The Project Gutenberg eBook, The Ethics of Medical Homicide and Mutilation, by Austin O'Malley

THE ETHICS
OF
MEDICAL HOMICIDE
AND
MUTILATION

BY

AUSTIN O'MALLEY, M.D., Ph.D., LL.D.

NEW YORK
THE DEVIN-ADAIR COMPANY
1922

Nihil obstat

ARTHUR J. SCANLAN, S.T.D.

Censor Librorum

Imprimatur

✠ JOHN CARDINAL FARLEY

Archbishop of New York

Copyright, 1919, by
The Devin-Adair Company
——
All Rights Reserved by
The Devin-Adair Company

Third Printing

PRINTED IN U.S.A.

CONTENTS

PREFACE

In this book is discussed the morality involved in the ordinary cases of medical homicide and mutilation. Craniotomy has been omitted because this operation on the living child is never morally licit, and when done on the dead fetus it has no moral quality that requires explanation.

The articles may seem to be intended for Catholic physicians and spiritual directors alone, but the desire in writing them was to reach all practitioners, to the end that the Natural Law which binds every man may be observed. Morality is not made such in its fundamental principles by any religious creed, but by the requirements of Divine Order, which finally prevails no matter what the opposition. Killing and maiming without sufficient extenuation did not become unlawful solely by the establishment of Christianity. Practically, however, physicians who have no religion, or a religion which is so illogical as to pay no attention to dogma, or even to rail at it as obtrusive, necessarily gravitates to the emotional in morality, and the principles of this book will not even interest them. Dogmas are abstract propositions, and all human society rests on abstract propositions. The most vital facts in morality, the basic distinction between crime and all that is virtuous or indifferent morally, is in abstract principle alone, but physicians and pastors who are not trained in philosophy and rational religion cannot appreciate an abstract principle—they are influenced only by the concrete.

Obstetrical text-books, unfortunately, are written by such emotional men; by men who lack all training in ethics other than that inculcated in childhood out of the mental vagaries of the women in the household; and these authors prescribe therapeutic homicide as if it were a drug in the American Pharmacopœia. The reader is told that if the patient is a Catholic he is to respect her religious "prejudices"; if she is not a Catholic one need not bother about moral scruples when it is necessary to take a life to stop fits. Since the civil law does not prosecute a physician for therapeutic abortion on an inviable child, most physicians deem such an act not only permissible but scientific, and they hold that if a man's conscience will not let him kill a fetus to alleviate maternal distress he is guilty of malpractice.

Decrees of the Catholic Church are cited in these pages, not because morality is an asset of the Catholic Church alone, but because it alone pronounces officially on these medical subjects after careful consideration by competent specialists. This Church has made decisions in comparatively few medico-moral cases, and the questions still undecided authoritatively are very numerous. They are quite difficult, too, because judgment supposes a knowledge of both medicine and ethics, a combination seldom found in one person. As physicians do not know ethics, and moralists do not know medicine, there is often trouble in getting at even a statement of the questions at issue between them. In the preface to Essays in Pastoral Medicine, in 1906, I mentioned a noted case of this kind, and in 1911 a similar incident occurred in a discussion of the morality involved in the sterilization of criminals and the defective by the state. This dispute was taken up by the leading canonists and moral theologians in the United States, Belgium, Holland, Austria, Spain, Italy and France, and for nearly two years these men wrote article after article based upon utterly erroneous physical data.

The books we have on medico-moral subjects are either obsolete at present, or insufficient; or, more commonly, they are the work of amateurs in medicine. These last are worthless when they are not harmful. If, however, I may judge from the questions sent to me for answer by clergymen and physicians from all parts of the country, our theological seminaries and medical schools are in grave need of courses on the morality of medical practice. In this book, to the preparation of which I have given years of anxious thought because of the extreme responsibility involved in its decisions, the data for the most important parts of such courses are presented.

Austin O'Malley.

THE ETHICS OF
MEDICAL HOMICIDE AND MUTILATION

THE ETHICS OF MEDICAL HOMICIDE AND MUTILATION

[CHAPTER I]

General Principles Concerning Suicide and Homicide

A Discussion of euthanasia through the use of narcotics in cases of incurable diseases periodically recurs, and the opinions of those in favor of putting the patient out of his misery are expressions of mere sentimentality, as in Maeterlinck's essay, Our Eternity. They think either that the passing of a law by a legislature removes all moral difficulty, or that morality is a trifle which should never stand in the way of expediency. Those who oppose this method of euthanasia base their argument, first, on the fact that many patients supposed by even clever diagnosticians to be incurable recover health; and, secondly, on the fact that the giving power of life and death to physicians is liable to grave abuse. This side misses the central truth and argues from accidental and secondary premises. Whether it is expedient, humane, or impolitic to kill incurable patients are almost irrelevant considerations: the fundamental question to be answered here is, Is there a Supreme Being who alone is master of life, to give it or to take it?

By its very definition such a Being is necessary (as opposed to contingent), self-existent; its essence always has been and always will be actualized into existence, and that from itself alone; it is an individual substance of an intelligent nature, and therefore a person. A contingent being is one that happens to be (contingere); it is of necessity neither existent nor non-existent; it has no logical aversion to existence, but in itself it has no more than a possibility of actuality. A necessary Being, on the contrary, essentially must be; it cannot not be; it is absolutely and essentially its own existence.

There must be such a Necessary Being. If there were not, all things would be contingent, which is an absurdity. The absurdity arises from the fact that if all things were contingent nothing would be actual, nothing could ever come into existence, because there would be nothing to bring the primitive potentiality of the contingent beings into actual existence. The sufficient reason for the existence of contingent beings is either in themselves or in something outside themselves. It cannot be in themselves, because as they do not yet exist they are nothing; therefore it is in a Being which is not contingent, but whatever is not contingent is necessary. Therefore the existence of contingent beings absolutely requires the existence of a Necessary Being, which always was in existence. The ordinary name for this Necessary Being is God. Contingent beings are all creatures, all organic and inorganic beings without exception. There is, then, a God, the first cause or creator of all contingent beings, among whom is man; and since God created man wholly, this creature is wholly subservient to God, under the dominion of God, and his life is owned solely by God; God alone is the master of life and death, and he alone can delegate such mastery.

From the relation between the Creator and the creatures arises the natural law. Violation of this law is the source of all moral evil in the world, and of much of the physical evil. Reason shows us this law, and the method of observing it; and reason and unreason, observance or disregard, of the order fixed by the natural law are the foundation of happiness and unhappiness. Whatever a human being is or does, he must seek happiness; that is an essential quality of his being. Happiness is the satisfying of our desires; but as our desires are limitless, only infinite good can satisfy them. The sole sufficient good that sates all human longing is the infinite Necessary Being, and to be happy we must be united with that Being. Obviously the only possible method of possessing this infinite God is through mental union, by undisturbable contemplation of his infinite truth, goodness, being, beauty, and his other attributes. If perfect, everlasting happiness is not in that, in what can it be? Is it in human fame, honor, riches, science, art, man, woman, or child? None of these can give lasting happiness, and no other happiness is real happiness.

Now, the only means we have to obtain union with infinite good is to follow out the condition inexorably placed by God, which is to act in life in keeping with right reason, to obey the law. Man's supreme honor is in freedom from the tyranny of unreason, and in a full obedience to external and immovable order, with the belief that his chief duty is to apprehend and to conform thereto.

This is morality. From the beginning men have held that certain acts are wrong and to be avoided, and that others are to be done. What is wrong, moreover, is such of its own nature, not from our will: we deem the fulfillment of duty, obedience to law, the first, highest, and last necessity of life. If we deny this truth we let in chaos. What is right or wrong is one or the other on its own merits, prescinding from its pleasurableness or pain.

We must seek good whether we will or not. Good is the sole object upon which the will operates, it is the raw material of the will's business. The ultimate standard of this good is God himself as its exemplary cause, but proximately the standard of moral good is our rational nature. Through our reason we judge whether a thing is good or bad; that is, whether it perfects or injures us; and as it is good or bad for us our will's tendency toward it is good or bad. Many acts are indifferent in themselves, but take on a good or bad quality from our intention; others are good or bad in themselves apart from our volition: charity is good, lying is bad, whether they are willed by us or not.

The morality of any action is determined (1) by the object of the action; (2) by the circumstances that accompany the action; (3) by the end the agent had in view.

1. The term object has various meanings, but here it means the deed performed in the action, the thing which the will chooses. That deed by its very nature may be good, or it may be bad, or it may be indifferent morally. To help the afflicted is in itself a good action, to blaspheme is a bad action, to walk is an indifferent action. Some bad actions are absolutely bad; they never can become good or indifferent—blasphemy or adultery, for example; others, as stealing, are evil because of a lack of right in the agent: these may become indifferent or good by acquiring the missing right. Others are evil because of the danger necessarily connected with their performance,—the danger of sin connected with them, or the unnecessary peril to life. An action, to have a moral quality, must be voluntary, deliberate; and mere repugnance in doing an act does not in itself make the act involuntary.

2. Circumstances sometimes, though not always, may add a new element of good or evil to an action. The circumstances of an action are the Agent, the Object, the Place in which the action is done, the Means used, the End in view, the Method observed in using the means, and the Time in which the deed is done. If a judge in his official capacity tells a sheriff to hang a criminal, and a private citizen gives the same command, the actions are very different morally because of the circumstance of the agent giving the command. The object—it changes the morality of the deed whether one steals a cent or a thousand dollars. The place—what might be an offensive action in a residence might be a sacrilege in a church. The means—to support a family by labor or thievery. The end in view—to give alms in obedience to divine command or to give them to buy votes. The method used in employing the means—kindly, say, or cruelly. The time—to do manual labor on Sunday or on Monday. Some circumstances aggravate the evil in a deed, others excuse or attenuate it. Others may so color the deed that they specify it, make it some special virtue or vice. The circumstance that a murderer is the son of the man he kills specifies the deed as parricide.

3. The end also determines the morality of an action. Since the end is the first thing in the intention of the agent, he passes from the object wished for in the end to choosing the means for obtaining it. Without the end the means cannot exist as such. There are occasions when an end is only a circumstance: for example, if it is a concomitant or extrinsic end. When this extrinsic end is in keeping with right reason or when it is discordant thereto, it may become a determinant of morality. In every voluntary, or human, act there is an interior and exterior act of the will, and each of these acts has its own object. The end is the proper object of the interior act of the will; the exterior object acted upon is the object of the exterior act of the will; both specify the morality, but the interior object or end specifies more importantly, as a rule, than the exterior object does. The will uses the body as an instrument on the external object, and the action of the body is connected with morality only through the will. We judge the morality of a blow not by the physical stroke, but from the intention of the striker. The exterior object of the will is, in a way, the matter of the morality, and the interior object of the will, or the end, is the form. Aristotle said: "He that steals to be able to commit adultery is more of an adulterer than a thief."[1] The thievery is a means to the principal end, and this principal end chiefly specifies or informs the action.

The means used to obtain an end are very important in a consideration of the morality of an act. There are four classes of means—the good, bad, indifferent, and excusable. Good means may be absolutely good, but commonly they are liable to become vitiated by circumstances,—almsgiving is an example. Some means are bad always and inexcusable—lying, for instance. The excusable means are those which are bad, but justifiable through circumstances. To save a man's life by cutting off his leg is an excusable means. The end sometimes may vitiate or hallow indifferent means, but it does not in itself justify all means. Means, like other circumstances, are accidents of an action, but they are in the action just as much as color is in a man. Color is not of a man's essence, but we cannot have a man without color.

