ACUTE CASES 
 IN MOR^t MEDICINE 
 
 REV: EDWARD R BURKE 
 
Class. 
 Book.. 
 
 X '7 59 
 
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 COPffilGHT DEPOSIT. 
 
ACUTE CASES IN 
 MORAL MEDICINE 
 
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 THE MACMILLAN COMPANY 
 
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 MACMILLAN & CO., Limited 
 
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ACUTE CASES IN 
 MORAL MEDICINE 
 
 BY THE REVEREND 
 EDWARD F. BURKE, M.A., Ph.D. 
 
 PROFESSOR OF THEOLOGY, ST. MARY S SEMINARY, 
 CLEVELAND 
 
 &tto gotfc 
 
 THE MACMILLAN COMPANY 
 1922 
 
 All rights reserved 
 
^BX /76"f 
 
 PRINTED IN THE UNITED STATES OE AMERICA 
 
 Copyright, 1922, 
 By THE MACMILLAN COMPANY. 
 
 Set up and electrotyped. Published October, 1922. 
 
 Press of 
 
 J. J. Little & Ives Company 
 
 New York, U. S. A. 
 
 OCT 18 '22 
 
 ?)CH686366 
 
To that love of God and man, which in- 
 spires the doctor and the nurse, the sister 
 and the priest to deeds of untiring zeal and 
 heroic self-sacrifice, this book is respectfully 
 dedicated. 
 
NIHIL OBSTAT 
 
 T. C. O'Keilly, S.T.D., 
 Censor Deputatus 
 
 IMPKIMATUR 
 
 IJIJOSEPHUS SCHREMBS, 
 
 Episcopus Clevelandensis 
 Cleveland, Ohio, March 25, 1922 
 
FOREWORD 
 
 The trained nurse holds a position of 
 highest (rust and responsibility in the 
 professional world of to-day. 
 
 She (Miters our homes at a most crit- 
 ical time when the lives of our loved ones 
 hang in the balance. 
 
 Her responsibilities involve loyalty to 
 the physician or surgeon, faithful and 
 devoted care of the patient, the utmost 
 regard tor the sacredness of the home 
 and its intimate relations and confi- 
 dences, and absolute fidelity to her own 
 
 conscience. 
 
 This fourfold relationship demands a 
 
 correct knowledge of the sacred prin- 
 ciples of sound morality and the consci- 
 entious application thereof to the daily 
 
 tasks o\' the trained nurse. 
 
 The truest measure of her service to 
 
X FOREWORD 
 
 humanity will ever be found in her fidel- 
 ity to her conscience and to the sacred 
 laws of God. 
 
 The real value of the present publica- 
 tion lies in its splendid presentation of 
 the fundamental principles of Christian 
 morality bearing on the duties of the 
 trained nurse. 
 
 The author has accomplished his task 
 in a most admirable manner, and I take 
 pleasure in recommending this book as 
 a text for our schools of nursing. 
 
 ^ Joseph Schrembs 
 Bishop of Cleveland 
 
INTRODUCTION 
 
 Those whose duty it is to care for the 
 sick, doctors, nurses and others, are 
 called upon frequently to meet perplex- 
 ing emergencies. 
 
 It is the purpose of this book to mark 
 out a safe line of conduct, brief and 
 readily accessible in those ever-recur- 
 ring cases in which the rights of others 
 are directly concerned. 
 
 Man's rights are two-fold, temporal 
 and spiritual, corresponding to the two- 
 fold order of which he is a being. The 
 foundation of his temporal rights is his 
 right to life; chief among his spiritual 
 rights is the right of religion. It is with 
 certain phases of these two rights that 
 this treatise deals. 
 
 The treatment naturally falls into two 
 distinct parts. The first part concerns 
 
Xll INTRODUCTION 
 
 itself with the respective rights of the 
 mother and her unborn child, adding 
 under the caption "Special Cases" cer- 
 tain ethical directions on matters of 
 practical moment. The second part, 
 assuming the recognition of our duty to 
 those in dire need of spiritual help, 
 treats of the ways in which this help 
 may be accorded. 
 
 In neither part is there any attempt 
 at argumentation; there is, however, 
 ample reference to authoritative works 
 which discuss at length the conclusions 
 based upon established principles. The 
 aim throughout has been to give a defi- 
 nite answer to difficulties and in every 
 instance the conclusion herein accepted 
 in response to a moot question, is in 
 accord with solid principles of morality, 
 often the embodiment of a positive 
 divine enactment, and, not infrequently, 
 the decisive expression of the Sacred 
 Congregation of the Holy Office. 
 
CONTENTS 
 
 PAGE 
 
 I. Temporal Rights — Life 1 
 
 1. Principles 3 
 
 2. Application 20 
 
 I. Embryotomy 20 
 
 II. Abortion 21 
 
 A. direct 25 
 
 B. indirect 28 
 
 (1) medical treatment 33 
 
 (2) operative treatment .... 34 
 
 (A) not involving uterine con- 
 
 tents 35 
 
 (B) involving uterine contents 36 
 
 (C) tumors of the womb . . 42 
 
 III. Ectopic Gestation 48 
 
 IV. Special Cases 54 
 
 1. Euthanasia 54 
 
 2. Twilight Sleep 55 
 
 3. Illicit Operations 57 
 
 4. Co-operation 60 
 
 5. Race Suicide 62 
 
 6. Professional Consultation 63 
 
 II. Spiritual Rights — Religion 65 
 
 A. Baptism of Necessity 67 
 
 xiii 
 
XIV CONTENTS 
 
 PAGE 
 
 I. Principles 67 
 
 II. Application 75 
 
 A. Adults . . 75 
 
 1. conscious 75 
 
 2. unconscious 78 
 
 3. demented 79 
 
 4. comatose 80 
 
 B. Infants 81 
 
 1. no sign of life 81 
 
 2. premature birth 82 
 
 3. difficult parturition 85 
 
 4. children of non-Catholics ... 88 
 
 5. foundlings ........ 88 
 
 6. abnormalities 89 
 
 7. unborn, and mothers dead, dying, 
 
 and sick 97 
 
 B. Last Sacraments 101 
 
 C. Christian Burial 107 
 
 General Conclusion 109 
 
 Appendix I. — Decrees of the Holy Office . . . Ill 
 
 Appendix II. — Suggestions 113 
 
 Glossary 117 
 
 Bibliography 123 
 
 Index ......... . ; 125 
 
PAET I 
 
 TEMPORAL EIGHTS 
 
 LIFE 
 
 ITS SOURCES AND 
 
 SAFEGUARDS 
 
 Since we are all of a common clay, it behooves us 
 to assist our brethren of the dust in their needs to 
 the end that disease and suffering be forestalled 
 and prevented, health and happiness restored, and 
 the divine spark preserved in its fragile tenement. 
 We are our brother's keeper. 
 
ACUTE CASES IN MORAL 
 MEDICINE 
 
 1. Establishment of Principles 
 
 This book assumes the existence of Postulates. 
 
 God, Creator and Supreme Legislator, 
 
 without Whom there can be no authority, 
 
 no law. It assumes the freedom of the 
 
 human will, without which there can be 
 
 no responsibility, no imputability. It 
 
 assumes an essential difference between 
 
 right and wrong. Irrespective of any 
 
 human law or positive divine enactment 
 
 certain actions are intrinsically and of 
 
 their very nature morally good, others 
 
 intrinsically and of their very nature 
 
 morally bad, so that if the former came 
 
 under no command, the latter under no 
 
 prohibition, the former would, neverthe- 
 3 
 
4 ACUTE CASES IN MORAL MEDICINE 
 
 less, be morally right, the latter, mor- 
 ally wrong. Without this distinction 
 there can be no true basis for morality, 
 radically there can be no true ground 
 for coercion or punishment. 
 God's The nature of the morally good and 
 
 Design. J & 
 
 the morally evil we shall not discuss, nor 
 shall we speak at length of what consti- 
 tutes the standard of judgment — the 
 norm of morality. Suffice it to say that 
 God in His Infinite Power has absolute 
 dominion over all creatures, that in His 
 Infinite Wisdom He has appointed to 
 them certain ends and has endowed 
 them with means proper to the attain- 
 ment of those ends. This is the Eternal 
 Law: — "the plan of government in the 
 mind of God according to which He 
 has eternally decreed to guide all things 
 and direct them to their final goal." 
 According to this decree, each creature 
 is directed along a definite line of action 
 in keeping with its nature, irrational 
 beings by physical necessity, those en- 
 
TEMPORAL, RIGHTS O 
 
 dowed with intelligence and free will, 
 by moral obligation. As man is an intel- 
 lectual creature, endowed with freedom 
 of choice, God directs him, not by phys- 
 ical necessity, not as He directs the 
 planet in its course and the brute by its 
 instinct, but by the Natural Law, by 
 "the participation of the Eternal Law in 
 a rational creature," by the knowledge 
 of the Eternal Law and its obligations — 
 by a moral necessity. Whatever befits 
 man as a rational being is good, the 
 Natural Law commands it. What ill 
 befits him as a rational being is evil, the 
 Natural Law forbids it. Do good and 
 avoid evil, is the basic principle of 
 morality. 
 
 In virtue, then, of the Natural Law, ^f^f 6 of 
 
 7 y J Right. 
 
 which arises immediately from the rela- 
 tion between Creator and creature, man 
 stands possessed of certain rights. By 
 the very fact of his rational nature he is 
 endowed with an inviolable moral power 
 of having, acquiring, or doing some- 
 
O ACUTE CASES IN MORAL MEDICINE 
 
 thing. This power is moral because its 
 exercise is in accord with the rational 
 nature of man; it is inviolable because 
 simultaneous with the origin of right in 
 one, arises in all others the duty to re- 
 spect that right. 
 Right to The object of right — the things which 
 
 a man has the moral power to possess, 
 acquire, or do, are the means the Creator 
 has given man to attain his end. Chief 
 among these is his right to life. It is 
 connatural because it belongs to man by 
 his very nature ; it is moral because he 
 possesses it in virtue of eternal decrees ; 
 it is inviolable because there is a boun- 
 den duty to respect it. And this duty 
 binds every individual man, for while he 
 has the right to preserve and enjoy his 
 life, he has not the right of ownership 
 in his life and cannot dispossess himself 
 of it. And if no man may take his own 
 life, for a stronger reason no other may; 
 in his mere private capacity my fel- 
 lowman in regard to my life has 
 
TEMPORAL RIGHTS i 
 
 right neither of benefit nor of owner- 
 ship. 
 
 And yet the right to life is not abso- *JJJf£- of 
 luteiy inalienable. A man may forfeit Life * 
 it. There are crimes which call for blood 
 punishment. The State may remove the 
 member which threatens the soundness 
 of its social life. The individual in 
 blameless self-defense may meet vio- 
 lence with violence, that is to say, in case 
 of unjust aggression, the rights of the 
 aggressor, by the very act of aggression, 
 are temporarily suspended and he him- 
 self placed in juridic inferiority to the 
 rights of the one attacked. 
 
 The right of the State to levy on its 
 own manpower and compel its citizens 
 to risk their lives in its just defense is 
 conceded. Conceded, too, is the right of 
 mortal risk to individual life in the dis- 
 charge of public duty, nay, even in a 
 private capacity in the interests of 
 science or where a great good is to be 
 obtained. 
 
8 ACUTE CASES IN MORAL MEDICINE 
 
 The principles enunciated in the Dec- 
 laration of Independence are in strict 
 accord with this doctrine: "We hold 
 these truths to be self-evident, that all 
 men are created equal; that all are en- 
 dowed by their Creator with certain in- 
 alienable rights; that among these are 
 life, liberty, and the pursuit of happi- 
 ness.' ' In framing that immortal Char- 
 ter the Fathers of our country would 
 have us understand that where there is 
 question of direct killing of an innocent 
 person, life is strictly inalienable; that 
 the innocent stands in full possession of 
 his God-given rights, and so sacred are 
 they that not even public authority can 
 authorize their deprivation. And the 
 reason is, life destruction assumes abso- 
 lute mastery; it is therefore an infringe- 
 ment on the dominion which God alone 
 possesses. Nor is this all. The Foun- 
 ders of our Liberty would have us note 
 a still further sense in which there is an 
 element of inalienability associated with 
 
Child. 
 
 TEMPORAL BIGHTS 9 
 
 human life, namely, that there are cer- 
 tain rights conditioned upon the inviola- 
 bility of life, particularly the right to 
 worship God and the right to eternal 
 salvation, of which no power on earth 
 can rob us. 
 
 The Right to Life, then, is natural, 
 moral, inviolable, intrinsically inalien- 
 able, unassailable and God-given. 
 
 In the practice of their profession Life of 
 
 Mother and 
 
 doctors and nurses often meet what 5^° m 
 many are pleased to style a "Conflict 
 of Rights ' ' ; a precise case would be the 
 right to life between the mother and the 
 unborn child. From the standpoint 
 sometimes adopted by medical science, 
 theoretically the right of the child must 
 give way before that of the mother, if 
 the destruction of the child becomes 
 necessary to save the mother's life, and 
 practically, there are cases in which 
 embryotomy, abortion, and the removal 
 of an inviable ectopic fetus are, they say, 
 positively indicated. 
 
10 ACUTE CASES IN MORAL MEDICINE 
 
 view^of From the standpoint of moral science 
 
 science. there may be a conflict of claims, but a 
 conflict of rights is a contradiction. As 
 regards the case in question, that, viz., 
 of the mother and the unborn child, the 
 answer of moral science is in direct 
 opposition to the answer given by some 
 members of the medical profession. Bas- 
 ing its claim upon the conclusions of 
 biology and psychology, moral science 
 teaches that the right to life begins at 
 the moment of conception, at the moment 
 the spermatozoon penetrates the ovum 
 and they become one fusion principle 
 acting with an independent life. From 
 then on the life within the womb de- 
 serves the same consideration as life 
 outside the womb. The life of the child 
 is to be safeguarded equally with the life 
 of the mother ; to attack either is crim- 
 inal. There is no question here of pref- 
 erence, there may be no balancing of 
 importance; it is not a point for medi- 
 cine to decide or statute to determine; 
 
TEMPORAL RIGHTS 11 
 
 it is strictly within the domain of right 
 and duty; it is a matter of the natural 
 law and, therefore, must be judged in 
 accord with moral principles. The great 
 moral principle governing the case is : — 
 each is a human being, each is innocent, 
 each has rights ; it is morally wrong to 
 attack either directly in order to assist 
 the other indirectly ; death from natural 
 causes is one thing, so-called therapeutic 
 death, quite another. You are never al- 
 lowed to do evil that good may come 
 from it — a dictate of reason which the 
 word of God confirms. Hence, no matter 
 the treatment said to be indicated, itj£ 
 never permissible to kill the fetus to 
 save the mother. The direct termina- 
 tion of fetal life can never be justified. 
 It should be noted here that insistence 
 is to be placed upon the words " direct 
 termination of fetal life," for, as will be 
 shown in the discussion on abortion, 
 there is a termination of fetal life, re- 
 sulting from medical or surgical pro- 
 
12 ACUTE CASES IN MORAL MEDICINE 
 
 cedures which may be absolutely without 
 blame. At this juncture, however, a 
 word on the general principles under- 
 lying direct and indirect killing does not 
 seem out of place. 
 
 An action takes its moral color from 
 three constituents, the object, the end, 
 and the circumstances: 
 
 rfSonS 8- ( a ) ^^£ object is the deed performed, 
 Diagnosis. ^he thing done, e.g., to pray, to 
 
 steal, to walk. 
 
