1. ANESTHESIA

THE BLESSINGS of ANESTHESIA are best appreciated in the light of the millenia of agony that preceded it. Only opium and compression with clamps had been available to partially dull the pain of surgery and disease.

In The journals of Fanny Burney (The Journals and Letters of Fanny Burney  (Madame D’Arblay), Vol. 6, France, 1803-1812, ed. Joyce Hemlow et. al., Oxford, 1975), a Victorian novelist describes her mastectomy in 1812 without anaesthetic. She had consulted a surgeon after discovering a lump in her breast.  She received a message that surgery was necessary, and that the surgeons would come to her home. The operation was performed in her apartment, after she had contrived to send her husband and son away on several errands:

ANESTHETICS began to be used seriously beginning in the United States with Horace Wells, (1815-48), a dentist who employed nitrous oxide for dental extraction in Boston in 1844. In 1846 the dentist William Morton (1819-68) was able to demonstrate the value of ether in a surgical demonstration in Boston. Shortly thereafter the practice was taken up in Britain; and in 1847 the Scottish physician James Simpson (1811-70) introduced chloroform for use in obstetrics.

 2. ANTISEPSIS and INFECTIOUS DISEASE

Edward Jenner “Vaccinated” (from cows) patients with cowpox pus rather than “innoculating” patients with what was hoped to be an attenuated form of the disease: i.e. pus from smallpox sufferer.

AS a junior surgeon in Vienna, Ignaz Semmelweis observed a high incidence of often-fatal puerperal sepsis (child-birth fever) among women whose infants were delivered by students who had come directly from dissecting corpses in the morgue.  Requiring students to wash their hands with chlorine-water before performing deliveries effectively eliminated this dreaded complication.  His professional colleagues reacted with fury at Semmelweis' insistence that they must wash their hands, and Semmelweis was effectively driven out of Vienna.  He achieved the same results in the obstetrical wards in Budapest, was again excoriated by the medical community, and died, probably as a result of beating by guards, two weeks after his involuntary commitment to an insane asylum in Vienna

THE memorial bas-relief of Semmelweis in the “Hall of Fame” at the University of Vienna is an astonishingly hypocritical acknowledgement of his genius by an institution that unrelentingly persecuted him during his lifetime and probably contributed to his insanity.

LOUIS PASTEUR, one of the truly great scientists of the nineteenth century, was a chemist who discovered that organisms in the air could make wine sour.  He discovered how to prevent this contamination and how to kill the causative microorganisms with heat (1862). 

PASTEUR went on to develop immunizations for chicken pox, cholera, diphtheria, anthrax (1870) and rabies (1876). However, his recommendation that surgical instruments be boiled before before surgery so as to kill microorganisms (aseptic surgery as opposed to Lister's antiseptic surgery - Lister was a physician and surgeon) was not heeded until the 20th century.

 3. NURSING

NURSING, particularly in the English-speaking world, underwent a regression from the seventeenth through the early nineteenth centuries.  Part of this was the result of the Reformation and the dissolution of monastic and religious orders that had provided health care throughout Western Europe since late antiquity.  In Protestant countries the monasteries which had formerly provided food, medicine, and shelter for the needy were disbanded and their lands were given to nobles loyal to the Crown, who were not always committed to  caring for the poor.  In Catholic countries the Enlightenment philosophers derided the religious orders as corrupt and parasitic, and urged Catholic rulers to emulate their Protestant counterparts by secularizing the religious orders and confiscating their extensive landholdings: this the rulers of France, Bavaria and Austria were only too eager to do.  This could not have happened at a worse time, as industrialization and urbanization increased overcrowding, taxed sanitary facilities and promoted infectious diseases.  Following the religious persecutions and secularizations of the French Revolution the situation became desperate.  Some religious orders devoted to care of the sick had survived and continued to maintain hospitals they had established; but the need was far greater than they could supply.

Into this malaise there stepped a Protestant laywoman, willing to learn from Catholic nursing orders, and eager to establish the profession of nursing in a position of respect and honor.

