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ESSAYS IN PASTORAL MEDICINE

BY

AUSTIN ÓMALLEY, M.D., Ph.D., LL.D,

PATHOLOGIST AND OPHTHALMOLOGIST TO SAINT AGNES'S HOSPITAL PHILADELPHIA

and

JAMES J. WALSH, M.D., Ph.D., LL.D.

ADJUNCT PROFESSOR OF MEDICINE AT THE NEW YORK POLYCLINIC SCHOOL FOR GRADUATES IN MEDICINE; PROFESSOR OF NERVOUS DISEASES AND OF THE HISTORY OF MEDICINE FORDHAM UNIVERSITY, NEW YORK

LONGMANS, GREEN, AND CO.

91 AND 93 FIFTH AVENUE, NEW YORK

LONDON AND BOMBAY

1906

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_Copyright, 1906_

By Longmans, Green, and Co.

_All rights reserved._

THE UNIVERSITY PRESS, CAMBRIDGE, U. S. A.

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PREFACE

The term Pastoral Medicine is somewhat difficult to define because it comprises unrelated material ranging from disinfection to foeticide. It presents that part of medicine which is of import to a pastor in his cure, and those divisions of ethics and moral theology which concern a physician in his practice. It sets forth facts and principles whereby the physician himself or his pastor may direct the operator's conscience whenever medicine takes on a moral quality, and it also explains to the pastor, who must often minister to a mind diseased, certain medical truths which will soften harsh judgments, and other facts, which may be indifferent morally but which assist him in the proper conduct of his work, especially as an educator. Pastoral medicine is not to be confused with the code of rules commonly called medical ethics.

The material of pastoral medicine requires constantly renewed discussion, because medicine in general is progressive enough frequently to devise better methods of diagnosis and treatment, and thus the postulates of the moral questions involved are changed. This discussion, however, is not easily made. The facts upon which the ethical part of pastoral medicine rests are furnished by the physician for the consideration and judgment of the moralist--the physician educated after modern methods knows little or nothing of ethics and can not himself make accurate moral decisions. The moralist, on the other hand, is commonly a poor counsellor to the physician, because long training in medicine is needed before the physical data of the moral decisions is comprehended. The physician, therefore, is at a loss to determine what he may or may not do in {vi} cases that involve the greatest moral responsibility, and the priest is a hesitating guide because the moral theologies do not convincingly present the doctrine in these cases.

Now and then such subjects have been proposed for discussion to a group of physicians and moralists, but usually no practical conclusion has been reached because one side did not understand the other. In 1898 there was a series of articles on ectopic gestation in the _American Ecclesiastical Review_, in which moralists like Lehmkuhl, Sabetti, Aertnys, and Holaind, and some of the leading gynaecologists of America considered the questions but arrived at no decision. The physicians did not understand certain questions, other questions were on obsolete medical practice, essential questions were omitted, and from the data the moralists came to opposed conclusions.

We find also in moral theologies deductions drawn from false medical sources. Reasons are given, for example, to justify the use of a large quantity of alcoholic liquor at a dose in cases of great pain, typhoid fever, snake-poisoning, and other diseases, in the supposition that such doses will benefit or cure the patient, whereas the physician that would follow that treatment would be guilty of malpractice. There was recently in America a discussion on the relation of öophorectomy to the _impedimentum impotentiae_. One side held that a lack of ovaries constitutes impotence; the other side, that it does not. The discussion was useful because it incidentally gathered the full doctrine of the moralists on this subject, but from the medical point of view there is no connection whatever between these conditions.

A small number of books on pastoral medicine have been written by clergymen that were not physicians, and a few German books by physicians that were also moralists. Those by the physicians draw conclusions from antiquated medical practice, or they are mere popular treatises on hygiene; those by the clergymen have some value on the ethical side, but they are incomplete because the authors had not the necessary medical knowledge. The essays offered in this book by no {vii} means cover the entire field of pastoral medicine, but as far as they go we have endeavoured to offer the medical doctrine of the present day on the questions considered, and that as completely as is necessary to draw the moral inferences.