The effect of an action, the result or product of an effective cause or agency, may in itself be an end or an object or a circumstance, and it has influence in the determination of morality. Sometimes an act has two immediate effects, one good and the other bad. For example, ligating the blood-vessels going to the uterus to stop a hemorrhage and so save a woman's life, a good effect, has also in ectopic gestation while the fetus is living another immediate effect, namely, to shut off the blood supply from the fetus and so kill it, a bad effect. To make such a double-effect action licit there are four conditions which are explained in the chapter on Mutilation.

The doctrine of Probabilism is very important in morality. Any law must be promulgated before it really becomes a law, and promulgation in a rational conscience is sufficient. Sometimes there is rational doubt of the existence, the interpretation, or the application of a law in a given case. Here probability is the only rule we can follow. A law which is doubtful after honest and capable investigation has not been sufficiently promulgated, and therefore it cannot impose a certain obligation because it lacks an essential element of a law. When we have used such moral diligence as the gravity of the matter calls for, but still the applicability of the law is doubtful in the action in view, the law does not bind; and what a law does not forbid it leaves open. Probabilism is not permissible where there is question of the worth of an action as compared with another, or of issues like the physical consequences of an act. If a physician knows a remedy for a disease that is certainly efficacious and another that is doubtfully efficacious, he may not choose this probable cure. Probabilism has to do only with the existence, interpretation, or applicability of a law, not with the differentiation of actions. The term probable means provable, not guessed at, not jumped at without reason. The doubt must be positive, founded on reason, not a matter of mere ignorance, suspicion, emotional bias. The opinion against a law to permit probabilism must be solid. It must rest upon an intrinsic reason from the nature of the case, or an extrinsic reason from authority, always supposing the authority is really an authority. The probability is to be comparative also. What seems to be a very good reason when standing alone may be weak when compared with reasons on the other side. When we have weighed the arguments on both sides, and we still have a good reason for holding our opinion in a doubtful case, our opinion is probable. The probability is, moreover, to be practical. It must have considered all the circumstances of the case.

There is, then, a Supreme Being whom we must obey, who created and owns human life primarily; there is also a moral law. On these facts rests the argument relating to the destruction of human life. How far, then, has a human being dominion over his own life, and, secondly, over the life of any one else?

St. Thomas,[2] Lessius,[3] and others offer as one argument to prove suicide is not licit, that it is an injury to society or the state of which the suicide is part, and to which the use and profit of his service rightly belong. Lessius, while developing this proof, acknowledges its weakness.

If there were only one man in the world, and no society or state, suicide would still be illicit, because its basic deordination lies deeper than society or the state. If suicide were a moral evil solely because it deprives the state of the suicide's life, then for the same reason no one might become a citizen of another state, emigrate, nor might man abandon society and live as a recluse. Moreover, if a man were detrimental to the state rather than beneficial, in this point of view that fact alone would justify suicide, and the state would then be justified in permitting or even commanding suicide; and we shall show later that the state has not this power.

It is true that the injury done the state or society by loss of use and profit, by scandal and similar evils, is a solid argument against suicide, as such injury aggravates the deordination of suicide, but in itself the injury done to the state and society is not the fundamental reason against suicide.

St. Thomas[4] argues against suicide because it is contrary to the charity a human being should have for himself. This is true ordinarily, and suicide takes on part of its guilt just because it is an offence against the rational regard a person should have for himself; yet this argument is not basic. We are told that if one sins against charity in killing his neighbor, a fortiori he sins in killing himself. Yet suppose just what the advocates of euthanasia suggest, viz., that a neighbor is in great agony and incurable: then the act of killing him takes on a quality of charity rather than of uncharity. And so for the suicide: if the patient is willing to be killed, there would be no uncharity; if he were unwilling, then homicide in any form would be uncharitable and unjust. The argument from charity, therefore, is too narrow to fit the whole case; and its very weakness is a source of error for the advocates of euthanasia.

Still another argument is often advanced against suicide, viz., that a man is obliged to love his own life, since it is the foundation, or the necessary condition, to him, of all good and every virtue, and this circumstance makes the destruction of that life unlawful. That argument has solid truth, but if it held absolutely it would prevent us from desiring death in any case, and no one denies that there are conditions in which a desire for death is fully legitimate. No desire for death, however, can give the slightest justification for the destruction of life.

Again, the argument that suicide is cowardice is not broad enough. Fortitude is a mean between fear and rashness, and this argument maintains that the suicide sins against fortitude by rashness. If we have good reason it is not rash to expose ourselves to death; the soldier may do so, the person struggling to save a neighbor's life, and so on; it may be the highest form of fortitude thus to expose oneself to death. If the suicide can persuade himself that by his act he is seeking greater good than the life he possesses he would have reason for his act, and at least be above cowardice. This argument is one that can be turned at times so as to cut the fingers of the man that uses it. The fundamental reason that suicide is not lawful is that man cannot be master of his own life, and therefore he may not dispose of it as he pleases.

Suicide is the direct killing of oneself on one's own authority. A killing is direct when death is intended as an end, or chosen as a means to an end. Direct killing is positive by commission, or negative by omission. In such cases the will directly rests in the death as a voluntary and free act. A killing is indirect when the act of which death is the effect by its nature and the intent of the agent is directed toward another end, but concomitantly, or as a consequence, results in death. In such case death is an accidental effect, and comes indirectly from the activity of the will—it is not necessarily voluntary. If one has a right to do that other deed, or if it is his duty to do it, and there is a proportion between it and his life, he may do the deed and permit the consequent death.

A direct homicide may be done on one's own authority, or on that of another person. It is done on one's own authority if the agent assumes a natural individual dominion over life, and by virtue of such dominion directly kills himself or another; it is done on the authority of another when a man directly kills himself or another by the mandate of a positive divine or human law, and in the name and on the authority of a positive divine or human legislator. It is evident that God, as Creator, has supreme dominion over human life, and therefore by his positive authority he may command a man directly to kill himself. God, however, does not by the natural law confer on man the right thus to kill. The question here is of the natural duty or right which comes from the natural law alone.

Direct suicide on one's own authority may happen in two ways: positively, that is, by doing an act which is directly homicidal; or negatively, by omitting an act necessary for the preservation of life. That a negative homicide be direct, death must be intended as an end or means. If, however, one voluntarily intends an end or a means, but for the sake of antecedent good or evil omits some act necessary to preserve life, his suicide is indirect, per accidens, and not always illicit unless there is a precept against just such an omission. Man has no dominion over his own life, he has only the use of it; and the natural law obliges us while using a thing which is under the dominion of another not to omit ordinary means for its preservation. We are not, however, held to extraordinary means. His own death is criminally imputable to him who negatively and indirectly kills himself by omitting the ordinary means for preserving his life, because the precept he is under to preserve his own life makes his act voluntary. If he omits extraordinary means, the death is not criminally imputable to him because there is no precept obliging such means. Certain circumstances may by accident oblige one to use extraordinary means to preserve one's own life—a dependent family, a public office in perilous times, or the like. The proposition, then, is: The natural law does not give a man absolute dominion over his own life.

I. The natural law gives no rights except such as are finally founded in human nature itself; but human nature cannot give a title to dominion over one's own life; therefore the natural law does not give man such a right.

Every natural right is either congenital or acquired. The title to a congenital right is human nature itself; the title to an acquired right is some act consequent to the exercise of human activity. The right to such exercise is, in turn, congenital and founded in human nature.

If nature established the title to dominion over one's own life it would thereby establish the power of destroying that life, and thus of removing the fundamental title to all rights; but nature exists as the foundation for rights, not for the subversion of rights; therefore human nature cannot give a final title to dominion over our own life.

Again, this minor of the first argument is confirmed by the fact that if nature even remotely established the power of self-destruction there should be in nature itself some natural tendency to such destruction, but the direct contrary is the fact.

II. The natural law cannot grant a right to man which is not a means to the common end of human life; but absolute dominion over one's own life is not such a means, therefore the natural law cannot give one dominion over his own life.

The natural law is only an ordination of man to that common end of human life and to the means toward that end. As regards the minor of this second argument, an absolute dominion over his own life would give man power to stop all his human activity, yet the common end of human life is attainable only by man's activity. The stopping, or the power of stopping, all activity cannot be a means to that end.

III. The natural law cannot give man a power which is opposed to the essential needs of human nature itself; but that a man should have absolute dominion over his own life is opposed to an essential need of human nature itself, therefore the natural law cannot give such a power.

Dominion over his own life implies the power in man of rebelling against the subjection which he owes to God; but human nature essentially demands that man be in subjection to God, since dominion over one's own life and subjection to God are contradictory.

Again, if man had absolute dominion over his own life he could stand aloof from all influx of the natural law and avoid every duty arising from that law. A law, however, cannot give a power which nullifies itself.

The objection that suicide is licit because no injury can be done a man by an act if the man is willing to submit to the act, is irrelevant. The injury in suicide is not to man at all, but to God.

There is also nothing in the objection that a gratuitous gift may be renounced. Life is not a gratuitous gift; it is an onerous gift with obligations inseparably affixed thereto which forbid the destruction of the gift.

IV. Destruction is an act proper to a master alone. Man cannot be master of his own life; he can have dominion of things that are outside himself, distinguishable from himself, but not of the very existence of himself, which is not really distinguishable from himself. The definition of dominion supposes relation. The offices of master, father, magistrate, are relative conditions which suppose superiority over another person, not over oneself. Even God is not a superior over himself, although he has all perfection. For this reason a man cannot sell himself; he can sell only his labor.

God, who should have absolute dominion over all creatures, and who has, wills to confine these creatures to certain lines of action in keeping with the creature's nature. This is the law underlying even the moral law when it touches humanity; it is the eternal law coeternal with God's decree of creation, but not necessary as God is. When this law exists in the mind of God it is the eternal law; when it exists in the minds of creatures it is the natural law, governing the free acts of intellectual creatures. When the natural law becomes a motive to the human will, obliging but not forcing it, a law through knowledge within the consciousness of a man regulating his behavior, it is called the law of conscience.

Conscience is an act, a practical judgment on one's own action in some particular case. It testifies, accuses, excuses, restrains, urges. It is a rational faculty, not an emotional, sentimental power. Emotion blinds its judgments. Yet mere emotion, and that foolish deordination of emotion called sentimentality, are promptings which the ignorant mistake for conscience and obey. Conscience is the enlightened eye of the heart, not the vagary of any appetite that blunders into action. It must be educated; left to itself, it is guilty of all the perversions of the streets.

The natural law is immutable, not subject to recall by every rascal under the goad of the flesh. In morality what was, is; what was once right because reasonable, always will be right and reasonable. Since opposition to the natural law as applied to man is repugnant to human nature, no power can make opposition to that law licit. For the same reason this law is not subject to evolution. Truth in morality is eternal. What is ugly now was ugly a millennium ago; what was immoral yesterday was immoral in the sixth century. If our ancestors thought permissible what we know to be illicit, our ancestors were ignorant; the fact has not changed. It was as immoral to steal, lie, or murder in the day of Abraham as it is to-day.

The ultimate tendency of man is toward happiness, and, of course, happiness, or any other perfection, is impossible without existence; hence the instinctive recoil from the destruction of our life, which is the requisite condition for happiness. Even those that abnormally destroy their own life do so with horror for the destruction itself, and act thus unreasonably to escape evil, not to escape life; or they seek what they think will be a better life. We can do no other injury to a man so great as the depriving him of his life, for that deprivation destroys every right and possession he has. He can recover from all other evil, or hold his soul above every other evil, but death is the absolute conqueror. No matter how debased or how diseased a man's body may be, no one may dissociate that body from its soul, except in defence of individual or social life under peculiarly abnormal conditions; but even such defence is permissible only while the defender respects other human life and the social life, while he is innocent, has done no harm to society commensurate with the loss of his own life.