 (b) The end is the reason why the 
 deed is performed, the thing is 
 done; it is the intention of the 
 agent, e.g., praying to honor God, 
 stealing to obtain money for 
 drink, walking to cure insomnia. 
 
 (c) The circumstances are the various 
 conditions which accompany the 
 action, increasing or lessening, or 
 changing the moral color which it 
 already has from the object and 
 the intention of the agent; e.g., 
 
TEMPORAL RIGHTS 13 
 
 to steal from a poor widow is a 
 greater crime than to steal the 
 same amount from a millionaire 
 miser; were a son to kill his 
 father he would be guilty not only 
 of the ordinary kind of murder 
 but of that specific type called 
 parricide. 
 
 Now, that a concrete action be morally 
 good, it must be good in all its constitu- 
 ents, object, end, and circumstances; if 
 any one of these elements is bad, the act 
 is vitiated and at once becomes morally 
 wrong. To sleep is good, but for a sen- 
 try to sleep while on duty merits court- 
 martial. To assist the poor may be a 
 worthy act of charity, but to steal in 
 order to do so is surely stepping beyond 
 the sphere of strict right. To pray, as 
 did the Pharisees, that you may be seen 
 and praised by men, is certainly a waste 
 of time and hypocritical to boot. From 
 this it can be readily seen that a bad 
 
14 ACUTE CASES IN MORAL MEDICINE 
 
 intention can vitiate an act otherwise 
 morally good, and, too, that no matter 
 how praiseworthy and noble an end may 
 be, it can never justify an evil means. 
 Responsi- Further, it is one thing to set forth the 
 
 principles of moral diagnosis and quite 
 another to say that an action is impu- 
 table to a man as its author, that he is 
 responsible for it and its consequences. 
 Knowledge and freedom are necessary 
 prerequisites for imputability, but they 
 are not the only essentials; the action 
 must also be voluntary, that is, it must 
 proceed from the will; it may proceed 
 from the will in one of two ways, directly 
 or indirectly. 
 
 (a) An action proceeds from the will 
 directly when it is performed either for 
 itself alone or as a means to something 
 further. 
 
 ( b) An action proceeds from the will 
 indirectly when it follows as a foreseen 
 result from another action willed di- 
 rectly, either as an end or as a means. 
 
TEMPORAL RIGHTS 15 
 
 Since no one should ever have occa- 
 sion to regret the unmixed good he does, 
 reference is made whenever there is 
 question of imputability to an action bad 
 in itself or in its consequences. If the 
 action is bad in itself (in its object, end, 
 or circumstances), be it a means or an 
 end, there can be no doubt of the imputa- 
 bility of wrong to the agent and conse- 
 quently of his responsibility. Should a 
 man extremely desirous of amassing 
 wealth, steal to amass it, theft is the 
 object and there the action rests; but 
 were he convinced he could amass more 
 by gambling and then steal in order to 
 gamble, gambling would be the end, theft 
 the means. In the first case the stealing 
 is directly voluntary, in the second case 
 both the stealing and the gambling are 
 directly voluntary. In each case the 
 action is imputable to the man as its 
 author and he is responsible, in the 
 former instance for one, in the latter for 
 two specific infractions. If, however, 
 
16 ACUTE CASES IN MORAL MEDICINE 
 
 the action is not bad in itself, but good 
 (in object, end, and circumstances) and 
 the agent directly intends it alone, but 
 foresees that, were it performed, evil 
 consequences would result, is he obliged 
 to refrain from performing the good 
 action on account of those evil conse- 
 quences? In other words, granted that 
 he may never approve, is he ever allowed 
 to tolerate or permit a moral or physical 
 evil? Is he allowed to perform an 
 action from which he foresees that be- 
 sides the good, an evil effect will also 
 follow? 
 
 Eecalling the principles already given, 
 let us submit the matter to analysis : 
 
 If (1) the action viewed in itself is 
 good, or indifferent; 
 
 if (2) the agent intends only the 
 good; 
 
 if (3) the evil is not the means to the 
 good but results from the same 
 cause as the good, then evi- 
 
TEMPORAL RIGHTS 17 
 
 dently the only obstacle to the 
 action would be the absence of 
 
 (4) a sufficiently grave reason for 
 permitting the evil. 
 
 The other conditions, then, being ^concrete 
 present, if the good effect is equal to or 
 greater than the evil effect, the action 
 may be performed without blame; if, 
 however, the good effect were not at 
 least equal to the evil effect, the per- 
 formance of the action would be wrong 
 and blameworthy. When, therefore, in 
 a concrete case the solution resolves 
 itself down to a question of proportion 
 between the good and the evil, it is a 
 matter of keeping things in their proper 
 sphere and applying sane judgment. 
 Take a concrete case. "Suppose a per- 
 son whose clothes have caught fire jumps 
 into a lake to extinguish the blaze. The 
 fire is extinguished but incidentally the 
 person drowns. Is he guilty of suicide? 
 
18 ACUTE CASES IN MORAL MEDICINE 
 
 No, because all the conditions enumer- 
 ated are present: 
 
 (1) The action of jumping into the 
 lake was in itself indifferent; 
 
 (2) The agent did not intend the 
 drowning, but the extinguishing 
 of the fire ; 
 
 (3) The good effect — putting out the 
 fire — is not caused by the drown- 
 ing; 
 
 (4) There was a sufficient reason to 
 justify the action, namely, the 
 avoiding of the agony of death by 
 fire." (Ross: "Ethics," p. 19.) 
 
 When, therefore, it is said that indirect 
 killing may sometimes be licit, it is 
 meant that under certain conditions it 
 may be tolerated as a consequence 
 within the knowledge but not the inten- 
 tion of an agent, from an action which 
 it was lawful for him to perform. And, 
 as we shall see later, this is what is 
 
TEMPORAL RIGHTS 19 
 
 meant by the indirect termination of 
 fetal life. 
 
 To recapitulate: 
 
 (1) It is never allowed to perform an 
 action, the direct and only conse- 
 quence of which is wrong — we 
 must do good and avoid evil. 
 
 (2) It is never allowed to perform an 
 action, the direct consequence of 
 which is wrong though that con- 
 sequence in turn is the means to 
 a far surpassing good result — the 
 end does not justify the means. 
 
 (3) Under certain conditions it is al- 
 lowed to perform an action from 
 which a two-fold effect follows, 
 one good, the other evil. 
 
 Thus far the principles. 
 
2. Application of Principles 
 
 Embryotomy 
 
 Definition. Embryotomy is the cut- 
 ting of a fetus to facilitate delivery. 
 
 Species. Embryotomy comprises all 
 those operations whose purpose is the 
 dismemberment of the fetus to reduce 
 the bulk, such as craniotomy, cephalo- 
 tripsy, cephalotomy, embryulcia, evis- 
 ceration. 
 
 Morality. Embryotomy is never per- 
 missible upon a living fetus. It is an 
 operation directly against the right to 
 life, the command: "Thou shalt not 
 kill. ' ' In the words of the late lamented 
 giant in medicine, Dr. John Murphy, "it 
 is scientifically unjustifiable, — a blunder 
 
 in surgery." While there is no pro- 
 20 
 
TEMPORAL RIGHTS 21 
 
 hibition of embryotomy upon a dead 
 fetus, yet the presence of life must be 
 presumed till the fact of death has been 
 duly established. And positive evidence 
 is required. Each case demands com- 
 petent consultation. 
 
 ii 
 
 Abortion 
 
 Definition. Abortion is the expulsion 
 of the fetus before it is viable — before 
 it is sufficiently developed to continue its 
 life outside the maternal womb. 
 
 A word here on viability and the in- 
 duction of premature labor will not be 
 out of place. Dr. Austin O'Malley in 
 his work, * ' The Ethics of Medical Homi- 
 cide and Mutilation," page 56, says: 
 "A full seven-months infant may be 
 reared with proper feeding and skilled 
 care ; a six-months infant may be reared 
 (with difficulty) in a hospital, with 
 skilled care." With this view Professor 
 
22 ACUTE CASES IN MORAL MEDICINE 
 
 Williams, of Johns Hopkins, is in al- 
 most literal agreement. By the word 
 "months" Dr. O'Malley means calendar 
 or solar, not lunar, months. The prac- 
 tical conclusion is that with the most 
 skilled care fetal life may not be ter- 
 minated before the twenty-sixth week of 
 gestation, and where only average care 
 is to be had, not before the thirtieth 
 week. Later, in the same chapter, that 
 eminent authority adds a further con- 
 sideration, namely, that owing to the 
 diseased condition of the mother, often 
 a six-month fetus in age is really not so 
 in development. The period, then, of 
 arrival at viability is somewhat relative, 
 and each case must be considered to- 
 gether with the attendant circumstances. 
 Further, while viability is in the primary 
 condition for the acceleration of birth, 
 it is not the only requisite; it is neces- 
 sary, besides, that there be a just and 
 grave reason for the interruption of 
 pregnancy and that the method em- 
 
TEMPOKAL EIGHTS 23 
 
 ployed be not ordinarily fatal to either 
 mother or child. 
 
 Species. It is necessary to view abor- 
 tion from the standpoint of both medical 
 and moral science. 
 
 A. Medical Science distinguishes 
 abortion into accidental — that 
 which is due to accident, — and 
 artificial or induced — that which 
 is brought on purposely ; and fur- 
 ther, it divides artificial abortion 
 into criminal and therapeutic; 
 criminal abortion it styles that 
 which is unnecessary for thera- 
 peutic reasons and therefore un- 
 justifiable ; therapeutic abortion 
 it terms that which is induced to 
 save the life of the mother, and 
 because of this some practitioners 
 claim it is justifiable. 
 
 B. Moral Science distinguishes arti- 
 ficial abortion into direct and in- 
 direct : 
 
24 ACUTE CASES IN MORAL MEDICINE 
 
 Direct abortion is that in which 
 the fetus is the object of attack- 
 that is, when the intention is to 
 remove the inviable fetus or when 
 the means employed tend pri- 
 marily by their very nature to the 
 removal of it. "It is the imme- 
 diate end of the invasion of the 
 pregnant womb, ' ' the natural and 
 necessary result of the means 
 employed. 
 
 Indirect abortion is that which 
 occurs when the fetus is in no 
 wise the object of attack — that is, 
 when the abortion results as a 
 secondary and unintentional con- 
 sequence from means which by 
 their very nature tend immedi- 
 ately to effect the cure of the 
 mother, and only remotely en- 
 danger the fetus. In direct abor- 
 tion, the abortion itself is the 
 means to the cure; in indirect 
 abortion, the cure is independent 
 
TEMPORAL RIGHTS 25 
 
 of the removal of the fetus, and 
 the abortion, if it occurs, is a 
 secondary consequence of the 
 treatment. 
 
 Morality. Moral science does not ad- 
 mit the distinction of abortion into crim- 
 inal and therapeutic, made by medical 
 science; on the contrary, it expressly 
 teaches that you are never allowed to do 
 evil that good may result. A humani- 
 tarian motive, a lofty purpose, profes- 
 sional confirmation, statutory acquies- 
 cence, neither singly nor in combination, 
 can render an evil act morally good. In 
 pursuance of its distinction of abortion 
 into direct and indirect abortion, moral 
 science enunciates two principles: 
 
 A. Direct abortion, be it criminal or ?i rec * 
 
 ' Abortion. 
 
 therapeutic, is never permissible upon a 
 living fetus. It is a violation of the laws 
 of nature, the rights of the individual, 
 and the command of God ; it is the direct 
 killing of an innocent person and, there- 
 
26 ACUTE CASES IN MORAL MEDICINE 
 
 fore, murder. There are no exonerating 
 circumstances. Moral science unhesi- 
 tatingly brands as murder the perform- 
 ance of therapeutic abortion in each 
 and every case in which the medical pro- 
 fession has taught its indication; even 
 the most serious conditions of pregnancy 
 furnish no exception. Moral science ad- 
 mits of no treatment, medicine or opera- 
 tion, whose purpose directly and of its 
 very nature is to attack the inviable 
 fetus. Hence, there must be no artificial 
 disturbance of pregnancy — 
 
 (1) In the toxemias of pregnancy, as 
 pernicious vomiting, eclampsia, 
 nephritis, acute yellow atrophy of 
 the liver; 
 
 (2) In acute or chronic infectious dis- 
 eases, as pneumonia, influenza, 
 typhoid, tuberculosis, malaria, 
 chorea ; 
 
 (3) In those diseases which it is 
 claimed pregnancy aggravates, as 
 
TEMPORAL RIGHTS 27 
 
 diabetes, heart disease, pyelitis, 
 pernicious anemia; 
 
 (4) In case of contracted pelvis or any 
 pelvic malformation. 
 
 While the artificial abortion in these or 
 similar cases is illicit or immoral, yet 
 the condition of the mother may be such 
 as to warrant premature delivery or the 
 caesarean section, provided the child is 
 viable. 
 
 It should not be necessary to mention 
 that there must be no curettement of the 
 pregnant uterus or during pregnancy 
 any dilatation of the os uteri ; care, too, 
 must be taken that the expectant mother 
 be not subjected to a general anesthetic 
 or to X-ray photography except under 
 grave necessity. 
 
 In this connection it may be well to 
 mention that the mother, irrespective of 
 any professional treatment, has certain 
 duties: she may take no oxytocic drug 
 or emmenagogue, engage in no violent 
 
28 ACUTE CASES IN MORAL MEDICINE 
 
 exercise, perform no heavy labor with 
 the intent of affecting the pregnancy. 
 And, too, her diet and clothing should be 
 in conformity with her condition. 
 
 Under no circumstance, then, may a 
 living, inviable fetus be expelled from 
 the womb. As a therapeutic measure, 
 direct abortion is the doing of evil that 
 good may result; it is the assuming of 
 mastery over innocent life; it is, there- 
 fore, morally wrong, unjustifiable, and 
 absolutely criminal. 
 
 But the mother, too, has rights, and 
 while the fetus may never be attacked 
 directly, no matter what the benefit ac- 
 cruing to the mother, it may at times be 
 wholly within the domain of right, in 
 fact morally imperative, to provide for 
 the cure of the mother even at the risk 
 of abortion. This accounts for the sec- 
 ond principle of moral science, that on 
 indirect abortion, 
 indirect B. Indirect abortion may sometimes 
 
 Abortion. " 
 
 be licit morally; while the direct termi- 
 
TEMPORAL BIGHTS 29 
 
 nation of fetal life is never permissible, 
 its indirect termination is not always 
 wrong. Under certain circumstances it 
 is allowed to administer a drug or to 
 perform a treatment from which as a 
 secondary and unintentional result abor- 
 tion may ensue. 
 
 The reason for this principle is 
 founded on the moral fact that one is not 
 always prohibited from performing an 
 action in itself not bad, but good, or at 
 least indifferent, from which a twofold 
 effect follows. Eecall here the prin- 
 ciples on indirect killing together with 
 the illustration — the person whose cloth- 
 ing has caught fire jumping into a lake. 
 In like manner apply those principles to 
 the work of a policeman, an electrician, 
 a structural iron-worker, a painter, a 
 chemist — occupations which carry with 
 them constantly the risk of sudden 
 demise, yet no one maintains it is mor- 
 ally wrong to engage in (hem. No one 
 will deny it is perfectly licit to admin- 
 
30 ACUTE CASES IN MORAL MEDICINE 
 
 ister a general anesthetic for an opera- 
 tion even slightly serious. Take a 
 specific case. Suppose your friend has 
 been stricken with cholera and the only 
 remedy at hand is liquor. You insist 
 upon his taking an enormous quantity; 
 as a result he becomes stupidly drunk, 
 but the poison is counteracted, the dis- 
 ease checked, and his life saved; now — 
 
 (1) The object, the giving of liquor, 
 is indifferent; 
 
 (2) The intention, the saving of his 
 life, is good ; 
 
 (3) Both the good effect, the saving 
 of his life, and the evil effect, the 
 drunken stupor, follow equally 
 and immediately from the same 
 action, the giving of the liquor, — 
 the evil effect is not the cause of 
 the good effect; 
 
 (4) There is a sufficiently grave rea- 
 son ; surely no one would hold you 
 morally blameworthy. 
 
