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Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. WRESTLING WITH THE ANGEL: THE STRUGGLE OF ROMAN CATHOLIC
CLERGY, PHYSICIANS, AND BELIEVERS WITH THE RISE OF
MEDICAL PRACTICE, 1807-1940
by
Joseph Glennon Pierce Ryan
submitted to the
Faculty o f the College of Arts and Sciences
of the American University
in Partial Fulfillment of
the Requirements for the Degree
of Doctor of Philosophy
in
Chain Dr. Alani
Dr. Micl
Dr. Dale Smith
Acting Dean oojjthe f the College . - „ l AujZLl- / f t t - Date
1997
American University
Washington, D.C. 20016 7‘77f
THB UOEHICAir UHIVE5SITY LIBHAHY
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. UMI Ntamber: 9809515
Copyright 1997 by Ryan, Joseph Glexmon Pierce All rights reserved.
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UMI 300 North Zeeb Road Ann Arbor, MI 48103
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. © COPYRIGHT
by
Joseph Glennon Pierce Ryan
1997
ALL RIGHTS RESERVED
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. WRESTLING WITH THE ANGEL: THE STRUGGLE OF ROMAN CATHOLIC
CLERGY, PHYSICIANS, AND BELIEVERS WITH THE RISE OF
MEDICAL PRACTICE, 1807-1940
BY
Joseph Glennon Pierce Ryan
ABSTRACT
This study explores the role of Catholicism in shaping American medical practice
from 1807 to 1940. Catholics interacted with American society against the background
of deeply held beliefs in marriage, procreation, and salvation. The gradual adoption of
epigenisis by the Church, and the assumption that human life began at the moment of
conception, challenged existing beliefs on the nature of human identity. A Catholic belief
that life had absolute value shaped an emerging ideal of scientific medicine whose goal
was the preservation of all life.
Five chapters on childbirth dilemmas reveal the struggle of physicians to achieve
this new ideal. Catholicism shaped a cesarean debate among physicians and the search
for alternatives to craniotomy, or therapeutic abortion. Catholic beliefs on human identity
also shaped opposition to abortion from 1834 to 1871. The Church promoted dissection
and surgical education to promote lifesaving operations. However, outmoded concepts of
disease hampered the search to cure women’s disease and prevent reported abortions.
ii
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. From 1865 to 1940, the Church goaded physicians toward the ideal of life saving
operations.
The effort revealed a reciprocal process of change that shaped and reshaped
Catholicism and the culture of medicine. The Church’s ideal awaited a one-hundred year
learning curve in surgical education. By 1940, new questions arose for women,
physicians, and the Catholic hierarchy who faced the issues posed by childbirth
intervention. However, the ideas that emerged from these early debates on the continue
to shape debates over the medical dilemmas of the present day.
iii
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. ACKNOWLEDGEMENTS
The title Wrestling With the Angel is an apt description of the struggle o f the
Catholic Church with the growth of medical practice. Sometimes the image fit for my
own efforts to complete this dissertation. I would like to take this opportunity to
acknowledge the contributions of those who have made the successful conclusion of this
effort possible. First, I would like to thank my parents, William and Kathryn, who first
nurtured my interest in the Catholic faith and the science of medicine from my youth.
As an adult, the Brothers of Order of St. Augustine, Province of St. Thomas of
Villanova, took on the task of nurturing the former quality. I am grateful to my brothers
for their generous commitment of time and resources that made my years of study
possible. I owe special thanks to Fr. John Bresnahan, O.S A. for his advice on matters of
translation, and his encouragement throughout my years of study.
I would also like to thank the members of my committee, Alan Kraut, Michael
Kazin, and Dale Smith, for their continued faith in me. Each member of my committee
has persevered with me as I continue to learn the craft of history. Each has taken the time
and effort to share their own skills so that I may hand them on to others.
This study has been enriched by the helpfulness of many archivists and librarians
who shared their collections and knowledge with me. Special thanks to Steven
Greenberg, Ph.D., and the staff of the History of Medicine Division at the National
iv
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Library o f Medicine for their help and access to the library collections. I am also grateful
to Richard Behles of the Special Collections Division at the University o f Maryland at
Baltimore for his encouragement and the willingness to provide a copy of “De Abortu”
for my use. I am especially grateful to Judy Torrence, MX.S. and the staff of the
Interlibrary loan office at the Learning Resource Center of the Uniformed Services
University of the Health Sciences in Bethesda, Maryland. Ms. Torrance obtained the text
of Peter Baltes’ Sacred Embryology for my use. Obtaining century-old documents
through interlibrary loan is no small feat. Finally, I am grateful for the editorial skills of
Sarah Larsen, and her helpful suggestions for the sharpening of my manuscript.
The task of completing my studies has been a happy one with the support of
faithful friends. Special thanks to Father Lawrence Hennessy, for his encouragement
during my early years of study. I am also grateful to Father Melvin Blanchette and Father
George Pucciarelli for their support of my efforts. I am especially grateful to Susan
Reidy, William Emery, Edward Cockrell, and Mark Griffin for their friendship over many
years.
v
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. TABLE OF CONTENTS
ABSTRACT...... ii
ACKNOWLEDGEMENTS...... iv
Chapter
1. INTRODUCTION...... I
2. EARLY CESAREAN SECTION, 1807-1865 ...... 13
3. ROMAN CATHOLICISM AND ABORTION IN AMERICA, 1834-1871 ...... 47
4. ROMAN CATHOLICISM, DISSECTION, AND THE GROWTH OF MEDICAL EDUCATION, 1820-1889 ...... 79
5. ROMAN CATHOLICISM AND THE PROBLEM OF WOMEN’S DISEASE, 1864-1910 ...... 122
6. ROMAN CATHOLICISM AND THE PROBLEM OF DIFFICULT BIRTHS, 1867-1940 ...... 156
7. CONCLUDING REMARKS ...... 199
SOURCES...... 215
vi
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INTRODUCTION
John Cardinal O’Connor, the Roman Catholic Archbishop of New York, yesterday helped arrange for the transfer o f a brain-dead infant from a Queens hospital that was unwilling to continue caring for her to a Catholic hospital in Manhattan, which will presumably let her remain on a mechanical ventilator until her heart stops breathing. The transfer puts an end, for now, to the legal arguments over the fate of the infant, Mari ah Scoon.1
The transfer of Mariah Scoon to a Catholic hospital in Manhattan reflected
Cardinal O’Connors’s compassion for the child’s parents, and his vision of the Church as
an active participant in the shaping of American medical practice. The parents,
Protestants, refused to accept the scientific definition of brain death offered by another
hospital as justification for ending Mariah’s life support. By his offer of the Catholic
hospital’s resources, the Cardinal helped the child’s parents face the dilemma presented
by her illness against the background of their own religious beliefs. The Cardinal’s
decision was based on his belief in the sanctity of life and his desire to prevent a civil
court from defining the limits of the care available to other families facing the same
dilemma.
The Cardinal’s actions have ample precedent in the life and history of the Catholic
Church. In the United States, the Church has long helped those who faced difficult
'Frank Bruni, “Baby’s Move Ends A Battle Over Her Fate,” New York Times. 1 March 1996, B, 1:5 (N). 1
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dilemmas posed by sickness and disease. Such decisions have always challenged all
Catholics, whether they were clergy, physicians, or lay people. This dissertation explores
the influence of Catholicism on these complex choices, focusing particularly on childbirth
and those decisions confronting physicians assisting birthing mothers in an era of
dramatic medical progress from 1807 to 1940.
My study began with a seminar paper on the history of St. Agnes Hospital in
Baltimore, Maryland. While the study highlighted the success of Sisters of Charity in
providing health care for the indigent, it also yielded evidence of significant medical
progress at the institution. For instance, Dr. Joseph Colt Bloodgood, a physician at the
hospital, compiled a library of tissue samples on slides to aid surgeons in the
identification of cancerous tumors. Previous studies of Catholic hospitals revealed the
efforts of women’s religious orders to heal the suffering and help patients preserve their
Catholic faith. However, these studies failed to account for the contribution of physicians
Like Bloodgood to both medical progress and the rise of Catholic hospitals.
One reason for the short shrift given Catholic physicians in Catholic
historiography is the almost exclusive focus of such studies on the role of religious
women in shaping the religious identity o f Catholic hospitals.2 While such works
acknowledge the role of the physician as a healer, they fail to explain how Catholicism
2Ursula Stepsis and Dolores Liptak, Pioneer Healers (New York: Crossroads, 1989), 15; Bernadette McCauley, “Who Shall Take Care of Our Sick?: Roman Catholic Sisterhoods and Their Hospitals, New York City, 1850-1930” (Ph.D. diss., Columbia University, 1992), 7; Kathleen Joyce, “Science and the Saints: American Catholics and Health Care, 1880-1930” (Ph.D. diss., Princeton University, 1995), 6; Christopher Kauffman, Ministry and Meaning (New York, NY: Crossroads, 1995), 5.
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shaped that role or how religion contributed to the medical mission of the institution.3
Unlike sisters, physicians used the hospital as a means to achieve material success. This
motivation precluded doctors from identifying with the idealized role of the sister as a
selfless servant.4 Accounts o f Catholic hospitals in the Progressive era depict physicians
as adversaries who struggled with sisters for the control o f institutions.5 Other studies
have cast individual members of the Church hierarchy in a similar role.6 Consequently,
such studies depicted these influential actors as marginal figures in the story of Catholic
health care.
This dissertation recounts the story of how the American Catholic hierarchy and
physicians of the nineteenth century interpreted the significance o f new methods of
healing against the background of Catholic ideas. This intersection of Catholicism and
medicine shaped decisions about which methods constituted appropriate forms of
therapeutic intervention. Such decisions gradually drew and redrew the boundaries of
medical practice for individual physicians and medicine as practiced in Catholic
hospitals.
3McCauley, “Who,” 158.
4Joyce, “Science,” 11.
sIbid., 72; Charles Rosenberg, The Care of Strangers (Baltimore, MD: Johns Hopkins, 1987), 272.
6Kauffrnan, Ministry. 235.
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Much of nineteenth century medical practice occurred outside the hospital.7
Therefore, efforts by doctors to establish appropriate norms of medical intervention began
long before hospitals assumed their preeminent role in medical treatment. Catholic
physicians debated the propriety of new methods o f healing with their colleagues in the
profession and helped shape the culture of medical practice. But here again, there is no
account of the influential role played by Catholicism in shaping the growth of medical
practice in either studies of American Catholicism or the history of medicine.
The failure to account for the influence of Catholicism on medical practice also
reflects the failure of historians to fully account for the influence of Catholicism in the
development of American society, hi 1993, Leslie Tender addressed the problem of the
marginal status of Catholic history within the historical profession. Tender criticized a
belief among historians that Catholics of the nineteenth century were insular or removed
from the rest of society.8 As she argues, contemporary historians do not accurately
account for the influence of the Catholicism in contributing to the evolution of a
pluralistic society in America.
The same flaw appears in works of American history. In 1995, Colleen
McDannell explored the legacy of American piety in a study of Christian material culture.
McDannell discussed the belief in the miraculous healing power of Lourdes water among
Roman Catholics from 1870 to 1896. Her analysis of correspondence between believers
7Rosenberg, Care. 22.
8Leslie Woodcock Tender, “On the Margins: The State of American Catholic History.” American Quarterly 45 (March 1993): 105.
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and priests who promoted the Lourdes devotion revealed the significance of the
miraculous in Catholic piety. However, McDannell mistakenly claimed that the world of
late-nineteenth-century Catholics excluded any interest in the “medical establishment,”
hospitals, or surgical progress because of their belief in the miraculous.9 In so doing,
McDannell depicted Catholic believers as a population removed from the wider currents
of American society.
This dissertation focuses specifically on the influence of Catholicism in shaping
the culture of medicine and American society. The mid-nineteenth century marked the
infancy of scientific medicine in America. As the century advanced, the growth of
surgery presented physicians with new opportunities to heal illness. Issues created by the
growth of medical practice engaged rather than removed Catholics from contact with
society. In turn, they changed and were changed by contact with a pluralistic society.
Catholicism shaped believers’ attitudes toward issues of medical practice. Their
participation in debates over medical issues shaped the culture of medicine of the wider
society.
In a study o f Tridentine Catholicism, Marvin O’Connell traced the role of
Catholicism in shaping the daily lives of believers. O’Connell contended that
Catholicism is a faith in a God who remains engaged with all that is created.10 The
9Colleen McDannell, Material Christianity (New Haven, CT: Yale University Press, 1995), 145.
I0Marvin O’Connell, “The Roman Catholic Tradition Since 1545,” in Caring and Curing, ed. Ronald L. Numbers and Darrel W. Amundsen (New York, NY: Macmillan Company, 1986), 132.
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Incarnation, the belief that God became a man, gave all human life a sacred character.
Catholics believe that the death and bodily resurrection of Jesus Christ made eternal
salvation possible for all believers. Therefore, Catholics believe that each person's life,
from beginning to end, is sacred and has an eternal destiny.
For Catholic believers, the journey toward an eternal destiny begins with baptism
and continues with the practice of their faith throughout their lives. Roman Catholics
believe that Jesus instituted the sacraments as the means of sanctification necessary for
their salvation. The Church’s worship in word and sacrament communicates the grace
and closeness of God to believers throughout their lives. The Catholic insistence on the
necessity of the seven sacraments for salvation distinguished Catholicism from
Protestantism.11
Ordinarily, the sanctification of believers from the cradle to the grave is the
appropriate task of the local parish and its priests. Accounts of the immigrant church in
America emphasize the role of the parish in guiding newly arrived believers toward
salvation.12 Recent studies of Catholic hospitals emphasize their role in providing the
sacraments of baptism and extreme unction in the face of death and as a path to
1 'Some Protestant denominations share sacramental beliefs similar to those of Roman Catholics. During the period of study, however, sharp differences in belief on the reality of the sacraments, such as transubstantiation, separated Protestants from Catholics. Owen Chadwick, The Reformation (New York, NY: Oxford University Press, 1984), 275.
12Jay Dolan, The Immigrant Church (Baltimore, MD: Johns Hopkins University Press, 1977), 4.
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salvation.13 However, the administration of the sacraments in cases of emergency and in
the face of death represents an experience of Catholicism removed from the daily lives of
believers. In the threat of death any believer may administer the sacrament o f baptism.
Ordinarily, however, baptism is a joyous celebration of the beginning of life that occurs at
a parish church. The priest acts on behalf of the Church to welcome the child into a
community of believers who will lead the child to salvation.
Likewise, this dissertation explores the intersection of Catholicism and medical
practice as experienced in the daily lives of believers, rather than in the extraordinary
setting of the hospital. In a 1983 encyclical, Pope John Paul II called the Catholic family
the “little domestic church” because parents teach children the first lessons of
Catholicism by their own good example.14 The concerns o f the present dissertation arise
from the issues of this domestic Church rather than those constructed of brick and mortar.
This study assumes that the family represents the basic unit of the Catholic Church.
The medical issues of this dissertation emerge in the context of the sacrament of
marriage in which the family is created. The era of Tridentine Catholicism, the period
between the Council of Trent and the Second Vatican Council, lasted from 1545 to 1962.
During this period, marriage had the twofold purpose of the mutual support of the
spouses and the procreation and education of children. Education involved the
responsibility of parents to have children baptized and raise them in the Catholic faith.
13Rosenberg, Care. 45; Kauffman, Ministry. 13; Joyce, “Science,” 17; McCauley, “Who,” 39.
l4Pope John Paul H, “Familiaris Consortio.” Origins 11 (24 December 1981): 453.
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Through marriage, parents cooperated with the creator in renewing the cycle o f life to
accomplish God’s saving will for humanity. Any attempts by couples to prevent
conception, or accomplish abortion, represented an offense against the divine will of
God.15 Therefore, the linkage between marriage, creation, and salvation accounts for the
Church’s concern with the transmission and protection o f fetal life.
From 1807 to 1940, the Catholic Church in America absorbed a significant part of
two great waves of immigration that originated in northern and southern Europe.16 New
arrivals faced the task of adapting to life in a pluralistic society, shaped largely by
Protestant ideals. Immigrants negotiated their lives in America by choosing or rejecting
among the options presented by their new culture. In this way they changed and were
changed by America. In this way they contributed to the growth of pluralism in America.
The contact of the faithful with a largely non-Catholic American society presented
a serious challenge to the leadership of the Church as it sought to encourage family
formation. The willingness of both spouses to accept children in married life would
prove crucial for the future growth of Catholicism in America. By 1840, the emergence
of abortion as a business, caused many American women to choose to terminate
pregnancies with increased frequency.17 Women’s fear o f the dangers of childbirth, “the
shadow of maternity,” reflects a likely contribution to the increased incidence of abortion
lsO’Connell, “Roman,” 138.
16Alan Kraut, Silent Travelers (New York, NY: Basic Books, 1994), 4.
17James C. Mohr, Abortion in America (New York, NY: Oxford University Press, 1978), 46.
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among women.18 The susceptibility o f recent immigrants to rachitic pelvis, the result of a
nutritional disease, raised the prospect that Catholic women would seek recourse to
abortion as well.19 This increased practice of abortion presented a threat to Church’s
ideal of procreation and its vision of family life. This search for safe alternatives to
preserve the lives of both patients in cases o f difficult births seemed to Churchmen
crucial to the continued survival of the Catholic Church in America.
The problems presented by difficult births challenged the central role o f the
Church in shaping the lives of Catholic families. However, there is no account of this
intersection between Catholicism and medical practice in the existing literature of the
history of medicine. Previous studies of the history of women have explored the perils of
childbirth during the nineteenth century.20 Yet, no study has explored the role of
Catholicism in shaping attitudes toward childbirth intervention. The dilemmas raised by
difficult childbirth throw into sharp relief the role of Catholicism in the development of
medical practice. The task of this dissertation is to account for this particular struggle of
the Church with the angel of science.
18Judith Walzer Leavitt, Brought to Bed (New York, NY: Oxford University Press, 1986), 14, 71.
I9Rachitis or rickets is a disease caused by a vitamin D deficiency that results in skeletal deformity, hi women, the disease often causes pelvic deformity that obstructs the birth canal during childbirth. Adapted from William R. Hensyl, ed. Stedman’s Medical Dictionary (Baltimore, MD: Williams and Wilkins, 1982), 1364.
20See discussions o f childbirth in: Deborah Kuhn McGregor, Sexual Surgery and the O rigins of Gvnecologv (New York, NY: Garland, 1989); Virginia A. Metaxas Quiroga, Poor Mothers and Babies (New York, NY: Garland, 1989); Jane B. Donegan, Women & Men Midwives (Westport, CT: Greenwood Press, 1978); Richard W. Wertz and Dorothy C. Wertz, Lying In (New York, NY: Free Press, 1977).
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This dissertation covers the period from 1807 to 1940 in the United States. The
year 1807 corresponds with the publication o f the first American edition of Baudeloque’s
Midwifery, the first text to discuss the support of Catholicism for the cesarean operation.
By 1940, the safe practice of the cesarean operation resolved the Church’s dilemma with
the problem o f difficult childbirth. Each chapter in this thesis explores an episode
involving the intersection of Catholicism and American medical practice. An underlying
theme of the narrative, is the development of the Church’s beliefs on the transmission and
preservation of human life in the face o f medical progress.
Chapter Two explores the struggle of Catholicism with cases of difficult births
from 1807 to 1865. The gradual adoption by the Church of a new theory of human
origins, called immediate animation, affirmed the human identity of the fetus from the
moment of conception. This belief challenged quickening, the belief that the fetus
became human when it kicked in the womb, as the prevailing theory of human origins.
Consequently, American Catholic proponents of the cesarean operation opposed
craniotomy, removing the fetus by crushing its skull, as a solution for difficult
pregnancies on the grounds that it was murder and the violent destruction of a Catholic
life. But by the outbreak of the Civil War, the cesarean remained a high risk operation
and one for which few physicians had complete and careful training. Thus, the advocates
within the Church found themselves in the position of advocating a standard of care many
physicians were not trained to meet.
Chapter Three explores the parallel struggle of Catholicism with abortion in
America from 1834 to 1871. The gradual acceptance and understanding of the concept of
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immediate animation by influential Catholic physicians and the Chuich hierarchy in
America yielded a belief that children shared an equal right to life with their mothers.
Craniotomy came to represent a form of abortion, a rejection of the will of the creator. In
Europe, some theologians allowed the practice of therapeutic abortion as a last resort. In
America, this alternative was unacceptable to Catholics. Instead, Catholic physicians and
the Church hierarchy promoted scientific medicine and improved medical education in
search of non-destructive alternatives to craniotomy. The chapter explores the influence
of Catholicism in shaping opposition to abortion within the influential American Medical
Association.
Chapter Four explores the influence o f Catholicism on medical education from
1844 to 1889. New methods of intervention in childbirth held out hope for the success of
deliveries in cases of difficult births. Competence in midwifery, however, depended on a
knowledge of anatomy gained by dissection. In America, dissection met with widespread
opposition due to popular revulsion toward the mutilation of the dead body. The chapter
discloses how the Church submerged its traditional beliefs in the sanctity of the body to
preserve the health of the living.
Chapter Five explores the struggle of Catholicism with the problems of women’s
disease from 1864 to 1910. hi the past, the medical treatment of amenorrhea resulted in
reports of accidental abortion. Surgical treatment held out the hope of preventing the
destruction of unborn children.21 This chapter explores how the persistence of faulty
21 Amenorrhea is the absence or cessation of the menses. Hensyl, Stedmans. 54.
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concepts of disease hampered the attempts of physicians and the Church to develop
norms for the appropriate practice o f gynecological surgery.
Chapter Six explores the continued struggle of the Church with the problem of
difficult births from 1865 to 1940. After the Civil War, the growth of support for the
cesarean operation continued among Catholic physicians and the hierarchy. However, the
lack of skilled doctors confined the practice of the operation to the most prominent
surgeons. This chapter explores the slow demise of craniotomy, and the struggle within
the Church over the propriety of therapeutic abortion.
This study fills an existing void in both the literature of the history of medicine
and Catholicism in America. Cardinal O’Connor’s actions on behalf of Mariah Scoon
revealed the role of religion in shaping contemporary health care decisions. However, no
existing study has explored the heritage of Catholicism in shaping such decisions, hi the
nineteenth century, new ideas on human origins gradually reshaped Catholic beliefs on
the significance of human life. However, the Church’s evolving beliefs clashed with the
reality of existing solutions to childbirth emergencies. While the Church goaded
American physicians toward the aim of preserving all human life, their limited skills
sometimes brought the Church, American physicians, and patients short of this ideal.
Catholic hierarchs, physicians, and the laity, like Cardinal O’Connor, sought a balance
between compassion, the teaching of the Church, and the limits of science in a pluralistic
society. This dissertation recounts how the Church’s search for the ideal influenced the
efforts of American physicians to achieve the highest standard of care.
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EARLY CESAREAN SECTION, 1807-1865
The terrible dilemmas posed by difficult births for American Catholics was an
international issue that became uniquely American as time passed, and as the American
Church and American medicine became more distinctive. The first cases, however, were
simply part of a broader international debate. In the eighteenth century, American
medicine, like other American institutions, was an outpost of European culture. The
impact of French Catholicism came through New Orleans and Louisiana, as well as
sometimes down from lower Canada. At the same time, English (and Anglican) ideas
entered through Virginia and Pennsylvania. Philadelphia was the second largest English
city in the world in 1770. hi this setting it is not surprising that the European concerns
about child birth are reflected in the diversity that resulted from the colonization of North
America.
The debate occurring among physicians at Catholic institutions in American cities
prior to the Civil War echoed an earlier debate that had occurred in eighteenth century
Europe. For centuries, continental Catholic thought influenced the search to solve the
problems of reconciling doctrine with the exigencies of difficult childbirth. The nature of
the debate over the appropriate management of difficult births was probably first set in
eighteenth century France because of the strong Catholic traditions in France and the
13
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emergence of French medicine and surgery in the eighteenth century.22 During the
seventeenth century, some critics viewed Jesuit philosophers as doctrinal laxists because
of their belief that abortion before forty days of gestation did not represent homicide.23 In
1733, French surgeons consulted Roman Catholic theologians to determine when the
cesarean operation proved appropriate on living patients. The surgeons posed four
dilemmas as questions disputandi to the faculty of the University of Paris.24
The theologians ruled that the operation proved justified in cases that held out
hope of saving either the mother or the child. The risk of the cesarean operation was
unjustified in cases where the safety of the child was assured. Desperate cases where the
loss of both seemed certain justified the operation. The final instance, and the most
difficult, represented cases where the survival of only one patient proved possible, hi
such cases, while justice favored mothers, the theologians ruled that charity called for the
protection of children. The rulings reflected the teachings of Thomas Aquinas and
Cassabutus, with Catholicism shaping the search for possible solutions to difficult
^Toby Gelfand, Professionalizing Modem Medicine: Paris Surgeons and Medical Science and Institutions in the Eighteenth Century (Westport. CT: Greenwood Press, 1980), 9; Ronald Numbers, ed. Medicine in the New World: New Spain. New France, and New England (Knoxville, TN; University of Tennessee Press, 1987), 7.
23L. W. B. Brockliss, “The Embryological Revolution in the France of Louis XIV: the Dominance of Ideology,” in G. R. Dunstan, The Human Embrvo (Exeter, England: University of Exeter Press, 1990), 164.
24J. H. Young, The History of Cesarean Section (London, England: H. K. Lewis, 1944), 2.
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deliveries. For French surgeons, such as Jean Louis Baudeloque, the protection of infants
became the crucial criterion in favor of the cesarean operation.25
The intersection of theology and new ideas on human origins soon became a
second factor favoring the cesarean operation. During the eighteenth century, belief in
epigenesis slowly took hold in French institutions of higher learning.26 In 1762, the
French translation of an Italian sacred embryology treatise revealed the embrace of
epigenesis by some Catholic theologians. For F. E. Cangiamilla, human life originated at
the moment of conception. For some French surgeons of the early nineteenth century, the
belief in immediate animation supported their arguments in favor of the cesarean
operation and against therapeutic abortion. In Catholic countries, the operation also
represented a means of baptizing infants to ensure their eternal salvation irrespective of
the surgical outcome.27
English physicians also struggled with the ambiguities of difficult childbirth.
During the eighteenth century, the practice of delivery by forceps caused the man-
midwife to eclipse his female counterpart in professional authority.28 Yet in many
25Ibid., 39-40.
26Epigenisis is the development of an organism from an undifferentiated cell, consisting in the successive formation and development of organs and parts that do not preexist in the zygote or fertilized ovum. Dorland’s Illustrated Medical Dictionary (Philadelphia, PA: W. B. Saunders, 1988), 566.
27Angus McLaren, “Policing Pregnancies: Changes in Nineteenth-Century Criminal and Canon Law,” in The Human Embryo ed. G. R. Dunstan, (Exeter, England: University o f Exeter Press, 1990), 199.
28Donegan, Women. 42.
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pregnancies, physicians arrived too late in labor to assure a successful delivery, hi cases
of pelvic obstruction the physician faced the choice of letting both patients die or
performing a craniotomy on the infant in the hope of assuring the mother’s survival. The
lingering influence o f quickening, the belief that human identity began when a child
kicked in the womb, supported the belief of many English physicians that the interests of
justice favored preserving the lives of mothers.29
The reports of French success with cesarean operations in the late eighteenth
century divided British surgeons into cesareanists and anti-cesareanists. Surgeons
remained divided over the propriety of craniotomy to resolve obstructed deliveries.30 In
1799, William Dease of Dublin justified the cesarean operation with the fifth
commandment of the decalogue.31 Some surgeons, early proponents of immediate
animation, decried the continued use of quickening as a criterion in laws prohibiting
29Fleetwood Churchill believed that physicians bore a responsibility for the lives of both patients. However, Churchill asserted that the prospect of the mother’s survival had an immeasurable value to her family and society. The impact o f the same decision on the lives of her spouse, living children, and her family also entered into childbirth decisions. Churchill argued that the resolution of a given delivery might not permit the survival of a child. However, Churchill believed that a competent physician could always accomplish a safe delivery without compromising a mother’s life. Hence, the preservation of a mother’s life became the operators sole concern. The consideration of the comparative value of a mothers life with that of her infant, and the belief that physicians could always save mother’s lives caused many British operators to destroy infants in cases of obstructed pelvis through the practice of craniotomy and other destructive operations. See Fleetwood Churchill, “Obstetric Morality:” being a reply to an article in No. LXXXVIL of “The Dublin Review,” Dublin Quarterly Journal of Medical Science 26 ( 1 August 1858): 8-10.
30McLaren, “Pregnancies,” 192.
31“Thou shalt not kill,” Exodus 20: 13.
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abortion. Opponents challenged the veracity of the French reports of success and
emphasized the danger involved in the procedure. For most British surgeons, the
cesarean operation remained an option of last resort But surgery attempted on women
exhausted by hours of labor held out little hope of success. In Britain, the first successful
operation occurred in 1798, the next in 1834.
For America, the years before 1800 represented the infancy o f the medical
profession. At the time European medical institutions dwarfed their counterparts in the
early republic. Although six medical schools existed, a system of apprenticeship
prevailed. The European social structure that favored the traditional practice of midwives
was largely absent in America. While medical practice laws existed, lacunae in the
statutes allowed unlicensed physicians to continue to practice. Local medical societies
were either unstable or nonexistent. No nationally organized profession existed during
this era.32
Prominent American practitioners of the eighteenth century, such as William
Shippen, were no doubt influenced by their British training. With the 1800s the European
debate over appropriate intervention during difficult births reached an American
audience. During the first half of the nineteenth century, American medical textbooks
debated European ideas in translations of works by European authors. William Potts
Dewees of Philadelphia rejected arguments favoring the necessity o f labor pain.33
32William G. Rothstein, American Physicians in the Nineteenth Century: From Sects to Science. (Baltimore, MD: Johns Hopkins University Press, 1972), 63.
33 William P. Dewees, “An Examination of Dr. Osbum’s Opinion o f the Physical Necessity of Pain and Difficulty in Human Parturition,” Philadelphia Medical Museum 1
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Dewees translated Baudeloque’s Midwifery for an American audience. Dewees also
echoed Baudeloque’s rejection o f destructive methods in favor of the cesarean operation.
This advocacy o f the cesarean helped popularize the continental debate in America.34
During the same era other works appeared which explored the phenomena of
difficult childbirth and the ambiguous state of surgical knowledge. One South Carolina
physician noted the resistance of French surgeons to the cesarean operation before 1733.35
Some works like Baudeloque’s represented translations of works by European authors.
Others reflected the experience of American physicians. Many of the American texts
shared the assumptions of British anti-cesareanists, that the cesarean operation
represented a means of last resort. For some authors the preferred means of intervention
remained craniotomy on the living child.36 In one translation of a French text, the
author’s advocacy of craniotomy revealed his retreat from rigid adherence to French
(1805): 271; William P. Dewees An Essav on the Means of Lessening Pain, and Facilitating Certain Cases of Difficult Parturition (Philadelphia, PA: John M. Oswald, 1806), 62-66.
^William P. Dewees, ed., An Abridgment of M r. Heath’s Translation of Baudeloque’s Midwifery (Philadelphia. PA: Bartram and Reynolds, 1807), 51; William P. Dewees A Compendius System of Midwifery (Philadelphia, PA: H. C. Carey and I. Lea, Chestnut Street, 1824), 14, 569.
3SWilliam Michel, “Essay on the Causes Which Demand the Caesarean Operation.” Carolina Journal of Medicine Science and Agriculture 1 (July 1825): 250.
36Samuel Bard, A Compendium of the Theory and Practice of Midwifery 4th ed. (New York, NY: Collins and Perkins, 1817), 262; Charles D. Meigs, The Philadelphia Practice of Midwifery (Philadelphia. PA: James Kay, 1838), 318.
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Catholicism in favor of liberal ideas.37 British works published in America often
ridiculed the Catholic practice of the cesarean operation for the purpose of baptism.38
Many operators clearly feared the dangers involved with the practice of cesarean
operations. Such works indicated the sharp divisions that persisted among doctors over
the appropriate means to resolve difficult births.
Catholicism shaped the culture of medicine in former French and Spanish
colonies.39 In Louisiana, the influence of Catholicism on the culture of medicine was
deeply entrenched. Ursuline sisters staffed the Royal Hospital, founded in the Spanish
period of colonization, as nurses in the colonial city of New Orleans. French Sisters of
Charity followed in 1826, and assumed responsibility for nursing care at the Charity
37Alf. Velpeau. A.L.M. An Elementary Treatise on Midwifery trans. Ch. D. Meigs (Philadelphia, PA: Grigg & Elliot, 1838), 498, 504. hi the first American edition, Velpeau acknowledged the desire of Catholics to perform the cesarean operation for the purpose of Baptism. See Alf. Velpeau, A.L.M. An Elementary Treatise on Midwifery trans. Ch. D. Meigs (Philadelphia, PA: Grigg & Elliot, 1831), 1, 509.
38James Blundell, The Principles and Practice of Obstetricitv. ed. Thomas Castle (Washington, DC: Duff Green, 1834), 353; Henry Maunsell, M.D., Dublin Practice of Midwifery, ed. Chandler R. Gilman, M.D. (New York, NY: William E. Le Blanc, 1842), 156; Churchill, Fleetwood. On the Theory and Practice o f Midwifery, ed. Robert M. Huston (Philadelphia, PA: Lea and Blanchard, 1843), 339.
39From 1799 to 1833, Franciscan friars practiced cesarean section on deceased Indian women. The friars performed such operations with baptism in mind, rather than the preservation of life. These operations do not represent the practice of cesarean operations in the modem sense, which seeks to save both patients. The practice account does however, reveal the high priority of the Church in seeking the salvation of infants. Rosemary Keupper Valle, “The Caesarean Operation in Alta California During the Franciscan Mission Period (1769-1833),” Bulletin of the History of Medicine 48 (Summer 1974): 275-276.
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Hospital. While the latter institution reverted to municipal authority in 1811 it continued
to seek and receive financial support from Church authorities.40
In 1830, tensions arose among French and Anglo-American doctors in Louisiana
over the cesarean operation, particularly between Charles Luzenberg and French
physicians, over Luzenberg’s claim that he was the first to perform a cesarean operation
successfully 41 The New Orleans Bee claimed that doctors Dubreuil, Lacroix, and
Francois Prevost, all French Louisianans, performed the operation successfully before
Luzenberg.42 Moreover, they suggested that this was hardly a successful operation since
both the mother and baby died.43 In denouncing Luzenberg, the New Orleans Argus
reported that thousands of the same operations had occurred successfully in European
hospitals.
The editor of Louisiana Courier defended Luzenberg with the text of an English
encyclopedia that rejected continental claims of success in the cesarean operation.44
40John Salvaggio, The Charity Hospital: A Story o f Physicians. Politics, and Poverty (Baton Rouge, LA: Louisiana University Press, 1992), 8, 14.
4lNew Orleans Louisiana Courier. 21 August 1830.
42New Orleans, Bee. 19 August 1930; quoted in Rudolph Matas, “Francois Marie Prevost and the early History of Cesarean Section in Louisiana,” New Orleans Medical and Surgical Journal 89 (May 1937 ): 61.
43New Orleans Louisiana Courier. 26 August 1830.
44New Orleans Louisiana Courier 20 August 1830; John Duffy, The Rudolph Matas History of Medicine in Louisiana. 2 vols. (New Orleans, LA: Louisiana State University Press, 1962), II: 73. While Matas’ account mentions the four newspapers involved in the dispute, the account in the Louisiana Courier of 20 August set out the bounds of the debate among the four periodicals. Matas cites block quotations from the Courier and the Bee. John Duffy’s account cites the Courier alone. This may be because the Argus and the Mercantile Advertiser no longer exist in Louisiana collections.
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Next, the editor argued that the assertions of rival claimants defamed Luzenberg. The
dispute ended when the Bee editor denied any intention of defaming Luzenberg.45
An account of a more successful cesarean operation in Philadelphia exemplified
the emergence of the international debate as an issue in the practice o f American
physicians. Dr. Joseph Nancrede wrote, “I was, however, convinced of the impropriety in
this...[of craniotomy] of permitting such a sacrifice of life to an innocent being, who had a
just claim to the benefit of my professional exertions in its behalf, and still more so of the
injustice and sin o f perforating its head before the extinction of life.”46 Nancrede’s
45In 1879, a Philadelphia surgeon settled the dispute over the authentic claimant for the distinction of Louisiana’s first successful cesarean section. After a lengthy investigation, Robert P. Harris named Francois Prevost of Donaldsonville as the first successful operator. Harris’ study revealed that Prevost achieved four successes before Luzenberg’s first failed attempt. The study also revealed that over half of Louisiana’s operations from 1825 to 1873 were performed by surgeons of French descent or were Catholic immigrants. The study also revealed that all the operations, save one, occurred on African American women. Thus, there is a strong suggestion that racial criteria were a factor in was or was not a candidate for this admittedly risky surgery. Robert P. Harris, “A Record of the Caesarean Operations that Have Been Performed in the State of Louisiana During the Present Century,” New Orleans Medical and Surgical Journal 6 (June 1879): 935. However, In America at large, 48 percent of all such operations from 1822 to 1877 were performed on African-American women. The findings suggest that racial ideas shaped the practice of obstetrics in the nation at large. Robert P. Harris, “The Operation of Gastro-Hysterotomy (True Caesarean Section), Viewed in the Light of American Experience And Success; With The History and Results of Sewing Up the Uterine Wound; and a Full Tabular Record of the Caesarean Operations Performed in the United States, Many of Them Not Hitherto Reported,” The American Journal o f the Medical Sciences 150 (April 1878): 340. Harris’ earlier study of 1872, recounted actual case histories, and disclosed that five of fifty-nine cases, or 12 percent of the nations Caesarean operations were performed on Irish immigrants. Three cases identified Irish nativity, others reflected identifiably Irish surnames (Mullen, O’H—). Robert P. Harris, “The Caesarean Operation in the United States,” American Journal of Obstetrics 4 (February 1872): 622-663.
46Joseph G. Nancrede, Observations on the Cesarean Operation, in Which Both Mother and Child Were Preserved (Philadelphia. PA: 1835), 1.
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remarks, from the report of an early cesarean operation, illustrated the dilemma
confronting the physician in cases of difficult childbirth. Should he try a cesarean
operation or opt for the even more repugnant option of ending a fetus’s life by perforating
the skull?47 The account illustrates Nancrede’s Catholic belief that the destruction of
infants represented a grave sin against the creative will of God. In 1835, Nancrede’s
account celebrated the cesarean operation as a means of preserving the lives of both
patients.
Nancrede’s patient, Mrs. Reybold, an Irish immigrant, had survived two previous
unsuccessful deliveries. With Nancrede’s help she also survived this one. The first
pregnancy, supervised by Dr. George Fox, ended in the cephalotomy of a dead child after
he concluded that the cesarean operation represented “so much.. .risk as to be necessarily
fatal.”48 Dr. Charles Meigs supervised the second pregnancy, which ended in craniotomy
after Mrs. Reybold refused the alternatives of premature delivery and the cesarean
operation. Meigs believed that the performance of a third craniotomy on Mrs. Reybold
47Statistics from Philadelphia’s Blockley Hospital from 1835 to 1844 reveal that foreign bom patients accounted for 34 percent of deliveries. Of this group, 62 percent were Irish immigrants, and 20 percent were of German nationality. Five embryotomies occurred during the period of study, including three Irish women and one African American. The incidence of craniotomy cases, one in 117.6, was almost twice the average o f British hospitals. George N. Burwell, “Statistics and Cases of Midwifery; compiled from the Records of the Philadelphia Hospital, Blockley,” American Journal of the Medical Sciences 7 (April 1844): 318,338. Fleetwood Churchill reported rates of one in 219 in Britain, one in 1,205.66 in France, and one in 1,944.33 in Germany. Churchill, Midwifery. 347. Professor Hugh Lenox Hodge is identified as the operator in two of the crochet cases.
48Cephalotomy, like craniotomy, was another means of destroying a child during labor. See Nancrede, Observations. 6.
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after two prior pregnancies would represent no less than an act of homicide. Nancrede
intervened after Meigs refused to perform a third craniotomy on the patient. After
consulting the approved authorities, Nancrede assembled a team of surgeons to assist
him. Mrs. Reybold agreed to submit to the perilous procedure after lengthy consultation
with Nancrede and a Catholic priest.49 Each doctor’s choice of intervention revealed the
influence of the Anglo-American debate over appropriate measures childbirth
emergencies. Significantly, however, while a priest and physician spent hours persuading
the patient o f the merits of the cesarean operation, they left the ultimate decision to Mrs.
Reybold herself.
In St. Louis, like New Orleans, Catholic medical institutions shaped the culture of
medicine through their leadership in medical care and medical education.50 The
establishment of St. Louis University represented the dream of Bishop Louis Duborg, a
French immigrant, for a Catholic institution of higher education. When it opened in
1818, the college served as a secondary school for boys. By 1829, the transformation o f
the University from a secondary school into an institution of higher learning had begun,
due to the efforts of fifteen Belgian emigres, all members of the Society of Jesus. In
49Nancrede reported: “The propriety of the operation having been long agreed upon, the next question was to apprize the patient of it and to obtain her consent. This I had some difficulty in accomplishing, but after wasting a couple of hours in persuasion, in which I was aided by the influence of my respected friend, the Rev. John Hughes, I had at last the satisfaction of hearing her say that she was resigned, and was now ready.” Ibid., 8.
50J. Thomas Scharf, History of St. Louis City and Countv 2 vols. (Philadelphia, PA: Louis H. Everts & Co., 1883), 2:1518.
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1830, the separation of the Missouri mission from the Maryland province allowed the
group to turn away from parish duties and focus on higher education.51
In 1835, Fr. Verhaegen, Chancellor o f the University, proposed establishing a
Medical College.52 Verhaegen asked members of the local medical society to select a
faculty. The by laws of the new medical school, enacted in 1839, provided for a board of
trustees composed of members from the different faith groups of the city. The selection
of the board represented an attempt to defuse nativist opposition to the new school. Yet,
for reasons that remain unclear classes did not begin until 1842. The University may
have acted to prevent a rival medical school from becoming predominant in St. Louis
medical education.
