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Whither, Ethics in Medicine?

By

JOHN F. QUINLAN, M.D.

San Francisco, California

( Reprinted with permission from “The Linacre Quarterly**)

New York, N. Y.

THE PAULIST PRESS
401 West 59th Street



Deacfdifier*



Whither, Ethics in Medicine?

TTISTORY runs as the growth of a man, slowly,

persistently, imperceptibly. Its course can be

appraised through the run of ages as a man's in in-

fancy, youth, adolescence, maturity. It runs with

all its parts. Let us examine the course of medicine.

From the dawn of its scientific era the sociolog-

ical ramifications of Medicine were well appreciated

;

so well appreciated that the applicant to practice

was required to subscribe to a formula of conduct

before being admitted to apprenticeship .
1

*
2 And

sanction for this subscription was had in recourse

to the deity with a prayer of benediction for com-

pliance and a curse for its transgression. He called

upon the deity as the witnesses for his earnestness

;

for his piety and devotion to his teachers; for his

honorableness in practice specifically withholding

himself from the malpractice of abortion; for the

uprightness of his life; for the secrecy of informa-

tion entrusted to him in the performance of his

duties
;
for his deference to the more skillful in times

of difficulty.

But all this is by way of tradition. The earliest

recorded version of a Hippocratic oath is the cruci-

form Christian Oath of the tenth or eleventh cen-

tury . 2 Its only essential difference from the so-

called Pagan Oath is that the Witness for the Chris-

tian is the Trinity. The bodies of the oaths are

otherwise similar in their brevity of form, and sub-

stance. From these features we may judge that

3



4 WHITHER, ETHICS IN MEDICINE?

much was left, because it could be on account of a

common Faith or Religion, to the conscience of the

individual.

But it is not so with us. The religious upheaval

of the sixteenth century wrested from Christendom

its unity of Belief, the common ground upon which

all matters of ethics must be judged. For, as Ches-

terton says, speaking of standards: “If I would

measure the distance between the earth and the

moon my reed must not be in a pot.”

And what has been the result? Out of deference

to the amoral and unbelieving segments among us,

our principles have degenerated into mere codes

which require frequent recodifications, amplifica-

tions, deletions, to allow for the changing conven-

tions of the times. In its own short history Ameri-

can medicine has modified its principles of ethics

several times. It has become so wanting in logic

and the meaning of terms that “Principles” is sub-

stituted for “Code” with the ease and flaccidity of

an alcoholic’s gesture. Its Principles of Medical

Ethics is but a sad prototype for any book on eti-

quette.

The Christian Age gave man much. Though it

was ignorant of Science (as we know it) it showed

him the meaning of life, demonstrated its purposive-

ness and intelligibility, and rediscovered for him the

principles upon which it could be directed to its end.

While these principles were yet virile as the inspira-

tion of man’s activity, Sydenham could say : 3 “Who-

ever takes up medicine should seriously consider

the following points, firstly, that he must one day



WHITHER, ETHICS IN MEDICINE? 5

render to the Supreme Judge an account of the lives

of those sick men who have been entrusted to his

care. Secondly, that such skill and science as, by

the blessing of Almighty God, he has attained, are

to be specially directed towards the honor of his

Maker and the welfare of his fellow creatures : since

it is a base thing for the great gifts of Heaven to

become the servants of avarice and ambition.

Thirdly he must remember that it is no mean or ig-

noble animal that he deals with. Lastly he must

remember that he himself hath no exemption from

the common lot, but that he is bound by the same

laws of mortality and liable to the same ailments

and afflictions with his fellows. For these and like

reasons let him strive to render to the distressed

with the greater care, with the kindlier spirit, and

with the stronger fellow feeling.”

More than three hundred years have passed since

Sydenham’s day. The principles by which his con-

duct was motivated, the heritage of a more Chris-

tian age, have become diluted with the sophistries

of the Industrial Age in which we live. They no

longer move man’s life or regulate his conduct. The

modern physician has his own code, appraises his

own actions, and is accountable only to himself

—

except he fall afoul of the law. He is in the service

of Humanity and Humanity cannot exact an account

of what he does. He has become so engrossed in

Humanity that he is forgetting his patients are hu-

man
;
forgetting that man is body-soul and not body

alone.

And what is the result? Having lost sight of



6 WHITHER, ETHICS IN MEDICINE?

fundamental principles we have had recourse to

conventional rules or codes to which we can give but

nominal assent. Where there is no common con-

viction there can be no conformity. And, in our

bewilderment, we cry out for a “guild,” forgetful

again of the one thing that gave the guilds suste-

nance and made them practicable.

An instance of our present state of confusion is

the cry that goes up for the general practitioner.

We have forgotten the service for which our pro-

fession has been renowned and have thought pri-

marily of remuneration. That is the primary rea-

son for the glut in specialism. In consequence we

have had to emphasize our service to the public.

We have done it so well that our astute politicians
would make us truly the public’s servants. And,

now that the remuneration of specialism is rapidly

lessening, and specialists are widening the fields of

their activity, and realizing the thing called “exten-

uating circumstances” and making allowances for it,

the little fellow over the drug store is coming into

his own again and is having a halo placed over his

head.