TEMPORAL RIGHTS 31 
 
 In like manner, indirectly imperiling 
 the life of the fetus is sometimes per- 
 mitted. There are, however, conditions 
 governing the case and only when they 
 are verified may the fetal life be jeopar- 
 dized. Imperiling the life of the child 
 is serious, and only the grave condition 
 of the mother would furnish a reason 
 sufficiently good and proportionate to 
 warrant its being endangered; and the 
 treatment itself, though it has the ten- 
 dency to dislodge the fetus, must be such 
 as to be effective independently of any 
 connection with the fetus ; finally, in no 
 case may the expulsion of the fetus be 
 the object aimed at. The situation may 
 be analyzed as follows: 
 
 (1) A crisis in the mother which calls 
 for extreme treatment. 
 
 (2) A treatment, medicine or opera- 
 tion, which has a double effect : 
 
 a. One good, the cure of the 
 mother, willed; 
 
32 ACUTE CASES IN MORAL MEDICINE 
 
 b. One evil, the expulsion of 
 the fetus, reluctantly per- 
 mitted. 
 
 (3) The evil effect is not the means to 
 the good, but follows from the 
 same cause, — medicine or opera- 
 tion. 
 
 (4) The crisis in the mother is a suffi- 
 ciently grave reason. 
 
 While, then, no means, general or spe- 
 cial, may be employed with the view of 
 terminating the pregnancy, yet with 
 those conditions verified, no ethicist can 
 hold a doctor, nurse or mother morally 
 responsible for the abortion which may 
 ensue; for it cannot be denied that in 
 safeguarding her life the mother has a 
 certain right to the use of all good means 
 which do not first and directly attack the 
 equally important rights of others. 
 
 Though this principle is clear enough 
 in theory, the practical application 
 creates a difficulty — and medicine and 
 
TEMPORAL RIGHTS 33 
 
 surgery concern themselves with con- 
 crete cases. Hence, to render a practical 
 judgment easier, it may not be amiss to 
 treat the matter under the following 
 headings: (1) Conditions Indicating 
 Medical Treatment; (2) Conditions In- 
 dicating Operative Treatment. 
 
 First, Conditions Indicating Medical £**££ t 
 Treatment. A question may place this 
 matter in a clearer light : Is a physician 
 permitted to administer a certain medi- 
 cine needful for the mother if he fore- 
 sees it is liable to induce abortion? In 
 answering, distinction must be made be- 
 tween the necessity and the utility of the 
 medicine on the one hand, and its lia- 
 bility to induce abortion on the other. 
 If the medicine is necessary to save the 
 life of the mother, it is permissible to 
 give it, irrespective of the abortion 
 which may ensue; further, even though 
 it is not necessary but very useful to the 
 mother, it is permissible to give it, pro- 
 viding the danger to the child is very 
 
3i ACUTE CASES IN MORAL MEDICINE 
 
 slight; if, however, the danger to the 
 child overbalances the usefulness to the 
 mother, it is morally wrong to admin- 
 ister the medicine. With these distinc- 
 tions in mind it is readily seen that in 
 threatened abortion the cautious use of 
 morphin for the relief of uterine irrita- 
 bility is morally permissible despite its 
 narcotizing properties. Quinin in large 
 doses (even in small doses frequently 
 repeated) is decidedly oxytocic, yet in 
 accordance with the principles estab- 
 lished, there is nothing against its use 
 as a specific in malaria, or as an anti- 
 pyretic as, e.g., in grippe and influenza. 
 It follows as a corollary, which scarcely 
 needs mention, that when medical treat- 
 ment is imperative, and there is a choice 
 of remedies equally beneficial to the 
 mother, the physician is morally obli- 
 gated to administer the one less danger- 
 ous to the child, 
 surgical Second, Conditions Indicating Opera- 
 
 tive Treatment. Although as a general 
 
 Treatment. 
 
TEMPORAL RIGHTS 35 
 
 rule it is advisable, unless grave neces- 
 sity intervenes, to defer all operative 
 procedures until after delivery, yet 
 when in the course of pregnancy condi- 
 tions arise, in which to the best judg- 
 ment of the conscientious and capable 
 surgeon, operative treatment is indi- 
 cated, the necessary operation is morally 
 licit provided the fetus be not thereby 
 directly attacked. 
 
 (A) When the operation deemed 
 imperative is remedial of a condition 
 unconnected with the pregnancy , its 
 licitness is readily understood from the 
 general principles. Hence, there need 
 be no hesitancy in operating for: 
 
 (1) The cure of such conditions as 
 acute appendicitis, diseased kid- 
 ney, intestinal obstruction, cancer 
 of the stomach or breast, chole- 
 cystitis, strangulated hernia. 
 
 (2) The cure of the uterine adnexa 
 menacingly diseased, as ovarian 
 
36 ACUTE CASES IN MORAL MEDICINE 
 
 or tubal tumors, and this to the 
 extent of the removal of the 
 ovaries and tubes themselves if, 
 in accord with the best diagnostic 
 judgment, their condition de- 
 mands removal. (See Special 
 Cases, 3.) 
 
 (3) Eeposition in uterine displace- 
 ments, especially in case of in- 
 carceration. 
 
 (B) When, however, the uterine con- 
 tents come under operative considera- 
 tion, the matter presents a more difficult 
 angle and the line betiveen what is right 
 and what is wrong is more delicately 
 drawn. Among the conditions which 
 evoke special moral interest, threatened 
 abortion, placenta praevia, premature 
 separation of the placenta, rupture of 
 the uterus, and disease of the ovum, are 
 among the most common. 
 
 Threatened (1) In threatened abortion, all possible 
 
 Abortion. 
 
 means must be employed to save 
 
TEMPORAL RIGHTS 37 
 
 the fetus; only when the hemor- 
 rhage has become so profuse that 
 the woman 's life is endangered and 
 the abortion inevitable, is packing 
 morally licit. Under no circum- 
 stance may curettage be employed 
 as a remedy in threatened abor- 
 tion. It would be the direct de- 
 struction of innocent life. How- 
 ever, once the ovum has been ex- 
 pelled curettage is morally licit. 
 
 (2) In placenta praevia— the develop- placenta 
 ment of the placenta so that it en- 
 croaches upon or covers the in- 
 ternal os — if the child is viable, the 
 induction of premature labor or the 
 csesarean section is morally per- 
 missible ; if the child is not viable, 
 then, again, all possible means 
 must be employed to save it ; pack- 
 ing is allowed only when the woman 
 
 is bleeding to the risk of her life. 
 
 (3) In premature separation of the pla- gj 6 ™*^}™ 
 centa the method of treatment de- of Placeuta 
 
38 ACUTE CASES IN MORAL MEDICINE 
 
 pends upon whether the placenta 
 has been completely or only par- 
 tially detached from the uterine 
 wall. If the separation is but par- 
 tial, the accident may be without 
 serious significance ; interference 
 is morally licit only when symp- 
 toms become gravely urgent. If, 
 however, the separation is com- 
 plete, then it is necessary to begin 
 delivery at once, no matter what 
 be the stage of fetal development. 
 The moral aspect is clear, for, 
 technically, the abortion has actu- 
 ally taken place ; it was effected by 
 accident which caused the separa- 
 tion. The utmost haste is impera- 
 tive if the child is to be saved for 
 Baptism. 
 Rupture of (4) In rupture of the uterus several 
 
 Uterus. v ' x 
 
 moral phases are presented. If 
 the fetus is dead the skillful ob- 
 stetrician will meet the situation in 
 accord with the exigencies of the 
 
TEMPORAL RIGHTS 39 
 
 case. If the fetus is alive and 
 viable, whether it is still within the 
 uterus or has already escaped into 
 the abdominal cavity, laparotomy 
 is performed, the child extracted 
 and the demands of the case met 
 with the necessary operative pro- 
 cedures. If the fetus is alive and 
 inviable, it must not be attacked 
 directly; if necessary to prevent 
 fatal hemorrhage, excision of the 
 uterus or ligation of the arteries 
 would be morally licit, even though 
 the fetus would die through the 
 cutting off of the blood supply. 
 For the object of the operation is 
 an organ of, or something belong- 
 ing to the mother, the condition of 
 which, here and now, threatens her 
 life ; it is only then, indirectly, and 
 in consequence of the means em- 
 ployed to save that life, that the 
 death of the fetus is permis- 
 sible. 
 
40 ACUTE CASES IN MORAL MEDICINE 
 
 of iB ovum. ( 5 ) ^ n treating diseases of the ovum 
 the moral aspect varies with the 
 certainty of diagnosis and the na- 
 ture of the disease. The ordinary 
 conditions requiring ethical con- 
 sideration are the mole, hydram- 
 nios and clear ovum. 
 
 MolQ - (a) Mole. It must be remem- 
 
 bered that where there is any rea- 
 sonable ground for doubt, the pre- 
 sumption stands in favor of a 
 normal conception ; hence when the 
 presence of a mole is suspected, the 
 diagnosis must be certain enough 
 to offset the assumption of a prob- 
 able pregnancy before any opera- 
 tive procedure may be begun. 
 However, hemorrhage is charac- 
 teristic of the mole in any of its 
 species. If, then, the bleeding is 
 dangerously profuse, packing to 
 check it is permissible; the re- 
 moval of the pack may be followed 
 by curettement or hysterectomy, ac- 
 
TEMPORAL BIGHTS 41 
 
 cording to the demands of the case. 
 But if the diagnosis of mole is cer- 
 tain and it is threatening the life 
 of the woman in some other way 
 than through hemorrhage, it may 
 be removed, even though it involve 
 a fetus. However, such cases are 
 practically unknown after the first 
 three months of pregnancy. If the 
 mole involves a fetus it should be 
 opened upon removal, so that if 
 possible, Baptism may be admin- 
 istered. 
 
 (b) Hydr amnios — excessive li- Hydramnios. 
 quor amnii. There may be no arti- 
 ficial interference with the course 
 
 of pregnancy unless the child has 
 reached the stage of viability ; the 
 liquor amnii belongs to the ovum 
 and it is necessary for the life of 
 the fetus. 
 
 (c) Clear ovum — one in which ciear ovum, 
 the embryo has been dissolved in 
 
 the water of the ovum. The con- 
 
. 42 ACUTE CASES IN MORAL MEDICINE 
 
 dition is difficult to diagnose; in 
 case of doubt, the presumption 
 always stands for life, the fact of 
 death must be established upon 
 reasonable grounds. Hence, to 
 render operative interference licit, 
 moral certainty as to diagnosis is 
 required. 
 
 Tumors of C. Finally, the cases which present 
 the greatest difficulty from the stand- 
 point of both medical and moral science 
 are tumors of the womb. 
 
 Depending upon their location, uterine 
 tumors may be within, between the walls 
 of, or on the womb; hence they are 
 termed submucous, intramural and sub- 
 serous, respectively ; depending upon 
 their nature, they may be benign, as 
 fibromyomata, or malignant, as carcino- 
 mata. 
 
 nbro- (a) Fibromyomata. It may be stated 
 
 myom&ta. 
 
 that, as a rule, operative inter- 
 ference should be deferred as long 
 
TEMPORAL RIGHTS 43 
 
 as possible, for, according to the 
 highest authorities, the majority 
 of women who have fibromyomata 
 go to delivery without trouble ; in 
 that case the procedure will be 
 such as the skillful obstetrician 
 deems best. 
 
 If, however, profuse hemor- 
 rhage threatens the mother's life 
 or if the tumor has become septic, 
 its removal is morally licit, — and, 
 if you except the submucous, the 
 removal does not necessarily 
 cause abortion; statistics point 
 the other way. 
 
 Further, were profuse hemor- 
 rhage to follow the excision of the 
 tumor and were the only means 
 of saving the mother amputation 
 of the pregnant uterus, that too 
 would be licit, as the conditions 
 requisite for the twofold effect 
 are verified there. 
 
 Finally, if a submucous tumor 
 
Car- 
 
 cinomata. 
 
 44 ACUTE CASES IN MORAL MEDICINE 
 
 involving the fetus has become 
 gangrenous and its removal is 
 necessary to save the life of the 
 mother, again on the double-effect 
 principle, its enucleation is licit, 
 even though the removal will 
 hasten the death of the fetus. 
 (See Special Cases, 3.) 
 
 (b) Carcinomata. A strikingly clear 
 exposition of the ethical aspect of 
 operative procedure when cancer 
 complicates pregnancy is to be 
 found in Dr. O'Malley's work: 
 1 ' The Ethics of Medical Homicide 
 and Mutilation. ? ' On page 150 
 the doctor writes: "Cancers of 
 the cervix are always malignant 
 and cause death if they are not 
 removed before they have gone 
 on to metastasis." The case, as 
 Dr. O'Malley explains, presents 
 many aspects according as the 
 mother is operable or inoperable 
 
TEMPORAL RIGHTS 45 
 
 — has one chance in four or none 
 at all — and the child viable or in- 
 viable. Hence there are the fol- 
 lowing possibilities: 
 
 (a) If the mother is operable 
 and the child viable, the 
 proper procedure is ce- 
 sarean section and hyster- 
 ectomy. Every good and 
 reasonable mother should 
 submit to it, if for no other 
 reason than to save the 
 child. In fact the only 
 reason why moralists do 
 not make operation a duty 
 in this case, is that it is 
 considered a more than or- 
 dinary means to preserve 
 life. In the preservation 
 of life we are strictly 
 obliged to employ only or- 
 dinary means. (Confer pp. 
 97-100.) 
 
46 ACUTE CASES IN MORAL MEDICINE 
 
 (b) If the mother is inoperable 
 and the child viable, the 
 mother may submit to ce- 
 sarean section to save the 
 child, but she has no strict 
 duty to do so ; nor may the 
 operation be performed un- 
 less her consent has been 
 obtained after she has been 
 made fully aware of the 
 circumstances. 
 
 (c) If the mother is inoperable 
 and the child inviable, there 
 is nothing to do but to wait 
 in hope that the child may 
 reach viability. 
 
 (d) If the mother is operable 
 and the child inviable, in 
 accord with strict moral 
 probability, operative pro- 
 cedure is licit. Under the 
 most favorable circum- 
 stances the child has but 
 
TEMPORAL RIGHTS 47 
 
 one chance in two of going 
 on to viability; if opera- 
 tion is deferred, its chances 
 diminish with those of the 
 mother ; on the other hand, 
 the chances of the mother 
 diminish rapidly, even a 
 few days may suffice to 
 render her inoperable. 
 Hence the conclusion of Dr. 
 'Malley : ' ' The one chance 
 in four in immediate opera- 
 tion gives the mother a 
 solid ground for hope, and 
 the probability is sufficient, 
 in my opinion, to permit 
 the operation with a per- 
 missive loss of the fetus." 
 
 From the solution just proposed, it 
 follows that it is morally licit to treat 
 carcinomata with X-rays ; besides, in the 
 present advanced stage of methods of 
 treatment, it is by no means certain that 
 
48 ACUTE CASES IN MORAL MEDICINE 
 
 the fetus would be injured ; even though 
 it were, the grave condition of the 
 mother would render the risk permis- 
 sible. 
 
 in 
 Surgical Removal of an Ectopic Fetus 
 
 Definition. Ectopic gestation is a ges- 
 tation that is out of place, a gestation 
 outside its normal site within the womb. 
 
