In my first lecture I proved to you the existence and thebinding power of a higher law than that of human legislators, namely, ofthe eternal law, which, in His wisdom, the Creator, if He created atall, could not help enacting, and which He is bound by His wisdom andjustice to enforce upon mankind. 

We are next to consider what are the duties which that higher lawimposes upon the physician. In this present lecture I will confinemyself to one duty, that of respect for human life. 

A duty is a bond imposed on our will. God, as I remarked before, imposessuch bonds, and by them He directs free beings to lead worthy lives. AsHe directs matter by irresistible physical laws, so He directsintelligent and free beings by moral laws, that is, by laying duties ormoral bonds upon them, which they ought to obey, which He must requirethem to obey, enforcing His commands by suitable rewards andpunishments. Thus He establishes and enforces the moral order. 

Now the duties He lays upon us are of three classes. First, there areduties of reverence and honor towards Himself as our sovereign Lord andMaster. These are called the duties of Religion, the study of which doesnot belong to Medical Jurisprudence. The other classes of duties regardourselves and our fellow-men, with these we are to deal in our lectures. 

I. Order requires that the meaner species of creatures shall exist forthe benefit of the nobler; the inert clod of earth supports vegetablelife, the vegetable kingdom supplies the wants of animal life, the bruteanimal with all inferior things subserves the good of man; while man, the master of the visible universe, himself exists directly for thehonor and glory of God. In this beautiful order of creation, man can useall inferior things for his own benefit. 

This is what reason teaches concerning our status in this world; andthis teaching of reason is confirmed by the convictions of all nationsand all ages of mankind. The oldest page of literature that has comedown to us, namely, the first chapter of the first book of Holy Writ, lays down this same law, and no improvement has been made in it duringall subsequent ages. Whether we regard this writing as inspired, asChristians and Jews have always done, or only as the testimony of themost remote antiquity, confirmed by the acceptance of all subsequentgenerations, it is for every sensible man of the highest authority. 

Here is the passage: "God said, Let us make man to our image andlikeness; and let him have dominion over the fishes of the sea, and thefowls of the air, and the beasts, and the whole earth, and everycreeping creature that creepeth upon the earth. " And later on inhistory, after the deluge, God more explicitly declared the order thusestablished, saying to Noe and his posterity: "Every thing that movethand liveth shall be meat for you; even as the green herbs have Idelivered them to you. " But He emphatically adds that the lives of menare not included in this grant; they are directly reserved for His owndisposal. "At the hand of every man, " He says, "will I require the lifeof man. "

All things then are created for man; man is created directly for God, and is not to be sacrificed for the advantage of a fellow-man. Thusreason and Revelation in unison proclaim that we can use brute animalsas well as plants for our benefit, taking away their lives when it isnecessary or useful to do so for our own welfare; while no man is everallowed to slay his fellow-man for his own use or benefit: "At the handof every man will I require the life of man. "

II. The first practical application I will make of these generalprinciples to the conduct of physicians is this: a physician and astudent of medicine can, with a safe conscience, use any brute animalthat has not been appropriated by another man, whether it be bug or birdor beast, to experiment upon, whatever specious arguments humanesocieties may advance to the contrary. Brute animals are for the use ofman, for his food and clothing, his mental and physical improvement, andeven his reasonable recreations. Man can lawfully hunt and fish andpractise his skill at the expense of the brute creation, notwithstandingthe modern fad of sentimentalists. The teacher and the pupil can usevivisection, and thus to some extent prolong the sufferings of the brutesubject for the sake of science, of mental improvement, and intelligentobservation. But is not this cruelty? and has a man a right to be cruel?No man has a right to be cruel; cruelty is a vice, it is degrading toman's noble nature. But vivisection practised for scientific purposes isnot cruel. Cruelty implies the _wanton_ infliction of pain: there arepeople who delight in seeing a victim tortured; this is cruelty orsavagery, and is a disgrace to man. Even to inflict pain withoutbenefit is cruel and wrong; but not when it is inflicted on the brutecreation for the benefit of man, unless the pain should be very greatand the benefit very small. Certainly it is right to cultivate habits ofkindness even to animals; but this matter must not be carried to excess. 

The teaching of humane societies condemning all vivisection is due tothe exaggeration of a good sentiment and to ignorance of firstprinciples. For they suppose that sufferings inflicted on brute animalsare a violation of their rights. Now we maintain that brute animals haveno rights in the true sense of the word. To prove this thesis we mustexplain what a right is and how men get to have rights. A _right_ is amoral claim to a thing, which claim other persons are obliged torespect. Since every man has a destiny appointed for him by his Creator, and which he is to work out by his own acts, he must have the meansgiven him to do so. For to assign a person a task and not to give himthe means of accomplishing it would be absurd. Therefore the Creatorwants him to have those means, and forbids every one to deprive him ofthose means. Here is the foundation of rights. Every man, in virtue ofthe Creator's will, has certain advantages or claims to advantagesassigned him which no other man may infringe. Those advantages andclaims constitute his rights, guaranteed him by the Creator; and allother men have the _duty_ imposed on them to respect those rights. Thusrights and duties are seen to be correlative and inseparable; the rightslodged in one man beget duties in other men. The same Creator thatassigns rights to one man lays upon all others duties to respect thoserights, that thus every free being may have the means of working out itsHeaven-appointed destiny. 

Thus it is apparent that rights and duties suppose free beings, persons;now an irrational animal is not a person; it is not a free being, havinga destiny to work out by its free acts; it is therefore incapable ofhaving duties. Duties are matters of conscience; therefore they cannotbelong to the brute animal; for it has no conscience. And, since rightsare given to creatures because of the duties incumbent on them, bruteanimals are incapable of having rights. When a brute animal has servedman's purpose, it has reached its destiny. 

III. But it is entirely different with man: there is what we may call aninfinite distance between man and brute. Every man is created directlyfor the honor and service not of other men, but of God Himself: byserving God man must work out his own destiny--eternal happiness. Inthis respect all men are equal, having the same essence or nature andthe same destiny. The poor child has as much right to attain eternalhappiness as the rich child, the infant as much as the gray-beardedsire. Every one is only at the beginning of an endless existence, ofwhich he is to determine the nature by his own free acts. In thisinfinite destiny lies the infinite superiority of man over the brutecreation. 

That all men are equal in their essential rights is the dictate ofcommon-sense and of sound philosophy. This truth may not flatter kingsand princes; but it is the charter of human rights, founded deeper andbroader in nature and on the Creator's will than any other claim ofmankind. As order requires the subordination of lower natures to higher, so it requires equality of essential rights among beings of the samenature. Now all men are of the same nature, hence they have all the sameessential rights. 

If any people on earth must stand by these principles, certainly theAmerican people must do so; for we have put them as thefoundation-stones of our civil liberty. There is more wisdom than many, even of its admirers, imagine in the preamble to our Declaration ofIndependence; upon it we are to base the most important rights andduties which belong to Jurisprudence. The words of the preamble read asfollows: "We hold these truths as self-evident, that all men are createdequal; that they are endowed by their Creator with certain inalienablerights; that among these are life, liberty, and the pursuit ofhappiness. " I feel convinced, gentlemen, and I will take it for grantedhenceforth, unless you bring objections to the contrary, that you allagree with me on this important point that _every man has a naturalright to his life, a right which all other men are solemnly bound torespect_. It is his chief earthly right. It is called an _inalienable_right; by which term the fathers of our liberty meant a right whichunder no circumstances can be lawfully disregarded. A man who takes itupon himself to deprive another of life commits two grievous wrongs: onetowards his victim, whose most important right he violates, and onetowards God, who has a right to the life and service of His creatures. "Thou shalt not kill" is a precept as deeply engraven on the human heartby reason itself as it was on the stone tables of the Ten Commandmentsby Revelation. 

So far we have chiefly considered murder as a violation of man's rightto his life. We must now turn our attention to God's right, which themurderer violates. It may indeed happen that a man willingly resignshis right to live, that he is tired of life, and longs and implores forsome one to take it away. Can you then do it? You cannot. His life doesnot belong to him alone, but to God also, and to God principally; if youdestroy it, you violate God's right, and you will have to settle withHim. God wills this man to live and serve Him, if it were only bypatient endurance of his sufferings. 

For a man may be much ennobled and perfected by the practice of patienceunder pain and agony. Some of the noblest characters of history are mostglorious for such endurance. The suicide rejects this greatness; he robsGod of service and glory, he rebels against his Creator. Even Plato ofold understood the baseness of suicide, when he wrote in his dialoguecalled "Phædon" that a man in this world is like a soldier stationed onguard; he must hold his post as long as his commander requires it; todesert it is cowardice and treachery; thus, he says, suicide is agrievous crime. 

This being so, can a Doctor, or any other man, ever presume tocontribute his share to the shortening of a person's life by aiding himto commit suicide? We must emphatically say No, even though the patientshould desire death: the Doctor cannot, in any case, lend hisassistance to violate the right and the law of the Creator: "Thou shaltnot kill. "

I have no doubt, gentlemen, that some of you have been saying toyourselves, Why does the lecturer insist so long upon a point which isso clear? Of course, none of us doubts that we can in no case aid apatient to commit suicide. My reason for thus insisting on this matteris that here again we are dealing with a living issue. There are to-dayphysicians and others who deny this truth, not in their secret practiceonly, but, of late, to justify their conduct, they have boldlyformulated the thesis that present apparent expediency can lawfully bepreferred to any higher consideration. Here is the fact. At aMedico-Legal Congress, held in the summer of 1895, Dr.  Bach, one of itsleading lights, openly maintained it as his opinion that "Physicianshave the moral right to end life when the disease is incurable, painful, and agonizing. "

What his arguments were in support of his startling proposition, I havenot been able to learn. But I know that a cry of horror and indignationhas gone up from many a heart. Many have protested in print; but unless, on an occasion like this, moralists raise their voice against it withall the influence which sound principles command, the saying ofDr.  Bach may at least shake the convictions of the rising generation ofphysicians. The only argument for Dr. Bach's assertion that I canimagine--and it is one proceeding from the heart rather than thehead--is that it is cruel to let a poor man suffer when there is nolonger hope of recovery. It is not the Physician that makes him suffer;it is God who controls the case, and God is never cruel. 

He knows His own business, and forbids you to thwart His designs. If thesufferer be virtuous, God has an eternity to reward his patientendurance; if guilty, the Lord often punishes in this world that He mayspare in the next. Let Him have His way, if you are wise; His command toall is clear, "Thou shalt not kill. "

One rash utterance, like that of Dr.  Bach, can do an incalculable amountof harm. Why, gentlemen, just think what consequences must follow if hisprinciple were, admitted! For the only reason that could give it anyplausibility would be that the patient's life is become useless andinsupportable. If that were a reason for taking human life away, then itwould follow that, whenever a man considers his life as useless and nolonger supportable, he could end it, he could commit suicide. Thatreasoning would practically justify almost all suicides. For, whenpeople kill themselves, it is, in almost all cases, because theyconsider their lives useless and insupportable. Whether it results fromphysical or from moral causes that they consider their life a burden, cannot, it seems to me, make any material difference; grief, shame, despair are as terrible sufferings as bodily pains. If, then, we acceptDr.  Bach's principle, we must be prepared for all its banefulconsequences. 

IV. But are there no exceptions to the general law, "Thou shalt notkill"? Are there no cases in which it is allowed to take another's life?What about justifiable homicide? There are three cases of this nature, gentlemen; namely, self-defence, capital punishment inflicted by thestate, and active warfare. With only one of these can a physician, assuch be concerned or think himself concerned. He is not a public hangmanexecuting a sentence of a criminal court; nor is he acting as a soldierproceeding by public authority against a public foe. As to the plea ofself-defence, it must be correctly understood, lest he usurp a powerwhich neither human nor divine law has conferred upon him. 

1. _Self-defence. _ It is a dictate of common-sense, already quoted byCicero as a universally received maxim of Jurisprudence in his day, thatit is justifiable to repel violence by violence, even if the death ofour unjust assailant should result. In such a case, let us consider whatreally takes place. A ruffian attempts to take away my life; I have aright to my life. I may, therefore, protect it against him; and, forthat purpose, I may use all lawful means. A lawful means is one thatviolates no law, one that I may use without giving any one reasonableground of complaint. Suppose I have no other means to protect my lifethan by shooting my aggressor; has he a right to complain of my conductif I try to do so? No, because he forces me to the act; he forces me tochoose between my life and his. Good order is not violated if I prefermy own life: well-ordered charity begins at home. But is not God's rightviolated? It is; for God has a right to my life and to that of myassailant. The ruffian who compels me to shoot him is to blame forbringing both our lives into danger; he is responsible for it to God. But the Creator will not blame me for defending my life by the onlymeans in my power, and that when compelled by an unjust assailant, whocannot reasonably find fault with my conduct. 

But it may be objected that no evil act may be done to procure a goodresult, that a good end does not justify a bad means. That is a correctprinciple, and we will consider it carefully some other day. But my actof necessary self-defence is not evil, and therefore needs nojustification; for the means I employ are, under the circumstances, well-ordered and lawful means, which violate no one's rights, as hasjust been shown. Of course the harm I do to the aggressor is just onlyin as far as it is strictly necessary to defend the inalienable right Ihave to life or limb or very valuable property. Hence I must keep withinthe just limits of self-defence. To shoot an assailant, when I am in noserious danger, or when I can free myself some other way, or when I actthrough malice, would not be self-defence, but unjustifiable violence onmy part. 

2. The principles that make it lawful for a man to defend his own lifewith violence against an unjust assailant will also justify a parent inthus defending his children, a guardian his wards; and in fact any onemay forcibly defend any other human being against unjust violence. Aparent or guardian not only can, but he is in duty bound to, defendthose under his charge by all lawful means. Similarly the physicianwould be obliged to defend his patient by the exercise of his professionin his behalf. 

Now the only case in which the need of medical treatment against unjustaggression could become a matter for discussion in Jurisprudence is thecase of a mother with child. Is the child under those circumstancesreally an unjust aggressor? Let us study that important case with theclosest attention. Let all the rays of light we have gathered so far befocussed on this particular point. Can a physician ever be justified indestroying the life of a child, before or during its birth, bycraniotomy or in any other manner, in order to save its mother's life, on the plea that the child is an unjust assailant of the life of itsmother? Put the case in a definite shape before you. Here is a mother inthe pangs of parturition. An organic defect, no matter in what shape orform, prevents deliverance by the ordinary channels. All that medicalskill can do to assist nature has been done. The case is desperate. Other physicians have been called in for consultation, as the civil lawrequires before it will tolerate extreme measures. All agree that, if nosurgical operation is performed, both mother and child must die. Thereare the Cæsarian section, the Porro operation, laparotomy, symphysiotomy, all approved by science and the moral law. But we willsuppose an extreme case; namely, the circumstances are so unfavorablefor any of these operations--whether owing to want of skill in theDoctors present, or for any other reason--that none can safely beattempted; any of them would be fatal to the mother. 

In this extreme case of necessity, can the Doctor break the cranium ofthe living child, or in any way destroy its life with a view to save themother? If three consulting physicians agree that this is the only wayto save her, he will not be molested by the law courts for performingthe murderous operation. But will the law of nature and of nature's Godapprove or allow his conduct? This is the precise question under ourconsideration. We have seen that the infant, a true human being, has aright to live, as well as its mother. "All men are created equal, andhave an equal right to life, " declares the first principle of ourliberty. The Creator, too, as reason teaches, has a clear right to thechild's life; that child may answer a very special purpose ofProvidence. But whether it will or not, God is the supreme and the onlyMaster of life and death, and He has laid down the strict prohibition, "Thou shalt not kill. "

Now comes the plea of self-defence against an unjust aggressor. If thechild is such, if it _unjustly_ attacks its mother's life, then she candestroy it to save herself, and her physician can aid the innocentagainst the guilty party. But can it be proved that the infant is anunjust aggressor in the case? There can be no intentional or _formal_guilt in the little innocent babe. But can we argue that the actualsituation of the child is an unjust act, unconsciously done, yet_materially_ unjust, unlawful? Thus, if a madman would rush at me with asharp sword, evidently intent on killing me, he may be called an unjustaggressor; though, being a raving maniac, he does not know what crime heis committing, and is _formally_ innocent of murderous intent. _Materially_ considered, the act is unjust, and I can defend myselflawfully as against any other unjust assailant. Such is the commonteaching of moralists. But can the innocent babe be classed in the samecategory with the raving maniac? Why should it? It is doing nothing; itis merely passive in the whole process of parturition. 

Will any one object that the infant has no right to be there at all? Whoput it there? The only human agents in the matter were its parents. Themother is more accountable for the unfortunate situation than the child. Certainly you could not, to save the child, directly kill the mother, treating her as an unjust assailant of her child's life? Still less canyou treat the infant as an unjust assailant of its mother's life. 

The plea of self-defence against unjust aggression being thus ruled outof court in all such cases, and no other plea remaining for thecraniotomist, we have established, on the clearest principles of Ethicsand Jurisprudence, that it is never allowed directly to kill a child asa means to save its mother's life. It would be a bad means, morallyevil; and no moral evil can ever be done that good may come of it; theend cannot justify an evil means. In theory all good men agree with usthat the end can never justify the means. But in practice it seems to bedifferent with some of the medical profession. Of late, however, thepractice of craniotomy and all equivalent operations upon livingsubjects has gone almost entirely out of fashion among the better classof physicians. 

Allow me, gentlemen, to conclude this lecture with the reading of twoextracts from articles of medical writers on the present state ofcraniotomy in their profession. You will find them in accord with theconclusions at which we have arrived by reasoning upon the principles ofJurisprudence. 

Dr.  W.  H. Parish writes ("Am. Eccles. Review, " November, 1893, p.  364):"The operations of craniotomy and embryotomy are to-day of relativelyinfrequent occurrence, and many obstetricians of large experience havenever performed them. Advanced obstetricians advocate the performance ofthe Cesarian section or its modification--the Porro operation--inpreference to craniotomy, because nearly all the children are saved, and the unavoidable mortality among mothers is not much higher than thatwhich attends craniotomy. Of one hundred women on whom Cesarian sectionis performed under _favorable conditions_ and with _attainable_ skill, about ninety-five mothers should recover and fully the same number ofchildren. Of one hundred craniotomies, ninety-five mothers or possibly alarger number will recover, and of course none of the children. Theproblem resolves itself into this: Which shall we choose--Cesariansection with one hundred and ninety living beings as the result, orcraniotomy with about ninety-five living beings?"

Even if a liberal deduction be made for unfavorable circumstances anddeficient skill, the results, gentlemen, will still leave a wide marginin favor of Cesarian section. My second extract is from an article ofDr.  M. O'Hara, and it is supported by the very highest authorities (ib. P.  361): "Recently [August 1, 1893] the British Medical Association, themost authoritative medical body in Great Britain, at its sixty-firstannual meeting, held at Newcastle-upon-Tyne, definitely discussed thesubject before us. In the address delivered at the opening of thesection of Obstetric Medicine and Gynecology, an assertion was put forthwhich I regard as very remarkable, my recollection not taking in anysimilar pronouncement made in any like representative medical body. Theauthoritative value of this statement, accepted as undisputed by themembers of the association, which counts about fifteen thousandpractitioners, need not be emphasized. 