In his comment upon the Majority Opinion con-

cerning the Study of the Cost of Medical Care,

Cushing 4 well illustrated our present dilemma as

regards the dearth of general practitioners in his

parable of the knife-maker. He wails the loss of the

family doctor who was the family adviser as well.

He pleads for more men to engage in general prac-

tice because the nation needs more old-time family

physicians.



WHITHER, ETHICS IN MEDICINE? 7

But, to engage in general practice and be a gen-

eral practitioner, as Cushing implies, is not the

same thing. The general practitioner was the fam-

ily adviser and counselor. To be a counselor pre-

supposes convictions; convictions follow from prin-

ciples; and principles are established upon a phi-

losophy of life. Ours seem to be naught but the

transigence of Pragmatism. Until our profession

is infused with an immutable philosophy it cannot

expect to fill the need of the general practitioner.

Let us go on ! The aspirant to medical practice

during four long years is filled with the glory of

Medicine, is steeped in its noble traditions, and ab-

sorbs its high idealism. The while, he is exposed

to the stress laid upon the economics of medicine

and the propaganda for the inclusion of courses re-

lated to it in the medical curriculum. He is taught

indications for abortion which are limned with a

gravity that leaves him impressed only with its

questionable necessity. Then, in glorious proces-

sion, in cap and gown, following the file of an awe-

some professorate in the beautiful multicolored vel-

vet capes of their various distinctions and schools,

to the assembly hall to receive the reward of his

labors. With cap in hand, shielding his heart and

the precious parchment he has won, and head erect

he intones, in silly solemnity, the pagan Hippocratic

oath, swearing before gods that are not, for prin-

ciples the existence of which he can only question

but, nevertheless, impressing him with the idealism

of his brothers of a former day.

He engages in practice. He calls upon his elders,



8 WHITHER, ETHICS IN MEDICINE?

sometimes his old teachers, in his difficulties only

to find that problem and patient, as well as his

meager sustenance are deftly maneuvered from his

control into their own. And they have with them

young men who are nurtured to continue and extend

the pernicious practice. He hears of exorbitant fees

and the exaction of fees before service is rendered.

He observes their bitter jealousies; often, malicious

slanders. He notices with what dexterity the laws

regulating the practice of therapeutic abortion are

circumvented. He observes with what noble con-

sistency his colleagues in public life fight for hon-

esty in the food and drug traffic and its advertising

while, at the same time, they sponsor, on the radio,

proprietary medicines whose only merit is a price

several times that of an equivalent article not bear-

ing the copyrighted name; a member of our es-

teemed College of Surgeons founded to end the per-

nicious practice of fee-splitting, conducting a pro-

gram for Lysol. These men, as often as not, hold

high places in academic circles and in the councils

of our societies. There he has heard their effusions

for better ethics. He wonders, and logically con-

cludes: Ethics, for our saps and saplings!

He falters in his adherence to professional ideal-

ism and ethics. Often he fails
;
the pressure against

them has been too persuasive. But he is made of

weak stuff and is unworthy of his high calling who

would find excuse for failure in the example of these

perfidious brothers. He is unworthy of the trust

of the secrets of other men's tribulations and some-

times their very lives. But how can he show that



WHITHER, ETHICS IN MEDICINE ? 9

devotion to his teachers, that deference to the more

skillful, when they prove themselves so unworthy

of it?

In these considerations I have shown how the

lack of ethical principles has affected our conduct

towards each other. In what follows, it is my pur-

pose to show how it affects our conduct towards our

patients, the peerage of medicine, and the common-

weal.

We are all teachers, some formally by choice, all
by circumstance. Though we may not be professors

of medicine we are all instructors in the fields of

sociology. We teach in the classroom, at conven-
tions, at the bedside, in the sancta of our offices,

over teacups. What we advance and support in the

name of Science will have more weight in molding

Public Opinion than reams of polemics. Questions

to the fore at present, upon which we should declare

ourselves because of their medico-sociological im-

portance are: sterilization of defectives; disposal of

the incurably affected; abortion; and contraception.

So far, from us there has been only an ominous si-

lence; or, what is worse—officially—an attitude of
unconcern or “scientific detachment,” as it is called

in the J. A. M. A . 6

Sterilization

The object of our ministrations is a human be-

ing. For, if he be not human, we are not physicians

but veterinarians. He is free. He has rights which

are prior to the State. There is a law of nature

written in the heart of man confirmed by religion,



10 WHITHER, ETHICS IN MEDICINE?

and which forms a part of the basic philosophy of

our American State: “All men are created equal.

They are endowed by their Creator with certain in-

alienable rights, that among these are Life, Liberty,

and the Pursuit of Happiness. That to secure these

rights Governments are instituted among men”

These rights are inalienable; they may not be re-

linquished though they can be forfeited; nor are

they dispossessable. As the State, anticipating a

crime, may not punish a man, much less may it pun-

ish him in anticipation of an inconvenience. But,

in view of its foreknowledge, it has the duty of pro-

tecting the community against any possible attack.

A frankly insane person cannot commit a crime,

and, the State recognizing this, rightly segregates

him from the rest, preventing him from abusing the

faculties the proper use of which he is incapable of

realizing. The idiot, the imbecile, and the feeble-

minded, in a measure, are insane. To that ex-

tent they are incapable of crime. The State has no

authority over their persons; but it has the duty

of securing for them the possession of their facul-

ties while it safeguards the community from the in-

conveniences which are the result of their irration-

ality; poverty, squalor, social diseases, enfeebled off-

spring.