MODERN ADAPTATION of the IDEALS and PRACTICES of the NURSING ORDERS

Florence Nightingale experienced a conversion a - “call to service” - on Feb. 7 1837, when she was age sixteen. Not initially permitted to study nursing by her family, she eventually visited hospitals throughout Europe, workhouses in England, and Roman Catholic nursing orders on the Continent. At age thirty-one she was able to spend three months at the Lutheran Deaconess Institute at Kaiserswerth At thirty-three that she was permitted to take a position as a nurse, superintending an institution for ill governesses in Upper Harley St., London.

In 1854-56, at age thirty-four she led the nursing team for the British Army in the Crimean War, and returned a national heroine for saving lives and reforming many practices, against significant opposition from the military physicians. She then began her perhaps even more influential career as a foundress of teaching institutions, a political advocate of the poor, and a social reformer. 

 4. PUBLIC HEALTH and HYGIENE

OTHERWISE well-known for his work on obstetrical anesthesia, Dr. Snow, was able to determine the cause of a horrific outbreak of cholera in the Soho district of West London that began on August 31, 1854: overnight, within a radius of a few blocks, doctors reported 56 new cholera cases. By the next evening there were 143, and the death toll had reached 70 and was climbing.

Snow analyzed the new cases on a map and determined that a public water pump, the Broad Street Pump, was the center of the outbreak.  He had the pump handle removed, and the outbreak ceased. Water pumped to that location from the Thames river had been contaminated by sewage. 

Investigators such as John and Sonya McKinlay and Thomas McKeown have emphasized that the primary determinants of change in mortality rates over the past three centuries included:

A. Improvement in the nutritional status of the population

B. Improvements in living environment and non-medical technology

C. Impact of the hygiene and public health measures (such as improving water quality and sewage disposal)

D. Demographic changes - (reduction in overcrowding)

E. Changes in the biological organism causing the disease (i.e.: changes in the organisms influence transmission and zero mortality rates)

 5. MEDICAL PRESTIGE and PATERNALISM

DURING the nineteenth century the movement to base the practice of medicine solely on experimental and reproducible science, rather then unproven inherited theory, accelerated.  “Orthodox” (“allopathic”) physicians progressively distanced themselves from popular (and often lucrative) fringe therapies, such as passing small magnets or “tractors” over affected body parts.  Phrenology, popular since the late eighteenth century, was declared to be a pseudo-science in 1845.  Unproven, sometimes dangerous nostrums, such as arsenic wafers to improve the complexion, and radium water were increasingly subjected to closer scrutiny and government intervention, guided by an increasingly organized medical community.

Trained as a physician at Edinburgh University in 1765, Thomas Percival coined the term “medical ethics” in a pamphlet he later expanded into a book, occasioned by a disedifying and dangerous dispute between health-care workers at the Manchester Royal Infirmary

In 1792, a festering dispute, exacerbated by a pamphlet war, erupted into a work stoppage by surgeons that coincided with the outbreak of an epidemic. Hospital trustees were outraged that desperate patients were being turned away from the hospital because of a dispute between surgeons. They called upon Percival to lead a committee to draft rules to prevent any recurrence of this fiasco. The committee drafted the needed regulations, which were promptly implemented. Then, two years later [...] Percival published Medical Jurisprudence or a Code of Ethics and Institutes' Adapted to the Professions of Physic and Surgery. Nine years later he issued the revised pamphlet as a book, Medical Ethics.