"Dr.  James Murphy ('British Medical Journal, ' August 26, 1893), of theUniversity of Durham, made the presidential address. He first alluded tothe perfection to which the forceps had reached for pelves narrowed atthe brim, and the means of correcting faulty position of the fœtusduring labor. He then stated: 'In cases of great deformity of thepelvis, it has long been the ambition of the obstetrician, where it hasbeen impossible to deliver a living child _per vias naturales_, to findsome means by which that child could be born alive with comparativesafety to the mother; and that time has now arrived. It is not for me todecide, ' he says, 'whether the modern Cesarian section, Porro'soperation, symphysiotomy, ischiopubotomy, or other operation is thesafest or most suitable, nor yet is there sufficient material for thisquestion to be decided; but when such splendid and successful resultshave been achieved by Porro, Leopold, Saenger, and by our own MurdochCameron, I say it deliberately and with whatever authority I possess, and I urge it with all the force I can master, that we are not nowjustified in destroying a living child; and while there may be somethings I look back upon with pleasure in my professional career, thatwhich gives me the greatest satisfaction is that I have never done acraniotomy on a living child. '"

You will please notice, gentlemen, that when this distinguished Doctorsaid, "We are not _now_ justified in destroying a living child, " he wasspeaking from a medical standpoint, and meant to say that suchdestruction is now scientifically unjustifiable, is a blunder insurgery. From a moral point of view it is not only now, but it wasalways, unjustifiable to slay a child as a means to save the mother'slife; a good end cannot justify an evil means, is a truth that cannot betoo emphatically inculcated. This is one of the most important subjectson which Medical Jurisprudence has been improved, and most of itstext-books are deficient. The improvement is explained with muchscientific detail in an address of the President, Samuel C. Busey, M. D. , before the Washington Obstetrical and Gynecological Society ("Am. Journal of Obstetrics and Diseases of Women and Children, " vol.  xvii. N.  2). 

LECTURE III. 

ABORTION. 

Abortion, gentlemen, is the theme of my present lecture. 

I. An important point to be determined is the precise time when thehuman embryo is first animated by its own specific principle of life, its human soul. It is interesting to read what various conjectures havebeen ventured on this subject by the learned of former ages. They weretotally at sea. Though gifted with keen minds, they had not the properdata to reason from. And yet some of those sages made very shrewdguesses. For instance, as early as the fourth century of our era, St.  Gregory of Nyssa taught the true doctrine, which modern science hasnow universally accepted. He taught that the rational soul is created byAlmighty God and infused into the embryo at the very moment ofconception. Still, as St. Gregory could not prove the certainty of hisdoctrine, it was opposed by the majority of the learned. 

The Schoolmen of the Middle Ages, while condemning abortion from thetime of conception, preferred the opinion of Aristotle, that therational soul is not infused till the fœtus is sufficiently developed toreceive it. The embryo lived first, they taught, with a vegetable life;after a few days an animal soul replaced the vegetative principle; thehuman soul was not infused into the tiny body till the fortieth day fora male, and the eightieth day for a female child. All this sounds veryfoolish now; and yet we should not sneer at their ignorance; had welived in their times, we could probably have done no better than they. 

It was not till 1620 that Fienus, a physician of Louvain, in Belgium, published the first book of modern times that came near the truth. Hemaintained that the human soul was created and infused into the embryothree days after conception. Nearly forty years later, in 1658, areligious priest, called Florentinius, wrote a book in which he taughtthat, for all we know, the soul may be intellectual or human from thefirst moment of conception; and the Pope's physician Zachias soon aftermaintained the thesis as a certainty that the human embryo has from thevery beginning a human soul. 

Great writers applauded Fienus and his successors; universities favoredtheir views; the Benedictines, the Dominicans, and the Jesuits supportedthem. Modern science claims to have proved beyond all doubt that thesame soul animates the man that animated the fœtus from the very momentof conception. The "Medical Jurisprudence" of Wharton and Stillé quotesDr.  Hodge of the Pennsylvania University as follows (p.  11): "In a mostmysterious manner brought into existence, how wonderful its formation!Imperfect in the first instance, nay, even invisible to the naked eye, the embryo is nevertheless endowed, at once, with the principles ofvitality; and although retained in the system of its mother, it has, ina strict sense, an independent existence. It immediately manifests allthe phenomena of _organic_ life; it forms its own fluids and circulatesthem; it is nourished and developed; and, very rapidly from being a_rudis indigestaque moles_, apparently an inorganic drop of fluid, itsorgans are generated and its form perfected. It daily gains strength andgrows; and, while still within the organ of its mother, manifests someof the phenomena of animal life, especially as regards mobility. Afterthe fourth month its motions are perceptible to the mother, and in ashort period can be perceived by other individuals on closeinvestigation. 

"The usual impression, " the authors add, "and one which is probablystill maintained by the mass of the community, is that the embryo isperfected at the period of quickening--say the one hundred and twelfthor one hundred and twentieth day. When the mother first perceivesmotion, is considered the period when the fœtus becomes animated--whenit receives its spiritual nature into union with its corporeal. 

"These and similar suppositions are, as has been already shown, contraryto all fact, and, if it were not for the high authorities--medical, legal, and theological--in opposition, we might add, to common-sense. "

At present, gentlemen, there seems to be no longer any authority to thecontrary. But many people, and some Doctors, seem to be severalgenerations behind the times; for they still act and reason as if in thefirst weeks of pregnancy no immortal or human soul were in question. 

Physicians worthy of their noble profession should strive to remove suchgross and mischievous ignorance. In many of the United States the lawcasts its protection around an unborn infant from its first stage ofascertainable existence; no matter whether "quickening" has taken placeor not, and consequently no matter what may be the stage of gestation, an indictment lies for its wilful destruction (Wharton and Stillé, p.  861). "Where there has been as yet no judicial settlement of theimmediate question, it may be reasonably contended that to make thecriminality of the offence depend upon the fact of quickening is asrepugnant to sound morals as it is to enlightened physiology" (ib. ). "That it is inconsistent with the analogies of the law is shown by thefact that an infant, born even at the extreme limit of gestation afterits father's death, is capable of taking by descent, and being appointedexecutor" (ib. ). Dr.  Hodge adds this sensible remark: "It is _then_ only[at conception] the father can in any way exert an influence over hisoffspring; it is _then_ only the female germ is in direct union with themother--the connection afterwards is indirect and imperfect" (ib. ). Thefact, therefore, is now scientifically established that the embryo fromthe first moment of conception or fecundation is a human being, having ahuman immortal soul. 

II. Now we come to the direct study of abortion. Abortion, ormiscarriage, strictly means the expulsion of the fœtus before it isviable, i. E. , before it is sufficiently developed to continue its lifeoutside of the maternal womb. The period of arrival at viability isusually after the twenty-eighth week of gestation. When birth occurslater than that period, and yet before the full term of nine months, itis called _premature birth_, which is altogether different fromabortion; for it may save the life of the child, which abortion alwaysdestroys. "Premature labor is frequently induced in legitimate medicalpractice, for the purpose of avoiding the risks which in some casesattend parturition at term.... The average number of children saved bythis means is rather more than one-half of the cases operated upon, " sayWharton and Stillé ("Parturition, " p.  96). But they caution thephysician against too ready recourse to this treatment; for, they addvery truly, "The sympathetic phenomena of pregnancy are often morealarming in appearance than in reality, and will rarely justify anyinterference with the natural progress of gestation. In all cases thephysician should consult with one or more of his colleagues beforeinducing premature labor; in this manner his humane intentions will notexpose him, in case of failure, to reproach, suspicion, or prosecution. "

The first time my attention was practically called to the case of achild in danger of dying before the time of delivery occurred overtwenty years ago, when the mother of a highly respected family, then inmy spiritual charge, was wasting away with consumption during her stateof pregnancy. You know that we Catholics are very solicitous thatinfants shall not die without Baptism, because we believe that heavenis not promised to the unbaptized. I therefore directed the lady'shusband to consult their family physician on the prospects of the case, and take timely precautions, so that, if death should come on the motherbefore her delivery, the infant might be reached at once and be baptizedbefore it expired. The physician, a learned and conscientiouspractitioner, answered that we should not be solicitous; for that Naturehad so provided that mothers in such cases rarely die before the childis born. He was right. The child was born and baptized; the mother dieda few hours later; the little one lived several weeks before it went tojoin the angels in heaven. I learned from that occurrence the lessonwhich Wharton and Stillé inculcate that "the phenomena of pregnancy areoften far more alarming in appearance than in reality, and we are rarelyjustified in interfering with the natural progress of gestation. "

To return to our subject. Abortion, or miscarriage, is often, as youknow, gentlemen, the result of natural causes beyond human control; atother times it is brought on by unintentional imprudence on the part ofthe mother or her attendants. It is the duty of the family physician, when occasions offer, to instruct his pregnant patients and otherpersons concerned on the dangers to be avoided. A good Doctor should beto his patients what a father is to his children; very important mattersare confided to him, and therefore grave responsibilities rest on hisconscience. 

III. We are now ready to consider the chief question of this lecture, namely, whether there can be any cases in which a physician is justifiedin bringing about an abortion, or in prescribing a treatment from whichhe knows an abortion is likely to result. 

1. It is evident that, if he acts with due prudence, and yet, from somecause which he did not foresee and could not have been foreseen, histreatment brings about a miscarriage, he cannot justly be heldaccountable for what he could not help. 

2. But what if he foresees that a drug or treatment, which, he thinks, is needed for the mother's health, may perhaps bring on a miscarriage?Can he still administer that drug or prescribe that treatment? Noticethe question carefully. It is not supposed that he wants to bring on themiscarriage. He does not; he will do all he can to prevent it. Nor willhis treatment or drug directly destroy the life or the organism of theembryo; but it is intended to affect favorably the system of the mother, and it is applied to her own organism. Still the Doctor knows that theprescription may indirectly bring about abortion. Can he prescribe thedrug or treatment from which he knows the death of the fœtus mayindirectly result, the direct purpose being to remove an ailment of themother's?

There is a sound moral principle bearing on such cases; it isuniversally admitted in Ethics and Jurisprudence, and its application isso extensive that it well deserves careful study. It is this: "He whowilfully puts a cause is answerable for the effect of that cause, "_causa causæ est causa causati_. Therefore, if the effect is evil, he isanswerable for that evil. This, however, supposes that he could foreseethe danger of such evil effect. 

That evil effect is said to be _indirectly_ willed; for it follows froma cause which is _directly_ willed. If, then, you should give a dose toa pregnant mother which is intended to stop her fever or other ailment, but may also bring on abortion, the stopping of her fever is directlyintended, and the abortion is said to be indirectly intended or willed. Those are the received terms in moral science. It were more correct tosay that the abortion in this case is an effect not intended at all, butonly _permitted_. That, then, which is permitted to result from ouracts is said to be indirectly willed. 

Are we then always responsible for evil effects permitted or indirectlywilled? The principle laid down seems to say so. But then that principleadmits of important exceptions. If we could never do an act from whichwe know evil consequences may follow, then we could scarcely do anythingof importance; a young man could certainly not become a physician atall, for he is almost certain to injure some of his patients in thecourse of his professional life. But if we had no Doctors, such a losswould be a much greater evil to mankind than their occasional mistakes. Here then we seem to be in a dilemma, with evil on both sides of us. Andthen we are reminded of that other principle of which we spoke before, that we may never do evil at all that good may come of it. What shall wedo? The solution is this: we should never _do_ evil, but we are oftenjustified in _permitting_ evil to happen; in other words, we can neverwill evil _directly_, but we can often will it _indirectly_: we can dowhat is right in itself, even though we know or fear that evil willalso result from our good act. 

This conduct requires four conditions: 1. That we do not wish the evilitself, but make all reasonable effort to avoid it. 2. That theimmediate effect we wish to produce is good in itself. 3. That the goodeffect intended is at least as important as the evil effect permitted. 4. That the evil is not made a means used to obtain the good effect. 

Now let us apply these principles to the case in hand. 

1. If the medicine is necessary to save the mother's life, and it is notcertain to bring on abortion, though it is likely to do so, then thegood effect is greater and more immediate or direct than the bad effect;then give the medicine to save the mother, and permit the probable deathof the child. 

2. If the medicine is not necessary to save the mother's life, thoughvery useful, for the sake of such an advantage, you cannot justly exposethe child's life to serious danger. 

3. But if the danger it is exposed to is not serious but slight, and theremedy, though not necessary, is expected to be very useful to themother, you may then administer the medicine; for a slight risk need notprevent a prudent man from striving to obtain very good results. 

4. But what if the drug is necessary to save the mother, and asdangerous to the child as it is beneficial to her; can you then give themedicine with the moral certainty that it will save her and kill herchild? When we know principles clearly we can apply them boldly. Ianswer then with this important distinction: you can give such medicineas will act on her system, her organs, in a manner to save her life, andyou may permit the sad effects which will indirectly affect the child;but you cannot injure the child directly as a means to benefit herindirectly; that would be using a bad means to obtain a good end. 

Suppose, then, what is said to be a real case of occasional recurrencein obstetrical practice, namely, that a pregnant mother is seized withviolent and unceasing attacks of vomiting, so that she must die if thevomiting be not stopped; and you, as well as the consulting physiciancalled in, can discover no means of relieving the vomiting except byprocuring an abortion, by relieving the womb of its living burden. Abortion is then the means used to stop the vomiting. Are you justifiedin using that means? Abortion is the dislodging of the child from theonly place where it can live and where nature has placed it for thatpurpose. Therefore abortion directly kills the child, as truly asplunging a man under water kills the man. Can you thus kill the child tosave the mother? You _cannot_. Neither in this case nor in any othercase can you do evil that good may come of it. 

You notice, gentlemen, that I lay great stress on, this principle that_the end can never justify the means_. It is an evident principle, whichall civilized nations acknowledge. Its opposite, that the end justifiesthe means, is so odious that the practice of it is a black stamp ofignominy on any man or any set of men that would be guilty of it. TheCatholic Church has, all through her course of existence, taught themaxim that the end cannot justify the means. She has impressed it on thelaws and hearts of all Christian peoples. She inculcates it in theteachings of all her theologians and moral philosophers and in all herchannels of education. And since we Jesuits are among her leadingeducators and writers, we have maintained that thesis in thousands ofprinted volumes, as firmly as I am maintaining it before you to-day. NoJesuit ever, nor any Catholic theologian or philosopher, has taught thecontrary. And yet even such pretentious works as the "EncyclopædiaBritannica" have carried all over the earth the slander that we teachthe opposite maxim, that the end does justify the means, and the odiousterm _Jesuitry_ has been coined to embody that slander. 

Is it not strange then, very strange, that they who thus falsely accuseus are often the very men who will procure an abortion to save themother's life, who will do wrong that good may come of it? And you findsuch men maintaining the lawfulness of abortion on the plea that theoperation, whether licit or not, is a necessary means to obtain a goodend. 

IV. Gentlemen, if once you grant that grave reasons would justifyabortion, there is no telling where you will stop in your career ofcrime. To-day, for instance, you are called to attend a mother, who, youthink, must die if you do not bring on a miscarriage. You are urged todo it by herself and her husband, and perhaps by other physicians. Thereare money considerations too, and the possible loss of practice. Willyou yield to the temptation? The next day you are visited by a mostrespectable lady; but she has been unfaithful to her marriage vow. Theconsequences of her fall are becoming evident. If her husband finds outher condition, he may wreak a terrible vengeance. Her situation issadder than that of the sick mother of the preceding day. You can easilyremove the proof of her guilt, we will suppose, and spare a world ofwoes. Will you withstand the temptation? The third day comes a younglady, a daughter of an excellent family; bright prospects lie beforeher; her parents' lives and happiness are wrapped up in that girl. Butin an evil hour she has been led astray. Now she is with child. Shebegs, she implores you to save her from ruin, and her parents fromdespair. If you do not help her, some other Doctor or a quack will doit; but you could do it so much better. If you should have yielded onthe two former occasions, if you have already stained your heart withinnocent blood, will you now refuse? Where are you going to draw theline?

The passions of men are insatiate, even in modern society; the more youyield to them, the stronger grows their craving. Let me illustrate mymeaning by a fact that happened a few years ago in Russia. It is just toour point. During a severe winter, a farmer, having his wife andchildren with him on a wagon, was driving through a wild forest. All wasstill as death except the howling of wolves in the distance. The howlingcame nearer and nearer. After a while a pack of hungry wolves was seenfollowing in the track of the wagon. The farmer drove on faster, butthey gained on him. It was a desperate race to keep out of their reach. At last they are just back of the wagon. What can be done? The nextmoment the wolves may jump on the uncovered vehicle. The children, horrified, crouch near their trembling mother. Suddenly the father, driven to despair, seizes one of the little children and flings it amongthe pack of wolves, hoping that by yielding them one he may save therest. The hungry beasts stop a few moments to fight over their prey. Butsoon they are in hot pursuit again, fiercer because they have tastedblood. A second child is thrown to them, and after a while a third and afourth. 

Human society, gentlemen, in this matter of sacrificing fœtal life is asinsatiable as a pack of hungry wolves. Woe to any one of you if hebegins to yield to its cravings; there is no telling where he will stop. In proof of my statement, let me read to you an extract from a lectureon Obstetrics, delivered by Doctor Hodge, of Philadelphia, to themedical students of the University of Pennsylvania: "We blush while werecord the fact, that, in this country, in our cities and towns, in thiscity where literature, science, morality, and Christianity are supposedto have so much influence; where all the domestic and social virtues arereported as being in full and delightful exercise; even hereindividuals, male and female, exist who are continually imbruing theirhands and consciences in the blood of unborn infants; yea, even medicalmen are to be found who, for some trifling pecuniary recompense, willpoison the fountains of life, or forcibly induce labor, to the certaindestruction of the fœtus and not infrequently of the parent. 

"So low, gentlemen, is the moral sense of the community on this subject, so ignorant are the greater number of individuals, that even mothers, inmany instances, shrink not from the commission of this crime, but willvoluntarily destroy their own progeny, in violation of every naturalsentiment and in opposition to the laws of God and man. Perhaps thereare few individuals in extensive practice who have not had frequentapplications made to them by the fathers and mothers of unborn infants(respectable and polite in their general appearance and manners) todestroy the fruit of illicit pleasure, under the vain hope of preservingtheir reputation by this unnatural and guilty sacrifice. 