And, here we come to the consideration of

heredity. It is a long jump from peas and rats and

flies under absolutely controllable conditions to the

gregarious human. Regardless. There are two

kinds of heredity, the one, intrinsic, absolutely in-

dependent of environment; the other extrinsic, con-



WHITHER, ETHICS IN MEDICINE? 11

ditioned thereon. If I have a defect that is intrin-

sically heritable it must have been a blossom on my

genealogical tree; it is characterized by recessive-

ness; if it is obvious it must have existed in the

chromosomes of both my parents—and in the same
order

;
and the instances of its occurrence were more

numerous the farther back my genealogy is traced.
The obvious conclusions for this kind of defective

heredity are : Since it has a tendency to perpetuate

itself only in purity, its elimination can most ef-

fectively be accelerated by mixed breeding. Al-

binism remains dominant in a colony of Central

American Indians because of inbreeding. It has

been dissipated from a colony in western Canada

by the infusion of unaffected stock. And polydac-

tylism disappeared from a colony in Brittany by

the same means. The same result 7 will follow in

cases of hereditary blindness, otosclerosis, the abi-

otrophys or any other intrinsically heritable dis-

ease.

The instances of the occurrence of this kind of

heredity as a recessive characteristic are discover-

able only through the offspring. Sterilization, be-

cause of the complex and unpredictable character

of hereditary transmissibility, and the unwholesome

results for the community (to be discussed later),

is but a futile gesture.

The eastern seaboard Indians, seeing in what

a maze the colonists were with the maize-seed they

had given them, in stunted stock and sparse yield,

advised them to put rotted fish in the soil when the

seed was being planted. The rotten fish applied



12 WHITHER, ETHICS IN MEDICINE?

when the seed was planted was responsible for a

luxuriant growth and prolific yield; when applied

after the stalks were half-grown it had to be used

more generously and, as often as not, the yield was

disappointing; when applied after the stalks were

full-grown the results were fruitless. The quality

and abundance of the corn was as much, if not

more, dependent upon the character of the soil as it

was upon the factors inherent in the seed. This is

the type of conditioned heredity. The stock is man,

the seed his character, the soil the conditions in

which we live, and the rotten fish the irksome re-

strictions with which civilization surrounds us that

our best characters may be produced. And we are

in a maze. Our eugenists and geneticists would

have us destroy the seed by sterilization rather than

apply the needed fertilizer.

The present generation of Japanese, on the av-

erage, is taller by one inch than the generations pre-

ceding it. It has been brought about by the institu-

tion of a Western dietary. Before a recent medical

conference at the University of California a boy of

nineteen was presented as a case of constitutional

psychopathic personality. In the discussion it was

stated, almost as an irrelevancy, that he had indul-

gent parents, and that all his desires were acceded

to from early infancy. A few years ago at the San
Francisco State Teachers College, Behaviorism held

forte; let the child express itself; it should not be

hampered with restrictions; they tend to form only

shut-in characters and to warp the personality.

How soon its force was dissipated ! And now, from



WHITHER, ETHICS IN MEDICINE? 13

the University of California, we hear over the radio,

in a series of lectures on Education to Character,

that the child must be taught to say “no.” Self-

restraint as the cardinal principle in character for-

mation is again being asserted and the biblical

adage of sparing the rod and spoiling the child is

being proven daily with increasing emphasis.

We little realize that for years, long before the

days of Jung and Freud, Catholic sociologists have

been carrying on this work of character reclama-

tion. The Sisters of the Good Shepherd and others

have been taking girls before they were confirmed in

their Behavioristic tendencies and, after years of

patient and relentless guidance, have returned them

to the community as useful citizens. Were many

of them allowed to continue in the path of least re-

sistance they would, no doubt, reach the stage that

would entitle them to the label “constitutional psy-

chopath.”

The crime wave is assuming tidal proportions.

We hear much of its causes and of committees in-
vestigating them. In our confusion we cry out:

“Something must be done.” It is only “something.”

We do not know what. We remain unimpressed
when it has been discovered that the teachers in our

schools have been bought by big business or com-

munistic groups, or subserve other selfish projects.

Their interest is not the child or its welfare which,

in the end, is the welfare of the State. How timely
it is that out of the city that might be called the

“nation’s shooting gallery” should rise the Catholic

Youth Organization, a movement whose purpose it



14 WHITHER, ETHICS IN MEDICINE?

is, under competent religious guidance and leader-

ship, to direct the mind of youth into channels which

will lead to the formation of wholesome characters.

In a few years we may look for the trough to appear

in the tidal wave of crime through the instrumen-

tality of just such organizations.

Insanity is on the increase. Some authorities

claim the increase is out of proportion to the in-

crease in population. Psychiatrists tell us that it

is due, in great measure, to the complex civilization

in which we live, to the strain incidental to making

a living. Temperaments which would bear up well

in a simpler environment crack under the strain in

our own. Schizophrenia is given as an illustration.

Doesn’t it strike you that much of life’s complexity

is needless? Why this obeisance to wealth, to posi-

tion, to learning? These futile goals which men

have set for which they goad themselves beyond

their endurance are, in greatest measure, responsi-

ble for this rupture.