"The weariest and most loathed worldly life

That age, ache, penury, and imprisonment

Can lay on nature is a paradise

To what we fear of death."

Existence, no matter how sordid, is immeasurably better than non-existence, for non-existence is nothing; and when we consider eternal life after separation from the body, even as a probability, that raises existence to infinite possibilities above the void of non-existence. A human life, even in an Australian Bushman, in a tuberculous pauper, in the vilest criminal, is in itself so stupendously noble a thing that the whole universe exists for its upholding toward betterment. The raising of human life toward a higher condition has been the sole tendency of all the magnificent charity, sacrifice, patriotism, and heroism the best men and women of the world since time began have striven in. The necessary first cause itself is life, and life is by far the most sacred thing possible for the first cause to effect. Eternal life is the greatest reward of the just.

It is not permissible under any possible circumstance directly to kill an innocent human being. By killing directly is meant either (1) as an end desirable in itself, as when a man is killed for revenge; or (2) as a means to an end. By an innocent human being is meant a person who has not by any voluntary act of his own done harm commensurate with the loss of his own life.

To kill a human being is to destroy human nature, by separating the vital principle from the body; to destroy anything is to subordinate and sacrifice that thing absolutely to the purposes of the slayer; but (1) no one has a right so to subordinate another human being, because man and his life are solely under the dominion of God. If a man may not kill himself, as we proved above, because he is not master of his own life, he surely may not kill another to whom he is no more closely related as master than he is to himself. (2) No man has a right to subordinate another human being as is done in slaying him, because this other human being is a person, an intelligent nature, and consequently free, independent, referring its operations solely to itself as to their centre. This very freedom differentiates man from brutes and inanimate things. These are not independent; they are rightly possessed by man; but man may be possessed by no one except God. Even extrinsic human slavery is abhorrent to us as a corollary of the intrinsic freedom of man, which is absolute. This intrinsic freedom is such that we may not under any circumstances lawfully resign it to another's possession. This is one of the chief moral objections to oath-bound secret societies which exact blind obedience. All morality depends on that freedom, all peace in life, all civilization, and society itself.

The end of our struggles, toil, fortitude, temperance, thrift, is freedom,—freedom to do and to hold, freedom from the thraldom of vice and barbarity. The rational endeavor of every civilized nation is that it be free; and this means solely that every citizen thereof, from the highest to the lowest, is made secure in his rights as a human being. It intends that justice should prevail. Nearly all the unhappiness, crime, moral misery, and much of the physical misery in the world are due to a disregard for liberty, for the safeguarding of men in their inalienable rights. Give every man his bare rights as a man and all troubles of capital and labor, all race problems would cease, the prisons would be empty, war would be unknown. Our struggle toward justice, toward the protection of the rights of man, toward liberty, must go on, or anarchy and social destruction will ensue. Now, as there is nothing greater and nobler than liberty, the freedom of the sons of God to do what they have a right to do, and as every human being has a right to that liberty, so there is nothing baser than its contrary, the destruction of that liberty; and no destruction is so final as that of killing the man, no usurpation so abhorrent to human nature and all liberty. Abhorrence for such a destruction is the primal instinct of all human beings; even the irrational reflexes of our bodies react quickest in protecting us from that destruction.

Justice and order must prevail; that is a fundamental natural law to which all other laws are subordinate. Justice, moreover, is a moral equation, and whenever one right transcends another it must be superior to the right it holds in abeyance. The right an innocent human being has to his life, however, is so great that no other human right can be superior to it while he remains innocent. Subversion of this right by creatures is intrinsically evil, as blasphemy and perjury are evil, although not in exactly the same degree.

There are occasions upon which it is permissible to kill, indirectly, innocent persons. An effect is brought about indirectly when it is neither intended as an end for its own sake, nor chosen as means toward an end, but is attached as a circumstance to the end or the means. Means help to an end, circumstances often do not, although they may affect the morality of an act.

Suppose two swimmers, Peter and Paul, are trying to save Thomas, who dies in the water; as he dies Thomas grips Peter and Paul so tightly that they cannot shake the corpse off. Peter is weak, and he will soon sink and drown, owing to his weakness and the weight of the corpse; Paul also will go down later, owing to the weight of Peter and Thomas. Peter, however, cuts his own clothing loose from the grip of the corpse and is saved; but Paul immediately is drowned, owing to the fact that the full weight of the corpse comes upon him. Is Peter justified in cutting himself loose? Certainly he is. This is an example of indirect killing, a case of double effect, one good, the saving of Peter's life, the other evil, the loss of Paul's life, both proceeding immediately and equally from the causal act, the cutting loose of the clothing. The good effect is intended, the bad effect is reluctantly permitted.

Again, let us set the same condition for Peter, Paul, and Thomas; but Peter is not able to cut himself loose. John, a fourth person, can cut Peter loose and save him, but can do no more; he must let Paul go down with the corpse of Thomas. May John cut Peter loose? Certainly he may, on the principle quod liceat per se licet per alium. This is another case of double effect, with the extenuating circumstances as above.

Suppose, however, Peter represents a living infant in the womb of Ann, and that she is in labor; further, this infant cannot be delivered owing to the contraction of Ann's pelvis. May John, a physician, cut away Peter by craniotomy and so save Ann's life? Certainly he may not. John here directly brains Peter to save Ann, although Peter is not an unjust aggressor; he does a murder to get a good effect, and the end does not justify the means. There are two effects, but the good effect follows from the bad one, and not immediately from the causal act.

Take another example: Peter is a swimmer disabled by cramps and about to drown; Paul, going to save Peter, is seized by Peter, and both are now in danger of drowning; John goes to help Peter and Paul. He cannot get Peter's grip loose by ordinary means, and he sees he can save only one man, either Peter or Paul. May John knock Peter senseless to loosen his grip from Paul, bring in Paul, and thus leave Peter to drown? Certainly he may. You have the double effect here also. Moreover, Peter is a materially unjust aggressor; he is like a maniac trying to kill Paul. In the craniotomy case the child is not a materially or formally unjust aggressor, it is not doing anything at all. It is where the mother put it, and it has a full right to its position and its life.

John most probably might also knock Paul senseless and save Peter, if through affection or similar motive he preferred this course. He would then be justified by the double-effect principle alone, although Paul is in no sense an aggressor. The intention of the blow would have to be solely to loosen Paul's hold.

In a just war a commander may shell an enemy's works and indirectly thereby kill non-combatants. The gunners that cause the death of the non-combatants do not intend this death; they permit it as the evil effect which comes immediately with the good effect (the capture of the works) from the causal act of firing the guns.

If we keep within the bounds of a just defence we may protect ourselves against an unjust aggressor to the effusion of his blood, or even, if need be, to killing him. An aggressor is any one who does injury to us contrary to our rights and the ordination of right. A formally unjust aggressor is a sane intelligent person who intentionally attacks us; a materially unjust aggressor is one who is not intelligent, not responsible, as an insane person, a child, or a sane person who is injuring us unintentionally. This question is important in medicine because the fetus in utero is often erroneously called an unjust aggressor.

It is a primary law of nature that every human being should and will strive to resist injury and destruction. Justice requires a moral equation, and if one right prevails over another it must be superior to the right it supersedes. At the outset both the aggressor and the intended victim have equal rights to life, but the fact that the aggressor uses his own life for the destruction of a fellow man sets the aggressor in a condition of juridic inferiority to the victim. The moral power of the aggressor here is equal to his inborn right to life, less the unrighteous use he makes of it; while the moral power of the intended victim remains in its integrity, and has therefore a higher juridic value.

The right of self-defence is not annulled by the fact that the aggressor is irresponsible. The absence of knowledge saves him from moral guilt, but it does not alter the character of the act considered objectively; it is yet an unjust aggression, and in the conflict the life assailed has still a superior juridic value. In any case the right of wounding or of killing in self-defence is not based on the ill will of the aggressor, but on the illegitimate character of the aggression.

The condition's of a blameless defence (moderamen inculpatae tutelae) are: (1) that the aggressor really threatens the defender's life, and there is no means of offsetting that violence except like violence; (2) that no more violence is used than is adequately required: if the aggression can be stopped by wounding the aggressor the defender is not to kill him; (3) that the violence in the defence is used with the intention of defence, not in revenge, hatred, anger, or the like motives.

We may do an act good in itself from which a double effect immediately follows, one good, to which the agent has a right, and the other bad, which the agent is not obliged to omit if permitted by him and not intended; but in the case of a necessary defence of life against an unjust aggressor, made even with the death of the aggressor, the defence is such an act, provided the moderation of a blameless defence is observed.

The evil effect here is not a means to the good effect, nor does it more immediately follow from the act done. The evil effect is an effect per accidens, and thus not directly voluntary, either in itself, because it is not intended, or in its cause. It lacks the condition necessary to make it voluntary in cause as regards the accidental effect since the act is not prohibited precisely because this accidental effect follows.

The act in the case is good in itself; it is an application of physical force in defence of a proper right, and any right supposes a compulsive power. The two effects of this double-effect act are: (a) the preservation of the defender's life, and (b) the death of the aggressor. The first effect is good because the defender has a right to his own life; the other effect is evil, not only physically for the one who dies, but morally inasmuch as the death conflicts with the dominion of God. This death, however, is an accidental effect of the act, because in general the defensive act is not directed by its nature to that death but to the preservation of the defender's life; nor does the death follow more immediately than the preservation. Thus it is not a means of the defence. Finally, the defensive act is not prohibited precisely lest that death follow: not in justice, for there is no justice in any right of the aggressor which requires from the defender an omission of defence unto the loss of life; there is no obligation in charity, since charity does not oblige us to love another more than ourselves, or to exalt the good of another above our own.

In an aggression which is merely material—say, in an attack by an insane man—the defender has a right to the infliction of such damage as is necessary and proportionate to an efficacious defence. The right of the aggressor yields to the superior right of the defender, not through the fault of the aggressor but through his misfortune. There is a collision where both rights cannot be exercised at the same time, and there is no reason obliging the defendant to forego his own right.

We may defend another against an unjust aggressor because we can assume that the attacked person communicates to us the use of his own coactive right. If the aggressor is our own father, mother, son, or daughter, or in general any one to whom charity obliges us more than to the person attacked, we are not permitted to kill our own kin because charity does not oblige us to prefer the good of an alien to the good of one of our blood. Ordinarily we are not obliged in justice or charity to defend another at the risk of our own life.

We may kill an unjust aggressor, servatis servandis, in defence of good equivalent in value to life: for example, to prevent life imprisonment, the loss of reason, a mutilation which would render us useless, the loss of a woman's chastity.

There are cases of accidental homicide, in medicine and elsewhere, which have an element of guilt in them. If a death follows accidentally upon an act which in itself is licit, and the agent uses all proper precautions, he is not morally guilty in case of an accidental death following his act. This is true even if the agent foresaw a probable death but did not intend it. If, however, the agent's primary act is illicit in itself, and an accidental death follows from this act, the agent may be guilty of homicide, provided the first act in itself is naturally likely to cause homicide. Should the first act be always dangerous, such that death commonly follows from it, like rocking a row-boat, aiming a supposedly unloaded gun at a person and pulling the trigger, striking a pregnant woman, drinking whiskey and then overlying an infant in the bed, throwing building material from a roof to a street, racing an automobile through a crowded thoroughfare, sending a crew out in a rotten ship, and so on, the accidental homicide that follows is imputable to the agent no matter how much precaution he may say he has used to avert such a death.

Suppose, secondly, the original act of the agent is illicit but such that accidental death rarely follows from it; then if he takes due precaution he is not ordinarily guilty of homicide. He has, say, stolen an automobile, and is going along the street leisurely, when a careless child runs off the sidewalk under the machine and is killed.