Michael Davis, Writing a Code of Ethics, (1999)

The following text from Percival's Medical Ethics was incorporated word-for word into the First Code of Medical Ethics of the A.M.A. (American Medical Association) in 1847:

Public health measure aimed at widespread  public hygiene were significantly reducing infant mortality and epidemic disease.  Medicine became increasingly “paternalistic”, with physicians demanding passive cooperation from patients, who were generally assumed to be incapable of understanding the complexities of medical science.  Patient compliance was presumed, not necessarily earned or encouraged as in Hippocratic times, especially as effective antimicrobial drugs were discovered. It became increasingly taken for granted that:

 6. PIUS IX and ABORTION

CONTINUING advances in microscopic anatomy led to the development of a new subject in medicine, embryological development.  Two early contributors to the burgeoning science of embryology were Caspar Friedrich Wolff (1733–1794) a German physician, surgeon and physiologist, and  Karl Ernst von Baer (1792–1876), an Estonian zoologist who in 1827 was the first to described the human egg cell or oocyte.  Their publications described and depicted very early embryological development, necessarily calling into question traditional philosophical distinctions between preanimate and animate (ensouled) stages in the human embryo.

It is probable that advances in the science of embryology played a part in enabling Catholic theology to develop beyond the ancient distinctions of animate versus inanimate life, and the notion of a succession of different kinds of souls in the human embryo. A related theological development was the promulgation by Pope Pius IX of the doctrine of the Immaculate Conception of the Blessed Virgin Mary.  It will be recalled that Thomas Aquinas had insisted that the distinction between an animate and inanimate embryo could not apply in the case of Christ's conception and embryonic development.  With his official declaration that the Blessed Virgin Mary had been conceived without sin “from the first moment of her conception,” Pope Pius IX effectively implied that this distinction could no longer be applied to any human being: for unless one has a soul, there can be no question of either freedom from or subjection to original sin.

The canonical implications of this were formalized in 1869 when Pope Pius IX removed the distinction between formed and unformed in his bull Apostolicae Sedis moderationi.  The canonical penalty for abortion had remained unchanged since 1591, when Pope Gregory XIV (Sedes Apostolicae) imposed excommunication, reserved to the bishop, for abortion of a formed foetus. The legislation of Pius IX thus effectively returned to the ancient canonical approach of St. Basil the Great (“we make no subtile distinction between formed and unformed”).  Apostolicae Sedis moderationi imposed excommunication reserved to the bishop for any abortion at any stage: the same penalty that remains in place for Catholics at the present time.

It may be helpful to briefly review what we have see so far in order to more clearly appreciate that the tradition we are tracing represents the development of doctrine and not a substantive “change” in the Church's teaching concerning the need to protect human life from its beginnings.

1. From the earliest years of the Christian Church both abortion and the failure to care for newborns have been regarded as serious sins.  This teaching has remained unchanged since the late first century.

2. During the fourth century the establishment of formal canonical penalties for sins raised the question of what penance to impose in the case of abortion.  While it was considered the moral equivalent of murder (and sometimes suicide, as well), it became the norm to assign a lesser penance to abortion than to murder.  This was not because of the nature of the act itself, but rather out of pastoral consideration of the psychological and social circumstances that often accompanied it: women who attempted abortion ware often abandoned, frightened and desperate, and thus not fully morally culpable.

3. From the fifth through the ninth centuries the Christian Church in the West encountered cultures (e.g. Celtic and Germanic) that had already established varying criminal penalties for violence against pregnant woman: these penalties were more severe and approximated those for homicide when the pregnancy was advanced.  Christian penitential discipline in the West made use of these existing legal traditions as a way of emphasizing the gravity of the sin of abortion.  The adoption of Aristotelian physics and metaphysics by western theologians in the twelfth century provided what was thought to be a scientific basis for the distinction between the grave sin of abortion early in pregnancy and the even more heinous sin of late abortion, which was regarded as the moral equivalent of homicide.

4. Theological debates from the fourteenth through the sixteenth centuries necessitated a clearer and official articulation of the Church's position by the magisterium.  Abortion was declared to be a “reserved” sin that carried the penalty of an excommunication that could be remitted only by the bishop.  Scientific developments in the eighteenth and nineteenth centuries confirmed the ancient conviction that distinctions between early and late abortions were arbitrary and the penalties were therefore applied without regard to the stage of pregnancy.  This does not represent a lessening of pastoral compassion; rather, in a culture that trivializes abortion and even seeks to defend it as a “right”:

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