"Married women, also, from the fear of labor, from indisposition to havethe care, the expense, or the trouble of children, or some other motiveequally trifling and degrading, have solicited that the embryo should bedestroyed by their medical attendant. And when such individuals areinformed of the nature of the transaction, there is an expression ofreal or pretended surprise that any one should deem that act improper, much more guilty; nay, in spite even of the solemn warnings of thephysician, they will resort to the debased and murderous charlatan, who, for a piece of silver, will annihilate the life of the fœtus, andendanger even that of its ignorant or guilty mother. 

"This low estimate of the importance of fœtal life is by no meansrestricted to the ignorant or to the lower classes of society. Educated, refined, and fashionable women, yea, in many instances, women whoselives are in other respects without reproach--mothers who are devotedwith an ardent and self-denying affection to the children who alreadyconstitute the family--are perfectly indifferent concerning the fœtus_in utero_. They seem not to realize that the being within them isindeed _animate_, that it is in verity a _human_ being, body and spirit;that it is of importance; that its value is inestimable, havingreference to this world and the next. Hence they in every way neglectits interests. They eat and drink, they walk and ride; they willpractise no self-restraint, but will indulge every caprice, everypassion, utterly regardless of the unseen, unloved embryo.... 

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

Dr.  Walter Channing, of Massachusetts, refers to the difficulty ofobtaining a conviction for abortion, and adds: "I believe there hasnever been one in this State, this moral State by eminence, and perhapsin none is this crime more rife. " ("Boston Med. And Surg. Journal, "April, 1859, p.  135). 

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

While these principles are clear and undoubted, there are cases in whichthe right application of them is beset with great difficulties. Theseoften occur in connection with what is called _ectopic_ or_extra-uterine gestation_, namely, when the nascent human form lodges insome recess not intended by nature for its abode. Of late years, Dr.  Velpeau, of Paris; Dr. Tait, of Birmingham, and many other eminentphysicians have shown that cases of ectopic gestation are more numerousthan had been supposed; one practitioner reports that he had attendedfifty cases, another eighty-five. 

1. We will first suppose the case of an interior growth occurring, thenature of which cannot be determined. It may be only a tumor, yet it maybe the growth of a living fœtus. If no immediate crisis is feared, youwill wait, of course, for further developments. If it proves to be achild, you will attempt no operation till it becomes viable at least. But suppose that fatal consequences are apprehended before the presenceof a human being can be ascertained by the beating of the heart; supposethat delay would endanger the mother's life; and yet if you undertake tocut out the tumor, you may find it to contain fœtal life. In such urgentdanger, can you lawfully perform the operation? Let us apply ourprinciples. You mean to operate on a tumor affecting one of the mother'sorgans. The consequences this may have for the child are not directlywilled, but permitted. The four conditions mentioned before are herebyverified, under which the evil result, the death of the possible fœtus, may be lawfully permitted; namely: (_a_) You do not wish its death;(_b_) What you intend directly, the operation on the mother's organism, is good in itself; (_c_) The good effect intended, her safety, to whichshe has an undoubted right, overbalances the evil effect, the possibledeath of the child, whose right to life is doubtful, since its veryexistence is doubtful; now, a certain right must take precedence of adoubtful right of the same species; (_d_) The evil is not made the meansto obtain the good effect (see "Am. Eccl. Rev. , " Nov. , 1893, p.  353). This last condition would not be verified if it were proposed, not tocut out the cyst, but to destroy its contents by an electric current. Then, it would seem, the fœtus itself, if there be one, would bedirectly attacked. 

2. The case would present greater difficulties if the growth in questionwere _known_ to contain a living fœtus. Such a case is discussed in allits details, with remarkable philosophical acumen, and in the light ofcopious information furnished by prominent members of the medicalprofession, in the pages of the "American Ecclesiastical Review" forNovember, 1893, pages 331-360. The participants in this interestingdiscussion are writers who enjoy a world-wide reputation for keenness ofintellect and soundness of doctrine in philosophical and theologicallearning. They are not at all agreed as to the practical conclusionarrived at, and even those who agree to the same conclusion do so fordifferent reasons. Three of them agree that in the case of a cyst knownto contain a living embryo, when a rupture most probably fatal to motherand child is imminent, the abdominal section might be performedlawfully, the cyst opened and the child baptized before its certaindeath. Two of these justify this conclusion on the principle that thedeath of the child is then permitted only or indirectly intended; onemaintains that the killing of the embryo is then directly procured, buthe considers that an embryo in a place not intended for it by nature iswhere it has no right to be, and therefore may be treated as an unjustaggressor upon the mother's life. At least one of the disputantscondemns the operation as absolutely unlawful. 

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

A Catholic physician has here a special advantage: for he has in casesof great difficulty the decisions of Roman tribunals, composed of mostlearned men, and renowned for the thoroughness of their investigationsand the prudence of their verdicts, to serve him as guides and vouchersfor his conduct. Although these tribunals claim no infallibility, yetthey offer all the advantages that we look for, with regard to civilmatters, in the decisions of our Supreme Court. These Roman courts haveuniformly decided against any operation tending directly to the death ofan innocent child ("Am. Eccl. Rev. , " Nov. , 1893, pp.  352, 353; Feb. , 1895, p.  171). 

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

LECTURE IV. 

VIEWS OF SCIENTISTS AND SCIOLISTS. 

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

Dr.  L. Charles Boislinière, to whom I refer, had by his scientificacquirements and his successful practice, during forty years of hislife, become, to a great extent, identified with the progress of thescience of obstetrics in this country; and a few months before his latedemise, he had published a useful work on "Obstetric Accidents, Emergencies, and Operations. "

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

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

"Hippocrates, Celsus, Avicenna, and the Arabian School invented a numberof vulnerating instruments to enter and crush the child's cranium. Withthe advance of the obstetric art, more conservative measures weregradually adopted, such as the forceps, version, induction of prematurelabor, and, finally, Cesarean section. 

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

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

"_Are we ever justified in killing an unborn child in order to save themother's life?_

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

"In answer to the question, I, at the outset, reply _No_, and claimthat, under no conditions or circumstances, is it ever allowable todestroy the life of the child in order to increase the mother's chancesof living. And the day may arrive when, by the law of the land, the actwill be considered criminal and punished as such. In support of thisopinion, and to illustrate this position, allow me to take a purelyethical and medico-legal view of the subject, and to relate to you aparallel case, as also the decision arrived at by the Lord Chief Justiceof England, Judge Coleridge, than whom there is not a greater juristliving. 

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

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

"On the eighteenth day, having been without food for seventeen days andwithout water for five days, the prisoners suggested that some oneshould be sacrificed to save the rest. Brookes dissented, and the boy, to whom they referred, was not consulted. On that day Dudley and Stevensspoke of their having families, and of their lives being more valuablethan that of the boy. The boy was lying in the bottom of the boat, quitehelpless, extremely weak and unable to make any resistance; nor did heassent to be killed to save the others. Dudley, with the assent ofStevens, went to the boy and, telling him that his time had come, put aknife into his throat and killed him. They fed upon his flesh for fourdays. On the fourth day the boat was picked up by a passing vessel, andthe sailors were rescued, still alive but in a state of extremeprostration. 

"The prisoners were carried to the port of Falmouth and committed fortrial, the charge being murder. Their excuse was that, if they had notkilled the boy and fed upon his flesh, there being no sail in sight, they would have died of starvation before being rescued. They said thatthere was no chance of saving their lives, except by killing some onefor the others to eat. The prisoners were committed for murder andsentenced to death, but appealed to the mercy of the court, pleadingignorance. It was found by the verdict that the boy was incapable ofresistance, and authorities were then quoted to prove that, in order tosave your own life, you have the right to take the life of an unjustaggressor in self-defence--a principle the truth of which is universallyadmitted. 

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

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

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

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

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

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

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

"Therefore, I repeat that the two cases are analogous; and if, asremarked by Justice Coleridge, murder was committed in the firstinstance, so is murder committed in the analogue. So, we see, theprincipal points of the opinion enunciated by the learned judge, and theprinciples therein laid down, can, with equal force, be applied to thenon-justification of craniotomy, by which the life of a defencelesschild is sacrificed to save the mother. 

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

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

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

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

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

"'_Dulce et decorum est pro patria mori_, ' says Horace. Such was heathenethics, and it is enough in a Christian country to teach that there isnot always an absolute and unqualified necessity to preserve one's life. 

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

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

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

"As a hopeful sign, it is to be noticed that a gradual change is takingplace in the opinions of the profession as to the propriety ofperforming craniotomy. Busey says: 'To state the issue plainly, theaverment must be made that no conscientious physician would deliberatelyand wilfully kill a fœtus, if he believed that the act was a violationof the commandment "Thou shalt not kill. "' It has been well said byBarnes, the ablest and most conservative defender of craniotomy, that'it is not simply a question for medicine to decide. Religion and thecivil law claim a preponderating voice. In the whole range of thepractice of medicine, there arises no situation of equal solemnity. '

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

"Parvin says that the improved Cesarean section has given in Germanyresults so satisfactory that, possibly, the day is at hand whencraniotomy upon the living fœtus will be very rarely performed, if doneat all. Kinkead, a high English authority, states: 'To reduce the bulkof the child, or to extract it afterward through a pelvis of two andone-half or less conjugate diameter, is an operation of extremedifficulty, lengthy, requiring a very great experience, as far as themother is concerned, requiring an amount of manual dexterity rarely tobe acquired outside of a large city. While, on the other hand, theCesarean section is an easy operation, capable of successful performanceby any surgeon of ordinary skill. '

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

"I could quote many other authorities, showing the change that is takingplace in the profession upon this important question. It is establishedby the consensus of professional opinion that craniotomy has beenfrequently performed in cases where delivery could have been safelyaccomplished by the forceps, turning, and even by the unaided power ofnature (Busey); and there is no case known to him where a woman, on whoma section had been successfully performed, has refused to submit to itsrepetition in subsequent pregnancies. In Belgium the Cesarean sectionhas been performed seven times on the same woman, and in Philadelphiathree times. Doctor Bretoneaux, of Tours, has performed it six times onthe same woman; and this woman his wife. 'The brutal epoch of craniotomyhas certainly passed. The legitimate aspiration and tendency of scienceis to eliminate craniotomy on the living and viable child from obstetricpractice. '--Barnes' words as quoted by Busey. Tyler Smith is in perfectaccordance with Barnes. Barnes again writes: 'For the Cesarean sectiontwo very powerful arguments may be advanced. First, that the child isnot sacrificed. Second, that the mother has a reasonable prospect ofbeing saved. '

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

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

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

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

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

"From the moment of conception the child is living. It grows, and whatgrows has life. '_Homo est qui homo futurus_, ' says an ancient and highauthority. 

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

"The killing of the defenceless fœtus is sometimes done in cases ofuncontrollable vomiting of pregnancy, in cases of tubal or abdominalgestation, and the killing of the fœtus is done by electricity, injections of morphine in the amniotic sac, the puncturing of that sac, etc. 

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

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

"Without wishing to load this paper with elaborate statistics, I shallfurnish the latest arrived at in the two operations of craniotomy andCesarean section. 

"In the combined reports of the clinics of Berlin, Halle, and Dresden, the maternal mortality in craniotomy was 5. 8 per cent--of course, onehundred per cent of the children lost. 

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

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

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

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

You notice, gentlemen, that the eminent physician whom I have beenquoting speaks with much indignation of the killing of the embryo, whenhe calls it a "massacre of the innocents. " By this odious term weusually denote the massacre of the babes at Bethlehem, ordered by theinfamous Herod to defend himself against the future aggression, as heimagined, of the new-born King of the Jews. A craniotomist would, nodoubt, feel insulted at being compared with Herod. And yet, if weexamine the matter closely, we shall find that the two massacres, Herod's and the craniotomist's, could only be defended by the same plea, that of necessity. "Necessity knows no law, " writes Dr.  Galloway, in hisdefence of craniotomy, to which I referred in a former lecture. "Thesame law, " he writes in the "Medical Record" for July 27, 1895, "whichlies at the basis of Jurisprudence in this respect justifies thesacrifice of the life of one person when actually necessary for thepreservation of the life of another, when the two are reduced to suchextremity that one or the other must die. This is the _necessitas nonhabet legem_. "

Did not Herod look on the matter just in that light? Expecting Christ tobe, not a spiritual, but a temporal ruler, as the Jewish nation supposedat the time, he looked upon it as a case of necessity to sacrifice thelives of the innocents for his own preservation. "Necessity knows nolaw" was his principle. True, many had to die on that occasion to saveone; but then he was a king. Anyhow, their death was necessary, and_necessitas non habet legem_; that settles it: Herod must not be blamed, on that principle. It is not even certain that, cruel as he was, hewould have confessed, with the modern obstetrician, "I would as lief, ifit were necessary, kill an unborn child as a rat. "

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

The principle "_Necessitas non habet legem_" has indeed a true andharmless meaning when properly understood; it means that no law isviolated when a man does what he is physically necessitated to do, andthat no law can compel him to do more than he can do. Thus a disabledsoldier cannot be compelled to march on with his regiment; necessitycompels him to remain behind. In this sense the principle quoted is atruism; hence its universal acceptance. Applying the same principle in awider sense, moralists agree that human law-givers do not, and inordinary circumstances cannot, impose obligations the fulfilment ofwhich requires extraordinary virtue. Even God Himself does not usuallyexact of men the performance of positive heroic acts. But no such pleacan be urged to justify acts which God forbids by the natural law. [1]When necessity is used as a synonym for a "very strong reason, " as itis in the plea of the craniotomist, then it is utterly false that verystrong reasons for doing an act cannot be set aside by a divine law tothe contrary; what is wrong in itself can never become right, eventhough the strongest arguments could be adduced in its favor. It wouldbe doing wrong that good may come of it, or making the end justify themeans. Such principles may be found in the code of tyrants andcriminals, but should not be looked for in the code of MedicalJurisprudence. 

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

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

The writer of this article asserts: "Procuring the death of the fœtus tosave the life of the mother is, I am sure, to be defended on ethicalgrounds. " And here is the way he attempts to defend it: "We may safelyassume, " he argues, "that the theory of evolution is the best workinghypothesis in every branch of natural science. We are learning throughHerbert Spencer and all late writers on ethics and politics, that thesame principle will best explain the facts" (p.  395). 

I do not deny that a certain school of scientists is trying to rewriteall history and all Ethics and Jurisprudence. But the writer strangelymisstates the case when he says that "all great writers on ethics andpolitics" agree with Mr.  Spencer. Besides a multitude of others, LordSalisbury for one, has clearly shown of late that the school of agnosticevolutionists is coming to grief; it has had its short day, and it isnow setting below the horizon of ignominy and subsequent oblivion. Thewriter of the article in question does not attempt to prove theevolution theory; therefore I need not stop to disprove it. But he makesthe following application of it to our subject--an application soshocking to humanity and so revolting to common sense that, if it islogical, it is by itself sufficient to refute the whole theory ofMr.  Spencer and his school. 

He argues that, if that theory be admitted, it must necessarily followthat, while the human embryo is from the first alive, it is not a humanbeing until it has developed and differentiated to such a point ascorresponds to that point at the birth of the race where the animalbecomes a man. "I am sure, " he adds, "I do not know when that occurredin the past, and I do not know at what point it occurs in theindividual.... In inquiring for that distinct feature whichdistinguishes the man from the animal, I find none but mentality. If wewait for distinct mentality to appear in the development of theindividual, it would be some time after birth. "

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

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

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

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

LECTURE V. 

VENEREAL EXCESSES. 

In the opening lecture of this course, I remarked to you, gentlemen, that the scope of Medical Jurisprudence is much wider than that ofMedical Law. It embraces many subjects of which human laws take nocognizance, and in particular such vicious actions as do not violate therights of others, but are injurious to those only who practise them. They undermine the health and shorten the lives of the guilty parties, and bring in their train diseases the most destructive and often themost incurable. It is the physician's beneficent task to lessen theweaknesses and sufferings of the body, and to prolong human life inwell-preserved vigor to a green old age. It is not the least importantpart of his valuable services to provide for the sound and vigorouspropagation of the human race to future generations. Of this propagationof our race, of the laws which govern it, and of the criminal abuses bywhich these laws are violated, I am to treat in this present lecture. Mysubject is "Venereal Excesses. "

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

The passion which prompts to sexual intercourse is altogether natural initself, and, as such, intended by the Creator to be indulged in at theright time and in the proper manner. It is the stimulus which He hasprovided for the propagation of the human race. If the stimulus isstrong at times, this too is a special effect of His wisdom; becausewithout a powerful prompting of this kind, most men would shirk theburden of married life, just as very many would not care to toil if theyhad no hunger and thirst and other bodily wants to satisfy. 

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

Besides, it is only in the married state that the children, which arethe fruit of such intercourse, can be properly educated. To generate arace of young barbarians is certainly not the purpose of the sexualrelations. Children must not be begotten unless they can be properlyraised, in a manner worthy of their noble destiny. Now, it is only inthe married state, in the family or domestic society, that they can bethus educated. They need the tender hand of a mother to supply theirmaterial wants; they need the manly care of a devoted father to providethe necessaries of life, his firm hand to break their wanton wills, andhis wise direction to set them well on the road to temporal and eternalhappiness. Therefore, no one has the right to beget or to bear childrenexcept in marital life. Now, the sexual passion is to be exercised onlyin connection with its proper object, the procreation of children andthe fostering of such mutual love between husband and wife as isconducive to domestic happiness. Therefore this passion is to be keptunder careful and rational constraint. This the law of moralityrequires; all nations have ever exacted that this passion shall besubject to established rules; no free-love has ever been tolerated wherethere was the least pretence to civilization, and I do not know that itwas ever permitted even among barbarians. 

Even the distant approach that Mormonism made towards free-love has beenabsolutely condemned and repressed by the common-sense of the Americanpeople, as incompatible with civilization. In fact, all historytestifies that the true civilization of any race or country rises orfalls with the restraints imposed on the passion of lust; no polygamousnation has ever been more than half-civilized. The greatness of Rome andGreece decayed when the laws of social purity declined; and in our ownday the immorality of what is called "the social evil" is the darkeststain on modern civilization. 

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

II. But how can a passion so ardent be properly restrained? Inparticular, what can a physician do to prevent the manifold injurieswhich, if not properly controlled, it will bring to his patients? Theseare practical questions directly to our purpose. 

The first requisite for all effective action is to have correctknowledge and strong convictions on a subject. No one will check apassion with firmness if he have a lingering doubt as to whether, afterall, he is strictly bound to restrain it. As a man's mind matures, atleast if his mind be upright and not distorted by the strain of a rulingpassion, he understands more and more thoroughly that his perfectionconsists and his highest interests lie in obeying at all times the lawof reason, in maintaining his specific dignity of a rational being, andnot allowing himself to be controlled by passion, the ruling power ofbrute animals. Besides, he becomes aware in various ways of the evilresults of immoral practices, and he sees many reasons to keep hispassions in check. But young people have neither such experience norsuch information, and they are not always wise enough to understand theimperative dictates of self-restraint. And yet it is often in earlyyears, while body and mind are in the period of development, that themost serious injury is done to the constitution and to the character bythe indulgence of carnal pleasures. Habits are then engendered whichbecome a real slavery; so that later in life when there arises a sinceredesire to stop such disgraceful practices, there is a feeling ofimpotence to resist temptations which by one's own fault have become asecond nature. 