 Species. Ectopic gestation has a 
 broader meaning than extra -uterine 
 pregnancy. It includes not only gesta- 
 tion outside the uterus in the adnexa or 
 peritoneal cavity, but also gestation in 
 the horn of an abnormal or rudimentary 
 uterus as well as gestation in that part 
 of the fallopian tube which lies within 
 the uterine wall. "As," in the words 
 of Professor Williams, "the fertilized 
 ovum may be arrested at any point on 
 its way from the graafian follicle to the 
 uterine cavity, it may undergo develop- 
 
TEMPOEAL BIGHTS 49 
 
 ment in the ovary or in any portion of 
 the tube, giving rise to ovarian or tubal 
 pregnancy, respectively. ' ' There is much 
 discussion as to whether a primary ab- 
 dominal pregnancy is possible, but that 
 has no practical bearing upon the ethical 
 aspect of the question ; certainly abdom- 
 inal pregnancies exist, and, whether pri- 
 mary or secondary, they have to be dealt 
 with. Hence there are three species of 
 ectopic gestation — ovarian, tubal, and 
 abdominal; by far the most common of 
 these is tubal pregnancy. 
 
 Morality. An ectopic gestation, no 
 matter what its species, deserves the 
 same consideration as the fruit of a 
 normal conception. Its situs is not of 
 its own choice, it is entirely undirected 
 by its own will, it is an innocent human 
 being, hence it has a right to life. But 
 as there are various circumstances in a 
 normal conception where operative pro- 
 cedure may result indirectly in the death 
 of the fetus, so, too, there are similar 
 
50 ACUTE CASES IN MORAL MEDICINE 
 
 cases of ectopic gestation. Those ordi- 
 narily met in practice are the following : 
 
 1. Maternal hemorrhage and collapse. 
 Surgically, celiotomy and hemostasis are 
 urgently indicated, and the procedure is 
 perfectly licit morally. 
 
 2. A tumor containing a living fetus. 
 If the tumor is endangering the mother's 
 life, whether it be from malignancy or 
 from other causes, it may be removed, 
 even should the fetus contained therein 
 be inviable. If it is not endangering the 
 mother's life it may not be removed. 
 Of course it is evident that, in the 
 absence of such neoplastic tissue, the 
 ectopic sac itself may not be removed 
 on the plea that it is a tumor dangerous 
 to the woman's life. 
 
 3. An interior growth of undeter- 
 mined nature. The growth may be a 
 tumor, a pyosalpinx, or a fetus. Neither 
 the ordinary signs nor the history of the 
 case afford grounds sufficient for a posi- 
 tive diagnosis. While in such a con- 
 
TEMPORAL RIGHTS 51 
 
 tingency operative procedure would be 
 strictly licit, yet, if no immediate crisis 
 is feared, the expectant treatment is 
 preferable morally; but if the physi- 
 cian's practiced eye observes an ap- 
 proaching crisis, owing to the insoluble 
 doubt, he is permitted to open the ab- 
 domen; if the diagnosis is still uncer- 
 tain, he may slit the tube and finish the 
 operation even though he finds a living 
 fetus, for once the tube has been opened 
 the arteries must be ligated to prevent 
 fatal maternal hemorrhage. But if in 
 any particular case, after celiotomy, 
 before opening the tube, the diagnosis 
 of a fetal presence becomes certain, 
 morally, he can proceed no further. That 
 tubal abortion or tubal rupture may oc- 
 cur in a few hours or a few days is not 
 sufficient reason to attack directly and 
 remove a fetus which here and now is 
 developing in accord with natural laws 
 without any serious indication of ma- 
 ternal collapse or hemorrhage. 
 
52 ACUTE CASES IN MORAL MEDICINE 
 
 At this juncture it may be well to add 
 that the application of electric current 
 or the injection of various poisonous 
 substances to destroy the contents of 
 the growth of a doubtful nature, would 
 be as morally wrong and as absolutely 
 unjustifiable as Dr. Williams says they 
 would be in an ectopic pregnancy where 
 the diagnosis is positive. 
 
 4. A positive diagnosis of tubal preg- 
 nancy : 
 
 (a) If the fetus is dead, remove 
 it. 
 
 (b) If there is doubt as to life, then 
 the solution depends on the 
 urgency of the case ; if the case 
 is not urgent, wait ; but if there 
 are signals of danger, even 
 aside from hemorrhage and col- 
 lapse (e.g., toxemia), of which 
 only the practiced physician 
 can judge accurately, then the 
 certain right of the mother pre- 
 
TEMPOBAL RIGHTS 53 
 
 vails over the doubtful right of 
 the child, and the surgeon is 
 justified in operating. 
 
 (c) If the fetus is viable, remove 
 it. 
 
 (d) If the fetus is inviable, the pro- 
 cedure depends upon the cir- 
 cumstances. If there are no in- 
 dications of hemorrhage or col 
 lapse, nothing can be done but 
 wait. No operation may be per- 
 formed which has for its object 
 the removal and killing of the 
 fetus either as a means or as an 
 end. If there are symptoms of 
 hemorrhage, the patient must 
 be watched closely, everything 
 kept in readiness and the mo- 
 ment her condition gives evi- 
 dence of becoming grave, the 
 woman should be opened imme- 
 diately, the arteries ligated, and 
 the extracted fetus, if not cer- 
 tainly dead, baptized. 
 
54 ACUTE CASES IN MORAL MEDICINE 
 
 Permit me, then, to reiterate with 
 added emphasis what I said in the begin- 
 ning concerning an ectopic fetus : The 
 ectopic fetus has the same right to life 
 as the fruit of a normal conception, and, 
 in consequence, deserves the same con- 
 sideration and demands the same pro- 
 tection. 
 
 IV 
 
 Special Cases 
 
 From the foregoing discussion and 
 application of principles a few conclu- 
 sions of practical moment may be drawn. 
 Euthanasia. l. Even though the state of the sick, 
 the insane, the criminal, the mother, be 
 helpless, it is, nevertheless, murder to 
 drug them into eternity. They may be 
 irremediably afflicted but they remain in 
 full possession of their rights ; their con- 
 dition may seem hopeless, yet in similar 
 instances time has proven the judgment 
 of mere men wrong. Besides, who is 
 
TEMPORAL RIGHTS 55 
 
 man that he should assume life mastery- 
 over an innocent human creature ? The 
 advocates of this wholesale slaughter of 
 the innocents use the euphemistic term 
 euthanasia, an easy death, but in bring- 
 ing it about they run contrary to the 
 command of God and usurp His right. 
 Euthanasia, despite the easy, is less 
 honorable than the murder committed by 
 the thug; the latter takes a chance on 
 being caught and convicted, the easy 
 death advocate escapes because a social 
 conscience is warped. While it is licit 
 to administer morphine with discretion 
 in quantity sufficient to ease suffering 
 and produce necessary sleep, yet to rob 
 the patient purposely of the use of his 
 faculties in his last hours is unscrupu- 
 lous and criminal. 
 
 2. Twilight Sleep is a method in- |£^ gllt 
 tended to effect painless childbirth 
 through the use of scopolamine and 
 morphine. Although introduced as late 
 as 1902, it is even now being discon- 
 
56 ACUTE CASES IN MORAL MEDICINE 
 
 tinued by the authorities in the medical 
 profession. Green of Harvard, Williams 
 of Johns Hopkins, Hirst of Pennsyl- 
 vania, DeLee of Northwestern, not to 
 mention the eminent practitioners Baer, 
 Edgar and Holmes, look askance at its 
 general use. It has been given a fair 
 trial; the desired results have not been 
 obtained. It does not prevent the pains 
 of labor, but at most destroys the recol- 
 lection of them. According to Dr. Wil- 
 liams (Obstetrics — page 347) ordinarily 
 the women complain bitterly during the 
 pains, and some women contend that 
 they have perfect recollection of their 
 severity. Besides, it prolongs labor, 
 renders more frequent operative de- 
 livery, brings forth apneic children, en- 
 genders unslakable thirst, induces head- 
 ache, vertigo, and delirium, and through 
 restlessness increases in the mother the 
 risk of self infection. Finally, there is 
 ever present the danger of destroying 
 the life of the child through asphyxia, 
 
 _ 
 
TEMPORAL RIGHTS 57 
 
 and the life of the mother through post- 
 partum hemorrhage. 
 
 These are the scientific facts on which 
 the moral judgment is based. In every 
 case there is serious risk of performing 
 grave evil to effect slight good. To 
 alleviate the pains natural to childbirth 
 a host of ills is introduced and fetal and 
 maternal life placed in jeopardy. It is 
 obvious then that there is no proper pro- 
 portion between the good and evil 
 effects. Hence while it is entirely pos- 
 sible that in the future vast improve- 
 ment may be made in regard to its ad- 
 ministration, in the present stage of its 
 development Twilight Sleep is both 
 unscientific and immoral. Some mem- 
 bers of the medical profession even 
 consider its administration little short 
 of malpractice. 
 
 3. There may be no operation on any ™jff t|1fflf 
 of the female generative organs, unless 
 their condition be so diseased as to de- 
 mand it, and then only in so far as is 
 
58 ACUTE CASES IN MORAL MEDICINE 
 
 necessary to remedy the condition effec- 
 tively. This prohibition affects not only 
 hysterectomy and ovariotomy (oopho- 
 rectomy), but also the burial and the 
 closure as well as the removal of the 
 tubes (salpingectomy). It applies as 
 well to X-ray and radium treatment 
 which without operative interference 
 may be employed for purposes of ster- 
 ilization. That pregnancy may, per- 
 haps, aggravate a disease such as 
 tuberculosis, is no more reason for 
 permitting sterilization than would be 
 the desire of some society women to 
 escape the primary and legitimate bur- 
 den of marriage. Such an operation is 
 a grave mutilation without sufficient 
 reason, hence it is a violation of the 
 moral order, and, therefore, a deordina- 
 tion strictly forbidden. The same is 
 true of vasectomy. The State has no 
 right to authorize it. Further, where 
 only one tube or one ovary is diseased, 
 it is not lawful to remove the undis- 
 
TEMPORAL RIGHTS 59 
 
 eased tube or the undiseased ovary to 
 guard against possible future infection. 
 Such procedure would constitute a grave 
 mutilation without sufficient reason. 
 The evil would be certain and pres- 
 ent, the good but possible and re- 
 mote. 
 
 There is, however, a peculiar case con- 
 cerned with the female generative or- 
 gans in which mutilation is not pro- 
 hibited. Sometimes a fibroid so involves 
 the uterus that it cannot be removed 
 unless the uterus is taken out together 
 with it. Xow, even though the only 
 danger to the woman is from recurrent 
 abortion owing to the presence of the 
 tumor in the womb, that is sufficient to 
 justify the extirpation of a uterus so 
 affected. But when there is no other 
 danger to the woman than that resulting 
 from the possible abortion, hysterectomy 
 would not be licit were the uterus actu- 
 ally gravid with fetal life. (See Fibro- 
 in} omata, p. 42.) 
 
60 ACUTE CASES IN MORAL MEDICINE 
 
 operation. 4t " ** * s morally wrong to perform 
 
 an operation, it is also morally wrong to 
 assist in it, or even to be present at it. 
 There is such a thing as formal coopera- 
 tion which makes the one who cooperates 
 equally guilty with the perpetrator ; it is 
 not a slight offense to stain one's hands 
 with innocent blood; it is not a small 
 thing to be a party to a procedure which 
 runs contrary to the canons of ordinary 
 decency and is directly opposed to the 
 first principles of the Natural Law\ If, 
 however, a nurse does not know and has 
 no reason to suspect that an illicit opera- 
 tion is to be performed (embryotomy, 
 abortion, removal of ectopic fetus in 
 absence of maternal shock and hemor- 
 rhage, impairing the function of any 
 reproductive organs without necessity) 
 she is in no wise responsible ; if she has 
 well-founded reasons to suspect, her 
 only course is a positive and unqualified 
 refusal to assist. If dismissal from the 
 school, the case, or the service of the 
 
TEMPORAL RIGHTS 61 
 
 doctor follows such an action, let her 
 rejoice in duty done, remembering the 
 while that such schools and such doctors 
 do not like publicity. It goes without 
 saying that the nurse in charge of the 
 operating room should be apprised of 
 the nature of the operation about to be 
 performed. Even, especially where 
 moral questions are involved, it may be- 
 come her duty to inquire into the neces- 
 sity of certain procedures, which many 
 have come to consider a matter of surg- 
 ical routine. Nor should it be neces- 
 sary to mention that following the 
 doctor's orders in giving drugs which 
 are plainly designed to terminate an 
 apparently played-out life would mani- 
 festly be cooperation in human slaugh- 
 ter. What is said here of a nurse is 
 equally true of an assistant doctor 
 placed in a similar position. 
 
 While refusal to be party to an il- 
 licit operation is absolutely imperative, 
 once the crime had been committed, it 
 
62 ACUTE CASES IX MORAL MEDICINE 
 
 would not be wrong to nurse such a 
 patient. 
 5*» 5. The doctor and the nurse must be- 
 
 Suicide. 
 
 ware of the unscrupulous and those with- 
 out conscience who seek information that 
 they may turn it to criminal use. The 
 ugliest practices are being indulged in 
 nowadays simply for the sake of sexual 
 pleasure or in virtue of the claims of 
 so-called economic necessity; and worse 
 still, in the name of social progress they 
 are receiving public attention and almost 
 authoritative sanction. These crimes 
 are the ruin of the individual and a 
 menace to the nation. They attack the 
 sanctity of the home and, thereby, shake 
 the very pillar of the state. Hence, the 
 doctor and the nurse, far from divulging 
 should guard as a sacred trust the 
 professional knowledge which could be 
 turned to wicked uses. Xow as never 
 before the world needs strong characters 
 firmly rooted in moral principles and 
 grimly determined in their courageous 
 
TEMPORAL RIGHTS 63 
 
 application to stick to the outposts of 
 righteousness till society, high and low, 
 its dizzy spell over, returns to sane 
 thought and action. 
 
 6. The doctor, physician or surgeon, uo£ 8Ulta " 
 is the self -professed and legally consti- 
 tuted guardian of human life. It is his 
 to conserve and not to destroy. The re- 
 lated experience of men eminent in the 
 medical profession manifests how fre- 
 quently a diagnosis has been faulty, and 
 clinical discussion shows forth how often 
 in properly diagnosed cases the treat- 
 ment has been faulty. Hence the neces- 
 sity of strong exhortation to prudence in 
 both diagnosis and treatment, and where 
 there is serious doubt as to diagnosis or 
 treatment, the patent necessity of com- 
 petent consultation. Consultation is 
 necessary occasionally for the old and 
 experienced, frequently necessary for 
 the young and less experienced. Con- 
 sultation should be the constant rule in 
 all cases where the doctor is not sure as 
 
64 ACUTE CASES IN MORAL MEDICINE 
 
 to the proper procedure, and this is espe- 
 cially true when disease complicates 
 pregnancy and threatens either maternal 
 or prenatal life. 
 
 The greater a man is in his profession, 
 the more readily will he acknowledge his 
 limitations and the more apt will he be 
 to seek advice where human life is hang- 
 ing in the balance. 
 
