“In the combined reports of the clinics of Berlin, Halle, and Dresden, the maternal mortality in craniotomy was 5.8 per cent—of course, one hundred per cent of the children lost.
“In Cesarean section the maternal mortality was eight or eleven per cent; children’s mortality, thirteen per cent.
“Caruso, the latest and most reliable statistician, not an optimist, sums up the results from the different clinics, and comes to the conclusion that craniotomy shows ninety-three and one one-hundredth mothers recover, Cesarean section eighty-nine and four one-hundredths.
“Caruso, therefore, concludes that craniotomy on the living child is to be superseded by Cesarean section. He says, therefore, that the mother has three chances out of four, and her child nine out of ten, for life.
“Leopold, as stated above, shows a much better result, viz.: ninety-five mothers saved out of one hundred by Cesarean section, a result equal that obtained in craniotomy.”
You notice, gentlemen, that the eminent physician whom I have been quoting speaks with much indignation of the killing of the embryo, when he calls it a “massacre of the innocents.” By this odious term we usually denote the massacre of the babes at Bethlehem, ordered by the infamous Herod to defend himself against the future aggression, as he imagined, of the new-born King of the Jews. A craniotomist would, no doubt, feel insulted at being compared with Herod. And yet, if we examine the matter closely, we shall find that the two massacres, Herod’s and the craniotomist’s, could only be defended by the same plea, that of necessity. “Necessity knows no law,” writes Dr. Galloway, in his defence of craniotomy, to which I referred in a former lecture. “The same law,” he writes in the “Medical Record” for July 27, 1895, “which lies at the basis of Jurisprudence in this respect justifies the sacrifice of the life of one person when actually necessary for the preservation of the life of another, when the two are reduced to such extremity that one or the other must die. This is the necessitas non habet legem.”
Did not Herod look on the matter just in that light? Expecting Christ to be, not a spiritual, but a temporal ruler, as the Jewish nation supposed at the time, he looked upon it as a case of necessity to sacrifice the lives of the innocents for his own preservation. “Necessity knows no law” was his principle. True, many had to die on that occasion to save one; but then he was a king. Anyhow, their death was necessary, and necessitas non habet legem; that settles it: Herod must not be blamed, on that principle. It is not even certain that, cruel as he was, he would have confessed, with the modern obstetrician, “I would as lief, if it were necessary, kill an unborn child as a rat.”
Such sentiments, revolting as they are, and a disgrace to civilization, are the natural outcome of rash speculations about the first principles of morality.
The principle “Necessitas non habet legem” has indeed a true and harmless meaning when properly understood; it means that no law is violated when a man does what he is physically necessitated to do, and that no law can compel him to do more than he can do. Thus a disabled soldier cannot be compelled to march on with his regiment; necessity compels him to remain behind. In this sense the principle quoted is a truism; hence its universal acceptance. Applying the same principle in a wider sense, moralists agree that human law-givers do not, and in ordinary circumstances cannot, impose obligations the fulfilment of which requires extraordinary virtue. Even God Himself does not usually exact of men the performance of positive heroic acts. But no such plea can be urged to justify acts which God forbids by the natural law.[1] When necessity is used as a synonym for a “very strong reason,” as it is in the plea of the craniotomist, then it is utterly false that very strong reasons for doing an act cannot be set aside by a divine law to the contrary; what is wrong in itself can never become right, even though the strongest arguments could be adduced in its favor. It would be doing wrong that good may come of it, or making the end justify the means. Such principles may be found in the code of tyrants and criminals, but should not be looked for in the code of Medical Jurisprudence.
[1] See this point more fully treated in the Author’s “Moral Philosophy,” Book. I. c. ii., “The Morality of Human Acts.”