The admission of Parisian trained physicians to the medical faculty represented a
re-infusion of French ideas into the culture of medicine in St. Louis. The faculty for the
1842-1843 session included Moses Linton and Charles Pope. Linton served as the first
professor of obstetrics for the fledgling institution and was best known as the editor of the
St. Louis Medical and Surgical Journal.53 Charles Pope later became dean of the medical
51 William B. Faherty, S.J., Better the Dream (St. Louis, MO: St. Louis University, 1968), 29.
S2Ibid., 59.
53Moses L. Linton, M.D., “Biographical Sketch of Prof. M.L. Linton,” Saint Louis Medical and Surgical Journal 4 (January and February 1867): 3.
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school and president of the American Medical Association. After graduation from
American medical colleges, both professors had studied in French medical schools.54
The influence of Catholicism on Linton’s thought is evident in his introductory
lecture to medical students in 1845. He promoted the study of chemistry as a means to
advance the cause of “religion, science, and humanity” The influence of his faith is more
evident in his praise of the Sisters of Charity whom he termed the “praetorian band” of
Christian hospitals. Such women, in institutions like S t Louis’ Mullanphy Hospital,
were charged with executing, “the dictates alike of priest and doctor, of religion and
science.”55
The impact of Catholic ideas and French attitudes toward childbirth intervention,
is most evident in the practice of the school’s early graduates. Frank E. Polin performed
the first successful cesarean operation using silver sutures in 1852.56 Louis C. Boisliniere
remained an outspoken opponent of craniotomy throughout his career. At the close of his
life, Boisliniere wrote a text promoting the practice of cesarean section. His classmate,
Timothy Papin, opposed the operation as well. Both doctors opened obstetric clinics at
S4Russell M. Jones, “American Doctors and the Parisian Medical World, 1830- 1840,” Bulletin of the History of Medicine 47 (January-February 1973): 47.
55Moses L. Linton, An Introductory Lecture Delivered in the Hall of the Medical Department of the St. Louis University. November 4th. 1845 [St. Louis, MO: Printed at the Reporter Office, 1845], 17.
56J. A. McCormack, “A Successful Cesarean Section Made in 1852,” Medical Herald 2 (December 1880): 352; “Death of Dr. Frank E. Polin, of Springfield, KY.” St. Louis Medical and Surgical Journal 18 (March 1860): 183. Dr. Paul Anderson of the Becker Library at Washington University Medical School confirmed that F. Polin graduated on 27 February 1850.
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Catholic hospitals in St. Louis long after the Jesuit affiliation with the medical school
ended in 1855.57
While Catholicism was shaping medical progress in S t Louis, the Church in other
parts of the United States expressing concerns about the problems of difficult births.
Such concerns reflected the existence of a two way migration of knowledge form Europe
to America. In Theoloeiae Moralis. Bishop Francis Kenrick, the Bishop of Bardstown,
Kentucky, explored the moral consequences of abortion.58 Kenrick taught that use of
obstetric instruments to destroy infants represented an evil in itself, even if the effort
represented an attempt to save a mother’s life. Only the death of an infant justified its
destruction to complete a delivery.59
Kenrick shared the views of Fr. Thomas Sanchez and St. Alphonsus Ligouri, both
influential European Catholic theologians, on the propriety of the cesarean operation.
57Frank A. Glasgow, “Louis Charles Boisliniere,” Transactions of the American Association of Obstetricians and Gynecologists 7 (1895): 396-397. Papin established his own clinic at St. John’s Hospital. See: “St. Louis Institute for the Treatment of Diseases of Women,” St. Louis Medical and Surgical Journal 8 (10 September 1871); Scharf, History. 2: 1540.
58John Connery, Abortion: The Development o f the Roman Catholic Perspective (Chicago, IL: Loyola University Press, 1977), 225. Francis Patrick Kenrick became the coadjutor bishop of Philadelphia on 25 February 1830. In 1842, Kenrick rose to become the Archbishop of Philadelphia, hi 1851, Kenrick became the Archbishop of Baltimore. In 1852, the Archbishop presided over the first Plenary Council of Baltimore in the role of apostolic delegate. Archbishop Kenrick died on 8 July 1863. Joseph Bernard Code, Dictionary of the American Hierarchy (New York, NY: Longmans, Green and Co., 1940), 181-182.
59“Si constet foetum intra uterum jam extinction esse, utique licet istrumentis eum per partes educere.” [If it is clear that the fetus in the womb has already died it is certainly allowed to draw the infant out in parts.] Francisco Patrick Kenrick, Theoloeiae Moralis (Philadelphiae, PA: Apud Eugenium Cummiskey, MDCCCXLI), I: 112.
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Due to its clanger, if little hope of success existed, women were free from any obligation
of submitting to it. In support of the operation, however, Kenrick noted the claims of
success by Cangiamilla, a theologian, and a Philadelphia surgeon some years before. The
bishop noted that only a skilled surgeon should attempt the operation on living patients.60
Kenrick also noted that guidelines for such operations on deceased women already
existed in the Roman Ritual. While Roman Catholic seminarians were the intended
audience of Kenrick’s manual o f moral theology, the discussion of such issues with future
priests reflected an effort to prepare such students to advise physicians and women on the
moral dimension of obstetric dilemmas. Kenrick’s comments on cesarean section on the
living acknowledged the existing limits o f surgical knowledge among American
physicians. In the face of continued ambiguity, mothers rather than physicians
represented the final arbiters o f propriety for such operations.
Publication of Dr. Fleetwood Churchill’s Midwifery in America disclosed the
ongoing struggle of physicians, on both continents, with the dilemmas of difficult
childbirth.61 The prominent British physician asserted that his belief in the priority of
“ “Caeterum neminem nisi peritissimum chirurgiae debere id aggredi liquet.” [Surely, no one else but the most skilled surgeons ought to attempt it.] Ibid., 113.
6'Fleetwood Churchill graduated with an M.D. from Edinburgh in 1831. Soon after, he became a licentiate in the King and Queens College of Physicians. Churchill established the Western lying-in hospital in Dublin, Ireland, where he provided instruction in midwifery for medical students. The doctor garnered many professional honors. Churchill served twice as the president of the Obstetrical Society of Dublin in 1856 and 1864. From 1867-1868 he served as President of the King and Queen’s College of Physicians. Churchill was a devout member of the Church of Ireland. Churchill died on 31 January 1878. Leslie Stephen and Sidney Lee, eds. Dictionary of National Biography (London. England: Oxford University Press, 1937-1938), 4: 313.
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maternal life reflected “an established maxim of midwifery.” He claimed that craniotomy,
with its 20 percent mortality rate for mothers, held a comparative advantage in safety over
the cesarean operation. According to Churchill’s findings, the cesarean operation had a
43 percent mortality rate for mothers and 29 percent forinfants, hi cases of obstructed
pelvis, the induction of premature labor represented the safest means of delivery.
Churchill’s use of statistics represents an early use o f utilitarian reasoning to determine
appropriate means of intervention.62
The English surgeon’s views differed sharply with traditional French belief in the
equal claim of both patients to life. The difference is evident in Churchill’s ridicule of
craniotomy’s delay until infant death, a reservation shared by Catholics, as a
“conscientious quibble.”63 The surgeon appealed to the ancient origin of destructive
methods as a justification for their use. Such arguments revealed the difficulty met by
surgeons in accurately determining the vital status of an infant during labor. In the face of
such ambiguity, physicians acted against a background of different visions of faith and
justice to resolve difficult pregnancies.
For Churchill, the cesarean operation represented a means of last resort to save
both patients in an obstructed delivery. The attempt to save an infant after maternal death
reflected another possibility. The operation might also protect mothers from infection,
“owing to the fetus...acting as a foreign body.”64 This is the first time that a serious
62Churchill, Theory. 346-348.
63Ibid., 339.
“ ibid., 365.
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medical tract referred to a child as a “foreign object.” Ultimately, Churchill approved of
such surgery only in cases where the remains o f the child could not be dragged through
the birth canal. American reviewers praised Churchill’s grasp of physiology and his
helpful comments.65
By contrast, Gunning Bedford, a Paris trained American physician, promoted the
cesarean operation. Bedford, a Catholic, despised the practice of craniotomy on live
infants. He charged in an editorial note to his English translation of a treatise by M.
Chailly, a liberal French physician, and critic of cesarean section overstated the danger of
the operation. Bedford condemned the practice of craniotomy insisting, “The man who
would wantonly thrust an instrument of death into the brain of a living foetus, would not
scruple.. .to use the stiletto of the assassin.”66 The surgeon noted the 20 percent mortality
of craniotomy for mothers and its perils when the pelvic diameter remained below two
inches.
Bedford’s views received both praise and blame from other physicians. The range
of opinion revealed the continued ambiguity which attended the resolution of difficult
deliveries. One surgeon gave “involuntary praise” to Bedford. While he shared
Bedford’s views on the perils of instruments, he doubted French claims of success in the
65Review of On the Theory and Practice o f Midwifery, by Fleetwood Churchill, ed. by Robert Huston, In Medical Examiner 6 (2 September 1843), 198-199; Review of A Practical Treatise on Midwifery, by Fleetwood Churchill, ed. by Robert Huston, In New York Journal of Medicine 2 (January 1844): 104.
66M. Chailly, A Practical Treatise on Midwifery, trans. and ed. by Gunning S. Bedford (New York, NY: Harper Brothers, 1844), 385.
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practice of the cesarean operation.67 Robert Huston assailed Chailly’s exclusion of
“everything that is not French” from the text. He also assailed Bedford, though, for not
having “Americanized” the work.68
Not all American surgeons shared Huston’s ire toward Bedford and Chailly.
David Meredith Reese criticized the “sectional jealousy and personal interest” evident in
Huston’s remarks against Bedford. Reese, a Methodist reformer, shared Bedford’s
revulsion at the abuse of destructive instruments by physicians. Yet his defense of
Bedford reveals the dilemma that confronted most physicians. Reese still reserved the
use of instruments to cases where their use proved necessary to save a mother’s life. Like
Bedford, he supported efforts to deliver a living child before full term by premature
delivery in such cases and reserved craniotomy to cases of infant death.69
Bedford’s own lectures, at a New York medical school, revealed his firm belief in
cooperation with the natural process of labor. To illustrate his opposition to the careless
use of instruments to resolve problem deliveries, he recounted cases from his own
practice. One physician’s haste in using forceps resulted in the mutilation of an infant
and its removal with a crochet, a cutting instrument. In another case he recalled his
intervention after other physicians had deserted the victim of a botched embryotomy.
67Review of A Practical Treatise on Midwifery, by M. Chailly, trans. and ed. by Gunning S. Bedford, In New York Journal of Medicine 2 (March 1844): 254.
^Review of A Practical Treatise on Midwifery by M. Chailly, trans. and ed. by Gunning S. Bedford, In Medical Examiner 7 (4 May 1844): 101.
69David Meredith Reese, review of A Practical Treatise on Midwifery by M. Chailly, trans. and ed. Gunning S. Bedford, In New York Journal o f Medicine 3(Julv 1844): 122, 125.
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Such operators, he claimed, shared “an eclat for bloody deeds.”70 Bedford’s insistence on
the equal claim of infants and mothers to life shaped his view that destroying infants to
save mothers was murderous in God’s eyes. Such remarks disclose that both French
physiology and Catholicism shaped Bedford’s views toward the resolution o f difficult
deliveries.
John Barry, an Irish Catholic immigrant living in Kentucky, wrote a work in 1846
that struggled with the problems of difficult childbirth, hi Medico-Christian Embryology
Barry condemned the practice of craniotomy on living children as a grave sin. He also
rejected the destruction of deformed infants, and the practice of killing infants after
baptism when mothers refused the cesarean operation. Barry based his views on the
scriptural imperatives that “Thou shalt not kill: do not evil that there may come good.”71
70Gunning S. Bedford, New York Universitv-Department of Medicine An Introductory Lecture Delivered hv Gunning S. Bedford. AM. M.D.. Professor of Midwifery and the Diseases o f Women and Children, in the New York University Session MCCCCXLV-XLVI (New York, NY: Printed for the Medical Class of the University, at the Herald Job Office, 97 Nassau Street. 1845-46), 8.
71 John Barry, Medico-Christian Embryology, or the Unborn Child, (from the Earlv Period of its Existence.) Considered in a Medical. Moral, and Religious Point of View. Comprising Also. Brief Practical Observations on the Regimen o f the Pregnant Female and on the Diseases with Which She May Be Attacked (Louisville, KY: Printed for the Author 1846), 28. Barry was a physician who practiced in Clay Village in Shelby County, Kentucky. The doctor was bom on 30 May 1803 at New Mill, county Cork, Ireland. He migrated to America in 1832. hi his work, Barry refers to his studies at Thomas Jefferson University in Philadelphia. The student rolls of the institution included John Barry of Ireland, aged 24, as a non-graduating matriculating student from 1835- 1836. See: Register of Matriculants, No. 1 [September 13, 1835] Jefferson Medical College Registration Book 1828-1837. Thomas Jefferson University Archives, Philadelphia, PA. The student rolls of the Louisville Medical Institute list John Barry as a member of the 1838-39 graduating class. See: Louisville Medical Journal 1 (2 March 1838): 249-250. Later, he became the attending physician at the Gethsemani Abbey, New Haven, KY. One account claims that he moved on to become the attending physician at
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Barry’s arguments countered the views of liberal British and French surgeons who
claimed that justice demanded the sacrifice o f infants to protect the lives of mothers. His
terms of intervention, informed by the Catholic belief in immediate animation, precluded
such practices.
For Barry, the cesarean operation represented an appropriate recourse for living
mothers and on deceased bodies. In case of obstructed pregnancy, a cesarean operation
represented a means to save both patients, or infants in the event of maternal death. In
cases of ectopic pregnancy, the operation represented a means to baptize infants. Barry
urged caution in undertaking the operation. On the living, Barry only operated in cases
where both patients' lives were in mortal danger.72 In a case of pelvic obstruction, a
pelvic diameter of two and a half inches justified the procedure.73
the University of Notre Dame, in South Bend, Indiana. Barry died at New Haven on 17 June 1880. [From: Allen-R.W. Research Medical Aid & Public Health Service: Comette, JPB, 12/21/39, Biographical Sketches of Doctors by Counties by Women’s Auxiliary, Kentucky. Medical Society (Nelson County), Filson Club, July 1936; Interview with Mrs. Winfield Scott Gabhart by Nancy F. Baldwin, Danville, November 10,1938. Microfilmed Records of the WPA Kentucky Medical Historical Research Project, University of Louisville, Komhauser Health Sciences Library, Louisville, KY, Microfilm Project Reel 2 #115.
^Ibid., 67.
73Physicians determined the indications for the cesarean operation through the measurement of the diameter of the pelvis. Given the biological function of childbirth, the openings in the center of the (superior and inferior apertures) of the female pelvis are wide and elliptical to permit the passage of an infant. Rickets causes the deformation of these passages. Physicians measured the extent of pelvic deformity, and the extent of obstruction, by measuring of the diameter of the superior strait (upper pelvis) at the pelvic brim. Barry’s measure represents the diameter from the front of the pelvis to the back(antero-posterior or conjugate diameter). Some obstetricians used the transverse pelvic diameter (left to right) as a measure of deformity as well. Henry Gray, The
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The surgeon expressed the hope that all mothers would submit to the cesarean
operation in such cases. Barry viewed the decision as the greatest act of charity possible
for mothers because it made the baptism of infants possible and he hoped that pastors
would assist physicians in urging mothers to endure the operation with “Christian
resignation.”74 Should mothers refuse the operation, Barry urged physicians to baptize
infants inutero unless mothers refused the sacrament as well.
Like Bishop Kenrick, Barry considered whether a real obligation existed for
mothers to submit to surgery. Kenrick, freed women from the responsibility to submit to
the operation. Barry offered no conclusion to the same question. He claimed that
authorities remained divided on the subject. While he was an advocate of the operation,
he noted that some authorities viewed the operation on a weakened mother as a positive
act of killing. Other authorities, he noted, urged the delay of such dangerous surgery on a
chronically ill mother until after her death. Scholastic theology gave Bishop Kenrick, a
theologian, a clear and negative answer to the question of a mother’s obligation to submit
to dangerous surgery. As a Catholic layman, the physician may not have been exposed to
the same ideas. Barry’s knowledge of the dangers of the operation probably accounted
for his failure to give a clear answer to the question. However, for many Catholic
Anatomy o f the Human Body ed. Charles Mayo Goss, (Philadelphia, PA: Lea & Febiger, 1959), 266-267.
74Ibid., 69.
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surgeons and clerics alike, Barry’s text represented an authoritative source of Catholic
teaching well into the second half of the century.?s
The conduct of medical education at Georgetown Medical College was typical of
many American medical schools and reflected Anglo-American Catholic ideas.76 A
secular faculty established the school as a proprietary institution in 1851. During the
1850s, the school operated loosely under the aegis of Georgetown College. While
European Jesuit emigres taught at the College, local graduates of Columbian Medical
College predominated at the medical school. Only one member of the founding faculty
was a Roman Catholic. At Georgetown, the works of Fleetwood Churchill and like
minded practitioners dominated the teaching.
In 1858, the Dublin Review, also published in New York City, revealed the
interest of the American Catholic clergy in the continued international debate over the
appropriate resolution of difficult births. George Crolly, writing anonymously, attacked
destructive methods of obstetric practice. Crolly, a Catholic theologian from Ireland’s
Maynooth Seminary, criticized the refusal of some British physicians to perform baptism
during difficult deliveries. The theologian asserted that such surgeons jeopardized the
prospects of infants for eternal life and rejected claims, by proponents of craniotomy, that
75See: Horatio R. Storer, “Criminal Abortion,(continued) HI. Its Victims,” North American Medical Chirurgical Review. 3 (May 1859): 450-451.
76Robert Emmet Curran, The Bicentennial History of Georgetown University: From Academy to University. 1789-1889 (Washington, DC: Georgetown University Press, 1993), 133,146.
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the lives of infants were secondary to those o f mothers.77 Crolly’s argument reflected
sharp differences in religious belief and the preferred solutions to resolve dilemma’s of
difficult childbirth.
For Crolly, the cesarean operation reflected an appropriate means of resolving an
obstructed delivery, with the added advantage that it made infant baptism possible. The
induction of premature labor also represented an acceptable means to successfully resolve
an obstructed pregnancy. However, Crolly bemoaned the fact that, despite the opposition
of the Catholic clergy, craniotomy remained the preferred practice for unskilled private
practitioners.78
Crolly’s belief in immediate animation, that the fetus was human, grounded his
insistence on infant baptism. For Roman Catholics, of the era of Trent, baptism was
essential for salvation, hi contrast, Crolly noted that, “they [Protestants] ask if it is not
absurd to suppose that God would exclude [a child] from heaven for ever because it has
not been baptized?”79 The comments revealed differences among Catholic and Protestant
on the nature and significance of the sacraments. The remarks also imposed an additional
duty on Catholic physicians, the obligation to baptize imperiled infants to assure their
eternal salvation.
77[George Crolly], “Obstetric Morality,” Dublin Review 44 (March 1858): 102- 106; Walter E. Houghton, ed. The Wellesley Index to Victorian Periodicals. 1824-1900 (Toronto, Canada: University of Toronto Press, 1974), 2:61.
78Ibid., Ill, 117.
79Ibid., 126.
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Dr. Fleetwood Churchill soon responded to the charges of the unnamed author.
Churchill cited English civil law and the Catholic theory o f just war to justify craniotomy.
Civil Law, he claimed, provided for acts of killing dictated by necessity. Churchill also
justified craniotomy by citing Bishop Cullen’s views on just war theory in the context of
warfare. The surgeon maintained that craniotomy represented an act of self-defense to
protect mother’s lives.80 Churchill was not the first author to appeal to just war theory
and self defense as a justification for the practice of craniotomy. In 1857, one writer in
the Revue Theologioue. a Catholic periodical, argued in favor of therapeutic abortion on
the grounds of just war theory.81 The existence of the article reveals the existence of an
ongoing debate among continental theologians on therapeutic abortion.
Churchill challenged Crolly’s views on the subject of infant baptism. Churchill,
an Anglican, cited the Book of Common Prayer in support of his belief that baptism
80Fleetwood Churchill, “Obstetric Morality:” Being a Reply to an Article in No. LXXXVD of “The Dublin Review.” Dublin Quarterly Review of Medical Science 26 (1 August 1858): 3. Cardinal Paul Cullen served as the leader of the Roman Catholic Church in Ireland from 1849 to 1878. Stephens and Lee, eds. Dictionary 5:277. The true source, if any, of Churchill’s reference to Cullen’s views on just war is unclear. According to Valerie Seymour, the special collections librarian at Maynooth Seminary in Ireland, John Fumiss was the author of the text Churchill attributed to Cullen. The discovery of Whether Fumiss referred to Cullen’s views is not possible at present as the text is missing at Maynooth. In 1867, in a sermon on the defense of the Papal States, Cullen argued that actions of an unjust aggressor justified acts of killing in self defense. A review of Cullen’s published sermons and pastoral letters revealed no reference to just war theory in the context of craniotomy or abortion. See Paul Cullen, “Discourse delivered in The Cathedral, Marlborough Street, 17 December 1867, On the Occasion of the Solemn Requiem Mass for the Eternal Repose of the Brave Men Who Fell at Mentana and Other Recent Battles in Defense of the Holy See,” in Patrick Francis Moran, ed., The Pastoral Letters and Other Writings of Cardinal Cullen 3 vols. (Dublin, Ireland: Brown and Nolan, 1882)3: 118,122.
8,Connery, Abortion. 214-215.
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proved generally necessary, but not essential for salvation. He believed that matters
absent from scripture imposed no obligation on believers as an article of faith. Since
scripture remained silent on the matter of baptism in utero, it represented an unnecessary
practice. Such infants, he believed, “leave their future lot to the loving-kindness and
tender pity of him who died for all.”83
The surgeon addressed Crolly’s critique of both craniotomy and his other views
on difficult childbirth. Churchill favored craniotomy when other means of delivery
proved impossible. Cases of obstruction presented the surgeon with two alternatives;
perforating the cranium of a living infant or awaiting its death to accomplish the same
task. The first option, according to Churchill, presented mothers with the best hope of
survival and served the interests of fathers. The doctor believed that physicians who
risked women’s lives must, “Be prepared to meet the responsibility he incurs toward
society.”84
^Churchill’s comment that baptism is “generally necessary” for salvation revealed the differences in belief between Roman Catholics and Protestants on the nature and significance of the sacraments. Roman Catholics believe that the sacraments, such as baptism, are themselves the sole means through which God communicates the sanctifying grace necessary for the salvation of Christians. Protestants believe that sacraments are not the sole means of grace. While baptism, for example, represents a biblically sanctioned form of the word of God it does not represent the only form of the word of God. For Protestants, like Churchill, the Roman Catholic understanding of the sacraments places human limits on God’s power to save by other means than the sacraments themselves. Adapted from Harvey Van Austin, A Handbook of Theological Terms (New York, NY: Macmillan, Company, 1966), 212-213.
83Churchill, “Obstetric,” 6.
’“ibid., 9,13.
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The propriety of the cesarean operation remained an unresolved dilemma for
Churchill. The operator cast doubt on his previous findings of a 43 percent surgical
mortality rate and noted other findings which set maternal mortality at fifty to seventy
five percent. At its most favorable, he claimed, the mortality rate of the cesarean
operation equaled that of craniotomy.85 Given such findings, the surgery remained a
means of last resort. He believed that such operations resulted in an unjustified sacrifice
o f women’s lives.
Churchill concluded by challenging Crolly’s authority, as a non-practitioner, to
speak with authority on the dilemmas of midwifery. The surgeon reiterated his support
for abortion through induced labor as a means to resolve cases of pelvic obstruction and
he expressed his approval, with a father’s consent, for the practice o f refraining from
delivering an infant after the mother’s death. Finally, Churchill challenged the authority,
credentials, and veracity of M. Debreyne; the Catholic authority cited most in the attack.
William Burke Ryan, a Catholic obstetrician, soon rushed to Crolly’s defense.
Ryan attacked what he termed the “loose discipline” of the Anglican Church on baptism
and craniotomy. No part of scripture, he asserted, justified the destruction of living
infants.86 Ryan claimed that differences in belief on human origins set Catholic surgeons
85Ibid., 16-17.
“ [William Burke Ryan], “Child-Murder-Obstetric Morality,” Dublin Review 45 (September 1858): 86; Houghton, ed. Wellesley. II: 63. However, Ryan noted that Dr. Thomas Percival also rejected quickening as a theory of human origins. Percival, a Unitarian, published an influential guide to medical ethics in 1803. Stephen and Lee, eds. Dictionary. 15: 829.
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apart from their Protestant counterparts. Churchill’s views, he argued, reflected a growing
materialism that substituted the statutes of civil law for divine authority.87
Ryan shared his opponent’s suspicion o f surgical statistics. Noting the reports of
success by French, German, and American surgeons, he accused British operators of bias
against the cesarean operation. Ryan termed the practice of craniotomy as “erroneous and
immoral,” and charged Churchill with indifference to the destruction of infants.88 These
views, Ryan charged, reflected the success of secular ideas in eliminating religion’s
influence on the practice of medicine. Such appeals to “the common sense of mankind”
had, in the past, only resulted in the savagery witnessed in the French Revolution.
Churchill replied with a challenge to Ryan’s belief in the necessity of infant
baptism. The British surgeon cited Thomas Aquinas, Jacques Paul Migne, and
Alphonsus Liguori in support of his own belief that such efforts were unnecessary.
Churchill also rejected the charge that he favored craniotomy. Instead, craniotomy
represented an option of last resort when forceps delivery foiled.89 Churchill hoped for
the future success of the cesarean operation. However, he remained opposed to
impromptu attempts by operators o f the present day.
Churchill argued against the background of different religious assumptions than
Ryan and Crolly. The surgeon’s embrace of Protestant theology represented his belief in
87Ibid., 88-89.
88Ibid., 105.
89Fleetwood Churchill, “Obstetric Morality,” Dublin Quarterly Review of Medical Science 26 (1 November 1858): 318
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scriptural authority rather than an established hierarchy. Churchill’s attempt to justify
craniotomy through civil law, based in a belief in quickening, reflected his conservatism
as a practitioner. Each antagonist attempted to justify the safety o f each operation
through appeals to quantitative data. However, accusations of statistical bias on both
sides nullified the arguments. The account revealed that the extent to which religious
presuppositions defined the arguments of each side in the debate. Each participant held
different beliefs shaped by religious tenets in the origin and significance of human life.
These beliefs, rather than the accumulated results of actual interventions, defined their
support for or against a given operation.
In 1859, Tyler Smith inveighed against craniotomy before the Obstetrical Society
of London. His comments exemplified the continued international debate over the
resolution of difficult births. Smith asserted that craniotomy and the cesarean operation
presented equal dangers for patients. Early physical examination, not delay during labor,
would help physicians resolve difficult deliveries. The practice o f early diagnosis, the
skilled use o f forceps, turning, and induced labor all would give physicians the means to
abolish craniotomy. Smith noted that some extreme cases still called for craniotomy.
However, he concluded, “Neither foeticide nor matricide need be entertained by the
accoucheur.. .the treatment which most certainly assures the safety of the child, is also the
safest for the mother.”90 Early diagnosis o f obstructed pelvis, then, represented the best
means to avoid destructive interventions.
90W. Tyler Smith, “On the Abolition of Craniotomy From Obstetric Practice, hi All Cases Where the Foetus is Living and Viable,” Transactions o f the Obstetrical Society of London 1 (1859): 50. William Tyler Smith studied at the Bristol School of Medicine.
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In America, physicians engaged in their own continued debate over the
appropriate means to resolve difficult births, hi 1859, Horatio Storer published a series of
articles in which he struggled with the practice of craniotomy on living infants as well.
Storer, a Boston physician, who would eventually convert to Catholicism, believed that
craniotomy represented a form of abortion. He told of his attempts to discern fetal vital
sign during obstructed pregnancies. Storer scorned those who ridiculed the practice of
baptism in utero.91 He endorsed the views of John Barry and asserted that baptism
provided solace to physicians amid the trials of responding to obstructed deliveries.
In 1861, Gunning Bedford published his own classroom lectures. Bedford
condemned the excessive use of destructive instruments among the practitioners of New
York City.92 The professor favored the cesarean operation, which posed risks to mothers
yet did not compromise their lives. In fact, he claimed, the operation “equalized the
chance of life” for both patients.93 Bedford noted the wide disagreement that persisted on
the indications for such operations. And noted that he relied on the degree of pelvic
diameter necessary to remove a child safely.
A frequent contributor to the Lancet he later became one of its sub-editors. Smith also took part in the establishment of the Obstetrical Society of London. William Munk, “William Tyler Smith, Lives of the Fellows of the Roval College of Physicians of London, comp. G. H. Brown, (London, England: Published by the College, 1955) 4:119- 120.
91 Horatio R. Storer, “Criminal,” 450-451.
^Gunning S. Bedford, The Principles and Practice of Obstetrics (New York, NY: Wood, 1861),619.
93Ibid., 619.
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The New York surgeon proposed to solve the dilemma posed by such operations
through an analysis of surgical statistics. Bedford accused British surgeons of
prejudgement in their frequent decisions against the cesarean operation. Using
Churchill’s statistics, Bedford noted that national ratios often concealed the excessive
practice of craniotomy by individual institutions. In Germany, the ratio of craniotomies
to live births was one in 1,675 of all deliveries. The ratio for Great Britain reflected a rate
of one in 291 deliveries. At the Dublin Lying-In Hospital, the ratio soared to a level of
one in 208 deliveries.94 Bedford expressed his suspicion that the rate proved even higher
among private practitioners. Like Smith, Bedford maintained that fear motivated the
actions of British surgeons. The continued practice of craniotomy reflected the deadly
legacy of the cesarean operation in Britain. The cause of such failures, he claimed,
reflected delay and the practice of surgery on women too exhausted to recover. Such
operations ignored the counsel of authorities who urged the practice o f early intervention.
Bedford noted the findings of John Hull, Johann Klein, and Jacque Pierre Maygrier in
support of his claim that early cesarean operations proved more safethan embryotomy.
Bedford concluded his remarks on the cesarean operation with a condemnation of
those who boasted o f their frequent recourse to craniotomy on a living foetus.95 The use
of anesthesia, he claimed, rendered the former operation safer than destructive surgery.96
Bedford’s discussion o f appropriate pelvic diameters illustrated the continued difficulty in
’“ibid., 629-630.
95Ibid., 634.
96Ibid., 651.
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resolving cases of difficult childbirth. The account also reflected Bedford’s effort to
reconcile his own Catholicism with the promise of medical progress. The author’s
criticism of practitioners of craniotomy illuminated the fear that bound doctors, on both
sides of the Atlantic, to the destructive operation.
In 1864, Hugh Lenox Hodge o f Philadelphia examined the merits o f both
operations in his text.97 For Hodge, the option of craniotomy posed a dreadful prospect
for operators.Oft Craniotomy often resulted in pelvic lacerations or death for mothers.
Hodge considered European mortality statistics in his search for appropriate terms of
intervention. While William Dewees intervened at two inches of pelvic contraction
“conscientious British authorities” awaited contraction of one and a half to one and three
quarter inches. Hodge noted that “modem accoucheurs” performed cesarean operations
at two and a quarter degrees of pelvic contraction.
Hodge’s discussion of the limitations of auscultation in childbirth illustrate the
continued problems of intervention in difficult cases. Like most physicians, Hodge
preferred to perform craniotomy on dead infonts. Hodge favored auscultation as a means
to determine the infants vital status before commencing. However, the technique had
97Hugh Lenox Hodge, obstetrician, graduated with the M.D. from the University of Pennsylvania in 1818. He replaced William Dewees as Chair of Obstetrics at the University of Pennsylvania and became physician to the lying-in department of the Pennsylvania Hospital. Hodge was also a fellow of the College of Physicians in Philadelphia. Howard Kelly and Walter Burrage, eds. Dictionary of American Medical Biogaphv (Boston, MA: Milford House, 1928; repr. Boston, MA: Milford House, 1971), 574-575.
98Hugh Lenox Hodge, The Principles and Practice of Obstetrics (Philadelphia, PA: Blanchard and Lea, 1864), 271.
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shortcomings of its own. As an illustration Hodge noted one pregnancy where the
consultation of four physicians proved necessary to establish the presence of an infont’s
heartbeat through auscultation.99
Hodge believed that cesarean operations were “fraught with danger” for
mothers.100 and he speculated about whether the procedure proved necessary at all.
Pelvic deformity, he argued, proved most common among “foreigners” who suffered the
effects of childhood disease.101 The cesarean operation, he argued, remained the sole
domain of the most skilled surgeons. While Hodge questioned the accuracy of
contemporary mortality statistics, he expressed hope that future hospital statistics would
reflect an accurate means to assess the value o f the procedure for future operators. Given
the varied results of the new technique, Hodge rejected Bedford’s criticism of
craniotomists. The dilemma presented by the choice represented, a delicate question of
professional ethics, and should be decided by the conscience of every enlightened
practitioner under the influence of the past experience of the profession, the weight of
individual authority, and the peculiar standards o f each individual case.102 Hodge praised
Joseph Nancrede, who thirty years before had succeeded in the performance of cesarean
section in Philadelphia, and asserted that cesarean operations “may be justifiable.” The
"ibid., 228.
IOOIbid., 280.
l01Ibid., 285.
102Ibid., 283.
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complete substitution of the cesarean operation for craniotomy awaited verification by
additional evidence.
The cesarean debate in America reflects the international study of medical science
and the unique social setting of a particular nation. In Louisiana, Catholic ideas shaped
the culture of medicine before 1800. hi the English settlement, Catholic attitudes toward
childbirth reached American physicians through other means. The publication of
European medical textbooks contained accounts of successful cesarean operations.
Newly trained physicians returned from Paris to hand on their own knowledge of
midwifery to students in American medical schools. The achievement of Joseph
Nancrede, a Catholic, encouraged American advocates o f the future prospects for
successful cesarean operations. The establishment of Catholic institutions represented
another means to hand on an emerging ideal of non-destructive midwifery. The
introduction of these ideas resulted in an American cesarean debate among physicians.
The Bedford-Hodge debate revealed the emergence of a cesarean debate that was
uniquely American. Informed by the differing moral perspectives existing in a pluralistic
society, churchmen and physicians advanced a range of approaches to medical
intervention. Ironically, while improvements in obstetric knowledge gave physicians
more options in the search for solutions to difficult deliveries they also added the moral
complexity posed by the dangers of surgery. The debate was confounded increasingly by
the understanding that craniotomy was a special subset o f interventions that could be
called therapeutic abortion. By 1865, medical science could not carry physicians,
Catholic or Protestant, as far as their ideals would take them, but moral limits needed to
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be established and the standards of the Catholic Church provided the medical profession
with a clear limitation if craniotomy was seen as an abortion.
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ROMAN CATHOLICISM AND ABORTION
IN AMERICA, 1834-1871
Even as physicians and theologians on both sides of the Atlantic debated
acceptable surgical procedure in the case of problem pregnancies, they debated the
circumstances and method of aborting a fetus. Though he was not a Roman Catholic, the
sentiments of American physician Dr. Horatio Storer reflect the desire of many physicians
to reconcile a spiritual position with what they regarded as the best medical option—
abortion.
Is it not, however, due to humanity in every way to prevent this frequent murder? For such, by our apathy and neglect, the mother’s death in these cases becomes. Can we, as Christians, refuse any aid? I am not ashamed to acknowledge that for myself, though no Catholic, I have performed this intra-uterine baptism, where delivery without mutilation was impossible. I could neither conscientiously assert the child’s death, nor allow the mother to linger till it should occur.103
Horatio Storer’s comments appeared in a series of articles entitled Criminal Abortion.
The effort during a difficult birth to baptize a child before destroying it suggests that
surgeons were averse to abandon spiritual obligations to the press of medical exigency.
The Aristotelian notion of quickening still prevailed as a theory of human origins.
Under this theory, the fetus assumed human identity when it kicked in the womb.
Therefore, physicians often destroyed infants to save mother’s lives. After 1800, new
103Storer, “Criminal,” 451. 47
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ideas, like immediate animation, challenged such ancient precepts. Storer’s dilemma
reflected his belief that life began at the moment of conception, and his honor that he had
no alternative but to destroy the child. Such beliefs reshaped the views of physicians
toward abortion and the search for new solutions like the cesarean operation. As the
Roman Catholic Church gained in influence in the United States, Churchmen were more
able to affect debate among secular physicians. Changing beliefs within the Church
resulted in a desire to alter medical practice in the United States to reconcile them with
this new Catholic perspective. By 1871, changing theological perspectives on birth
persuaded the American Medical Association to alter its own position and to formally
censure abortion. This chapter explores how Catholicism changed popular beliefs on
conception, resulting in the AMA censure o f abortion in 1871.
No scholar has folly accounted for the role of religion in shaping American
attitudes against abortion. James Mohr argued that opposition to abortion reflected anti-
Catholicism, fears of some native bom Americans that a decline in the birth rates of the
native-born and the increased birth rates o f Catholic immigrants would result in a
Catholic takeover of the early republic.104 Janet Farrell Brodie viewed efforts to outlaw
abortion as attempts to disempower women. Such efforts were the outcome of a purity
crusade by white, middle-class, native-born, men and women.105 However, no one has
104Mohr, Abortion. 35, 167, 183.
10S Janet Farrell Brodie, Contraception and Abortion in Nineteenth Century America (Ithaca, NY: Cornell University Press, 1994), 1.
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explored the role of Catholic ideas in shaping opposition to abortion among American
physicians and the public.
The phenomena of European immigration introduced new ethnic and religious
folkways into American culture. During the 1840s, Catholicism reshaped public attitudes
in favor of the criminalization of abortion. Advances in European biology, in turn,
reshaped long-held religious assumptions about the origins of human life in favor of ideas
that gave infant life an absolute value, hi 1869, with the adoption of these ideas, the
reshaping of Catholic theology culminated in the restatement of the Church’s opposition
to abortion. Within the American medical profession these new ideas helped create a
consensus against the practice of abortion. The Catholic hierarchy, practicing physicians,
and believers shaped a social consensus against abortion in America by advancing the
same ideas both within and beyond the confines of the organized medical profession.
While disagreement persists among scholars on the antiquity o f universal
legislation, the prohibition of abortion has the most ancient roots as a Catholic faith issue.
Early Christian authors, such as Clement of Alexandria and Hippolytus of Rome,
condemned the practice as early as the second century. By the fifth century, the Church
maintained that abortion surpassed homicide in criminality because it prevented the
baptism of children. I fW« The norms of ecclesiastical councils established by the hierarchy
l06Roland W. Amundsen and Gary B. Femgren, “The Early Christian Tradition,” in Caring and Curing ed. Ronald Numbers and Darrel W. Amundsen, (New York, NY: Macmillian, 1986), 50.
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of regional Churches, such as the Council o f Ancvra (317), represented precedents for the
Latin Rite Church.107
The primitive state of the knowledge of embryology created confusion about
human origins and complicated for Churchmen and the laity penitential norms for the
crime of abortion. Augustine and Aquinas considered only abortion of the formed fetus
as homicide. In the twelfth century, Gratian allowed for the same distinction. Pope
Sixtus V established excommunication as the penalty for the crime of abortion in 1588.
In 1591, the next Pope revised the penalty to allow for a distinction between the formed
and unformed fetus. Then at the close of the eighteenth century, Alphonsus Liquori, a
prominent theologian, asserted that the moment of conception marked the origin of life.
In 1869, Pope Pius EX abandoned the distinction between the formed and unformed fetus
in favor of immediate animation.108
The discussion of abortion has deep roots in the history of biology and sexual
reproduction. During the seventeenth and eighteenth centuries, biologists grappled with
the question of human origins. By the close of the seventeenth century, two theories
posited by William Harvey had gained acceptance. He suggested, first, that some
primordium or conception created human embryos; second, this conception remains as an
egg within the body until the fetus developed. Less agreement existed on the relationship
I07Connery, Abortion. 88.
108Ibid., 148,210.
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between the egg and semen in the process. Such disagreements fueled the debates of the
next century. tOQ
During the eighteenth century mechanistic notions o f sexual reproduction
prevailed. Naturalists, influenced by Cartesian philosophy, proposed the theory of germ
pre-existence. Under this theory, God made human germs with all their parts pre-existent
on the day of creation to await transmission into the world. Ovists maintained that the
human egg represented the abode of the pre-existent person. Nicholas Hartsoeker, a
spermist, viewed the sperm as a homunculus containing the pre-existing parts o f the
human person.110
Not all naturalists believed in theories of pre-existence. Carl Linnaeus taught that
both sexes contributed to the process of conception. However, Linnaeus had no idea how
conception occurred. Proponents of Newtonian ideas arose to challenge the ideas of the
Cartesian naturalists. Pierre Louis de Maupertis viewed conception as the result of the
interaction of male and female seminal fluids. George Louis de Buffon promoted the
dynamism of nature, claiming that conception represented the recycling of “organic
molecules” released at death and re-formed into a new life. Lazzaro Spallazani, a
proponent of pre-existent ovism, was challenging Bufifon’s ideas at the turn of the
century.
109John Farley, Gametes & Spores (Baltimore, MD: Johns Hopkins University Press, 1982), 16.
uoIbid.,20.
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During the nineteenth century, German Universities nurtured new ideas on the
origins of human life among European scientists. Proponents of epigenesis asserted that
conception had a homogeneous beginning that resulted in a process of growth and
differentiation. Hence, each embryo became a distinctively new being. Karl Von Baer
validated the findings of early epigenicists in 1828. Early epigenicists, asserted that
conception involved the chemical reaction of seminal fluid. Theodor Bischofif believed
that contact with sperm rather than seminal fluid fertilized the egg. Modem notions of
epigenisis the ideas of Oscar Hertwig, Hermann Fol, and Edward Strasburger, emerged
after 1870. Like theology, progress proved non-linear as a consensus emerged in the
early twentieth century. Proponents of earlier theories existed late into the nineteenth
century.111
Concurrently, and perhaps inadvertently, the Roman Catholic Church in Europe
was also engaged in its struggle over the origins of human life. In 1854, Pope Pius DC
concluded a centuries-iong process of doctrinal development with a solemn definition of
dogma on Mary as the Mother of God.112 The Dogma of the Immaculate Conception
proclaimed that God protected Mary from the moment of her conception from the effects
of original sin through an act of divine grace. For believers, Mary became the sinless
bearer or Theotokos of Jesus the Son of God by divine initiative.
m Ibid.,31.
m Edward Dennis O’Connor, The Dogma of the Immaculate Conception (Notre Dame, IN: University of Notre Dame Press, 1958), V-VT.