1. No person, then, may hasten his own death or permit any one else to hasten it.

2. No physician may in any possible condition kill a patient merely to effect euthanasia.

3. The state has no more right than the physician to permit the killing of patients to bring about euthanasia.

Were such permission given to physicians it would immediately be abused by men with even the best intentions. In all countries and in the largest cities the medical profession is swarming with quacks. What is done in crass ignorance by licensed physicians and specialists every day in the name of medicine is appalling. Professor Orth of the Pathologic Institute in Berlin makes the statement that of all the appendices that have been submitted to him for microscopic examination after removal by conservative and supposedly skilled physicians, 17 per cent. showed no disease at all, and should not have been removed. In this country the percentage of normal appendices removed because of vague abdominal pains is much larger.

The Journal of the American Medical Association (June 7, 1913) gave a list of post-mortem examinations where the diagnosis made by men with a reputation for fair work had been correct in only the following ratios:

Pneumonia is a very common disease, extremely dangerous, and by skilful treatment it is very often cured, yet of these 100 cases 66 were not diagnosed. I recently saw a severe case of double pneumonia which a physician was treating as "indigestion," and he was giving pepsin tablets for the supposed indigestion. There is such a thing as extraordinary scientific precision in medical work, but it is rare; the ordinary physician treats symptoms without knowing the cause of the symptoms; that is, the symptom-treater is a quack, and if euthanasia were legalized thousands of such quacks would be permitted to murder with an overdose of morphine any querulous old man or woman who might fall into their hands. Osteopaths and chiropractors are masseurs, and they know very little of massage, but they are licensed by legislatures to practise medicine, and some of them even try obstetrical malpractice. They, too, would be licensed to inflict euthanasia. Pure homeopathy is little more than a name at present; it is faith-healing without prayer. It attenuates its drugs 100 per cent. for thirty repetitions, to a degree expressible by one with sixty ciphers. Consequently it gives sugar of milk or alcohol in minute quantities plus a label, and one cannot make much of an impression on any disease with a label. Such practitioners also would come under the euthanasia act.

BIBLIOGRAPHY

Cardinal John de Lugo. Disputationes Scholasticae et Morales, vol. vi; De Justitia et Jure, disputatio x.

St. Augustine. I Contra Petilianum, cap. 24; Ad Marcellianum Comitem, cap. 21; De Civitate Dei, cap. 17 to 28.

Aristotle. III Ethicorum, cap. 7, and lib. v, cap. ii. Plato. Phaedo.

Cicero. Quaestiones Tusculanae. I, lib. v; De Somno Scipionis.

Lessius. De Justitia et Jure, lib. ii, c. 9, dub. 6, 7.

Molina. De Justitia et Jure, vol. i, tr. 2, disp. 119; vol. iv, tr. 3, disp. 1 and 9.

St. Thomas Aquinas. Summa Theologica, 2, 2, q. 64, a. 5, 7.

St. Alphonsus Liguori. Theologia Moralis, vol. iv, tr. 4. See this book for opposed opinions and a bibliography.

Costa-Rossetti. Philosophia Moralis, thesis 120.

Ferretti. Philosophia Moralis, theses xci, xciv.

Macksey. De Ethica Naturali, theses xxxiv et seq.

[CHAPTER II]

General Principles Concerning Mutilation

The members of the human body may be injured (1) by a blow, which without bloodshed causes pain or a bruise; (2) by a wound, which breaks the continuity of the tissues; (3) by mutilation, which, without killing, removes some member requisite for the integrity of the body. The term Mutilation as applied to the human body has various meanings. In the civil law mutilation of a person is called Mayhem, an old form of the word Maim, and is defined by Blackstone[5] as "such hurt of any part of a man's body as renders him less able in fighting to defend himself or annoy his adversary." By statute in the United States and Great Britain the scope of the offence has been so extended as to include injuries to a person which merely disfigure or disable. Mutilation in the civil law now implies the taking away of some part of a legal instrument, as a will, contract, or the like, by any one who has no right to make this alteration.

In canon law mutilation is like malicious or accidental mayhem in the civil law, and it has also a technical phase in relation to irregularity as affecting the reception of ecclesiastical orders. The mutilation requisite to irregularity as affecting the reception of Holy Orders may differ from mutilation in its purely moral and accidental aspects. Broadly, an irregularity is a canonical and permanent impediment to the reception and exercise of ecclesiastical orders. It does not exist unless it is actually promulgated in some canon, and it is not necessarily grounded on corporal deformity. Defects of the body that cause canonical irregularity are such as would render the public ministration of a clergyman either impossible or indecent.

Molina, treating of mutilation, says[6] it does not exist unless there is an amputation or shortening (detruncatio) of a member. When a foot or hand is so weakened without amputation that it cannot exercise its function the person is said to be maimed or lame, not mutilated. He holds that a finger, and a fortiori a phalanx of a finger, are not properly members. In defining mutilation as a cause of canonical irregularity[7] he contends that the weakening of a member so that it cannot perform its function is not a true mutilation canonically. He does not agree[8] with Cajetan, de Soto, and others who hold that an important part of a whole member is equivalent to a member so far as technical canonical mutilation is concerned. Molina says that a part of the body as a member to fulfil the requirements of the law on mutilation as a cause of irregularity must have a distinct, complete function of its own, not be a mere part conducing to the function. Ballerini[9] agrees with Molina, but he draws attention to a decretal of Innocent I. which makes an amputation by oneself of even a part of one's own finger a full canonical irregularity, because of the unnatural quality of the act.

Suarez defines mutilation thus: "Mutilare significat proprie membrum aliquod abscindere"[10]—to mutilate means, strictly speaking, to cut off any member. He holds with Cajetan that an important part of a member is in itself equivalent to a member. A reason he offers for his opinion is that a eunuch is enumerated among those who are canonically mutilated, but the eunuch, he tells us, "does not lack any member which in itself has a function in the body independent of all other organs." This is not true. The testicles, which the eunuch lacks, have two distinct functions, independent of other organs—they make the spermatozoa and an important internal glandular secretion. These facts were not known in Suarez's time (1548-1617). Suarez adds this remark: "There can be a grave sin in a marring [diminutio] of any chief member, although there may be no grave mutilation; as, for example, to cut off a part of a finger is undoubtedly a mortal sin, yet, in the opinion of all moralists, it is not enough to cause irregularity."

St. Alphonsus Liguori defines mutilation thus: "Mutilation here signifies that some principal member be separated from the body; that is, a part of the body that has in itself a distinct function, as a foot, hand, eye, ear, etc."[11] He says[12] canonical irregularity as a punishment is not incurred by a person who cuts off another man's finger, thumb, lips, nose, auricle, or who knocks out teeth, because these are supposed by canonists not to be properly members of the body, but parts of members. To blind a man in one eye is not enough to cause canonical irregularity; the eye must be taken out.[13] All these injuries are of course mutilations in the moral sense of the term. To blind a man without removing the eye, to cut out his spleen in the treatment of Banti's disease, to remove a woman's ovary or uterus, to cut off part of the point of a finger, to crop the top of an auricle, to knock out a tooth, and any other permanent marring of the body, even to cause an unsightly scar across the face, are all mutilations in the moral sense of the term. A physician, midwife, nurse, or parent who neglects an infant's eyes, and so permits ophthalmia neonatorum to blind the child, is guilty of grave mutilation. In the year 1914, in the Chicago schools, 45,176 children were found suffering from various defects, and 35,425 were advised by the examining physicians to seek treatment; in each of these cases the parents were informed of the nature of the disease and the necessity for treatment, but only 40 per cent. of the parents paid any attention to the notices. Of 5754 cases of diseased tonsils, which are likely to affect the heart permanently, only 4 per cent. were treated; of 1254 cases of discharging ears only 10 per cent. were treated, although such a condition may go on to deafness if not attended to. These parents were criminally guilty of grave neglect in permitting the mutilation of the heart and ears.

Any notable mutilation inflicted upon oneself is akin to the malice of suicide, and when perpetrated on another it is related to homicide. The dominion over the members of the body, as over the whole body, belongs to God alone. Man is constituted by his parts, members, taken together, and if he were master of his members he would be master of himself. Again, each member of the body is naturally united to that body and ordained for determined organic functions; so it is wrong to render these members unfit for their natural function or to separate them from the body, unless such actions are necessary for the preservation of life itself. Although man is not master of himself, he is the administrator of himself; and therefore when the amputation of any member is necessary for the preservation of the life of the whole body it is licit to subordinate this part to the good of the whole.

A direct mutilation is one intended as an end, or as a means to an end; it is a voluntary and free act. An indirect mutilation is one in which the mutilation is the natural effect of the act, but the intention of the agent is directed toward another end. The mutilation follows indirectly from the activity of the will, but there is a satisfying proportion between the accidental effect (the mutilation) and the end intended. In such an act there are two effects which follow the causal act aeque immediate, or directly (not indirectly, that is, not all from the other effect, but each immediately from this cause): one effect is good (to save life, avoid unbearable pain, or the like), and the other evil (the mutilation), but the good effect is the end intended, the evil effect is reluctantly permitted. Such an act is licit provided the usual conditions of the double effect are present, that is:

1. The action that is the cause of the good and bad effects must be itself good or indifferent morally.

2. The good and the bad effects must each be an immediate result of the causal act; the good effect may be not so subordinated to the evil effect as to be obtainable only through the evil effect.

3. The bad effect must not be intended, either immediately or remotely; it may at most be tolerated as unavoidable.

4. There must be a sufficiently grave reason for the act.

Indirect mutilation may be licit when the evil to be avoided is proportional to the mutilation. Direct mutilation, where there is one direct effect of, say, the surgical operation, namely, to remove the somatic organ, is not licit, except for the good of the whole body; and that good to the whole body must be juridically equivalent to the damage done the body by the mutilation. There is to be a direct effect in such mutilation, which is the good of the whole body. It is not permitted to kill directly to save the life of another, but it is permissible to mutilate directly to save the whole body. Direct mutilation, however, is never unavoidable because the agent can always correctly order his intention before the operation.

All direct mutilation, unless for the good of the whole body, implies deordination: it offends against the supreme dominion of God, who reserves to himself, as Creator, ownership of human life and its organs. As we may not destroy life, which belongs to God, we may not amputate a member to suppress any vital function. The exception which permits us to mutilate a member or organ is, as has been said, the adequate good of the whole body. The reason for this is that man is the administrator of his members, to the good of the whole person. Each member is not for itself but for the whole body.

The good of the body is the sole cause that renders direct mutilation licit. The members of the body by their nature are not immediately subordinate to anything except the conservation of the total natural good, or that of the body. Therefore direct mutilation is not permissible to effect immediately spiritual good, or the good of the soul. We may not castrate a man, or do vasectomy on him, to preserve his continence, because there is no immediate subordination and connection between the members of the body and the salvation of the soul. Moreover, as St. Thomas says,[14] "Spiritual health can always be preserved by means other than amputation of bodily members," that is, through moderating by the will the use of these members. If a mutilation that immediately conduces to the good of the whole body, happens also to do good to the soul, this second effect is then legitimate. (The various mutilations of the body by surgical operations will be considered separately hereafter.)

May the state, then, sterilize criminals, and persons afflicted with dangerous hereditary diseases, to prevent the propagation of moral and physical defectives? This question is considered specially in another chapter.