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

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

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

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

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

III. No possible evil to any individual man or woman can result from thefirm control that one may acquire over the passion of lust. On thecontrary, if it should be controlled all through life, this would onlyadd to a man's strength of mind, firmness of will, soundness of body, and length of life. For in the school of morality, in which everyPhysician should be educated, the leading principle is: "Contraries arecured by contraries, " "_Contraria contrariis curantur_. " On thisprinciple, lust is most efficiently controlled by aiming, at least inyouth, at total abstinence from its indulgence. You know that, in theCatholic Church, priests and religious lead a single life, and pledgethemselves for life to practise the most perfect control of the sexualpassion. What do you think is the result of their total abstinence onthis point with regard to their length of days? As a rule their life ismuch longer, in normal circumstances, than that of the other learnedprofessions. Here are a few proofs. In France, during the twenty yearsfrom 1823 to 1843, 750 priests died in the diocese of Paris. Of theseonly 200 were under sixty years old; there were 554 between sixty andseventy years old, 448 over seventy, and 177 over eighty. Again, of 202Carmelite nuns who died in a large convent of Paris, Dr.  Descuret, theattending physician, states that 82 had lived over seventy years, 23over eighty years. Most Trappists and Carthusians die of scarcely anyother sickness than old age. All young people who aspire to the clericalor religious profession learn from their early years the holiness andthe loveliness of purity. Our Church effects this result by placingbefore their youthful imaginations the most perfect of patterns ofvirtue, the infant Saviour, the virgin Mother, the boy saints Aloysiusand Stanislaus, the maidens Agatha and Cecilia, and a whole phalanx ofChristian heroes and heroines. 

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

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

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

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

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

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

"It is a fact that the American family with more than one or twochildren is the exception. From the records of six generations offamilies in some New England towns, it was found that the familiescomprising the first generation had on an average between eight and tenchildren; the next three generations averaged about seven to eachfamily; the fifth generation less than three to each family. Thegeneration now on the stage is not doing so well as that. InMassachusetts the average family numbers less than three persons. In1885 the census of Massachusetts disclosed that 71. 28 per cent of thewomen of that State were childless. The census of 1885 in the State ofNew York shows that twenty-five per cent of the women of that State arechildless, fifty per cent average less than one child, and seventy-fiveper cent average only a trifle over one child. 

"Southern California has fully as dark a record as New England--that is, in the family where the man and wife are American-born. It goes withoutsaying that the medical profession in this country is composed to agreat extent of typical progressive Americans, and I ask you to makemental statistics of the children in the families of the physicians inSouthern California, and you will find very few of them containing morethan two. 

"Had the Rev. T.  R. Malthus lived in the United States to-day, he wouldnever have argued about the danger of over-population, as he did in hisinteresting volume on 'The Principles of Population. '"

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

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

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

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

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

"By constantly bearing in mind the danger of the present tendencies, hecan do much to change the current. Let us hope that we shall again seethe day when thoughtful motherhood shall be considered the highestfunction of womanhood, and to shirk this natural duty will be deemed adisgrace. "

Gentlemen, it would be easy to prove that this testimony of Dr.  Lindleyis not that of an exceptional witness, or a piece of special pleading;but it is the acknowledged conviction of the medical professiongenerally, confirmed by the last United States Census, and in fact notquestioned, to my knowledge, by any weighty authority. As early as 1857, Dr.  H.  B. Storer, an eminent physician of Boston, startled the communityby publishing two books on this subject, entitled: "Criminal Abortion. Why not?--A Book for Every Woman"; "Is it I?--A Book for Every Man. "Soon after, Rev. John Todd, a Protestant minister of Pittsfield, Massachusetts, published a work styled "Serpents in the Dove's Nest, "all which works and a multitude of others tell the same tale of woeregarding the increase of child-destroying crimes in New England, chiefly among the old stock peculiarly called Americans. Dr.  NathanAllen, of Lowell, Massachusetts, in his treatises, "Changes in the NewEngland Population" and "The New England Family, " gives overwhelmingtestimony. "Harper's Magazine" (quoted by the "Catholic World" forApril, 1869) remarks: "We are shocked at the destruction of human lifeon the banks of the Ganges, but here in the heart of Christendomfœticide and infanticide are extensively practised under the mostaggravating circumstances. " We Catholics are not personally interestedin this matter; but the good of our fellow-men and chiefly ourfellow-countrymen calls for the earnest exertion of us all to stop thisdreadful evil. All the works I have referred to exempt Catholics fromthe blame pronounced; the "Harper's Magazine" article referred toexpressly says: "It should be stated that believers in the RomanCatholic faith never resort to any such practices; the strictlyAmericans are almost alone guilty of such crimes. " This matter is fullyexplained in a recent work called "Catholic and Protestant CountriesCompared, " by Rev. Alfred Young, C. P. , ch. Xxxii. 

VII. Now, gentlemen, I am very much afraid that while physicians as abody abhor all such murders and openly condemn them, many do not showmuch repugnance to allow, and even sometimes to suggest, such onanisticintercourse among married people as shall prevent the possibility ofconception. For instance, if it happens that a young mother suffers muchin her first confinement, at once the suggestion is made that a secondparturition may prove fatal. From that moment regular intercourse isdreaded. Either onanism is habitually practised, or the husband becomesa frequent visitor to dens of infamy, where to where to save his wife'shealth, he encourages a traffic that leads multitudes of wretched girlsto a premature and miserable death. Every one despises those outcasts ofsociety; but are not the men who patronize them just as guilty? Probablyenough, if the imprudent suggestion about dangers of a secondchild-bearing had not been made by the Doctor, the young wife might havebecome the happy mother of a numerous family of healthy children. For wemust trust in Divine Providence. If a husband and wife do theirconscientious duty, there is a God that provides for them and theirfamily more liberally than for the birds of the air and the lilies ofthe field. And if He should so dispose that the worst should befall, well, such temporal clangers and sufferings as attend child-bearing arethe lot of woman-kind, just as the dangers and hardships of thebattlefield, the mine, the factory, the forest, and the prairie are thelot of the men. 

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

Certainly, the husband of a delicate woman ought to spare her strengthand restrain his passion, but not at the sacrifice of morality; andDoctors ought to be very careful not to cause false or exaggeratedalarms, and thus make themselves to some extent responsible for untoldmoral evils. They should remember that, as a rule, the raising of afamily is the principal purpose of a married life. The happiness andvirtue of the parties concerned depend chiefly on the faithfulperformance of this duty. How sad is the lot of those--and they aremany--who undertook in early years of married life to prescribe a narrowlimit to the number of their children; they had one or two, and theywould have no more, and for this purpose criminally thwarted thepurposes of nature. Then comes death and snatches away their solitaryconsolation: and they spend their old age childless and loveless, inmutual upbraidings and unavailing regrets. 

How different is the lot of those aged couples--and they were many ofyore, and are yet in various nations--who are like patriarchs amid theircrowds of children and grandchildren and great-grandchildren, dwellingin mutual love and as if in a moral paradise where all domestic virtuesbloom!

VIII. True, such families are usually the outcome of moderately earlymarriages; and many Doctors nowadays disapprove of such unions as anevil. A moral evil they certainly are not; and the physical evilssometimes attending them must, I think, be traceable to a variety ofcauses; for such evils are certainly not inseparable from earlymarriages. As to their moral advantages, Mr.  Wm. E.  H. Lecky, in his"History of European Morals, " writes of the Irish people in particular:"The nearly universal custom of early marriages among the Irishpeasantry has alone rendered possible that high standard of femalechastity, that intense and jealous sensitiveness respecting femalehonor, for which, among many failings and some vices, the Irish racehave long been pre-eminent in Europe" (v. I. P.  146). And that he doesnot confine his statement to female chastity is evident from what headds farther on: "There is no fact in Irish history more singular thanthe complete and, I believe, unparalleled absence among the Irishpriesthood of those moral scandals which in every Continental countryoccasionally prove the danger of vows of celibacy. The unsuspectedpurity of the Irish priesthood in this respect is the more remarkable, because, the government of the country being Protestant, there is nospecial inquisitorial legislation to insure it, because of the almostunbounded influence of the clergy over their parishioners, and alsobecause, if any just cause of suspicion existed, in the fiercesectarianism of Irish public opinion it would assuredly be magnified. Considerations of climate are quite inadequate to explain this fact; butthe chief cause is, I think, sufficiently obvious. The habit of marryingat the first development of the passions has produced among the Irishpeasantry, from whom the priests for the most part spring, an extremelystrong feeling of the iniquity of irregular sexual indulgence, whichretains its power even over those who are bound to perpetual celibacy"(p.  147). No one will say, I believe, that the custom of early marriagesin Ireland has any injurious effects on the health of either parents orchildren. Nor need it necessarily have such effects on those of ourAmerican young men and women who lead regular lives and are notenfeebled by unnatural vices or demoralized by dainty food and luxuriousmanners. 

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

LECTURE VI. 

THE PHYSICIAN'S PROFESSIONAL RIGHTS AND DUTIES. 

Gentlemen, so far I have explained the duties which the physician has incommon with all other men, and which arise directly from the natural lawindependently of any civil legislation. The natural law requires theDoctor to respect the life of the unborn child, thus forbiddingcraniotomy and abortion. It also obliges him to protect his patientsfrom the baneful effects of venereal excesses. Over these matters humanlaw has no control, except that it may and ought to punish such overtacts as violate the rights of individuals, or seriously endanger thepublic welfare. 

We shall now consider the physician's natural rights and duties inregard to matters which civil and criminal legislation justly undertaketo regulate. One of the chief functions of civil authority is to providefor the observance of contracts. Now, the physician in his professionalservices acts under a double contract, a contract with the state and acontract with his individual patients. By accepting his diploma of M. D. From the college faculty, and indirectly from the civil authority, hemakes at least an implicit contract with the state, by which he receivescertain rights conditioned on his performance of certain duties. Inoffering his services to the public, he also makes an implicit contractwith his patients by which he obliges himself to render them hisprofessional services with ordinary skill and diligence on condition ofreceiving from them the usual compensation. 

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

1. Protection against all improper interference with his professionalministrations. 

2. Protection for his professional career by the exclusion ofunauthorized practitioners. 

3. Immunity from responsibility for evil consequences that may resultwithout his fault from his medical or surgical treatment of patients. 

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

These rights are not granted him arbitrarily by the state; they arefounded in natural justice, but made definite and enforced by humanlegislation. Take, for an example, his right to receive duecompensation for his services. This right was not recognized by the oldRoman law in the case of advocates and physicians, nor by the common lawof England until the passing of the Medical Act in 1858. Surgeons andapothecaries could receive remuneration for their services, but notphysicians. These were presumed to attend their patients for an_honorarium_ or honorary, that is, a present given as a token of honor. 

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

As to the amount of compensation to which the Doctor is justly entitled, Ewell's "Medical Jurisprudence" remarks: "By the law of this country, all branches of the profession may recover at law a reasonablecompensation for their services, the amount of which, unless settled bylaw, is a question for the jury; in settling which the eminence of thepractitioner, the delicacy and difficulty of the operation or of thecase, as well as the time and care expended, are to be considered. Thereis no limitation by the common law as to the amount of such fees, provided the charges are reasonable. The existence of an epidemic doesnot, however, authorize the charge of an exorbitant fee. 

"A medical man can also recover for the services rendered by hisassistants or students, even though the assistant is unregistered; it isnot necessary that there should be any agreed specified price, but hewill be allowed what is usual or reasonable. 

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

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

We must, however, remember, on the other hand, that excessive fees arenothing else than theft; for theft consists in getting possession ofanother's property without just title. The following rules of Dr.  Ewellare sensible and fair:

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

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

In these rules Dr.  Ewell regards chiefly what conduct the courts ofjustice will sustain. It is evident that the Doctor is never entitled torun up his bill without any benefit to his patient; where there is noservice rendered at all, there can be no claim to compensation. Still itis not necessary that actual benefit has resulted to the patient; itsuffices for the claim to the fee that measures have been taken with aview to such benefit. Even when no physical advantage can reasonably behoped for from the visit, the consolation it affords the patient and hisfriends may render those who are to bear the expense fully willing thatit should be often repeated and, of course, charged on the bill. Provided care be taken that they understand the situation, no injusticeis done them. "_Scienti et consentienti non fit injuria_" is a goodmoral maxim. 

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

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

1. He must acquire and maintain sufficient knowledge of his professionfor all such cases as are likely to come in his way. No Doctor has theright to attempt the management of a case of which he has not at leastordinary knowledge. In matters of special difficulty, he is obliged touse special prudence or ask for special consultation. The courts justlyhold him responsible for any serious injury resulting from grossignorance; in such cases they will condemn him for malpractice. I wouldhere remark that, in an age in which the science of medicine is makingsuch rapid progress, every Doctor is in duty bound to keep up with theimprovements made in general practice, and in his own specialty if hehas one. 

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

3. A third duty of the physician is to use only safe means in medicaland surgical practice. He has no right to expose his patient to needlessdanger. What is to be thought of the use of such remedies as will eitherkill or cure? They cannot be used as long as safer remedies areavailable and capable of effecting a cure; for neither Doctor norpatient has a right to expose a human life to unnecessary risk. But whenno safer remedies are going to effect a cure, then prudence itselfdictates the employment of the only means to success. In such a case, however, the patient, or his parents or guardian, should, as a rule, beinformed of the impending danger, so that they may give or refuse theirconsent if they please. For, next to God, the right to that life belongsto them rather than to the physician. The same duty of consulting theirwishes exists when not life but the possible loss of a limb is at stake, or the bearing of uncommon sufferings. Moralists teach that a man is notobliged in conscience to submit to an extraordinarily painful orrevolting operation even to save his life. Certainly, when the naturallaw leaves him at liberty, the physician cannot compel him to submit tohis dictation; all he can do is to obtain his consent by moralpersuasion. 

4. As a consequence from the Doctor's duty to use only safe means itfollows that he cannot experiment on his patients by the use oftreatment of which he does not know the full power for good or evil. Noris he excused from responsibility in this matter by the fact that theexperiment thus made on one patient may be very useful to many others. His contract is with the one now under treatment, who is not willing, asa rule to be experimented upon for the benefit of others. And even ifthe patient should be willing, the Doctor cannot lawfully expose him togrievous danger unless it be the only hope of preserving his life. Thisfollows from the principle explained before, that human life belongschiefly to God and not to man exclusively. 

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

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

It is a debated question in Medical Jurisprudence whether the Doctor'sprofessional knowledge of criminal acts should be privileged before thecourts, so that he should not be forced to testify to a crime that hehas learned from his patients while acting as their medical adviser. Dr.  Ewell speaks thus on the subject (p.  2): "The medical witness shouldremember that, by the common law, a medical man has no privilege toavoid giving in evidence any statement made to him by a patient; butwhen called upon to do so in a court of justice, he is bound to discloseevery communication, however private and confidential, which has beenmade to him by a patient while attending him in a professionalcapacity. By statute, however, in some of the United States, communications made by a patient to a physician when necessary to thetreatment of a case are privileged; and the physician is eitherexpressly forbidden or not obliged to reveal them. Such statutes existin Arkansas, California, Indiana, Iowa, Ohio, Michigan, Minnesota, Missouri, Montana, New York, and Wisconsin. The seal upon thephysician's lips is not even taken away by the patient's death. Suchcommunications, however, must be of a lawful character and not againstmorality or public policy; hence, a consultation as to the means ofprocuring an abortion on another is not privileged, nor would be anysimilar conference held for the purpose of devising a crime or evadingits consequences. 

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

The practical rule for a Doctor's conscience on the subject of secrecyis, that he must keep his professional secrets with great fidelity, andnot reveal them except in as far as he is compelled to do so by a courtof justice acting within its legal power or competency. If so compelled, he can safely speak out; for his duty to his patient is understood to bedependent on his obedience to lawful authority. 

As to the question of Jurisprudence whether the courts _ought_ to treatthe physician's official secrets as privileged, in the same way as theydo a lawyer's secrets, this will depend on the further question whetherthe same reasons militate for the one as for the other. The lawyer'sprivilege is due to the anxiety of the state not to condemn an innocentman nor a guilty man beyond his deserts. To avert such evil, the accusedparty needs the assistance of a legal adviser who can guide him safelythrough the mazes and technicalities of the law, and, even should he beguilty, who can protect him against exaggerated charges and ward offunmerited degrees of punishment. Now, this can scarcely be accomplishedunless the attorney for the defence learn from his client the entiretruth of the facts. But the client could not safely give suchinformation to his lawyer if the latter's professional secrets were notheld sacred by the court of justice. 

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

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

1. _As a man_, he is a member of the human family, not a strangerdwelling amid an alien race, but a brother among brothers. He cannotsay, as did the first murderer, Cain, "Am I my brother's keeper?" Butrather he must carry out the behest of the great Father of the humanfamily: "God has given to each one care of his neighbor. "

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

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

(_b_) In this connection of regard for the poor, allow me also to callyour attention, gentlemen, to a point which students of medicine are aptto forget at times, and yet which both God and the world require youever to bear in mind: it is the respect which every man owes to themortal remains of a departed brother. I do not know that a people hasever been found, even among barbarians, who did not honor the bodies oftheir dead. For the good of humanity, dead bodies may at times besubjected to the dissecting-knife, but never to wanton indignities. Reason tells you to do by others as you wish to be done by, andRevelation adds its teaching about a future resurrection andglorification of that body of which the Apostle says that "it is sown indishonor, but it shall rise in glory. " Be men of science, but be nothuman ghouls. There is such a thing as retribution. But lately a formermillionaire died in a poorhouse and left his body as a cadaver formedical students. We cannot afford to ignore the mysterious ways ofDivine Justice. Ever handle human remains in a humane manner; and assoon as they have answered the purpose of science, see that they bedecently interred, if possible. 

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

(_a_) When your patients are in real danger of death, let them have agood chance to prepare properly for their all-important passage intoeternity. Give them fair warning of their situation. Doctors andrelations are often afraid of alarming the patients and thus injuringtheir health. But those who attend Catholic patients at least soon findout by experience that the graces and consolations of the LastSacraments usually bring a peace of mind that benefits even the bodilyhealth. In any case, the interests of the future life are too importantto be ignored. 

(_b_) For the same reason, the physician should not prescribe such dosesof morphine or other anæsthetics as will render the patient unconsciousat a time when he ought to be preparing to meet his Judge. This would benot kindness but cruelty. A little suffering more in this life may savemuch suffering in the next. If a Catholic priest, on being called to apatient's bedside, finds that the family's physician has been soinconsiderate, he cannot help protesting against employing such a man inCatholic families. 