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For centuries, evolution of this dogma involved theological reflection on human
conception. Medieval debates on original sin resulted in distinctions between active and
passive conception. Active conception occurred with the completion of the fertilization
of the embryo following sexual intercourse. Passive conception occurred later when God
infused an immortal soul into the human body. This ambiguity led to the notion of
mediate animation, the thesis that ensoulment occurred sometime after conception.
Other physician-theologians proposed new ideas about conception. Thomas
Fienus, a seventeenth century professor of medicine at Louvain, advanced the theory of
immediate animation. Fienus argued that “ensoulment is coincident with fertilization, or
at least, as early as possible after conception.”113 Paul Zacchias, a Roman physician,
maintained that fertilization and ensoulment were simultaneous.114 Prominent Catholic
physicians in nineteenth-century America endorsed immediate animation as well.lls
Mediate animation began to give way to immediate animation as Church teaching.
The latter became the bulwark of the Church’s teaching against abortion and reproductive
control in the nineteenth century.116 Like science, the progress of theology represented a
113Thomas A. Shannon and Allan B. Wolter, “Reflections on the Moral Status of the Pre-Embryo,” Theological Studies 51 (December 1990): 615.
ll4Rev. E. C. Messenger. Theology and Evolution (London. England: Sands & Co. Ltd., 1952), 238.
IISBarry, Embryology. 16; Gunning S. Bedford, Clinical Lectures on the Diseases of Women and Children sixth ed. (New York, NY: Samuel S. & William Wood, I860), 535.
116During this century Reverend E. C. Messenger and Canon Dorlodot o f Louvain University have called immediate animation into question on philosophical grounds. More recently, Thomas Shannon and Allan B. Wolter have called for its re-evaluation
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non-linear movement forward. The ideas of active and passive conception, and
immediate and mediate conception, coexisted for some time within the Church.117 In
1843, Pope Benedict DC adopted immediate animation in his discussion o f the
Immaculate Conception.
In the United States, Catholic theology, shaped by new ideas on human origins,
began to change the attitudes o f physicians toward abortion. John Monmonier, of
Baltimore, published the first discussion of abortion by an American Catholic
• t A physician. In 1834, Monmonier wrote his M.D. dissertation at the University of
Maryland School of Medicine. The paper commented on the signs and causes of
because of recent developments in embryology, hi his recent encyclical, Pope John Paul H, maintained that human life begins from the moment of fertilization. The position is a response to those who maintain that, for a time, the embryo is not a personal human life. See John Paul II, “Evangelium Vitae.” Origins 24 (6 April 1995): 710.
117For an example of a Catholic physician who continued to believe in mediate animation, see John D. Bryant, The Immaculate Conception (Boston, MA: Patrick Donohue, 1855), 46.
118Johanne Monmonier, “De Abortu.” M.D. dissertation, AMs, 12 pgs. University of Maryland, Health Sciences Library, Baltimore, MD, 1; See also “Monmonier, John Francis. 1849. Bom at Baltimore, April 4, 1813; Son of F.W. Monmonier. Educated at St. Mary's College, Baltimore; Student in the Private Anatomical School of Dr. Duncan Turnbull; M.D. University of Maryland, 1834; Member of the City Council of Baltimore, 1836-1837 and 1840-1847; School Commissioner, 1836-1852, and for several years the President of the School Board; Physician to the Board of Health, 1849-1851; Chairman of the Executive Committee of the Medical and Chirurgical Faculty of Maryland, 1854- 1877; Assisted in the Organization of Washington University School of Medicine in Baltimore, 1867; Professor of Physiology, Washington School of Medicine, 1867-1875; Orator, Medical and Chirurgical Faculty, 1871; Professor Diseases of Women and Children, Washington University School of Medicine 1875-1877; President, Medical and Chirurgical Faculty, 1875-1876; President of the Baltimore Medical Association 1880- 1881, Died at Baltimore June 8, 1894.” Eugene Fauntleroy Cordell, Medical Annals o f Maryland (Baltimore, MD: Williams & Wilkins Company, 1903), 508.
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abortion. The text dealt with the prevention of a miscarriage from premature labor as
well. Abortions were possible after three months, when the pregnant womb could be
stimulated to expel its contents.119 Women, he claimed, who engaged in illicit
intercourse might approach physicians with false complaints of dysmenorrhea.120
Treatment for the illness could result in the unintentional commission of a crime.121
Affluent women rather than the poor, he claimed, approached physicians most frequently
to seek abortion.122 Obviously, Monmonier viewed the practice of procured abortion as a
crime. The text also suggests that in nineteenth century Maryland abortion represented a
common practice.
In 1841, Bishop Francis Kenrick published the first Roman Catholic teaching on
the subject. Kenrick published Theologiae Moralis. a training manual of moral theology
for seminarians. In an essay entitled De Abortu. Kenrick condemned the destruction of
119“Progressio gestationis cito impedisi potest, nam ex causis abortum producentibus post lapsum trium mensum.” [After the passage of three months the progress of gestation can quickly be impeded for the cause of producing abortion.] Ibid., 1.
120Dysmenorrhea is defined as painful menstruation. Dorland’s. 516.
I21“Hiis mediis ejiciendi foetum saepe utuntur quae illicitum commercium habuerunt, et cum signa in hoc casu Dysmenorrhea simmillima saint, no raro se praebet medicus, ad crimen perpetrandum.” [Those women who have had illicit intercourse use these means of procuring abortion, since the signs of dysmennorhea are most alike in such a case, the doctor presents himself for the perpetration of a crime.] Ibid., I.
122“Inter mulieres honestiores et vita commodis affluentes et etiam delicatores sappissime occurit, inter eos vero qua humilem locum tenet raro videtur.” [Among the more esteemed and refined abounding in life’s conveniences it happens most often but among those of a more humble station it is rarely seen.] Ibid., 1.
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the living fetus in utero.123 Like Tertullian, a theologian of the third century, Kenrick
argued that such acts were intrinsically evil because they impeded the birth of a human
being already present in the seed.124 The bishop acknowledged the differences in opinion
over ensoulment but his adoption of Tertullian sidestepped the ambiguities of ensoulment
and mediate animation. The stance placed Kenrick in opposition to abortion before
quickening.
Gunning S. Bedford, a Catholic physician, condemned abortion in his account of
an obstructed pregnancy experienced by a client o f Madame Restell, a purveyor of
abortifacients. Bedford successfully delivered Mrs. M, despite the attempted abortion, by
performing a bi-lateral section of the uterus, hi the account, Bedford repeatedly
condemned Restell’s flourishing practice of abortion.125 Despite Bedford’s outrage,
Restell’s services remained in demand in New York. Restell, first arrested in 1841,
123Connery, Abortion. 225; Kenrick, Theologiae. 110.
I24“Homicidio semel interdicto, etiam conceptum utero, dum adhuc sanguis in hominem deliberatur, dissolvere non licet. Homicidii festinatio est prohibere nasci; nec refert natam quis eripiat an imam, an disturbet nascentem. Homo quifuturus est, nam fructus in semine est. Constat numquam licere abortum procurare, quum res per se mala sit impedire ne homo nascatur, qui in semine jam est.” [Once homicide is forbidden it is not permissible to put an end to what is conceived in the womb as long as blood is provided to a human being. Prohibiting one to be bom is hurrying a murder it makes no difference who would disturb the process of life being bom. It is a man about to be for the fruit is present in the seed, it is clear that it is never allowed to procure abortion for it is an intrinsically evil thing to impede a human being bom who is already present in the seed.] Ibid., 111.
125Gunning S. Bedford, “Vaginal Hystereotomy,” New York Journal of Medicine 2 (March 1844): 201.
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continued practicing until her arrest and suicide in 1878.126 This persistence suggests that
a social consensus on the criminality o f abortion did not exist in the wider culture during
the ante-bellum era.
The existing evidence suggests that such a consensus did exist in other quarters.
Many Catholics read Bedford’s lectures against embryotomy.127 Despite his failure to
stem Restell’s practices, Bedford’s outspoken attitudes on abortion and Christian
behavior found a ready audience among the Catholic community. Book reviews and
articles in Catholic periodicals reveal that lay Catholics were aware of recent
developments in anatomy, physiology, and midwifery. The wide publication of such
journals caused Bedford’s views to reach an audience for beyond the New York medical
community.
Dr. John Barry, known for his advocacy of the cesarean operation, sought to
prevent promiscuous individuals from learning about abortion and contraception. In his
opinion, continence, refraining from sexual intercourse, represented the only acceptable
means of preventing births. Barry justified his rejection of abortion by reference to his
126Mohr, Abortion. 199.
l27“Ask the moralist, and he will tell you that the foetus is a living being in the broadest acceptation of the term, and that the unjustifiable taking of its life is, in the eye of Heaven, murder. I am not ignorant that a man, under the privileges conferred by his diploma, may recklessly, and with impunity, so for as human law is concerned, sacrifice life in the manner I have just described to you; but if truth be not a fiction there will come a day of fearful retribution.” Bedford, Delivered. 13. Reviews of Bedford’s lectures appear in the following issues of the U.S. Catholic Magazine 6 (1847): 115, 7(1848): 224, 8(1949): 89, 101; Louisville Catholic Advocate. 16 January 1847. Catholics were not unaware of the dilemmas of abortion. See Mohr, Abortion. 190-191.
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belief in immediate animation.128 Barry supported Valentini and Cangiamilla’s claims
that immediate animation held wide acceptance among European bishops, theologians,
and medical faculties.129 For Barry, claims that a fetus was inanimate did not justify
abortion. The Kentucky doctor distinguished between miscarriage and voluntary
abortion. Barry believed that the fetus possessed an immortal soul, and that any attempt
to abort the fetus after conception represented a grave crime. He also argued that
physicians should baptize a fetus at risk like any newborn child.
Dr. Barry criticized the absence of abortion laws in the United States. Women of
the early Church who had abortions had faced public penance and absolution only at
death. The surgeon discussed the penal statutes promulgated by Pope’s Sixtus V and
Gregory XIV. Britain’s Ellenborough Act of 1803, he noted, protected the lives of
infants. Strict statutes against abortion also existed in France before and after the
revolution. The Kentucky surgeon thus became an early proponent of laws against
abortion in the United States.130
128Barry, Embryology. 9,10; Barry also cited: Rosiau, J. J. Medecine Pratique Populaire. Secours a Donner aux Emnoisonnes et aux Asphyxies et Nouveau Traite d'Embrvologie Sacree. (Mamers,1839); Pierre Jean Comielle Debreyne, Precis de Phvsiologie Humaine. (Bruxelles, 1844). Debreyne was a French physician who became a Franciscan friar, priest, and moral theologian.
129Ibid., 18.
130Public penance represented a practice of the Patristic Era for men and women. The Canons of the Council of Nicea (325) contained public penances as lengthy as thirty years. Public penitential practices proved impractical for the Church. By the early fifth century, the monastic practice of private confession emerged, the forerunner of the modem day practice of Catholics of the Latin Rite. See Monika K. Hellwig, Sign of Reconciliation and Conversion (Wilmington, DE: Michael Glazier, 1984), 37-38,41-43.
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In May of 1847, a review of Barry’s work appeared in the St. Louis Medical and
Surgical Journal. Moses Linton, the reviewer, taught at St. Louis University, a Jesuit
school. Linton observed that for most readers Barry's ideas represented nothing new.
The essay noted however that physicians, religious or not, held ideas about their duties
toward the unborn that were not expressed in rules or fixed laws in America. Linton
viewed Barry’s work as an important book for all physicians because it provided a guide
in a field of medicine lacking fixed ethical precepts.131 The review is important because
it points out that the author’s intent is not solely to serve a Catholic audience, but to serve
as a moral guide for all troubled by the issues inherent in abortion.
Other accounts of the history of abortion in America have revealed many motives
for the zeal of physicians in seeking to outlaw abortion.132 Linton attested to the same
diversity of motivations when he wrote, “Physicians of all religion and of no religion,
have certain innate or acquired ideas in regard to their duties to the embryon; but not
many of them are governed by any fixed laws or rules.”133 In Jacksonian America, this
individualism characterized American life at large. However, the role of Catholicism in
shaping the motivations of individual physicians in movement against abortion has been
largely overlooked.
131Moses Linton, “Review of Medico-Christian Embryology.” in The St. Louis Medical and Surgical Journal 4 rVfav 1847): 553.
132Mohr, Abortion. 35,167,183; Brodie, Contraception, 1.
133Linton, “Review,” 553.
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In the 1840s, the influence of religious ideas on the medical profession was
uneven. While the Catholic Church established hospitals and infant asylums, physicians
often kept religion at arm’s length. Advocacy of sectarian medicine and the endorsement
of quack remedies by some clerics aggravated matters further. As late as 1905, the
Georgetown medical faculty prevented Jesuits from teaching ethics in the medical school.
This tendency is due, in part, to a struggle for social authority in ante-bellum America.134
The association o f medicine with science, and the verifiable success o f medical treatment,
ultimately gave physicians professional authority that surpassed other professions.
However, in the age of Jackson, the poor results of heroic medicine drove many
Americans to seek other solutions in the cures of sectarian medicine. In obstetrics, the
best physicians contributed to the advance of medical knowledge. However, many poorly
trained physicians continued to practice midwifery to the detriment of their patients. Due
to poor therapeutic outcomes, the public lacked confidence in antebellum physicians.
Consequently, state legislatures ignored physician's efforts to promote new medical
practice laws which would reserve the practice of medicine to regular physicians.13S
The struggle for social authority is evident in the AMA’s early efforts to proscribe
abortion.136 At the 1857 convention, discussion of abortion illustrated the tension
between proponents of self-remedy, and regular physicians who promoted the
,34Paul Starr, The Social Transformation of American Medicine (New York, NY: Basic Books, 1982), 35-36.
I35Ibid., 58-59.
I36Ibid., 18.
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intervention of physicians in obstetric practice. The denunciation of midwives, like
Madame Restell, and those who sold abortifacients disclosed the same tensions. The
published proceedings o f the convention also reveal the influence of religion on those
who denounced abortion.
D. Meredith Reese, a frequent contributor to the Methodist Review, testified
before the AMA Special Committee on infant mortality. Reese’ criticism of urban infant
mortality and abortion abounded with religious imagery. The unnaturally high mortality
rates reflected “our ignorance, our misfortunes, our follies, or our crimes” rather than the
plan of God.137 Such mortality rates did not correspond with actual totals for internment
of infants. The phenomenon was attributable to the “ghastly crime of abortion.”138
Reese viewed abortion as a murderous trade in large American cities. Corrupt
civil authorities protected such commerce while “male and female vampires” promoted it
in the printed press. Public authorities knew the names, addresses, and post office boxes
of practitioners. Reese viewed abortion providers as murderers who, “take their seats at
the opera: promenade our fashionable thoroughfares, and drive their splendid equipages
upon our avenues.” Meanwhile, “the blood of the slaughtered innocents” cried out for
vengeance.139 The latter is a biblical allusion to the crime of Herod in Matthew 2:1-18.
I37D. Meredith Reese, “Report on Infant Mortality in Large Cities. The Sources of its Increase and Means for its Diminution,” Transactions of the American Medical Association 10 (1857): 96.
I38Ibid., 97.
139Ibid., 97.
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Reese denounced abortion by married couples who sought to delay the
responsibilities of parenthood. He condemned premature delivery for the same purpose
as well. For Reese, procreation represented the primary aim of coitus—an end “ignored in
these degenerative days.”140 High rates of mortality for both stillborn and early infancy
cases reflected use of unnatural means of preventing conception. Reese also believed
medications, including medication to ease the pain of childbirth, reflected another cause
of mortality. Given the lack o f detailed knowledge of pharmacology and the physiology
of infants in relation to their mothers it is entirely possible that the often heroic use of
anesthetics, like alcohol and opium as analgesics, did damage infonts.
Reese proposed measures to improve the health and moral habits of parents to
stem infant mortality. The civil regulation of marriage was among the means suggested
to stem abortion. Compulsory celibacy for those who suffered from infectious and
sexually transmitted diseases reflected a more draconian solution. The establishment of
foundling hospitals for women unmarried or unwilling to bring infants to term proved less
severe.141 Improved housing for the poor reflected another means of promoting
children’s health, hi children’s hospitals, he claimed, patients could avoid sources of
infection present in the home. Finally, Reese promoted sanctions against the sale of
adulterated food and milk. Apart from his severe views on celibacy, Reese's Sanitarian
views suggested a means of diminishing infant mortality through broader social uplift.
l40Ibid., 98.
141 Ibid., 102-103.
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His arguments are of interest because they illustrate both the tensions of urbanization and
the existence of religious grounds for the opposition to abortion.
At this same 1857 AMA convention, the AMA addressed abortion directly with a
special committee led by Horatio Robinson Storer, the Boston physician. The committee
endorsed a report and resolutions submitted by Alexander Jenkins Semmes, a
Georgetown graduate, and future Catholic priest. This study uncovered no evidence of
opposition within the AMA to the prominent role played by Catholics in the movement to
outlaw abortion. Semmes’ report on the medical and legal duties of coroners addressed
abortion indirectly.142 He mentioned the District of Columbia, where no means existed
for the registration of births and deaths.143 Semmes hoped that the registration of births
and deaths would prevent practitioners from concealing abortions. In December of 1857,
an editorial on the same report in the Boston Medical and Surgical Journal also cited
determination of the cause of death, and its civil registration, as a means of ferreting out
suspected abortionists.144
Roman Catholic ideas on abortion were further elaborated during the 1859 AMA
Convention. A report by physician Horatio Storer explored three reasons for the frequent
142 Alexander J. Semmes, “Report on the Medico-Legal Duties of Coroners,” Transactions of the American Medical Association 10 (1857): 111-124.
I43Since 1850, Washington physicians resisted efforts to register births and deaths. Similar attempts in 1866,1870, and 1871 failed as well. See D. S. Lamb et. al., History of the Medical Society of the District of Columbia (Washington, DC: Published by the Society, 1909), 107-110,249-250.
144“Infant Mortality,” Boston Medical and Surgical Journal 62 (3 December 1857), 364-365.
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crime of abortion. First, the prevailing popular ignorance that held to belief in
quickening. Second, the perceived failure of physicians to prevent abortions. Finally,
defects in common and statutory law that failed to recognize the foetus as a living
person.145 Storer promoted creation of an obstetric code to prevent abortion. The report
urged the AMA to lobby state, District of Columbia, and federal officials to establish
effective laws against abortion.
Storer proposed resolutions for consideration by the whole convention
membership following his report. First, the convention acknowledged the frequency of
the crime of abortion with a “solemn and earnest protest against such unwarrantable
destruction of human life.”146 The second resolution sought legislative remedies to end
the crime of abortion. Finally, state medical societies were exhorted to bring the issue
before state legislatures. The convention delegates adopted the resolutions by an
unanimous vote.
The AMA Convention was not the sole arena for the abortion debate. Storer
wrote a series of articles in the North American Medico-Chimrgical Review running from
January to November of 1859. Later, Storer consolidated the series in Criminal Abortion.
In May, Storer discussed how religion influenced the incidence of abortion both in France
and the United States, hi both countries, he pointed to the tendency of the wealthy to
145Horatio R. Storer, “Report on Criminal Abortion,” Transactions of the American Medical Association 12 (1859): 75-76.
146Ibid., 27-28; 76-77.
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stem childbirth.147 In France, he attributed abortion to the existence o f loose morals. In
America, Storer attributed the frequency of abortion to the failure o f Protestant
Christianity to compel behavior.
Storer, noted that Protestantism in no way encouraged abortion stating, “its tenets
are uncompromisingly hostile to all crime.”148 Much of the problem Storer grappled with
resulted from the lack of official religion in America, Protestants could simply change
churches if one became too restrictive or punitive. Such failure, according to Storer,
reflected popular ignorance, and the failure of abstract morality to motivate human
behavior. Catholic discipline, imposed by the local bishop, crossed parish lines and if
serious at all would follow a parishioner from one diocese to the other. In contrast, Storer
cited the doctrine and practice of the Roman Catholic Church “which has saved countless
of infant lives.”149 Catholicism’s perceived ability to compel the actions of individuals
through the confessional, sanctions, and excommunication distinguished it from
Protestantism. While differences in discipline existed between the two faith groups, no
reliable data on the incidence of abortion in either group exist for the era of study.
Though not a Catholic, Storer cited the Canon Law and pastoral practice of the
Roman Catholic Church, especially its prohibition of abortion in the early months of
pregnancy. Catholic infants had a right to sacramental baptism, which corresponded with
a Catholic physician’s duty to verify death before removing a foetus from the womb. In
147Storer, “Criminal,” 448-449.
148Ibid., 453.
149Ibid., 453.
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cases of obstructed pregnancy “where delivery without mutilation was impossible,”
Storer urged physicians to baptize children with a water-filled syringe before resorting to
instrumental delivery. The surgeon directed operators to John Barry’s text for
instructions on the practice.150 Storer noted a case where he could not ascertain the death
of the child, nor could he risk the death of the mother. Bany, however, never permitted
the destruction of a living child in such cases. Instead, Barry urged physicians to practice
the Caesarean operation to save both padents.ISI While Storer shared Barry’s belief in
baptism, his solution of baptizing the child before destroying it differed with Barry’s own
obstetric method. Discussions of the principle of double effect revealed that, for
centuries, European theologians differed over the appropriate solution to the emergencies
of childbirth.IS2
While debates raged in European departments of theology and medicine, Storer
promoted the teaching and practice of the Catholic Church in the United States. In his
series of articles, Storer noted his correspondence with Archbishop John Fitzpatrick of
Boston, an ardent supporter of the AMA’s 1857 opposition to abortion. Fitzpatrick
referred to the long history of opposition to abortion in the Church Canons, Pontifical
Constitutions, and writings of theologians. The Archbishop claimed that such sources of
authority teach, and have always taught that from the moment of conception abortion is a
l50Ibid., 450.
lslBarry, Embryology, 46,67.
,S2John T. Noonan, The Morality of Abortion (Cambridge, MA: Harvard University Press, 1970), 31-32.
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crime at least equal in guilt to murder. Fitzpatrick noted the ruling of Pope Sixtus V
(1588) that treated abortion as murder. The Archbishop offered the teaching of Tertullian
as proof of the ancient character of the prohibition.
Fitzpatrick further asserted that no one could determine the precise moment that
God infused life into the body. Theology could only verify that human life existed. For
Fitzpatrick, the foetus was a person from the moment of conception. Abortion drove a
divinely created human soul back into nothingness without the opportunity to exist in
creation.I:>3 Thus abortion represented an interference with God’s creative plan,
compounding its criminality.
Fitzpatrick criticized women who used abortion to avoid illicit pregnancies. He
also charged affluent women with choosing abortion to avoid missing “trips and
amusements” of summer. The Bishop viewed abortion as a threat to the existing social
vision for women of maternal responsibility. The separation of reproduction from
sexuality, he claimed, degraded women by making them objects of the lust and
licentiousness of men.
Storer’s public advocacy of Fitzpatrick’s views raises questions about claims that
the doctor appealed to nativist sentiments. Storer does compare the birth rates of the
Catholic with Protestant Americans. Yet, Storer appears in at the convention in
Louisville, as a public advocate of Catholic teaching against abortion. Storer takes this
stand in an age o f Know-Nothing agitation against Catholics and foreign immigrants.
I53Horatio R. Storer and Franklin Fisk Heard, Criminal Abortion. Its Nature. Its Evidence, and its Law ( Boston, MA: Little, Brown, 1868; reprint, New York, NY: Amo Press, 1974), 71. (page reference is to reprint edition).
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The clear interpretation of both Storer’s advocacy of Catholic leaders and, his comparison
of birth rates for native and foreign bom Americans requires further study.
In a later article, Storer decried the lack of statutes against abortion in States and
the District of Columbia, especially laws that prevented the concealment of births and
burials. Storer claimed that French laws enacted to prevent secret burials had the desired
effect of preventing abortion. The establishment of an efficient coroners office would
provide a means to differentiate fatalities from criminal abortions. Storer lamented, “we
could wish that this point might have received special attention from Dr. Semmes, in his
late admirable report to the American Medical Association.” Semmes circumspection on
the aim of reform in the coroners’ office perhaps reflects the pall that nativism
engendered in Catholics of the era.154 This explanation perhaps accounts as well for the
early silence of Catholic bishops on the issue.
During the next AMA convention, AMA president Henry Miller reported on the
progress of the 1859 resolutions. In January of 1860, Miller detailed his success in
contacting state and federal governments. Efforts to contact the cooperation of state
medical societies were less successful and faced significant obstacles. Miller pointed out
the obstacles to success. Popular opinion “winked” at the resort to abortion early in
pregnancy and widely accepted menstrual purgation to end a pregnancy. All hinged on
the dubious belief that “fetal life is not thereby sacrificed, but only its kindling
154William W. Warner, At Peace With All Their Neighbors (Washington, DC: Georgetown University Press, 1994), 225-226.
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obviated.”155 Belief in quickening, he argued, must yield to acceptance of immediate
animation.
The outbreak of Civil War would end the AMA’s campaign against abortion for
the duration of the hostilities. Many physicians entered military service in the North or
South. However, the war did not prevent Joseph Meredith Toner, a Catholic physician,
from denouncing the induction o f premature labor to obtain abortion. Like Fitzpatrick, he
decried belief in quickening and the resort of affluent women to abortion. Toner rejected
instrumental delivery on the living in favor of the Caesarean section operation. The
solution to the problem of abortion was, for Toner, for physicians to denounce the
destruction of the foetus in the womb.
Toner condemned the mechanical and medicinal means used by women for self
induced premature labor, because he believed that such practices placed women's lives in
danger. He illustrated this, with the account of a woman who sought his assistance in the
use of abortifacients purchased by mail. The physician refused to cooperate and asserted
that he would act as a witness against her if she obtained an abortion. Toner pointed to
“dens of wickedness and crime” in Washington where abortions were and urged the
medical profession to expel practitioners of abortion from its ranks.156 Finally, Toner
lssHenry Miller, “Address of Henry Miller, M.D., President of the Association,” Transactions of the American Medical Association 13 (1860): 57.
156Joseph M. Toner, [Abortion hi A Medical and Moral Aspect?], AMs, n.d., Joseph M. Toner Collection, Box 97, Medical Writings, Manuscripts Division, Library of Congress, Washington, DC., 10.
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faulted the medical profession for failing to change laws that enshrined outdated theories
of human origins that shielded criminals from prosecution.
At the close o f the Civil War, Storer won the first AMA prize essay contest with a
work on the evils of forced abortion. He published this work later as a pamphlet for
women entitled “Why Not?” Another work for men entitled, “Is it I?” followed in
1867.157
American Catholic theologians were as busy as AMA and Catholic physicians in
their efforts to discourage abortion. In 1867, Bishops first denounced abortion and
infanticide in Catholic newspapers. The Philadelphia Catholic Standard ran a series of
articles appearing as letters from different cities. An author, using the name “Hermit” as
a sobriquet, wrote the weekly letter from Baltimore. The Hermit’s letter of 1 September
1867 explored the increased incidence of infanticide in Baltimore. The author
commented on the discovery of dead infants in Baltimore's alleys and vacant lots.ISS
During the same year, the Maryland State legislature passed the first statute outlawing the
practice of abortion.IS9 The concern with the issue extended well beyond the Catholic
community.
157See also Horatio R. Storer, A Proper Bostonian on Sex and Birth Control (New York, NY: Amo Press, 1974).
lS8Philadelphia Catholic Standard. 7 September 1867.
IS9On 20 March 1867, Maryland’s first law restricting abortion passed the state legislature. The statutes establishing the Baltimore Medical Association as a functioning medical faculty contained the abortion law. The bill included statutes for the creation of a board of medical examiners. Section Eight provided that no physician should practice without obtaining a license from the permanent medical board. Section Eleven of the statute prohibited abortions unless they were “deemed necessary for the safety of the
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In 1869, Pope Pius DC extended the penalty of excommunication to those who
procured abortions, hi the United States, the hierarchy asserted itself in condemning
abortion as well. Archbishop Martin J. Spalding of Baltimore charged Bishop James
Gibbons of North Carolina with the task of writing the pastoral letter for the tenth
provincial Council of Baltimore.160 Spalding informed Gibbons that the text should be
“fresh, full of zeal+severity, terse, and practical,” a daunting task for the younger
bishop.161 Spalding suggested four main topics for the letter: Catholic education, social
welfare institutions, the education of African Americans, and parochial rights of the
mother, after consultation with not less than two members of the faculty, including one member of the Board of Examiners.” Likewise, this section prohibited the advertising of medicines or service available to procure abortion. Penalties for the crime included three years at hard labors and, a fine of five hundred dollars. It appears that instrumental deliveries, rather than Caesarean operations were still commonplace in Maryland. The Medical and Chirurgical Faculty of Maryland met tins challenge to its authority through a successful effort to repeal the bill in the next legislative session. The new bill contained no provisions for a new medical faculty or Board of Examiners. The bill focused exclusively on the prohibition of abortion. Section Two contained penalties similar to the law passed in 1867. The addition of the phrase “knowingly” to the statute made the criminal intent for offenders a requirement for prosecution. The proviso contained in the new bill contained significant differences. The new proviso excluded cases of abortion from natural causes from prosecution. The consultation clause included a provision for abortions in cases where physicians had already verified foetal death. The new bill continued with a provision for abortion after consultation with other physicians. See March 20, 1867, ch.185,1867 MD. Laws, 339-344; March 28, 1868, ch.179, 1868 MD. Laws, 314-317.
I60The province of Baltimore included: Baltimore, Charleston, Erie, Harrisburg, Philadelphia, Pittsburgh, Richmond, Savannah, Scranton, Wilmington, Wheeling, and the Vicariates Apostolic of East Florida and North Carolina.
l6IMartin J. Spalding, Archbishop of Baltimore, Baltimore, MD, to James Gibbons, Vicar Apostolic of North Carolina, 4 March 1869, ALS, lp, 7I-U-I, AAB, Baltimore, MD. Future citation to this archives will appear as AAB. Other short references to Catholic Archives will appear as GUA for the Georgetown University Archives, and AaBo for the Archives of the Archdiocese of Boston.
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clergy. Spalding mentioned a fifth topic of obscene theatricals. The final subject
concerned the “murder of the innocents.” Gibbons focused on the need to prohibit the
killing of the child to save the mother’s life.
Within the letter, abortion was the third of eight topics explored. The pastoral
condemned “the practice o f infanticide, especially before birth.”162 Such a monstrous
crime that prevented baptism should “not even be mentioned among Christians.” Catholic
believers, Gibbons asserted, were strangers to this unnatural vice. The Bishop's
sentiments then were words of warning rather than reproof. Gibbons stressed that no
mother could permit the death of her infant, “not even for the sake o f preserving her own
life; because the end never justifies the means, and we must not do evil that good may
come of it.” Gibbon’s views are notable in that they leave no doubt that the Church
viewed the fetus as a living person. The letter also set clear boundaries for acceptable
practices for Catholic practitioners. The letter echoed the Vatican’s effort to clarify the
Church’s long opposition to abortion on the basis of new assumptions about the origins of
human life.
In May of 1870, the AMA addressed the issue of criminal abortion once again. A
resolution establishing a committee to examine criminal abortion and proposed by D. A.
O’Donnell, a Catholic physician from Baltimore, passed with unanimous consent.163 The
162Philadelphia Catholic Standard. 15 May 1869.
163 “Minutes of the Twenty First Annual Meeting o f the American Medical Association, 4 May 1870,” Transactions of the American Medical Association. 21 (1870): 35.
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committee consisted o f O’Donnell, Washington Atlee, and Henry Askew o f Delaware.164
The group was asked to find a means to stem abortion and expel offending practitioners
from the profession.165 The committee planned to report on the matter at the next AMA
meeting. The actions of the Third Provincial Council provided encouragement for
Catholic physicians such as O’Donnell and Atlee to join the hierarchy in denouncing
infanticide.
On 3 May 1871, O’Donnell reported back to the AMA before the section on the
practice of medicine and obstetrics chaired by Horatio R. Storer.166 hi the report,
Catholic theology, ethics, and secular science, converged in a ringing denunciation of
physicians who practiced abortion.167 Washington Atlee proposed the referral of the
report to the committee on publications.
164Washington Atlee was a Catholic. Storer became a Catholic convert while under the age of fifty. Storer’s conversion occurred shortly before or after the AMA Convention. See James J. Walsh, “Catholic Achievement in Medicine,” chap. in C. E. McGuire, ed. Catholic Builders of the Nation (Boston, MA: Continental Press, 1925), 59, 62-63.
l65Ibid., 35.
I66“Minutes o f the Twenty Second Annual Meeting of the American Medical Association, 2 May 1871.” Transactions of the American Medical Association 22 (1871): 36. See also “O’Donnell, Dominick A. 1833. Bom in County Donegal, Ireland, 1809. Educated at Mt. St. Mary’s College, Emmitsburg; M.D. Jefferson Medical College, 1833; Practiced first at Williamsport, Md. Then in Mississippi, Hancock, Md., and Cumberland Md.; Settled at Baltimore, 1848; A.M. Honorary, Loyola College, Baltimore, 1854; Vice- President, Medical and Chirurgical Faculty of Maryland, 1874. Died at Baltimore, August 26, 1874.” CordeU. Medical. 713.
I67Dominick A. O’Donnell and John Atlee, “Report on Criminal Abortion,” Transactions of the American Medical Association 22 (1871): 239-258. Another source lists John Monmonier as an author of this document. Monmonier was present as a delegate at the convention. It is possible that the two collaborated in the effort to draft the
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O’Donnell used biblical imagery to depict the physician as the Good Shepherd.
He also identified physicians with ordained priests in his belief that medicine, “is second
only in usefulness and dignity to that of the servants of the Church.” O’Donnell viewed
abortionists as false brothers, (Pauline) betrayers of God and the medical profession. For
O’Donnell, the abortionist frustrated the divine plan of creation by destroying a human
soul destined for eternal salvation. The abortionist, he claimed, represented a
demoralizing influence on younger members of the profession. The call to expel such
offenders from the professional ranks posed an eschatological question, by proclaiming
“Shall God or the Arch-enemy gain the ascendancy?”
O’Donnell believed that society had a low estimation of the value of human life,
reflected in the continued belief in outmoded theories of human origins. Such ideas, he
claimed, were used as a pretext for killing. Mediate animation, he maintained, was
merely a rationale used to deny the humanity of the embryo and justify abortion.
O’Donnell viewed the theory of immediate animation as a theory with greater scientific
validity.168
Citing John Barry in support of the theory of immediate animation, O’Donnell
also noted St. Basil of Caesarea (379), as proof of the antiquity of Christian belief in
immediate animation. O’Donnell then mentioned Zacchias, Debreyne, and Dr. Rossan
(Rosiau); the same authorities used by Barry. The Baltimore physician also embraced
Barry’s rudimentary understanding of fertilization. This knowledge included the belief
report.
168Ibid., 248.
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that while the evidence of organization was not perceptible in the newly fertilized ovum,
“we should not conclude that a homonocule does not exist in it.”169 The views illustrate
the ambiguity of the era regarding embryology. Nonetheless, O’Donnell’s arguments
illustrate the continuity of Catholic belief against abortion and its impact on the
leadership of the AMA.
Speaking for his committee, O’Donnell argued that that the crime o f abortion held
horrific consequences for American society. Practitioners of abortion resembled Herod in
their willingness to kill the innocent, and Judas Iscariot in their willingness to accept
payment.170 British laws, he noted, viewed abortion as a capital offense but such laws
were lacking in the United States. Some philanthropists, he argued, opposed cruelty to
animals while remaining silent on the wrong of abortion.171 O’Donnell attempted to draw
attention to a problem he viewed as a blind spot in the nation’s social conscience.
O’Donnell’s committee proposed that medical education be used to prevent
abortion. The report asserted that professors should teach students what to do and, what
not to do as practitioners. Students should be urged, like the students of Hippocrates, to
refrain from the prescription of abortifacients.172 As guardians of the nations’ health,
O’Donnell asserted that a physicians conduct must be above moral reproach. O’Donnell
noted the incidence of abortion among married couples and urged the clergy to dissuade
169Ibid., 249.
170Ibid., 251.
171Ibid., 253.
172Ibid., 254.
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couples from the practice. As for men, in a veiled reference to Genesis 10:28, O’Donnell
urged clerics to counsel against the sin o f Onan. To effect the education of the clergy, the
author urged that deputation’s of physicians visit clerics to instruct them.173
The physician invoked images from Patrick Henry’s Virginia assembly speech to
depict abortionists as enemies of American Society. Physicians, he emphasized, must
guard their patients from this menace as a shepherd guards his flock. O’Donnell urged
doctors to root out abortionists and bring them to justice. Physicians guilty of the crime
should, “be marked as Cain was marked; they should be made the outcasts of society.”
The report closed with a call to physicians to crusade against the practice of abortion.
Six resolutions on abortion were adopted at the AMA convention on 5 May 1871.
The first condemned abortionists and barred them from the regular profession. The
Second, classified all abortions as illegal without the concurrent opinion of a consulting
physician and a view toward the safety of the child, hi the third resolution, professors of
medicine were charged with the duty of preventing students from participating in the
practice of abortions. Resolution four called the Clergy’s attention to the moral perversity
that countenanced abortion and its risk to the human family. The fifth resolution called
upon physicians to act as delegates to educate the clergy. The final resolution urged
physicians to crush “this pest of society”174 and thus raise the public standing the
173Ibid., 255.
174“Elevate the profession to that eminence and moral standard for which God has designed it, and which honorable and high-toned public sentiment must expect at the hands of its members.” Ibid, 258.
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profession. O’Donnell sought to raise the social authority of physicians by making them
the guardians o f an ethic that upheld the preservation o f all life.
This chapter revealed how Catholicism and new ideas on human origins reshaped
American attitudes toward abortion. While the process o f human reproduction remained
imperfectly understood in 1871, the distance travelled since 1834 clarified some of the
moral ambiguity of abortion. By the outset of the nineteenth-century, epigenesis had
gained increased acceptance among European scientists. After 1800, the Catholic Church
gradually adopted immediate animation as the assumption underlying its beliefs in human
origins. In America, the Catholic Church communicated the belief that life began at the
moment of conception to a wider audience of American physicians. By 1859, the same
ideas shaped the opposition of AMA physicians to abortion. This belief in the absolute
value of fetal life made abortion for the prevention of unwanted pregnancies and the
resolution of difficult births far less acceptable to physicians and the public.
The Catholic Church’s insistence on the absolute value of human life set a high
standard of practice for American physicians. However, published accounts of
destructive operations and the existence of consultation clauses in laws limiting abortion
revealed that the highest standard of care was not yet achievable for most American
physicians. If the Church wished to oppose abortion, it would be necessary for the
Church and its physicians to participate in the search for new medical means to save the
lives of mothers and their infants. The success of this search would depend largely on
improved medical education. New methods, such as the cesarean operation, would only
become possible for physicians with an improved knowledge of human physiology, the
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diagnosis of pregnancy, and general surgical skill. In the absence of such improvements,
the practice of craniotomy, also known as therapeutic abortion, would continue to pose a
difficult dilemma for American physicians and the public.
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THE CATHOLIC CHURCH, DISSECTION, AND THE GROWTH
OF MEDICAL EDUCATION, 1820-1889
The call for the resolution o f difficult births with the cesarean operation, the
recognition of the immediate animation of the fetus, and the claim that human life began
at the moment of conception caused the Church to grapple with the existing state of
medical practice. Diagnostic and therapeutic capabilities o f doctors became an issue for
the Church because a uniform standard of care based in Catholic morality could only exist
if there was a uniform baseline for a safe practitioner in America, or any other country.
This concern of the Church led it to endorse the reform o f medical practice.
This concern developed in parallel with a growing desire on the part of the
American medical profession to reform American medical education. Some reformers
were apprehensive about the large number of physicians practicing medicine and the
economic impact of oversupply. Others were also disturbed by what they regarded as
inadequacies in American medical training.175 As advances in physiological knowledge
and physical diagnosis came out o f the Parisian medical school, it became increasingly
175William Frederick Norwood, Medical Education in the United States Before the Civil War (Philadelphia, PA: University of Pennsylvania Press, 1944; reprint, New York, NY: Amo Press, 1971), 422. 79
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necessary to incorporate such advances into American medical education. By the 1820s,
this need for changes had resulted in nascent reform efforts such as the Northhampton
convention.
In America, the limitations of the existing apprenticeship system resulted the
proliferation of poorly trained physicians. The apprentice learned medicine by following
his preceptor on his rounds and reading medicine under his supervision. This form of
education usually left the new physician with a dated and limited theoretical knowledge
of medicine. By 1830, dissatisfaction with the shortcomings of apprenticeship caused
some of the wealthier apprentices to leave for Europe, where students had frequent
opportunities to dissect cadavers at medical schools and in the dead houses of hospitals.
In Paris, the practice of dissection linked students’ theoretical knowledge with experience
gained in knowledge of the treatment of illness learned in the hospital clinic.176
Upon their return from Europe, early graduates were eager to share their
knowledge of anatomy through courses of private lectures in Philadelphia and New York.
Such educators were well aware that anatomical knowledge was a necessary part of
education for the competent practice of medicine and surgery.177 However, acquiring the
means to provide such education to students represented a continued challenge to
educators.
176Russell, C. Maulitz, “Pathology,” in The Education of American Physicians, ed. Ronald Numbers, (Berkeley, CA: University of California, 1980), 124.
I77Martin Kaufman, “American Medical Education,” in The Education of American Physicians ed. Ronald Numbers (Berkeley, CA: University of California Press, 1980), 10.
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The absence of a structure to support medical education, such as anatomy laws,
resulted in the shortage of specimens for dissection. Educators relied on the judicial
system for bodies of convicted criminals and on quasi-legal methods, such as the
purchase of specimens from body snatchers. In America, the public opposed such efforts
because of a widespread revulsion toward dissection and the desecration of graves.