PAET II 
 
 SPIRITUAL RIGHTS 
 
 RELIGION 
 CARE OF THE SOUL 
 
 The soul of even the humblest among men is of 
 priceless value. Immortal by nature, by grace it 
 is fitted for eternal glory. In serious illness when 
 the danger of death is even slight, the relatives or 
 friends of the patient should be apprized at once, 
 that they may interest themselves in his spiritual 
 welfare. And without disturbing his religious 
 convictions the nurse in all fitness may propose 
 motives of sorrow to such a patient and elicit from 
 him acts of perfect contrition. 
 
A. Baptism of Necessity 
 I. Establishment of Principles 
 
 1. What is Baptism of Necessity? 
 
 Baptism of Necessity is Baptism 
 in which the mere essentials of 
 the sacrament are performed, 
 the other ceremonies usually 
 prescribed by the Church being 
 omitted. 
 
 2. When is it administered? 
 
 It is administered whenever 
 there is danger that he (child or 
 adult) may die before he can be 
 brought to the Church for 
 Solemn Baptism. 
 
 3. Who is to administer it? 
 
 Anyone having the use of reason 
 
 may baptize validly, provided he 
 
 perform what is required and 
 07 
 
68 ACUTE CASES IN MORAL MEDICINE 
 
 have the intention of doing what 
 the Church of Christ intends by 
 Baptism. Yet when possible, a 
 certain order of preference is to 
 be observed. If a priest can be 
 called it is his duty to administer 
 the sacrament; if one cannot be 
 summoned readily, then a cleric 
 (deacon, subdeacon, etc.) takes 
 precedence over a lay person ; a 
 man is preferable to a woman. 
 Only when no competent person 
 is available should the father or 
 mother of the child perform the 
 rite. 
 4. How is it to be administered? 
 
 It is to be administered by pour- 
 ing water on the head (forehead) 
 of the one to be baptized, in 
 quantity sufficient to flow, and at 
 the same time the person pouring 
 the water must pronounce dis- 
 tinctly the words: "1 baptize 
 thee in the name of the Father 
 
SPIRITUAL RIGHTS 69 
 
 and of the Son and of the Holy 
 Ghost." "While it is not neces- 
 sary, yet the water may be so 
 poured as to make three distinct 
 crosses on the forehead; the 
 words, however, are to be pro- 
 nounced but once. 
 
 Observation 
 As regards 
 
 1. The water 
 
 (a) Clear natural water is to be 
 used ; it may be water from 
 the tap or pump, spring 
 water, rain water, sea water, 
 water from the river, pond 
 or fountain, water from 
 mists or dew, condensed 
 steam or melted ice, water 
 sterilized or boiled. 
 
 (b) The water must touch the 
 skin and is to be poured in 
 quantity sufficient to flow; 
 
70 ACUTE CASES IN MORAL MEDICINE 
 
 enough could be held in a 
 cupped hand; where bap- 
 tism might occasion disturb- 
 ance a handkerchief or bit of 
 gauze soaked in water could 
 be wrung out so that the 
 drops would run on the fore- 
 head. 
 
 2. The ivords 
 
 A. Absolute baptism 
 
 (a) The proper w T ords are: 
 "1 baptize thee in the 
 name of the Father and 
 of the Son and of the 
 Holy Ghost." All must 
 be pronounced — it is not 
 enough to say: "In the 
 name of the Father and 
 of the Son and of the 
 Holy Ghost"; the words 
 "7 baptize thee" are also 
 essential; there must be 
 no substitution, no appa- 
 
 
SPIRITUAL RIGHTS 71 
 
 rent equivalents. The 
 word "Amen" should 
 not be added at the 
 end. 
 
 (b) The words are to be pro- 
 nounced by the person 
 pouring the water; one 
 may not pour the water 
 and another say the 
 words, nor may anyone 
 baptize himself. 
 
 (c) The words are to be pro- 
 nounced, not after, not 
 before, but while pouring 
 the water. 
 
 (d) The words are to be pro- 
 nounced distinctly; it is 
 not enough to think 
 them ; they must be care- 
 fully expressed; the 
 words can be spoken 
 clearly even in a whisper 
 and it is not necessary 
 
72 ACUTE CASES IN MORAL MEDICINE 
 
 that they be perfectly 
 audible to bystanders. 
 
 B. Conditional baptism 
 
 Sometimes there may be 
 reason to doubt 
 
 (a) As to whether the person 
 was previously baptized, 
 or 
 
 (b) As to whether the pre- 
 vious baptism was valid, 
 or 
 
 (c) As to whether the person 
 is living, or 
 
 (d) As to whether the object 
 under consideration is 
 human, then the baptism 
 is to be conferred condi- 
 tionally. The words ex- 
 pressing the condition 
 are themselves distinctly 
 pronounced and prefixed 
 to the proper form ; for 
 
SPIRITUAL RIGHTS 73 
 
 example, if there were a 
 doubt as to whether the 
 person were previously 
 baptized, the conditional 
 form would be : "If thou 
 art not baptized, I bap- 
 tize thee in the name of 
 the Father and of the 
 Son and of the Holy 
 Ghost." Although the 
 words expressing the 
 condition vary under dif- 
 ferent circumstances, yet 
 should the person bap- 
 tizing not know how to 
 formulate the conditions 
 in a particular case, it is 
 always safe to use the 
 one of capability: "If 
 thou art capable, I bap- 
 tize thee in the name of 
 the Father and of the 
 Son and of the Holy 
 Ghost." 
 
74 ACUTE CASES IN MORAL MEDICINE 
 
 Note especially: In baptism of neces- 
 sity 
 
 1. There need be no name given. 
 
 2. There need be no sponsors, unless 
 one can be procured easily ; yet, if 
 possible, there should be at least 
 one witness to the fact of baptism. 
 
 3. There must be probable danger of 
 death. Should a nurse, however, 
 about to leave a case, feel morally 
 certain that the child is in such 
 condition that it will die soon and 
 probably without baptism, she may 
 administer the sacrament before 
 departure. 
 
 4. The one who baptizes should make 
 a precise record of all that has been 
 done. The record should contain 
 the name, if one has been given, the 
 age, the parent's names, the name 
 of the one who administered the 
 private baptism, and relate how it 
 was done. All this information 
 
SPIRITUAL RIGHTS 75 
 
 should be presented to the priest 
 of the parish to which the person, 
 thus privately baptized, belongs. 
 
 II. Application of Principles 
 
 At any time occasions may arise which 
 demand clear thought and quick action. 
 The emergency may regard either an 
 adult or an infant. By an adult is meant 
 anyone who has attained the use of 
 reason; while an infant is one who has 
 not attained the use of reason, even 
 though he be advanced in years. 
 
 A. An Adult in Danger of Death 
 
 1. // conscious: For the valid recep- 
 tion of baptism it is necessary 
 that the adult have the intention 
 of receiving it, that he ask to be 
 baptized or at least assent to be 
 baptized when questioned regard- 
 ing it. Now: 
 
 (a) If there is time for instruc- 
 tion, call a priest. If this is 
 
76 ACUTE CASES IN MORAL MEDICINE 
 
 not convenient or there is 
 danger in prolonged delay, 
 let the nurse in charge or 
 some person well-informed 
 teach him the principle mys- 
 teries of religion: 
 
 1. That God exists and is a 
 Eewarder of them that 
 seek Him. 
 
 2. That in God there are 
 three Persons, and that 
 the Second Person became 
 man and died for our sins. 
 
 3. That it is necessary to 
 pray. 
 
 That done, the person should 
 be told to be sorry for his sins 
 and motives of sorrow pro- 
 posed to him, namely: 
 
 1. The Infinite Goodness of 
 God. 
 
 2. The sufferings and death 
 of Christ on the Cross. 
 
SPIRITUAL RIGHTS 77 
 
 3. The loathsomeness of sin. 
 
 4. The everlasting reward 
 that is lost by mortal sin. 
 
 5. The everlasting punish- 
 ment to which mortal sin 
 makes us liable. 
 
 Finally, an Act of Contrition 
 should be made with him. 
 (Confer p. 107.) 
 Then if the person has never 
 been baptized before, baptize 
 him absolutely: "I baptize 
 thee in the name of the 
 Father and of the Son and 
 of the Holy Ghost." 
 If there is doubt regarding 
 anyjSjormer baptism, baptize 
 him conditionally : "If thou 
 art not baptized, I baptize 
 thee in the name of the 
 Father and of the Son and 
 of the Holy Ghost." 
 
 (b) If there is no time for in- 
 
78 ACUTE CASES IN MORAL MEDICINE 
 
 struction, it is sufficient that 
 the person believe in God, 
 that he assent in a general 
 way to whatever God has re- 
 vealed. He should then be 
 told to be sorry for his sins 
 and baptism conferred as in 
 the previous case (a). 
 2. If unconscious : For the valid re- 
 ception of baptism by an adult, 
 the habitual intention of receiving 
 baptism is necessary. Now, if the 
 unconscious person, either during 
 his past life or in his present ill- 
 ness has manifested in any posi- 
 tive way his intention of receiving 
 baptism, he should be baptized 
 conditionally: "If thou art ca- 
 pable, I baptize thee in the name 
 of the Father and of the Son and 
 of the Holy Ghost." Eelatives 
 and friends might know of such 
 intention ; diligent inquiry should 
 be made of them ; the unconscious 
 
SPIRITUAL RIGHTS 79 
 
 person should be given the benefit 
 of any doubt. If he recovers he 
 should be instructed, then if any 
 doubt exists regarding the valid- 
 ity of the former baptism, he 
 should be baptized conditionally: 
 "If thou art not baptized, I bap- 
 tize thee in the name of the Father 
 and of the Son and of the Holy 
 Ghost." 
 
 3. If insane: 
 
 (a) If the person has never had 
 the use of reason, he is to be 
 baptized absolutely; his con- 
 dition is the same as that of 
 an infant. 
 
 (b) If the person has had the use 
 of reason, then: 
 
 (1) If the insanity is perma- 
 nent and there is any 
 reason for believing' that 
 the person while sane 
 manifested any desire of 
 
80 ACUTE CASES IX MORAL MEDICINE 
 
 receiving it, baptism 
 should be administered 
 conditionally. But if 
 there is no reason for 
 believing that any such 
 desire ever existed, he 
 should not be baptized. 
 (2) If the insanity is not per- 
 manent, — that is, if there 
 are lucid moments or 
 periods of saneness, — 
 then if there is no danger 
 of death, nothing is to be 
 done until a rational in- 
 terval, when he is to be 
 treated as an ordinary 
 adult. If, however, there 
 is danger of death before 
 return of reason, the con- 
 dition is to be treated as 
 under (1), above. 
 4. If comatose: 
 
 What has been said of insanity 
 applies with equal force to coma 
 
SPIRITUAL RIGHTS 81 
 
 or to stupor. Nothing is to be 
 done unless there is danger of 
 death, and nothing even then, un- 
 less the person had previously in 
 some way manifested a desire of 
 receiving baptism. If some prob- 
 able manifestation of desire for 
 the sacrament is obtained, then 
 the person is to be baptized con- 
 ditionally: "If thou art capable, 
 I baptize thee in the name of the 
 Father and of the Son and of the 
 Holy Ghost." Upon the recovery 
 he is to be instructed and if any 
 doubt exists as to the validity of 
 the former baptism, he is to be 
 baptized conditionally: "If thou 
 art not baptized, I baptize thee in 
 the name of the Father and of the 
 Son and of the Holy Ghost." 
 
 B. An Infant: the case of: 
 
 1. A child bom showing no sign of 
 life. The absence of evidenl signs 
 
82 ACUTE CASES IN MORAL MEDICINE 
 
 of life is not a certain proof of 
 death. In an intact fetus the only 
 sure sign of death is putrefaction 
 or decomposition. Hence if the 
 fetus is not mangled to an extent 
 that would render the presence of 
 life impossible, or if dissolution 
 or maceration is not discernible, 
 it must be baptized conditionally : 
 "If thou art alive, I baptize thee 
 in the name of the Father and of 
 the Son and of the Holy Ghost." 
 
 2. A child born prematurely — pre- 
 mature being taken in the wide 
 sense of abortion or miscarriage : 
 
 (a) If what is ejected is recogniz- 
 able as a living fetus, no 
 matter how small, it is to be 
 baptized absolutely: "1 bap- 
 tize thee in the name of the 
 Father and of the Son and 
 of the Holy Ghost." If there 
 is any doubt as to life, it is 
 
SPIRITUAL RIGHTS 83 
 
 to be baptized conditionally: 
 "If thou art alive, I baptize 
 thee in the name of the Fa- 
 ther and of the Son and of the 
 Holy Ghost." 
 
 (b) If what is ejected is not rec- 
 ognizable as a living fetus, it 
 may be a fertilized ovum or 
 its membranes, or a patho- 
 logical growth, it is then to 
 be baptized conditionally: 
 "If thou art capable, I bap- 
 tize thee in the name of the 
 Father and of the Son and of 
 the Holy Ghost." 
 
 (c) If the embryo is delivered in 
 its membranes: 
 
 1. If it seems well-developed, 
 open the_sac carefully, 
 drain off the amniotic 
 fluid and pour water on 
 the fetus, using the form : 
 "7/ thou art alive, I bap- 
 
84 ACUTE CASES IX MORAL MEDICINE 
 
 tize thee in the name of 
 the Father and of the Son 
 and of the Holy Ghost." 
 2. If it is not well-developed, 
 then open the sac under 
 tepid water so that the 
 water floods the sac fully; 
 then lift it out and place 
 it in the water again three 
 times, pronouncing at the 
 same time, once only, the 
 form: "If thou art capa<- 
 ble, I baptize thee in the 
 name of the Father and of 
 the Son and of the Holy 
 Ghost." 
 Note. In case of such immature 
 births, do not lose valu- 
 able time trying to ascer- 
 tain definite signs of life. 
 If the fetus is not cer- 
 tainly dead, give it condi- 
 tional baptism at once. 
 The same injunction holds 
 
SPIRITUAL RIGHTS 85 
 
 in regard to immature 
 ectopic fetuses. 
 
 A difficult parturition: 
 
 (a) Within the womb. While 
 there remains a well- 
 grounded hope that the child 
 will be born alive, baptism 
 within the womb is not to be 
 attempted. If there is grave 
 reason to believe that the 
 child will not be born alive, 
 then it is the duty of the 
 physician (who best knows 
 how to apply the water with- 
 out endangering the life of 
 the child) to try to reach the 
 child through the vagina by 
 means of some instrument, 
 as an aseptic syringe filled 
 with sterilized water. The 
 baptism is to be conferred 
 conditionally: "If thou art 
 capable, I baptize thee in the 
 
86 ACUTE CASES IN MORAL MEDICINE 
 
 name of the Father and of the 
 Son and of the Holy Ghost." 
 If the danger of death con- 
 tinues, the child upon full 
 delivery, or upon presenta- 
 tion of the head, is to be bap- 
 tized again, conditionally : 
 "If thou art not baptized, I 
 baptize thee in the name of 
 the Father and of the Son 
 and of the Holy Ghost." 
 Even a non-Catholic mother 
 should, if possible, be per- 
 suaded to permit intrauterine 
 baptism that the child be 
 given every chance of spir- 
 itual happiness. 
 (b) In delivery. This assumes 
 that delivery is in progress 
 but there is danger that the 
 child may die before being 
 completely delivered. The 
 probable cases of presenta- 
 tion are : 
 
SPIRITUAL RIGHTS 87 
 
 1. The head. It is to be bap- 
 tized absolutely as under 
 normal circumstances : "I 
 baptize thee in the name 
 of the Father and of the 
 Son and of the Holy 
 Ghost." 
 