(_c_) If you attend a woman in childbirth, you may be asked by aChristian mother not to let her child die without Baptism. The vastmajority of Christians believe that this sacrament is necessary toobtain supernatural happiness. The ceremony is easily performed: noharm can come of it, but immeasurable good for eternity. It shouldproperly be performed by the clergy. But if this cannot be done, anyman, woman, or child, even one not a Christian himself, can administerthe sacrament. Every Doctor in a Christian land should understand how todo it, and do it with unerring accuracy. It were a disgrace for him tobe ignorant of what even an ordinary child is expected to know. Theceremony is so simple; and yet, being an institution of Christ, no mancan modify it to suit his notions; if what is done is not just whatChrist appointed to be done, it will be of no avail. Notice, therefore, carefully every detail. You will take a little water, say a cupful, realwater--cold or lukewarm, that matters not--you will slowly pour it onthe head of the child, and, _while you do so_, you will say, "I baptizethee in the name of the Father, and of the Son, and of the Holy Ghost. "That is all. Notice, you must say the words while the water is beingpoured on the child. For "I baptize" means "I wash"; pour, therefore, orwash while you say, "I wash. " Should you hereafter wish to refresh yourmemories on this matter, you can do so by consulting the "CenturyDictionary, " which explains Baptism, and in particular Catholic Baptism, as "consisting essentially in the application of water to the personbaptized by one having the intention of conferring the sacrament, andwho pronounces at the same time the words, 'I baptize thee in the nameof the Father, and of the Son, and of the Holy Ghost. '" If a cup ofwater given to the thirsty brings a blessing, how much more the givingof the water of salvation! Should it happen that the child is in dangerof dying before delivery, it should be baptized in the womb provided itbe at all possible to cause the water to reach or wash its body, projected upon it by any instrument whatever; but the water should flowover the body, not merely over the cyst enclosing it, for the cyst is nopart of the child. Even if but an arm or other minor portion of the bodyis washed, the baptism is probably valid. If any doubt about the validadministration is left, the infant after delivery should be carefullybaptized _under condition_, as it is called; that is, with the conditionadded that, if the former ceremony was validly conferred, there is nointention of giving a second baptism. For that would not be right; sincethe sacrament cannot be validly received more than once; it is a sacredinitiation, but it were mockery to initiate one that is alreadyinitiated. 

Should a physician be present when a pregnant woman has recentlyexpired, and the child may still be living in the womb, it will be aneasy and important task to perform the Cesarean section as soon aspossible, and baptize the little one before it dies. In all this thereis no money, but what is far more precious, the securing of eternalhappiness. I add with great pleasure that many physicians are wont tocomply with all these instructions most carefully, and even to instructmidwives and nurses in the best manner of rendering such services. 

3. Lastly, we must consider the duties which a Doctor owes to others andto himself _as a gentleman_. It may not be easy to define what is meantby "a gentleman, " and yet to some extent we all know it; we recognize agentleman when we meet one, we pay him sincere homage in our hearts. Wereadily allow him to influence us and to guide us. We esteem himinstinctively as a superior being, as we distinguish a precious stonefrom a common pebble; so we value a gentleman for precious qualitiesexhibited in the beauty of his conduct. His conduct ever exhibits twocharacteristic marks: a proper degree of dignity or respect for self, and a proper degree of politeness or respect for others. Self-respectwill not allow him to do anything which is considered vulgar, unmannerly, gross, rude, or selfish; he will avoid the two extremes, ofself-neglect on the one hand and self-display on the other. His respectfor others will make him treat all around him so as to make them feelcomfortable in his presence; he will avoid whatever gives pain or causesembarrassment to even the lowest member of society. 

Gentlemanliness has much to do with every one's success in life, and inparticular with a Doctor's success. It is especially when sick that weare sensitive to everything displeasing in the conduct of others. It isnot then the bold thinker or the extensive reader that is the acceptablevisitor to the sick-room; but the gentlemanly consoler who always saysthe right thing at the right time, whose very eye expresses and whosecountenance reflects the thought and sentiment most appropriate on theoccasion. 

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

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

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

LECTURE VII. 

THE NATURE OF INSANITY. 

The subject of the present lecture, gentlemen, is "Insanity. "

I. This subject belongs to a course of Medical Jurisprudence, because aphysician who treats patients for insanity is liable, from time to time, to be cited before a court of law either as a witness or as an expert. His conduct in such cases is to be guided by the principles of naturaland legal justice. 

Various important cases at law turn upon the question of a person'ssoundness of mind; and frequently the medical expert has it in his powerto furnish the court with more reliable information in this matter thanany one else. At one time, the validity of a last will may be contested, and the possession of a fortune by one party or another may hinge on thequestion whether the testator at the time of making his will was insufficient possession of his mental powers to perform an act of so muchconsequence. 

At another time, interested parties may plead for or against thevalidity of a sale or other bargain made by a person of doubtfulcompetency of mind; or a life-insurance company may be interested inascertaining the mental condition of an applicant for membership; or itmay be questioned whether the payment of an insurance policy is due tothe family of a suicide, the doubt depending for solution on the soundor unsound condition of his mind at the moment of the fatal act. Again, there may be a real or pretended doubt whether a certain property-owneris so far demented as to be unfit to manage his estate; or whether heneeds a guardian to take care of his person; or it may even seemnecessary to confine him in a lunatic asylum. There may be objectionsraised to the mental soundness of a witness in a civil or a criminalsuit; or, finally, a criminal prosecution will depend mainly on thesanity or insanity of the culprit at the moment when the crime wascommitted; as was the case with a Prendergast and a Guiteau. 

You see, then, gentlemen, that important interests are dependent on thethorough and correct understanding of this matter; and therefore muchresponsibility rests upon the experts consulted in such cases: property, honor, liberty, nay, even life itself may be at stake. 

That cases involving an insane condition of mind must be of frequentoccurrence, both in the medical and in the legal professions, isapparent from the large and rapidly increasing amount of lunacy in ourmodern civilization. Wharton and Stillé's "Medical Jurisprudence" states(sec.  770, note) that in 1850 there was in Great Britain one lunatic toabout one thousand persons; only thirty years later the LunacyCommission of Great Britain reported one lunatic to 357 persons inEngland and Wales, that is, nearly three times as many. In New Yorkthere is one to 384 persons. It appears certain that its increase oflate is out of all proportion to the increase of population; and eventhough I see reasons to distrust somewhat the figures quoted forEngland, enough is known to create serious alarm regarding the fruits ofmodern manners and customs on the minds of thousands. This fact makesthe matter of insanity very important for the medical and the legalstudent. 

II. Still it must be noted that the responsibility of deciding cases oflunacy does not rest chiefly with the medical expert. In cases ofdoubtful insanity the decision is to be given not by the Doctor but bythe court of justice. Except on very special occasions, as when aphysician is appointed on a committee or commission of inquiry, heappears before a court either as an ordinary witness, stating whatfacts have fallen under his personal observation; or as an expert, explaining the received opinion of medical men with regard to cases of acertain class. Even though he feels convinced that the culprit or thepatient is as mad as a March hare, the physician cannot expect that hisstatement to that effect will be received as decisive. It is for thejudge to instruct the jury what kind or degree of insanity will excuse aculprit from legal punishment, or will disqualify a person fromtestifying as a witness, or from being a party to a civil contract incertain cases; and it is for the jury to decide whether, in the case inhand, the fact of such insanity exists or not. In criminal cases, thejury pronounces on the double question, whether the accused did the actcharged to him, and whether he has been juridically proved to have beenaccountable for the act under the laws as expounded by the judge. 

1. To come to a decision on this double question, the jury might need tohear the facts stated which the physician has personally observed, andof which he is summoned to be a sworn witness. In such a situation allthat is required of the Doctor is that he shall give a most faithfuland intelligent account of the facts. 

It would disgrace his standing in society if any fault could be foundwith his testimony; and, as a sworn witness, he is bound in conscience, like any other witness, to state the truth, the whole truth, and nothingbut the truth. This is always the case when the purpose of the inquiryis the discovery of the sane or insane condition of a person's mind. Butif the inquiry concerns the performance of the guilty act, thecommission of the crime, many States of the Union, as explained before, consider the Doctor's professional secrets as privileged, just likethose of the lawyer and the clergyman; i. E. , the Doctor must not useagainst his patient any knowledge he has become possessed of whileacting as his medical adviser. 

2. When the physician appears before a court or commission as an expert, he is expected to give the views of the medical profession uponhypothetical cases resembling the one under examination, and thescientific reasons and authorities on which those views are advanced. 

3. But here a considerable difficulty presents itself; it is so seriousthat, owing to it, the weight of the medical expert's testimony withjudge and jury is often much less than could reasonably be desired. Thedifficulty is to ascertain what really are the views of the medicalprofession on any given subject. Of course no individual Doctors canput themselves up as representing the convictions of the medicalprofession, nor can they always appeal to the unanimous agreement oftheir leading men. Leading physicians, unfortunately, are far fromentertaining concordant views on many most vital questions. It is thiswant of agreement that has made the testimony of experts so powerless tosway the minds of judge and jury. 

The medical profession has no organization through which it canpronounce judgment. In fact, many of its most conspicuous members haveadopted principles at variance with the deepest convictions of mankindgenerally; such, for instance, are the followers of Darwin, Huxley, Maudsley, and similar agnostic and materialistic leaders of modernthought. 

4. What still further diminishes the credit of medical experts is thefact that, both in civil and criminal trials, they are summoned eitherby the defence or by the prosecution, and are thus naturally selected, not on account of their thorough knowledge, but on account of theirpeculiar views known beforehand to the parties citing them. Thus theirtestimony is likely to be partial to either side, and is distrusted; atleast it fails to command perfect confidence. The only way in which theprejudices thus created against the physician can be overcome is by hisacquiring thorough knowledge of his specialty, and showing himself onall occasions to be as honorable and faithful as he is evidentlyexperienced and intelligent. 

5. The medical profession could be brought to be much more useful tosociety for the discovery of insanity if we could have here somethinglike what exists in some parts of Germany. "The practice obtains thereof requiring the medical faculty of each judicial district to appoint aspecial committee, to which questions of this kind are referred. Thiscommittee is examined directly by the court, and gives testimonysomewhat in the same way, and with the same effect, as would acommon-law court when reporting its judgment in a feigned issue fromchancery, or as would assessors called upon under the canon law tostate, in proceedings under the law, what is the secular law of the landon the pending question" (Wharton and Stillé, sec.  274). 

The matter of introducing some such practice into this country has beenagitated of late, and may by and by lead to beneficial results. Dr.  Shrady has taken steps to promote this object by striving to have alaw enacted by the New York legislature providing for the regulation ofexpert medical testimony in jury trials. According to his plan, oncesuch a commission has been established, the court is to send themedical issue to these experts, just as it sends other issues to specialjuries to be decided. The regular petit jury will then decide only uponthe facts constituting the crime. 

This would do away with special pleas of insanity before a jury thatknows little or nothing about the nature of the disease, and whosesympathies may readily be worked upon by shrewd lawyers to render averdict of acquittal. 

As things are now, the medical expert, summoned to testify in a case ofcontested sanity or insanity of mind, ought to rise above minorconsiderations, and promote the cause of justice, by giving all thevaluable information that his profession enables him to acquire on thevery difficult subject of mental unsoundness. 

6. For this purpose, he must be skilled in three departments of science. 

(_a_) In _law_--sufficiently to understand what are considered by thecourts as characteristic marks of an insane mind, and what amount ofsanity the courts require to hold a culprit responsible for his crime ora contract valid in its effects. 

(_b_) In _psychology_--to such an extent that the expert witness canspeak analytically and correctly as to the properties and actions of thehuman mind. 

(_c_) In _medicine_--so far as concerns the treatment of the insane, andthe understanding of their peculiarities, so as to reason from them byinduction to the real condition of the client's or patient's mind. 

But the main requisite for an expert witness is to understand clearly inwhat insanity properly consists, and how far it ought to excuse aninsane man from bearing the consequences of his acts. 

III. This two-fold knowledge is obtained by the psychological study ofinsanity, on which study we are now to enter, and it is the principalpoint in this whole matter. 

Insanity means a want of soundness; he is insane whose mind is notsound, but is deranged, and therefore, like a machine out of order, itcannot properly perform its specific task, namely, to know the truth ofthings. An insane man cannot judge rightly. 

1. Insanity takes various forms, which may be reduced to two kinds, withthe doubtful addition of a third kind, namely, moral insanity, of whichwe shall speak in our next lecture. 

The first kind consists in the total want or gross torpor of mentalactivity. When there is a total, or nearly total, eclipse of theintellect, the disease is called _idiocy_, the state of an idiot. Whenthere is an abnormally low grade of the reasoning power, it is styled_imbecility_. The failure or decay of reason in old age is called_dotage_. 

The second kind of insanity is called _illusional_ or _delusional_. Init the intellect is not impotent; on the contrary, it is often unusuallyactive; but its action is abnormal, its conclusions are false. Not thatit reasons illogically or draws conclusions which are not contained inthe premises. Very keen logicians may be demented. Their unsoundnessarises from the fact that they reason from false premises; and they gettheir false premises from their diseased imaginations, whose vagariesthey take for realities. 

2. Here a difficulty presents itself, which we must explain at once, namely, how can there be unsoundness of mind at all? Is not theintellect of man a simple power, and his soul a simple being? How can asimple being become deranged? Can that which has no parts becomedisarranged, disorganized? I answer, the soul is a simple being, itsintellect is a spiritual faculty; and therefore we never say that the_soul_ is insane, nor should we say that the _intellect_ is insane ordiseased; but we say that the _mind_ is deranged or insane; the mindcomprises more than the intellect; it designates the intellect togetherwith those lower powers that supply the materials for our thought, thechief of which is the imagination. Now the imagination is an organicfaculty: it works in and by a bodily organism, which is the brain. Therefore, when the brain is not in a normal condition, the action ofthe imagination may be disordered. And the intellect or understanding ofthe spiritual soul is so closely united in its action and its very beingwith the organic body that the two ever act conjointly, like the twowheels of a vehicle. If one wheel breaks down, the other is thrown outof gear. Thus it is readily understood that mental unsoundness is anaffection of the brain, a bodily disease, which may often be relievedand even cured by bodily remedies, by the use of drugs or wholesomefood, healthy exercise, fresh air, and all that benefits the nervoussystem. 

Pathologically considered, the nerves may be too excited or too sluggishand torpid; and we have as the result two subdivisions of mentalinsanity--_mania_ and _melancholia_. The differences between these twoare very striking; as they proceed from opposite causes they produceopposite effects, and, therefore, they betray themselves by verydifferent manifestations; but in one point the two agree, and with thispoint precisely we are concerned, because in it lies the essence ofmental insanity, namely, that both produce a disordered action of theimagination. 

3. The manner in which the imagination co-operates in mental action isthis. It presents to the intellect the materials from which that powerforms its ideas. When we see, feel, hear, taste, or smell anything byour bodily senses, our imagination takes note of the object perceived byforming a brain-picture of it which is called a _phantasm_. I do notmean to say that it forms a photographic picture of the object; forthere can be no photographing taste or smell or feeling; but it forms animage of some kind which it presents to the intellect. This power atonce proceeds to form, not a brain-picture, but an intellectual orabstract image of the object presented. For instance, you see this book, and at once you, in some mysterious way which has never yet beenexplained, impress some image of it on your brain. That you do so isclear from the fact that the image remains when the book is withdrawn. That material image or brain-picture is the _phantasm_. It is not an_idea_, though it is often improperly so called. But your intellectforms to itself an idea of a book; that is, you know what is meant by abook. You distinguish between the mere form of a book and the bookitself. Your idea of a book is a universal idea, which stands for anybook, no matter of what shape or size. Every phantasm, or brain-picture, is a representation which presents its object as having a definite shapeor size, while your idea of a book ignores any shape or size. And yet, when your intellect conceives a book, your imagination will picture someparticular form of book. If your brain became so affected by disease asto be unfit for the formation and retention of the proper phantasms, then your intellect either would not work at all or it would workabnormally; your mind would then be insane. 

4. Now, in an infant the brain is still too soft and imperfect to formthe proper phantasms from which the intellect is to elaborate its ideas. A false school of psychology would say that the infant's brain cannotyet _ideate_; but that is incorrect language. No brain can ideate orform ideas; an idea is an intellectual or mind image, not a brain image;it is an abstract and universal image, and matter cannot represent butwhat is concrete and individual. Only a simple and spiritual being, therational soul, can form ideas. Nevertheless our soul, in its presentstate of substantial union with our body, is extrinsically dependent onthe body; to form ideas it needs to have the sensible object presentedto it by a phantasm or brain-picture. Now, a child born blind and deaf, and thus having its mind, as it were, cut off from communication withthe outer world, could scarcely form the necessary phantasms, becausethe clogged senses could not supply proper materials for them; such achild would, therefore, be apt to remain idiotic. And even in childrenwhose outer senses are sound the brain or the nervous system may be tooimperfect to allow of its forming proper phantasms. In this torpor ofthe mind then consists the first kind of mental unsoundness, that of_idiocy_, or its milder form _imbecility_. In old age, and in peculiardiseases, the worn-out system may return to a second childhood, thencalled _dementia_ or _dotage_. The existence of such species of insanityis not difficult to discover. 

5. The second and more common form of insanity, and that which it isoften difficult to discover and pronounce upon with certainty, is thatwhich I have called _delusional_ or _illusional_. Its characteristictrait, its very essence, lies in this, that the insane man mistakes whathe imagines for what is real; and he cannot be made to distinguishbetween imagination and reality, though the difference is obvious to anintellect in its normal state. 

In this connection, it is well to point out a distinction, not alwaysobserved, but useful to explain the workings of an insane mind, between_illusions_, _hallucinations_, and _delusions_. 

(_a_) An _illusion_ is properly a deception arising from a mistake insense-perception; as when a half-drunken man sees two posts where thereis only one. He has a picture of the post in each eye, and his brain istoo much disturbed to refer the two pictures to the same object. In thiscase the cause of the mistake is subjective. A _mirage_ offers anotherinstance of a sense-illusion; but in it the cause is objective. 

(_b_) A _hallucination_ is a creation of the fancy mistaken for areality. The deception may be but momentary, as when Macbeth is stealingon tiptoe to the chamber of his guest to murder him. His mind isdisturbed by the imagination of the horrid deed he is about toperpetrate. He thinks he sees a dagger in the air, and he says: "Is thisa dagger that I see before me, its handle towards my hand? Come, let meclutch thee. I hold thee not, and yet I see thee still; and on thydudgeon gouts of blood, which was not so before. " But Macbeth, upon amoment's reflection, sees it is all imagination. "There's no suchthing, " he exclaims. He is not insane, though deceived for a while. 