American Catholics shared this revulsion toward the desecration of graves. For
centuries the Church had opposed the disturbance o f graves and mutilation of corpses as a
forms of desecration, based on its belief in the integrity of the body and the resurrection
of the dead.178 In 1299, Pope Boniface VIB forbade the mutilation of corpses. A later
commentator noted that the edict applied to those who died on pilgrimage and sought to
have their remains returned to Europe for burial. In 1482, however, Pope Sixtus IV
permitted students at Tubingen University to dissect the bodies o f criminals to learn the
art of healing.179 The actions of the Pope reveal that while the Church opposed
desecration, the proper treatment of the body made the practice o f dissection to advance
medical knowledge permissible. Therefore, the bodies of the dead served to promote the
health of the living. The efforts of the hierarchy in America to promote medical
education would tread the same fine line.
The persistence of quasi-legal practices led to popular outrage, hi 1788, a student
prank resulted in a riot at New York’s Kings College. The riot occurred when local
I78Caroline Walker Bynum, Fragmentation and Redemption (New York, NY: Zone Books, 1991), 280,296-297.
I79Edward M. Hartwell, “The Study of Anatomy, Historically and Legally Considered,” Journal o f Social Science 2 (March 1881): 68.
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children noticed a dissected limb hanging out of a dissection room window, which
outraged neighbors. In England, reports o f murdered paupers sold as cadavers led to calls
for a dissection law. In 1831, a year before England's Warburtop Anatomy Act.
Massachusetts became the first state to pass laws permitting dissection.180 The
Massachusetts State Medical Society overcame public opposition with a circular letter
and petition to the legislature. The documents stressed the necessity of dissection as a
means to improve physician’s surgical skills. High mortality among sick paupers, they
claimed, often reflected the anatomical ignorance of physicians which could be corrected
through dissection. Such legislation would also prevent the desecration of graves as well
by body snatchers. With these documents, the Massachusetts State Medical Society
successfully reshaped the views of legislators and the public on the necessity of
dissection.181
In Massachusetts, the change of public opinion resulted in the successful passage
of an anatomy bill. However, asylum trustees in Massachusetts still often ignored the
requests of professors for cadavers. The resistance reflected the persistence of popular
l80See also John B. Blake, “The Development o f American Anatomy Acts,” Journal of Medical Education 30 (August 1955): 434. See also Frederick Waite, “The Deelopment of Anatomical Laws in The States of New England,” New EnglandJournal of Medicine 233 (13 December 1945): 716-726; John B. Blake, “Anatomy,” in The Education of American Physicians ed. Martin Kaufmann (Berkeley, CA: University of California Press, 1980), 29; Linden Edwards, “Cincinnati’s “Old Cunny,” A Notorious Purveyor of Human Flesh.” Ohio State Medical Journal 50 (May 1954): 466-469; “A Ghoulish Tale o f Three Cities,” Ohio State Medical Journal 55 (June 1959): 788-790; “A Ghoulish Tale o f Three Cities, Part H,” Ohio State Medical Journal 55 (July 1959): 946- 949.
181HartweU, “Study,” 93-94.
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beliefs against dissection that persisted despite the passage of anatomy laws. Few states
sought to regulate dissection in the antebellum era. In many states, the practice of
anatomical study remained unregulated into the early decades of the twentieth century.182
Consequently, the pillage of cemeteries for specimens continued unabated.
By the 1830s, proprietary schools, run for the profit of their faculty, were
established to supplement the apprenticeship model. Theoretically, at such institutions
students studied under several proprietors competent in different medical subjects.
However, competition between such schools resulted in a decline in the standards for
admission and graduation.183 Many institutions exaggerated the quality of their facilities
in the circulars that advertised their courses of study. Moreover, establishment of the
schools placed increased demand on an already short supply of anatomical specimens.
Eventually, the practice of deception caught up with medical educators.
Proliferation of poorly trained physicians contributed to a widespread distrust among the
public. By 1832, the ineffectual results o f heroic remedies during periodic outbreaks of
cholera further eroded public confidence in regular physicians.184 Thus, Americans of the
Jacksonian era sought alternative remedies in sectarian medicine. By the Civil War, this
lack of confidence resulted the repeal of medical practice laws throughout the country.
182George B. Jenkins, “The Legal Status of Dissecting,” Anatomical Record 7 (November 1913): 389.
183Martin Kaufman. American Medical Education (New York, NY: Greenwood Press, 1976), 40.
I84Charles Rosenberg, The Cholera Years (Chicago, EL: University of Chicago Press, 1987), 68.
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While the practice of dissection was a stated requirement in many schools by
1833, the quality of such instruction remained uneven or nonexistent. Most anatomical
instruction was conducted by demonstration and lecture; difficulty in obtaining specimens
limited the quality such anatomical study. Most medical schools required that a student
take at least one ticket in dissection, but some required none at all. To supplement their
education, some students attended schools that did not grant degrees, such as the
Philadelphia School of Anatomy.183 More serious and affluent students continued to look
to Europe as the place to go for serious medical study, but such a course was limited by
its expense. Therefore, American medical schools continued to look for ways to improve
instruction.
hi St. Louis, the Catholic Church’s search for a uniform standard of care based in
Catholic morality shaped the efforts to reform the St. Louis Medical College. From its
founding in 183S, Jesuit administrators sought respectability for the nation’s first Catholic
medical school, including representatives of St. Louis’ major religious denominations on
the school’s board of trustees.186 Yet, the College exemplified both the hopes and
failings of antebellum medical instruction. The catalogue for the 1842-1843 session
presented dissection as optional for students. Not all students wished to incur the
commitment of time, expense, and discomfort of practicing dissection in a foul smelling
185Blake, “Anatomy,” 34.
l86Board of Trustees Meeting, 13 October 1841, “Charter And Minutes St. Louis University Board Of Trustees, 1832-1914,” TD, p. 46-47, St. Louis University Historical Archives, Pius XU Memorial Library, St. Louis, MO.
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dissecting room. The fear of losing students to a rival school, Kemper Medical College,
made the faculty reluctant to establish a firm requirement for dissection.
The recruitment of two French-trained American physicians reflects the interest of
the Jesuits in advancing the existing level of obstetric knowledge at St. Louis. In 1842,
Moses Linton became professor of obstetrics at the Medical College. In 1843, after
graduation from the University of Pennsylvania and study in Paris, Charles Pope assumed
the professorship of anatomy and physiology.187 These educators attempted to link the
theoretical knowledge from lectures with clinical knowledge by encouraging the practice
of dissection among their students.
However, dissection soon caused problems for the nascent medical school. On 25
February 1844, readers of the St. Louis Democrat discovered the following headline: “we
regret to leam.. .the medical college was forced [to] open the doors and windows
demolished and the benches, floors & c tom up.”188 Reacting to the careless handling of
cadavers by students, rioters looted St. Louis University Medical College. Neighbors
resented the nuisance caused by the stench of decaying remains. The resentment turned
violent when children, chasing a lost ball, stumbled on the pit used to dispose o f dissected
limbs. The editor of the St. Louis Democrat admitted the necessity of dissection.
However, he called for physicians to practice dissection with “circumspection and care”
to avoid public outrage by the “obtaining or disposing of subjects.”
I87Ellsworth Smith, “Charles Alexander Pope, 1818-1870,” Washington University Medical Al»mni Quarterly 1 (January 1938): 60.
188St. Louis Democrat 26 February 1844.
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One might have thought that the Church reacting to this casual treatment of
cadavers would have halted dissection at the medical college. However, by the 1845-
1846 session, dissection was a requirement for graduation. The catalogue for the session
noted, "they [students] can become practical surgeons and physicians only by their own
exertions in the dissecting room, and their own observations at the bedside.”189 The local
Church hierarchy and Jesuit sponsors of the school were aware that such methods were
necessary to replicate the advances of French surgical knowledge in America.
hi fact, the school continued to incorporate the benefits of European medical
education, hi 1847, Pope became Dean and emphasized the necessity of clinical
instruction. As Professor of the Principles and Practice o f Surgery, Pope supervised
clinical instruction in the wards of the City Hospital and the St. Louis Hospital, the latter
staffed by Sisters of Charity. The 1849 catalogue alleged, “we believe that in no school
of our country is more importance attached, and time devoted to hospital teaching.”190
Pope brought his appreciation for the benefits of French clinical instruction to St. Louis.
Advances in clinical education were also incorporated into the education of
students in midwifery. Until 1843, a student’s obstetric instruction at the medical college
consisted of didactic lectures and practice on models. Louis Boisliniere, an 1848
I89“ Annual Announcement of the Medical Department o f the St. Louis University, session 1845-1846.” St. Louis Medical Journal 3 (June 1845): 44.
l90Annual Announcement of the Medical Department of the St. Louis University. Session 1849-1850. p.5, RG01F, St. Louis Medical College Catalogs, 1842-1890, Archives and Rare Books, Becker Medical Library, Washington University, St. Louis, MO.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 87
graduate, established the St. Anne’s Infant Asylum in 1853.191 Its establishment at St.
Louis Hospital involved the Sisters of Charity in one of the nation’s first examples of
clinical obstetric instruction. By the 1854-1855 session, the college offered clinical
education in three hospitals and one dispensary. Through these efforts, the Church in St.
Louis attempted to shape the advance of medical practice by providing instruction in non
destructive method o f childbirth intervention.
The involvement of the Jesuits in St. Louis medical education did not persist.
While the relationship of the faculty with its Jesuit sponsors proved positive throughout
the years, the specter of nativism cast its shadow on the medical school. The faculty of
the proprietary school feared nativists and the risk to their livelihood from riots. In 1855,
the faculty dissociated itself from it’s Jesuit sponsors.192 However, the instruction of
medical students in midwifery continued in the same hospitals staffed by the Sisters of
Charity. Jesuit involvement in medical education ended in St. Louis until the University
established a new medical school in 1906.
In 1847, a committee of what soon became the American Medical Association
attempted to confront the problems of medical education. After a survey that revealed a
wide disparity in the requirements for graduation from the nation’s medical schools, the
191 Annual Announcement of the Medical Department of the St. Louis University, session 1854-1855. p. 4, RG01F, St. Louis Medical College Catalogs, 1842-1890, Archives and Rare Books, Becker Medical Library, Washington University, St. Louis, MO; Edward J. Goodwin, A History of Medicine in Missouri (St. Louis, MO: W. L. Smith, 1905), 163-164.
192Charles A. Pope, St. Louis, MO to W.S. Murphy, S J., St. Louis, MO, 17 April 1855, ALS, 3 pp, no. M-45, SLU Medical Department, Pope Correspondence, 1855, St. Louis University Historical Archives, Pius XII Memorial Library, St. Louis, MO.
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committee, chaired by Austin Flint, offered its own recommendations for reform. The
committee suggested that students take at least two six-month courses of lectures after an
apprenticeship with a competent preceptor. The committee also suggested that schools
have at least seven professors, providing competency in the seven branches o f medicine.
Reformers also recommended that students take three months of dissection and that
colleges require hospital work.193
Unfortunately, adoption of these reforms by the University of Pennsylvania and
New York’s College o f Physicians and Surgeons proved disastrous because competing
schools refused to alter their requirements. Lower standards at Jefferson Medical College
and New York University resulted in an increase in applications to the two schools
because students could graduate with a shorter course of study. Pennsylvania and the
College of Physicians and Surgeons soon reverted to a four month session. An 1849
AMA survey revealed that, of the twenty-eight medical schools contacted, twenty-two
had seven or more professors. However, only seventeen schools required dissection and
only seven mandated hospital attendance.
Meanwhile, the Catholic Church continued its own search for the reform of
medical practice. Soon, it became possible to tie medical schools to emerging Catholic
institutions even when the school itself was not Catholic. Austin Flint, of the AMA,
oversaw establishment o f the Medical College of the University of Buffalo in 1846.194
However, Buffalo had no hospital to care for the poor or provide clinical instruction for
193Kaufinan, “American,” 13.
l94Norwood, Education. 163.
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medical students. In 1848, Bishop Timon approached the Sisters of Charity to open a
hospital in a former orphan asylum.195
James P. White, professor of obstetrics at Buffalo Medical College, helped the
Bishop establish the hospital and other health care institutions.196 When the hospital
opened, the faculty of the Medical College arranged to provide its medical staff and
conduct clinical training on its wards.197 An account of the 1849 session reported, “Daily
lectures will be given in the new college.. .clinical lectures on cases at the adjoining
hospital of the Sisters of Charity, and dissections prosecuted.”198 hi 1849, the College
moved into a new building next to the hospital to take advantage of its clinical
opportunities. Despite the enthusiasm of the medical faculty, the Sisters struggled to
overcome the prejudice that existed against a Catholic charitable institution in Buffalo.199
l9sByron Daggett, Historical Sketch O f The Buffalo Hospital O f The Sisters Of Charity And The Three Foundresses O f The Hospital (Buffalo, NY: A.T. Brown Printing House, 1899), 6; Austin Flint ed., “Editorial Department: Buffalo Hospital O f The Sisters Of Charity,” Buffalo Medical Journal 4 (October 1848): 325.
l96Austin Flint, “A Memoir Of Professor James Platt White, M.D. Read By Professor Austin Flint, M.D. At The Meeting O f The Medical Society O f The State Of New York, Held At Albany, February 1882,” in Memorial. James Platt White (Buffalo, NY: Commercial Advertiser, 1882), [8]. James B. White was Bishop Timon’s personal physician. See Charles Deuther, The Life and Times of Rt. Rev. John Timon. D.D. (Buffalo, NY: Published by the Author, 1870), 157.
197Austin Flint, “Editorial Department: Buffalo Hospital Of The Sisters Of Charity” Buffalo Medical Journal 4 (December 1848): 458.
198Austin Flint, “Editorial Department: Buffalo Medical College,” Buffalo Medical Journal 5 (September 1849): 244.
'"Austin Flint, “Editorial Department: Pauperism, Hospitals,” Buffalo Medical Journal 5 (October 1849): 307; “Editorial Department: Supplement To Semi-Annual
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White, who served as a consulting surgeon, soon became involved in a dispute
over obstetric instruction. During the fall session of 18S0, White invited his students to
observe an actual delivery on an anonymous patient. The delivery took place in the
apartment occupied by the medical school janitor and his wife. The presence of the
janitor’s wife during the delivery was intended to protect the patient’s modesty. White
also restricted each student’s observation o f the labor to a brief period, although all the
students, and the janitor’s wife, were present at delivery.200
A dispute arose when the graduating students published resolutions of thanks to
White.201 Soon, twelve physicians from Buffalo and its environs condemned America’s
first clinical obstetric instruction as “wholly unnecessary for the purpose of teaching,
unprofessional in manner, and grossly offensive, alike to morality, and common
decency.”202 Austin Flint and others voiced their support for White in the Buffalo
Medical Journal. However, this did not end the controversy.203
Report Of Medical And Surgical Cases At The Buffalo Hospital Of The Sisters O f Charity” Buffalo Medical Journal 5 (November 1849): 373.
200Austin Flint, “Editorial Department: Demonstrative Midwifery,” Buffalo Medical Journal 5 (March 1850): 624-625.
201 Austin Flint, “Editorial Department: Demonstrative Midwifery,” Buffalo Medical Journal 5 (February 1850): 565.
202Austin Flint, “Editorial Department: Demonstrative Midwifery,” Buffalo Medical Journal 5 (March 1850): 621.
203Austin Flint,. “Editorial Department: Demonstrative Midwifery, Racine Letter,” Buffalo Medical Journal 6 (June 1850): 64; Austin Flint ed. “Editorial Department: Demonstrative Midwifery, Racine Letter,” Buffalo Medical Journal 6 (September 1850): 250-251; Carl T. Javert, “James Platt White, A Pioneer in American Obstetrics and
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White attempted to redeem his reputation in a libel suit against Horatio Loomis,
who criticized White in an evangelical Protestant newspaper. However, a jury found
Loomis innocent despite his efforts to defame White.204 Opposition to demonstrative
midwifery existed outside of Buffalo as well. In 1851, the AMA rejected White’s method
of obstetric instruction.205 Later, Flint attributed the actions of Loomis and others to
professional jealousy.206
The account reveals that popular prejudice, rather than Catholic doctrine, drove
opposition to dissection and demonstrative midwifery. Innovations in medical education
offended neither the sisters nor the bishop. In 1851, the College announcements noted
that dissection continued within the Sister’s hospital.207 Such events had no effect on
White’s service at Buffalo Medical College or the Catholic hospital. White served at
both institutions until his death in 1881. The continued support of the Church for these
methods of education revealed its interest in promoting safe and non-destructive methods
of childbirth intervention.
Gynecology,” Journal of the History of Medicine and Allied Sciences 3 (Autumn 1948): 496.
204Horace Nelson, “Report of the Trial o f the People vs. Dr. Horatio N. Loomis, for Libel,” Northern Lancet 2 (31 November 1850): 12.
205W. Hooker, et al. “Report of the Committee on Medical Education in Relation to Demonstrative Midwifery,” Transactions o f the American Medical Association 4 (1851): 439.
206Flint, “A Memoir,” [5-6].
207“Medical Department of the University of Buffalo,” Northern Lancet 3(1 May 1851). [unpaginated advertisement].
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The willingness of Timon, and the Sisters, to permit dissection in the hospital is
significant since it was also illegal. In 1853, John Draper denounced New York State
statutes that required anatomical knowledge for medical practice while prohibiting
dissection.208 Draper observed that the highest Catholic and Protestant authorities
permitted dissection and argued that physicians and surgeons could only gain a
knowledge of disease through dissection.
Irish emigrant societies, however, protested against efforts by the New York State
Legislature to pass a dissection law. The societies protested the inhumanity of dissecting
immigrants who died during their passage from Ireland to America. A law permitting
dissection passed the State legislature in 1854 209 The Church’s willingness to allow
dissection revealed its willingness to override traditional beliefs to bring about a uniform
standard of medical care based in Catholic morals.
208John Draper, “An Appeal to the State of New York to Legalize the Dissection of the Dead,” Northern Lancet 8 (December 1853): 106. A review of periodical literature revealed some opposition to the law among recent Irish immigrants. See “Dissection of the Dead bodies of Emigrants” The New York Citizen 28 January 1854. The same issue contained a report on Irish immigrants who died during the course of their passage to America. While the editor of the New York Freeman’s Journal disliked the law, Archbishop Hughes of New York appears to have remained silent on the matter. See New York Freeman’s Journal. 28 January 1854. Hughes was on his way to Cuba for a holiday when the law passed in Albany. Hughes left New York on 30 December 1853 and returned on 4 April 1854. See New York Freeman’s Journal. 31 December 1853; New York Freeman’s Journal. 8 April 1854. Timon’s cooperation with the Buffalo Medical College reveals his support for dissection. Buffalo’s Catholic newspaper, the Buffalo Sentinel, which might have revealed Timon’s views has not survived. Timon criticized Buffalo Catholics for excessive display at funerals. See Deuther, Life. 268.
209David Humphrey, “Dissection and Discrimination: The Social Origins of Cadavers in America, 1760-1915,” in Essays on the History of Medicine, ed. Saul Jarcho, (New York, NY: Science History Publications, 1976.), 271.
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By adopting this position, the Church allied itself with the aims of national
medical reformers, hi 1849, the AMA denounced schools that boasted in their
advertisements of the absence of a dissection requirement. O f the thirty-nine medical
schools that answered a survey of the AMA Committee on Medical Education, only 45
percent required dissection of its students. St. Louis University and Buffalo Medical
College were among the schools that required practical anatomy. Georgetown Medical
College, also affiliated with a Catholic school, failed to respond to the survey.210 The
report of the Committee on Medical Education highlighted the disparity in requirements
that existed among medical schools.
The Church’s direct participation in the reform of medical education occurred in
cities other than Buffalo. William E. Homer persuaded St. Joseph’s Hospital of
Philadelphia to admit clinical students to its wards from 1852 to 1857. Before his death
in 1853, Homer, a Catholic convert, acted as Professor of Anatomy and as Dean of the
University of Pennsylvania Medical School. In 1857, a new bishop reorganized the
hospital under the supervision of the Sisters of Charity. St. Joseph’s, always self-
sustaining, never served as an almshouse. Consequently, when the sisters and patients
voiced concerns about privacy, caused the Archdiocese barred students from the wards.211
Interestingly, the faculty at Georgetown Medical College in Washington, D.C. resisted
2l0John Ware, Jacob Bigelow, and Oliver Wendell Holmes, “Report, Committee on Medical Education,” Transactions of the American Medical Association 2 (1849): 277.
21 'Gail Farr Casterline, “St. Joseph’s and S t Mary’s: the Origins of Catholic hospitals in Philadelphia,” Pennsylvania Magazine of History and Bioeraohv 108 (July 1984): 302-303.
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efforts to institute reforms. In 1853, a plan to establish a clinic staffed by Sisters of
Charity faltered out of concern that the added expense would deter students. The same
Sisters staffed an infirmary for a rival institution. Later, the prank deposit o f a dissected
cadaver on the school’s front steps caused a great uproar. The faculty requested an
investigation by civil authorities to preserve its reputation. Mindful of competition of
competition and driven to make a profit, Georgetown, like other schools, rejected
prospective reforms in medical education.212
Austin Flint, who is part of this reform movement that is the AMA as chairman of
the Committee on Medical Education, was concerned about these problems. Not
surprisingly, Flint was later involved in New Orleans at the Catholic-based Charity
hospital, which he again used for innovative clinical work, hi 1856, the New Orleans
School of Medicine’s first prospectus emphasized the practice of clinical education 213
Erasmus Fenner, established a clinical clerkship where students observed and recorded
patient progress as a narrative read before the professor during rounds. In the event of
death, the class performed an autopsy on the deceased to reveal the cause of death.
Fenner built the college building directly across the street from the Charity Hospital,
staffed by Sisters of Charity, which provided a ready source of clinical subjects. In 1859,
Austin Flint left Buffalo Medical College to teach at the institution. Each of the school’s
ten faculty members provided bedside instruction. Unfortunately, the outbreak of the
212Curran, Bicentennial. 154.
2I3Dufly, Matas. 1: 263.
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Civil War closed the school and interrupted Fenner’s innovations in medical education.214
However, the Church’s cooperation with clinical education and autopsy represents
another example of its willingness to tie itself to existing institutions to participate in the
reform o f medical education.
After the Civil War, the recognition on the part o f many people that general
surgical skill was low contributed to a desire to elevate anatomical and surgical
knowledge that fit into the Catholic Church’s longer standing desire to elevate these areas
of expertise.215 During the 1867 AMA convention, delegates attempted to draft standards
for preliminary education and a graded curriculum for medical study. The three-year
program would include the acquisition of anatomical knowledge through dissection. But
from 1867 to 1871, these reform efforts met with little success, largely due to competition
for students and the profit motive thwarted reform efforts again.216
hi 1867, in Pennsylvania, William S. Forbes, the Professor of Anatomy at
Jefferson Medical College, used the poor performance of Union surgeons in his efforts to
promote a state anatomy act. Forbes attributed surgeons’ lack of practical anatomical
knowledge to, “the obstacles in the way of having fully and systematically dissected the
2l4Edward C. Atwater, “Internal Medicine,” in The Education of American Physicians ed. Ronald Numbers (Berkeley, CA: University of California Press, 1980), 165-166.
2l5In the Union Army, penetrating chest wounds bore a 62 percent mortality rate. Those who suffered abdominal wounds, fared worse, with a mortality rate of 87 percent. Kenneth Ludmerer, Learning to Heal (New York, NY: Basic,1985), 10.
2I6Kaufinan, Medical. 113.
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dead body during their novitiate and afterwards.”217 Like Warren and Draper before him,
Forbes overcame legislative opposition by equating surgical skill with anatomical
knowledge learned through dissection.
hi 1867, Pennsylvania passed the first of two anatomy laws. A later statute
extended the laws beyond Philadelphia to the whole state and compelled the custodians of
public institutions to turn over unclaimed bodies to medical schools. Other states began
to enact anatomy laws in the years following.
While St. Louis Medical College was no longer a Catholic institution, by the late
1860s the influence of Catholicism and its encouragement of anatomical study remained
evident in the practice of two of its early graduates. Louis Charles Boisliniere, an 1848
graduate and founder of the St. Anne’s Infant Asylum, remained at the College after
1855. Boisliniere, a devout Catholic, served before the war as St. Louis’ first medical
examiner. In 1870, he assumed the Chair of Obstetrics at St. Louis Medical College.218
The curriculum at the proprietary school continued to emphasize the close relationship
between anatomical knowledge learned by dissection and surgical skill. The 1872-1873
catalogue announced the passage of a dissection law in Missouri.219 Suggesting that this
217George M. Gould, The Jefferson Medical College of Philadelphia (New York, NY: Lewis Publishing Company, 1904), 206.
218Frank Glasgow, “L. Ch. Boisliniere, AM ., M i)., LL.D,” Transactions of the American Association of Obstetricians and Gynecologists 8 (1895): 396.
219Thirtv Second Annual Announcement of the St. Louis Medical College. Winter Session, 1873-1874. and Catalogue for 1872-1873 (St. Louis, MO: Southwestern Book and publishing Company, 1873), p. 7, RG01F, St. Louis Medical College Catalogs, 1842- 1890, Archives and Rare Books, Becker Medical Library, Washington University, St. Louis, MO.
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would lead to an increased supply of specimens, at decreased cost to students. As it did
before the war, the medical college offered courses in both practical and surgical
anatomy. Catholic hospitals continued to provide the arena for the school’s clinical
instruction. The Obstetric Clinic supervised by Boisliniere offered students the
opportunity to observe deliveries. Later, the college established a gynecological clinic at
St. Louis Hospital.
Another early graduate, Timothy Papin, rose to the Chair of Obstetrics at the
competing Missouri Medical College, hi 1871, Papin established an obstetric clinic
supervised by the Sisters of Mercy.220 Both Papin and Boisliniere were staunch
opponents of destructive methods in midwifery.221 hi St. Louis, the presence of two
devout Catholics as Chairmen of obstetrics departments revealed the Church’s success
there in promoting the reform of medical education toward a standard of care shaped by
Catholic norms.
During the 1870s, most attempts to reform American medical education failed.
Two American medical schools departed from the proprietary norm. Chicago Medical
School did so by admitting fewer students. The school upheld preliminary education
requirements, lowered the number of entering students, and conducted a five month
graded course. Charles Eliot, as President of Harvard University, asserted control over
the Harvard Medical School in 1871. The Harvard corporation imposed a graded course
220“S t Louis Institute For the Diseases of Women” S t Louis Medical and Surgical Journal 8 (10 September 1871). [Unpaginated Advertisment].
^Glasgow, “Boisliniere,” 397.
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of studies, a three year course of nine month terms with oral and written examinations in
each department.222
The importance of the Church’s support o f scientific education is seen in the
general social change supporting a new medicine in post-bellum America. In 1877, the
state of Illinois passed statutes establishing regulations for medical schools and specifying
the number of faculty members, and requirements for laboratory and hospital study. Soon
after, the state passed laws requiring the passage o f stringent examinations for individual
practitioners to enter practice.223
But in Washington, D.C., anatomy like medical education, remained unreformed.
Dr. Llewellin Eliot, a professor at Georgetown Medical College, enjoyed regaling
listeners with the exploits of body snatchers of the nineteenth century. Eliot remarked,
“W e...call body snatching a nefarious trade that bummers, outcasts, derelicts, only will
engage in... for while there is honor among thieves, there were honor, bravery, and
friendship among rival demonstrators.”224 An anatomist’s diary, seized during one arrest,
exposed Georgetown Medical College as the frequent client o f body snatchers.225
Georgetown University continued to obtain its cadavers from quasi-legal sources through
out the 1870s.
222Kaufinan. Medical. 130-131.
223Kaufman, “American,” 17.
224LleweIyn Eliot, “Discussion of: A History of Body Snatching,” by Frank Baker, M.D., Washington, D.C.,” Washington Medical Annals IS (July 1916): 247.
^ Washington Evening Star. 2 September 1873; Eliot, “History,” 250.
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The Catholic Church condemned the desecration of graves and the theft of bodies
from cemeteries. In 1880, the body snatching of a Catholic woman in Baltimore drew
attention to the lack of anatomical laws in Maryland.226 In response to the crime, the
Baltimore Catholic Mirror urged the legislature to pass strict laws against body
snatching.227 T. A. Ashby, editor of the Maryland Medical Journal, claimed that the
passage of desecration laws would only increase the incidence of such crimes.
Dissection, he claimed, remained a necessity for medical schools. Ashby urged the
legislature to regulate the trade of cadavers by “well guarded requirements.”228 The
perpetrator, Jensen, was extradited from Washington but was later acquitted.229
The frequent reports of grave robberies that followed in the Mirror revealed the
concern of Catholics readers with acts of desecration.230 In March of 1881, the looting of
Sweet Home cemetery in Baltimore proved embarrassing for the Catholic Church, with
the Mirror castigating the pastor in charge of the cemetery for his failure to protect the
dead. The pastor responded with a proposal to erect high fences and hire armed guards to
226Baltimore Sun. 19 November 1880.
U7iiA law stringent in terms, explicit in directions, should be should be passed at the next session of the legislature making body snatching a felony. Its provisions should be so adequate and imperative that the police authorities would neither be slow or remiss to enforce it.” Baltimore Catholic Mirror. 27 November 1880.
228T. A. Ashby. “Editorial,” Maryland Medical Journal 7 (December 15,1880): 376.
^Baltim ore Catholic Mirror. 5 March 1881.
230Baltimore Catholic Mirror. 29 January 1881; 5 February 1881; 19 February 1881. An article in Baltimore Sun, confirmed the frequency of desecrations in the vicinity of Baltimore. See Baltimore Sun. 22 March 1881.
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protect the cemetery.231 However, despite anger over such incidents the Mirror never
criticized the practice of dissection.
However, such crimes did prompt the Maryland legislature to pass both
desecration and anatomy laws. During the 1882 legislative session, Bill No. 105
established body snatching as a misdemeanor with a penalty of five to fifteen years
imprisonment.232 Senate Bill No. 106 made bodies of deceased persons slated for burial
at public expense, in Baltimore County, available to medical colleges for dissection after
forty-eight hours. Initially, Ashby praised the new anatomy law in the pages of the
Maryland Medical Journal.234 But by the year’s end, the editor reported the failure of
23‘Baltimore Catholic Mirror. 5 March 1881.
232For the text see, House Bills. 1882. No. 105, Maryland Legislative Research Library, Annapolis, MD. The bill was introduced in the House on 24 January; read for the first time on 23 February; read in the Senate for the first time on 28 March, and sent to the Judiciary Committee for reading on the following day. After it passed the Senate on 31 March, it returned to the House. See Journal of Proceedings. Maryland House of Delegates, January Session, at 125, (1882); Journal o f Proceedings, Senate of Maryland, January Session, 1882, at 848, 891, 999, (1882). The governor signed the bill at the close of the session. See An Act to Add Additional sections to Article Thirty of the Maryland Code Public General Laws, title “Crimes and Punishments, providing punishment for the removal or the attempt to remove, from any graveyard, burial ground or vault in the State of Maryland, any dead body that may have been buried in such graveyard, burial ground or vault,” Public General Laws. (1882), Art 27, sec. 1, ch. 422,1904 MD. Laws, 850.
233Senate Bills. No. 106, Maryland State Legislative Research Library, Annapolis, MD; proposed and read for first and second time on 8 March; 10 March read a third time and passed the Senate, hi the House: first read on 15 March; second reading March 16th; 3rd reading and passed 28 March. See Journal of Proceedings. Senate of Maryland, January Session, 1882, at 517, 577 (1882); Journal of Proceedings. Maryland House of Delegates, January Session, at 873,901,995, (1882); signed on 30 March 1882. See An Act to Provide for the Prosecution of the Study of Anatomy in the State of Maryland. March 30,1882, Public General Laws. Art 3, sec. 63, ch. 163,1882 MD. Laws, 222-223.
234T. A. Ashby, “The Study of Anatomy in the State of Maryland,” Maryland
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public officials to comply with the law. Soon the Journal noted a new shortage of
cadavers in Maryland medical schools.
In the early 1880s, Georgetown Medical College in Washington shared the lot of
most proprietary institutions. In 1878, Georgetown had modeled its curriculum on that of
the Harvard Medical School. Clinical education began at Providence and Children’s
hospitals, respectively, in 1883, but Georgetown lacked the financial resources to easily
implement the process of reform. Although the curriculum called for an increased
emphasis on dissection, five years passed before rigorous instruction began with a new
professor of anatomy.236 The conduct of anatomical instruction and the procurement of
specimens remained a problem at Georgetown and other regional medical colleges.
Emphasis on anatomical study increased both demand for cadavers and incidents
of body snatching in Washington.237 One Georgetown demonstrator resigned because of
his inability to procure cadavers for the school.238 The Forty-Eighth Congress soon
Medical Journal 9 (October 15, 1882): 285-286.
235Ludmerer, Learning. 56.
^Curran, Georgetown. 309,393 n.l 18.
^T he trial of the Shaw resurrection revealed that Vigo Jans in Ross stole a cadaver he previously delivered to Georgetown for re-sale to the Howard University Medical School. It appears that cadavers were for sale to the highest bidder. The account also revealed that such deliveries occurred late at night to conceal the illegal trade in bodies from the public. See Washington Evening Star. 24 January 1883; Eliot, “History,” 251.
238Louis Kolipinski, Washington, DC, to Faculty of the Medical Department, University of Georgetown, 9 January 1885, MLS, lp., Archives Subject Files: Medical School, 1885-1888, Georgetown University Archives, Washington, DC.
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debated a bill designed to regulate anatomy and prevent desecrations. The bill’s sponsor
acknowledged the problem presented by the collusion o f physicians, civil authorities, and
body snatchers in the quasi-legal trade of cadavers.239 As proposed, the bill promised to
provide a legal source of cadavers and calm a frightened public by requiring physicians to
provide for the burial of subjects after dissection. The bill died when Congress failed to
act on it before the close of the legislative session.240
Two new anatomy bills appeared in the Forty-Ninth Congress.241 However,
President Grover Cleveland vetoed the Senate version passed by Congress, because it
239Congress, House, Committee on the District o f Columbia, Promotion o f Anatomical Science, report prepared by Representative W. L. Wilson, 48th Cong., 2nd sess., 1885, Rep. No. 2257, Serial 2328.
240On 3 March 1884, Representative Willis introduced an anatomy bill in the House of Representatives. On 12 January 1885, it was read a third time and passed in the House; 13 January 1885, read twice and in Senate and sent to committee; on 2 February 1885, reported before the Senate and recommended for passage; bill dies with the close of the session. See Congress, House, Representative Willis, H.R. 5650,48th Cong., 1st Sess., Congressional Record (3 March 1884), vol. 15,1568; Congress, House, Representative Wilson of Maryland, H.R. 5650,48th Cong., 2nd Sess., Congressional Record (12 January 1885), vol. 16,637; Congress, Senate, Senate Orders, HJL 5650, 48th Cong., 2nd Sess.. Congressional Record (\ 3 January 1885), vol. 16,647; Congress, Senate, Committee on the District of Columbia, Report fto accompany bill H.R. 5650. report prepared by Senator Zebulon B. Vance of North Carolina, 48th Cong., 2nd sess., 2 February 1885 Rep. No. 1122, Serial 2273; Washington Evening Star. 2 February 1885.
241 On 10 December 1885, read twice and returned to Committee. On 7 January 1886, House bill read twice and returned to Committee. On 4 February 1886, Senate reported and recommended for passage. On 4 March 1886, House bill tabled. See Congress, Senate, Senator Zebulon B. Vance of North Carolina, S. 349,49th Cong., 1st Sess., Congressional Record (10 December 1885), vol. 17, 154; Congress, House, Representative Wilson of Maryland, H.R. 5650,49th Cong., 1st Sess., Congressional Record (7 January 1886), vol. 17, 521; Congress, Senate, Committee on the District of Columbia, Report fto accompany bill S.349]. report prepared by Senator Zebulon B. Vance of North Carolina, 49th Cong., 1st sess., 4 February 1886, Rep. No. 78, Serial 2273; Congress, House of Representatives, Committee on the District of Columbia, The
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failed to delimit the responsibility o f authorities for the management of dead bodies. He
also stated that medical schools, rather than individual physicians, should post bond for
cadavers. Finally, the bill failed to specify a recourse for survivors who sought to reclaim
the bodies of loved ones.242 A later Senate vote failed to override the President’s veto.243
In the midst of these Congressional maneuverings, body snatching continued
unchecked. Graves at Mt. Olivet, Washington’s Catholic cemetery, were rifled on 30
January 1888.244 The Church News commented, “So revolting is this infamous crime that
the adoption of the severest law is an urgent necessity to punish the ghouls who rob the
dead of their silent rest.”245 However, as in Baltimore, the editor of the Church News
directed the ire of the Church at grave robbery rather than dissection; no doubt reflecting
the distinction between the two in the contemporary view of the Church.
Congress attempted to draft and pass yet another anatomy law during the Fiftieth
Congress.246 Washington’s Commission government endorsed efforts to pass the new
Promotion of Anatomical Science and Prevention of the Desecration o f Graves Report rTo Accompany bill S.349], report preparedby Senator Zebulon B. Vance o f North Carolina, 49th Cong., 1st sess., 4 March 1886, Rep. No. 873, Serial 2473.
242Congress, Senate, Message from the President of the United States. Returning Senate 349. With his Objections Thereto 49th Cong., 1st sess., 26 April 1886, Exec. Doc. No. 131, Serial 2340.
243Congress, Senate, President pro tempore. S. 349,49th Cong., 1st Sess., (30 April 1886), vol. 17,4002.
244Washinptnn Evening Star, 30 January 1888.
245Washington Church News. 5 February 1888.
246John B. Blake, “Anatomy and the Congress,” in, Medicine. Science and Culture Lloyd G. Stevenson and Robert P. Multhauf (Baltimore, MD: Johns Hopkins Press, 1968), 171.
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law.247 as did the editors of the Star and Church News.248 A report on Bill HJL 5042
noted that past efforts failed because they did not account fully for popular beliefs in
favor of burial.249 The debates in both houses reflected the truth of this claim. Senator
Taulbee, the bill’s chief opponent, argued against the display o f specimens after
dissection in the laboratory, and a flurry of amendments proposed to stall it prevented the
bill’s passage.
Georgetown Medical College, caught up in a power struggle with its host college,
became further entangled in the controversy over dissection. In 1886, the medical faculty
built its own new class building. This move raised questions for the Jesuits about the
medical department’s relationship with the Georgetown College.230 hi June of 1888,
Joseph Havens Richards, a physicist, succeeded James Doonan as President of the
College. Richards hoped to improve Georgetown, especially the law and medical
247W. B. Webb, President, Commissioners of the District of Columbia, to Hon. John Hemphill, Chairman, Committee for the District of Columbia, House of Representatives, February 7,1888,33710, Letters Sent, 1874-1965, Government of the District of Columbia, Record Group 351, Entry 19, National Archives, Washington, DC.
248Washinpton Evening Star. 17 February 1888; Washington Church News. 19 February 1888.
249Congress, House, Committee on the District o f Columbia, Promotion of Anatomical Science. Etc.. report prepared by Congessman Atkinson, 50th Cong., 1st sess., 1888, Rep. No. 539, Serial 2599, no. 12, p.l. Both Atkinson and Congressman Cutcheon testified in favor of the Bill. Atkinson was the author of Pennsylvania’s anatomy statute.
^Curran, Bicentennial. 328.
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departments, and help Georgetown regain its status from Fordham University as the
premier Catholic college o f the nation.251
Thomas Campbell, Provincial of the New York Province, believed that greater
Jesuit control over the medical school was becoming necessary.252 In correspondence
with Campbell, Richards addressed Jesuit concerns over conformity with Catholic
teaching. But, the President’s confidence in Doctors Kleinschmidt and Magruder,
professors at the Georgetown Medical College, helped allay these concerns. Finally,
Richards also revealed his plan for increased control in his letter to Campbell. Richards
planned to “tighten our hand on the rein there” by assuming the debt and ownership of the
new medical building.253 By making the professors salaried employees o f the University,
Richards obtained a controlling voice in faculty appointments.254 Richards saw a close
relationship with the graduate institutions as integral to the university’s future progress.
Soon, a new challenge arose to threaten the medical school. Saint Joseph’s
Orphan Asylum, established in 1855, stood next to the new building. The president of the
251Ibid., 329.
252Campbell wrote; “the school ought to be got altogether in our control + after the 4 years even that is a big concession (to the M-D.s) salaries ought to be paid.” Thomas Campbell, New York, to Joseph Havens Richards, Georgetown, ALS, 10 September 1888,4p., Archive Subject Files: “Medical School 1885-1888,” GUA, Washington, DC.
253George L. Magruder, Washington, to Joseph Havens Richards, Washington, ALS, 10 October 1888, lp., Archives Subject Files: “Medical School 1885-1888,” GUA, Washington, DC.
^Joseph Havens Richards, Georgetown, to Thomas Campbell, New York, ALS, 13 October 1888, lOp, 501:19, Box 94, File 4, Varia [501:16-32], Maryland Provincial Archives, GUA, Washington, DC.
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orphanage, Fr. Jacob Walter, served as pastor of St. Patrick’s Church and as a Consultor
to the Archbishop of Baltimore. Since St. Joseph’s opened, Dr. Joseph Toner, a
prominent Catholic physician and former President of the AMA, had acted as the
orphanage physician. The Sisters of the Holy Cross cared for one hundred boys in the
asylum. By 1888, the orphanage was a venerable institution broadly supported by the
contributions of the local Catholic community.255
The proximity of the two institutions resulted in a widely reported conflict. On 10
November 1888, neighborhood residents approached the Health Department to complain
that the.dissecting room of the Georgetown Medical College posed a health nuisance to
the community. After an inspection o f the dissecting room, the Health Department
ignored the complaint. On the following day, Henry Towles, a local merchant, Fr.
Walter, and a group of angry neighbors presented their petition against the school before
the City Commissioners.256 The complaint called not only for the abatement of the
nuisance, but also for the removal of the dissection room from the center of the city. A
letter in the Evening Star, complained o f the health nuisance at the Georgetown Medical
255Original Bill to Enjoin Nuisance, Case No. 11496; Docket No. 28; Equity Court Records, United States Supreme Court for the District of Columbia, Record Group 21, National Archives, Washington, DC.
256This account is confirmed by the following entry in the correspondence registers o f the Commissioners of the District of Columbia. “152343 Dissecting o f Bodies at Georgetown Col. Complaints of -Towles” in Subjects of Letters Received 145998 to 160562 April 7, 1888 to September 29,1889 Book 7 (1888), RG 351 Entry 15, National Archives-Washington, DC. The complaint itself is noted in the Washington Post 15 November 1888.