 2. A prominent or less prom- 
 inent part such as shoul- 
 ders, back, buttock, chest, 
 hand, arm, foot, leg, re- 
 spectively. The part pre- 
 sented is to be baptized 
 conditionally : "If thou 
 art capable, I baptize thee 
 in the name of the Father 
 and of the Son and of the 
 Holy Ghost." Then upon 
 delivery, provided the 
 child still lives and the 
 danger has not passed, the 
 child is to be baptized 
 again conditionally: "If 
 thou art not baptized, I 
 
88 ACUTE CASES IN MORAL MEDICINE 
 
 baptize thee in the name 
 of the Father and of the 
 Son and of the Holy 
 Ghost." 
 
 4. The children of non-Catholic pa- 
 rents. The indiscriminate bap- 
 tism of children of non-Catholic 
 parents is certainly wrong. That 
 private baptism be allowed, there 
 must be danger of death, and 
 where this is present, the children 
 are to be baptized even against 
 the will of their parents. This 
 can be done quietly, without osten- 
 tation; if the child survives, he 
 should be informed of his duty at 
 least at the age of discrimination. 
 (Confer Observations 1 (b),ip. 
 69.) 
 
 5. Foundlings. If such little cast- 
 aways are not in danger of death 
 consult a priest. If they are in 
 danger of death and no statement 
 
SPIRITUAL RIGHTS 89 
 
 can be obtained to prove previous 
 baptism, then they are to be bap- 
 tized conditionally. 
 
 Abnormalities. In case of abnor- 
 mal births it is to be noted that if 
 baptism is to be conferred, it 
 should be administered before the 
 placental circulation is cut. The 
 deformation may represent the 
 appearance of: 
 
 (a) A shapeless mass of flesh, in 
 no way distinguishable as a 
 human fetus and having no 
 lineament of a human body. 
 Now such is not to be bap- 
 tized. If, however, there is 
 any reason to believe that the 
 "shapeless mass" # may be a 
 human being or a mole con- 
 taining a fertilized ovum, 
 then baptism is to be con- 
 ferred conditionally : "If 
 thou art capable, I baptize 
 
90 ACUTE CASES IN MORAL MEDICINE 
 
 thee in the name of the 
 Father and of the Son and of 
 the Holy Ghost." Of course, 
 in case of the mole it should 
 first be opened. 
 
 (b) A human being. If alive, it 
 must be baptized absolutely, 
 no matter how deformed or 
 misshapen it may be : "I bap- 
 tize thee in the name of the 
 Father and of the Son and of 
 the Holy Ghost." If any 
 doubt exists as to the pres- 
 ence of life, it is to be bap- 
 tized conditionally: "If thou 
 art alive, I baptize thee in 
 the name of the Father and of 
 the Son and of the Holy 
 Ghost." 
 
 (c) Twin births. Such defor- 
 mations may present many 
 angles. The terata may be so 
 separated that they are quite 
 distinguishable or so joined 
 
SPIRITUAL RIGHTS 91 
 
 that one is almost indistin- 
 guishable : 
 
 1. Readily distinguishable: 
 
 (a) One head and one 
 chest. Baptize the 
 head absolutely: "I 
 baptize thee in the 
 name of the Father 
 and of the Son and of 
 the Holy Ghost." 
 
 (b) One head and two 
 chests. Baptize the 
 head absolutely: "I 
 baptize thee in the 
 name of the Father 
 and of the Son and 
 of the Holy Ghost/' 
 Then baptize each 
 chest conditionally : 
 "If thou art not bap- 
 tized, I baptize thee 
 in the name of the 
 Father and of the 
 
92 ACUTE CASES IN MORAL MEDICINE 
 
 Son and of the Holy 
 Ghost." 
 
 (c) Two heads and one 
 chest. Baptize one 
 head absolutely: "I 
 baptize thee in the 
 name of the Father 
 and of the Son and 
 of the Holy Ghost." 
 Then baptize the 
 other head condition- 
 ally : "If thou art not 
 baptized, I baptize 
 thee in the name of 
 the Father and of the 
 Son and of the Holy 
 Holy Ghost." 
 
 (d) Two heads and two 
 chests. Baptize each 
 head absolutely: "7 
 baptize thee in the 
 name of the Father 
 and of the Son and 
 of the Holy Ghost." 
 
SPIRITUAL RIGHTS 93 
 
 2. Scarcely distinguishable: 
 
 (a) Two partial heads 
 joined and two dis- 
 tinct chests. Baptize 
 each partial head ab- 
 solutely: "I baptize 
 thee in the name of 
 the Farther and of the 
 Son and of the Holy 
 Ghost." Then bap- 
 tize the other partial 
 head conditionally : 
 "If thou art not bap- 
 tized, I baptize thee 
 in the name of the 
 Father and of the 
 Son and of the Holy 
 Ghost." 
 
 (b) If one of the beings is 
 fairly developed, and 
 the other has no head 
 or only a rudimen- 
 tary head, the more 
 developed one is to be 
 
94 ACUTE CASES IN MORAL MEDICINE 
 
 baptized absolutely: 
 "I baptize thee in the 
 name of the Father 
 and of the Son and of 
 the Holy Ghost/' The 
 less developed is to 
 be baptized condition- 
 ally : "If thou art not 
 baptized, I baptize 
 thee in the name of 
 the Father and of the 
 Son and of the Holy 
 Ghost." And al- 
 though ' i the standard 
 of judgment in such 
 cases as regards the 
 presence of one or 
 two souls, is the evi- 
 dence of one or more 
 distinct conscious- 
 nesses " (0 'Malley, 
 op. cit., p. 80), yet in 
 a matter so important 
 as baptism, the safest 
 
SPIRITUAL RIGHTS 95 
 
 and surest means 
 must be employed ; 
 conditional baptism 
 is to be administered 
 lest a soul be de- 
 prived of the happi- 
 ness of heaven. 
 
 Note. (1) When there is any doubt 
 in the aforementioned 
 cases as to whether such 
 terata are living, the con- 
 dition: "If thou art 
 alive" must be prefixed 
 to the formula. Now, if 
 the baptism was condi- 
 tional for another reason 
 also, the twofold condi- 
 tion may be expressed: 
 "If thou art alive and 
 not baptized, I baptize 
 thee in the name of the 
 Father and of the Son 
 and of the Holy Ghost." 
 
96 ACUTE CASES IN MORAL MEDICINE 
 
 Or the following brief 
 form may be used: "If 
 thou art capable I bap- 
 tize thee in the name of 
 the Father and of the 
 Son and of the Holy 
 Ghost." 
 (2) When in case of such ab- 
 normal births danger of 
 death is so imminent that 
 it is feared there would 
 not be time sufficient to 
 baptize each separately, 
 the water is to be poured 
 over them together (on 
 the heads or parts corre- 
 sponding to the head) 
 while the form: "I bap- 
 tize you (plural) in the 
 name of the Father and 
 of the Son and of the 
 Holy Ghost" is be- 
 ing pronounced but 
 once. 
 
SPIRITUAL RIGHTS 97 
 
 A Woman's 
 
 Unborn Infants and Mothers Death 1 
 dead, dying, and sick : If a woman nancy. 
 dies in pregnancy, the caesarean 
 section is to be performed imme- 
 diately and the extracted fetus, if 
 certainly alive, is to be baptized 
 absolutely, or, if there is doubt 
 as to life, conditionally. Should 
 the fetus be very small, the pre- 
 cautions mentioned in treating of 
 premature births are to be ob- 
 served. If upon opening the 
 womb, the fetus should be found 
 to be certainly dead, it should not 
 be removed but buried with the 
 mother. To absolve the doctor 
 and the institution from blame 
 and to avert legal entanglements, 
 the written permission of the hus- 
 band or family to operate should 
 be obtained and the woman pro- 
 nounced dead in the presence of 
 competent witnesses before the 
 operation is begun. 
 
98 ACUTE CASES IN" MORAL MEDICINE 
 
 The obligation of performing the 
 cesarean section that the child, if alive, 
 may be baptized, is gravely serious, no 
 matter how short has been the duration 
 of the pregnancy. Primarily, the obli- 
 gation rests upon the surgeon, secon- 
 darily, upon the nurse in charge or upon 
 some other skilled female. Nor should 
 the fact that the woman has been dead 
 several hours cause hesitation. In- 
 stances are on record in which living 
 infants have been extracted from the 
 womb at a considerable time after the 
 mother's death. If it is necessary to 
 wait for some one skilled to perform the 
 operation, care should be taken to keep 
 the woman's abdomen warm by means 
 of hot water bottles or electric pads. 
 a woman if the woman is already in the throes 
 pr^nancy. of death, the acceleration of birth by 
 forcibly dilating the cervix is morally 
 permissible. "If the woman is slowly 
 dying, the fetus is likely to die through 
 lack of oxygen." (O'Malley, op. cit., p. 
 
SPIRITUAL RIGHTS 99 
 
 88) : hence, by turning and delivering 
 the child before it is too late, it is saved 
 for baptism, and if viable perhaps per- 
 manently, while at the same time the life 
 of the mother is not determinably short- 
 ened. However, neither the spiritual 
 nor temporal welfare of the child fur- 
 nishes grounds sufficient to justify any 
 procedure which would certainly curtail 
 the mother's life. In case of doubt there 
 is always the expedient of intrauterine 
 baptism before, and cesarean section 
 after, her death. 
 
 A pregnant woman in grave danger of a woman 
 death presents a decidedly practical Dan « er - 
 moral difficulty. It may be put in the 
 form of a question. Is a woman in a 
 critical condition obliged to undergo the 
 cesarean section that the child, if alive, 
 may be baptized? In answer it is neces- 
 sary to draw the line of demarcation 
 between the licitness and the obligation 
 under the given circumstances. The 
 operation would be licit, provided there 
 
100 ACUTE CASES IX MORAL MEDICINE 
 
 is a likelihood of the fetus being viable 
 and that the operation would not be a 
 determinable shortening of the mother's 
 life. Otherwise the operation would be 
 morally wrong. But supposing the 
 operation licit, even then the woman 
 would not be obliged to submit to it, 
 although it were the only way in which 
 the infant's spiritual safety could be 
 procured. For, while the steady advance 
 of surgical technique has rendered this 
 operation less bloody and dangerous 
 than it was formerly, yet should a 
 woman turn from it in abhorrence it 
 must be considered an extraordinary 
 means and as such cannot be imposed as 
 of obligation in a particular case. The 
 indications for the operation, the great 
 danger of infection, and the maternal 
 death rate under the most favorable cir- 
 cumstances confirm this view. Hence 
 the woman may be urgently persuaded 
 but must not be obliged. {Confer 4 'Car- 
 cinomata," p. 44.) 
 
SPIRITUAL RIGHTS 101 
 
 B. The Last Sacraments 
 Every Catholic who has attained the 
 use of reason and is in danger of death 
 is under obligation to receive the con- 
 solations of Eeligion afforded by the 
 Last Sacraments. Whenever there is 
 sickness or accident from which death 
 may result, even though the danger is 
 not immediate, the pastor of souls should 
 be summoned at once. For the Last 
 Sacraments are to be given as soon as 
 there is real danger of death and while 
 the patient is still conscious. Hence the 
 doctor and nurse must not wait till he 
 has been deprived of the use of his 
 senses before acquainting his family, 
 relatives or friends with the seriousness 
 of his condition. Nay even, since in 
 their professional capacity the doctor 
 and nurse should ever consult the best 
 interests of their patient, in the absence 
 of those interested in his welfare, they 
 themselves will see to it that the priest 
 is called. 
 
102 ACUTE CASES IX MORAL MEDICINE 
 
 In regard to the administration of the 
 sacraments two perplexing situations 
 may arise; one has reference to a con- 
 tingency following the reception of Holy 
 Communion, the other to a case of sud- 
 den and unexpected death. 
 
 Holy Communion. It may be stated 
 as a rule that even though the patient 
 be conscious and able to swallow, yet 
 Communion should not be administered 
 if his stomach is in an unsettled condi- 
 tion. Still, despite the utmost pre- 
 caution, it may happen that, after re- 
 ceiving, some unforeseen cause induces 
 vomiting. In such a contingency the 
 reverence due the Blessed Sacrament 
 must be safeguarded. 
 
 If vomiting occurs within twenty 
 minutes after the reception of the 
 Sacrament the entire ejection should be 
 placed in a clean vessel and the priest 
 notified. 
 
 If a priest cannot be had immediately, 
 then the method of procedure depends 
 
SPIRITUAL RIGHTS 103 
 
 upon whether the Sacred Species is dis- 
 cernible or not. If the Host is readily 
 discernible It should be separated care- 
 fully (by means of a spoon) from the 
 other matter ejected and placed in a 
 clean vessel. Then It may be taken to 
 the priest by a trustworthy person or 
 preserved in a safe place awaiting his 
 coming. If, however, It is not discern- 
 ible, as is usually the case, then the whole 
 matter ejected should be absorbed with 
 cotton or gauze, burned, and the ashes 
 put into the sacrarium. In case the 
 accident happens at a private home 
 or a hospital with no chapel attached, 
 the ashes may be buried in a decent 
 place where they will not be dis- 
 turbed. 
 
 Of course, these directions are not 
 limited to Holy Viaticum but have refer- 
 ence to any case in which vomiting oc- 
 curs within twenty minutes after receiv- 
 ing Holy Communion. 
 
 The second difficulty in the adminis- 
 
104 ACUTE CASES IN MORAL MEDICINE 
 
 tration of the Sacraments from which 
 complications may arise has reference 
 to the moment of death. 
 
 Moment of Death. Strange as it may 
 seem, it is not always easy to say, in each 
 particular case, just when death occurs. 
 The rigor of death and the general dis- 
 solution of the organism are the only 
 certain signs of death known at present. 
 Not even an accumulation of the ordi- 
 nary signs furnishes sufficient proof that 
 life has passed out. Neither any nor all 
 are absolutely certain. So many per- 
 sons have been revived after what is 
 generally termed death, that experts 
 admit that, in any case of death, the 
 exact moment at which the soul leaves 
 the body is unknown. The important 
 fact is that life lingers for varying 
 periods after apparent death ; how long 
 is undetermined, but — 
 
 1. In the case of one in the bloom of 
 health snatched away by accident 
 
SPIRITUAL RIGHTS 105 
 
 or sudden sickness, there is latent 
 life possibly for hours; some au- 
 thorities claim that there is life till 
 the signs of putrefaction become 
 apparent. Hence in such cases, no 
 matter how long since apparent 
 death, the priest should be sum- 
 moned that the person may receive 
 the benefit of the doubt in the 
 conditional administration of the 
 sacraments. 
 
 In case of one who has succumbed 
 to an ordinary sickness, distinction 
 must be made between a wasting, 
 protracted disease and one which 
 terminates life in a short time and 
 rather suddenly. In the former 
 latent life may linger for from a 
 quarter to a half hour after ap- 
 parent death; in the latter, for 
 from one hour to possibly three 
 hours. While in such contingencies 
 the only reason why sick persons 
 should have been deprived of spir- 
 
106 ACUTE CASES IN MORAL MEDICINE 
 
 itual ministrations would be the 
 criminal negligence of those in 
 charge, yet in the event of their 
 being guilty of such grave dere- 
 liction, the priest should be 
 notified at once and briefly ac- 
 quainted with the attendant cir- 
 cumstances. 
 