(_c_) A _delusion_, on the contrary, is a permanent deception, whetherit results from an illusion or a hallucination, it matters not; as afact, it almost always originates in hallucinations. The deluded manclings to his imaginings; you cannot talk them out of his head. Such isthe case of an inebriate who suffers from _mania a potu_, or "thehorrors;" he sees snakes and demons, he thinks, and persists in hiserror. Such also is a fixed idea not arrived at by faulty reasoning, butcome unbidden and proof against all reasoning and evidence. Thus aninsane man may be convinced, solely by his imagination, that he ispoisoned or pursued or conspired against. 

6. This delusion constitutes the essence of mental insanity, whichtherefore is often called delusional insanity. It may be chronic, i. E. , of long continuance, or it may be temporary, acute. For the time being, the effects are the same. Perhaps any man may, at times, be for a momentthrown off his guard, and mistake a fancy for a reality; this does notconstitute lunacy. But when the error is so firmly held in the mind'sgrasp that nothing can dislodge it thence, then the mind is deranged inits special sphere of action, which consists in knowing the real fromthe unreal; the mind is then insane. 

You notice, gentlemen, that I speak of the mind as grasping the error, and I suppose it to do so independently of the free will's command. Butwhen the error is voluntary; when a man clings to it simply because heloves it; when he hugs a delusion to his heart, this shows not mentalbut moral obliquity; it is not insanity but self-deception, and it is byno means of rare occurrence. In a well-reasoned article on "TheMetaphysics of Insanity, " written by Mr.  James M. Wilcox and printed inthe "American Catholic Quarterly Review" for January, 1878, some verysevere and no less true strictures are made upon the readiness of a vastmultitude of people to practise this wilful self-deception. "Self, " hewrites (p.  54), "is the prolific origin of such errors; and so indulgentare we to its faults that we try secretly to hide them even from our owneyes, mostly with success; and where success is not perfect, we make asecond effort to hide the imperfection. Repeated efforts of this kind, from which we but half turn away, are crowned in the end, and we soonforget what successful hypocrites we have been. Our numerous passions, the complexities of our desires, the tenacity of their grasp, and thepleasant gentleness of its touch explain an infinity of temptationsfollowed by wilful successes in blindness, all of which are nothing lessthan guilty acts of self-deception. "

7. It oftens happens in real insanity that mental derangement manifestsitself upon one error or one group of errors only, while for all therest the patient appears to be quite rational. Such a man is called a_monomaniac_. But he is truly an insane man; for the essence of insanityis in him. It is usually found that a monomaniac will, sooner or later, exhibit signs of mental unsoundness on other matters as well; and evenwhile he has given no such signs, it still remains true that a mindcannot be trusted, but has something radically unsound about it, if itis really unhinged at any point at all. 

But then you must be very careful not to confound monomania witheccentricity. The distinction is as important as it is real. _Eccentricity_ is a conscious aberration from the common course of life;it consists in peculiarities in reasoning, words, and actions, which arewilfully indulged, in defiance of popular sentiment. The eccentric manknows that he is eccentric; he is willing to be so, and to take theconsequences; but he is not insane. 

As this matter is of frequent occurrence before the courts of justice, and the validity of last wills in particular often depends on the viewthat judges and expert witnesses take of it, I think it well to referthe earnest student for further information to Wharton's and Stillé's"Medical Jurisprudence, " in the volume on "Mental Unsoundness andPsychological Law;" in particular to secs.  29, 38, 39, 40. 

8. We must now return to the consideration of the manner in which thedisturbance of the brain may affect the mind. The brain is a storehouseof records of things formerly noted there by the imagination, either asthe results of sense perception or of arbitrary combinations ofphantasms; it is a library of facts and fancies. And these are notsingle, but grouped together, so that when one is stirred it will arouseothers as well. When the brain is affected, whether by an acute or achronic derangement, its images may become so disordered that records ofmere imaginations get mixed up with records of real perceptions ininextricable confusion. You may have had occasion to notice the processin the case of a man who is becoming intoxicated and then passes on to_mania_ or _delirium tremens_: he gradually proceeds to mix upbrain-pictures with realities, and after a while he speaks and acts likea very crazy man. He is in a kind of dream; his imaginations are wildand disconnected, his language is incoherent. 

The delirium arising from violent fevers, for instance from typhoidfever, is very similar to that arising from the excessive use ofintoxicants and narcotics; similar in these respects; that the mania isonly temporary, and that the exciting cause is not altogether unknown. 

The _bacilli_ of the infection, like the alcohol, the opium, themorphine, or other drugs, are accountable for the disordered action ofthe brain. But I do not pretend to know, nor do medical writersgenerally pretend to understand, _how_ the poison, or whatever causesthe disease, gets to affect the brain. Does it do so directly, or bymeans of the alteration it causes in the whole nervous system or in theblood? We do not know; nor does it matter for the purposes of MedicalJurisprudence. 

IV. The questions with which the courts of justice, the lawyers, and theexpert witnesses are concerned are these: Is the man really insane? Orwas he insane at a given time when he performed a certain civil orcriminal act? Is he now, or was he then, so far controlled by his mentalunsoundness as to be incapable of acting like a rational beingaccountable for his actions? Even if he is now, or was then, amonomaniac, can the deed in question be traceable to his monomania as toits real cause?

1. When we know that a man is suffering from a fever, or has beendrinking to excess, or has been addicted to the use of morphine, opium, cocaine or to similar deplorable practices, it is then easy enough toconclude from this that he is not in his right senses; knowing thecause, we can fairly estimate the effect. But in many cases ofdelusional insanity the cause is hidden; neither pulse nor other medicaltest betrays it. Whether the mind is sane or not is then to be found outfrom the man's words and actions; and these may be affected for apurpose: he may play the fool to escape punishment. 

2. Phrenologists have pretended that the peculiarities of a person'smind could be known by the conformation of his brain, and even by theelevations and depressions of the skull. But brain and skull do notalways correspond with sufficient closeness; and besides, Sir WilliamHamilton has shown conclusively, I believe, that phrenology is quackery;its principles are not scientific and its observations not reliable. Hepoints out, among other errors, that while women as a class are morereligiously inclined than men, what phrenologists call the bump ofreverence, an important element in religious sentiment, is generallymore developed in men than in women, and is often most conspicuous inreckless criminals. 

Nor is it at all certain that a lunatic's brain, if it could be examinedwith a microscope while he is alive, would exhibit the marks of anydisorder to the eye of the observer. It is stated by Dr.  Storer thatthe results show that "insanity may exist without structural changes ofthe brain, and that structural changes in the brain may exist withoutinsanity. " Dr.  Bell, of the Somerville Asylum, says that "the autopsiesof the insane generally present no lesion of the brain. " Dr.  Bucknilmaintains that "the brains of the insane appear to be certainly not moreliable than those of others to various incidental affections. " Nor hasthe microscope discovered in the demented any exudation or addition tothe stroma of the brain, or any change in size, shape, or proportionalnumber of its cells. Dr.  Storer concludes: "It is thus seen not merelythat there is no direct correspondence between the exterior of the skulland mental integrity, any more than between the exterior of the skulland the shape and consistence of its contents" (Wharton and Stillé, "Mental Unsoundness, " sec.  323). In the cases of insanity among women, the causes are largely to be found in derangement of their productiveorgans, and are to be met by special local treatment (ib. ). 

It does happen, however, at times, that the brain itself is diseased, _idiopathically_ diseased, as it is technically called; but at othertimes it is merely affected by _sympathy_ with some other organ that isphysically deranged. A physical cause there is for all mental insanity, and that physical cause determines its kind of mania or melancholia, itsduration, its chances of a perfect cure. But what that cause is in agiven case is often very hard if not impossible to determine. Besidesnatural and inherited predispositions--some taint of derangement in thefamily, often betrayed by fits of epilepsy, hysterics, etc. --excitingcauses are usually traceable. Every form of disease may bring onsympathetic affection of the brain when the circumstances for suchaffection are favorable. 

But while affirming that the disease usually arises in the body, andeven frequently in parts far removed from the brain, we must not denynor ignore the fact that intellectual and protracted worry, or suddenand violent grief, can also be the direct cause of disturbance in thebrain. For the brain is the organ not of the imagination alone, which isput to an unhealthy strain by excessive mental labor, but probably alsoof the passions, whose emotions when excessive may cause even permanentlesion. Hence mental insanity may and does often arise from ill-subduedpassions. 

The knowledge of all this may enable the physician to remove theexciting cause or to mitigate its influence; it may also aid expertwitnesses, judges, lawyers, and jurymen to ascertain the main fact withwhich the courts are concerned, namely, the presence or absence ofmental insanity at the time of a given civil or criminal action. 

V. Supposing then that, in the case before the court, the fact ofinsanity is established, the next question of Jurisprudence to determineis this: How far and why ought such unsoundness of mind to excluderesponsibility for deliberate acts?

It is a clear principle of reason that no man can justly be blamed orpunished for doing what he cannot help doing; now an insane man cannothelp judging wrong at times; he cannot then justly be blamed for actingon his mistaken judgments. If he invincibly judges an act to be morallygood whereas it is morally bad, no matter how criminal the act maybe--say the killing of his own father or child--if he commits the deedwith the full conviction that he is doing right, he cannot be blamed orpunished for committing that awful crime. 

The principle then is clear that an insane man is not to be heldresponsible to God or man for his insane acts. For the root and reasonof our responsibility for an act lies in the fact that we do the deed ofour own free choice; knowing its moral nature, being masters of our ownfree will, so that, if we do one act in preference to another, wewilfully take upon ourselves the consequences of this preference as faras we can know or suspect them. 

If we do what we are firmly convinced is right, just, worthy of a man, we deserve praise; if we do what we are convinced or suspect is wrong, unjust, unworthy of a man, we deserve blame and punishment. But aninsane man may do the most unjust act, and yet feel invincibly convincedthat it is just; he cannot then be held responsible for doing it, because the root of responsibility is then wanting. 

I do not, however, maintain that one who is insane on any one point isthereby made irresponsible for all his actions. If he does what hethinks to be wrong, he acts against the dictates of his conscience, hedeserves punishment from God; and if he violates a just law of the land, and it can be proved that his deed proceeded from a bad will, he may bepunished by the civil courts as well, even though he is insane on otherpoints. For instance, if a young man were to have a crazy notion thathis father disliked him, that he is often in various ways unjust to him, and if, in consequence of this insane conviction, he were to attempt hisfather's life, he should be punished for the criminal act; because, evenaccording to the way he views the matter, he could not be justified inkilling his father for such a reason. It were different if he insanelyimagined that his father was in the act of killing him, and that hecould not escape death but by killing his father first; for then hecould plead the right of self-defence against an unjust aggressor, as hefoolishly imagines his father to be. 

The conclusion then from all this explanation is that an insane manshould not be held responsible for a deed which he insanely thinks to beright; but he is responsible for all his other acts. 

In our next lecture we shall consider more fully the treatment of theinsane by the civil and criminal tribunals. 

LECTURE VIII. 

THE LEGAL ASPECTS OF INSANITY. 

In our last lecture, gentlemen, we considered the nature and causes ofdelusional insanity. We saw that its essence lies in mistakingimaginations for realities with a firmness of conviction which noargument to the contrary can shake. The reasoning of the insane man maybe logically faultless, we said, but he reasons from false premisessupplied to him by the phantasms of a diseased imagination. The cause ofthe disease I showed to lie in an abnormal action of the brain, which isthe storehouse of the phantasms or brain-pictures. And this abnormalaction may itself proceed either from a local lesion of the brain, orfrom a sympathetic affection due to indisposition in other parts of thehuman body. I finished by examining the responsibility of an insane manfor his actions, and arrived at this practical conclusion, that a victimof delusional insanity should not be held responsible for any acts whichhe insanely thinks right, but should be held responsible for all hisother human acts. 

I. This teaching of psychological and ethical science is to-day thereceived rule of action followed by the courts of justice in England andthe United States. Sound philosophy and positive law are in perfectagreement on this subject. But it was not so a hundred years ago. It iswonderful to us now how strange and erroneous were the views of insanityformerly entertained by English jurists. For instance, when, in 1723, Arnold was tried for shooting at Lord Onslow, the instruction given tothe court was that, for one to be exempt from punishment in such a case, "it must be a man that is totally deprived of his understanding and doesnot know what he is doing, no more than an infant, than a brute or awild beast. " On such a theory, very few lunatics indeed would beacquitted; few ever are so totally demented. 

The first jurist that pointed out the true test of insanity was LordErskine, who, in 1800, when Hudfield was tried for shooting at the king, delivered a celebrated speech, in which he maintained that the real testof insanity was in delusion: if delusion existed the man was insane;else, he was not insane. The deluded man, he said, might reason withadmirable logic from his false principles; he was nevertheless dementedif he mistook his imaginations for realities, and did so irresistiblyand persistently. 

Erskine's test has been, from that time on, followed in the courts ofEngland. But you will notice, on careful consideration, gentlemen, thatwhile the principle is correct so far as it goes, it does not go farenough to cover all cases of disputed responsibility. It will apply, indeed, to all cases of total insanity, that is, when the delusionexisting in a lunatic's mind affects a variety of subjects; then hispremises are never reliable, and therefore he cannot be held accountablefor any of his acts. 

But what if his insanity is partial only, if he is a monomaniac, deranged on one point and sound in mind on all other matters? This wasnot clearly understood till about the middle of the present century. Inorder to secure uniform views and action on this important matter, theBritish Parliament, in 1843, proposed various questions to the judges, with a request that they would agree upon and report answers. Thisinvestigation, and in fact the whole history of English legislation oninsanity, is briefly and yet clearly explained in an article of Rev. Walter Hill, S. J. , which appeared in the "American Catholic QuarterlyReview" for January, 1880. The first question was: What was the lawrespecting the crime of one who is partially deluded but not insane inother respects, when he commits what he knows to be a crime in order toredress some wrong or obtain some public benefit? The answer was thatsuch a one, even though insane, is to be punished for the crime which heknew he was committing. 

To another of those questions the judges answered, that a personpartially insane was to be treated _as if the facts were just what heimagined them to be_, as if his delusions were realities. His conductwas to be judged by his own premises. This was accepted as law byEngland, and is the law now both there and here, and, I suppose, throughout the civilized world. Now, these are exactly the conclusionsabout an insane man's responsibility which we had arrived at before, reasoning from psychological and ethical first principles. 

It is therefore for the consequences of an insane delusion only that aman is not responsible before the inward court of conscience and theoutward courts of justice. 

But the case is altogether different when the error is not the result ofinsane delusion. When a man, sane or partially insane, has reasonedhimself into a false opinion or conviction, not the result of hisinsanity, that the crime he is going to commit is justifiable, suchconviction being his own free act does not exempt him from punishment. This was the precise point on which turned the celebrated case ofGuiteau, the murderer of President Garfield. His trial before theSupreme Court, District of Columbia, December, 1882, was one of the mostinteresting that have ever occurred in this country or elsewhere inconnection with the plea of insanity. In his very able and exhaustiveinstructions to the jury on that occasion, Judge Cox states the rulethat is to guide the jury in these words: "It has been argued with greatforce on the part of the defendant that there are a great many things inhis conduct which could never be expected of a sane man, and which areonly explainable on the theory of insanity. The very extravagance of hisexpectations in connection with this deed--that he would be protected bythe men he was to benefit, would be applauded by the whole country whenhis motives were made known--has been dwelt upon as the strongestevidence of unsoundness. Whether this and other strange things in hiscareer are really indicative of partial insanity, or can be accountedfor by ignorance of men, exaggerated egotism, or perverted moral sense, might be a question of difficulty. And difficulties of this kind youmight find very perplexing if you were compelled to determine thequestion of insanity generally, without any rule for your guidance. 

"But the only safe rule for you is to direct your reflections to the onequestion which is the test of criminal responsibility, and which hasbeen so often repeated to you, viz. , whether, whatever may have been theprisoner's singularities and eccentricities, he possessed the mentalcapacity, at the time the act was committed, to know that it was wrong, or was deprived of that capacity by mental disease. "

What furnished the clearest proof, gentlemen, that Guiteau's opinionconcerning the expediency of killing the President resulted not from aninsane delusion but from his own reasoning is contained in a paper whichhe had himself drawn up to justify the murder. 

It is an address to the American people, published on June 16, in whichhe says: "I conceived the idea of removing the President four weeks ago;not a soul knew my purpose. I conceived the idea myself and kept it tomyself. I read the newspapers carefully, for and against theAdministration, and gradually the conviction dawned on me that thePresident's removal was a political necessity, because he proved atraitor to the men that made him, and thereby imperilled the life ofthe Republic. " Again he says: "Ingratitude is the basest of crimes. Thatthe President under the manipulation of the Secretary of State has beenguilty of the basest ingratitude to the Stalwarts, admits of no denial. The express purpose of the President has been to crush Senator Grant andSenator Conkling, and thereby open the way for his renomination in 1884. In the President's madness he has wrecked the once grand old RepublicanParty, and _for this he dies_. --This is not murder. It is a politicalnecessity. It will make my friend, Arthur, President, and save theRepublic, " etc. 

When instructing the jury, Judge Cox told them clearly that, if theyfound, from all the testimony presented, that the culprit had been ledto commit the murder by an insane delusion, they were to acquit him; butthat reasoning one's self into an opinion or conviction was not actingupon an insane delusion. "When men reason, " he said, "the law requiresthem to reason correctly, as far as their practical duties areconcerned. When they have the capacity to distinguish between right andwrong, they are bound to do it. Opinions, properly so called, that is, beliefs resulting from reasoning, reflection, or examination ofevidence, afford no protection against the penal consequences ofcrime. " On this precise point of the question then the verdict was todepend. 

But to understand this matter thoroughly there remains one moreimportant point to notice in the instructions of Judge Cox. It relatesto the question on whom rests the burden of proof regarding theexistence of insanity in the culprit. Is the prosecution bound to provethat insanity did not influence the crime? Or is the defence to provethat it did? And, in case neither party can prove its point to acertainty, so that the jury remains in doubt as to the existence or theinfluence of insanity in the crime, is the doubt to weigh in favor ofthe culprit or against him? The judge, after a careful exposition of theconflicting views on this subject by different courts, and afterweighing their respective claims, favors the opinion which holds that"the sanity of the accused is just as much a part of the case of theprosecution as the homicide itself, and just as much an element in thecrime of murder, the only difference being that, as the law presumesevery one to be sane, it is not necessary for the government to produceaffirmative proof of the sanity; but that, if the jury have a reasonabledoubt of the sanity, they are just as much bound to acquit as if theyentertain a reasonable doubt of the commission of the homicide by theaccused. "

But the jury, enlightened by the lucid instructions of the court, wereconvinced that Guiteau had not been led to commit the murder by aninsane delusion, but by his own reasoning and his own free will, andthat, therefore, he was to bear the consequences of his own deliberatechoice. Their verdict was "guilty, " and the political crank was hanged. 