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School.257 Nell, the author, complained about the ( coming from the dissection laboratory. The “butchered humanity” evident on the back porch also offended the neighbors. These “ghastly sights” forced the orphanage to close its windows to protect the innocence of its inmates. Such accusations, and anger over the quasi-legal trade in cadavers, posed a threat to the existence of the medical school. Smith Townshend, Washington’s health officer, readily endorsed the health complaint. Inadequate ventilation in the dissection laboratory caused the nuisance. He noted however, “O f course, the college is a regularly chartered institution, and we cannot force it to move its dissecting room, but we can make it supply the usual contrivances for the escape of the smell, and that much I am determined shall be done.”259 On 15 November 1888, Townshend issued a health notice to the college calling for the abatement of the nuisance. The official gave Georgetown College ten days to remedy the nuisance. The medical school responded to the allegations on the following day. George Magruder, the Dean, claimed that a school custodian’s had caused the problem. His 257Washingtnn Evening Star. 14 November 1888. 258Smith Townshend submitted a one-page report to the Commissioners on 29 November 1888, as a reply to No. 1523434 [the Towles complaint above] and appears in the Court evidence as Exhibit A: To Answer of Defendant; Case No. 11496; Docket No. 28; Equity Court Records, United States Supreme Court for the District of Columbia, Record Group 21, National Archives, Washington, DC. The reply of the Commissioners included a copy of Townshend’s report. W.R. Tindall, Secretary, Commissioners of the District of Columbia to H.O. Towles and Others, December 3, 1888,37857, Letters Sent, 1874-1965, Government of the District of Columbia, Record Group 351, Entry 19, National Archives, Washington, DC. 259Washirt|zton Post. 15 November 1888. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 108 failure to fire the building’s furnace and ventilation system, due to unseasonably warm weather caused the offensive odors. Likewise he had neglected to disinfect the laboratory after the dissection of a decomposed cadaver. The Washington Post noted that none of these explanations satisfied the desire of residents to move the dissection room to another part o f town.260 Reports o f the dispute soon reached other cities. The New York Times cast the Health Department’s initial reluctance to act as a sign of the federal governments’ neglect of District residents. Georgetown, it alleged, had deceived residents by omitting the dissection room from the original building plans. The press also reported Fr. Walter’s views on the detrimental effects of the dissection laboratory to orphans. Walter feared that St. Vitus dance or “some dreadful disease” would result from their exposure to the nuisance.261 Newspaper accounts also criticized medical students for the carnival atmosphere that allegedly attended their dissections. In the Baltimore Sun. Doctor Lovejoy, a professor at Georgetown, defended the medical school. Like Magruder, he cited faulty ventilation as the true cause of the nuisance. And he suggested that new screens installed on the dissection room windows would prevent anyone from observing the activities within. The professor dismissed Fr. Walter's fears of harm to those breathing the foul air of the dissecting room.262 On 19 November 1888, the Washington Post reported on a meeting of the Board of Managers of 2 ^Washington Post 16 November 1888. 26lNew York Times. 17 November 1888. 262Baltimore Sun. 19 November 1888. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 109 the orphanage. During the meeting, Walter called for an injunction against the medical school.263 The proximity of the orphanage to the medical school rendered compromise impossible. Georgetown College, he argued, “would not have that dissecting room and pest on their grounds.”264 For Walter and the managers the task o f removing the dissecting room from the neighborhood represented “war to the knife.”265 The Washington Post published a letter from Magruder to a health officer expressing Georgetown’s desire to end the conflict.266 The letter mentioned an architect’s suggestions for structural improvements for the building that would provide more effective ventilation. Magruder that such improvements had already been carried out.267 Magruder also invited health officials to visit the school and inspect it on a weekly basis. A second inspection verified the truth of Magruder’s claims. While secular publishers featured the dispute, between orphanage and medical school, the silence from the Catholic press was deafening. During this period, the Mirror’s only mention of Georgetown College concerned plans for the centennial celebration planned for 20 to 23 February of 1889.268 Another issue announced a fund 263Washington Post 19 November 1888. 264Washington Evening Star. 19 November 1888. 26sW ashington P o st 19 November 1888. 266Washington Post. 20 November 1888. 267Washington Evening Star. 24 November 1888. 268Baltimore Catholic Mirror. 10 November 1888. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 110 raiser for St. Joseph’s Asylum.269 The Church News did not even mention the disputing parties at all. The silence of both newspapers is curious, hi the past, each had commented on the outrage of body snatching and supported statutes to punish the desecration of cemeteries. Privately, some Jesuits were more outspoken in their views. James Joseph Doonan, Richard’s predecessor as President of Georgetown College, condemned the campaign against the medical college. Doonan characterized the conduct of Fr. Walter as “extremely offensive.” While he acknowledged some grounds for the criticism, Doonan viewed the actions taken by the complainants as unfair. He believed that other parties to the dispute, especially businessmen, should exhibit more loyalty to the medical school given their personal profit from the college. Doonan suggested that the Jesuits should “boycott them all” and do business with others who would treat the college fairly.270 On 10 Decemberl888, the dissection room disputed emerged again in the press.271 Fr. Joseph Walter, and Mary Dashiell filed a bill of complaint against the medical school 269Baltimore Catholic Mirror. 24 November 1888. 270James Joseph Doonan, S.J., New York, to Joseph Havens Richards, S.J., Washington, 21 November 1888, ALS, 4p., Archive Subject Files: Medical School, 1880- 1916, Medical School, 1885-1888, GUA, Washington, DC. 27lThe dissection room dispute had remained out of the secular press since 24 November 1888. However, the issue of medical education remained in the public eye. A letter written under the pseudonym “B” appeared in the Star. The letter criticized the current method of medical study. The author called instead for the establishment of a four year medical program and, ridiculed the practice of a post-graduate year in Vienna without the benefit o f German language proficiency. “B” called for an emphasis on clinical training and asserted that students should have all die necessary facilities, including dissection, for their study. Finally, the author called for hospitals and medical schools to cooperate in providing students opportunities for clinical education. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. I l l in the equity couit before Judge William Cox.272 The document accused the medical school of dissecting disease victims, “exhumed in various stages o f decomposition after burial in the earth for varying periods o f time.”273 Late night transport of cadavers to the school also awakened neighboring residents, and “the remnants o f said bodies after such dissection are in great part burned in the furnace.”274 The complaint called these practices, “Offensive and demoralizing to the infants of said asylum, the most of whom are as aforesaid children of tender years.”27S The charges identified the stench as a recurring grievance with a deleterious effect on local property values. Apparently, self interest united Fr. Walter and the neighborhood William Magruder responded to “B” four days later. Magruder acknowledged the lack of cooperation between Washington’s medical schools and hospitals as an impediment to effective clinical education. Yet, Magruder disputed “B’s” contention that Washington schools were behind those of other cities in the promotion of a four year program. The writer defended both the role and availability of post-graduate study in Washington medical schools. In actuality, however, such specialized education was in its infancy in Washington. Curiously, Magruder overlooked this opportunity to promote the study of dissection. See Evening Star (Washington!. 4 December 1888. I suspect that “B” is John Shaw Billings, the Army Surgeon General, since he testified in favor of the medical school during the trial in the equity court. See Washington Evening Star. 8 December 1888. 272Mary Dashiell owned a boarding house next to the medical school. She claimed that the health nuisance caused in a decline of boarders in her residence. The case appeared on the docket as Trustees of the St. Joseph’s Orphan Asylum, et. al. v. Faculty of the Georgetown Medical Department of Georgetown University, 11496 (D.C., docketed, December 11,1889); Original Bill to Enjoin Nuisance, Case No. 11496; Docket No. 28; Equity Court Records, United States Supreme Court for the District of Columbia, Record Group 21, National Archives, Washington, DC. 273Ibid., Count 8. 274Ibid., Count 9. 27sIbid., Count 10. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 112 residents. Appeals to the interests o f the children represented a tactic used to buttress the complaint. The closing prayer of the complaint called on Judge Cox to restrain the medical school from using the property for, “the deposit thereon or dissection therein of any dead human or other body.”276 Second, the complainants sought further relief on the premises as may have been required.277 Finally, the prayer called upon the medical college to answer the bill of complaint.278 In answer to the prayer, Judge Cox issued a restraining order against dissection at the medical college. The court served the order on G. Lloyd Magruder and scheduled a hearing on the nuisance for 17 December 1888.279 Affidavits accompanying the complaint recounted the discomfort of daily living near the school. Resident Fannie Towles complained of the clamor made by the evening deliveries of cadavers and the damage to her household linens from the stench of the incinerator.280 Cornelia Bishop, a servant in the Towles home, compared the smell of the medical college with that of a dead rat.281 Mary Dashiell complained o f the discomfort 276Ibid., Prayer, Petition 1. 277Ibid., Prayer, Petition 2. 278Ibid., Prayer, Petition 3. 279Restraining Order, December 10,1888 Case No. 11496; Docket No. 28; Equity Court Records, United States Supreme Court for the District of Columbia, Record Group 21, National Archives, Washington, DC. 280Affidavit of Fannie Towles, Affidavits in Support of Complaint, Case No. 11496; Docket No. 28; Equity Court Records, United States Supreme Court for the District of Columbia, Record Group 21, National Archives, Washington, DC. 28IAffidavit of Cornelia Bishop, Affidavits in Support of Complaint, Case No. 11496; Docket No. 28; Equity Court Records, United States Supreme Court for the Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 113 created for residents of her boardinghouse by the stench of the laboratory.282 Neighbor Kate Moore claimed to have witnessed the late-night delivery of bodies to the school.283 Moore’s account is plausible given published accounts of prior deliveries. Curiously, Fr. Walter did not submit his own affidavit, but the gruesome testimony of the other witnesses provided an unsavory picture o f life near the medical college. The medical school responded to all these charges during a hearing on 17 December 1888. Georgetown denied that it exhumed bodies “in various stages of decomposition” after burial. Instead, the college purchased only fresh subjects. The college also denied burning human remains in the school furnace. Human remains were packed in barrels, disinfected, and disposed of according to the rules established by the Health Department. The medical college claimed to exercise discretion in its efforts to procure and transport specimens. Such discretion proved necessary in view of the morbid curiosity of some neighbors. According to the college, when warm weather caused students to open the dissection room windows, neighbors used opera glasses to view the dissections from District of Columbia, Record Group 21, National Archives, Washington, DC. 282Affidavit of Mary Dashiell, Affidavits in Support of Complaint,No. Case 11496; Docket No. 28;Equity Court Records, United States Supreme Court for the District of Columbia, Record Group 21, National Archives, Washington, DC. 283Affidavit of Kate Moore, Affidavits in Support of Complaint, Case No. 11496; Docket No. 28;Equity Court Records, United States Supreme Court for the District of Columbia, Record Group 21, National Archives, Washington, DC. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 114 the surrounding buildings. The defense averred that “infants” from the orphanage accomplished the same end by breaking dissecting room windows.284 Georgetown admitted its negligence in failing to promptly remove human remains from the premises. Already, the school had taken measures to remedy the complaint Such compliance was offered willingly because the prohibition against dissection ordered by Judge Cox hindered anatomical instruction at the school. If the restraint on dissection persisted, “it [the college] would be irreparably injured...and by preventing of attendance by students, would have its school broken up and destroyed.”285 Such fears were reasonable given the competition among local medical schools. Affidavits accompanying the defendant's answer minimized the nuisance. Hugh Smith, the demonstrator of anatomy, stressed the infrequency of cadaver deliveries to the college.286 Dr. Frank Baker, professor of anatomy, claimed that the continued prohibition of dissection would destroy the medical school.287 Students who testified denied any part in the delivery of cadavers to the college. G. Lloyd Magruder, the Dean, testified to his 284Defendants Answer, Case No. 11496; Docket No.Equity 28; Court Records, United States Supreme Court for the District of Columbia, Record Group 21, National Archives, Washington, DC. 285Ibid., Count 11. 286Affidavit of Hugh Smith, Case No. 11496; Docket EquityNo. 28; Court Records, United States Supreme Court for the District of Columbia, Record Group 21, National Archives, Washington, DC. 287Affidavit of Dr. Frank Baker, Case No. 11496; DocketEquity No. 28; Court Records, United States Supreme Court for the District of Columbia, Record Group 21, National Archives, Washington, DC. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 115 efforts to abate the nuisance.288 President Richards recounted his own recent visit where he found the building in “excellent condition, and free from offensive odors.”289 The affidavit asserted further that he found no evidence of the complaint during his visit. Evidence presented at the hearing included testimony from the city health officer, which certified that Georgetown had remedied the nuisance within the required period.290 John Shaw Billings, the Army Surgeon General, testified about his visit to the college. Billings believed that the practice of dissection in the building posed no threat to the neighbors.291 Z. T. Sowers, a health inspector, reported on the absence of odors during his inspection of the college. Sowers claimed that the only possible objection to the school stemmed from, “the sentiment of the women in the neighborhood that there are dead bodies near to them, and whose imaginations make them believe that there is at times as much going on as there actually is.”292 288Affidavit of Dr. Frank Baker, Case No. 11496; Docket EquityNo. 28; Court Records, United States Supreme Court for the District of Columbia, Record Group 21, National Archives, Washington, DC. 289Affidavit of Fr. Joseph Havens Richards, Case No. 11496; Docket No. 28; Equity Court Records, United States Supreme Court for the District o f Columbia, Record Group 21, National Archives, Washington, DC. 290Affidavit of Smith Townshend, Case No. 11496; Docket EquityNo. 28; Court Records, United States Supreme Court for the District of Columbia, Record Group 21, National Archives, Washington, DC. 291 Affidavit of Dr. John Shaw Billings, Case No. 11496; DocketEquity No. 28; Court Records, United States Supreme Court for the District of Columbia, Record Group 21, National Archives, Washington, DC. 292Affidavit of Z.T. Sowers, Visit of Inspection, Case No. 11496; Docket No. 28; Equity Court Records, United States Supreme Court for the District of Columbia, Record Group 21, National Archives, Washington, DC. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 116 Sowers comments highlighted the Victorian attitudes toward women present in testimony by both sides. The counsel for the complainants characterized a Sister of the Holy Cross thus, “such a woman could not but be honest and sincere in her statements against the College.”293 Such comments recall earlier, confining gender roles like the ideal of the virtuous woman.294 The counsel for the defense referred to the complaint as a “woman's case.” He further characterized the complainants as “women peculiarly, perhaps morbidly sensitive to the proximity of a dead person, whether they can see it or not.”295 Such comments clearly played to nineteenth century images of women as victims of hysteria.296 Judge Cox’s denial of an injunction to the complainants reflected similar attitudes. Cox rejected the veracity of accounts of the transport o f cadavers at night and the incineration of human remains. This view contradicts accounts of the Shaw resurrection, which described the late night deliveries to medical schools. Cox argued that the “very agitation of this subject would stimulate the imagination o f people.”297 The comments 293Washington Post 18 December 1888. 294These images resemble the gender imagery o f the “Cult of True Womanhood” presented in the work of Carroll Smith-Rosenberg and others. Carroll Smith Rosenberg, “The Cross and the Pedestal,” chap. in Disorderly Conduct (New York: Oxford University Press, 1985), 133. 29SWashington Post 18 December 1888. 296Carroll Smith Rosenberg, “The Hysterical Woman: Sex Roles and Role conflict in Nineteenth Century America,” chap. in Disorderly Conduct (New York: Oxford University Press, 1985), 202. 297Washington Post 18 December 1888. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 117 appear to agree with the defense argument that women were unreliable witnesses in the case. Cox ruled in favor of the medical school given the amount of capital the school had at risk in the institution. A second consideration concerned the potential expense to the complainants for a security bond required in the case of an injunction. Cox believed that giving Georgetown an opportunity to exercise greater discretion in its conduct of dissection reflected the best solution for all concerned. Despite popular opposition to dissection, Cox realized that dissection served the public good through the advance of medical knowledge. In large part, the Georgetown University dissection laboratory dispute ended. Apart from a damage suit filed by Mary Dashiell to seek restitution for damage to her boarding house, the matter was laid to rest. Dashiell’s suit met with dismissal in 1894 due to her death. Georgetown University continued its anatomical instruction at the medical college. Georgetown Medical College settled down to the business o f educating physicians. However, the silence of the official Church on this issue is deafening. The Catholic newspapers of Baltimore and Washington often condemned grave robbing. However, none of these publications commented on the practice of dissection by Georgetown medical students. Furthermore, the Archbishop of Baltimore took no action against the medical college or its Jesuit sponsors. On 23 February 1889, Archbishop Gibbons participated in the centennial celebration of Georgetown College. His presence at the event suggests that he endorsed the activities of the medical college. Dr. Thomas Dwight of Harvard, a long-time Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 118 Catholic advocate of the Church’s role in the history of medicine, received an honorary Doctor of Laws during the celebration.298 hi an 1879 article, Dwight had proclaimed that during the Renaissance the Church promoted study of anatomy by its silence.299 The evidence suggests that Gibbons’ silence on the Georgetown controversy reflected his support for the advance of medical education. Gibbon's silence also countered those who questioned the propriety of a Church presence in American higher education.300 The silence of Gibbons on the issue of dissection suggests that the Archbishop believed that ultimately, effective anatomy laws would make his own intervention to stem the abuse of the sepulcher unnecessary. The equity court case represented a local issue with national consequences. Gibbon’s silence proved his mastery of the role of liberal conciliator within the Church. The silence of the Church allowed the practice of anatomy to flourish at Georgetown ensuring the schools’ survival. Unlike Fr. Jacob Walter, Gibbons refused to yield to the popular revulsion of practicing Catholics toward dissection.301 Through his restraint, and openness to science, Gibbons helped preserved a 298Washington Church News. 3 March 1889. 299[Thomas Dwight], “The Church and Science,” Catholic World 29 (May 1879): 194. The article in the Catholic World is the only one of its kind to appear during this era in the widely read journal. It is unlikely that Gibbons overlooked it. 30°John William Draper, History of the Conflict Between Religion and Science (New York, NY: D. Appleton and Company, 1875), 351-352, 355. 301 It appears that Walter lacked the prudence and caution that characterized the behavior of Gibbons. Shortly after the dissection case Gibbons responded coolly [it appears to be a polite deflection] to Walter’s proposal to construct a new hospital in the Capital city. See James Cardinal Gibbons, Baltimore, MD to Jacob Walters, Washington, DC, 13 March 1889, ALS, Ip, 85 T 8, AAB, Baltimore, MD. See also Thomas Spalding, The Premier See (Baltimore. MD: Johns Hopkins Press, 1989), 181. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 119 place for the Catholic Church in future of medicine through its continued participation in medical education. The nuisance suit against Georgetown represented typical public fears about unregulated and uncontrollable dissection. By 1890, other states passed laws similar to those of Illinois regulating medical education and practice. The same year corresponded with the establishment of the American Association of Medical Colleges. The association soon began providing the standards of enforcement for state licensing agencies. In 1880,26.8 percent of medical schools required a three year curriculum; by 1894,96.3 percent had such requirements. Four of the leading medical schools,— Harvard, Pennsylvania, Michigan and Chicago—had four year programs.302 However, the later writings of Thomas Dwight reveal that anatomical instruction remained a problem for medical educators, hi 1896, as President of the American Association of Anatomists, Dwight claimed that dissection constituted a social problem that remained “an abomination to the public mind.”303 He suggested that difficulty stemmed from doctors’ efforts to conceal the surreptitious origin of their subjects.304 Well-regulated anatomy laws that respected the rights o f survivors provided the only 302Kaufinan, “American,” 19. 303Thomas Dwight, “Our Contribution to Civilization and to Science,” Science 3 (17 January 1896): 75. 304Thomas Dwight, “Anatomy Laws Versus Body Snatching,” Forum 22 (December 1896): 501. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 120 solution to the problem.305 In the absence of such laws, physicians would continue to share the scorn reserved for the body snatcher. While Congress passed an anatomy law in 1895, body snatching continued in the Mid-Atlantic region. Franklin Mall wrote of his struggle to procure subjects for the 1893 session of the Johns Hopkins University Medical Department. As Mall prepared for the first session, only forty-nine subjects were delivered by the state health commissioner for use by Maryland’s seven medical schools. Consequently, two of Hopkins first three dissection subjects were obtained from body snatchers. The scientist ultimately overcame the problem by relying on improved techniques of preservation and the legal regulation of procurement. In 1905, however, Mall noted that he still faced resistance from a local burial society. Popular revulsion toward dissection still persisted in Maryland.306 Given the high levels of public resistance, it is even more striking that the Catholic Church demonstrated such willingness to allow dissection in its institutions. But the Catholic hierarchy was well aware that only through medical reform would physicians be able to achieve the high standard of care advocated by the Church in surgery and midwifery. Only through dissection would students be able to link the theoretical knowledge of the classroom with experience gained in clinical education. This awareness forced the Church to submerge traditional beliefs on the sanctity of the grave and the 305Ibid., 501; Dwight, “Civilization,” 76. 306Franklin P. Mall, “Anatomical Material-Its Collection And Its Preservation At The Johns Hopkins Anatomical Laboratory,” Johns Hopkins Hospital Bulletin 167 (February 1905): 38-39. Popular resistance to autopsy persisted among the nation’s Catholics as well. See James J. Walsh, “The Priest and Post Mortem Examinations,” Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 121 mutilation of the body. With the growth of anatomy it became increasingly possible to develop a tradition o f gynecological surgery that was consistent with Catholic norms. Better trained surgeons would be better prepared to save the lives of mothers and their babies through surgical intervention. Thus, the Church promoted the education of medical students, that they would gain the knowledge necessary to heal the living. American Ecclesiastical Review 58 (March 1918): 405. Body snatching persisted in America until the early 1920s as is evident in Humphrey, ‘‘Discrimination,” 274. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. CHAPTER 5 ROMAN CATHOLICISM AND THE PROBLEM OF WOMEN’S DISEASE, 1864-1910 During the nineteenth century, American physicians engaged in a great search to improve the diagnosis and treatment of women’s diseases. The Catholic Church, because it wanted to eliminate abortions and bad outcomes in difficult pregnancies by promoting medical progress, supported the efforts of physicians. Still, this search took place in an age when scientific ignorance and underlying attitudes toward women may have affected diagnosis. The search to cure women’s disease led to experimental surgery that could be controversial. However, the Catholic Church remained silent because of the prospect of saving women and their children through the same operations. By 1864, the failure to discover the true nature of the diagnosis o f pregnancy and pathological changes in the ovary and uterus caused great confusion to persist among doctors. This confusion reflected the imperfect understanding of human reproductive functions such as ovulation and menstruation among physicians. Physician Horatio Storer’s comments illustrated the existing confusion on the nature and origin of menstrual problems. There are others, however, where the ovaries exist, and are perhaps well developed, and where there is an evident ovarian molimen. Here the question of attempting treatment will depend on the theory held by the attendant, as to the 122 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 123 essential nature of menstruation, and upon the condition of the patient during these monthly attempts at effective discharge.307 Storer attempted to cure amenorrhea, the absence o f menstruation, through surgical means without the risk of abortion. He promoted use of anesthesia as a means of increasing the safety of diagnosis through physical examination. Storer, a future Catholic, believed that stimulating menstruation through surgical means would relieve women’s suffering and discomfort as a result of amenorrhea. However his comments acknowledge that different theories existed on the nature of menstrual problems.308 One, held by Storer, proposed that a nervous reflex prompted by ovulation prompted menstruation.309 Others criticized the theory that menstruation 307Horatio Storer, “The Surgical Treatment of Amenorrhoea,” American Journal of the Medical Sciences 47 (January 1864): 83. 308If a woman has never menstruated, the illness is known as primary amenorrhea. If a women has menstruated in the past, the absence of menstruation for six months is termed secondary amenorrhea. The most common cause of amenorrhea is pregnancy. Other causes for this gynecological condition include: hypothalamic-pituitary dysfunction, ovarian dysfunction, and the alteration of the genital outflow tract. Adapted from Charles Beckmann, et. al., Obstetrics and Gynecology (Baltimore, MD: Williams and Wilkins, 1995), 375. 309Horatio R. Storer, “Cases Illustrative o f Obstetric Disease-Deductions Concerning Insanity in Women,” Boston Medical and Surgical Journal 70 (7 April 1864): 194; Boston Medical and Surgical Journal 71 (13 October 1864): 209-218; Horatio Robinson Storer, ‘The Relations of Female Patients To Hospitals For the Insane: The Necessity on their Account of a Board of Consulting Physicians to Every Hospital,” Transactions of the American Medical Association 15 (1865): 125. Storer beUeved that in insane women, symptoms of derangement often corresponded uterine or ovarian excitement. The theory supposes that such outbreaks were caused by a nervous reflex from the reproductive organs. However, Storer’s discussion of cures for amenorrhea did not involve mental illness. See also Barbara Ehrenreich and Deirdre English, Complaints and Disorders Old Westbury, NY: Feminist Press, 1973; Barbara Sicherman, “The Uses of Diagnosis: Doctors, Patients, and Neurasthenia.” in Sickness and Health in America Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 124 corresponded with ovulation. Proponents of a second theory argued that each function occurred independently as the result of an underlying erethism, that stimulated the reproductive organs. While some physicians observed that women menstruate because they do not conceive, a more complete understanding o f the reproductive cycle as a complex process stimulated by internal secretions awaited the twentieth century science of endocrinology.310 In the meantime, the search for appropriate means to cure menstrual problems continued to baffle American physicians. Like Storer, the Catholic Church sought to prevent the practice of abortion. The campaign against abortion revealed that physicians and the clergy acted as arbiters of social mores. Some surgeons also promoted the medicalization of moral disorders over and against clergy.311 Sometimes, these ideas resulted in the surgical treatment of disease without the identification of a localized disease entity. An account of normal ovariotomy at Washington’s Providence Hospital reveals the practice of such surgery in Catholic hospitals.312 Such operations disclose that the Church, like American physicians, faced the same problem presented by the definition and identification of gynecological disease. ed. Judith Walzer Leavitt and Ronald Numbers, (Madison, WI: University of Wisconsin Press, 1985), 22-35; McGregor, Sexual. 318; Dally, Women. 1-20. 310Theodore Cianfrani, A Short History o f Obsterics and Gynecology (Springfield, IL: Charles Thomas, 1960), 392. 311Sicherman, “Uses,” 27,32. 3I2Joseph Taber Johnson, “A Case of Battey’s Operation, With Remarks,” Maryland Medical Journal 9 (1 February 1883): 450,452. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 125 Given its vocal opposition to abortion, the silence of the Church on experimental surgery is perplexing. Such operations often resulted in the sterilization of patients, but the practice o f surgery to cure menstrual disorders persisted into the first decade o f the twentieth century. The Church, like physicians, struggled with the causes and appropriate treatment of women’s diseases. The study of ovariotomy reveals how ambiguity on the nature of disease hindered the Church’s ability to assess the validity of surgical practices. The use of paracentesis to treat ovarian tumors was the first surgical method used to treat the ovary as the seat of pathology. Draining the abdomen of serous fluids temporarily relieved women of the debilitation caused by abdominal swelling. While effective, the results of tapping were most often temporary, and the cure often resulted in the death of patients by exhaustion or infection. Ephriam McDowell of Kentucky was the first American surgeon to successfully remove such growths from the abdomen through an abdominal incision in 1809.313 However, the popularization of ovariotomy awaited the achievements of John and Washington Atlee of Philadelphia. British and American surgeons feared the risks of abdominal surgery, such as death by infection and shock. The Atlees pioneered changes in surgical care that made the practice o f abdominal surgery safer. Such advances were not apparent in their first attempt to remove diseased ovaries. Like McDowell, John and Washington Atlee accomplished their first operation in 1844 without anesthesia. The brothers decided to operate on Miss C. R. of Lancaster, Pennsylvania after four years of heroic therapy and the repeated practice of paracentesis. 3l3Dally, Women. 1-20. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 126 After a sixth tapping, Washington Atlee located two tumors during a vaginal and rectal examination.314 After consultation with Dr. William E. Homer, and the patient’s family, the brothers decided to operate. The protrusion of intestines from the incision complicated the conclusion of the surgery. However, after a forty-five minute procedure the Atlees successfully removed two tumors from the abdomen of Miss C. R. In comments on his success, John Atlee promoted the future practice of gastrotomy, a form of abdominal surgery, for the removal o f ovarian tumors. The success of French and American operators, he believed, held out hope for the relief of women from ovarian disease. Atlee argued that British innovations, such as the long surgical incision, would help his own countrymen overcome their prejudice against abdominal surgery. However, Atlee cautioned that such attempts should only follow lengthy observation and treatment of illness. Like proponents of the cesarean operation, the surgeon promoted the importance of early intervention to assure success. In the months following, Atlee received plaudits on his success from other British and American surgeons. Nathaniel Chapman remarked that his success would place him “among the most skilful of the surgeons o f our country.”315 However, more conservative 314John Atlee, “Case of Successful Peritoneal Section for the Removal of Two Diseased Ovaries Complicated with Ascites,” American Journal of the Medical Sciences 7 (January 1844): 48. 31sNathaniel Chapman, Lectures on the More Important Eruptive Fevers. Haemorrhages, and Dropsies, and on Gout and Rheumatism. Delivered in the University of Pennsylvania (Philadelphia, PA: Lea and Blanchard, 1844), 316. Other surgeons supported the Atlees as well. See Robley Dunglison, “Abdominal Surgery,” Medical Examiner 7 (27 January 1844): 14,16; James Huston, “Case o f Successful Peritoneal Section of the Removal of two Diseased Ovaries Complicated with Ascites. By John L. Atlee, M.D., of Lancaster City, Penn,” Medical Examiner 7 (10 February 1844): 33; Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 127 practitioners criticized the attempt to heal patients with abdominal surgery. One physician questioned whether such operators rendered a complete account of their failures.316 Another writer charged that ovariotomists reported their successes before assessing the permanency of such cures.317 Other cases demonstrate the limitations o f diagnosis by palpation. A second Atlee patient died of peritonitis after surgery. An autopsy revealed a large tumor hidden in the patient’s abdomen as the source of a fatal infection.318 Physical examination of a third patient yielded a diagnosis of ovarian tumors. After opening the abdomen, however, Washington Atlee discovered a large tumor in the peritoneum instead. Nevertheless, the attempt resulted in the successful removal of a uterine tumor.319 Despite great ambiguity, such attempts resulted in advances in surgical knowledge. Before the failed second attempt, Washington Atlee used paracentesis and microscopy to establish the existence of ovarian tumors. Atlee claimed that changes in Fleetwood Churchill, “Notes on Ovariotomy,” Dublin Journal of Medical Science 25 (1 July 1844): 397. 3I6James Huston, “Ovariotomy,” Medical Examiner 7 (6 April 1844): 77-78. 3I7John Rose Cormack, “Ovariotomy,” The London and Edinburgh Monthly Journal of Medical Science 4 (January 1844): 67-68. 318 Washington L. Atlee, “Case of Extirpation of a Bilocular Ovarian Cyst by the Large Peritoneal Section,” American Journal of the Medical Sciences 8 (July 1844): 45, 64-65; Washington Atlee, General and Differential Diagnosis of Ovarian Tumors (Philadelphia, PA: J3 . Lippincott, 1873), 57. 3I9Washington Atlee, A Retrospect of the Struggles and Triumph of Ovariotomy in Philadelphia with Some Remarks on Allied Subjects (Philadelphia, PA: Collins, Printer, 1875), 10. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 128 the color and density of drained fluid indicated the presence o f disease.320 The surgeon also argued that the existence of granular cells verified the existence of ovarian tumors. During the third operation, Atlee administered opium to the patient to prevent the risk of convulsions during surgery. The use of opium facilitated the surgical management of patients.321 The analysis of serous fluids permitted the Atlees to determine the existence of a localized disease entity. The Atlees were early proponents of surgery as a means to treat disease beyond the reach of medicines. Such advances did not convince critics of the efficacy of abdominal surgery. One critic noted that practice of surgery without anesthesia supported the claim of a recent philosopher that man was “among the most cruel of all animals.”323 Another critic, Charles Meigs, claimed that the ratio of success in ovariotomy did not justify its practice. Meigs believed that palliation proved the best means of treating ovarian tumors. The Philadelphia physician also believed that such tumors sometimes receded through a spontaneous cure. Meigs comments, in the translation of a French text, also revealed different ideas on the ovary as a seat of disease. The surgeon believed that hysteria had its source “from the ovaria and other reproductive organs.” For the Atlees, ovaritis remained a localized organic disease subject to future study by physiologists. 320Atlee, “Case,” 45. 321 Atlee, Retrospect. 314. 322Ibid., 315. 323Thomas D. Mutter, Introductory for 1844-45 on the Present Position of Some of the Most Important of the Modem Operations of Surgery (Philadelphia, PA: Merrihew & Thompson, 1844), 24. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 129 In 1845, the Philadelphia College of Physicians denounced the practice of ovariotomy as “unwarrantable and unsafe.” Citing Meigs, opponents rejected the claim that mortality rates of ovariotomy were comparable with other operations. While supporters downplayed the risk of surgery, opponents claimed that the mental distress and abdominal distention caused by ovaritis were preferable to death during surgery. Critics also claimed that ovariotomists never operated with a certain diagnosis. Instead, such operations were painful exploring expeditions that often resulted in the death of patients. For the Atlees, surgery represented a means to cure disease and prolong life. For Meigs, palliative treatment by purely medical measures remained the appropriate course of treatment.325 The actions of the College of Physicians had a chilling effect on the Atlees and other operators. John Atlee performed one ovariotomy after the report. Washington Atlee refrained from any future ovariotomies until 1849.326 In 1848, the discovery of chloroform anesthesia by James Young Simpson revived the practice o f ovariotomy in America. Later in the year, Henry Miller and Samuel Gross used anesthesia to perform a successful ovariotomy in Kentucky.327 324William Parrish, “The Annual Report on Surgery,” Summary of the Transactions of the College of Physicians of Philadelphia 1 (3 November 1845): 367. 325Martin Peraick, Calculus of Suffering (New York, NY: Columbia University Press, 1985), 112-113. 326Washington Atlee, “A Table o f All the Known Operations o f Ovariotomy from 1701-1851.” Transactions of the American Medical Association 4 (1851): 304. 327Henry D. Miller, “Case of Successful Extirpation of the Ovarium,” Western Journal of Medical Science 2 (October 1848): 40. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 130 On 15 January 1849, Washington Atlee followed the example of Miller and Gross. Atlee commented that the anesthetic eliminated shock and the protrusion of bowels during surgery. The surgeon also believed that a mixture of ether and chloroform made for a safer anesthetic. From 1849 to 1851 Washington Atlee used anesthesia to perform thirteen ovariotomies, more than any other American surgeon. Eight patients survived the operations during this period.328 However, a debate over the merits of anesthesia, between Charles D. Meigs and James Young Simpson, revealed that not all American surgeons endorsed the new surgical tool. The use of anesthesia during labor provided the first arena for debates over the merits of the new drug. Meigs feared reports of fatalities from the use of chloroform. The need to use drugs in the treatment o f labor revealed that nineteenth-century physicians viewed labor as a pathological condition like disease, in a slap at the Atlees, he claimed that none of Philadelphia’s premier surgeons used the drug. The use of chloroform represented a form of intemperance, he believed, because it acted as an intoxicant rather than a sopoforic. Finally, Meigs believed that the existence o f labor pain helped guide the physician’s use of forceps during deliveries.329 Labor pain, Simpson believed, was not a divine punishment for Adam’s sin. The surgeon ridiculed any belief that the use o f anesthesia represented a form o f intemperate 328Atlee, “Table,” 305-307. Between the years 1849 and 1855, Washington Atlee performed a total of twenty-eight ovariotomies, using a mixture of chloroform and ether as an anesthetic. Sixteen patients survived the operations. Washington Atlee, “Synopsis of Thirty Cases of Ovariotomy Occurring in the Practice of the Author,” The American Journal of the Medical Sciences 29 (April 1855): 387-393. 329“On Chloroform.” Medical Examiner 39 (March 1848): 145-147, 149, 151. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 131 behavior. The surgeon believed that patients from the “higher ranks of life” could not bear the same level of pain as the “uncivilized mother.” Simpson maintained that pain represented a non-essential physiological function which could be changed by “the science and art of civilized life.”330 American surgeons used similar race and class distinctions in their treatment of women who were recent immigrants.331 Some historians have questioned whether Christianity influenced the early opposition toward anesthesia. Such works fail to account for the growth of American pluralism. A review of available Catholic sources reveals no opposition to anesthesia. The St. Louis Medical Journal endorsed Simpson’s criticisms of Meigs, although a second article cautioned readers against the use of such drugs for recreational purposes.333 The Dublin Review, an ultramontane journal, also endorsed anesthesia remarking, 330J. Y. Simpson, Anaesthesia or the Employment of Chloroform and Ether in Surgery. Midwifery. Etc. (Philadelphia, PA: Lindsay and Blackiston, 1849), 235. 33‘“Unaccustomed by their mode of life to pain and fatigue, patients in the higher ranks of life are not fitted to endure either of them with the same impunity as the uncivilized mother, or even as females in the lower and hardier grades of civilized society.” Ibid., 246. See also Wertz & Wertz, Lvine-ln. 113-114; Leavitt, Brought 116- 117. 332A. D. Farr, “Religious Opposition to Obstetric Anaesthesia: a Myth?” Annals of Science 40 (March 1983): 176. Valentine Mott also rejected religious objections to anesthesia, see Valentine M ott “Remarks on the Importance of Anaesthesia from Chloroform in Surgical Operations,” New York Journal of Medicine 7 (July 1851): 10. 333“Those gentlemen who contend that the prevention of pain in surgical operations is unnecessary and improper, are very handsomely cauterized.” Review of “Anesthesia, or the employment of Chloroform and Ether in Surgery, Midwifery, &c., by J.Y. Simpson, M.D.,” St. Louis Medical and Surgical Journal 8 (January 1850): 43; David Prince, “Ether and Chloroform,” St. Louis Medical and Surgical Journal 8 (July 1850): 315. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 132 “Nations of the world! You have had a boon bestowed, -precious above your powers of thought. Learn to use it and be grateful.”334 Such accounts, and the absence of opposition from the hierarchy, suggest that the Church approved of such practices. In 18S2, the AMA Report on Surgery reflected the division that persisted among physicians on the issues of anesthesia and ovariotomy. The report refused to censure physicians for their reluctance to use the new drug. As for ovariotomy, the report emphasized the “insuperable” obstacles that hampered the diagnosis and removal of ovarian tumors. The report questioned whether the mortality of ovariotomy outweighed the merits of palliative treatments. Consequently, the report failed to draw a conclusion for or against ovariotomy.335 Philadelphia surgeon Henry Smith supported the Atlees’ efforts to treat ovarian tumors through the practice of surgery. Smith believed that prejudice and envy motivated some conservative opponents. However, the author acknowledged that the technique remained “sub iudice” given mortality statistics reported for ovariotomy.336 Smith hoped 334Charles Hawkins, “Ether and Chloroform,” Dublin Review 29 (September 18S0): 246-247. The term “ultramontane” refers to those Catholics who promoted the centralized authority of the Papacy within the Church during the period of study. 33sPaul Eve, “The Report of the Committee on Surgery,” Transactions of the American Medical Association 5 (1852): 449. 336Henry H. Smith, A System o f Operative Surgery (Philadelphia: Lippincott, Grambo and Co., 1852), 569. Smith hoped that the control of surgery through: 1) the selection of cases, 2) etherization, 3) temperature control of the operating room, 4) the close application of dressings, 4) and effective after care, would further diminish the mortality of ovariotomy. Ibid., 578. Smith was a professor at the University of Pennsylvania and a surgeon at St. Joseph’s Hospital in Philadelphia. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 133 that the success o f pioneering operations would convince others that the perils of surgery could be overcome. Samuel D. Gross acknowledged the uncertainty that persisted on the cause of ovarian tumors.337 Gross rejected Meigs’ belief that ovarian tumors would recede through a spontaneous cure. However, he believed that ovarian tumors were treatable through both palliation and surgery. Persistent accumulation of serous fluid, after repeated efforts at tapping, called for the surgical removal of the tumors. The surgeon also noted that uncertainties of diagnosis made such operations perilous, particularly in light of the 40 percent mortality rate.338 While Gross remained a proponent of surgery, he even-handedly castigated those who were too reluctant or too eager to use the knife. The practice of ovariotomy just prior to the Civil War indicates wide differences among physicians on the terms of appropriate intervention.339 The Atlees treated ovarian tumors as localized forms of organic disease. Others, like Charles Meigs and Horatio Storer, believed that menstrual molimen caused a wide range of women’s disease. Surgeons also differed on whether abdominal surgery or palliation represented the appropriate measure to treat ovarian tumors. The Atlees were early proponents of surgery as a means to remove diseased tissues. Meigs still believed in the medical treatment of such disease. Furthermore, the physicians differed on whether pain represented a 337Samuel David Gross, A System of Surgery (Philadelphia: Blanchard and Lea, 1859), 1015. 338Ibid., 1026; Samuel David Gross, A System of Surgery (Philadelphia: Blanchard and Lea, 1864), 872. 3390n the persistence of doubt toward anesthesia, see Pemick, Calculus. 196-207. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 134 diagnostic tool. Mortality statistics published by Samuel Gross revealed that surgery still held ambiguous consequences for physicians and their patients. The war years did little to quell the debates over ovariotomy and abdominal surgery. However, in 1864, Edmund Peaslee received the recognition denied to the Atlee brothers. Peaslee countered the objections of those who denounced ovariotomy as a barbarous operation.340 Failure to operate, he argued, caused death from twelve to eighteen months from the onset of disease. Peaslee’s claim that 80 percent of patients survived the operation represented the first conclusive argument for the safety of ovariotomy. 341 The persistence of the ovarian theory of menstruation is evident in Horatio Storer’s account of an early hysterectomy. In 1866, Storer removed a thirty-seven pound tumor from a patient along with her uterus and ovaries. Storer removed the ovaries to prevent the “annoyance of menstrual molimen, without the relief to the disordered circulation afforded by the normal discharges.”342 The account focused on the use of abdominal surgery as a safe means to remove such tumors. However, like Meigs, 340E. R. Peaslee, “Ovariotomy,” American Medical Times 9 (16 July 1864): 25- 26; “Ovariotomy,” American Medical Times 9 (23 July 1864): 37-38; Ovarian Tumors (New York: D. Appleton, 1872): 331. 