 Here it may be noted that in the case 
 of dying people, science has demon- 
 strated that the sense of hearing is 
 invariably the last to function. Fre- 
 quently it remains remarkably acute 
 even though there is no other manifest 
 evidence of life. Hence, in all cases 
 where death is not certain, it is proper 
 that appropriate prayers be recited in 
 a calm, audible voice ; and it is especially 
 fitting that ejaculations, words of resig- 
 nation and acts of contrition be spoken 
 into the ear of the dying person. The 
 following act of contrition was approved 
 January 13, 1921 : 
 
SPIRITUAL BIGHTS 107 
 
 my God! I am heartily sorry for 
 having offended Thee, because Thou art 
 so very good; and I firmly purpose by 
 the help of Thy grace not to offend Thee 
 again. (300 days indulgence.) 
 
 C. Christian Burial 
 
 All baptized adults, except those ex- 
 plicitly excluded therefrom, are to re- 
 ceive ecclesiastical burial. Catechumens 
 — those under instruction in the Catholic 
 Faith — who, with no fault of their own, 
 die without receiving Baptism, are to be 
 considered as baptized. Even the am- 
 putated members of Catholics, except 
 serious difficulties intervene, should be 
 buried in consecrated ground or at least 
 in a place on the hospital grounds set 
 apart and blessed for that purpose. 
 And, too, while the disposal of the blood 
 taken from our Christian dead in the 
 process of embalming has not been made 
 the object of specific legislation, yet 
 ordinary reverence demands that it be 
 
108 ACUTE CASES IN MORAL MEDICINE 
 
 not disposed of in an unbecoming man- 
 ner. (Ecclesiastical Review, January, 
 1921.) 
 
 Baptized infants are to be buried in 
 consecrated ground according to the 
 laws of the Church. Unbaptized infants 
 as human beings have a right to a re- 
 spectable interment. Xo matter how 
 immature, they should be buried de- 
 cently and should never be disposed of 
 in any other way. 
 
 In case of the death of both mother 
 and child, the child, be it unborn or still- 
 born, is to be buried with the mother 
 even though unbaptized. 
 
 Let it be noted here that there exists 
 no ecclesiastical prohibition of autopsies 
 and post-mortem examinations. Of 
 course the permission of the relatives 
 or friends of the deceased should be 
 obtained and the requirements of the 
 civil law fulfilled before any dissection 
 is begun. 
 
spiritual rights 109 
 
 General Conclusion 
 
 The substance of the foregoing pages 
 refers not only to the physical order, but 
 to the social and moral order as well. 
 Generally those who consider only the 
 physical aspect are extremely prone 
 to reach sentimental conclusions, but, 
 where right is directly concerned, senti- 
 ment must be set aside. 
 
 Not to mention the positive expression 
 of the Divine Will, there is a Natural 
 Law which may not be disregarded with- 
 out peril of conscience. No matter how 
 wholesome the intention, it is never al- 
 lowed to do evil that good may result. 
 
 Given the conditions explained in 
 treating Baptism of Necessity, it is 
 readily seen that it causes no grave in- 
 convenience, that it entails no loss of 
 dignity, that it does not lower self- 
 respect. The one who believes in God 
 need never be ashamed to manifest that 
 belief. Deference to the belief of others 
 
110 ACUTE CASES IX MORAL MEDICINE 
 
 and the promptings of mere natural 
 charity should be sufficient for those who 
 do not believe. It is therefore incon- 
 ceivable that anyone through a motive 
 of hatred, human respect or indifference 
 would refuse to perform this rite when 
 necessity demands it. 
 
 No matter what their personal per- 
 suasion, doctors and nurses in all justice 
 should respect the religious belief of 
 their patients. And while to the fulness 
 of their power they try to further the 
 temporal happiness of those entrusted 
 to their charge, they should not be un- 
 mindful of aught tending to insure their 
 eternal glory. Impoverishing not them- 
 selves, they may make others rich indeed. 
 
APPENDIX I 
 
 Decrees of the Holy Office 
 
 The Holy Office is the Roman Congregation 
 which deals with faith and morals. It consists of 
 a college of Cardinals under the presidency of the 
 Pope. They are assisted by numerous consultors 
 of different nationalities. They are not endowed 
 with the prerogative of infallibility, hence their 
 decrees are provisional and not definitive. Need- 
 less to say these decrees do not formulate a new 
 morality; they simply apply the eternal principles 
 of morals to specific cases. 
 
 The subjoined list contains the latest pronounce- 
 ments of the Holy Office on the topics treated in 
 the foregoing pages. The date is given first, that 
 the growth in the legislative utterances may be 
 grasped at a glance: 
 
 May 28, 1884. "Craniotomy" condemned. 
 
 August 19, 1889. "Every surgical operation di- 
 rectly destructive of the fetus 
 or the pregnant mother" con- 
 demned. 
 
 July 24, 1895. "Abortion" condemned. 
 
 May 4, 1898. 1. Premature labor in itself is 
 
 not illicit, provided it is done 
 for Sufficienl reason, and at 
 111 
 
112 APPENDIX 
 
 the time and by such methods 
 as will under ordinary cir- 
 cumstances preserve the life 
 of the mother and the fetus 
 
 2. Cccsarean delivery may be 
 performed at the proper 
 time, if the maternal pelvis 
 is so narrow that premature 
 delivery is impossible. Abor- 
 tion, however, is illicit in this 
 circumstance according to the 
 decree of July 24, 1895. 
 
 3. Laparotomy for the extrac- 
 tion of an ectopic fetus is 
 lawful, provided the lives of 
 both mother and fetus are 
 carefully safeguarded. 
 
 March 5, 1902. 1. The extraction of an ectopic 
 fetus before the age of via- 
 bility is unlawful. 
 
 2. No premature delivery is licit 
 unless effected at the time 
 and by the methods which, 
 under ordinary 7 circumstances, 
 will preserve the lives of 
 mother and fetus. 
 
APPENDIX II 
 
 Suggestions 
 
 These suggestions although in no wise entailing 
 an emergency, yet contain information of practical 
 value to a nurse: 
 
 1. When the sacraments are to be administered 
 a tidy room and clean bed linen are the simple 
 demands of ordinary respect. The patient, 
 too, should have been bathed, combed and 
 fittingly attired. Under his chin should be 
 placed a clean linen cloth to serve as a Com- 
 munion cloth. At the bedside there should be 
 a table, with a clean linen cover, on which are 
 placed 
 
 (1) A crucifix between two blessed candles 
 lighted, 
 
 (2) A glass with water, and a spoon, 
 
 (3) Holy Water and a sprinkler; a sprig 
 will serve. 
 
 This is sufficient preparation for the admin- 
 istration of Holy Communion. If Extreme 
 Unction is given on the same occasion, besides 
 the articles just mentioned, there should be 
 placed on the table: 
 
 (4) A plate with six small balls of cotton, 
 
 (5) Two little squares of bread. 
 
 113 
 
114 APPENDIX 
 
 The nurse may kneel during the administra- 
 tion of Holy Communion, but should assist 
 the priest at the anointing. 
 
 2. The nurse should be conversant with the ordi- 
 nary prayers, so that in case of necessity she 
 may recite them to the patient. For this pur- 
 pose a thorough acquaintance with a good 
 prayer book is strongly recommended. There 
 are a number of very good ones, such as 
 Manual of Prayers, My Prayer Book, With 
 God, Blessed Sacrament Book, Treasury of 
 the Sanctuary, Rejoice in the Lord, St. Vin- 
 cent's Manual, Welcome. 
 
 3. A nurse is called upon frequently to read to 
 a patient. Although it is not at all neces- 
 sary that she be a theologian, a historian or 
 a scientist, yet by a few well-directed ques- 
 tions she may readily obtain information as 
 to the classics in various fields, the safest 
 periodicals of current thought, and the best 
 works in modern fiction. Time is too valu- 
 able to waste, ideals too precious to destroy. 
 Only the best is good enough. 
 
 The following spiritual works are easily 
 procured and may be perused with benefit 
 and pleasure: 
 
 "Abandonment to Divine Providence," 
 
 Pere Caassade, S. J. 
 "Comfort and Consolations for the Sick," 
 
 Rev. Andrew Wyo. 
 "Consoler," Rev. Fr. Lambilette. 
 
APPENDIX 115 
 
 "Consolations of the Sick," Rev. Joseph 
 
 Egger, S. J. 
 "Counsels to the Sick," Kathleen 
 
 O'Meara. 
 "Devotions and Prayers for the Sick 
 
 Room," Rev. Joseph A. Krebs. 
 "Following of Christ," Thomas a Kempis. 
 "God and Human Suffering," Rev. Joseph 
 
 Egger, S. J. 
 "God and Myself," Rev. Martin Scott, 
 
 S.J. 
 "How to Comfort the Sick," Rev. Joseph 
 
 A. Krebs. 
 "Hospital Society Addresses," Rev. H. S. 
 
 Bowden. 
 "Night Thoughts for the Sick and Deso- 
 late," Rev. R. Eaton. 
 "Our Daily Bread," Rev. Walter Dwight, 
 
 S.J. 
 "Spiritual Pastels," J. S. E. 
 
 A. M. D. G. 
 
GLOSSARY 
 
 Abdomen. That portion of the body which lies 
 between the thorax and the pelvis. 
 
 Abortion. The expulsion of the fetus before it is 
 viable. 
 
 Alienable. Capable of being transferred or with- 
 drawn. 
 
 Amnion. The innermost fetal membrane forming 
 the bag of waters, within which the fetus de- 
 velops. 
 
 Anemia. Deficiency of blood either in quantity or 
 quality. 
 
 Anesthesia. Loss of feeling or sensation. 
 
 Antipyretic. A remedy for fever. 
 
 Antisepsis. The exclusion of the germs that cause 
 infection. 
 
 Apneic. Breathless, privation or suspension of 
 respiration. 
 
 Arch. See Pelvis. 
 
 Asepsis. Freedom from infection. 
 
 Atrophy. A wasting in the size of a part. 
 
 Cesarean Section. Delivery by incision through 
 abdominal and uterine walls. 
 
 Carcinoma. Cancer, a malignant tumor. 
 
 Celiotomy. Surgical incision into abdominal cav- 
 ity. 
 
 Cephalotomy. The culling of the fetal head to 
 facilitate delivery. 
 
 117 
 

 118 GLOSSARY 
 
 Cephalotripsy. The crushing of the fetal head to 
 facilitate delivery. 
 
 Cervix. The neck, or any neck-like part, — uteri, 
 the lower end of the womb. 
 
 Cholecystitis. Inflammation of the gall-bladder. 
 
 Chorea. St. Vitus' dance, a convulsive nervous 
 disease. 
 
 Chorion. The more external of the two fetal mem- 
 branes, the one which immediately encloses the 
 amnion. 
 
 Coma. Insensibility; profound stupor. 
 
 Comatose. In a state of coma. 
 
 Conception. The fecundation of the ovum. 
 
 Craniotomy. The cutting in pieces of the fetal 
 head to facilitate delivery. 
 
 Curette. A scraper for removing growths from 
 the walls of cavities. 
 
 Curettement. A treatment by the curette. 
 
 Cyanosis. Blueness of the skin from deficient 
 oxygenation of the blood. 
 
 Cyst. A sac. 
 
 Cystitis. Inflammation of the bladder. 
 
 Diabetes. A disease marked by habitually exces- 
 sive urine. 
 
 Diagnosis. The art of distinguishing one disease 
 from another. 
 
 Dilatation. The condition of being stretched be- 
 yond the normal. 
 
 Displacement. Removal from the normal position. 
 
 Duty. Moral obligation, something urged or for- 
 bidden by law and order. 
 
 Eclampsia. A sudden attack of convulsions; more 
 correctly a toxemic condition characterized by 
 hepatic lesions. 
 
GLOSSARY 119 
 
 Ectopic. Out of normal place. 
 
 Embryo. The fetus in its early stages of develop- 
 ment. 
 
 Embryotomy. The cutting up of a fetus to facili- 
 tate delivery. 
 
 Embryulcia. Destructive instrumental removal of 
 a fetus from the uterus. 
 
 Emmenagogue. Any agent stimulating menstrua- 
 tion. 
 
 Ethicist. One skilled in the science of Ethics. 
 
 Ethics. The science of morality. 
 
 Eugenics. The science dealing with the improve- 
 ment of inborn qualities. 
 
 Evisceration. Disembowelment. 
 
 Excision. The act of cutting away or out. 
 
 Fetus. The child in the womb after the third 
 month. 
 
 Fibroid. Resembling a fibrous structure. 
 
 Fibromyoma. A tumor containing fibrous and 
 muscular tissue. 
 
 Follicle. One of the small sacs in which eggs are 
 enclosed in the ovary. 
 
 Gangrene. The mortification of a part. 
 
 Graafian. Named after Rhinehart de Graaf, a 
 Dutch physician of the seventeenth century, — 
 graafian follicle. 
 
 Habitual. Pertaining to a habit, e.g., an intention 
 once formed and not retracted. 
 
 Hemorrhage. Bleeding. 
 
 Hemostasis. The checking of a flow of blood. 
 
 Hepatic. Pertaining to the liver. 
 
 Hernia. Rupture. 
 
 // yperemesis. Excessive vomiting; — gravidarum 
 of the pregnant. 
 
120 GLOSSARY 
 
 Hysterectomy. The excision of the uterus. 
 
 Immutability. The power of ascribing an act or 
 omission to another. 
 
 Inalienable. Not capable of being transferred. 
 
 Incarceration. The unnatural retention of a part. 
 
 Inoperable. Not suitable to be operated upon. 
 
 Inviable. Incapable of life outside the womb. 
 
 Laparotomy. Surgical incision into the abdominal 
 cavity. 
 
 Lesion. Hurt, wound, local degeneration. 
 
 Ligate. To tie or bind. 
 
 Liquor amnii. The waters enclosed by the amnion. 
 
 Membrane. A thin layer of tissue covering a sur- 
 face or dividing a space. 
 
 Menopause. The period when menstruation nor- 
 mally ceases. 
 
 Metastasis. The development of a disease in other 
 parts of the body from that in which it was first 
 localized. 
 
 Miscarriage. Birth of the fetus before viability. 
 
 Mole. A fleshy mass formed in the uterus by 
 degeneration of the ovum. 
 
 Morality. The quality of human actions which 
 determines their goodness or badness. 
 
 Mutilation. Deprivation of an integral part of 
 the human body; an act whereby a member of 
 the body is rendered unfit for normal action. 
 
 Myoma. A tumor made up of muscular elements. 
 
 Narcotic. Producing sleep or stupor. 
 
 Necrosis. The death of a part of the body, morti- 
 fication, gangrene; usually applied to bones. 
 
 Necrotic. Affected with necrosis. 
 
 Neoplasm. Any new and abnormal formation. 
 
 Neoplastic. Pertaining to neoplasm. 
 
GLOSSARY 121 
 
 Nephritis. Inflammation of the kidneys. 
 
 Obstetrics. The art of managing childbirth cases. 
 
 Obstetrician. One who practices obstetrics. 
 
 Operable. Capable of being operated with hope 
 of improvement. 
 
 Ovariotomy. Surgical removal of an ovary; more 
 correctly oophorectomy. 
 
 Ovary. The female sexual gland in which the ova 
 are formed. 
 
 Oviduct. Tube for passage of eggs from the ovary 
 — fallopian tube. 
 
 Ovum. The female reproductive cell. 
 
 Oxytocic. Accelerating delivery. 
 
 Parturition. The process of giving birth to a child. 
 
 Pathology. The science of dealing with disease. 
 
 Pelvis. Basin-like bony structure forming the 
 support of the viscera in human beings. 
 
 Placenta. The round, flat organ adhering to the 
 inner wall of the uterus which establishes com- 
 munication between the mother and child by 
 means of the umbilical cord. 
 
 Postulate. A statement assumed without proof; 
 the truths of kindred sciences granted without 
 demonstration. 
 
 Prognosis. A forecast as to the probable result 
 of a disease. 
 