Since, then, so many of the questions of pastoral medicine are not defined, physicians are likely to follow the doctrine of the standard medical books, which without exception advise them to take the life of a dangerous foetus almost as unconcernedly as they might prescribe an active drug, or in any case to put utility before justice. There is, therefore, an urgent necessity that competent men fix that shifting part of ethics and moral theology called pastoral medicine, and these essays are presented as a temporary bridge to serve in crossing a corner of the bog until better engineers lay down a permanent causeway.

Some may think that the authors are inclined toward an exaggerated charity in suggesting the measure of responsibility for many human actions, but the physician that is brought much in contact with those suffering from mental defects of various kinds soon learns how easily complete responsibility becomes marred. Responsibility is dependent entirely upon free will; and while the great principle of free will remains solid in truth, no two men are free in exactly the same manner. Physical conditions have not a little to do with modifications of freedom of the will. To point out this fact to the clergyman and the physician has been our intention, for a proper appreciation of it will widen the bounds of charity and save many that are more sinned against than sinning from the injury of grievous misjudgment. It is better to run the risk of exculpating a few individuals whose responsibility is not entirely clear when the application of the same principles lifts many others above the rash judgment of those that can be of most help to them.

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CONTENTS

_The Authorship of the respective Essays is indicated by the signature at the end of each Essay_.

Chapter Page

I. Ectopic Gestation 1

II. Pelvic Tumours in Pregnancy 40

III. Abortion, Miscarriage, and Premature Labour 48

IV. The Caesarean Section and Craniotomy 55

V. Maternal Impressions 60

VI. Human Terata and the Sacraments 69

VII. Social Medicine 88

VIII. Some Aspects of Intoxication 105

IX. Heredity, Physical Disease, and Moral Weakness 120

X. Hypnotism, Suggestion, and Crime 129

XI. Unexpected Death 135

XII. Unexpected Death in Special Diseases 150

XIII. The Moment of Death 164

XIV. The Priest in Infectious Diseases 168

XV. Infectious Diseases in Schools 187

XVI. School Hygiene 202

XVII. Mental Diseases and Spiritual Direction 211

XVIII. Neurasthenia 230

XIX. Hysteria 235

XX. Menstrual Diseases 240

XXI. Chronic Disease and Responsibility 245

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XXII. Epilepsy and Responsibility 251

XXIII. Psychic Epilepsy and Secondary Personality 259

XXIV. Impulse and Responsibility 266

XXV. Criminology and the Habitual Criminal 271

XXVI. Paranoia, a Study in Cranks 282

XXVII. Suicides 306

XXVIII. Venereal Diseases and Marriage 311

XXIX. Social Diseases 317

XXX. De Impedimento Matrimonii Dirimente Impotentia 326

APPENDIX. Bloody Sweat 347

INDEX 357

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ESSAYS IN PASTORAL MEDICINE

I

ECTOPIC GESTATION

Ectopic gestation is gestation in the uterine adnexa, the peritoneal cavity, or the horn of an abnormal or rudimentary uterus. It is opposed to natural uterine gestation, and, since it includes pregnancy in an abnormal uterus, it is a more comprehensive term than extrauterine pregnancy.

In this article the morality involved in the surgical treatment of ectopic gestation is considered; and to have the data requisite for judgment it is necessary to describe in outline the anatomy of the uterine adnexa and the growth of the foetus; to explain the varieties, effects, diagnosis, and treatment of ectopic gestation; to present the cases of this condition, or rather this disease, as they occur in medical practice; to set forth some of the moral principles or laws that govern medical practice, especially where there is question of life and death; and finally to apply these principles to the cases offered for investigation.

The uterus is in the pelvic cavity, between the bladder and the rectum and above the vagina, into which it opens. It is a hollow, pear-shaped, muscular organ, somewhat flattened, and about three inches long, two inches broad, and one inch thick. The base or fundus is upward, and the neck is downward. Passing out horizontally from the corners or horns of the uterus, which are at its base, are the two Fallopian Tubes, one on either side. These are about five inches in length and somewhat convoluted. They are true tubes, opening into the uterus, and they are about one-sixteenth of an inch in diameter along the greater part of their extent The ends farthest {2} from the uterus are fringed and funnel-shaped; and this funnel-end, called the Infundibulum or the Fimbriated Extremity, opens into the abdominal or peritoneal cavity. Near the Fimbriated Extremity of each tube is an Ovary,--an oval body about one and a half inches long by three-quarters of an inch in width.