341E. R. Peaslee, “Ovariotomy; When and How to Operate; After Treatment,” Medical and Surgical Reporter 16 (29 June 1867): 533. 342The paper included “a lesion, usually inflammatory, o f one or both ovaries” among the indications for amenorrhea. Storer suggested surgical means other than the removal of ovaries to cure the condition. See Horatio R. Storer, “The Surgical Treatment of Amenorrhea,” American Journal of the Medical Sciences 93 (January 1864): 82. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 135 Storer’s understanding of disease linked ovulation to a wide array o f nervous disorders among women. Storer, rather than Robert Battey, was the first operator to use abdominal surgery to cure amenorrhea.343 While Peaslee promoted the practice of abdominal surgery, other surgeons remained less optimistic, fat 1872, T. Gaillard Thomas decried the errors of diagnosis committed by inexperience operators. Statistical results on the practice of ovariotomy, he claimed, exposed a gulf between the mortality rates of skilled surgeons and the occasional operator. Thomas feared the consequences of fully taking into account the failures of inexperienced operators. Such data would skew the accounts of success reported by skilled operators and create unnecessary prejudice against the procedure.344 Washington Atlee completed a long awaited text on the diagnosis of ovarian tumors during the same year. Reiterating his belief that ovarian diseases were purely organic in origin, Atlee described the use of paracentesis as a means to identify the presence of disease before surgery. Thomas Drysdale, Atlee’s son-in-law, used microscopy to verify the presence of ovarian cells in serous fluid. Peaslee endorsed the same practice in his text.345 Atlee and Peaslee continued to practice surgery as a means of to cure a localized disease entity. 343This finding contradicts the following two authors. J. Marion Sims, “Remarks on Battey’s Operation,” British Medical Journal 2 (8 December 1877): 793; Lawrence D. Longo, “The Rise and Fall of Battey’s Operation: A Fashion in Surgery,” Bulletin of the History of Medicine 53 ( Summer 1979):244-267. 344T. Gaillard Thomas, Practical Treatise on the Diseases of Women 3rd ed. (Philadelphia: Henry Lea, 1872.), 729-730. 34SThe work reveals the ambiguity of diagnosis in the years before the X-Ray. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 136 The chasm created by the two theories of disease etiology widened with the account of Robert Battey’s first operation for normal ovariotomy. In 1872, Battey attempted to cure amenorrhea by the surgical removal of healthy ovaries. The operator believed that the creation of an artificial menopause would cure the symptoms of unrelieved “menstrual molimen.”346 Battey’s discussion o f the unity of nervous and gynecological complaints revealed the heritage of his understanding of disease. Battey himself acknowledged Horatio Storer as the source of his understanding of disease.347 However, Battey’s method of treatment was radically different from Storer’s own method of curing amenorrhea by attempting to stimulate menstruation. Battey, a Catholic convert, defended normal ovariotomy before the American Gynecological Society in 1876. He acknowledged the concern that ten operations were insufficient to prove his claims in favor of the operation. The surgeon used the Thomistic principle of totality to justify his practice of normal ovariotomy. Thomas Aquinas taught that, sometimes, the sacrifice of a limb would ensure the good of the whole body. Battey excluded surgery for the cure of nymphomania, yet he expanded the scope of the operation to “the case of any grave disease which is either dangerous to life or destructive Atlee discussed the shortcomings of percussion in locating diseased tumors. In an 1871 case, a patient complained of abdominal pain in the right lower quadrant. When Atlee opened the abdomen, he found a large tumor in the left lower quadrant. Ibid., 45. 346Robert Battey, “Normal Ovariotomy,” Atlanta Medical and Surgical Journal 10 (September 1872), 321. ^Ibid., 383. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 137 of health and happiness.”348 These comments opened normal ovariotomy to abuse as a cure ail for real and imagined illnesses. Critics questioned the validity of the disease etiology that supported his operations. Alexander Reeves Jackson took issue with the ovulation theory of menstruation. Jackson noted the popularity of normal ovariotomy following Battey’s first reports of success.349 Other physicians, he claimed, reported that Battey’s operation failed to end menstruation. Jackson used the results of earlier ovariotomies to point out that menstruation continued after removal of the ovaries.350 Such evidence, he claimed, supported the theory that both functions were a result of an erethism or common cause that stimulated the entire reproductive system. The belief that that ovulation was coincident with or, stimulated menstruation was later disproved. The belief that the failure of conception caused menstruation, rather than a nervous reflex from the extrusion of an ovum, gained later acceptance. However, the understanding of menstruation as part of a complex reproductive cycle awaited future discoveries. Menstruation occurs as the outcome of a cyclic interaction between the hypothalamus, pituitary glands, and ovaries after an existing egg remains unfertilized 348Robert Battey, ‘Extirpation of the Functionally active Ovaries for the Remedy of Otherwise Incurable Diseases,” Transactions of the American Gynecological Society. 1876 1(1877): 113. 349A. Reeves Jackson, “The Ovulation Theory of Menstruation: Will It Stand?” American Journal of Obstetrics 9 (October 1876): 549. 350Ibid., 551. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 138 dining the reproductive cycle.3S1 In short, confirmation of Jackson’s theory awaited the findings of twentieth-century endocrinology. Other critics began to make note of the great danger that accompanied Battey’s operation. Marion Sims noted that the mixed results of Battey’s operations helped fuel continued opposition to normal ovariotomy.332 Other operators, like George Englemann. asserted that Battey underestimated the danger of such operations. Fordyce Barker believed that an overemphasis on surgery hampered the progress of medical gynecology.3S3 Still others believed that such operation were conducted on the basis of pure supposition. Despite the confusion over disease etiology, the practice of ovariotomy did the advance surgical practice. In 1876, Joseph Lister discussed his methods o f antisepsis before the International Medical Congress in Philadelphia.354 John Homans, a surgeon at Carney Hospital, adopted Listerian methods the following year.35s The surgeon’s first 35IBeckmann, “Reproductive,” 359. “Of Battey’s twelve cases, two are marked improved; four, not improved; two died; and four were cured perfectly. Only twenty-five percent cured is not encouraging to the advocates of this operation.” J. Marion Sims, “Remarks on Battey’s Operation,” British Medical Journal 2 (29 December 1877): 916. 353Fordyce Barker, “Medical Gynecology,” Transactions of the American Gynecological Society. 1877 2 (1878): 39. 354Joseph Lister, “Antiseptic Surgery,” in Transactions of the International Medical Congress of Philadelphia, ed. John Ashurst, (Philadelphia, PA: John Ashhurst 1876), 541. 3SSJohn Homans, “Cases of Ovariotomy,” Boston Medical and Surgical Journal 107 (30 August 1877): 247. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 139 five ovariotomy patients had died from peritonitis. Homans taught the Sisters of Charity at the hospital to assist him in the operating room.356 The introduction of antiseptic methods resulted in a streak of success for Homans. From 1877 to 1887, Homans performed 282 ovariotomies with a mortality rate of 12.2 percent.357 Despite the favorable results of Listerian methods, many physicians resisted the practices which involved spraying carbolic acid into wounds. Catholic physicians also struggled with the consequences of ambiguous disease etiology. In 1879, Fr. Edward Dassell, translated an ethics text first published in 1877 Carl Capellmann, a German physician. The text did not discuss ovariotomy directly.358 However, like Storer, Capellmann saw links between masturbation, nervous disorders and gynecological disease.359 Capellmann also claimed that the safety o f chloroform 356Walter L. Burrage, “John Homans,” in American Medical Biographies, ed. Howard a. Kelly and Walter L. Burrage (Baltimore, MD: Norman, Remington Co., 1920), 549. 357Owen Wangensteen and Sarah Wangensteen, The Rise of Surgery (Minneapolis, MN: University of Minnesota Press, 1979), 644 n. 34. 358The text include a disclaimer that disavowed any conflict with Catholic teaching. Capellmann writes, “hi whatever is written in this work, it has been my intention to be in complete accord with the doctrines of the Holy Roman Catholic Church. Should anything have been inadvertently advanced ever so little at variance with them, I recall and disavow it, by anticipation, unconditionally. THE AUTHOR.” Carl Capellmann, Pastoral Medicine trans. William Dassel (New York, NY, F. Pustet, 1879), I. 359See Horatio Storer, “Cases Illustrative of the Diseases of Women.” Boston Medical and Surgical Journal 71 (12 January 1865), 475; H. Tristam Englehardt, “The Disease of Masturbation: Values and the Concept of Disease,” in Sickness and Health in America, ed. Judith Walzer Leavitt and Ronald L. Numbers (Madison, WI: University of Wisconsin Press, 1985), 14. For similar views among some British Victorian and Edwardian era physicians, see Janet Oppenheim, Shattered Nerves (New York, NY: Oxford University Ptess, 1991), 204. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 140 anesthesia challenged the right o f patients to refuse operations that, in the past, placed their lives at risk.360 Such beliefs created new dilemmas for Catholic patients faced with the prospect of Battey’s operation. The ambiguity created by two competing theories of disease accounts, perhaps for the silence of the Church on the operations noted by other authors.361 Many early operators believed that differences on the ease o f childbirth existed between civilized and uncivilized women. Some surgeons believed that women of the poorer classes developed more quickly than those of “the better classes.”362 Lawson Tait believed that gynecological surgery represented a means for women laborers, who could not afford a rest cure, to maintain their place in the workforce. Despite Battey’s continued claims in its favor, normal ovariotomy did not hold Universal acclaim among surgeons. In 1879, Thomas Addis Emmet, a Catholic champion of Irish immigrants, rejected the practice of normal ovariotomy for the cure of nervous disorders. However, the surgeon believed that such operations represented a means of last resort to relieve insanity, epilepsy, and tuberculosis. Like many, Emmet struggled with contradictory ideas about the nature of disease. 360“The decision, therefore, given hitherto by moralists must be modified. I do not take it on myself to make that decision.” Ibid., 22. 36lConnery, Abortion. 285-286; John T. Noonan, Contraception (Cambridge, MA: Harvard University Press, 1986.), 429. 362Thomas Addis Emmet, The Principles and Practice of Gynaecology (Philadelphia. PA: Henry Lea, 1879), 21. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 141 A small group of physicians promoted the operation as a mean to cure mental illness. In some cases, the practice of surgery intersected with long held beliefs of class and race. William Goodell believed that normal ovariotomy provided a cure for insanity and epilepsy.363 In 1880, Alexander Skene argued that mental illness occurred most frequently among the laboring classes. These physicians believed that all inmates in insane asylums should be sterilized to prevent the proliferation o f defectives in the wider population.364 hi nineteenth century America, foreign immigrants represented the largest population in such institutions. Such beliefs, while not representative of the profession at large, laid the groundwork for the twentieth century eugenics movement. Battey continued to promote normal ovariotomy for a wide array of illness.365 During the early years of the decade, other proponents responded to charges that normal ovariotomy represented an abuse of surgery. Still others attempted to fend off charges that such operations de-sexed women.366 However, in 1881, John Homans observed that 363William Goodell, “The Extirpation of the Ovaries for some of the Disorders of Menstrual Life,” Boston Medical and Surgical Journal 100 (19 June 1879): 845. Goodell was not alone in his belief. See Marion Sims, “Remarks on Battey’s Operation,” British Medical Journal 2 (29 December 1877): 917; Thomas Addis Emmet, The Principles and Practice of Gynaecology (Philadelphia. PA: Henry Lea, 1880), 774. 364Alex J. C. Skene, “Gynecology as Related to Insanity in Women,” Archives of Medicine 3 (February 1880): 4. 365Robert Battey, “Oophorectomy-Battey’s Operation-Spaying-Castration,” Transactions of the International Medical Congress 4 (1881): 302. 366William Goodell, Lessons in Gynecology 2nd ed., (Philadelphia, PA: D. G. Brinton, 1880), 347. Goodell noted that Hegar, Battey and Wells shared his belief. See also Review of Lawson Tait, “Oophorectomy in Cases of Dysmenorrhea,” American Journal of the Medical Sciences 80 (October 1880): 581; Tait, Lawson. “Battey’s Operation.” New England Medical Monthly 1 (May 1882): 341. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 142 such operations failed to stem menstruation.367 The efforts to defend normal ovariotomy by such surgeons reflected the ambiguous state of knowledge concerning the function of the human reproductive system. In America, in 1884, Alexander Reeves Jackson reported the recent findings of European and American surgeons on the nature of ovulation and menstrual function. The operator denied the existence o f reflex action, concluding that there was “no necessary connection between either function.”368 The findings undermined the theoretical basis for Battey’s operation. Among surgeons, however, the practice of normal ovariotomy continued. John Homans of Boston expressed the irony that attended the legacy of ovariotomy, hi 1885, Homans reported that ovariotomy, despite its shortcomings, resulted in surgical progress. Ovariotomy, he claimed, familiarized surgeons with operating in the peritoneal cavity. Such experience allowed surgeons to perform abdominal surgery on a wide array of organic disease.369 However, he still believed that Battey’s operation had a limited sphere of applications. 367John Homans, “A Year’s Work In Ovariotomy,” Boston Medical and Surgical Journal 104 (20 January 1881): 50. It appears, however, that Homans continued to perform Battey’s operation. Two out of four of the procedures were performed at Camey Hospital, a Roman Catholic institution. 368Alexander Reeves Jackson, “A Contribution to the Relations o f Ovulation and Menstruation,” Journal of the American Medical Association 3 (4 October 1884), 365. (cited hereafter as JAMA). 369John Homans, “The Influence of Ovariotomy on Surgery,” Boston Medical and Surgical Journal 112 (30 July 1885): 103. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 143 Soon, other operators reported that Battey’s operation represented an abuse of surgery.370 Henry Coe o f New York, criticized surgeons who practiced unjustifiable and indiscriminate operations on the supposition of disease.371 Coe acknowledged that many such operations took place because of an imperfect understanding of ovarian physiology. However, Coe believed that the role of fallopian tubes in menstruation was still unresolved.372 Despite his own desire to limit surgery to diseased tissues, Coe also had an ambiguous understanding of disease and reproductive physiology. In 1887, John Homans published the results of all of his laparotomies. Despite his previous doubts about the merits of Battey’s operation, Homans performed five operations for nervous disease from 1883 to 188S. The operations occurred in Boston area asylums. Based on his findings, Homans reported that he could not recommend such operations for nervous disorders and hysteria “unless the operation were advised by a 370“Conservative Ovariotomy,” Medical & Surgical Reporter 53 (15 August 1885): 190; “Oophorectomy Run Wild,” Medical & Surgical Reporter 53 (15 August 1885): 195-196. 37IOther surgeons echoed Coe’s call to verify the presence o f disease through pathological means. See John James Croft, “diseases of the Uterine Appendages,” Lancet 2 (28 August 1886): 407; Burton, J. E. “When Shall We Perform Castrating Operations?” in Transactions of the International Medical Congress. Ninth Session, ed. John B. Hamilton, vol 2, (Philadelphia, PA: W. M. Fell, 1887), 723; Horatio Bigelow, “Conservative Gynecology,” in Transactions of the International Medical Congress. Ninth Session, ed. John B. Hamilton, vol 2, (Philadelphia, PA: W.M. Fell, 1887): 576. 372Henry C. Coe, “Is Disease of the Uterine Appendages as Frequent as it has Been Represented?” American Journal of Obstetrics 19 (June 1886): 570, 575. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 144 competent alienist.”373 The ambiguity of disease etiology hampered the demise of normal ovariotomy. Other physicians attempted to use conservative means to cure uterine and ovarian disorders. Dr. Sarah E. Post explored the consequences of sterilizing operations in the married life of her patients. One female German immigrant faced the scorn of her husband when he learned of her inability to conceive a child.374 Post proposed that pessaries and tampons proved useful to relieve and support diseased organs and might be preferable to surgery. Post’s account illuminated the personal consequences of gynecological disease in women’s lives.37S Still other surgeons promoted the cause of conservatism in gynecology and obstetrics, hi 1889, Thomas Addis Emmet discussed his own hopes to stem the excessive practice of normal ovariotomy, hi the hands of younger men he claimed, “it had spread like wildfire on a prairie, and he [Emmet] had to turn and fight it in its destructive progress.”376 Emmet claimed that he cured over fifty percent o f cases referred to him for 373A laparotomy is a surgical incision into the abdominal wall. John Homans, Three Hundred and Eighty-Four Laparotomies for Various Diseases (Boston, MA: Nathan Sawyer and Son, 1887), 39. 374Sarah E. Post, “Support in the Treatment of Ovaries and Tubes,” New York Medical Journal 46 (24 September 1887): 341. 375Ibid., 345. 376Proceedings. Medical Society of the County of New York. 25 November 1889. Medical Record 36 (21 December 1889): 694. Emmet’s comments appear in a response to the following article. Malcolm McLean, “Conservatism in Gynecology and Obstetrics,” Medical Record 36 (21 December 1889): 676-680. While McLean promoted the medical treatment o f such disorders, he also promoted less traditional means such as electricity. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 145 surgery by medical means. Emmet claimed that many surgeons were too lazy or lacked the skill to save women from “mutilation of the knife.” Emmet believed that Tait’s operation proved valuable within narrow limits. However, Emmet claimed that he never operated for the cure o f nervous symptoms. Such operations represented, “the fearful abuse of the operation which has existed as a disgrace to the profession and a reflection on our knowledge o f the healing art”377 He believed that the surgery persisted, in part, because it proved lucrative for operators. Emmet’s comments attest to the persistence of ambiguous concepts of disease. As long as belief in ovulation as the source of reflex nervous disorders persisted, so would unnecessary surgery. By the end of the nineteenth century, research had still not discovered the true nature of reproductive functions such as menstruation. Claude Bernard is credited with discovering the existence of internal secretions that ground modem endocrinology, hi 1890, Edward Brown Sequard speculated that treatment with ovarian extracts might prove beneficial for women.378 However, the isolation of reproductive hormones, and their medical use, remained decades away. During the 1890s physicians remained divided on the merits of Battey’s operation. Howard Kelly, a professor of surgery, still promoted the operation as a means of curing 377Thomas Addis Emmet, “A Protest Against the Removal of the Uterine Appendages,” Medical Record 36 (28 December 1889): 711. 378In 1923, Edgar Allen and Edward Doisy isolated an ovarian hormone, hi 1929, Doisy isolated the extract later known as estrogen. In 1929, George Comer and Willard Allen isolated Progesterone and discovered its function. Adolf Butenandt, of Germany, Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 146 menstrual insanity and epilepsy.379 Other surgeons restricted, but did not eliminate such surgery, holding to outdated concepts of disease that allowed surgery in order to bring on an artificial menopause.380 Still others condemned the practice of normal ovariotomy for symptoms that were clearly neurasthenic.381 Joseph Taber Johnson, a Protestant professor at Georgetown Medical College, remained a staunch proponent of Battey’s operation.382 Some surgeons sought solutions in other theories of disease causality. At the turn of the century, E. E. Montgomery struggled with Beatson’s theory of inhibition as a theory of disease causation.383 In their healthy state, Thomas Beateson argued, the isolated male androsterone in 1931. Michael J. O’Dowd and Elliot E. Philipp, The History of Obstetrics and Gynecology (New York, NY: Parthenon, 1994), 255. 379Howard A. Kelly, “The Ethical Side of the Operation of Oophorectomy,” American Journal of Obstetrics 27 (February 1893): 206-207. 380Church, Archibald, ‘‘Removal o f Ovaries and Tubes in the Insane and Neurotic,” American Journal o f Obstetrics 28 (October 1893): 496. The discussion o f the paper before the Chicago Gynecological Society revealed that most operators present rejected any connection between neuroses and organic disease. Church however, still claimed that the operation represented a last resort to stem menstruation. Transactions of the Chicago Gynecological Society. 19 May 1893. American Journal of Obstetrics 28 (October 1893): 573. Two editorials listed only qualified support for writers who sought to end operations for nervous disorders. Both writers reserved such operations as a means to end menstrual disorders. The editorials reveal the persistence of belief in the ovarian theory of menstruation. See A. H. Buckmaster, ed. “The Genitalia and Neuroses,” New York Journal of Gynecology and Obstetrics 3 (April 1893): 306; “Does Extirpation of the Ovaries Usually Bring on a Normal Menopause?” New York Journal of Gynecology and Obstetrics 3 (December 1893): 1053-1059. 38ID. Maclean, “Sexual Mutilation of Women,” California Medical Journal 15 (July 1894): 382. 382Joseph Taber Johnson, “Battey’s Operation,” Virginia Medical Monthly 22 (January 1896): 1017. 383E. E. Montgomery, “Does the Removal of the Ovaries Exert Beneficial Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 147 ovaries inhibited disease. When unhealthy, the organs fostered the spread of pathology. On this basis, in 1895, Beatson removed a woman's ovaries to stem breast cancer. Montgomery maintained, that while empiricism favored the idea, the results of fifteen operations showed that it failed to stem the advance of cancer. Beatson’s views reflected another example where supposition determined the resort to surgical intervention. The confusion over disease etiology persisted into the first decade of the twentieth century. In 1906, Eli Van de Warker penned a scathing denunciation of Battey’s operation. The surgeon urged operators to reject faulty concepts of disease etiology in favor of the results of pathological investigation. Van de Warker believed that the continued abuse of surgery illustrated that “some doctors are careful, learned, and others are careless and ignorant.”384 The operator believed that such abuses would persist until the public grew in their knowledge of sexual hygiene. The publication of Catholic medical ethics texts reflected the prevailing ambiguity on the nature of hormones and reproductive function. The first discussion of ovariotomy appeared in such a text appeared in 1905. A brief discussion of castration by Walter Drum, S.J. noted that ovaries were removed to stem disease, and at other times, to stem the progress of nervous disorders. Drum believed that the origin of nervous disease had yet to be resolved hence, “error and failure may go along.”385 The discovery of such Influence on the Subsequent Progress of Malignant Disease,” JAMA 33 (23 September 1899): 751-752. 384Ely Van de Warker, “The Fetich of the Ovary,” American Journal of Obstetrics 54 (September 1906): 371. 385Alexander E. Sanford and Walter Drum, Pastoral Medicine (New York, NY: Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 148 disease origins justify such operations unless they occurred needlessly, frivolously, or for sterilization.386 Austin O’Malley and Janies J. Walsh published a text the following year. The writer’s discussion o f menstrual disease made no reference to Battey’s operation. However, O’Malley claimed that nervous disorders were dependent on the derangement of pelvic organs.387 The ambiguity in both texts is not surpassing given the primary state of endocrinology. Two years later, Hitschman and Adler described the histology of the menstrual cycle for the first time. In 1912, Henry Iscovesco of France used an ovarian hormonal extract to treat dysmenorrhea and amenorrhea. In 1939, George Comer discovered the axial relationship between pituitary secretions, the ovaries, and the endometrium.388 Such research exposed the great complexity o f human reproduction, and the false assumptions o f early surgeons. Joseph F. Wagner, 1905), 252. 386Ibid., 252. 387Austin O’ Malley and James J. Walsh, eds. Essays in Pastoral Medicine (New York, NY: Longmans, Green, and Co., 1906), 243. hi 1912, Andrew Klarmann published a second edition of a prior work in order to attack the practice of vasectomy. Klarmann argued against the practice of vasotomy for the practice of birth control and the punishment of criminals. See Andrew Klarmann, The Crux of Pastoral Medicine (New York, NY: Frederick Pustet, 1912), v, 182-203. The next manual to discuss ovariotomy appeared in 1919. See Austin O’ Malley, The Ethics of Medical Homicide and Mutilation (New York, NY: Devin Adair, 1919), 216-222. O’Malley also explored the Thomistic teaching which permitted mutilating operations to preserve life and promote the good of the whole body. Ibid., 222. 3880 ’Dowd and Phillip, History. 262 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 149 The stoty of St. Elizabeth’s Hospital in Boston illustrates the consequences of these false assumptions. Most historians characterize the reorganization of the medical staff from 1910 to 1911 as an opportunity for Cardinal William O’Connell to assure that Catholic teaching governed the practice o f medicine and surgery.389 Some historians make reference to the establishment of the Guild o f St. Luke, just prior to the reorganization in support of this thesis. But a strong case can be made for the thesis that the reorganization represented a reaction to the persistent ambiguity of the practice of gynecological surgery. In 1910, Malcolm Storer, a Protestant physician on the hospital staff, wrote to Cardinal William O’Connell about a disagreement with the Sister Administrator at St. Elizabeth’s. The issues included the supervision of surgery at the hospital. Storer wrote of the feeling among some patients that some physicians were overzealous in performing sterilizing operations.390 While Storer had performed Battey’s operation in the past, he professed surprise that anyone would wish to remove healthy ovaries. The operator claimed that such cases were justified only in cases of disease, tumors, the accumulation of pus, and distortion, hi such cases, Storer claimed, women received the benefit of the doubt. Storer meant that surgeons would avoid removing such organs if possible. He also explained the disagreement over surgery further, hi reference to sterilization, the 389A History of St. Elizabeth’s Hospital (Boston: Anchor Printing. 1914), 15; Kauffman, Ministry. 235-236; Vogel, Invention. 128. 390Dr. Malcolm Storer, Boston, MA to Cardinal William O’Connell, Boston, MA, 4 June 1910, TLS, 4 p., Chancellor’s Institutional Correspondence, St. Elizabeth’s Hospital, Box I, Folder 1, AaBo, Boston, MA. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 150 Superior called for practice of the Catholic teaching that opposed such operations. Storer, a Protestant, proclaimed his revulsion, and that of his colleagues, toward any practice of sterilizing operations. He believed that his dispute with the superior arose because of a physician’s failure to notify a patient of the necessity to remove diseased ovaries. Storer, noted that tactile senses proved imperfect, and that in some cases surgeons would face more blame in failing to remove organs than they would if they had been removed. Storer’s comments revealed the shortcomings of early diagnosis. The diagnosis of diseased ovaries by touch, by 1910, represented an outmoded means of diagnosis. It appears that Storer and his confreres still operated on the basis of supposition rather than pathological verification. Storer’s comments disclose that faulty pathological investigation, rather than malice toward immigrant patients, underlay the insinuation of unethical conduct. O’Connell himself, may have shared the suspicions of frightened patients, hi later remarks he proclaimed, At once, the whole staff of physicians was disbanded and reorganized with a group of Catholic doctors entirely in charge. This as I had expected, caused a momentary bit of excitement among the physicians discharged, but, as the record of their operations were in the hands of the director, this little furor soon died out. 391 The comments suggest that reorganization occurred due to the results of actual cases. Outmoded methods of diagnosis left physicians at the hospital open to charges of misconduct. 391 William Cardinal O’Connell. Recollections o f Seventy Years (Cambridge. MA: Riverside Press, 1934), 280. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 151 In the past, efforts of physicians and Catholic moral theologians to discuss medical issues had failed, “because one side did not understand the other.”392 The evidence suggests, that Cardinal O'Connell failed to understand the concerns of Malcolm Storer. Storer’s letter suggests that physicians struggled with the existing ambiguities of the diagnosis of ovarian disease. This dispute coincides with the earliest findings on the authentic nature of the menstrual cycle.393 The correspondence suggests that neither Storer nor O'Connell were aware of such findings. The lack of understanding about etiology and pathology created an unfortunate collision between the Church and physicians. The evidence suggests that Cardinal O’Connell suspected physicians of surreptitiously practicing vasectomy at St. Elizabeth’s. Likewise, Storer’s letter expressed popular mistrust of physicians since decades of surgery had failed to cure the symptoms that first prompted women to seek relief. It is likely that such distrust was widespread, and not the sole preserve o f Boston’s Irish Catholic immigrants.394 3920 ’ Malley and Walsh, Essays VI. This phenomena appears to reflect a pattern. In 1905, the Georgetown University Medical faculty refused to permit a Jesuit priest teach medical ethics at the institution. Some faculty members feared that association with Catholicism would repel potential students. Others insisted on the secular nature of medical education. See “Minutes of the Curriculum Committee, 12 November 1905,” TD, p.l, 3, Archives Subject Files: Medical School, 1880-1916, Medical School 1898- 1906, GUA, Washington, DC. Disagreements over administrative matters with Thomas McCluskey S.J., prompted James J. Walsh to resign as Dean of the Fordham Medical school in 1911. The institution closed in 1921. See Harry W. Kirwin, “James J. Walsh- Medical Historian and Pathfinder,” Catholic Historical Review 55 (January 1960), 426- 427. 3930 ’Dowd and Phillip, History. 261. 394See: Rosemary Stevens, hi Sickness and in Wealth (New York, NY: Basic Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 152 In the absence of certitude, O’Connell appears to have made his decision on the basis of mistrust toward Protestant physicians like Storer. Other historians have characterized O’Connell’s search to control Boston’s Catholic charities as a struggle for authority.395 Nonetheless, in 1908, O’Connell’s past efforts to assert control over Carney Hospital failed.396 The allegations of doubtful surgery at St. Elizabeth’s represented the primary motive for the reorganization. The desire to centralize institutions in the diocese represented a secondary aim.397 This thesis is supported by the absence, in the minutes of the Guild o f St. Luke, of any discussion of ovariotomy or Battey’s operation at the time of reorganization. However, Boston physicians discussed the limitation of family size among the poor.398 Books, 1989), 54-55; John Duffy, The Healers (Chicago, IL: University of Illinois Press, 1979), 130-131; Pemick, Calculus. 230-231. This phenomena contradicts to optimism expressed by Paul Starr pertaining to this era. See Starr, Social. 157. 395James M. O’Toole, Militant and Triumphant (South Bend, IN: University of Notre Dame Press, 1992), 112-113. 396Ibid., 113. 397Kauflman and O’Toole make no mention of surgical practice as a motive for the reorganization. See Kauffman, Ministry. 235; O’Toole, Militant 112-113. 398“In the Shattuck lecture before the Massachusetts Medical Society last week, Dr. F. H. Gerrish took occasion to comment on so-called race suicide, pointing out the truth that “the augmentation o f the family beyond the capacity of the family to support its members imposes an unwarrantable burden on those in die community who are honest, provident and sufficiently high-minded to deny themselves.” See “Some Aspects of Race Suicide,” Boston Medical and Surgical Journal 157 (16 June 1910):833. The editor explored the discussion of two physicians on the desirability of encouraging large families among the poor. Another editorial discussed the matter in 1911. Dr. J. L. Morse argued to the contrary argued, “that no family should produce more offspring than it can properly care for.” The editor opposed the views of Neo-Malthusians such as Morse. See “Large and Small Families” Boston Medical and Surgical Journal 164 (16 February 1911): 242-243. Gerrish and Morse appear to be early proponents of population control. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 153 The class ideas of the nineteenth century persisted among some physicians in the new century. The first meeting of the Guild of S t Luke on 18 October 1910 included the discussion of a paper on Vasectomy.399 The opposition to artificial birth control represented a concern for the Cardinal, and an opportunity to assert his authority. Catholic health care institutions, like S t Elizabeth’s, existed amidst the ambiguity of medical science, hi the case of St. Elizabeth’s Hospital, Storer’s correspondence disclosed that operators diagnosed disease on the basis of ambiguous and outmoded means of diagnosis and pathology. The contemporary research of endocrinology had not yet filtered down to operators like Storer. Cardinal O’Connell may have well reacted on the basis of his mistrust of non-Catholic physicians.400 However, it iclear that the reorganization resulted from the belief that surgery practiced there was both unnecessary and against Catholic teaching. However, the evidence suggests that claims made for the advance of surgery and the growth of public confidence in hospitals in the early twentieth century are 399“Report of the Meeting o f the Guild o f St. Luke,” Vol. 1, AaBo, 4. See also Klarmann, Crux. V, 182-203. Discussion of The Catholic Church’s opposition to involuntary sterilization is explored in Philip R. Reilly, The Surgical Solution (Baltimore, MD: Johns Hopkins University Press, 1991), 118-122. 400Cardinal O’Connell’s collected essays reflect the social tensions the early twentieth century. “Added to this was the feeling that the Irish and French Catholics, with their large families and their ability and willingness to do the hardest work, would in time outnumber the old stock, perhaps take over their positions, and possibly supplant them.” O’Connell, Recollections. 21. The Cardinals comments also reveal his belief that Lowell mill owners viewed their working class employees with disdain. Ibid., 26. O’Connell’s remarks clearly understood that some native-born Americans believed immigrants diminished the quality of American life. Ibid., 36. The medical literature in the period reflected similar prejudices in the discussion of the limitation of family size among the poorer classes. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 154 overdrawn.401 No convergence o f the subcultures of Medicine and Catholicism took place 1890 to 1915 in Boston. The evidence confirms Rosemary Steven’s belief that Americans were suspicious of surgeons given the poor results of operations.402 Storer’s letter suggests however, that such suspicion extended beyond the medical community to the public. These conclusions suggest that O’Connell’s actions were not merely the reactions of an ultramontane cleric, but were also, a reflection of the prevailing mistrust of physicians in society at large. The preceding discussion reveals the problems and promise presented by surgery to cure women’s disease both for Catholics and all Americans. The success of the Atlees, Catholic operators, revealed the promise of abdominal surgery as a means to heal illness. By the Civil War, the surgical treatment of amenorrhea held out hope for the hierarchy for the future prevention of abortion. Battey’s operation, however, revealed limits of theology and the disastrous consequences of flawed ideas of disease that resulted in decades of destructive surgery. Despite the entreaties of Thomas Addis Emmett, and others, such operations persisted. The events in Boston revealed the detrimental consequences of surgery from outmoded ideas of disease during the early twentieth century, and the fear of Roman Catholics in a society influenced by anti-foreign ideas. The irony of this chapter is the conclusion that such fearful operations resulted in surgical progress. The antebellum practice of ovariotomy with anesthesia resulted in 40lRosenberg, Care. 342-343; Starr, Social. 157; Kauffman, Ministry. 129,235.; Joyce Science. 94-95. 402Stevens, Sickness. 54-55. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 155 successful surgical interventions. After the war, the use of Listerian techniques further diminished the mortality of surgery. Finally, the frequent practice of normal ovariotomy familiarized surgeons with operations in the abdominalcavity. With increasing skill in gynecologic surgery, with better education, and with the abortion debate largely resolved, it now became possible for the Church to lead at least segments o f the American medical profession into a renewed understanding of the proper management of difficult birth. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. CHAPTER 6 ROMAN CATHOLICISM AND THE PROBLEMS OF DIFFICULT BIRTHS, 1867-1940 I am against late-term abortions and have long opposed them, except where necessary to protect the life or health of the mother. President William Clinton’s comments appear in a letter to Cardinal James Hickey. Cardinal Hickey, o f Washington, D.C., protested the President’s intention to veto a bill banning partial-birth abortions. The President vetoed the bill on 10 April 1996. The debate illustrates the present limits, in a pluralistic society, of Catholicism’s influence over highly controversial health care issues. After the Civil War, the clergy, physicians, and practicing laypersons, of the Church struggled with similar issues. Other historians have explored the evolution of theology involving abortion.404 However, no one has explored the impact of Catholicism on medical practice in cases of difficult births. The rise o f cesarean section and the demise of craniotomy reflect the Church’s struggle with the limits of science. After the Civil War, surgeons remained divided over whether cesarean section or craniotomy represented the most appropriate means to resolve difficult births. In 1867, a 403“President Clinton: April 10,” Origins 25 (25 April 1996): 755. 404Connery, Abortion. 284-304. 156 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 157 new study illustrated this conflict among physicians. Edward LeProhon, a Catholic physician from Maine, condemned the practice of craniotomy to save mother’s lives, claiming that craniotomy on poor patients represented the domain of “unprincipled and ignorant” physicians.405 LeProhon, who had studied in Paris, rejected the arguments of European operators who preferred craniotomy. In cases of difficult labor, he urged operators to leave their instruments at home. LeProhon promoted the cesarean operation and urged women to sacrifice their own lives rather than lose their infants. The surgeon’s search for the highest good proved perilous for women and the early state of abdominal surgery. LeProhon attributed the persistence of craniotomy to the poor skills of operators rather than the existence of any “murderous intent.”406 For the writer, the poor state of medical education caused the persistence of craniotomy. To raise the level of obstetric skill, LeProhon promoted the reform of medical education, elevation of admissions standards for medical schools, and statutory regulation of medical practice by the AMA and Congress. He hoped that such reforms would result in the demise of craniotomy. LeProhon’s concerns about the quality of medical education was a comment on the poor 40SEdward P. LeProhon, Voluntary Abortion: or Fashionable Prostitution with Some Remarks upon the Operation ofCraniotomy ^Portland.ME: Thurston, 1867), 17. Prior to the Civil War, LeProhon practiced in Providence, Rhode Island and served as physician to Bishop William Tyler. The discussion of Tyler’s conversion disclosed the identity of the lowly and the poor, hi New England, converts lost their social standing, “to live and die in die lowest class, called by the Puritans, poor Irish.” Edward P. LeProhon, Memorial of the Rt. Rev. William Tvler trans. J. M. Toohey (Notre Dame, IN: Catholic Archives of America, [n.d.], 6p. Tm, John Hay Library, Special Collections, Brown University, Providence, RI), 1. 406Ibid., 18. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 158 state of medical knowledge among physicians at large. The level of education of physicians ranged from skilled practitioners to untrained quacks. As for midwives, scorned by many physicians, the quality of training also varied widely. The issue generated a similar concern among theologians of the Roman Catholic Church. In 1869, the Church restated its opposition to abortion by eliminating from its penal statutes the distinction between the formed and unformed fetus.407 Before the war, some theologians had justified the induction of premature labor to end a pregnancy, hi 1869, the Vatican received an inquiry from the United States questioning whether embryotomy represented an appropriate means of intervention. The Vatican reply urged the questioner to consult the approved authors for an answer.408 Such an vague reply reflected a debate that raged among theologians during the second half of the nineteenth century. Soon, a succession of European theologians supported therapeutic abortion as a means to save mother’s lives. Some proponents argued that the surgeon’s intention to save maternal life justified therapeutic abortion as an act of indirect killing. Others viewed the fetus as an unjust aggressor on a mother’s life. Opponents of therapeutic abortion viewed such operations as acts of direct killing. The conversion of Horatio Storer, a prominent physician known for his opposition to abortion, exemplified the hopes of the hierarchy for the acceptance of Catholicism in American life. However, in 1869, Storer’s innovations in abdominal surgery gave added complexity to the ambiguous dilemmas of difficult births. During a delivery, Storer 407Ibid., 212. 408Connery, Abortion. 226. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 159 removed a pregnant uterus and its appendages to prevent the patient’s death from hemorrhage. Eduardo Porro, who popularized the operation in 1876, had sought the approval of a Catholic bishop after he operated.409 hi Italy, the resulting sterilization made such approval necessary. Scholastic theology provided for such operations only to prevent a mother’s death. This procedure had direct implications for all surgical interventions in difficult births. In America, proponents of cesarean section remained divided on the merits of suturing the uterus closed after delivery.410 In 1870, Charles F. Rodenstein maintained that suturing the uterus closed to prevent hemorrhage represented the best means to prevent fatalities.411 For Robert Harris, in 1879, delay represented the primary cause of fatalities. Harris urged American surgeons to ignore the unfavorable statistics of Irish and British surgeons and intervene before the mother was exhausted. He believed that climatic and hygienic conditions in America favored the successful practice of the operation. The perceived danger of cesarean operations, due to the risk o f infection, made the Porro section a popular alternative. Concerns over the skill of operators, the effects of 409Harold Speert, “Eduardo Porro and Caesarean Hysterectomy,” Surgery. Gynecology, and Obstetrics 106 (February 1958): 250. 4I0Nicholson J, Eastman, “The Role of Frontier America in the Development of Cesarean Section,” American Journal of Obstetrics and Gynecology 24 (December 1932): 919-920. 41 'Charles F. Rodenstein, “On the Introduction of Sutures into the Uterus after Caesarean Section,” American Journal of Obstetrics 3 (February 1871): 582. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 160 shock, and risk to mothers hampered the acceptance o f the cesarean operation.412 Thus, late in the 1870s, physicians had a variety of options for surgical intervention in cases of an obstructed pregnancy. Surgeons could still use forceps in the hope of extracting a living child, or destroy the child by craniotomy. However, the cesarean and Porro operations represented alternatives for the most skilled surgeons. Between 1877 and 1878, a Senate investigation o f Freedmen’s Hospital in Washington, D.C. placed the problems of difficult births and differing cultural perspectives on appropriate surgical intervention before a national audience. Two former patients accused Dr. William Palmer of mismanaging Freedmen’s Hospital, and of acting cruelly toward African-American patients, hi support of the patients’ charges, an African-American physician at the hospital, Dr. Alexander Augusta, offered an account of a delivery complicated by puerperal convulsions, during which, he testified, he witnessed cruelty toward the African American birthing mother. Dr. Augusta testified that Palmer unsuccessfully attempted a forceps delivery. When the effort failed, according to Augusta, he suggested to Palmer that Palmer perforate the child and remove it from the womb in pieces, a technique known as craniotomy. A second effort resulted in the partial delivery of the child. While Palmer was able to deliver the head, the torso remained lodged in the womb. Another physician present, Dr. C. B. Purvis, then placed a towel or a rope around the child’s neck and, 4I2Robert P. Harris, “Lessons from a Study of the Cesarean Operation in the City and State of New York and their Bearing upon the True Position of Gastro-Elytrotomy,” American Journal of Obstetrics 12 (January 1879): 91. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 161 according to Augusta, proceeded to place his foot against the mother’s body while forcibly withdrawing the child from the womb. The mother died soon after delivery.413 In his testimony, Dr. Purvis, an African-American himself, offered a very different account of the delivery, one that vindicated Palmer and his course of action. Purvis agreed with Augusta that Palmer had difficulty with the forceps delivery. However, he denied that Augusta had ever proposed craniotomy as an alternative to delivery. Palmer testified that no one in his right mind would suggest craniotomy if delivery by forceps seemed possible. What really happened, according to Purvis, was that Palmer actually delivered the child’s head successfully with a second set of sturdier forceps. Purvis denied that force was ever used to deliver the child from the mother’s womb. According to Purvis, Palmer managed the delivery and it was a third physician who supported the mother as he, Purvis, received the child in a towel. Having refuted Augusta’s charges with his own testimony, Purvis tried to thoroughly discredit Augusta with additional statements. Not only had Augusta not proposed craniotomy, but had he done so it would have been a “silly” proposition because the killing of a child was an act of malpractice. In support o f that assertion, Purvis cited Gunning Bedford’s 1861 condemnation of craniotomy as murder, and other authorities to justify the use of forceps instead of version in the presence o f puerperal convulsions. Purvis concluded by attributing the cause of the mother’s death to uremic poisoning, the 4I3Congress. Senate. Committee on Appropriations, Management of Freedmen’s Hospital. 45 Cong. 2d. sess., 9 March 1878, S. Report 209, Serial 1789, 221-222. Augusta was one o f two African American physicians excluded from the D.C. Medical Society in 1869 on account of race. See Lamb, History. 100. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 162 source of the convulsions. The Senate investigation ultimately exonerated Dr. Palmer and his associates.414 While the investigation exonerated Palmer of wrongdoing, it also illuminated the state of intervention practiced at Freedmen’s Hospital among poor African Americans. In 1877, Freedmen’s hospital existed as a poorly staffed and badly funded asylum where many patients went to die.415 Purvis did not mention recent medical literature supporting abdominal surgery in the testimony. Palmer and Augusta had studied medicine in the decade before the war. The data suggests a generational gap between physicians trained before the war and recent graduates leading to a lack of consensus among physicians on appropriate means of intervention. The ambiguity of obstetric practice affected Catholic physicians as well, hi 1879, Fr. William Dassell translated a German ethics text for use by Catholic physicians. Carl Capellmann, the author, endorsed the Church’s censure of abortion. The sole exception occurred when a child was lodged in the upper strait of a woman’s pelvis. In such cases, he suggested, the perforation of the amniotic sac represented the sole means possible to free the child, hi other cases, the principle o f indirect effect applied.416 4I4Congress. Senate. Committee on Appropriations, Management of Freedmen’s Hospital. 45 Cong. 2d. sess., 16 March 1878,S. Report 209, Ser. 1789.275-278. Purvis was also barred from membership in the medical society; See Lamb, History. 100. 4lsThomas Holt, Cassandra Smith-Parker, Rosalyn Terborg-Penn, A Special Mission: The Storv of Freedmen’s Hospital. 1862-1962 (Washington, DC: Howard University, 1975), 20-21. 416The death of the child could be tolerated if it occurred through unintended means, such as the administration of medicines to the mother to cure disease. See Capellmann. Pastoral. 15-16. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 163 Capellmann condemned craniotomy on a living fetus and endorsed the cesarean operation as a safe means to save both mother and child. He used statistics to argue that craniotomy not only proved fatal for the child, it placed mothers* lives at risk. Capellmann concluded, “this should suffice to make us reject any such operations, even if from a simply utilitarian standpoint.”417 The German physician struggled to reach the high standard set by the Church for surgeons. Still, the case of a lodged fetus revealed that the limits of surgical progress did not always allow the realization of such ideals. During the Gilded Age, great waves of immigrants, many from eastern and southern Europe, arrived on America’s shores. These new arrivals reshaped the Catholic Church in America, causing the hierarchy to open new institutions, including hospitals.418 During this period such institutions changed from asylums to modem scientific institutions 419 Rapid expansion of the Church prompted the hierarchy to rationalize its own organizational structure, with the dual aim of apostolic service and preserving the faith of new immigrants. Little had changed since the First Vatican Council of 1869 to 1870; many bishops sought to adapt Catholicism to American life. The efforts of Bishop Peter J. Baltes to bring rational organization to the Diocese of Alton, Illinois, exemplified the growth of the Church at large.420 In 1879, Baltes 4,7Ibid„ 19. 4I8Kauffinann, Ministry. 129. 4l9Casterline, “St. Joseph’s,” 290. 420Baltes, a German immigrant, began his studies for ordination with the Archdiocese of Chicago. The expansion of the Catholic population resulted in the creation of the Alton diocese, peopled largely by German immigrants. Baltes became Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 164 turned his attention to sacred embryology in a treatise virtually unknown today. Baltes’ years as a successful pastor probably introduced him to the problem of difficult births. His desire to assist pastors with such dilemmas prompted his to consultation with prominent physicians in preparing the text. This Bishop’s struggle with theology and science represented a second strand o f Catholic moral theology. The existence of divergent attitudes among members o f the hierarchy contradicts existing accounts that make claims for the existence o f a monolithic American Church during the period of study. In the preface, Baltes expressed his desire to explore Baptism in the Uterus, cesarean section, abortion, and embryotomy for an audience o f physicians and clergy, hi the past, he explained, he had refrained from publishing a text because his stance on embryotomy and other issues differed with the Holy See. However, he asserted, Vatican authorities encouraged his effort, “in order that they might hear what is and can be said on them, on the other side of the ocean.”421 Baltes expressed confidence in his views and his known as “the beloved pastor of Belleville” for his leadership of the town’s parish. In 1866, his appointment as Vicar General capitalized upon these skills. Baltes’ appointment as Bishop in 1870 revealed his zeal for rational organization. Baltes incorporated the Church and secured its right to hold property. He also established regulations for a wide range of sacramental and canonical practices. The bishop also enlisted the help of religious orders to establish schools and health care institutions. Richard H. Clarke, Lives of the Deceased Bishops of the United States (New York, NY: Richard Clarke, 1888), 189-191. 42IPeter J. Baltes, A Synoptical Treatise on Sacred Embryology (Alton, EL: Perrin and Smith, 1879), IV, 25,47. The baptism of infants in utero, with a water-filled syringe, represented a common subject of early embryology texts. For Baltes, physiology limited its practice. He observed that rupture of the amniotic sac would result in the rapid death of the unborn child. Hence, to perform the rite outside cases o f absolute necessity represented an act of killing. Contrary to Cangiamilla’s strict rule, only the likely death Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 165 resolve to hold them until the Holy See ruled otherwise. If this occurred, he claimed, he would “cheerfully submit” to the teaching of the Pope. Baltes believed that the decision to perform a cesarean operation was only justified when a mother’s life was at risk, and he barred the operation for baptism before two and a half months of gestation. Consent for the surgery hinged on whether it would preserve a mother’s life. When the operation represented a means to save the child, he urged healthy women to submit, as he asserted that most did.422 However, there was no penalty of mortal sin to submit to it in either case. If both the infant and mother’s life depended on the operation, there was a greater obligation to submit. The obligation to operate on a dead woman existed only in the event of sudden death or with the face presentation of a child 423 Baltes denied that priests incurred canonical penalties for the failure to baptize by cesarean section after the death of the mother. Baltes’ discussion of abortion distinguished between criminal and justifiable practices. Abortion accomplished to avoid inconvenience or embarrassment to mothers of the child, or the need to expel the fetus justified the attempt to baptize in the womb. No case justified risking the mother's life. Cases before four and a half months of gestation, required consultation with a physician to determine whether, “there is something there to be baptized.” Baltes views reflected the desire to baptize the child without risk to the mother. The discussion attempted to reconcile contemporary physiology with traditional theology. 422Ibid., 22. 423Ibid., 27. 424Ibid., 26. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 166 represented homicide.42s Abortion was justified when the destruction o f the infant’s life could save the mother.426 For Baltes, the use of abortifacients to expel the fetus constituted an acceptable practice. The same view held for a disease that threatened both lives. If some likelihood o f the child’s survival existed, Baltes endorsed the induction of premature labor. An underdeveloped fetus should remain in the womb long enough until it might be removed, “by medicines, by the cesarean section...or...embryotomy.”427 Baltes’ defense ofjustifiable abortion represented an argument from silence. While Church hierarchy, he claimed, condemned criminal abortion “they do not condemn it [justifiable abortion] in any way.”428 The Bishop offered four propositions in favor of embryotomy. First, the fetus represented an unjust aggressor when it threatened maternal life429 Second, none of the early fathers condemned it. Third, other Church fathers implicitly approved the practice through their silence. Finally, the Holy See never ruled against it and therefore tolerated the practice.430 Baltes justified the practice in difficult births on the basis o f the principle of double effect. 431 425Ibid., 32-33. 426Ibid., 39. 427Ibid., 47. 428Ibid., 64. 429Ibid., 51. 430Ibid., 50-53. 431 Ibid., 60-61. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 167 While Baltes’ views had scholastic roots, they also reflected ongoing European debates.432 His view of intervention favored the interests of the mother over the fetus. A physician should do the best they can, “if he cannot save them both, he must save what he can.”433 Baltes rejected assertions that embryotomy would result in the wanton destruction of infants and further claimed that the safety of embryotomy surpassed cesarean section’s 59 percent mortality rate.434 Hence, the argument in favor of embryotomy reflected the of dread abdominal surgery that existed among physicians. Baltes justified the practice of embryotomy as the safer course provided for by scholastic authors such as Thomas Aquinas and Alphonsus Liguori. 432Connery, Abortion. 225-283. 433Ibid., 81. 434The 59 percent mortality rate did not reflect the success o f more recent surgeons. Ibid., 86. Part of the reason for Baltes advocacy of craniotomy was perhaps the low level of medical knowledge in the region. The State of Illinois began regulating medical practice in 1887. Statutes for the minimal standards required for the practice of midwifery were passed by the legislature in 1889. See State o f Illinois, Illinois State Board of Health, Medical Education. Medical Colleges, and the Regulation of the Practice of Medicine in the United States and Canada. 1765-1891 ([Springfield, IL]: Illinois State Board of Health, 1891), XXXIV. hi Madison County, in 1879, within the Diocese of Alton, fifty-eight doctors were registered to practice in 1879; thirteen were educated before the war, seven had no medical degree, and three were homepathic physicians. The rest were educated during or after the war. Four of the eight registered midwives had no formal training. See State of Illinois, Illinois State Board of Health, Official Register of Physicians and Midwives ([Springfield, IL]: Illinois State Board of Health, 1891), 268. To give a small idea of the demographics, over 50 percent of poor farm deaths (64 percent) from 1880 to 1893 were immigrants. See Josephine Motz, comp. Madison Countv Poor Farm Death Records Index. (Madison County Historical Society, Edwardsville, EL, 1986). Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 168 A critical review of Baltes’ text reveals the conservatism of his physician advisors.435 The Bishop’s mortality statistics overlooked more recent findings that attributed fatalities in cesarean operations to delay and poor management. Baltes’ support of embryotomy reflected the ambiguity o f official teaching created in 1869.436 In 1879, the experienced pastor searched the ambiguities of obstetrics for the safest course for mothers. Evidence presented suggests that success in the cesarean operation remained beyond the reach of most physicians due to their lack of education and surgical skill. Ten years later, Edward LeProhon’s call for more skilled practitioners still rang true. The works of Baltes and Capellman reflected the ambiguous state of obstetric practice at large. Some physicians continued to practice craniotomy, sometimes at the insistence of a husband, to save mother’s lives.437 Others suggested that fear of the knife and delay represented the true source of failure in cesarean section 438 Still others claimed that the Porro operation reflected the safest means to resolve a difficult 43SThis text represents the only extant copy on record. The cover page bears the signatures of S. G. Moses and G. A. Moses. S. G. Moses practiced obstetrics in St. Louis beginning in 1842. If Moses, did in fact advise Baltes, his views represent the earlier generation of obstetric practice and explain the conservative views reflected in the text. 436Most Catholic sources of the present day, including the universal Magisterium of the Roman Catholic Church, reject Baltes’ claim that the fetus represented an unjust aggressor. Similarly, in the present day, the administration of drugs to the mother to directly cause expulsion from the uterus represent an act of direct killing. 437A. J. C. Skene, “The Principles of Gynecological Surgery Applied in Obstetric Operations,” Transactions of theAmerican Gynecological Society. 1878 2 (1877): 192- 193. 438Robert P. Harris, “The Operation of Gastro-Hysterotomy (True Caesarean Section), Viewed in the Light of American Experience And Success; With The History and Results of Sewing Up the Uterine Wound; and a Full Tabular Record of the Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 169 delivery.439 Some physicians favored the Porro because it prevented the future pregnancy of poor women who were a drain on public charities. Others favored the practice because it eliminated the danger of future pregnancy.440 In 1881, Robert P. Harris, a Protestant physician, explored the merits of each operation. Harris preferred the Cesarean section because 75 percent o f mothers survived the operation. Antiseptic techniques, silver sutures, and improved wound management had increased the success rates o f contemporary cesarean operations.441 Harris confined the Porro operation to cases of transverse presentation or where infection placed a mother’s life at risk. Using available statistics, he argued that mothers’ lives possessed a higher relative value than those o f infants. Until experience verified the safety of abdominal surgery, the Porro and craniotomy remained acceptable surgical techniques. Harris noted the opposition of the Roman Catholic Church to craniotomy, yet he rejected Caesarean Operations Performed in the United States, Many of Them Not Hitherto Reported,” TTie American Journal of the Medical Sciences 150 (April 1878), 335. 439T. Gaillard Thomas, “Comparison of the Results of the Caesarean Section and Laparo-Elytrotomy in New York,” New York Medical Journal 27 (May 1878): 511; G. F. Wales, “Gastro-Elytrotomy and Ablation of the Uterus versus the Caesarean Section,” Dublin Journal of Medical Science 66 (December 1878): 423-424. ^ sa a c E. Taylor, “Gastro-Hysterectomy, or the Recent Modification of the Caesarean Section by Dr. Porro,” The American Journal o f the Medical Sciences 80 (July 1880): 128; Robert P. Harris, “The Porro Modification of the Caesarean Operation, In Continental Europe,” The American Journal of the Medical Sciences 79 (April 1880): 337. ^'Robert P. Harris, “Special Statistics of the Caesarean Operation in the United States Showing the Successes and Failures in Each State,” American Journal of Obstetrics 14 (April 1881): 342-343. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 170 its practice of delaying intervention until the infant died.442 In cases where the pelvic diameter proved less restricted, Harris viewed craniotomy as the safest course. In cases of rachitic (or deformed) pelvis Harris urged mothers to submit to the cesarean operation. Like C. D. Meigs, he reviled the practice of multiple craniotomies on a single patient as acts of homicide, and he recalled Meigs’ refusal to perform a third craniotomy on Mrs Reybold. Harris noted the delay necessary, for Nancrede and a priest, to convince Mrs. Reybold to submit to a cesarean operation.443 In such cases, he claimed, the ligation of fallopian tubes during a Porro or cesarean operation provided an acceptable alternative to craniotomy. Here, the motive o f sterilization reflected a desire to prevent future pregnancies complicated by pelvic obstruction. Harris, viewed as a textbook surgeon by some, influenced an emerging generation of American physicians. In his 1884 medical school dissertation, John F. Roderer used Harris’ data to promote cesarean section over craniotomy.444 Roderer, a Catholic, rejected claims that the value of a mother's life surpassed that of her infant. All infants, he argued, possessed an unquestioned right to life.445 The surgeon also rejected claims that infants were unjust aggressors on the lives of mothers. Roderer echoed the views of ^Ibid., 358. 443Ibid., 360. ^Roderer’s preceptor Robert B. Cruice, was an Irish immigrant, who graduated from the University of Pennsylvania medical school in 1854. Cruice was also the chief of surgery of St. Joseph’s (Catholic) Hospital in Philadelphia. ^John F. Roderer, “Craniotomy and Cesarean Section,” AMs, (M.D. diss., University of Pennsylvania, 1884), 6. Department of Special Collections, Van Pelt- Dietrich Library Center, University of Pennsylvania, Philadelphia, PA. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 171 theologian P. F. C. Debreyne on the perils of craniotomy for both mother and child. Other more recent findings o f a 37% percent mortality rate convinced Roderer that the danger of craniotomy surpassed that o f the cesarean operation.446 Roderer confined craniotomy to the removal of dead infonts from the womb and cited Harris’ 75 percent rate of maternal survival to support his own belief in the cesarean operation.447 Like Harris, he maintained that delay was the primary cause o f mortality in such cases. For Roderer, the proper management of pregnancy represented the way to safer outcomes. The degree of pelvic contraction, found by early examination, represented a tool to determine an appropriate means of intervention,448 with the survival of both mother and child as the appropriate aim of obstetric operations. Roderer closed by echoing the fears of some British surgeons that obstetric practice had become unduly destructive.449 Opponents of craniotomy found an ally in the Holy See. On 31 March 1884, the Holy Office issued a prohibition against teaching craniotomy in Catholic schools.450 George Shrady, the editor of the Medical Record, noted the ruling in an editorial on craniotomy. He commented on the increased success of the cesarean operation, yet was unwilling to totally rule out craniotomy. The editor observed that the ruling prohibited 446Ibid., 11. ^Ibid., 25. ^Ibid., 22. “ 'Ibid., 30. 4S0Acta Sanctae Sedis 17 (1884): 556. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 172 Catholic doctors practicing craniotomy, even to save the mother. While he claimed that the Catholic stance proved logical and consistent, he added, “It is not however, that which physicians have always been taught, nor does it seem to us to be in harmony with the best and broadest ethical instincts.”451 Aloysius Sabetti, a Jesuit theologian, explained the Vatican’s opposition to the practice in a reply to Shrady. Sabetti claimed that Catholics always had, in the past, recognized the grave sinfulness o f craniotomy and he rejected recent claims of Italian theologians that craniotomy represented a means of indirect killing. Further, Sabetti argued that the fetus could never represent an unjust aggressor, as aggression required “some positive act.” For Sabetti, the Vatican ruling constituted an unambiguous rejection of the craniotomy on the living child.452 Not all commentators were pleased with the Vatican ruling. One St. Louis physician depicted the dilemma of the Church and craniotomy as “religious superstition v. humanity.”453 The writer, Dr. Frank James, criticized a French bishop who questioned the practices of the faculty at the Lyon University medical school, and suggested that the actions of the Church were an intrusion on faculty members’ rights. While such rulings 4S,George Shrady, “The Ethics o f Craniotomy,” Medical Record 28 (31 October 1885): 492. 4S2A. Sabetti, “The Roman Catholic View of Craniotomy,” Medical Record 28 (28 November 1885): 606-607. 4S3Frank L. James, “Religious Superstition vs Humanity,” St. Louis Medical and Surgical Journal 48 (May 1885): 388. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 173 applied rigidly to all Catholics, he doubted that “intelligent” Catholic physicians would refrain from craniotomy. Correspondence between the Jesuit president of Georgetown University and his superior in New York revealed the reluctance o f some Jesuit officials to advertise the medical program.454 They feared that some instruction, like craniotomy, differed with Catholic teaching.455 Joseph Havens Richards, the President o f Georgetown, University, discussed the matter with a faculty committee and received assurances that no infringements o f Catholic teaching existed.456 Antisepsis, faculty physicians claimed, increased the safety of the cesarean operation to such an extent that it had rendered craniotomy obsolete. Richards told his superior that the new professor of obstetrics, a prominent Catholic, would follow Church teaching on the issue 457 454Joseph Havens Richards, Washington, DC to Thomas Campbell, New York, NY, 13 October 1888, ALS, 10p., Maryland Provincial Archives, 501:19, Varia 501: lb- 32, Box 94, File 4, GUA, Washington, DC. 4S5Thomas Campbell, New York, NY to Joseph Havens Richards, Washington, DC, 10 September 1888,4p., ALS, Archive Subject Files: Medical School 1880-1916, File: Medical School, 1885-1888, GUA, Washington, DC. 4S6Richards noted that his predecessor discussed the matter o f craniotomy with Joseph Taber Johnson. At the time Johnson, a professor of gynecology, claimed that he would do the procedure himself, but refrained from teaching the technique to Georgetown medical students. See Richards to Campbell, 13 October 1888, GUA, Washington, DC. 4S7In 1888, Richards was aware of dissatisfaction with the medical college in Rome. Camillo Mazella, a fixture Cardinal, described Georgetown as a living tree with two dead branches [the medical and law schools]. The tension foreshadowed an unsuccessfixl attempt by the Vatican to take over the medical and law schools in 1893. See E. J. Burrus S J., trans. “Historical Notes: Father Joseph Havens Richards’ notes on Georgetown and the Catholic University.” Woodstock Letters 83 (February 1954): 85,90- 91. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 174 Within days, Joseph Taber Johnson, the Professor of Gynecology at Georgetown Medical College, reversed his past endorsement o f craniotomy before a local medical society.4SS P. J. Murphy, the new professor of obstetrics, published a similar paper condemning craniotomy soon after.459 Both physicians endorsed the prohibition of craniotomy at the Catholic university. The appearance of both their articles proved timely; on 19 August 1889, the Vatican reiterated its opposition to craniotomy and all operations that directly killed the fetus or the mother.460 At the close of the decade, American physicians remained divided on the matter of craniotomy.461 Some physicians continued to favor the measure of safety provided by the Porro operation. The prevention of future pregnancy represented an added benefit for others. Simplicity represented an advantage for country practitioners who lacked the skills necessary to perform Sanger’s operation.462 In 1890, Robert Harris reported that statistics of the Porro and Sanger operations remained roughly equivalent. Harris noted 4S8Joseph Taber Johnson, “The Wrong of Craniotomy on the Living Fetus,” Transactions of the Washington Obstetrical and Gynecological Society 2 (1887-1889): 176-177; Johnson presented the paper on 19 October 1888. 459P. J. Murphy, “Caesarean Section vs. Craniotomy,” Obstetric Gazette 12 (April 1889): 169. 460Acta Sanctae Sedis. 22 (1889-1890): 748. 461 George Rohe, “Is Craniotomy Justifiable on Living Children?” Transactions of the American Association of Obstetricians and Gynecologists 2 (18891:388-389. 462Charles W. Dulles, “Amputation of the Pregnant Uterus, Medical and Surgical Reporter 60 (June 1,1889): 30. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 175 that craniotomy persisted, because some practitioners reserved obstetric decisions to themselves.463 Progress toward the increased use o f the cesarean operation was slow but steady. Harris reported successful results in the practice of the improved cesarean operation from 1880 to 1891. The 3 percent mortality rate o f Dr. Max Sanger’s technique, he claimed, would call the future practice of Porro sterilizing operations into serious question. Speaking in defense of the poor, Harris claimed that the improved operation would silence those who claimed that infants of rachitic mothers were not worth saving.464 The condition occurred most frequently among the poor and foreign bom.465 Such concerns point to the persistence o f class and ethnic prejudice in American society. For Harris, the vital considerations reflected time and technique. All too often, bad management rather before labor, not disease, represented the true source of mortality. The persistence of class and ethnic prejudice reflected one reaction to the nation’s second great wave of immigration.466 Foreign immigrants faced the same charges of 463Robert Harris, “Lessons from the Caesarean Operations of Philadelphia, 1835- 1839,” American Journal of the Medical Sciences 94 (February 1890): 111. 464Max Sanger’s operation represented the first conservative cesarean operation. Sanger emphasized the importance of antisepsis to prevent fatal infections. The use of sutures to close the uterine wound also made fixture pregnancies possible. Robert Harris, “The Possible Results of Caesarean Delivery,” American Journal of the Medical Sciences 102 (October 1891): 376. 465McGregor, Sexual. 162-163, 177. 466Alan M. Kraut, Silent Travelers (New York, NY: Basic Books, 1994), 5. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 176 racial and physical inferiority leveled at their African American predecessors.467 The Catholic Church struggled to absorb the new immigrants that reached America’s shores. In response, the number of Catholic hospitals surged from seventy-five in 1872 to four hundred in 1910.468 Such institutions provided a refuge for the newly arrived and a means to preserve their Catholic identity. Increased involvement of the Church in health care prompted theologians to explore question of sterilizing operations, hi 1891, Rev. Paulinus Dissez, a Catholic theologian, expressed his preference for the Porro operation over the conservative cesarean operation. It is not clear whether the writer was aware o f the recent findings on the Sanger operation. In his defense of the Porro operation, the writer explored debates among recent theologians whose arguments reflected varied interpretations of scholastic precepts. Those who favored a severe stance only permitted the operation in cases of hemorrhage. The less severe stance favored the Porro due to its safety and the prevention of future pregnancy. The argument o f the article turned on the consequences of the Porro operation for married women. Dissez defended a woman’s right to protect her life from the danger of 467An 1890 discussion of birth control revealed the existence o f eugenic ideas among physicians. One physician asserted that overpopulation would lead to pauperism and crime. Another asserted that Irish, Germans, and Poles were guilty of having too many children. A third physician expressed fears that the population o f new immigrants would soon surpass that of native bom Americans. Another physician believed that birth control represented a mens to purify the race. The author, a Catholic, viewed Catholic schools as a means to insulate children from these ideas. See Julius Kohl, “Whom Shall We Follow?” [Belleville, EL, 1890] (Pamphlets in American History; Series IV., 1983, text-fiche), 5-6, 7, CA653. 468Kauffmann, Ministry. 130. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 177 future pregnancy.469 The theologian also excluded husbands from such surgical decisions, because of his belief that they were the domain of the individual patient. For Dissez, the conservative cesarean operation placed both mother and child at grave risk of death. Women with a history of difficult births faced the choice of refraining from sexual intercourse, a right of Christian marriage, or the risk of death from a new pregnancy. For Dissez, the Porro represented a mean between extremes, the assurance of both safety in surgery and future marital intimacy. Physicians continued their struggle with the propriety of surgical intervention. In 1892, E. E. Montgomery, the President of the AMA, expressed doubts about craniotomy given the favorable results o f the improved cesarean operation. Montgomery credited antisepsis with preserving life to such an extent that the “unborn individual” must be given a chance for life. He doubted the necessity of craniotomy on the living fetus, and, he noted, “It is a source o f continued opprobrium to our profession that we must sacrifice life to save it.”470 For Montgomery, the procedure remained permissible where the child appeared too feeble to survive after birth or suffered from hydrocephalus or other incurable disease. Montgomery expressed his own preference for the improved cesarean operation and suggested that Harris’ statistics for the operation revealed its superiority to the Porro method. Montgomery rejected the sterilization of rachitic women as the condition did not 469Paulinus F. Dissez, “The Morality of the Porro Operation,” American Ecclesiastical Review 5 (November 1891): 346. 470E. E. Montgomery, “Some Mooted Points in Obstetrics and Gynecology- President’s Address,” JAMA 18 (18 June 1892): 763. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 178 affect infants. The surgeon confined Porro operations to cases where fibroid existed or exhausted labor, hi July, the New York Journal of Gvnecologv and Obstetrics condemned craniotomy, citing Montgomery to support the claim that the procedure represented murder. In the next issue, the editor censured those who condemned abortion in public while practicing it in private. Foeticide represented a moral rather than a medical question for the editor, who claimed that the Jewish community and Christians shared the belief that a fetus held supernatural rights equal to the living.471 Agnostics, he asserted, took refuge in expediency, which allowed craniotomy in cases necessary to save the mother’s life. So did the existing New York statute, which the editor opposed as a violation of divine law. The New York Journal editors included an article by Charles Harris, an abortion proponent from Georgia. Physicians who endorsed abortion, he claimed, were guardians of female virtue. Those who practiced in secrecy for fear of public condemnation were worthy of ridicule. Fear of crime and the interests of the embryo, according to Harris, caused women to “suffer and sacrifice everything at the shrine of maternity.”472 Pregnant 47IIt appears that the editor, possibly Thomas Addis Emmet, attempted to hold the profession to the strict standard set out by die Roman Catholic Church. The official Catholic teaching reflected an absolute ban on abortion. Some Christians, like Fleetwood Churchill, viewed craniotomy as a means to save mother’s lives. According to a recent study of Jewish medical ethics, there is one exception to the prohibition of abortion. Abortion is permissible for women when pregnancy represents a physiological or psychological threat to her life. A discussion of the case of the rodef appears in Moshe D. Tendler, “Contraception and Abortion,” in Medicine and Jewish Law ed. Fred Rosner (Northvale, NJ: Jason Aronson, 1990), 118. 472Charles H. Harris, “Special Operation for Abortion,” New York Journal of Gvnecoloev and Obstetrics 2 (September 1892): 843. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 179 women who suffered from albuminuria, diabetes, or other grave illness should have the contents of the uterus emptied at the discretion of physicians. The writer asserted that doctors would gain income and social standing through practice of such abortions. The Editor of the New York Journal remained concerned with the issues of appropriate surgical intervention, criticizing obstetric and gynecological fads. In gynecology, he claimed, hysterectomy and dilation and curettage were often performed unnecessarily. Craniotomy, cesarean section, and foeticide with electricity topped the editor’s list o f unnecessary obstetric practices.473 The editor urged physicians consult pathologists before surgery to verify whether disease existed before operating.474 In 1893, the New York Journal reprinted a South Carolina physician’s discussion about the mortality of craniotomy. The prevention of embarrassment from the disclosure of an unwanted pregnancy, he claimed, rather than the preservation o f life represented the true motive of craniotomy. In his own comments, the editor charged those who practiced craniotomy with the attempt to act as “arbiters o f divine justice and as God’s executioners.”473 For the editor, foeticide always represented an act o f unjustifiable homicide.476 473A. H. Buckmaster, “Fads in Gynaecology and Obstetrics,” New York Journal of Gvnecoloev and Obstetrics 2 f September 1892): 1046-1047. 474A. H. Buckmaster, “A Challenge to Hysterectomists,” New York Journal of Gynecology and Obstetrics 2 (December 1892): 1150. 475Comelius Kollock, “Craniotomy on the Living Foetus is not Justifiable,” New York Journal of Gynecology and Obstetrics 3 (January 1893): 1150. 476A. H. Buckmaster, “The Turning of the Tide,” New York Journal of Gynecology and Obstetrics 3 (January 1893): 36. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 180 British operators were also concerned with appropriate means of obstetric intervention. In 1893, James Murphy, the President of the British Medical Association, rejected the practice o f craniotomy on the living child.477 Murphy noted that younger physicians readily endorsed abdominal surgery. Senior practitioners continued to practice craniotomy because of their reluctance to visit an operating theater for instruction in the new techniques. As in America, craniotomy persisted because of a gap in surgical knowledge between newly trained physicians and those long in practice. Outmoded procedures had an afterlife due to the continued practice of unskilled physicians. In the fall of 1893, two articles by physicians opposing craniotomy appeared in the American Ecclesiastical Review. The first article noted the recent stance o f the British Medical Association against craniotomy and argued that the mortality rate for cesarean section of less than 10 percent rendered craniotomy indefensible. The author, M. O’Hara, credited the Church with maintaining a high ethical standard, which science could no longer afford to ignore.478 This standard, deemed unrealistic in the past, proved achievable in the 1890s. The article closed with the hope that physicians would come to view craniotomy as a violation of the laws of society and morality. The conclusions of second author William Parish echoed the the first article. Review editor M. Hauser noted that, since Parish was a non-Catholic, no one could assail 477James Murphy, “An Address Delivered at the Opening of the Section of Obstetric Medicine and Gynecology,” British Medical Journal 18 (26 August 1893): 454. 478M. O’Hara, “Caesarean Section Versus Craniotomy: Is Not Embryotomy a Crime?” American Ecclesiastical Review 9 (November 1893): 363. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 181 his opposition to craniotomy with claims of theological bias.479 Parish focused on appropriate means of intervention rather than moral arguments,480 and touted the promise of the cesarean operation as a means to save both mother and child. For this Philadelphia physician, the undesired side effect of sterilization limited the Porro section to cases of mollities ossium or a septic uterine tumor. These Review articles suggest that the most skilled operators of the era opposed craniotomy.481 In November of 1893, R. J. Holaind explored the ethics of treating ectopic pregnancy in the pages of the American Ecclesiastical Review.482 The writer’s first article drew tentative conclusions based on the incomplete results of the survey of physicians and theologians. John P. Roderer, a respondent, emphasized the difficulty in diagnosing the presence or absence of a fetus in ectopic pregnancies. Holaind urged 479M. Heuser, “Conferences,” American Ecclesiastical Review 9(November 1893): 368. 480W. H. Parish, “The Present State of Craniotomy in the Medical Profession,” American Ecclesiastical Review 9 (November 1893): 365. 48IIbid., 366. Ectopic pregnancy occurs when a fertilized ovum is becomes situated in a fallopian tube. Dining the nineteenth century, physicians lacked the capacity to determine whether a disease entity existed in an inflamed tube or a fetus. The ambiguity created terrible dilemmas for surgeons because the prospect o f death by hemorrhage was real if a tube burst. A previous study emphasized the contribution of the three theologians to the debate. Yet, it overlooks the contributions of Holaind’s survey results in shaping his decision among the three. See Connery, Abortion. 301-302; R. J. Holaind, “A New Moral and Physiological Problem,” American Ecclesiastical Review 9 (November 1893): 331-343. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 182 physicians to prolong pregnancies as long as possible before removing such growths.483 Such delay represented a desire for an opportunity to baptize the child. The casus, or arguments, of three theologians followed the initial article. These theologians disagreed on whether the operation represented a cure for disease or a form of abortion. One theologian favored the removal of such growths, viewing such attempts as act o f indirect killing aimed to save the mother. A second theologian argued that such growths represented an unjust aggressor on the mother’s life, justifying their removal. The third theologian rejected efforts to remove such growths as acts of direct killing.484 The views of the theologians ranged from stringent to less stringent positions and indicated the wide latitude of opinion that existed within the bounds of Catholic theology. In the final article, Holaind expressed his own position. Most physicians concluded that the risk of a ruptured tube to a mother’s life ruled out the delay of surgery. In such cases, it was impossible to determine the whether a fetus existed in the tube.485 These findings convinced the author to agree with Augustine Lehmkuhl, a Catholic theologian, that the removal o f such growths represented a means to protect mother’s lives.486 Holaind, trusting in the experience of physicians, chose a less stringent stance. 483Holaind, “Moral,” 341. 484Connery, Abortion. 301-302; “Casus: De Conceptibus Ectopis. Seu Extra- Uterinus.” American Ecclesiastical Review 9 (November 1893): 343-360. 485R. J. Holaind, “The Discussion of a New Moral and Physiological Problem: The Testimony of the Medical Profession,” American Ecclesiastical Review 10 (January 1894): 35. 486Ibid., 38-39. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 183 The continuing ambiguity of medical abortion was made clear in an 189S exchange of correspondence in the Medical Record. George Shrady, questioned whether a consensus against craniotomy, or medical abortion, existed within Catholicism.487 Responding to his question, some opponents o f medical abortion appealed to the sixth commandment and the success of the cesarean operation to support their arguments.488 Another writer referred to “right, reason, and morals” rather than religion to argue against medical abortion.489 Two others responded in favor of craniotomy with variations on the traditional argument that justice favored the lives of mothers.490 One writer portrayed medical abortion as justifiable homicide. The other viewed such decisions as a case of the survival of the fittest. Such attitudes reflected different visions of the highest good on the part of physicians. Aloysius Sabetti, the Catholic theologian, answered by insisting that the Church had consistently condemned craniotomy.491 Reviewing Church rulings from 1872 to 1889, the theologian noted that less stringent theologians, like Lehmkuhl, had already 487George Shrady, “The Catholic Church and Obstetrical Science,” Medical Record 47 (2 February 1895): 148. 488John Hund, “The Catholic Church and Obstetrical Science,” Medical Record 47 (2 March 1895): 283. 489Thomas J. Keamey, “The Ethics of Craniotomy,” Medical Record 48 (31 August 1895): 320. 490The writer asserted that “good theology may be bad public policy and, that ecclesiastical deliberations are not always in harmony with Anglo-Saxon Law.” William A. Galloway, “Craniotomy and the Law.” Medical Record 48 (27 July 1895): 141. 491 Aloysius Sabetti, “The Catholic Church and Obstetrical Science,” Medical Record 48 (22 June 1895): 800. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 184 yielded their positions in favor of the Vatican.492 The appearance of the Sabetti’s remarks in a medical journal are significant because they reflect an attempt by the Church to meet the medical profession on its own ground. However, debates persisted among European theologians on the issue of medical abortion after the prior rulings of 1884 and 1889. After an inquiry by the Archbishop of Cambrai, the Vatican issued a ruling against medical abortion on 24 July 1895.493 This stance probably raised questions about the existing view toward ectopic operations as well.494 This ruling resolved the issue of craniotomy for the Church. As the century moved to a close, physicians continued to debate the validity of craniotomy. W. H. Meyers, a physician, acknowledged the role of religion and of husbands in shaping views toward craniotomy. He argued that cesarean section had rendered craniotomy obsolete and claimed that surgeons were no longer justified in citing old data to raise concerns about the safety of cesarean section. Monstrousities and other non-viable cases represented the only justification for craniotomy.49S Charles Boisliniere, a Catholic physician, published a text on obstetric emergencies in 1896. Boisliniere believed that the success of the improved cesarean 492Connery notes that a revision appeared in the twelth edition of the text. Connery does not provide a date. The twelfth edition, in feet appeared in 1914. See Connery, Abortion. 302. 493Actae Sanctae Sedis. 28 (1895-1896): 584. 494 Connery, Abortion. 302. 495W. H. Myers, “The Limitation of Craniotomy,” New York Journal of Gynecology and Obstetrics 7 (November 1895): 479. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 185 operation ruled out craniotomy, or abortion, as a means to preserve a mother’s life.496 Boisliniere also approved of the Porro operation for the preservation of life 497 However, one reviewer questioned Boislinieres’ grasp of contemporary science, and commented that the physician would be better off leaving the text in his bag than consulting it during an emergency.49ft In 1898, the Vatican ruled on the issue of ectopic pregnancy permitting the removal of a growth as an indirect means of killing 499 hi 1902, the Vatican issued a revised ruling, allowing such operations only after six months of gestation.300 The ruling contradicted Holaind’s conclusions, and eventually caused Austin O’Malley, a Catholic physician who wrote on ethical matters, to revise his own stance in accord with the Vatican ruling.s°l A series of works by Catholic authors on medical ethics followed in 496The surgeon is the same operator mentioned in Chapter Three. See Louis Charles Boisliniere, Obstetric Accidents. Emergencies, and Operations (Philadelphia, PA: W.B. Saunders, 1896), 323-324. 497Ibid., 326. 498G. H. M., “Review of: Obstetric Accidents, Emergencies, and Operations,” New York Journal of Gynecology and Obstetrics 7 (November 1896): 49. He served as Chair of the Department of Obstetrics at the St. Louis Medical College. The surgeon also ran the gynecological clinic at Mullanphy Hospital. Boisliniere died at the age of eighty while his book was in the process of publication. L. CH. Boisliniere, “Obituary” Transactions of the American Medical Association 8 (1895): 396-397. 499Acta Sanctae Sedis. 30 (1897-1898): 704. S00Acta Sanctae Sedis. 35 (1902-1903), 162. 501“In an article I wrote in Essays in Pastoral Medicine (New York, 1906), I argued in favor of this surgical intervention; but my position is now unteneable. Apparently also my tentative argument in that same book in favor of surgical intervention when a degenerating fibroid tumor of the uterus complicates pregnancy, is not “safe,” Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 186 the early decades o f the new century.502 The works were universal in their denunciation of craniotomy. Such studies also featured the Church’s opposition to vasectomy as birth control/03 Other issues such as ectopic pregnancy and the Porro operation required future revision by the authors.504 Craniotomy remained a concern for Church leaders at the outset of the new century. A translation of a Dutch work appeared with ecclesiastical approval in 1902.sos In Holland, a physician sought the establishment of legal penalties against anyone who interfered with the medical treatment of patients. The effort arose from a priest’s attempt to prevent a craniotomy attempted to save a mother’s life. The author urged the Dutch population to prevent the clergy from imposing its views on the wider society. Some because it was based on the same principles largely as my argument concerning ectopic gestation.” Austin O’ Malley, “The Ethics of Foeticide,” American Ecclesiastical Review 42 (June 1910): 683. 502Another study explored the evolution of these works and ideas on the application of the principle of double effect. See David Kelly, The Emergence of Roman Catholic Medical Ethics in North America (New York, NY: Edwin Mellen Press, 1979), 110-149. 503Andrew Klarmann, The Crux of Pastoral Medicine (New York, NY: Frederick Pustet, 1912), 190. A recent study explored the Church’s staunch opposition to involuntary sterilization. See Reilly, Surgical. 118-122. s04Jn 1933, the issue of ectopic pregnancy by theologians ended with the conclusion that such pregnancies failed to come to full term. Kelly, Roman. 305. sosHector Treub, et. al., trans. C. Van der Donckt, The Right to Life of the Unborn Child (New York, NY: Joseph Wagner, 1903), 14. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 187 years before, an American article in a Catholic publication suggested that priests should intervene to prevent craniotomies in similar cases.506 Adoption o f cesarean section as an alternative to craniotomy still met with limited acceptance. In 1904, a gynecologist from St. Joseph’s Hospital in Philadelphia promoted the practice of craniotomy. The writer believed that craniotomy remained appropriate for less-skilled country practitioners as only the most skilled surgeons were capable of successful abdominal surgery.507 The article suggests that despite the Vatican rulings physicians continued to view craniotomy as an appropriate measure in some cases. Fragmentary medical reports of a Catholic hospital in Quincy, Illinois contain evidence that craniotomy persisted. Records from 1892 disclosed that 35 percent of all hospital patients were foreign bom.508 In 1897, while twelve hysterectomies occurred, one case involved cancer. During the same year, two castrations occurred, with one case done for insanity.509 In 1908, nine abortions occurred at the hospital.510 Determining S06J. J. Heuser also ignored parents in the decision to baptize a child post mortem matris by cesarean section. For Heuser, the absolute right of infants to Baptism called for the operation. The official Vatican position in such cases proved less stringent. In such cases, the promotion of baptism represented the duty o f priests. Yet, nothing bound priests to do the procedure or coerce others to do so. J. J. Heuser, “The Priest and the Medical Profession,” American Ecclesiastical Review 3 (August 1890): 113. 507Wilmer Krusen, “Is Craniotomy Ever Justifiable?” International Medical Magazine 11 (August 1902): 470. 508Annual Report, St. Mary’s Hospital, Quincy, IL., year ending, 31 December 1892, National Library of Medicine, Bethesda, MD. 509Annual Report, St. Mary’s Hospital, Quincy, IL., year Ending, 31 December 1897, National Library of Medicine, Bethesda, MD. sl0Annual Report, St. Mary’s Hospital, Quincy, IL., year ending, 31 December 1908, National Library of Medicine, Bethesda, MD. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 188 whether the operators were Catholic and whether such operations were more frequent among the foreign bom remains a subject for future research. The difference of success in cesarean section between major hospitals and lesser institutions persisted, hi 1917, the study of cesarean section outcomes in four cities within a forty mile radius of Boston yielded shocking results.511 hi two cities the mortality rates reached 100 percent Mortality rates for a third city ranged from 60 to 75 percent. In the fourth city the mortality rates approached 50 percent. The writer attributed these failures to poorly trained physicians and the failure to use aseptic techniques. Studies from southern states revealed that the Boston area findings were common. One author attributed the failure to lack of trained physicians. In “borderline cases of contracted pelvis,” the writer noted that physicians too often referred cases to a surgeon as a last resort. Such cases were, “too often Caesareanized when craniotomy on the dying or dead child should be done.”512 However, the persistence of craniotomy is not reducible to a lack of skill alone. By 1920, some physicians viewed cesarean operations as a planned procedure, a means to avoid difficulties in delivery. Likewise, at the parents request, the surgeon 51 'Franklin S. Newell, “The Present Status of Abdominal Cesarean Section,” JAMA 68 (24 February 1917): 604-605. 5,2B. H. Gray, “The Present Status of Caesarean Section,” Virginia Medical Monthly 46 (May 1919): 30. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 189 could sterilize the mother to avoid future pregnancies.513 But craniotomy was still option in its “proper but narrow sphere.”514 A shift in practice o f such procedures from emergencies to elective surgical procedures ushered in the modem issues of reproductive choice. Difficult births remained a major problem for the Catholic Church. The first edition of Hospital Progress, in May 1920, contained a code o f surgery prepared for the Diocese of Detroit.515 The July issue revealed the reason for the code. Five physicians resigned from the Marquette School of Medicine on 7 May 1920 over a disagreement involving the practice of therapeutic abortion. Fr. H. Noonan, the Jesuit President, asserted that all such operations represented acts o f murder. Louis Warfield, a physician on the faculty, claimed that existing legal statutes permitted the practice and left Marquette with his colleagues when Noonan would not compromise.516 513Edward P. Davis, “Elective Caesarean Section,” Surgery Gynecology and Obstetrics 29 (December 1919): 554. 514Edward P. Davis "Delivery by Abdominal Section,” American Journal of Obstetrics 77 (May 1918): 790. slsThe obstetric code included prohibitions o f therapeutic abortion and craniotomy. The code also surgeons to all organs removed during surgery for pathological examination. The hospital pathologist would then examine specimens for the presence or absence of disease. The code sought the prevention of unnecessary surgery in Catholic hospitals and appeared in Rev. M. P. Bourke, “A Surgical Code,” Hospital Progress 1 (May 1920): 36-37. sl6Austin O’Malley, the author of the account, denied that legal statutes admitted such exceptions. The writer believed that abortions practiced for heart disease, narrow pelvis, eclampsia, and tuberculosis, were outmoded means o f treatment and, thus, became acts of murder. O’Malley admitted, however, that courts rarely challenged such practices when they represented attempts to save mother’s lives. The text reveals that the Church still struggled with the problems of difficult births within its own institutions. The text also raised the ambiguous dilemma of ectopic pregnancy. In the past, the Vatican Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 190 The publication o f such accounts revealed that Catholic churchmen continued to mistrust American physicians. The establishment of codes of ethics by the Church, with the cooperation of physicians favoring Catholic orthodoxy, represented a means to prohibit objectionable obstetric practices from Catholic hospitals. Thomas Gerrard noted that past efforts at eugenic sterilization involved the castration of men and the removal of women’s ovaries.sl7 Fears about the practice of abortion in Catholic hospitals accounted for the opposition of some Catholic physicians to hospital standardization.518 The ethical code covered the ambiguous ethical problem of ectopic pregnancy by observing the existing Vatican stance on the issue.519 During the 1920s other writers accounted for the merits of the new ethical code.520 prohibited such operations before viability at six months. The author supported such operations for the removal of tumors or a ruptured tube. O’Malley “reluctantly permitted such operations in the case of an inviable fetus.” See Austin O’Malley, “Ethics at the Marquette School of Medicine, Milwaukee,” Hospital Progress 1 (July 1920): 128-129. 517 Rev. Thomas Gerrard. The Church and Eugenics (St. Louis, MO: B. Herder, 1921), 28; Gerrard also note the absence of a Vatican ruling on vasectomy; Ibid., 25. Catholic theologians in England and America were divided on the issue until the close of the decade. “Literary Chat,” American Ecclesiastical Review 83 (December 1930): 651. sl8At the 1921 convention, CHA physician delegates resisted cooperation with the hospital standardization plan of the American College of Surgeons. Opponents feared that standardization might result in the practice of abortion in Catholic hospitals. In a compromise, the CHA convention passed the code published in May 1920 as its own ethical standard for surgery. See Robert J. Shanahan, The Catholic Hospital Association (St. Louis, MO: Catholic Hospital Association, 1965), 43. 5I9The code forbade operations prior to viability and prohibited surgeons from operating before the onset of hemorrhage. Such delay represented a grave risk of death for women because, all too often, the patient bled to death during the operation. See Bourke, “Surgical,” 36. 520Fr. William Robinson, the Jesuit President of St. Louis University, emphasized the ethical code’s strict prohibition of abortion and sterilization. However, Robinson Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. In 1927, Fr. Henry Davis, a British Jesuit, applied the findings of contemporary surgeons toward the issue of ectopic pregnancy. Davis believed that tubal pregnancy represented a pathological condition and placed his trust in the medical judgment of competent surgeons.521 Soon after, Patrick Finney, a Vincentian, challenged Davis. Finney rejected claims that a tubal pregnancy represented a case of pathology. He disagreed with the premise that norms for the removal of a diseased uterus applied in the case o f tubal pregnancy.522 For Finney, such operations represented acts of direct killing. These arguments illustrate that theologians within the Church continued to struggle with the dilemmas posed by difficult childbirth. However, the Church hierarchy promoted its emphasized that the removal of diseased tissues represented an exception to this norm. The Jesuit denounced appeals to the principle of indirect effect as a form of evasion. The author dismissed objections to the ethical norms on the basis of utilitarian norms, unjust aggression, and sentiment. Robinson also rejected the belief that the code applied only to Catholic physicians in Catholic hospitals. In some ways, the article reflects the debates of Aloysius Sabetti with earlier physicians. See William F. Robinson, “The Catholic Code of Ethics Based on Natural Law,” Hospital Progress 4 (January 1923): 4-5. S21Davis believed that the consent for the practice o f removing a diseased pregnant uterus in cases of cancer applied to ectopic pregnancy. Most of the surgeons surveyed believed immediate removal of the tube was necessary to prevent a patient’s death from hemorrhage. See Henry Davis, “A Medico-Moral Problem-Ectopic Gestation,” American Ecclesiastical Review 77 (September 1927): 289; “A Medico-Moral Problem-Ectopic Gestation,” American Ecclesiastical Review 77 (October 1927): 412-413. For Davis’ rejoinder, see Henry Davis, “A Medico-Moral Problem-Ectopic Gestation-A Rejoinder,” American Ecclesiastical Review 78 (April 1928): 413-416. Finney continued to advance the more stringent position as late as1930. Thomas Vemer Moore, “The Mortality of Certain Operations,” American Ecclesiastical Review 92 (January 1935): 148. 522For Finney, the operation failed the second principle of indirect effect. The Church rejected evil means to accomplish a good end result in Patrick A. Finney, “A Medico-Moral Problem-Ectopic Gestation,” American Ecclesiastical Review 78 (January 1928): 63. permission of the copyright owner. Further reproduction prohibited without permission. 192 own vision of appropriate intervention in Catholic institutions through physician’s guilds and its version o f hospital standardization.523 On 31 December 1930. Pope Pius XI promulgated the encyclical Casti Connubii. The document represented an expression of authoritative teaching on the sacrament o f marriage and included a discussion of “Vices Opposed to Christian Marriage.” Such vices included eugenic sterilization, therapeutic abortion, and artificial birth control.524 By the time the phenomena of reproductive choice arose, the Church’s stance reflected its present day insistence on the sanctity of all human life. The Church faced new challenges as the locus of medical decision making shifted from necessity to personal choice. However, the encyclical did not address ectopic pregnancy. A new work by Lincoln Bouscaren, a Catholic theologian, in 1933, largely settled the matter. While Bouscaren complimented Davis, he disagreed with his equation o f ectopic pregnancy with a cancerous uterus. While such growths destroyed the tube, he claimed, they did not represent a form of disease perse.525 Bouscaren, shared the belief that such operations represented a means of indirect killing. The decade also involved a debate about the S23Kauffinann, Ministry. 235-238. 524Pope Pius XI, Casti Conubii. in The Papal Encyclicals. 1903-1939 ed. Claudia Carlen, 391-414, (Wilmington, NC: McGrath Publishing, 1981), 64:401. 525In 1933, George Cardinal Mundelein o f Chicago granted his imprimatur, to the text. Bouscaren called physicians to make a judgment call about the extent of risk toward mothers before operating. In cases where the fetus was viable, the physician needed to determine the extent of the possibility that a fetus might survive. He noted, however, that such prospects were meager at best. The author cited the findings of Drs. Beck and Halstead to delay operations in cases that held out the possibility of a surviving child, in Lincoln Bouscaren, The Ethics of Ectopic Operations (Chicago, IL: Loyola University Press, 1933), 85. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 193 morality of removing a disease pregnant uterus and hyperemisis. The consensus among theologians reflect the belief that, if abortion occurs, it is indirect and accidental.526 Accounts reveal the differences that existed among theologians on how to assess the nature and significance of disease.527 During the 1930s, Catholics, like other Americans, struggled with a measure of distrust toward physicians. This sentiment emerged repeatedly in discussions of medical practice. One account complained about a dilemma of the presence of incompetent physicians on hospitals staffs.528 A nursing sister wrote of her own difficulty in enforcing Catholic medical ethics in the obstetric operating room.529 A third writer viewed the instruction of nurses in medical ethics as a means to prevent physicians from accomplishing illegal and immoral operations.530 Alphonse Schwittalla condemned the practice of eugenic sterilization in Germany.531 ^Connery, Abortion. 300. 527Ibid., 132. 528Joseph DeCourcy, “What of the Incompetent,” Hospital Progress 4 (May 1920): 495. 529Sister M. Victoria, “The Nurses’ Difficulty in Enforcing Ethical Standards in the Obstetrical Operating Room,” Hospital Progress 14 (May 1934): 395 S30Sister Marie Alinda, “The Necessity for a Thorough Knowledge of Ethics for Members of the Teaching Profession.” Hospital Progress 15 (October 1935): 382. S31Alphonse Schwittala, “Human Sterilization,” Hospital Progress 14(June 1934): 286; See also Fr. Thomas Vemer Moore, Principles of Ethics (Philadelphia: Lippincott, 1935), 251-252. Also previous issues o f the British Catholic Medical Guardian from vol. 6-10(1928-1932). Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 194 At the close of the decade, Catholic publications were still struggling with issues of medical ethics. Periodicals continued their condemnation of contraception long after the Papal encyclical.532 Before World War One, official pronouncements may have settled such issues for Catholic theologians. However, continued public debate indicates that, for physicians and patients, the practice of contraception was becoming more widespread, and perhaps among Catholics as well. By the late 1930s, the modem discussion of euthanasia arose in Catholic publications.533 By 1940, the improved surgical education available to physicians made the safe practice of the cesarean operation a possibility in the profession at large. One account of the operations in Mount Vemon, New York exemplified the success at local hospitals. The results of two continuous five-year studies ending in 1940 resulted in a decline of mortality from 10 percent during the first five-year period to 3.7 percent in the second.534 New methods of surgical incision, that avoided entering the peritoneal cavity helped 532Anthony Bassler, ed. “These Omniscient Birth Controllers,” The Linacre Quarterly 4 (December 1935): 5; Anthony Bassler, ed “Birth Controllers and the Milk Business.” The Linacre Quarterly 4 (December 1935): 22; Alphonse Schwittalla, “The American Medical Association and Contraception,” Hospital Progress17 (July 1937): 219-224; Rev. Charles Miller, “The Immorality o f Contraception,” The Linacre Quarterly 6 (October 1938): 90-98. 533Joseph A. Dillon, ed., “Mercy Killing Deluxe,” The Linacre Quarterly 7 (January 1939): 14. 534W. T. Liccione, “An Eleven Year Survey o f the Cesarean Section at a Small Community Hospital,” American Journal of Obstetrics and Gynecology 42 (September 1941): 447. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 195 lessen the risk of infection, still a frequent cause of death.535 Given the problems presented by pelvic deformity, the author urged general practitioners and surgeons to consult an obstetrician before attempting the operation. A national study affirmed the finding that maternal mortality in cesarean operations had declined from 1920 to 1940, noting that an interest in reserving the lives of children prompted the operation. New methods of incision and the use of antiseptics lessened the risk o f infection.536 Soon, the use of sulfanilimide drugs to stem infection added an additional measure of safety to the operations.537 These innovations gave the cesarean operation added complexity. An obstetric specialist assumed the task of 53SThe same author also revealed the impact o f changing social mores on the increased practice of the cesarean operation. A decline in family size in society at large, he believed, increased the value of individual infant’s lives. Women who overcame fertility problems later in life were inclined to choose the cesarean operation in order to diminish the risk o f a natural delivery. Ibid., 448. 536Louis Phaneuf, “The Progress o f Cesarean Section,” American Journal of Obstetrics and Gynecology 40 (October 1940): 605. 537R. Gordon Douglas, “Chemotherapy in Obstetrics and Gynecology,” American Journal of Obstetrics and Gynecology 39 (February 1940): 275. Gordon’s discussion of the impact of sulfanilimide drugs on the treatment of gonorrhea revealed the impact of prevailing racial attitudes on some American physicians. In his discussion of the findings he commented, “Two single delinquent irresponsible colored girls in the second decade of life, one of whom was pregnant, were found to have negative cultures and smears at the time o f their first follow-up examination after discharge, but both were positive when they returned for their second examination.” Ibid., 286-287. This study revealed highly suggestive evidence that racial assumptions also influenced medical practice in the past. This study revealed evidence of racial assumptions in medical textbooks. African Americans and foreign immigrants were also among the most frequent subjects for experimental techniques such as the cesarean operation. Early eugenicists commented on the excessive family size of the poor and foreign bom. A more thorough study of the implications of racial ideas on American medical practice awaits more evidence and further study. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 196 determining when the diagnostic indications were present for the use of antibiotics and when the cesarean operation itself was necessary. Increased emphasis on the role of the specialist also reflected a response to accusations that overzealous or greedy practitioners performed cesarean operations too readily. One writer noted the efforts of the government and specialty organizations to stem the abuse of the cesarean operation by physicians.538 Issues such as sterilization remained controversial topics during the early years of World War Two. One theologian feared that physicians might engage in their own unsupervised experimental practice of surgery.539 Suprisingly, the phenomena o f ectopic operations remained a continued source o f debate among physicians and theologians.540 The persistence o f such disagreements resulted in a renewed interest among Catholics for a new surgical code.541 While some proponents viewed the new code as a means of reigning in non-Catholic physicians who practiced in Catholic hospitals,542 others pointed out that Catholic physicians were ignorant of the many ethical obligations of their own 538S. A. Cosgrove, “Reduction of Unwarranted Operative Incidence in Obstetrics,” American Journal of Obstetrics and Gynecology 39 (March 1940): 371-372. 539John C. Ford, “Sterilization,” The Linacre Quarterly 10(January 1942): 5. 540Henry Davis, “Ectopic Gestation-A Rejoinder,” Linacre Quarterly 10 (July 1942):60-63; Gerald Kelly, “The Morality of Ectopic Operations,” Hospital Progress 29 (January 1948): 27 54'Some believed that Catholic operators did not appreciate the moral guidance provided by ecclesiastical authorities. See Joseph Dillon, “Along the Highway and Byway,” The Linacre Quarterly 7 (April 1939): 27. 542Rev. Lawrence Skelly, “Code of Ethics for Catholic Hospitals,” Hospital Progress 18 (January 1947): 17. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 197 faith.543 Many Catholic physicians had no formal training in issues of medical ethics. The new draft of the Catholic Hospital Association code suggested that Catholics and the public would continue to face ambiguous dilemmas in their struggle with medical science. This chapter explored the continued struggle of the Church with the problems of childbirth. After the Civil War, physicians remained divided over the propriety of craniotomy and cesarean section as methods of intervention during obstructed deliveries. The chapter revealed that similar disagreement existed within the Catholic hierarchy. In Europe, some theologians viewed craniotomy as a last resort, hi America, some Catholic churchmen allowed the same operation because of the shortcomings of the conservative cesarean operation. Discussions over the merits of both operations revealed the existence of different mores among physicians that shaped their outlook toward the resolution of childbirth emergencies. The slow resolution of the cesarean debate revealed a reciprocal relationship between religion and medical practice. During the Gilded Age, the discovery of the Sanger operation and antiseptic methods of surgery made successful interventions 543The 1949 code of ethics reiterated traditional teachings and expanded into new areas of medical science. As in the past, direct abortion and craniotomy were prohibited by the code. The teaching on ectopic pregnancy reflected a less stringent stance. Such operation were permitted before six months of gestation. However, die code explored new issues. The code opposed artificial insemination and the practice of euthanasia. While none of the post war texts mention this relationship directly, the existence of a new code may reflect the desire to prevent the experimental abuses committed by Axis powers during the war. Finally, the code prohibited the radiological treatment of pregnant women out of fear that exposure would cause abortion. See Gerald Kelly, “Revising the Hospital Code,” Linacre Quarterly 29 (July 1948): 259; “Ethical and Religious Directives for Catholic Hospitals,” Hospital Progress 30 (March 1949): 69. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 198 possible for the most skilled surgeons. The same innovation prompted the Vatican to rule out destructive operations by 1895. However, the practice of craniotomy persisted into the early decades o f the twentieth century due to the poor state o f medical education and the limited skills of practicing physicians. The Church struggled to eliminate such practices in its own institutions, but by 1930, the operation still remained an option reserved to the nation’s best physicians. The Vatican once again issued a broad prohibition of destructive operations during the same year. By 1940, the increased level of education and skill among operators made successful cesarean operations common in the nation at large. However, the dilemmas created by the excessive practice of surgery and changing social mores continued to pose difficult dilemmas for the Church and physicians in facing the dilemmas of childbirth. By the 1940s, however, medical practice had advanced to the stage where American physicians were capable of achieving the high standard of care held out as an ideal by the Catholic Church. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. CHAPTER 7 CONCLUDING REMARKS Sacramental absolution is not to be denied to those who, repentant after having gravely sinned against conjugal chastity, demonstrate the desire to strive to abstain from sinning again, notwithstanding relapses.544 This 1997 instruction for confessors by the Vatican involves the practice of artificial contraception by married couples. The threat presented by the discovery of new contraceptives and abortifacients prompted the Vatican review of existing pastoral practices. In the past, a stringent reading of the teaching of the hierarchical magisterium would require confessors to deny absolution to those who persisted in the practice. More recently, however, some American priests have instructed couples that contraceptive practices are permissible.545 The instruction reflects an attempt by the Church to reconcile those who struggle with the Church’s traditional vision of family life. Competing visions of the good and the just have often clashed in American life. These different visions are the result of pluralism in America, o f which Catholicism has been an important ingredient The Church has been a significant participant in many struggles involving basic moral values, including those occasioned by medical progress. ^Pontifical Council for the Family, “Vade Mecum for Confessors Concerning Some Aspects of the Morality of Conjugal Life,” Origins 26 (13 March 1997): 622. 545John Seidler and Katherine Meyer, Conflict and Change in the Catholic Church (New Brunswick, NJ: Rutgers University Press, 1989), 10. 199 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 200 Efforts by Catholics to resolve dilemmas of childbirth reflected a struggle with compassion, the teachings of the Church, and the limits of medical science. Central to this struggle is a pluralism within Catholic thought, unrecognized by scholars who see debate and disagreement within the Church as a twentieth-century phenomenon. Fr. Curran, a revisionist theologian, claimed that Catholic medical ethics emerged from a monolithic discipline before I960.546 The Second Vatican Council did not explore the issues o f medical ethics but Fr. Curran, and others, hoped that a reinterpretation of the Church’s norms might follow the Council. Revisionists believed that contemporary thought would assist the Church in measuring the demands of the Gospel in light of the challenges of experience. For Curran, the 1968 encyclical Humanae Vitae, which affirmed the traditional belief of the Church on marriage and contraception, represented a throwback to an earlier age. Dissent against the encyclical, he claimed, prompted the growth of a new pluralism in moral theology that continues in the present day. Since the promulgation ofHumanae Vitae, the hierarchical magisterium has upheld its traditional teaching on marriage and the family in a series of documents that reflect the Church’s continued belief in exceptionless moral norms. Cardinal Joseph Ratzinger, the Church’s highest ranking theologian, remains a tireless defender of the magisterium. Most recently, he criticized relativism as the greatest threat to faith of the present time, criticizing as a threat to the Christian conscience, “the so called pluralist ^Charles Curran, History and Contemporary Issues (New York, NY: Continuum Publishing Company, 1996), 102. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 201 theology of religion [which] has been developing since the 1950s.”547 Cardinal Ratzinger has also been a Sequent critic o f Fr. Curran’s stances on sexual ethics. Despite the sharp differences that exist between both theologians, their arguments rest on similar assumptions about the nature o f Catholic theology. Both writers assume the existence of a monolithic structure of moral theology before the second half of the twentieth century. This assumption that a hierarchical monolithic Church exercised tight control over its flock characterizes most studies of the history of Catholicism in America. Histories of hospitals explore the role of the Catholic institutions as a means o f social control.548 Histories of popular culture focus on Catholic artifacts and the miraculous in cementing loyalty, while overlooking the essence of belief.549 Such studies focus largely on religious practices, the horizontal dimension of faith, rather than the vertical or supernatural dimension of belief. The study of the problems of medical practice and difficult childbirth revealed the essence of Catholicism. The study revealed Catholics share a belief in the closeness of God, and a belief that all human life is sacred. The belief in the resurrection reveals a belief that Catholic Christians share the hope of eternal life. The hope for salvation, and the cycle of life, begins with creation. Childbirth then, represents a significant meeting S47Cardinal Joseph Ratzinger, ‘‘Relativism: the Central Problem for Faith Today,” Origins 26 (October 31,1996): 311. 548Rosenberg, Care. 265. ^cD annell, Material. 132-160. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 202 point for Catholics with the supernatural that shaped the choices made in their daily lives, especially in married life. While Catholicism has held the status of a religious minority among other Christian denominations, Catholicism had a significant influence on shaping the development of American medical practice from 1807 to 1940. Catholic ideas expressed in the teaching of the hierarchy and the practice of Catholic physicians shaped American debates about the nature of appropriate intervention in cases of difficult births. The Church set out the highest standard of medical practice for physicians, calling for them to preserve all human life. The articulation of this belief in the sanctity and preservation of all human life stemmed in no small measure from the influence of continental Catholic ideas on American Catholics and other Americans. The introduction of immediate animation, the belief that the fetus possessed it’s own human identity from the moment o f conception, gradually brought the Church’s belief in the sanctity of life into sharp focus. The belief that the human identity of the fetus was equal to that of its mother challenged assumptions that followed from quickening, either that the early life of the fetus was vegetative or that a mother’s life had greater comparative value than an infant’s. Immediate animation gave all human life an absolute value. This new concept of human identity drove early support for the cesarean operation and early opposition to abortion. After the Civil War, its adoption by the Catholic Church resulted in the gradual prohibition of all destructive operations. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 203 The existing limits of medical science, however, limited the application of this highest standard of medical practice in cases of difficult birth. The hierarchy, noting the dangers of the antebellum cesarean operation, did not require patients to submit to it during obstructed pregnancies. The same standard applied to decisions about the practice of early ovariotomy. After the Civil War, medical risk to the mother prompted one member o f the hierarchy to allow craniotomy and another theologian to permit sterilizing operations. The Church allowed dissection, anesthesia, and antisepsis—practices that ultimately improved the chances of mother and infant survival and lessened the chances of destructive surgery being the only option to save a mother’s life. While Church grounded its penal sanctions against abortion in immediate animation, Catholics disagreed on the solutions to cases of difficult births. At least one member of the hierarchy believed that justice favored the interests of mothers in cases of difficult births. In a departure from traditional teaching on marriage, Paulinus Dissez claimed that sterilizing operations represented a means to preserve the safety of marital intimacy for couples. By contrast, other members o f the hierarchy believed that the true aim of sterilizing operations was to offset the impact of a significantly Catholic foreign immigration. The same issues of medical ethics prompted continued debates among Catholic physicians after 1900. However, the converse is also true. Catholicism contributed to the creation of a distinctive American culture, especially in culture of medical practice. Historian Jay Dolan argued that the intersection of religion and culture created a distinctive American Catholicism. Dolan’s views, however, only account for the influence of America on Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 204 Catholics/50 Most studies, focus on institutions, including medical institutions, but offer little account of the dilemmas created for Catholics by the promise and limits of medical practice.551 Existing works of the history of medicine and childbirth render also little account of the influence of religion on American medical practice. In this dissertation, problems of childbirth provide the points of intersection for religion and medical science against the background of a pluralistic society. The interaction of these ideas resulted in a reciprocal process of change, where Catholicism shaped medical practice and, where the culture of medicine reshaped Catholicism. The first evidence of this reciprocal relationship between Catholicism and medical practice is evident in the introduction of the cesarean operation in America in 1807. William Dewees introduced Baudeloques’ text, shaped by Catholic belief in immediate animation, to an American audience. An American cesarean debate followed from 1807 to 1965. Continental Catholicism generated early support among some physicians for the cesarean operation. However, the limits of the existing state of American medical practice also influenced the Church hierarchy in its outlook. Consequently, Catholic women were not required to submit to the dangerous operation. The cesarean debate, shaped by different ideas of human origins, and constrained by the high risk of the operation, continued throughout the Civil War. 550Jay Dolan, “The Search for an American Catholicism,” Catholic Historical Review 82 (April 1996): 172. 55lMcCauley, “Who,” 47; Joyce, “Science,” 81; Kauffman, Ministry. 235-238. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 205 The rise o f opposition to abortion in America from 1834 to 1871 represented another nexus o f Catholicism and medical practice.552 The gradual adoption of belief in immediate animation by physicians and the Church gave fetal life an absolute value. The concept that human life began at the moment of conception drove early opposition to abortion among AMA physicians. In 1869, the Church hierarchy officially embraced immediate animation. However, the limits of medical science exerted a reciprocal influence on the Church. The dangers of the cesarean operation prevented the Vatican, like physicians, from issuing a broad condemnation of therapeutic abortion. The practice of dissection reflected a third nexus for the intersection of Catholicism and medicine. The Church established high expectations for physicians from 1844 to 1889 in its desire to protect both patients in cases of difficult births. However, the Church reciprocated in the search for a high standard of care by compromising its own beliefs on the sanctity of the body. The Church allowed dissection its institutions, and cooperated with medical educators in secular institutions to ensure that effective obstetric intervention would become a possibility in the future. In the antebellum era, the Church allowed ovariotomy and other operations with the hope of preserving life. After the Civil War, Robert Battey’s operation, the removal of healthy ovaries, held out the hope of preventing amenorrhea and reported abortions. The reciprocal influence of the culture of medicine on the Church is evident in the struggle over women’s disease. The Church interpreted the significance of such operations with the same faulty ideas of disease accepted by contemporary physicians. S52Mohr, Abortion. 186-187; Connery, Abortion. 3; Noonan, Morality. 36. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 206 Influenced by theories of disease that attributed a wide range of illnesses-physical and mental-to reproductive organs, the Church allowed practices that seem morbid in retrospect. The acceptance of faulty disease etiology delayed the Church’s condemnation of unnecessary sterilizing operations. The presence o f a reciprocal relationship between Catholicism and the culture of medicine is most evident in the discussion of late cesarean section. The Vatican, in its reaffirmation of its ban of abortion, held out a high standard of care for physicians. However, the problem of therapeutic abortion remained unclear. The limits of medical practice persuaded Bishop Peter Baltes and Rev. Paulinus Dissez that destructive operations were permissible for therapeutic reasons. While the Vatican slowly excluded the practice of such operations with rulings in 1884,1889, and 1895, these rulings corresponded roughly with reports of the advance of the cesarean operation as a means safely resolve obstructed deliveries. By 1895, the Catholic Church articulated a broad prohibition of craniotomy. However, such operations continued because of different beliefs on the morality of killing and the limited skills of physicians in successfully performing cesarean operations. By 1930, the Vatican reaffirmed the prohibition o f destructive operations in Casti Connubii. Now, destructive operations were evidence of poorly skilled physicians because an increasing number of doctors could perform cesareans safely and successfully. This newfound proficiency resulted from the development of surgical practice into a subject of postgraduate medical education with a curriculum and standards of certification Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 207 established by specialty boards. The publication of the Vatican encyclical asserted that surgery should provide a means of healing life rather than destroying it. This dissertation discovered a reciprocal relationship between the progress of surgery toward a high standard of care and the Vatican’s gradual prohibition of destructive surgery. By 1940, the Church and its physicians had a clearly developed understanding o f appropriate means of medical practice. However, this time, a different understanding o f marriage, family life, and childbirth existed in the wider society. These different attitudes are evident in the increased support for contraception in society. This created a widening chasm between the teaching of the Church and society on the issues of childbirth. The emergence of surgery as a scientific means of treatment allowed the Church to hold physicians accountable for the lives of both mother and child. However, the difficulties posed by the resolution of ectopic pregnancy illustrates, that scientific advances never eliminated the ambiguities o f medical practice. The discovery of a reciprocal relationship of religion and medical practice in shaping a high standard of care, revises existing assumption in the growth of American medical practice. Paul Starr depicted religion and medicine as competing authority structures.553 Instead, this dissertation revealed the common aims o f the Church and physicians. The Church’s belief in the sanctity of life informed and reflected the emerging ideals o f physicians. The belief that human life had absolute value corresponded with the aims of surgery. Often medicine of the heroic era constituted palliation. Heroic era surgery, like craniotomy, reflected the methods of an earlier age 553Starr, Social. 143. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 208 and the effort to save what one could. Scientific medicine, and surgery, held out the hope of curing rather than palliating disease. The cesarean operation allowed physicians to overcome the consequences of disease. The high standard set out by the Church corresponded with the future hope o f physicians in surgery itself, that it would indeed become a means to preserve life. The dissertation also revised the role of the clergy in the expanding horizon of medical knowledge. Previous studies depicted the hierarchy and clergy as figures who sought to control sisters’ institutions and the patients within them, while resisting change. This study depicts members of the clergy and hierarchy as agents of change. In antebellum Baltimore, St. Louis, New Orleans, and Buffalo the hierarchy cooperated with efforts to promote medical education. Such cooperation occurred in Catholic medical schools, and especially with the cooperation of Catholic sisterhoods with secular institutions. The Jesuits promoted medical education in the face of popular opposition to dissection. At Georgetown, Joseph Havens Richards faced of the fear and suspicion of other Jesuits over obstetric instruction as well. This study also revealed a flexible clergy sympathetic to the plight of patients caught between the Church’s teaching and their desire to resolve a medical emergency with the least pain and danger. Some bishops were unwilling to require believers to submit to dangerous methods of surgery. Others allowed destructive operations out of compassion for suffering women. Other churchmen upheld the absolute sanctity of infant life. Others sought to end unnecessary sterilizing operations at Catholic hospitals. The Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 209 effort revealed the existence of doctrinal pluralism within the Church and the gradual progress toward the exclusion of destructive measures concluding in 1930. By the Second World War, the reciprocal process o f change that shaped the Church’s response to the issues o f childbirth continued. The Church’s vision of marriage and the sanctity of life remained unchanged during the pontificate of Pope Pius XU from 1939 to 1958. However, in America, different visions of the good and real shaped the attitudes of Americans toward the same issues. Like other Americans, Catholics participated in the growth of suburban life that followed the Second World War. This change brought Catholics out of ethnic enclaves and into contact with other sectors of society. This contact with a pluralistic society also reshaped the attitudes of American Catholics toward the issues of marriage and family life,SS4 sometimes creating a tension with Church teaching. Consequently, Catholics began to share the preference of the wider society for smaller families.555 This study ends on the eve o f World War Two because despite continued medical progress, after the war, American women still faced the dilemmas of childbirth. During the 1950s, the specialties of obstetrics gynecology remained the domain of male practitioners. Many of these physicians viewed menstruation, pregnancy, and childbirth as illnesses rather than the natural functions of reproduction. The medical literature of 554Colleen McDannell, “Catholic Domesticity, 1860-1960,” in American Catholic Women: a Historical Explanation, ed. Karen Kenelly (New York, NY: Macmillan Publishing Company, 1989), 77. 555Judith Blake, “The Americanization of Catholic Reproductive Ideals,” Population Studies 20 (July 1966): 43. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 210 the 1950s criticized the unnecessary practice of hysterectomy and ovariotomy in the absence of disease but complaints about the unnecessary practice of hysterectomy persist in the present day.556 Eugenia Kaledin observed that the persistence of unnecessary surgery accounted in large part for the desire of women to assert control over the process of reproduction during the 1960s.SS7 By 1960, the commercial availability of oral contraceptives made it possible for women to control their fertility. The assertion of individual women’s control over reproduction challenged the Church’s belief that all acts of intercourse should remain open to life. In 1968, the encyclical Humanae Vitae reaffirmed the existing Catholic ethic of marriage and reproduction. Backlash against the encyclical has resulted in a decline in Church attendance and widespread dissent among theologians and believers. One recent study claimed that weekly Church attendance rate among believers has slipped as low as 26.7 percent o f believers.559 Similar dissent is evident in the Church because of the legalization of abortion in America. In a recent work, Fr. Charles Curran recounted the influence of pluralism in 556Gena Corea, The Hidden Malpractice (New York, NY: Harper Colophon, 1985), 288. 557Eugenia Kaledin, Mothers and More (Boston, MA: Twatney, 1984), 176. 558Michael Haut and Andrew Greeley, “The Center Doesn’t Hold: Church Attendance in the United States, 1940-1984,” American Sociological Review 52 (June 1987): 332. 559Mark Chavez and James C. Cavendish, “More Evidence on Catholic Church Attendance,” Journal for the Scientific Study of Religion 33 (December 1994): 380. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 211 theology in shaping dissent within the Church on abortion, sterilization and artificial insemination. The debate over partial birth abortion also shows the continued concern of Americans with reproductive issues. The introduction ofRU-486 as an abortifacient assures that abortion will become a more frequent form o f contraception and the recent issue of guideline for confessors by the Vatican anticipates the use of this drug as a replacement for traditional forms of contraception. Fr. Charles Curran and other theologians have criticized the static nature of the Church’s teachings on sexual ethics. However, Fr. Curran’s comments on abortion reveal that the Church continues to insist on the existence of exceptionless moral norms. By contrast, Curran observed, “I have reasoned that because of the existing doubts and debates in society at large about the personhood of the fetus, law should give the benefit of the doubt to the freedom of the mother.”560 Central to this debate, is the question of what constitutes human identity, the same dilemma that drove debates over appropriate obstetric intervention in the nineteenth century. The comments reveal the lasting impact of the Church’s insistence on the absolute value of human life on such debates. The contrast of the nineteenth-century debates on obstetric intervention reveal timeless questions about the nature of human identity. These questions continue to inform the most recent debates about new reproductive technologies. Catholicism’s continued linkage of marriage with creation and salvation continues to shape its outlook toward issues of reproduction, and conditions the Church’s continued opposition to artificial insemination by husband (AIH) and 560Curran, History. 115. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 212 artificial insemination by donor (AID). For the Church, both means separate the transmission of life from marital intercourse. Donor insemination, for Catholicism, violates the unity and dignity of the human person. Catholic belief in the equality of infant life is grounded in an insistence that infants share their parents identity transmitted only in marital love.561 This notion of equality originates in the belief that human identity begins at conception. Some Catholic theologians, however, dissent from the official stance against both practices.562 Some in the medical community share the Church’s belief that donor insemination erodes the basis of marriage and the family.563 To those who view parenthood as a right, the Church responds that such rights are limited to the practice of marital intercourse. For the Church, children should not become objects or possessions subordinate to science. Such concerns echo the Church’s opposition to craniotomy in the nineteenth century. The use of donor insemination outside of traditional marriage poses an added challenge to traditional visions of marriage and family life. 561Congregation for the Doctrine o f the Faith, “Instruction on Respect for Human Life in its Origin and on the Dignity of Procreation,” in Readings in Moral Theology no. 8, ed. Charles E. Curran and Richard McCormick (Mahwah, NJ: Paulist Press, 1993), 229. 562Dunstan, G. R. “Moral and Social Issues Arising from A.I.D,” in Law and Ethics of A.I.D. and Embrvo Transfer: Ciba Foundation Symposium. 17 (new series), by the Ciba Foundation (New York, NY: Associated Scientific Publishers, 1973), 52; Curran, History. 45. S63R. Snowden, “Ethical and Legal Aspects of Donor Insemination,” in Donor Insemination, ed. C. L. R. Barrat and I. D. Cooke (Cambridge, England: Cambridge University Press, 1993), 197; Oliver O’Donovan, Begotten Not Made (New York, NY: Oxford University Press, 1984), 44. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 213 Similar concerns emerge in the discussion of in-vitro fertilization and embryo transfer. The Church objects to the freezing and destruction of human embryos that it believes bear a distinct human identity. However, as in the past, not all Christian share this view of the status of the embryo.564 Individual theologians and other Christian denominations differ with the Catholic Church on the significance of homologous in-vitro fertilization (IVF).S65 On the matter of donor involvement in IVF, wide disagreement persists among the same groups. Finally, the resolution of the problems o f childbirth recall the dilemmas of the nineteenth century physician. The retrieval of the ova through laparoscopy poses an element of danger to the female patient, hi the past, the drainage of a diseased ovaries with a trocar posed similar dangers to patients. Theologians have raised such dangers as an obstacle to IVF.566 Like the case of Mrs. Reybold, who submitted to an early cesarean operation, surgeons and their patients still measure the risk of such operations against their potential benefits. Religious ideas, then, continue to shape debates over the issues of childbirth. The Catholic hierarchy continues to hold out the highest standard of medical practice to physicians. The continued existence of dissent within the Catholic community reflects 564James B. Nelson, Body Theology (Louisville, KY: Westminster/ John Knox Press, 1992), 154. 565Kevin T. Kelly, “What the Churches Are Saying About IVF,” in Readings in Moral Theology no. 8. ed. Charles E. Curran and Richard McCormick (Mahwah, NJ: Paulist Press, 1993), 293. 566Ibid., 157. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 214 the continued influence of pluralism on American Catholics. However, the continued debates over new reproductive techniques reveal that Church’s belief in the absolute value of the human embryo, that evolved over one hundred years, continues to have a lasting impact on the wider culture of medicine that persists in the present day. Today, as in the past, the Church hierarchy, physicians, and members of the Catholic flock continue to struggle with the angel of science in their search for solutions to the problems of childbirth. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. SOURCES 1. Primary Sources A. Unpublished Materials I. Archival Collections Archives Subject Files. Medical School, 1848-1970. Georgetown University Archives. Lauinger Library. Washington, DC. Archives of the Maryland Province of the Society o f Jesus. Georgetown University Archives. Lauinger Library. Washington, DC. Baltes, Bishop Peter Joseph. Bishop 1870-1886. Papers. Archives of the Diocese of Springfield. Springfield, IL. Chancellor’s Office. Records of Institutions. Institution Correspondence Files, 1907- Present. St. Elizabeth’s Hospital. Archives o f the Archdiocese of Boston. Brighton, MA. Manuscripts. Originals and Copies. St. Louis Mullanphy Hospital, 1828-1929. 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Further reproduction prohibited without permission. 219 Nancrede, Joseph G. Observations on the Cesarean Operation, in Which Both Mother and Child Were Preserved. Philadelphia, PA: 1835. Thirty Second Annual Announcement of the S t Louis Medical College. Winter Session. 1873-74. and Catalogue for 1872-73. St. Louis, MO: Southwestern Book and publishing Company, 1873. RG01F. St. Louis Medical College Catalogs, 1842- 1890. Archives and Rare Books. Becker Medical Library. Washington University. St. Louis, MO. II. Government Documents and Reports Maryland. An Act For The Protection O f The Public Against Medical Imposters And For The Suppression O f The Crime Of Unlawful Abortion. MD Laws (1867). Maryland. An Act To Repeal And Re-Enact The Act Of 1867. Chapter One Hundred And Eightv-Five. For The Supression Of The Crime Of Unlawful Abortion. MD Laws (1868). Maryland. An Act To Add Additional Sections To Article Thirty O f The Maryland Code Public General Laws, title “Crimes and Punishments,” providing for the punishment for the removal or the attempt to remove, from any graveyard, burial ground or vault in the State of Maryland, any dead body that may have been buried in such graveyard, burial ground or vault” MD Laws (1882). Maryland. An Act To Provide For The Prosecution O f The Study O f Anatomy In The State O f Maryland. MD Laws (1882). Maryland. Journal of Proceedings Senate of Maryland, January Session, 1882, at 577, (1882). Maryland. Journal of Proceedings Maryland House of Delegates, January Session, at 873, (1882). Maryland. Journal of Proceedings Senate of Maryland, January Session, at 188, (1888). Microfilmed Records of the WPA Kentucky Medical Historical Research Project. University of Louisville. Komhauser Health Sciences Library. Louisville, KY. Microfilm Project Reel 2 #115. State of Illinois. Illinois State Board of Health. 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Committee on the District of Columbia. Report fto accompany bill S.3491. Report prepared by Senator Zebulon B. Vance of North Carolina, 49th Cong., 1st sess., 1886. Report No. 78. Serial 2273. U.S. Congress. Senate. Senate Orders. HJL 5650.48th Cong., 2nd sess. Congressional Record (13 January 1885), vol. 16, pt. 1. U.S. President. Message from the President o f the United States. Returning Senate 349. With his Objections Thereto. 49th Cong., 1st sess., 26 April 1886. Executive Document No. 131. Serial 2340. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 221 HI. Newspapers Baltimore Catholic Mirror. 27 November 1880; 29 January 1881; 5, 19 February 1881; 5 March 1881; 10 November 1888; 24 November 1888. Baltimore Sun. 19 November 1880; 22 March 1881;19 November 1888. Louisville Catholic Advocate. 16 January 1847. New Orleans Louisiana Courier. 21,26 August 1830. New York Citizen. 28 January 1854. 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