II. We have now done with the study of mental or delusional insanity; itremains for us to speak of moral insanity. Of late years, the legal andmedical professions have been much divided upon the question whetherthere exists a disease which may properly be called moral, emotional, oraffective insanity, and which can justly be pleaded as an excuse fromlegal responsibility. 

Dr.  Pritchard, and later on, Dr.  Maudsley, with very many followers, have maintained the existence of such a disease, and have claimed that, even when it is not accompanied by any delusion, it ought, nevertheless, to free a man from all punishment for crimes committed under itsinfluence. Moral insanity consists, they say, in a perversion of thewill, which by this disease is deprived of its liberty, so that themorally insane man does what he knows to be wrong, but cannot helpdoing it. And they claim that therefore he cannot be blamed nor punishedfor the crime he thus commits, although he commits it knowingly andwillingly. 

But I absolutely deny that such a state of insanity is possible. It isagainst those clear principles of psychology and ethics which are notonly speculatively evident, but practically necessary to maintain thefabric of human society. I do not deny that there exists an emotionalinsanity of another kind, which I will explain further on, but not aninsanity of the will, as they understand it, which would excuse a manfrom the consequences of his wilful acts. Upon this subject Dr.  Chipleyjustly remarks: "If one is born with all the emotional endowments of ournature, but destitute of understanding, his irresponsibility isunquestionable. The same is true when the faculties of the understandingare perverted, impaired, or destroyed by disease. 

"In every aspect in which man's accountability is viewed, we arrive atthe same point that its sole basis is the existence and soundness of theintellectual powers. Those wonderful endowments which so eminentlydistinguish man from other animals, which enable him to discriminatebetween good and evil, right and wrong, and to choose the one and avoidthe other; or in the language of Judge Robertson, he is accountablebecause he has the light of reason 'to guide him in the pathway of duty, and a _free_ and _rational_ presiding will to enable him to keep thatway in defiance of all passion and temptation. '

"If then accountability is a structure erected solely on theintellectual power, must it not remain unshaken so long as itsfoundation is sound and unbroken? Is it not illogical to set out withthe fundamental proposition, that man is made responsible for his actsonly because he is gifted with an understanding and then arrive at theconclusion that he may become irresponsible without the impairment ordisease of any of its powers?" (Wharton and Stillé, "MentalUnsoundness, " p.  170. )

Gentlemen, let me give you a specimen of the false reasoning used insupport of their theory by those who believe in the insanity of thewill. "It would be as rational, " says one of their leading writers inthis country, "to punish a schoolboy whose antics and grimaces, theresult of chorea [St.  Vitus' dance], are a source of laughter anddistraction to his schoolmates, as to inflict punishment upon the insanecriminal who, knowing the difference between right and wrong, has it notin his power to execute that which his judgment dictates. One is underthe dominant influence of insanity of the _muscles_, the other is underthe influence of insanity of the _will_. To punish one would be as cruelas to punish the other. " This is indeed a very illogical argument. Thereason why we do not blame the boy is because his will is not in it; hemoves against his will. The reason why we blame the other is because hiswill is in it; he does what he wills to do. 

The will being a spiritual power can no more be diseased than can theintellect. But as the imagination, an organic power, can be disorganizedby an affection of the brain, and by delusion deceive the intellect, thus producing mental insanity, similarly I fully admit that a man'spassions, which are also organic powers, common to us and to bruteanimals, can become disordered by bodily disease; and the passions, whenexcited, will strive to drag along the consent of the will, as we allexperience. A man whose passions are abnormally influenced by bodilydisease, so that he is constantly inclined to act very unreasonably, maywell be called morally insane. Such a state of insanity is not a rareoccurrence, and there is no objection to denominate it emotional, affective, or moral insanity. 

But in such a disease the will remains free; if a man does what he knowsto be wrong and criminal, he then sees reasons for not doing it; and inthis lies the root of his liberty. For seeing himself drawn in onedirection by one motive and in another by another motive, he is notdetermined in his choice but by the act of his free will. A merelyorganic faculty must be determined by the stronger attraction, as is thecase with brutes; but a spiritual faculty, as our will is, acts freelyin choosing between two opposing motives of action. This is thephilosophical or psychological explanation: and I am well pleased tofind that here again, as in the matter of mental insanity, the courts ofEngland and the leading courts of the United States follow the soundteachings of philosophy. 

The nearest advance I know of, that has been made towards therecognition of this moral insanity as a total bar to responsibility, wasmade in 1864 by the court of appeals in Kentucky, and again in 1869under the same presiding Judge Robertson. But Chief Justice Williamsrebukes this strange ruling in most emphatic language. He says: "In allthe vague, uncertain, intangible, and undefined theories of the mostimpractical metaphysician in psychology or moral insanity, no court oflast resort in England or America, so far as has been brought to ourknowledge, ever before announced such a startling, irresponsible, anddangerous proposition of law, as that laid down in the inferior court. For, if this be law, then no longer is there any responsibility forhomicide, unless it be perpetrated in calm, cool, considerate conditionof mind. 

"What is this proposition if compressed into a single sentence? that, ifhis intellect was unimpaired and he knew it was forbidden both by humanand moral laws; yet if at the _instant_ of the act his will wassubordinated by any uncontrollable passion or emotion causing him to dothe act, it was moral insanity, and they ought to find for theplaintiff?... If so, then the more violent the passion and desperate thedeed, the more secure from punishment will be the perpetrator ofhomicide or other crimes.... The doctrine of moral insanity, everdangerous as it is to the citizen's life, and pregnant as it is withevils to society, has but little or no application to this case. Toouncertain and intangible for the practical consideration of juries, andunsafe in the hands of even the most learned and astute jurist, itshould never be resorted to for exemption from responsibility save onthe most irrefragable evidence, developing unquestionable testimony ofthat morbid or diseased condition of the affections or passions, so asto control and overpower or subordinate the will before the actcomplained of" (ib. , p.  172). 

You will notice, gentlemen, that Chief Justice Williams does not denythe existence of every kind of moral insanity. As I explained before, not the will but the passions may really be diseased or insane, and theymay prompt the lunatic to commit very unreasonable and even criminalacts. When the impulse of a passion is violent, so that a man is carriedalong by it before he has had time to reflect on the criminal nature ofhis act, or at least before he could do so calmly and deliberately, thecourts readily recognize such passion as a partial excuse: murder thuscommitted in a moment of strong provocation becomes manslaughter, notmurder in the proper sense of the word. It is not justifiable; but yetit is far less criminal and less severely punished than when committedin cold blood, or, as the law terms it, with malice prepense oraforethought. This practice of our courts is right and highlyreasonable, because on such occasions the will of the culprit is partlyoverpowered, or deprived of freedom. 

It is a matter of much discussion among jurists whether a passion canever be so violent as to overpower the will _absolutely_, so as todeprive it of all freedom at the moment. If it can, then the culpritshould be totally acquitted for doing what he could not help doing. Inseveral States of the Union, such an invincible impulse has beenrecognized by the courts of justice, and men have been acquitted foracting on what was supposed to be an invincible impulse to commit crime;the courts considered this as an extreme form of moral insanity. 

I have shown above that on sound principles of philosophy the will cannever be compelled to do wrong; at most it could be said that, in thecases just referred to, the will was not in the act. Now this, Isuppose, is the case in hydrophobia or _rabies_, in which terribledisease the biting of the sufferer appears to be spasmodic, notvoluntary. It is very doubtful whether such excuse can be substantiatedin what is called moral insanity. 

The courts of England and the leading authorities in the United Stateshave never departed from this correct rule, that a man is accountable, to some extent at least, for whatever he does willingly and without theinfluence of delusion. 

Moral insanity thus understood, as a derangement of the passionslessening a man's full mastery of himself, but not destroying italtogether, assumes various forms. There are kleptomania, or anabnormal impulse to steal; pyromania, an impulse to set things on fire;dipsomania, or an abnormal fondness for intoxicants; nymphomania, or thetyranny of lustful passions; homicidal mania, or a craving to commitmurder; etc. In all these the nature of the disease is the same, itwould appear. The imagination seizes the pleasure vividly, yet, it isclaimed, without delusion: and the passion, owing to organic disorder, is abnormally excitable. The organic derangement is supposed to be inthe brain. For the human brain, a masterpiece of the Creator's wisdom, is now generally believed to consist of various portions which are theorgans of the passions, of motive power and the phantasms, erroneouslycalled ideation. Hence it is easy to understand how it may happen thatone portion is diseased while the other parts are in a normal condition. And on the other hand it thus appears very probable also that a brainpartially diseased is liable to be soon affected in the other parts aswell. Hence we may suspect that moral insanity is likely to bring ondelusional insanity, and _vice versa_. In fact, I find that a medicalexpert of note, who had for many years taught that moral insanity wasquite a distinct disease and separate from mental insanity, has in hisold age changed his mind to some extent on this subject. "Of lateyears, " says Dr.  Bauduy, of St.  Louis, in his learned work on "Diseasesof the Nervous System, " "I have believed, notwithstanding the doctrineof Pritchard, that a careful study of moral insanity will enable us todetect some evidence, although, it must be confessed, often very feeble, of mental weakening. Even the classic cases of Pritchard, " he adds, "whofirst defined the so-called moral insanity, when carefully examined, will confirm this statement" (p.  227). Usually, as the same Dr.  Bauduyexplains, those who are morally insane are at least on the high road tomental insanity (p.  228). Moral insanity is known to exist when there isa sudden change of character which can have no other source than bodilydisease; as when a most honest man becomes of a sudden an habitualthief, a decent man openly profane, a miser becomes extravagantlyliberal, an affectionate father a very tyrant to his children, withoutany traceable causes for such transformation. The disease is made moremanifest if such a sudden change is preceded by certain physicalconditions, such as epilepsy, hereditary taint, suicidal attempts, "theinsane temperament, " as it is called, and other influences which are tobe taken into consideration. 

If ever you be summoned, gentlemen, to testify or pronounce on aperson's insane condition, let me give you one piece of advice which mayspare you much unpleasantness: be unusually cautious of what you say. If you appear as an expert or a witness, and you make a mistakeunfavorable to the patient, he will be your enemy for life; even he mayat times recover damages for libel. If he is really crazy, he may be allthe more dangerous. Do your duty, of course, as an honest man mustalways do; but do it very prudently. 

Dr.  Bauduy is very emphatic on the assertion that moral insanity is notmoral depravity. He is perfectly right; yet we must not forget thatmoral depravity is often screened before the courts by the plea ofinsanity. When a man of bad antecedents commits a crime, and is known tohave been sane just before and after the deed, he ought not to beexcused on the plea that he may have been insane at the moment when hecommitted the act; there is no reason for such a plea. And with thevictims of kleptomania, dipsomania, and other moral manias, it is wellknown that a sound whipping will often stop the nuisance. The rod forthe juvenile offender, and the whipping-post for adults, would cure manya moral leper and be a strong protection for society at large, especially if applied before bad habits freely indulged have demoralizedthe person beyond the usual limits. All of us have our passions; theyare an essential part of our nature and even an indispensable part. Butthey should be controlled by reason and will, whereas they are oftenindulged with guilty weakness. They are much strengthened by indulgence, especially in those predisposed to certain vices by hereditarytransmission. No doubt some children have worse passions to contendagainst than others. It is still worse if, at the same time, theirsurroundings are unfavorable to virtue; and this is a constant source ofincrease to the criminal classes. 

Wise statesmen will study the ways in which temptations to vice may bediminished; but it is mistaken mercy and dangerous to the community tospare the guilty when once they have committed criminal acts. If everthe principle were admitted in our courts of justice that the possibleexistence of mental insanity ought to protect a culprit from punishment, crime would soon increase tenfold both in the sane and in the insane. Both classes must be kept impressed with the conviction that the lawrules supreme and will not tolerate the destruction of public safety. Your profession, gentlemen, in this matter as in many others, by itssound views on Jurisprudence and Ethics, is one of the strongestbulwarks of the common good. 

LECTURE IX. 

HYPNOTISM AND THE BORDER-LAND OF SCIENCE. 

In this last lecture of our course I propose to make a brief excursionwith you into the border-land of science, a region chiefly occupied byimposture and superstition. To show there is such a territory, we haveonly to name a few of its inhabitants, such as mesmerism, animalmagnetism, odylism, hypnotism, mind-reading, faith-cures, clairvoyance, spiritism, including table-rapping, spirit-rapping, most of which havebeen used in connection with medicine. I do not maintain that all ofthese are mere vagaries, empty shadows, without the least reality, mereghosts and hobgoblins, mere phantoms of the heat-oppressed brain, orcunning devices of impostors to deceive a gullible crowd of the ignorantpublic. Yet most of these are such beyond a doubt, and as such aretotally unworthy of our attention. 

Medicine is a science; it deals with undoubted facts and certainprinciples, and with theories in so far as they are supported bywell-ascertained realities. The border-land of which I speak presentsto our investigation few certain facts. It is chiefly the domain ofimposture. Charlatans and showmen and medical quacks call things factsthat are not facts. Among all the inhabitants of the shadowy region thatI have enumerated, there is only one considered to-day by the science ofmedicine as worthy of its attention. It is hypnotism. As its firstorigin is connected with the history of mesmerism, and the latter, though itself a phantom, has been used as the chief patron of all otherphantoms, I will premise a few words about mesmerism itself. 

I. Mesmer was born about 1733, studied in Vienna and there became adoctor of medicine in 1766. Soon after, he began to speculate upon thecurative powers of the magnet, and claimed to have discovered theexistence of a force in man similar to magnetism and the source ofstrong influence on the human body. 

In 1775 he published an account of the medical powers of this animalmagnetism, which from his name was afterward called _mesmerism_. Pariswas then the centre of attraction for scientific discoverers andpretenders. Thither Mesmer betook himself and there he soon created alively sensation by the exhibition of mesmeric trances, some of whichwere accompanied by clairvoyance--that is, the power of seeing objectsconcealed from the eyes. He was also supposed to work some inexplicablecures. 

The secret of his art he could not be induced to reveal even for the sumof 340, 000 livres, which was offered him in compensation. People beganto doubt whether he had a real secret, or whether he was a rankimpostor. A royal commission was appointed to examine into the matter. Our Benjamin Franklin, then in Paris, was one of the commissioners. Their report was unfavorable. They found no proof of the existence of afluid such as animal magnetism, and thought that all that was notimposture could be accounted for by the power of imagination. In asecret report they pointed out very strongly the dangers likely to arisefrom this unhealthy stimulus to the imagination. Their verdict doeshonor to their learning and their common-sense. Mesmer left Paris, andhe died in obscurity in 1815. 

But his pretended discovery did not die with him. It was a mine ofresources to charlatans and impostors generally. There were strangeeffects produced, and at the sight of the inexplicable men lose theirwits. The gullible public wondered, restless minds experimented, andmany pondered thoughtfully on facts, most of which were not facts atall. But after eliminating all the elements of imposture andexaggeration there seemed to remain a residue of phenomena that werestrange and unaccountable. 

II. THEORY OF HYPNOTISM. 

About 1840 the vaunted claims of the many clairvoyants were exposedbefore the French Academy of Medicine, which passed a resolutionrejecting mesmerism altogether as unworthy of notice on the part ofscientific men. The theory of a mesmeric fluid, until then the only oneadvanced, had evidently to be abandoned. Science with all its testscould find no such cause of the results produced. But in 1842 an Englishphysician, Dr.  James Braid, hit upon a more plausible theory. Heconjectured that the actions of the mesmeric subject could be explainedwithout a fluid by the suggestion of phantasms to him on the part of themesmerizer. Dr.  Carpenter, then a great authority, defended his theory;but the medical branch of the British Association disdained to considerthe matter. Dr.  Braid thought the mesmeric trance was only a state ofsomnambulism artificially brought about, and he coined the word_hypnotism_ to indicate the artificial sleep. Other attempts to promotethe cause of hypnotism were made in the United States and other lands, but no very definite or scientific results were reached until 1878, whenthe celebrated Prof. Charcot and others made its nature andpossibilities the subject of a thorough study and abundantexperimentation at the Paris hospital of La Salpétrière and in otherplaces. At present it is admitted by distinguished medical scientiststhat hypnotism is a reality, capable of being utilized for importantpurposes. Many effects have been demonstrated to be produced by it asreal as any ordinary phenomena of nature. But on the explanation oftheir causes there hangs still a cloud of obscurity. 

The Paris School of Doctors attribute the effects to physical causes, chief among which are diseases of the nerves. Those of Nancy trace thephenomena to a psychical source, namely, to suggestion--that is, actionon the subject through his imagination excited by words, signs, or inany other manner. This appears to be, in the main, the theory ofDr.  Braid vindicated by modern science. Probably enough, both schoolsare right in their way, the suggestions not taking effect except wherenervous affections have prepared the way. The beneficial results claimedfor hypnotism by the scientific men who have made its study a specialtyare chiefly as follows:

III. BENEFITS OF HYPNOTISM. 

1. It acts as a temporary sedative, quieting the excited nerves of thepatient. It was thus employed, for instance, on an old woman who wasnear her death, and who had not been able to make necessary preparationsfor that important event, being beside herself with nervous agitation. She obtained by this means a calm condition for some seven or eighthours. Hypnotism was for her like the visit of a good angel from heaven. 

2. It is used as an anæsthetic in place of chloroform, which in manycases cannot be applied without great danger to health, or even life. Thus perfect insensibility may be procured and long continued, allowingsometimes of the performance of protracted surgical operations thatwould otherwise be almost impossible. 

3. At other times it is employed as a mere pain-killer without deprivingthe patient of consciousness, so that the hurt is felt indeed, but notattended with keen suffering. 

4. It is claimed that the skilful application of hypnotism can at timesnot only alleviate the pain of an injury, but even cure nervousaffections more or less permanently, removing, for instance, the defectof stammering. 

5. There are not wanting cases in which even moral improvements areclaimed to be produced, at least in the removing of bad habits, such asdrunkenness. If hypnotism can cure intoxication permanently, or even fora season, it deserves to be encouraged. Yet even then it must be usedwith great caution, for there may be very evil consequences resultingfrom its use. To realize fully the dangers and the evils attendant uponhypnotism you must understand the three stages through which the patientis made to pass--those of lethargy, catalepsy, and somnambulism. 

IV. DANGEROUS TREATMENT. 

Each of these is a disease in itself, and thus it is seen at once that atreatment which employs diseases as its means of cure must be of adangerous kind. After the patient has been hypnotized by any of thevarious processes--the chief are mesmeric passes of the hypnotizer'shands, his eyes fixed into the eyes of his subject, or the latter's onan object so held as to strain his eyes--the first stage of hypnotism isobtained, that of lethargy. In the lethargic state, the subject appearsto be sunk in a deep sleep; his body is perfectly helpless; the limbshang down slackly, and when raised fall heavily into the same position. In this condition all the striated or voluntary muscles react onmechanical excitement. Without an accurate knowledge of anatomy, muchharm may be done by the experiment. 