Euthanasia

Human life is sacred. Its inviolability is en-

graven in the heart of man and is confirmed in the

Commandment of the Decalogue: “Thou shalt not

kill.” The fathers of our country thought so highly

of it that they named it first of the gifts of man’s

Creator for which they were ready to sacrifice their

lives. We are its custodians. We are not free to

abuse it. The physician who is a Christian, recog-

nizing this law and its confirmation in the Fifth

Commandment, is deterred from any inclination to



WHITHER, ETHICS IN MEDICINE? 15

stifle it no matter what course expediency may dic-

tate.

However, many of our fraternity are not so

minded. With them the sentimental novelist has his

way. Their imaginations are so possessed that their

reason is clouded and the normal relationship of

man-to-man is lost sight of. Under a mask of sym-

pathy and compassion for the enfeebled aged—the
crippled old father, the paralytic old mother—the
duty of filial piety is discarded, and Nirvana, in the

form of painless death by poisoning, is substituted.

Some of these exponents of a New Medicine, inse-

cure in the possession of the license which shields

their ignoble acts, or sheepishly aware of an “an-

tiquated code” which they cannot ignore, content

themselves with proffering the fatal hemlock. Eu-

phemism has the day. Under the guise of Eutha-

nasia murder is committed or the stage is set for

the suicide.

Is there nothing for us in the selfless devotion of

father and mother, of sister and brother, or the dis-

interested service of religious to what modern man

may call “these animated gangling hulks”? By what

then does civilization advance? Osier answers for

us

:

8 “The spirit of Love only received its incarna-

tion with the ever memorable reply to the ever

memorable question—Who is thy neighbor?—a re-
ply which has changed the attitude of the world.”

But if we should not have these incurables where

would Medicine be? Yesterday's impossibilities are

Today's realities
;
Today's problems are Tomorrow's

discoveries. There is a meaning in Life. There is



16 WHITHER, ETHICS IN MEDICINE?

a plan in the universe. Who am I that I should con-

stitute myself competent to judge the part that you

should play, and how, and how long you should play

it? We are here to heal or assuage suffering hu-
manity not to snuff it out. “I will give no poison”

applies as well to us as it did to the pagan or the

medieval Christian.

Abortion

There is another phase of this materialistic phi-

losophy by which man is degraded to the level of

the beast and which accounts for the levity with

which man’s life is taken. A unity of identity is
recognized in the seed in the pod, the seed in the

sod, the tender sprout, and the flowering vine. And,

yet with human nature we would make distinctions

;

we will not see a unity running through the un-

formed embryo, the foetus, and the infant. Though

it would be abhorrent to us to take an infant’s life

we do not falter in the commission of a foeticide.

The therapeutic abortionist differs little from the

radical eugenist. Both stand on the untenable

ground of expediency. Make of this what you will

;

it is the reply of Dr. W. J. Robinson 9 in the

J. A. M. A. to the review of his book, The Law
Against Abortion, in an earlier issue: “Your re-

viewer places foeticide, infanticide, and homicide

on exactly the same level. . . . when I initiated the

propaganda for birth control thirty years ago, the

same thing exactly was said about the prevention

of conception that is now being said about abortion.

. . . Perhaps twenty-five years from now the views



WHITHER, ETHICS IN MEDICINE? 17

on abortion, in certain cases, will also undergo a

radical change. . . .
”

The obstetrician who would do an abortion, in a

sober moment, uninfluenced by the stress of circum-

stance will, more often than not, admit that the

course is little changed by abortion in the cases in

which it is considered indicated. Yet, in these par-

ticular circumstances, because of the tense atmos-

phere—the tearful cry of the patient for help, the
anguished pleading of husband and family, and his

own welling compassion for the patient’s sorry lot

—because he lacks that disposition of soul which
Osier so highly prized as the possession of the true

physician— equanimity — and because he cannot
realize the courage that is required of him in

“standing by,” he falteringly advises abortion or

foetcide.

But many of our fraternity are not swayed by

argument from natural ethics. Statistics is their

god so we must make him speak. The most frequent

indications for abortion are convenience, pernicious

vomiting, nephritis, eclampsia, heart disease, and

tuberculosis.

The toxemias of pregnancy include hyperemesis

gravidarum, eclampsia, and nephritic toxemia.

Straus and McDonald state

:

10 “As yet not one of the

toxins allegedly responsible for the anemias of

pregnancy, the polyneuritis of pregnancy, for hy-

peremesis gravidarum, or for eclampsia has been

identified, isolated, or recovered in any form.”

Their presence, though not of other abnormal sub-

stances, in eclampsia and other severe toxemias, is



18 WHITHER, ETHICS IN MEDICINE?

rendered questionable by the work of Macht and

Losee 11 on the blood of women affected with these

conditions. They have found nothing in the serum

of their bloods which is detrimental to the growth

of seedlings of Lupinus Albus. Eden, 12 in a study

of 2,005 cases of eclampsia, reports a death rate of

10.29% for Ireland, where conservatism reigns, and

of 25.0% and 23.8% for Scotland and England, re-

spectively, where intervention is the rule.