There is an error gradually infecting all nations of late which is that the state, as such, is above morality; that what the civil authority permits or orders is by that fact alone made licit or obligatory. Hence the interference with individual liberty, with the rights of man, shown by laws for the mutilation of the physically degenerate, laws conferring privileges on one part of the community to the detriment of another, meddling in parental rights, and so on. Political error has come to such a pass that the men on the street think any majority is justified, solely because it is a majority, in recalling a judge or a law, in overriding authority for the satisfaction of appetite. The sovereign people tries to be subject and sovereign at the same time, and it deems its rulers mere hired men who may be discharged at will like cooks.

A law is a rule and standard of action; a just, permanent, and rational ordination for the good of the community, promulgated by one who has charge of that community. Dominion is the power of claiming a thing as one's own, the right of ownership; and if this possessor has created the object, his dominion may be absolute. A governor, lawgiver, judge, has power or jurisdiction for the good of the governed. The business of government, of the state, is to protect each citizen in the pursuit of temporal happiness, to develop his natural faculties, establish and preserve social order, wherein each citizen is secured in his natural and legal rights, and is held up to the fulfilment of his own duties so far as they bear on the good of the community as such; and also to put within the reach of all citizens, as far as possible, a fair allowance of means to acquire temporal happiness, or external peace and prosperity. This is the whole business of the state. The state is for the people, and it may not transgress an inch beyond its proper limits, which are as hard and fast as those that bind the individual citizen. The citizen is not to be treated solely as an industrial or military unit; nor are material progress and military power, or even sheer intellectual civilization, to be the sole aim of the state. The state should develop a man's entire nature, physical, mental, and moral.

We must obey civil authority, but we are not slaves or chattels of that authority. The state's authority over us is not dominative; it is only a power for our good and utility. The civil authority has no more right to invade the rights of its meanest citizen than it has to lie or to blaspheme. God gives civil authority to the established community, and the community entrusts this to its ruler; authority is a divine institution, rulers are directly a human institution and only indirectly divine. When the ruler has once been set up, has had authority entrusted to him, obedience must be given to him while he acts in keeping with his contract. Kant and his followers erroneously separate the juridic from the moral order; they deny that beyond the state there are any rights preeminent to the state's rights, yet they say there is an innate liberty which belongs to every human being equally and inalienably. The moral order comprehends all factors that are necessary to make the free activity of man in every respect well disposed, and among these factors is the juridic order itself. Man is naturally social, and whatever means are necessary to preserve human society are also naturally befitting man. Such means are to preserve for each man what are his, and to abstain from injuring other men. Now, so to act, that is, to abstain from murder, theft, and the like, to fulfil contracts, are strictly juridic duties, and at the same time moral duties. Therefore the moral order comprehends the juridic order.

The end of the state, then, is not the public good considered as an end in itself. The individual citizen is not his own end in life, and so no mere multitude of men ever can become their own end. If the end of the state is the public good, then private good is subordinate to this, and the public good becomes man's final end, which is subversive of human dignity and is despotism.

A clear definition of the power of the state to interfere with the rights to life and limb of the individual citizen is very important, because, as has been said, of late there is an alarming tendency on the part of the civil authority to override the rights of private citizens, even in the most democratic forms of government. Encroachment on the liberty of the individual is characteristic of unchristian political societies, and all states are now receding from Christianity. A striking example of this tyranny is the laws recently passed in ten American states for the mutilation of degenerates. This definition is more readily made by considering concrete examples of public conduct.

Suppose an enemy demands from a city the surrender for execution of an innocent man on pain of the burning of the city and the destruction of its inhabitants. May the city cut off that member for the safety of the whole body politic, as a person may cut off his own hand to save his life? The state has not dominion over the life of a citizen, nevertheless it may kill a citizen in punishment of crime, because the punishment is useful to the whole people, is for the common good, is preservative of the social life. Why, however, should the state be permitted to kill a criminal rather than an innocent man, since it has no dominion over the life of either, and we suppose the death of each is necessary for the public good? If you answer by saying a man may cut off a diseased member but not a sound one to save his body, and the state in like manner may cut off a criminal, unsound member, but not an innocent one, this answer does not remove the difficulty: we may cut off even a sound member to save the body. Suppose, for example, a man caught by the arm and in danger of death from a flood; he might sever a sound arm to escape death if no other means presented. In like manner the state might cut off an innocent, sound member to save its life from the enemy, as described above.

This reasoning, however, is open to objection. The state has no dominion over the life of its members, and there is a vast difference between the members of the human body and those of a body politic. A member of a human body has no right in itself against the other members; nor is it capable of natural injury, since it is not separable from the whole suppositum, or person. The suppositum, or person, has a right to the use of the members; it alone is injured when a member is amputated; and the members are solely for the utility of the suppositum. Therefore we may licitly destroy a member to save the suppositum for which this member exists.

The state, however, is not a suppositum in this sense; it may not wrest the life of its members to its own utility, because the citizens are not for the state; on the contrary, the state is for them and their utility. That a rational being should be for the utility of another person or a society makes him a slave and supposes dominion in the user. A slave is differentiated from a subject by the fact that the subject is only politically governed—that is, governed for his own utility and good; the slave is governed despotically—that is, for the utility and good of his master. The state may not, as a master, use the life of a subject for its own utility alone. Although the suppositum does not own its members, yet since the members are not separable from the man, are not self-centred as are the citizens in a state, the man may use them for his own utility. They are as slaves under a master, not as subjects in a body politic; therefore they may be sacrificed for the good of the suppositum.

This is the argument used by De Lugo; Molina follows the same line of thought; but both authorities finally reach the conclusion, in the case of the enemy and the citizen whose life is required, that the state may at least drive this citizen out of the city to save its own existence. Molina also draws attention to the fact that there is a great difference between a member of a body politic and a member of the human body; this identification, if pushed far enough, becomes an analogical quibble.

Some hold that a judge or the civil authority in general may kill or maim a criminal by gubernatorial power alone, prescinding from dominative power, and this not to the utility of the criminal but for the utility of society. The killing of a criminal, these objectors say, is not for the good of the criminal; it is a deterrent, a protective act, for the good of society. This is not true. The penal law which the criminal breaks was not made solely for society; it was intended also for the utility of the person who becomes a criminal. The law was made and the punishment established that all subjects indiscriminately should be helped to live honestly and blamelessly, and to this end it was necessary to decree and inflict punishment as affecting all offenders. The obligation to receive punishment is in a manner essential to man. As he naturally requires direction and government unto virtue in his political and social life, he has a connatural obligation to endure punishment when he violates the law made for his advantage—one condition cannot exist without the other. Hence punishment really is to the utility of the criminal.

[CHAPTER III]

When Does Human Life Begin?

By the embryologists from the moment the spermatozoön joins the nucleus of the ovum until the end of the second week of gestation the product of conception is called the Ovum; from the end of the second week to the end of the fourth week it is the Embryo; from the end of the fourth week to birth it is the Fetus. At what moment during these three stages does the human soul, the substantial form of a man in the full comprehension of the term, enter the product of conception? When does the thing become a human being?

The question is evidently one of the greatest importance. If the rational soul does not enter until the ovum has developed into an embryo, or only after the embryo has passed on into the fetal condition, the destruction of this ovum, by artificial abortion or otherwise, would be a very different act morally from such destruction after the soul had turned the new growth into a living man. If the product of conception has first only a vegetative vital principle, and this is later replaced by a vital principle that is merely sensitive, and this again is finally superseded by a rational vital principle, the destruction by abortion or otherwise of the vegetative or sensitive life would not be a destruction of a rational life. In this hypothesis the killing of the embryo would be a great crime, because the embryo would be in potency for the reception of human life, but the act would not be murder.

The discussion concerning the moment the human soul enters the body is older than Christianity, and it was taken up by many of the early Greek and Latin Fathers of the Church, and revived again and again down to the present day. Plato thought the soul enters at birth; Asclepias, Heraclites, and the Stoics held it is not infused until the time of puberty; Aristotle[15] said the soul is infused in the male fetus about the fortieth day after conception, and into the female fetus about the eightieth day.

Tertullian,[16] Apollinaris, and a few others advocated Traducianism,[17] or a transmission of the spiritual soul by the parents. He said souls are carried over by conception and by the parents, so that the soul of the father is the soul of the son, and from one man comes the whole overflow of souls. St. Augustine used the metaphor, one soul lit from another as flame from flame, without decay in either. Augustine was in doubt as to the origin of the soul, and inclined to traducianism, because it seemed to him better to explain the doctrine of the transmission of original sin. "Tell me," he wrote to St. Jerome in 415,[18] "if souls are created singly for each person born to-day, when do infants sin so that they need remission in the sacrament of Christ, sin in Adam from whom the flesh of sin is propagated?... Since we cannot say that God makes of souls sinners, or punishes the innocent, nor may we hold that souls even of infants which without baptism leave the body are saved, I ask you how that opinion can be defended which thinks that all souls are not made from the single soul of the first man, yet as that soul was one to one man, these are particular to particular individuals."

Again, St. Augustine said:[19] "I do not know how the soul came into my body; he knows who gave it, whether he drew it [traxerit] from my father, or created it new as in the first man." In the Book of Retractions,[20] speaking of the articles he had written against the Academicians before he was a bishop, he says: "As to the origin of the soul, how it is set in the body—whether it is from that one man who first was created ... or, as in his case, is made particularly for each particular individual, I did not then know, and I do not know now." St. Gregory the Great also said he could not tell whether the human soul descends from Adam or is given particularly to each man.

St. Gregory of Nyssa, however, who died about 385, thirty years before St. Augustine wrote the letter to St. Jerome, held that the soul is infused into the body at the moment of conception, and he argues with absolute precision for his opinion.[21] St. Maximus the Theologian, who was martyred in 662, inveighs[22] against the notion that the soul is vegetative at first, then sensitive, and finally intellectual, and he thinks the assertion of Aristotle that the fetus is not animated before the fortieth day is altogether untrue.

St. Anselm, who died in 1109, very dogmatically denied that the fetus is animated at conception,[23] and after his time the doctrine of Aristotle, which is commonly called the Thomistic opinion, became almost general. Vincent of Beauvais, however, a contemporary of St. Thomas, opposed the Thomistic doctrine. Albertus Magnus[24] had the same opinion as St. Thomas, and probably taught it to St. Thomas. In the middle ages all held that each soul is directly created by God, and is infused into the embryo, not at the instant of conception, but when the embryo is sufficiently formed to receive it, which, as Aristotle said, happens at about the fortieth day in males and the eightieth day in females. The Thomists maintained the succession of the three souls; many others opposed this particular opinion.

Thomas Fienus, a physician and a professor in the University of Louvain, in 1620 published a book[25] in which he held that the soul is infused about the third day after conception, and his argument for the early advent of the soul is very sound. As a result of Fienus's revolutionary argument, Florentinus in 1658 brought out a book at Lyons, called De Hominibus Dubiis Baptizandis, in which he held that no matter what the age of the aborted fetus, if it could be differentiated from a mole it should be baptized. This book was brought before the Congregation of the Index. The congregation did not condemn the book, but the author was forbidden to teach that his doctrine holds sub gravi. The book went through many editions and was approved by the faculties of the principal universities and the theologians of the leading religious orders.

Zacchias, chief physician to Innocent X., in 1661 published his Questiones Medico-Legales, and in this he maintained that "the human fetus has not at any time any kind of soul other than a rational, and this is created by God at the first moment of conception, and is then infused."[26] By 1745 the opinion of Zacchias as to the moment life begins was virtually general among physicians, and has since remained the doctrine of physicists. Modern discoveries by biologists have confirmed the fact that human life exists in the impregnated ovum exactly as it does in all stages of life, and no scientist holds any other opinion. There are, however, a few moralists at the present day who incline to the old Thomistic doctrine or to modifications of it.