 Pyelitis. Inflammation of a section of the kidney. 
 
 Pyosalpinx. Development of pus in the connect- 
 ing tube between an ovary and the uterus. 
 
 Responsibility. The state of being accountable or 
 liable. 
 
 Sarcoma. A tumor made up of substance like the 
 embryonic connective tissue. 
 
 Section. An act of cutting. See C cesarean. 
 
122 GLOSSARY 
 
 Sepsis. Poisoning by the products of a putre- 
 factive process. 
 
 Septic. Condition produced by sepsis. 
 
 Specific. A remedy specially indicated for any 
 particular disease. 
 
 Spermatozoon. The motile generative element of 
 the semen which serves to impregnate the ovum. 
 
 Sphenotripsy. Crushing the fetal head with an 
 instrument applied at the base of the skull. 
 
 Terata. Plural of teras, a monster, a congenitally 
 malformed fetus. 
 
 Therapeutic. Curative, pertaining to the art of 
 curing. 
 
 Thorax. The part of the human body between the 
 neck and the abdomen. 
 
 Toxemia. Blood poisoning induced from without 
 or developed from within. 
 
 Toxic. Poisonous. 
 
 Tumor. A morbid enlargement, a mass of new 
 tissue with no physiological use, growing inde- 
 pendently of surrounding structures. 
 
 Umbilicus. Navel. 
 
 Umbilical Cord. The cord attached to the navel 
 of the fetus which connects the fetus with the 
 placenta and carries its blood supply. 
 
 Uterus. The womb. 
 
 Vasectomy. The cutting away of all or part of 
 the vas deferens, i. e., the tube which carries 
 the sperm of man. 
 
 Vasotomy. Incision of the vas deferens. 
 
 Viable. Capable of living outside the uterus. 
 
BIBLIOGRAPHY 
 Part I 
 
 "Codex Juris Canonici." 
 
 "Decreta Congregationis Sancti Officii." 
 
 Antonelli, "Medicina Pastoralis." 
 
 Cathrein, "Philosophia Moralis." 
 
 Coppens, "Moral Principles and Medical Practice." 
 
 Cronin, "Science of Ethics." 
 
 De Lee, "Obstetrics for Nurses." 
 
 Dorland, "Medical Dictionary." 
 
 Genicot, "Theologiae Moralis Institutiones." 
 
 Gould, "Medical Dictionary." 
 
 Howell, "Physiology." 
 
 Klarmann, "The Crux of Pastoral Medicine." 
 
 Lehmkuhl, "Theologia Moralis." 
 
 Meroier-Arendt, "Ethics." 
 
 Noldin, "Summa Theologiae Moralis." 
 
 O'Malley, "The Ethics of Medical Homicide and 
 
 Mutilation." 
 O'Malley-Walsh, "Essays in Pastoral Medicine." 
 Ross, "Christian Ethics." 
 Spalding, "Talks to Nurses." 
 Williams, "Obstetrics." 
 
 Part II 
 
 "Codex Juris Canonici." 
 
 "Decreta Congregationis Sacrorum Rituum." 
 
 "Rituale Romanum." 
 
 123 
 
124 BIBLIOGRAPHY 
 
 Arregui, "Summarium Theologiae Moralis." 
 Ferreres, "Compendium Theologiae Moralis." 
 Frieburg Instruction, "Baptism of Necessity." 
 Ojetti, "Synopsis Rerum Moralium." 
 O'Kane, "The Rubrics." 
 Sanford, "Pastoral Medicine." 
 
 (Besides those mentioned under Part I.) 
 
INDEX 
 
 A 
 
 PAGE 
 
 Abortion 21 
 
 accidental 23 
 
 artificial 23, 25 
 
 condemnation of 10, 25 
 
 co-operation of nurses in 60 
 
 criminal 23 
 
 direct, defined 24 
 
 nature and morality of 25 
 
 Holy Office on Ill 
 
 indirect 28 
 
 conditions governing licit 31 
 
 induced 23, 25 
 
 therapeutic, defined 23 
 
 condemned 25 
 
 threatened 36 
 
 hemorrhage in 36 
 
 and contracted pelvis 27 
 
 and infectious diseases 26 
 
 and toxemias of pregnancy 26 
 
 and curettage 37 
 
 when pregnancy aggravates disease x?6 
 
 view of medical science 23 
 
 view of moral science 93 
 
 Actions 
 
 analysis of 15, 16, 17 
 
 morality of 17, 18, 19 
 
 moral determinants of 19 
 
 125 
 
126 INDEX 
 
 Actions — contiTvued page 
 
 vitiated by bad intention 13 
 
 with double effect 15 
 
 Anemia 
 
 pernicious, in pregnancy 27 
 
 Anesthesia 
 
 in pregnancy 27 
 
 Appendectomy 
 
 in pregnancy 35 
 
 A UTOPS Y 
 
 permission of relatives for 108 
 
 B 
 Baptism 
 
 administration of 68 
 
 conditional 72 
 
 in delivery 85 
 
 in emergency 75 
 
 intrauterine 85 
 
 of abnormalities 89 
 
 of adults 75 
 
 comatose 80 
 
 insane 79 
 
 unconscious 78 
 
 of children of non-Catholics 88 
 
 of ectopic fetus 85 
 
 of embryo 83 
 
 undeveloped 82 
 
 well-developed 83 
 
 of fetus 53, 81 
 
 of foundlings 88 
 
 of necessity, denned 67 
 
 of premature child 82 
 
 of probable fetus 83 
 
 of seemingly still-born child 81 
 
 valid minister of 68 
 
 water of 69 
 
 words of 70 
 
 Birth 
 
 acceleration of 
 
 when permissible 22, 98 
 
INDEX 127 
 
 Blood page 
 
 disposition of, after embalming 107 
 
 Books 
 
 list of spiritual 114 
 
 Burial 
 
 of adults, baptized 107 
 
 of amputated members 107 
 
 of Catechumens 107 
 
 of child with mother 108 
 
 of infants 108 
 
 baptized 108 
 
 unbaptized 108 
 
 C 
 
 Carcinomata 
 
 in pregnancy 34, 44 
 
 X-ray treatment of 47 
 
 Cephalotomy 20 
 
 Cephalotripsy 20 
 
 Celiotomy 
 
 and ectopic gestation 50 
 
 Caesarean Section 
 
 after death in pregnancy 97 
 
 and viable child 27 
 
 an obligation of performance by doctor or 
 
 nurse 98 
 
 Holy Office on 112 
 
 liberty of patient regarding 99 
 
 permission of patient's relatives for 97 
 
 placenta praevia, in 37 
 
 Cholecystitis 
 
 in pregnancy 35 
 
 Chorea 
 
 and abortion 26 
 
 Communion, Holy 103 
 
 physical condition for 102 
 
 preparation for 113 
 
 vomiting after 102 
 
 Conception 
 
 moment of 10 
 
128 INDEX 
 
 Consultation page 
 
 necessity of, for doctor 63 
 
 Contrition 
 
 act of 107 
 
 motives for 76 
 
 Craniotomy 
 
 Holy Office on Ill 
 
 CuRETTEMENT 
 
 in pregnancy 27 
 
 in case of mole 40 
 
 in threatened abortion 37 
 
 D 
 
 Death 
 
 of woman in pregnancy 94 
 
 moment of 104 
 
 sign of, in intact fetus 81 
 
 signs of, general 104 
 
 Delivery 
 
 baptism in 86 
 
 in separation of placenta 38 
 
 premature 27 
 
 Holy Office on Ill 
 
 requisites for premature 22 
 
 Diagnosis 
 
 uncertainty of proper 63 
 
 principles of moral 12 
 
 Dilatation 
 
 of os uteri 27 
 
 Diseases 
 
 infectious, in pregnancy 26 
 
 of the ovum 40 
 
 Doctor 
 
 and consultation 63 
 
 duty toward patient 109 
 
 responsibility of 63 
 
 when woman dies in pregnancy 97 
 
 Drugs 
 
 and duty of nurse 61 
 
 oxytocic 27 
 
INDEX 129 
 
 Duty page 
 
 of mother in pregnancy 27 
 
 of nurse 
 
 as custodian of professional knowledge 62 
 
 in illicit operations 57 
 
 in immature births 84 
 
 toward patients 109 
 
 of surgeon 
 
 to hold consultation 63 
 
 toward unborn child 63, 97 
 
 E 
 
 Eclampsia 26 
 
 Ectopic Gestation 
 
 and Baptism 51 
 
 and normal conception 54 
 
 and operative procedure 49 
 
 denned 48 
 
 Holy Office on 112 
 
 immoral treatment in 52 
 
 of doubtful diagnosis in 50 
 
 species of 48 
 
 Embryotomy 
 
 and co-operation of nurse 57 
 
 and medical science 9 
 
 morality of 20 
 
 Murphy, on 20 
 
 species of 20 
 
 Embryulcia 20 
 
 Emergency 
 
 demanding Baptism 75 
 
 Emmenagogue 
 
 in pregnancy 27 
 
 Euthanasia 
 
 immorality of 54 
 
 meaning of 55 
 
 Evisceration 20 
 
 Extreme Unction 
 
 preparation for 113 
 
130 INDEX 
 
 F 
 
 Fetal Life page 
 
 and direct abortion 25 
 
 and indirect abortion 28 
 
 and separation of placenta 37 
 
 Holy Office on Ill 
 
 Fetus 
 
 and carcinomata 44 
 
 and ruptured uterus 38 
 
 Baptism of 53, 81 
 
 in ectopic gestation 50 
 
 in mole 40 
 
 FlBROMYOMATA 
 
 and operative interference 42 
 
 H 
 
 Hemostasis 
 
 in ectopic gestation 50 
 
 Hernia 
 
 strangulated, in pregnancy 35 
 
 Holy Office 
 
 Decrees of Ill 
 
 denned Ill 
 
 Hydramnios 
 
 cf. Liquor Amnii 
 
 and ovum 41 
 
 Hysterectomy 
 
 and illicit operation 57 
 
 in case of mole 40 
 
 of tumor 42 
 
 Incarceration 
 
 and surgical treatment 36 
 
 Influenza 
 
 and pregnancy 26 
 
INDEX 131 
 
 IN VI ABILITY PAGE 
 
 and abortion 21 
 
 of fetus 38 
 
 Laparotomy 38 
 
 Law 
 
 Eternal 4 
 
 natural 5 
 
 Life 
 
 and State rights 7 
 
 beginning of 10 
 
 fetal 11 
 
 fetal rights to 54 
 
 fetal, termination of 20 
 
 inalienability of 7 
 
 inviolability of 9 
 
 of unborn child 9 
 
 right to, qualities of 9, 11 
 
 M 
 
 Malaria 
 
 and abortion 26 
 
 quinine in 34 
 
 Mole 
 
 involving fetus 41 
 
 removal of 40 
 
 Morality 
 
 basic principles of 5 
 
 norm of 5 
 
 of embryotomy 20 
 
 of abortion 25 
 
 of removal of ectopic 49 
 
 Morphine 
 
 administration of 55 
 
 Mother 
 
 duties in pregnancy 87 
 
 rights in pregnancy 28, 99 
 
132 INDEX 
 
 N 
 
 PAGE 
 
 Nephritis 26 
 
 Nurse 
 
 and Baptism 74 
 
 and illicit operations 57 
 
 and patient 109 
 
 and professional knowledge 62 
 
 suggestions for , . . . . 113 
 
 O 
 
 Obstruction 
 
 intestinal, in pregnancy 35 
 
 O'Malley 
 
 on cancer in pregnancy 44 
 
 Oophorectomy 
 cf. Ovariotomy 
 
 and illicit operations 60 
 
 Operations 
 
 co-operation of nurses in illicit 60 
 
 Holy Office on 112 
 
 illicit 60 
 
 in disease of ovum 40 
 
 in ectopic gestations 49 
 
 in normal pregnancy 34 
 
 in tubal pregnancy 50 
 
 in uterine tumors 42 
 
 on reproductive organs 57 
 
 Ovum 
 
 clear 41 
 
 disease of 40 
 
 P 
 
 Pelvis 
 
 contracted 27 
 
 malformation of 27 
 
 Physician 
 
 obligations — cf. duties 
 
 relation to abortions 34 
 
INDEX 133 
 
 Placenta page 
 
 placenta praevia 37 
 
 and premature labor 37 
 
 Caesarean section 37 
 
 Pneumonia 
 
 and abortion 26 
 
 Post-Mortem 
 
 permission of relatives for 108 
 
 Pregnancy 
 
 abdominal 49 
 
 appendicitis in 35 
 
 carcinoma in 44 
 
 cholecystitis in 35 
 
 disturbance of 25 
 
 extrauterine 48 
 
 interference with 28 
 
 intestinal obstruction in 35 
 
 medical treatment in 33 
 
 operative treatment in 34 
 
 ovarian 49 
 
 treatment in tubal 50 
 
 tubal 48 
 
 Pyelitis 27 
 
 Pyosalpinx 
 
 ectopic gestation 50 
 
 Q 
 
 Quinine 
 
 use of in malaria 34 
 
 in influenza 34 
 
 R 
 
 Radium 
 
 and cancer 47 
 
 and sterilization 5$ 
 
 Race Suicide 69 
 
 Religion 
 
 consolations of 101 
 
134 INDEX 
 
 Reproductive Organs page 
 
 illicit operations on 57 
 
 licit operations on 36, 57 
 
 Responsibility 
 
 in illicit operations 60 
 
 nature of 14 
 
 requisites for 16 
 
 Right 
 
 nature of 5 
 
 objects of 6 
 
 of State 7 
 
 spiritual 65 
 
 to life, qualities of 6 
 
 S 
 
 Sacraments 
 
 administration of 101 
 
 external preparation for 113 
 
 Last 101 
 
 and duty of Catholics 101 
 
 and doctor and nurse 101 
 
 Salpingectomy 
 
 illicitness of 57 
 
 Science 
 
 Moral, on life 10 
 
 Section 
 
 Caesarean 37, 98 
 
 Sickness 
 
 and calling friends 65 
 
 and calling priest 101 
 
 Sterilization 
 
 illicitness of 57 
 
 radium for 58 
 
 X-ray for 58 
 
 T 
 
 Toxemia 
 
 in ectopic gestation 52 
 
 species of 26 
 
INDEX 135 
 
 Tuberculosis page 
 
 and abortion 26 
 
 Tumor 
 
 carcinoma 44 
 
 fibromyoma 42 
 
 gangrenous 44 
 
 in ectopic gestation 50 
 
 intra-mural « 42 
 
 ovarian 35, 50 
 
 sub-mucous 42 
 
 enucleation of 43 
 
 sub-serous 42 
 
 tubal 36 
 
 special case of 42 
 
 Twilight Sleep 
 
 medical authorities on 56 
 
 morality of 56 
 
 Typhoid 
 
 and abortion 26 
 
 U 
 
 Uterine Adnexa 
 
 cure of 35 
 
 Uterus 
 
 curettement of 27 
 
 excision of 28 
 
 removal of 58 
 
 rupture of . . . , 38 
 
 incarceration of 36 
 
 V 
 
 Vasectomy 
 
 illicitness of 58 
 
 Viability 
 
 O'Malley on 21 
 
 period of arrival at 22 
 
 Viaticum, Holy 
 
 preparation for 113 
 
136 INDEX 
 
 w 
 
 Williams page 
 
 on ectopic gestation 49 
 
 on Twilight Sleep 56 
 
 X 
 
 X-RAY 
 
 illicit use of 27 
 
 licit use of 47 
 
 use of, for sterilization, immoral 58 
 
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