Maternal Mortality in Eclampsia

2005 Cases

Locality Cases % Mortality

Edinburgh 148 25.0

Dublin 204 10.29

England, North of 804 24.43

Midland 302 25.10

London 547 21.90

Wilson 13 (1929), publishing observations of the

Johns Hopkins Hospital, found for the period

(1894-1912), including cases treated by early and

forced evacuation, a maternal mortality of 24.8%.

For the period (1912-1924) for cases treated by the

conservative method, the mortality was 12.8%.

Statistics from personal experiences in regard

to the effectiveness of abortion staying the course

of coincidental maternal diseases are extremely un-

reliable. They are too often affected by the author’s

attitude towards the subject we are considering

—

abortion. If he is by habit an interventionist his

mortality rate will be low; if conservative, it will

be hip*»



WHITHER, ETHICS IN MEDICINE ? 19

Vollman 14 admits the total mortality for abor-

tion is seven times greater than that of deliveries

at term. In Berlin (1922-1924) there were 1,348

deaths for puerperal fever following abortion

against 312 after births at term. In 1928 at the

Rotunda in Dublin, for the extern service, the ma-

ternal mortality was 0.5% in 1,979 cases. When

the intern service was included the mortality was

0.32%. In California in 1928,
15

there were 493

deaths attributable to puerperal causes. Abortion

preceded 102 (50%) of 206 deaths from septicemia.

It preceded the deaths of 134 women. Of these 15

(11%) were therapeutic and 70 (50%) were in-

duced. And 164 had been “delivered of previable

children.” These too are abortions, presumably

therapeutic, as criminal or self-induced abortions

are never designated as “deliveries of the previ-

able.” Therapeutic abortion, therefore, presum-

ably accounted for 37% of California's maternal

mortality in 1928. In Marys Help Hospital, 16 in the

last 2,616 cases, the mortality was 0.23%. The

deaths from puerperal causes per 1,000 live births

in the registration area in 1928 were 6.9, almost

0.7%. The comment in Mortality Statistics for

1928 17 is significant: Special attention is called to

the fact that for both white and colored, rates from

all puerperal causes and puerperal septicemia were,

without exception, lower for the rural part of the

birth registration area than for the urban:

Urban Rural

5.4

11.2

White

Colored

7.2

13.9



20 WHITHER, ETHICS IN MEDICINE?

In Russia,18 in 1,815 cases therapeutically aborted

for social reasons the mortality was 0.7%. The

obvious conclusions to be drawn from these figures

are: since abortions performed under “ideal” con-

ditions (social reasons) are fraught with greater

danger to the life of the abortee than delivery at

term is to the normal parturient, it is unlikely that

therapeutic abortion should diminish the hazard to

the sick mother
;
it is more likely to increase it. The

death rate is lower under conditions which do not

permit intervention— Ireland, Catholic hospitals,
rural communities—than it is under those that do.
Herein may lie an answer to our concern over the

national maternal mortality.

Disregarding these considerations the obstetri-

cian differs from the physician in ordinary circum-

stances of sickness in that he is concerned with the

well-being of two persons. If he cannot help the

one without jeopardizing the chances of the other

he may help neither. He is not judge but physician.

Women die at home and in the streets. Must we

close the one and barricade the other against them?

There are dangers imminent in every vocation; a

certain per cent of them will be fatal. “I will not

give treatment to women to cause abortion. ... I

will use treatment to help the sick according to my

ability of judgment” 1 * 2 applies as much to us as it

did to the ancients, Pagan or Christian.

Convenience. 19 How absurd ! Yet it is the most

widespread cause for abortion. Society's tacit ac-

knowledgment of the moral law that imposes mu-

tual fidelity upon married couples and chastity upon



WHITHER, ETHICS IN MEDICINE? 21

the unwed is responsible for the great trek to the

abortionists. The desire of self-expression and in-

dependence, greater participation in social activi-

ties, education and the quest of wealth send the

legitimately pregnant to them. And the regular

practitioner finds sufficient reason in squalor, pov-

erty, and sizable families as though all of us should

and could be cast in one mold.

Fortunately for us, but unhappily for Russia, we

do not need to speculate upon the results of such

an unwholesome policy. “Russian experiences with

legalized abortion as reflected in the First All-

Ukranian Congress of Gynecologists and Obstetri-

cians meeting in Kiev from May 23-28, 1927, do not

seem to have refuted or challenged by more recent

reports emanating from the same sources,” reads an

editorial in the J. A. M. A. 18 “The unbiased and ob-

jectively scientific attitude of the congress towards

the question seems apparent,” it states, and con-

tinues to enumerate a number of these experiences

:

13.5% of adnexal complications in 1,242 abortions;

uterine perforations in 0.04% of cases of which 75%

recovered with conservative treatment; 0.7% mor-

tality in 1,815 cases, the principle being infection;

the incidence of general sepsis four times, and of

adnexal inflammation two times as frequent after

repeated abortion than after one
;
as a result of the

replacement of normal mucosa by scar tissue oligo-

menorrhea in 74%, amenorrhaea 10%, secondary

sterility 5.4% and habitual abortion; from the ef-

fects of the sudden loss of decidual secretions on

the ovaries and uterus disturbed follicular forma-



22 WHITHER, ETHICS IN MEDICINE?

tion, cystic degeneration, perenchymatous atrophy,

thickening of the tunica albuginea, uterine atrophy

and hyperplasia; the incidence of tubal pregnancy

1.3% in 3,790 cases following abortion; of the ef-

fects upon succeeding pregnancies 32% post-partum

fever as of 9.5% in them not previously aborted,

prolongation of labor, increased incidence of pla-

centa praevia and necessity of manual removal be-

cause of retention of placenta, post-partum hemorr-

hage five to six times, subinvolution three times,

and stillbirths; from the interference with the at-

tainment of complete sexual characteristics caused

by the first pregnancy psychic disturbances—depres-
sion, hysteria, frigidity, dyspareunia, and discord;

and some of the conclusions arrived at by men of the

Congress : “Chronic inflammation of the uterus and

adnexa, as well as abortions without end, is the herit-

age of those years.” “There is no disease of the

female in the causation of which abortion does not

play an important role.” “When we report 140,000

abortions a year we report just that many women

on the road to invalidism.”

Already our English colleagues are widely spon-

soring social reasons for abortion. And, lest we ap-

pear too sanguine, let us revert to Dr. Robinson's

letter: “May I remind your readers that when I

initiated the propaganda for birth control thirty

years ago the same thing exactly was said about the

prevention of conception that is now being said

about abortion. . . . Perhaps twenty-five years from

now the views on abortion, in certain cases, will un-

dergo a radical change. . . . And if a modification



WHITHER, ETHICS IN MEDICINE ? 23

of the abortion law is desired it is necessary to en-

list the co-operation of the intelligent laity.”

There is a move on to relax the laws against

abortion. The intelligent laity is being comman-

deered to sponsor the movement. And twenty-five

years is given to effect the change. Is it not likely

that those regular practitioners who advance social

indications and would perform an abortion for them

are unwittingly the dupes of a deliberate social “re-

form”? The intelligent laity!—the general popu-
lace—whose average intelligence is but fourteen
years, is to decide the issue in a matter most tech-

nically involved and about which it will ever be most

abysmally ignorant.

Must the tidal wave be upon us before we will

realize that water is wet and that we are in for a

drenching? It is not difficult to foresee the results

of this movement should it be allowed to get under

way: marriage will be meaningless; the State will

totter because home and family will cease to be;

and the lot of womankind will beggar description.

Will we lie supinely by while these purblind agita-

tors take the reins and drive America through these

hellish experiences ? Russia has experienced all this

and Communism has had to compromise. 20 Must

we make compromises to it?

Confraception

Whatever else may be said of the leaders in the

birth control movement, stupidity is not one of their

characteristics. They know the sophisticated popu-

lar mind and what needs to be done to engage its



24 WHITHER, ETHICS IN MEDICINE?

support. When they discovered that “contracep-

tion” had begun to sound a discordant note they

deftly replaced it with “prevenception” as the pur-

pose of their movement. The lax public conscience

is rendered insensible by euphemisms. And, just as

“euthanasia” is the euphemism for medical murder

or suicide, “abortion” for foeticide, so are “birth con-

trol”, “contraception”, and “prevenception” for sex

perversion.

The sexual organs subserve the functions of pro-

creation and pleasure. They exist wholly in neither

sex, the one being but the complement of the other.

The functions are not essential to the well-being of

either and they may be rightly disposed only through

the mutual agreement of lawful marriage. Though

procreation is their primary function it may be

subordinated to the function of pleasure in a natu-

ral way without doing violence to nature. But when

a mechanical or chemical contrivance is interposed

between the sexes the act becomes an unnatural one

and is therefore perverted. Stripped of its euphem-

istic dress the practice of contraception is synchron-

ized bisexual masturbation. Prevalence is no indi-

cation of normality: it is rather an index of our

social depravity.

Dismissing the moral and aesthetic objections to

the birth control movement with these few remarks,

let us concern ourselves with some of the sociologi-

cal aspects.

There is dinned in our ears and flashed before

our eyes in all the pages of history the one solid

foundation of all human advancement, of civiliza-



WHITHER, ETHICS IN MEDICINE? 25

tion itself—Sacrifice! As it is with the nations so
it is with individuals; personal interests, the sen-

sual appetite, must be curbed. Children are reared

in the self-sacrificing devotion of parents; the com-

munity in the beneficence of the talented towards

the less gifted; the nation secured in peace by the

protection of the rights of the unprivileged. Char-

acter is built only through self-restraint or self-con-

trol.

The purposes of the propaganda of the contra-

ceptionists are twofold: to inform the public of the

benefits of eugenic childbearing and the harm of too

frequent pregnancies. But, as most of it has con-

cerned itself with the description of contraceptive

devices and the detailed manner of their use, the

mails have been officially closed to it. Actually, that

is not so; matters of contraceptive import are still

distributed under the guise of “incidentals of femi-

nine hygiene.” And here we may ask how is Eu-

genics furthered by the indiscriminate publicity and

sale of materials whose purposes are anti-genic?

The denial of the mails to the contraceptionist

has so hindered the progress of their movement that

they have resorted to direct contact and open adver-

tising in journals and stores. And, as the adult

population is not responding with sufficient alacrity

they are cultivating the juveniles—with more im-
mediate success. And, quite incidentally, the most

conspicuous displays, in some parts of the country,

have been in the proximity of the high schools.