St. Alphonsus Liguori[27] was a follower of the Thomistic opinion. He affirmed: "They are wrong that say the fetus is animated at the instant of conception, because the fetus certainly is not animated before it is formed, as is proved from Exod. xxi: 22, where in the Septuagint version we find: 'He that strikes a gravid woman and causes abortion, will give life for life if the child was formed; if it was not formed, he will be fined.'" This argument by St. Alphonsus is invalid apart from any facts that may bear upon either the Thomistic or the modern opinion concerning the quickening of the fetus. The text from the Septuagint Exodus is (1) too doubtful in itself to be the basis of any argument; but (2) even if it were authentic just as it stands, the conclusion St. Alphonsus draws from it is not warranted by the premises. The Septuagint text differs from the Vulgate and the Hebrew texts. The Vulgate has it thus: "Si rixati fuerint viri et percusserit quis mulierem praegnantem, et abortum quidem fercerit, sed ipsa vixerit, subjacebit damno quantum maritus mulieris expetierit et arbitri judicaverint; sin autem mors fuerit subsecuta, reddit animam pro anima, oculum pro oculo, dentem pro dente, manum pro manu, pedem pro pede, adustionem pro adustione, vulnus pro vulnere, livorem pro livore."[28] This version has nothing whatever to say about the foetus formatus or non formatus; it is merely an application of the Semitic Lex Talionis, and the form of the law is clearly corrupt and inaccurate.

The passage quoted by St. Alphonsus as that of the Septuagint is not exact even as the Septuagint has it. The full text is: "If two men fight, and one strike a woman that hath [29] in a fine he shall be mulcted; whatsoever the husband layeth upon him he shall give according to decision [i.e., of the judges]. But if it [the babe] be fully formed he will give life for life, eye for eye, tooth for tooth, hand for hand, foot for foot, burning for burning, wound for wound, stripe for stripe."

This is (1) evidently nothing but an application of the Lex Talionis, with no thought whatever of the biological animation, as such, of the fetus. It means that if a fully formed fetus be aborted, either no real damage is done, as such a child is viable; or the formed child may be maimed, and then the Lex Talionis is to be applied. If the fetus is not fully formed it is not a fit subject of the Lex Talionis since it cannot lose an eye, a tooth, and so on, because it lacks these organs and therefore the law of retaliation is not to be enforced.

(2) Suppose, however, the writer of the text as the Septuagint has it did think with St. Alphonsus that the formed fetus is animated, and the unformed is not animated, even then the conclusion drawn by St. Alphonsus is not warranted by the text. The laws of Exodus do not teach embryology, physiology, or any other part of physical science; and no authority worth a hearing holds that the Scriptures were intended to be infallible treatises on obstetrics or astronomy. Like the other parts of the Bible, the laws of Exodus presuppose the unscientific biological, astronomical, and other physical notions of the time in which they were written—the moral truth is the matter the Scripture is dealing with; there no inaccuracy is to be found. St. John (1:13) speaks of those who believe in Christ's name, "Qui non ex sanguinibus, neque ex voluntate carnis, neque ex voluntate viri, sed ex Deo nati sunt." Here he expresses the contemporary notion, which is also the Thomistic opinion, that men are generated from the specialized blood of their parents. He was interested solely in conveying the truth that those who received Christ were regenerated by him, not through heredity; and he does so, although the biology is inexact. If St. Alphonsus's conclusion is valid as from the text of Exodus, then men are generated ex sanguinibus, and so on indefinitely.

The Massoretic text of this passage seems to be the best preserved: "If men fight, and one hurt a woman who is with child, and her child come forth, yet there is no mischief, he [who struck her] shall be mulcted in a fine; whatsoever the husband of the woman layeth upon him he shall pay according to the judges. But if there be mischief, then he shall give life for life, eye for eye, tooth for tooth, hand for hand, foot for foot, burning for burning, wound for wound, stripe for stripe." Here the Hebrew text follows the Lex Talionis exactly. If, in a brawl, a man's pregnant wife is struck and abortion results, the offender pays the penalty. If the abortion does not kill or maim the child, the culprit is fined by the Sanhedrim; if the child is killed or maimed, then the penalty is according to the Lex Talionis. In the Hebrew text also there is no mention of a distinction between a foetus formatus and non formatus.

Whether the fetus is animated at conception or some time later, there is no foundation whatever for the notion that the female is quickened later than the male. As was said before, Aristotle held that the human male fetus is animated at the fortieth day, the female at the ninetieth day, and the old moralists accepted his statement. At the fortieth day, however, no one can differentiate sex unless the microscope is used, and this particular use of the microscope is altogether modern—the knowledge requisite for such use was not in existence sixty years ago. At the twentieth day, with the microscope and a stained specimen, a biologist can recognize whether the primordial ova are present or absent and thus determine sex. Only at the eighty-fourth day can sex now be differentiated without the aid of the microscope, but then the embryo must be dissected: nothing can be told from its external appearance. Sex can first be distinguished by the external appearance only at about the one hundred and twelfth day, the end of the fourth month of gestation. Therefore when Aristotle said the male fetus is animated at the fortieth day, and the female at the eightieth or ninetieth day, he was romancing.

The question, then, narrows to this: Is any human fetus animated immediately at conception, or from forty to eighty days after conception? The reason given by the followers of Aristotle for deferring animation is that the vital principle requires organs in the receptive material, but the embryo in the early stages, they say, lacks these organs. This notion, however, as to the lack of organs is altogether erroneous, and the rational soul enters the embryo in the oval stage, immediately after the pronuclei unite: there is organization in that stage of human life sufficient to receive the substantial form or soul. We do not know how long after insemination the pronuclei unite, but the proposition here is that as soon as they unite the human soul enters. Fecundation usually occurs after a menstruation, but not necessarily so; the spermatozoön may live in the tube for seventeen days awaiting the ovum.

The human body is made up of billions of microscopic living cells, all of which are derived by fission and differentiation from the two original single germ-cells, the ovum and the spermatozoön. Some nerve-cells have long processes running along the white fibres through the entire length of the body, but they cannot be differentiated except by the microscope. In the body are also various liquids which are not cellular, as water, saliva, tears, urine, blood and lymph plasma, and the gastric, intestinal, and glandular juices, and these are secreted or excreted by the somatic cells. The cells assimilate nutritive material carried to them by the blood, excrete refuse substances, secrete glandular products, and are the media for all human operations below certain acts of the intellect.

A typical animal cell is commonly spherical in shape, but it may take a great variety of forms through compression. It has a cell-body or protoplasm, which is called also cytoplasm, especially when contrasted with the nuclear karyoplasm, and a nucleus. A few cells, like fat-cells and the human ovum, have an external covering membrane, or cell-wall. There is a part called the Centrosome observable in many cells, and this is made up of one or two minute dots surrounded by a radiating aster called the Attraction-Sphere. The centrosome is concerned in the process of cell-division and in the fertilization of the ovum; it is an important organ in the production of cell from cell, though its full nature and function are not yet known. The Plastid, or Protoplast, is another less important part found in certain cells; and in this by enlargement and differentiation are formed starch, pigment, and in some cases chlorophyl. Vacuoles are seen in cells; and there is an opinion that these may be a special kind of plastid: some vacuoles pulsate.

The Nucleus is the most important part of a cell, the centre of its activity. The specific qualities of organism in origin and development are based upon nuclei, so far as the material element of the living cells is concerned. Vital stimuli pass through the nucleus into the surrounding protoplasm, and these stimuli control metabolism. The nutritive cytoplasm assimilates, but the vital principle energizes this assimilation through the nucleus, for a part of a cell deprived of the nucleus may live for a time, but it cannot repair itself. Constructive metabolism ceases when the nucleus is lost. A toxic disease like diphtheria kills by disintegrating cellular nuclei.

In the nucleus are several elements, the chief among which is Chromatin. Chromatin takes various forms, but commonly it is an irregular network. From the chromatin are derived the Chromosomes in the prophases of indirect cell-division which is the process of cell-division in the human body, except in lymph-cells and white blood-corpuscles, which split directly, or by Amitosis. Indirect cell-division is called Mitosis or Karyokinesis. In the male and female chromosomes, according to a common opinion of biologists, all the elements of parental and phyletic physical heredity are transmitted to the embryo.

Fig. I

A Cell.

Throughout the Cytoplasm is a mesh containing numerous minute granules called Microsomes.

The production of cell from cell is accomplished either by direct splitting of the nucleus and cytoplasm into two new cells, or by indirect division through a series of stages. In a typical direct, or amitotic, division the nucleus is constricted in the middle and divides into two daughter-nuclei. These by amoeboid movements withdraw to the poles of the cell; the cell finally divides between them, and thus two cells are formed. These, again, split into four, the four into eight, and so on. An amoeba by direct division can separate into two distinct new animals in ten minutes.

Heredity here is simple. In unicellular organisms, such as Rhizopoda and Infusoria, each individual grows to a certain stage, and then divides into two parts, which are exactly alike in size and structure, so that it is not possible to decide whether one is older or younger than the other. These organisms reduce the size of their overgrown bodies by division. Each individual of any such unicellular species is a part split off serially from an organism which started into life ages ago. Some of them have come down in uninterrupted life from geological epochs that passed away eons before the first man was created. Many of these unicellular plants and animals have immeasurably the most ancient form of life on earth. Heredity with them depends upon the fact that each offspring is merely half of its parent. In some cases the division has a sexual quality: two cells in Paramecium, and, like Infusoria fuse and then divide if they come into contact; they can, however, split without this sexual process.

Multicellular plants and animals do not reproduce by simple division, and the half of the parental body does not pass over into the progeny. Sexual reproduction is the chief means of multiplication in multicellular organisms, and in no case is it completely wanting; in most it is the only method of reproduction. In multicellular animals the power of reproduction is in the germ-cells, which differ from the somatic cells. Germ-cells do not maintain individual life as the body-cells do, but the germ-cells alone preserve the species. From two of these germ-cells under certain conditions is developed a complete bodily organism of the same species as the parents. These two cells are in a sense the undying cells; the somatic cells die.

Multicellular animals—Man, for example—grow embryologically by Mitosis or Indirect Division. As in Direct Division, typically, the nucleus in mitosis splits first and the cytoplasm secondly; but before the nucleus divides its content undergoes a series of changes. The chromatin loses its reticular arrangement and gives rise to a definite number of separate bodies, usually rod-shaped, known as Chromosomes. In this process the chromatin becomes a convoluted thread, called the Skein or Spireme. The thread thickens and opens out somewhat, and finally breaks transversely to form the chromosomes, which may be rods, straight, curved, ovoid, and sometimes annular. Commonly the nuclear material fades away and leaves the chromosomes in the cell-plasm. (Fig. II, 2 and 3.)

Fig. II

Diagram of Mitosis.

1. Cell with resting Nucleus. 2. Prophase: Chromatin in thickened convoluted threads, beginning of Spindle. 3. Prophase: Chromosomes. 4. Prophase: Spindle in long axis of the Nucleus, Chromosomes dividing. 5. Anaphase: Chromosomes moving toward the Centrosomes. 6. Chromosomes at the poles forming the Diaster, beginning splitting of the Cell-body. 7. Telophase, Daughter-Nuclei returning to resting state. 8. Daughter-Nuclei showing Monaster below. 9. The two new Cells.

It is almost an established fact that each species of animal and plant has a fixed and characteristic number of chromosomes, which regularly recurs in the division of all its cells. In forms arising by sexual production the number is even. The number of chromosomes in the human cell is said to be forty-eight. There are, according to some observers, forty-seven chromosomes in man and forty-eight in woman. There seem to be twice as many chromosomes in white men as in negroes. Wilson gives the number[30] of specific chromosomes for seventy-four animals and plants. Germ-cells as differentiated from the somatic cells have in the perfected cell always half the number of chromosomes found in a somatic cell.