The second stage is that of catalepsy, certainly not a healthy conditionto be in. Its grand feature is a plastic immobility by which the subjectmaintains all the attitudes given to his body and limbs, but with thispeculiarity, that the limbs and features act in unison. Join the handsof the patient as if in devout prayer, and his countenance assumes adevout expression; clench his fist, and anger is depicted in hisfeatures. 

The third stage is that of somnambulism. The skin is now insensible topain, but excessive keenness is manifested in the sight, hearing, smell, and muscular sense. Here the impostor can play off his pretendedclairvoyance or second sight; for the subject will discover objectshidden from sight by the sense of smell and other senses affected withabnormal power. The somnambulist will now exhibit the utmost sensibilityto suggestions made to him by the hypnotizer, so that he seems to bealmost entirely controlled by the influence of the latter's will. Thisis what chiefly favored the early theory that a mesmeric fluid emanatedfrom the mesmerizer by means of which he could act in his subject as hepleased. The experiment by suggestions seems to succeed best withhysterical patients, which fact confirms the morbid character of thehypnotic trance. 

V. FIELD FOR A SCIENTIST. 

If any distinguished scientist or Doctor who can afford it wishes tomake a special study of hypnotism, which is still so imperfectlyunderstood, he may render a valuable service to humanity, and inparticular to the science of medicine. But if any ordinary physicianasked my advice about devoting attention to this pursuit. I wouldemphatically tell him, "Leave it alone: you are not likely to derivereal benefit from it, and you are very likely to inspire your clientswith distrust of you when they see you deal with matters which havedeserved a bad name on account of the charlatanism and the superstitiousabuses usually connected with them. " This is not my opinion alone, butalso that of distinguished writers on the subject. 

VI. OBJECTIONS TO HYPNOTISM. 

When there is question of hypnotic séances or exhibitions such as aredesigned to feed the morbid cravings of the public for what ismysterious and sensational, I would call special attention to thefollowing objections against such practices. 

1. Medical authorities maintain that it requires at least as muchknowledge of therapeutics to use hypnotism safely as it does for thegeneral practice of medicine, and requires of a physician who engages init a more thorough mastery of his profession than many other branches ofthe healing art, and therefore that it is as objectionable to allownon-professionals to deal with hypnotism as it would be to allow medicalpractice promiscuously to all persons without a Doctor's diploma. Infact, in Russia, Prussia, and Denmark none but licensed physicians canlawfully practise hypnotism. Aside from a variety of accidents which mayresult to the subject hypnotized from the ignorance of physiology in thehypnotizer, there is this general injury sustained, that even strongsubjects frequently experimented upon contract a disposition to bereadily thrown into any of the three morbid states of the mesmerictrance. All these states are real diseases and are allied to hysteria, epilepsy, and a whole family of nervous troubles, any one of which issufficient to make a patient very miserable for life, and even to leadhim to an early grave. 

2. The moralist has still stronger objections against the use ofhypnotism, except when it is used as a means to most important results. He maintains that one of the greatest evils that can befall a man is theweakening of his will-power; this leaves him a victim to the cravings ofhis lower appetites. Now the frequent surrender of one's will to thecontrol of another is said (very reasonably, it would seem) to bring ona weakening of the will or self-control. We see this exemplified in thehabitual drunkard. He loses will-power to such an extent that he canscarcely keep his most solemn promises or withstand the slightesttemptations. There is a very serious question asked by the moralist uponanother resemblance of an hypnotic subject to a drunkard. He askswhether any man has a right for the amusement perhaps of the curiouslookers-on to forfeit for awhile his manhood, or the highest privilegeof his manhood--his powers of intellect and free-will. He admits that wedo so daily in our sleep. But then he argues that sleep is a necessityof our nature directly intended by the Creator, a normal part of humanlife. Besides it is a necessary means for the renewal of our strength, and on the plea of necessity the moralist may admit the use of hypnotismwhen it is needed for the cure of bodily diseases. But for the mereamusement of spectators he maintains that it is wrong for a man thus toresign his human dignity, as it would be wrong for him to get drunk forthe amusement of lookers-on. Still, in this latter case the evil wouldbe greater, for in drunkenness there is contained a lower degradation, inasmuch as the baser passions are then left without all control, andare apt to become exceedingly vile in their licentious condition. Thehypnotic subject has at least the mind and will of the hypnotizer todirect him. Here, however, appears the need of another caution, namely, that the hypnotizer should be known to be a virtuous man; else the evilthat he can do to his subject, as is readily seen, may be even worsethan that resulting from a fit of drunkenness. And as men who occupyeven respectable positions may yet be vile at heart, it is verydesirable for prudence' sake to have no one hypnotized in privatewithout the presence of a parent, close relative, or some other party, who will see to it that nothing improper be suggested during the trance. For the scenes gone through during the hypnotic state, though notremembered by the subject upon his return to consciousness, are apt torecur to him afterwards like a dream, showing that they have left tracesbehind them. 

3. Legal writers and lawyers have serious charges against hypnotism. This practice, they maintain, if publicly exhibited to old and young, begets dangerous cravings for sensational experiments. Turning awaymen's attention from the sober realities and duties of social life, itprompts them to pursue the unnatural and abnormal. It was this cravingthat in less enlightened ages led men to the superstitious practice ofastrology and witchcraft. At present it leads to such vagaries andunchristian and often immoral practices as are connected with spiritism, faith-cures, mind-reading, and similar foolish or criminal or at leastdangerous experimentations which dive into the dark recesses found inthe border-land of the preternatural. The atmosphere of that region ismorally unhealthy and should be barred off by the guardians of publicmorals. 

The most common objection of legal writers is directed against thevarious crimes to which hypnotism is apt to lead men of criminalpropensities. They point to the statements of Dr.  Luys, a respectableauthority on hypnotism, who says: "A patient under the influence ofhypnotism can be made to swallow poison, to inhale noxious gases. He canbe led to make a manual gift of property, even to sign a promissory noteor bill, or any kind of contract. " Indeed, how can notaries or witnessessuspect any fraud when even the Doctor needs all his experience and allhis skill to avoid falling into error? In criminal matters a man undersuggestion can bring false accusations and earnestly maintain that hehas taken part in some horrible crime. 

VII. FURTHER EXPLANATION OF HYPNOTISM. 

After considering the objections to the use, or rather abuse, ofhypnotism, I may add some further explanation of hypnotism itself--ofits nature so far as it is known to science. Science has ascertained thereality of the phenomena and facts--not single facts only, scatteredhere and there, but groups of facts uniformly obedient to certain lawsof nature. It has not yet discovered the exact cause or causes of allthese phenomena, but it gives plausible explanations of them, both inthe physical theory of the Paris School and in the psychical theory ofthe Nancy School of Physicians. Science has discarded the originaltheory of a mesmeric fluid as the cause of these phenomena, just as ithas discarded the formerly supposed fluids of electricity and magnetism. Of electricity the "Century Dictionary" says: "A name denoting the causeof an important class of phenomena of attraction and repulsion, chemicaldecomposition, and so on, or, collectively, these phenomenathemselves. " The true nature of electricity is as yet not allunderstood, but it is not, as it was formerly supposed to be, of thenature of a fluid. Similarly we may define hypnotism as the collectionof peculiar phenomena of a trance or sleep artificially induced, or theinduced trance or sleep itself. 

The true cause of these phenomena is not yet understood, but there is noapparent reason for attributing them to a special fluid; they seem to bepeculiar ways of acting, belonging to man's physical powers when hisnerves are in an abnormal condition. By laying down these definitestatements we gain the advantage that we isolate hypnotism from thefrauds and empty shades, from the ghosts and hobgoblins with which itused to be associated in the border-region which we have undertaken toexplore. Science deals with well-ascertained facts. Now of mesmerism, animal magnetism, and its kindred, odylism, we have seen that we have noreliable facts. We have done with those unsubstantial shades. But ofhypnotism we have well-known facts, and we have shown it to be placed ona scientific basis. 

VIII. SCIENCE DREADS ERROR. 

Of clairvoyance, mind-reading, palmistry, spiritual science cures wehave no certain facts, but we have many impostures connected with them. If ever we get real and undoubted facts proved to be connected withthem, we ought to examine them with care. Science is not afraid of anyportion of nature; all it dreads is ignorance, and what is worse, error. Error with regard to facts may be committed in two ways--by admitting asfacts what are not facts, and by denying facts. Now, there are factscertain and well ascertained, numerous and widely known, connected withsome other portions of the border-land of science that we have not yetlooked into, though I have mentioned their names. He who would assertthat spiritism, table-turning, spirit-rapping, and so on are mere idletalk, sheer impostures, is not well read in the literature of thepresent day. By denying all reality to these phenomena he strays as farfrom the truth as if he allowed himself to believe mere fabrications. They are not impositions, but they are worse; they are superstitions. Bysuperstitions I mean here the practice of producing results which cannotpossibly proceed from the powers of nature, and which could not withoutabsurdity be attributed to the interference of the Creator or His goodangels. 

Some persons strenuously object to introducing any reference to God intoscientific works. Science consists in tracing known effects to theirtrue causes. If there were no God, He could not be a true cause and itwould be unscientific to introduce His agency. But if there is a God andHe acts in the world which He has made, we must take His actions intoaccount when we study His works. Some say, "I do not believe in a God. "That may be, but that does not prove that there is no God. Belief is aman's wilful and fine acceptance of what is proposed to him on theauthority of some one else. Students have most of their knowledge on theauthority of their professors and other men of learning. If a medicalstudent would say, "I do not believe in microbes nor in contagion bydisease germs, " that would not kill the germs nor protect him againstcontagion. Nor would it show his superior wisdom, but rather hisextravagant conceit and ignorance. So with those who believe not in God. 

There are others who believe not in the existence of devils or fallenangels. That is not so bad; but yet they must remember that theirrefusal to believe in devils does not prove that there are none. Thegreatest enemies of science are those who blindly maintain falsestatements and false principles of knowledge. Let us look for the truthin every investigation. Even Huxley, in the midst of his attacks ondogmatic religion, protests also against dogmatic infidelity. Science, he says, is as little atheistic as it is materialistic. All this must beremembered chiefly when we undertake to explore, as we are now doing, the unknown region which we have called the border-land of science. There we find many strange phenomena, and we are trying to discovertheir true nature and true causes. If we can explain some of them bynatural causes, as by the powers of the imagination when it is in anabnormal or hypnotic state, very well, let us explain them. But let usnot rashly conclude that all other phenomena can be thus explained. Donot reason this way, as some writers have done: "Some effects, " theysay, "were formerly attributed to witchcraft or deviltry and can now beexplained by hypnotism. Therefore all other mysterious effects can alsobe thus explained. Therefore there is not and never was such a thing aswitchcraft or deviltry. So, too, some events often reputed miraculouscan be explained by natural causes, therefore no miracle has everhappened. " That is the reasoning of rash and ignorant men, and not ofscientific minds. It does not follow from the fact that God usuallyworks by natural causes, that He cannot on special occasions and forvery important reasons show His hand, as it were, and act so manifestlyagainst the course of nature as to show us that it is He who is at workand He wants us to mind Him. History furnishes many instances of thiskind. 

IX. CREDENTIALS OF CHRIST. 

Least of all have Christians a right to deny this, and we must rememberthat the civilized world is Christian, almost entirely. Christiansbelieve in the reliability of the Bible, and in it we are constantlyinformed of countless miracles in various ages. If all these accountsare false, then Christianity is a vast imposture. Christ appealed tothem as to His credentials in His mission to the world. "If you do notbelieve Me, " He said, "believe My works, for they give testimony of Me. The blind see; the lame walk; the dead are raised to life. " If He spokefalsely, He was a deceiver; if He worked those marvels by hypnotism, orany other natural cause, He was an impostor. There is no middle way. Either by working true miracles He proved Himself to be what He claimedto be, the Son of God, or He was the most bold and detestable impostorthat has ever appeared on earth. This no Christian can suppose, this nohistorian would admit; therefore, we must grant that He worked miracles, and miracles are realities to be taken into account by the writers ofhistory, and scientific workers must not sneer at them. 

X. DEVILTRY. 

Scientific men in their investigations need not expect to come intocontact with miracles; but they may and do find in the border-land ofscience facts which reveal the agency of intellectual beings distinctfrom men, and too vulgar in their manifestation to be confounded withGod or His blessed angels. Such agents in the book of the Scriptures arecalled devils, and intercourse with them is styled superstition, seekingtheir assistance is magic or witchcraft, and consulting them isdivination or fortune-telling. All these practices are directly andstrictly forbidden in the Scriptures, and yet they are commonly enoughin use in our own day to procure effects that gratify the curiosity ofsuch, especially, as have no settled belief in supernatural religion. 

Some of these effects are connected with bodily cures and thus are ofinterest to physicians. For instance, spiritualistic mediums, whetherconnecting their practices with magnetism or not, though entirelyignorant of medicine, are at times able to state the exact bodilyindisposition of sick persons living at a great distance, put intocommunication with them by holding some object belonging to them. Theywill indicate the seat of the disorder, its nature and progress, itscomplications. They propose simple and efficacious remedies, using notinfrequently technical terms which are certainly unknown to them before. They manifest the thoughts of others, reveal family secrets, answerquestions put in languages of which they know nothing. To deny factsattested by thousands of witnesses of various nations belonging tovarious religious denominations or professing no religion whatever, isnot the spirit of science. It it estimated that 100, 000 spiritist booksand pamphlets are sold yearly in the United States alone. It is certainthat much, very much imposture is mixed up with many undeniable facts, but that does not dispose of the real facts mixed up with theimpostures. Tyndall once caught an ill-starred spiritualistic impostorat his juggling. He concluded that all other spiritists were impostors. The world now laughs at him for his foolish reasoning. 

Of course, I do not suppose that spiritism is mainly employed in suchmatters as would directly interest the physician. It has grown into asystem of religion and morals, very peculiar and at variance with theChristian religion, a system rather resembling the religion of Buddha, with its reincarnations and transmigrations of souls while strugglingafter eternal after-progress. This is fully and clearly explained in anarticle on "Spiritism in its True Character" in the English publicationcalled "The Month, " for September, 1892. But with this phase of it weare not now concerned. As to the facts, it is enough to remark thatspiritists claim a following of 20, 000, 000. Suppose there are onlyone-half that number. 10, 000, 000 people are not readily deceived aboutmatters of their daily observation, for their meetings or séancesconsist chiefly of those manifestations which others call impostures. 

Their adherents are chiefly among the educated classes, I believe. Certainly they include multitudes of doctors, lawyers, professors, scientists, magistrates, clergymen, close students, keen intellects, even such men as Alfred Russell Wallace, Profs. Morgan, Marley, Challis, William Carpenter, and Edward Cox. If one has still lingering doubts onthis matter let him read the four learned articles written by mypredecessor in this chair of Medical Jurisprudence, Rev. James F. Hoeffer, S. J. , the former president of Creighton University. They arefound in the "American Catholic Quarterly Review" for 1882 and 1883. 

What must we think of the nature of spiritism, with its spirit-rappings, table-turning, spirit-apparitions, and so on? Can such of the facts asare not impostures and realities be explained by the laws of nature, thepowers of material agents and of men? All that could possibly be done bythe most skilled scientists, by the most determined materialists whobelieve neither in God nor demon, as well as by the most conscientiousChristians, has only served to demonstrate to perfect evidence thateffects are produced which can no more be attributed to natural agencythan speech and design can be attributed to a piece of wood. Oneprinciple of science throws much light on the nature of all thoseperformances, namely, that every effect must have a proportionate cause. When the effect shows knowledge and design, the cause must beintelligent. Now many of these marvels evidently show knowledge anddesign; therefore the cause is certainly intelligent. 

A table cannot understand and answer questions; it cannot move at aperson's bidding. A medium cannot speak in a language he has neverlearned, nor know the secret ailment of a patient far away, norprescribe the proper remedies without knowledge of medicine. Thereforethese effects, when they really exist, are due to intelligent agents, agents distinct from the persons visibly present; invisible agents, therefore, spirits of another world. 

Who are these agents? God and His good angels cannot work these wretchedmarvels, the food of a morbid curiosity, nor could they put themselvesat the disposal of impious men to be marched out as monkeys on thestage. The spirits which are made to appear at the séances are degradedspirits. Spiritualists themselves tell us they are lying spirits. Thoselying spirits say they are the souls of the departed, but who canbelieve their testimony if they are lying spirits, as they areacknowledged to be? This whole combination of imposture and superstitionis simply the revival in a modern dress of a very ancient deception ofmankind by playing on men's craving for the marvellous. Many imaginethese are recent discoveries, peculiar to this age of progress. Why?This spirit-writing is and has been for centuries extensively practisedin benighted pagan China, while even Africans and Hindoos are greatadepts at table-turning. It is simply the revival of ancient witchcraft, which Simon Magus practised in St.  Peter's time; which flourished inEphesus while St.  Paul was preaching the Gospel there. It is moreancient still. These were the abominations for which God commissionedthe Jews in Moses' time to exterminate the Canaanites and the otherinhabitants of the Promised Land. In the Book of Moses calledDeuteronomy, or Second Law, admitted as divine by Catholics, Protestants, and Jews alike, we have this fact very emphaticallyproclaimed by the Lord. He says: "When thou art come into the land whichthe Lord thy God shall give thee, beware lest thou have a mind toimitate the abominations of those nations; neither let there be foundamong you any one that ... Consulteth soothsayers, or observeth dreamsand omens, neither let there be any wizard, nor charmer, nor any onethat consulteth pythonic spirits, or fortune-tellers, or that seekeththe truth from the dead. "

Is not this just what spiritualists pretend to do? Many may call it onlytrifling and play. The Lord does not. The Scriptures continue: "For theLord abhorreth all these things, and for these abominations He willdestroy them at thy coming. " I certainly do not mean to say that allthat passes for spiritualism is thus downright deviltry to-day, nor wasit so in pagan times. Much imposture was mixed with it. The oracles ofthe pagan gods and goddesses were not all the work of the pythonicspirits. Much was craft of the priests of idols; and yet all wereabominations before the Lord, on account of the share that Satan tookin the deceptions. 

What must be the attitude of the scientific man towards all suchmatters? It should be an attitude of hostility and opposition. Scienceshould frown down all imposture and superstition. Medicine inparticular, intended to be one of the choicest blessings of God to man, should not degrade its noble profession by pandering to a vulgar greedfor morbid excitement. Not only will you personally keep aloof from allthat is allied to quackery and imposture, but in after-life yourpowerful influence for good will be most efficient in guarding othersagainst such evils, and even perhaps in withdrawing from suchassociations those who have already got entangled in dangerous snares. At all events the enlightened views you shall have formed to yourselveson all such impostures and impieties will be a power for good in thesocial circle in which your mental superiority and your moral integritywill make you safe guides for your fellow-men. 

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