And the rumor is widespread, and not unfounded,

that there is an increased incidence of juvenile preg-



26 WHITHER, ETHICS IN MEDICINE?

nancy and unwed maternity. It has been my own

observation in this matter that, even through the

depression, there has been a gradual increase in its

incidence.

Unwed Maternity 21

Age
1

Years

|
1928

|

1929
|

1930
|

1931
|

1932
|

1933

21 and over
1

24
|

20
1

22
|

22
1

24
|

23

Under 21
1

36
|

12
1

22
|

23
1

15
1

32

Total
1

60
|

32
1

44
|

45
1

39
|

55

And as the numbers increase the spread is more

dense in the earlier years.

Juvenile Maternity 21

Ages
1

Years

|

1928
i

1929
1

1930
|

1931
1

1932
1

1933

14
1

o
i

0
i

2
1

0
1

0
]

0

15
1

2
1

1
1

1
|

1
1

2
1

3

16
1

5
i

1
i

4
1

3
1

1 3

17
1

5
i

6
1

4
|

3
1

6
1

6

18
1

7
1

2
1

2
|

4
1

3
1

6

19
1

io
i

1
i

5
1

6
1

1
1

5

20
1

7
i

1
i

4
1

6
1

2
1

9

Total
I

36 JL 12 I 22 | 23 I 15 1 32

The juvenile is impetuous, in many respects un-

reasonable and, much more than his age-sobered

elder, inclined to the gratification of his sensual na-

ture. Fear of disease will not deter him, nor, in

most cases, will it persuade him to be cautious or to

take precautions. An epidemic of social diseases,

profligacy, and bastardy lies in the wake of this

movement.

And, with one exception—bastardy—what ap-



WHITHER, ETHICS IN MEDICINE? 27

plies to Contraception, applies more emphatically

to Sterilization. Our English brethren who have

studied the problem in relation to mental deficiency

report

:

22
“Sterilization does not improve the men-

tal condition and it does not lessen sexual activity.

The unstable and antisocial defective remains un-

stable and antisocial. The thief remains a thief.

The erotic girl or youth will still need institutional

care. The impossibility of procreation will not save

them from being a social menace.
,,

In the face of

these conclusions the J. A. M. A. proposes that we

who possess the only dependable information and

knowledge of public health, shall content ourselves

with standing by in an attitude of “scientific detach-

ment” while these misinformed zealots enjoy a feast

of human mutilations. “The medical profession can

perhaps serve its purpose best by assessing the

biologic and social results” 6 of the carnage. Is it

any wonder that organized Medicine has lost pres-

tige when, in the face of its own convictions, 23 it

succumbs to fantastic schemes of social betterment,

following rather than leading the blind in the mat-

ter of social health legislation

!

The incidence of cancer is increasing and cancer

of the uterus is participating in the increase. In-

juries incidental to child-birth are given as a rea-

son. Yet the women of the past bore many more

children than those of the present day and they did

not have the benefits of modern surgery. They

knew little of the methods of contraception. Is it

not more likely that contraception in the form of

chemicals may be the responsible factor?



28 WHITHER, ETHICS IN MEDICINE?

Gynecologists are concerned with the health of

the female organism. Often, for social reasons

alone, they institute measures to obviate the possi-

bility of pregnancy. They do but cut into their co-

ordinated activities as obstetricians. There were

600,000 fewer births in 1933 than in 1921
;
600,000

fewer still in 1937 than in 1933. It is not difficult

to see the ramifying results of this shortsighted pol-

icy as it affects Medicine in all its spheres.

Drug Topics
,
an organ of the pharmaceutical

trade, sponsors the movement because it means

$208,000,000.00 annually to the business. It is not

farsighted enough to see still further when the re-

duction in the birth rate will affect materially, and

more deeply, the sale of other merchandise. The

future of the drug trade is sacrificed for immediate

profits.

Nations 25 are interested in their population and

of those of rival countries. France, where contra-

ception is most widely practiced, and where its re-

sults are most conspicuous, suspiciously eyes Ger-

many whose man-power is more than 3 to her 2, and

bellows for “guarantees of security”. Germany,

which has taken up the movements of sterilization

and birth control, in like manner watches Italy,

whose birth rate and total births outnumber its own

though the total population is less. And we are

showing signs of concern because of the decrease

here. We know that nothing can stop the ingenuity

of man
;
that security is to the strong ; that a falling

Jbirth rate an omen of economic stagnation. Yet,



WHITHER, ETHICS IN MEDICINE? 29

we blindly foster every movement that encourages

it.

But how does all this come about? Why is the

common weal sacrificed to selfish interest? We have

lost sight of fundamental principles because expedi-

ency is the philosophy of our schools. Publicity and

the fame that attaches to it rather than intrinsic

merit are the bases of professional position and ad-

vancement. Context means little. Faced by an

audience of his colleagues, Prof. Thimblewit treads

cautiously, presenting his own work in the name

of “one.” How often have you been driven to dis-

traction while listening to him speaking, let us say,

on Technique: “One must choose one’s subject to

one’s liking and subject it to the test of experiment.

One must gather the results and arrange them so as

to prove the premise with which one started the

study. And, lest one overlook a pertinent detail in

the unused or discarded evidence that might be con-

sidered relevant by one’s critics one must draw one’s

conclusions circumspectly.”