While these changes are going on in the chromatin the Amphiaster forms. This consists of a fibrous spindle-shaped body, the Spindle, at either pole of which is an Aster made up of rays. In the centre of each aster is a Centrosome, and this may have a Centrosphere about it. As the amphiaster grows the centrosomes are grouped in a plane at the equator of the spindle, forming the Equatorial Plate. (Fig. II, No. 4.) The process so far makes up the Prophases of the Mitosis.

In the Metaphases of the Karyokinesis begins the actual division of the cell. Each chromosome splits lengthwise into exactly similar halves, and these, in the Anaphases of the mitosis, drift out to the opposite poles of the spindle to form the daughter-nuclei of the new cells. The daughter-nuclei receive precisely equivalent portions of chromatin from the mother-nucleus, and this is an important fact in mitosis. As the chromosomes go toward the poles the cell-body begins to constrict at the equator.

In the final phases, the Telophases, the cell divides in a plane passing through the equator of the spindle, and each daughter-cell receives half the chromosomes, half the spindle, and one of the asters with its centrosome. A daughter-nucleus is reconstructed in each cell from the chromosomes. The aster commonly disappears and the centrosome persists, usually outside the new nucleus, but sometimes within it. Every phase of mitosis is subject to variation in different kinds of cells, but the outline of the division given here is the fundamental method.

The germ-cells differ from the body-cells in general by containing half the number of chromosomes characteristic of a given animal or plant. If the body-cell has, say, twenty-four chromosomes, the spermatozoön of the animal or plant from which the cells are taken will have twelve chromosomes and the ovum will have twelve. When the nuclei of these two cells unite in fertilization the resulting primordial cell will have the twenty-four chromosomes restored, the specific number for this plant or animal. In oögenesis and spermatogenesis the phases of "Reduction," wherein the ovum and spermatozoön get rid of half the chromosomes during the stages of maturation of these germ-cells, are somewhat similar for both sexes. The process is very complicated, but it is of importance in the theories of inheritance. All the physical characteristics in a human being that come to him from his parents and remoter ancestors are supposed, by the biologists, to reach him through the chromosomes in the nuclei of the single parental germ-cells. The maternal physical heredity is handed on through the chromosomes in the ovum. The fetus in the womb is a parasite, autocentric, feeding at the start from the deutoplasm, or yolk, in the ovum, and later from the supplies brought to it by the maternal blood. The physical material it gets directly from the mother is very probably all in the chromosomes of the fecundated ovum. Some weeks elapse, and the embryo is quite advanced before it begins to draw food from the mother at all. So far as the father is concerned, there is no doubt whatever that every physical and pathological characteristic that can be handed down—and there are many such qualities—must come through the chromosomes of the paternal spermatozoön. Certain physical characteristics are passed on for centuries in a family—the Norseman's body in northeastern Ireland, the skin-pigment in the American negro, and so on indefinitely—and these qualities cannot come down except through the chromosomes. The germ-plasm has come to us from the first man, and it will be passed on to the last person of the race—we are all literally uterine brothers.

In the reduction of the germ-cells, if the primordial cell that finally produces the ovum has, say, four chromosomes, these four chromosomes first split longitudinally and reduce into two tetrads, or two groups of four chromosomes. Outside the nucleus is a spindle toward which the two tetrads move; they pass out of the nucleus and become the equatorial plane of the spindle; each tetrad divides into dyads (pairs of chromosomes), and one pair of these dyads remains in the ovum, while the other pair leaves the ovum entirely and becomes the nucleus of an abortive cell, called the First Polar Body. Later a second polar body forms and carries another dyad (two chromosomes) out of the ovum, leaving only one dyad, or two chromosomes, in the germ-cells; that is, half the number of chromosomes that were in the primordial cell.

The reduction-division in spermatozoa is similar, but the end process leaves four active spermatozoa, whereas in the ovum the final result is one ovum and three practically inert and cast-off polar bodies. The reduction-division in both ovum and spermatozoön is in reality far more complicated than the broad summary given here. In parthenogenetic insects and animals a polar body takes the place of the spermatozoön, and fuses with the egg-nucleus to start mitosis.

In general, the new nuclei in the cells formed by division are not made de novo, but arise from the splitting of the nucleus in the mother-cell. The new nucleus assimilates material, grows to maturity, and divides again into two daughter-nuclei. Whatever be the number of chromosomes that enter a new nucleus as it forms, the same number issues from it in mitosis. Boveri said,[31] "We may identify every chromatic element arising from a resting nucleus with a definite element that enters into the formation of that nucleus, from which the remarkable conclusion follows that in all cells derived in the regular course of division from the fertilized egg, one half of the chromosomes are of strictly paternal origin, the other half of maternal." It is not strictly true to say that the germ-nuclei fuse: they send in two sets of chromosomes that lie side by side, as has been frequently demonstrated since 1892[32] in many of the lower forms of life, and this law almost certainly extends also to man.

The primordial germ-cells appear in the human fetus about the twentieth day and finally mature at puberty. Then an ovum at menstruation breaks out through the surface of the ovary, and is taken by the fimbriae of the Fallopian tube into the lumen of this tube. Fecundation happens near the outer or ovarian end of the Fallopian tube, and the fecundated ovum finally is passed on to fasten on the wall of the uterus. The spermatozoön is a ciliated cell with the power of locomotion, through the movement of the tail of the cell. It can move 0.05 to 0.06 mm., or its own length, in a second. It thus passes up through the uterus and out through the Fallopian tube, against the cilary motion of the tubal cells, until it meets the ovum.

A human ovum is a typical cell, but it has a covering membrane, and a minute quantity of deutoplasm or yolk, which is not alive, and is food for the growing embryo before the embryo begins to draw sustenance through the placenta. The eggs of birds have a large quantity of food stored in the yolk, since their embryos live in the ovum and draw food therefrom during the entire period which corresponds to the time of gestation in mammals. The "white" and the calcareous shell of a hen's egg are adventitious parts, added in the oviduct after the egg leaves the ovary.

The spermatozoön is a complicated organism. The head is partly covered with a thin protoplasmic cap, and it contains the nucleus with the chromatin. In the neck are two centrosomes. The tail is in three parts with an axial filament throughout, which is a bundle of extremely minute fibrils. In the middle part the axial filament is surrounded by an inner sheath; outside this sheath is a spiral filament lying in a clear substance; and outside the spiral filament is a finely granular layer of protoplasm, called the Mitochondria. This organism is a living animal cell, and it can live in an incubator, or in the Fallopian tube for two or three weeks, altogether removed from the living male body that produced it. Sir John Lubbock[33] says he kept a queen ant alive for thirteen years. This ant, which died in 1888, had been fertilized in 1874, and never afterward. She laid fertile eggs for thirteen years; that is, the spermatozoa in her oviduct retained their vitality for thirteen years.

The human spermatozoön is a living cell: it has (1) the requisite structure; (2) the chemical composition of an organic being; (3) a figure in keeping with its species; (4) an origin from a living progenitor; (5) the explicatio naturae; (6) the power of assimilation; (7) the duratio viventium; (8) the power of reproduction; (9) motion and locomotion. As soon as the ovum breaks through the surface of the ovary it has all the qualities of the spermatozoön except locomotion. These two cells are animal cells, not vegetable; just as single-celled protozoa, like Actinophrys, Actinosphaerium, Closterium, Stentor, and the Amoebas are animals, not plants. It is not possible in our present knowledge sharply to differentiate ultimate forms of plants from animals. To say that animals have the qualities of plants plus a sentient vital principle is not enough. It is very doubtful that even the so-called sensitive plants feel, and it is practically certain that many low forms of animal life do not feel—they have no sentient mechanism. Plants have the qualities enumerated above plus the power of drawing nutriment directly from inorganic material, while animals can draw nutriment directly only from organic material; yet some fungi, bacteria for example, will grow and thrive only on organic material, and animals will take up mineral drugs. It is questionable, however, that minerals which thus find a way into animal cells are really assimilated. They excite or irritate these cells into intenser action, and thus cause growth, rather than affect development by direction. The so-called mineral tonics used in medicine act by irritation.

This irritation or stimulation by drugs can in certain very low forms of animal life start mitosis in the unfertilized ovum, and thus build up part, at the least, of a specific embryo parthenogenetically: here probably a polar body takes the place of the spermatozoön. Loeb, by treating the unfertilized egg of Arbacia (a sea-urchin) with magnesium chloride, started mitosis that resulted, it is said, in a perfect Pluteus larva.[34]

The human ovum is about half the size of a period in the type of this page, and two hundred and fifty spermatozoa will fit side by side along the horizontal diameter of the lowercase letter o here. The nuclei of these cells are extremely minute: they must be stained and be observed with a high-power objective on the microscope before they become visible. This small nucleus of the spermatozoön penetrates the covering membrane of the ovum, enlarges, and becomes the male pronucleus. The pronucleus unites permanently with the pronucleus of the ovum, and together they form the Cleavage or Segmentation Nucleus of the fertilized ovum. This new nucleus gives rise by division to the innumerable myriads of nuclei in the growing body. Hence every nucleus of the child apparently contains nuclear material derived from both parents, as has been said.

The two perfected germ-cells before fecundation are in a state of nuclear rest after the numerous mitotic changes that have taken place in the maturation of these cells. When these nuclei unite in the ovum an intense activity at once is set up. Biologists offer very many theories to explain this awakening force. Herbert Spencer, Herting, and others held that protoplasm when perfected tends to pass into a state of stable equilibrium and consequent lessened activity, but fertilization restores it to a labile state. This and similar theories are verbose amplifications of the obvious fact that the cells start to divide and the biologists do not know the cause. The soul, of course, cannot have anything to do with the matter, because you cannot smell a soul. "Senescence and rejuvenescence" is another sonorous explanation that does not explain, used by Minot, Engelmann, and Hansen. Weismann rejects these theories for his own "Fertilization as a Source of Variation." Anyhow, the fertilized cell starts to divide regardless of the biologists. Adult cells may be stimulated to divide by chemical irritation, by mechanical pressure as in the formation of calluses, traumatism, by any agency that brings about an abnormal condition of the body, but this fact does not explain the normal fission of the fecundated ovum.

In about fifteen days from the date of fertilization the ovum passes through the following stages:

1. The ovum, with a full series of mitotic changes of the ordinary somatic type described above, divides, subdivides, and grows within the cell-wall until a rounded mass of cells is formed, which is called the Morula or Blastula—the original cell-wall, of course, stretches to hold these new cells. They are of unequal size, and they divide at unequal rates.

2. An albuminous fluid collects within the morula, and thus the Vesicle or Blastocyst is formed. The blastocyst is called more commonly the Cleavage Cavity or the Segmentation Cavity. As this cavity widens the cells are seen to be arranged in two groups—(a) an enveloping layer, the epiblast, from the outermost plate of which develops later the Trophoblast, or the nourishing and protecting covering of the embryo; (b) an Inner Cell Mass, made up of granular cells, attached to the epiblastic layer at the Embryonic Pole of the Vesicle. These two stages probably take place in the Fallopian tube, and thereafter the embryo is in the cavity of the uterus.

3. In the third stage the Inner Cell-Mass separates into two layers derived from the inner cell-plate of the blastula. The mass flattens and spreads peripherally, until finally it is divided into two layers. The outer is the Ectoderm and the inner is the Endoderm or Hypoblast. The three steps just described have not yet been seen in the human species by any one, but they are inferred very confidently from what is well known of the development in mammals most closely resembling man in physical formation.