There is money in Science. And the cringing

press cares nil for verities if, by distortion or am-

biguity, the matters of Science can be made in-

telligible to the masses. And Thimblewit panders

to it in anonymity

:

26 “While it is true that half-

wits beget half-wits and criminals beget criminals

and for that reason should be made sterile the ‘black

sheep’ who break the hearts of respectable parents

are no longer thought to be the reincarnations of

some long dead criminal ancestors.” And how

weirdly and sensationally Dr. Cornish’s experiments



30 WHITHER, ETHICS IN MEDICINE ?

were presented! And what sorrow and gloom fol-

lowed in the wake of the news-hawk who “covered”

the meeting of pathologists at which the spectacular

results following the use of an adrenal extract were

reported

!

We have passed through many phases since the
dawn of our country but none so sharply as the

change in our philosophy. Washington, living in

an agrarian era, retired to private life admonishing

the people : “Of all the dispositions and habits, which

lead to political prosperity, religion and morality

are indispensable supports. In vain would that man

claim the tribute of patriotism, who should labor to

subvert these great pillars of human happiness, these

firmest props of the duties of men and citizens.”

We had heard during the past decade in which
the Industrial Era reached the zenith of its physical

and intellectual power, that: the old religion was

dead
;
the old morality was out-moded

;
religion must

conform to the times. And we lived it in ruthless

disregard of our fellow-man, crying out with Cain

:

“I am not my brother’s keeper.” We have seen that

philosophy extolled as rugged individualism.

Roosevelt came into office beholding the ruins of

this rugged individualism. His first public act as a

national figure, his last as a private citizen, was to

kneel before God in the Church of his persuasion to

ask Him for the strength and wisdom to lead his

nation aright. He has said that the money changers

must be driven from the temples of finance. And

he keeps on reiterating that there must be a reign

of social justice. Does that sound as though the old



WHITHER, ETHICS IN MEDICINE? 31

morality is dead
;
or that the bells which peal out the

old Faith are moss-covered or broken? The princi-

ples of ethics have not changed in all the Ages past

;

and they are equally valid today!

BIBLIOGRAPHY

1 Leake, C. D.: Percival’s Medical Ethics; Williams and

Wilkins, 1927.

2 Jones, W. H. 8: The Doctor’s Oath.

3 Sydenham, Thomas: Preface to First Edition of Med-

ical Observations— ; Northwestern University Press, 1931.
4 Cushing, Harvey: Medicine at the Crossroads; J. A.

M. A., 100:1567-1575, May 20, 1933.

6 Editorial : Human Sterilization in Germany and United
States; J. A. M. A., 102:1501-1502, May 5, 1934.

7 These among others are the subject of the German pro-

gram: Congenital Weakmindedness, Schizophrenia, Manic

Depressive Insanity, Epilepsy, Chorea Minor, Grave Bodily

Malformations, Hereditary Alcoholism.

8 Osler, William: Aequanimitas, Doctor and Nurse, p.

18; P. Blakiston & Sons, 1922.
9 Robinson, W. J.: Letter, J. A. M. A., 102:391; Feb. 2,

1934.

10 Straus, M. B., and McDonald, W. J.: Polyneuritis of

Pregnancy; Dietary Deficiency Disorder; J. A. M. A., 100:

1320; April 29, 1933.

11 Macht, D. I., and Losee, Joseph R.: Phytopharmaco-

logical Study of Eclampsia; Johns Hopkins Hosp. Bui., 46:

216.

12 Eden, T. W.: Eclampsia; J. Ohs. & Gyn. of British Em-
pire, 29:386-401; 1922. Maternal Mortality and Child-

bearing, Lancet, 2:998-1004, Nov. 11, 1922.

18 Cited in Clement, G.: Thou Shalt Not Kill, p. 106;

Peter Reilly Co., 1930.

14 Cited in Clement, G.: Thou Shalt Not Kill, p. 77.



32 WHITHER, ETHICS IN MEDICINE ?

15 An Analysis of Maternal Mortality in California : Cali-
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,

Vol. XII, No. 30.

16 Personal Review, years 1928 to 1933, inclusive. Mater-

nity Records, Mary’s Help Hospital.

17 Mortality Statistics, 1928, p. 14 ; United States Depart-

ment of Commerce.

18 Editorial : Russian Experiences with Legalized Abor-

tion; J. A. M. A., 100:341; February 4, 1933.

19 Karlin : Abortions Performed for Social Indications

;

J. A. M. A., abs., 100:1212; April 15, 1933.

20 Literary Digest, March 10, 1934.

21 Personal experience with the co-operation of other mem-

bers of the staff of Mary’s Help Hospital.

22 Editorial on Sterilization of Defectives
;
British M. J.,

1:156; Jan. 27, 1934. Departmental Committee Report; Brit-

ish M. J., 1:161.

23 Editorial: Problems of Human Sterilization; J. A.
M. A., 102:1609; May 12, 1934.

24 Drug Topics, Feb. 5, 1934.

25 O’Malley, A. : Ethics of Medical Homicide and Mu-

tilation; Deven-Adair, 1919.

26 Why Clergymen’s Daughters Went Wrong, Science Ex-
plains; American Weekly; April 8, 1934.

51
,