4. By the conversion of the one-layered blastula into two layers of cells, the Gastrula stage of the embryo is attained. The Gastrula consists of two layers of cells surrounding a central cavity, which is the Archenteron, or the body-cavity that will hold the intestines. During the past twelve years many specimens of human gastrulas have been observed. The earliest form was that seen in 1908 by Teacher and Boyce.[35] This embryo was 1.95 mm. in length by 0.95 mm. in width, about twice the size of a pin-head. It showed on section the endoderm, the ectoderm, and the beginning mesoderm, enclosed in a spherical mass of trophoblastic cells. The mesoderm is a plate of cells lying between the endodermic and ectodermic plates. When the mesoderm develops into two plates, a cavity, called the Primitive Coelom, appears between the plates. The Coelom becomes the space between the viscera and the body-walls in later development.

From the primary embryonic layers of cells, the ectoderm, the endoderm, and mesoderm, all the parts of the body are built up. From the ectoderm are produced the skin, nails, hair, the epithelium of the sebaceous, sweat, and mammary glands, the epithelium of the mouth and salivary glands, the teeth-enamel, the epithelium of the nasal tract, of the ear, of the front of the eye, and the whole spinal cord and the brain, with their outgrowths.

From the endoderm come the epithelium of the respiratory tract, of most of the digestive tract with the liver and pancreas, the epithelium of the thyroid body, the bladder, and other minor parts.

From the mesoderm are developed bone, dentine, cartilage, lymph, blood, fibrous and alveolar tissues, muscles, all endothelial cells, as of joint-cavities, blood-vessels, the pleura and peritoneum, the spleen, kidneys and ureters, and the reproductive bodies.

The epiblast now with its mesoblastic lining begins to form the Chorion, an embryonic intrauterine appendage; and the endoderm encloses the Archenteron or primitive gut. Before the end of the second week of gestation the heart is indicated as two tubes in the mesoderm, and the blood-vessels begin to be produced in the yolk-sac. About the twelfth day the mouth-pit shows, and the gut-tract is partly separated from the yolk-sac. The medullary plate of the nervous system is laid down about the fourteenth day, and the nasal area is observable. The maternal blood escapes into spaces about the embryo enclosed by masses of embryonic cells, which have not separated from one another, but which are known collectively as Syncytium.

5. With the third week the stage of the embryo, technically so called, begins. During this week the body of the embryo is indicated. There are three layers of cells, already mentioned, the ectoderm, mesoderm, and endoderm, and these lie on the floor of the enveloping Amnion. The amnion is a loose fluid-filled sac (the caul) enveloping the fetus to protect it from jarring. The fluid in it is the "waters" that escape in parturition when the infant breaks through the caul. The archenteron in the third week shows the beginning of a division into two parts: the part that will go to the body proper of the embryo, and the part outside the body of the embryo which will form the yolk-sac, or umbilical vesicle, from which the embryo will draw sustenance until the placental vessels have been formed. The part of the archenteron that remains within the embryo proper begins in this third week to be moulded into the head-cavity. The forepart of the archenteron will later make the alimentary tract from the mouth to the middle of the duodenum, or small intestine beyond the stomach. The other part of the archenteron wall make the Allantois, the hind gut and the bladder. The allantois becomes a part of the fetal umbilical cord after the formation of the placenta.

During this third week the dorsal outline of the embryo is concave; the heart has a single cavity, which will begin to divide during the fourth week; the vitelline blood circulation begins, and the blood-vessels of the visceral arch are laid down. The digestive system is advanced to a gut-tract, which is a straight tube connected with the yolk-sac. The liver evagination is present and the oral pit is a five-sided fossa. The respiratory system is represented by the anlage of the lungs, a longitudinal protrusion of the ventral wall of the esophagus. The genito-urinary system begins as the Wolffian bodies. The mesoderm starts to segment to form the skin, and the neural canal (from which develop the spinal cord and brain) for the nervous system forms. The fourth ventricle of the brain is indicated, and the vesicles of the fore brain, mid brain, and hind brain are recognizable. The ears, nose, and eyes, muscular system, skeleton, and limbs are also beginning to be recognizable. At about the sixteenth or eighteenth day of gestation the various parts of the embryo rapidly differentiate.

In the fourth week all these parts advance. The atrium cavity of the heart begins to divide; the alimentary tract shows the pharynx and esophagus, stomach, and gut; the pancreas starts, the liver diverticulum divides, and the bile-ducts appear. The lung anlage bifurcates and the primitive trachea is seen. The ventral roots of the spinal nerves appear, the interior ear is indicated, and the eye is deeper. The buds of the legs and arms appear about the twenty-first day—by the thirty-second day even the fingers are present. The four heart-cavities are formed, the intestinal canal is nearly closed, the first indications of the liver and kidneys appear. The child now has reached the fetal stage, and its living body is made up of myriads of cells all derived from the original fertilized ovum. The fetus is then one centimetre, or two-fifths of an inch, in length—about the length of the word "fetus" here.

At the end of the second month the fetus is two and a half centimetres long. The ears appear, and the tail-like process at the lower end of the spine disappears. The arms show the three parts, arm, forearm, and hand; and a little later the thigh, leg, and foot are differentiated. The navel begins to close, the liver develops, the abdomen is yet partly open.

At the end of the third lunar month the fetus is seven to nine centimetres long. The intestinal canal is formed and contains bile. The body resembles that of a human being, but the head is proportionately very large. Bony tissue begins to appear.

Fig. III.

The Development of the Fetus.

At the end of the fourth lunar month the fetus is ten to seventeen centimetres long. Some muscles are movable. The heart-beat is strong. Sex is distinguishable externally. The skin is bright red, and so transparent that the blood-vessels are visible through it.

Toward the close of the fifth lunar month the head is about the size of a hen's egg. The skin is somewhat less transparent. There are indications of hair and nails. The eyelids are closed. Parts of the brain and spinal cord are formed. Such a fetus may live for five or ten minutes if removed from the womb, and it may make attempts at respiration.

At the end of the sixth lunar month the fetus, if born, may live for several hours under favorable circumstances. Its respiratory, digestive, and related organs are not developed, and no artificial feeding will keep such a child alive. The brain cortex, the organ of consciousness, begins to laminate into three strata of nerve-cells at the beginning of the sixth month.

Here the time of fetal viability outside the womb may be considered. Langstein, of the Augusta Victoria Hospital in Berlin, reported[36] a study of the growth and nutrition of 250 prematurely born infants, and he found that a weight of 1000 grammes (2¹⁄₅ pounds) and a full body length of 34 centimetres (13³⁄₅ inches) are the lowest limits for viability under proper circumstances. A fetus 1000 grammes in weight and 34 centimetres in length has completed the sixth solar month, or the sixth and a half lunar month; that is, it is viable at the beginning of its seventh month, servatis servandis.

The child at term, as a rough average, is from 48 to 52 centimetres (19 to 20¹⁄₂ inches) in length, and it weighs from about 6³⁄₅ to 7¹⁄₂ pounds. It is impossible, however, to obtain the sizes and weights of infants in utero with scientific accuracy, because the date of conception cannot be determined with absolute certainty, and individual fetuses vary as do infants after birth. A full-term infant sometimes may weigh only 3¹⁄₂ pounds when the mother is diseased, and again an eight-month fetus will weigh as much as 8 pounds. Large muscular and fat women have large babies; women of the well-to-do classes have larger babies than do the poor; women who work during gestation bear smaller babies than do those women that rest. Mothers who work in tobacco, lead, or phosphorus have puny babies; white children are larger at birth than negro children; boys at term are 3 to 5 ounces heavier than girls.

Langstein says that prematurely born infants weighing from 900 grammes (31¹⁄₂ ounces) to 1500 grammes (3¹⁄₂ pounds)—that is, all born before the seventh solar month—must be kept in hot-water incubators in a room with ordinary ventilation. Babies weighing 2000 grammes (4¹⁄₂ pounds) or more get along in an ordinary crib if they are kept surrounded with hot-water bags. Such children are to be fed with human milk through a catheter passed into the mouth or they die of inanition. Only a few of them are strong enough to suck from a bottle, and these give up the effort after a few days and die. They cannot utilize fat, even from milk; and all artificial food is dangerous.

Most of the prematurely born become rachitic, and even human milk is not preventive of this condition. Rachitis is a constitutional disease, characterized by impaired nutrition of the bones and changes in their shape. In the third or fourth month craniotabes is frequent—that is, an atrophy of the skull bones with the formation of small conical pits. These infants show also a morbid tendency to convulsions—spasmophilia. Such diseases are caused by a lack of mineral salts, which normally are carried to the fetus by the placental blood during the last two months of gestation. Because of this lack premature infants require the administration of lime salts in their food; they also need iron because they are anemic.

A fetus, then, of six calendar, or solar, months (not lunar) is viable if treated in a hospital by competent physicians. Otherwise it is not viable, except in a strictly technical sense; it will not live more than a few days or weeks. Reports of infants younger than six months as having been successfully reared are not credible—it is easy to make an error in the reckoning.

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. If it is certain that the removal of a six-months fetus will here and now save the life of a mother (a very difficult matter to judge by the best diagnosticians), this removal may be done, provided the infant is delivered in circumstances where skilled care, incubator, and proper food are obtainable; otherwise the removal is not justifiable. That the ordinary physician says it is necessary to empty the uterus is not a sufficient reason, as he is likely to act from ill-digested information set forth by professorial pagans, who place no value whatever on human life in an infant.

A most important and essential circumstance in the matter of inducing abortion at the end of the sixth month of gestation to save a mother's life is that in practically every case requiring such interference the diseased condition of the mother has checked the growth of the fetus, and the fetus therefore is really not a six-months child in development. Such an undeveloped fetus is not viable. Eclamptic women, and those who have nephritis, are most likely to have undeveloped fetuses. In cases of this kind the seventh month should be completed before interference.

How is this human body in all its complexity developed from the microscopic germ-cells? There has been a vast deal of ink spilled in striving to solve this mystery, but we come out empty by the same door wherein we went. The early Preformationists guessed that the ovum contains an embryo fully formed in miniature, and development is a mere unfolding of what had already existed. The biologists of to-day mention the Preformationists with superior scorn, and then present Preformationism under other names. Weismann's theory is the most fashionable at present.

In a paper read at the Darwinian Memorial Congress in 1909, Weismann said: "With others I regard the minimal amount of substance which is contained within the nucleus of the germ-cells in the form of rods, bands, or granules, as the germ-substance, or germ-plasm, and I call the individual granules[37] ids. There is always a multiplicity of such ids present in the nucleus, either occurring individually or united in the forms of rods and bands (chromosomes). Each id contains the primary constituents of the whole individual, so that several ids are concerned in the development of a new individual." Actually there are such things as chromosomes, and when these are stained and are under the highest power of the microscope they appear to be granular. These granules Weismann calls ids. Beyond the fact that there are such granules, all else is sheer guessing.

He says further: "In every complex structure thousands of primary constituents must go to make up a single id; these I call determinants, and I mean by this name very small individual particles, far beyond the limit of microscopic visibility, vital units, which feed, grow, and multiply by division. These determinants control the parts of the developing embryo,—in what manner need not here concern us."

There is some truth here. The id is made up of molecules and atoms, ions and electrons, and in some manner, of course, these have to do with the development of the embryo; but as to the manner we have not the slightest knowledge, and just this knowledge is what we need to make the theory anything more dignified than a child's game at guessing. There is a structural differentiation in the unsegmented ovum, with all the embryonal axes foreshadowed in it, but this tells us nothing more than that the egg contains the man in germ.

He goes on: "The determinants differ among themselves; those of a muscle are differently constituted from those of a nerve-cell or a glandular cell, etc., and each determinant is in its turn made up of minute vital units, which I call biophors, or the bearers of life."

That these so-called determinants differ among themselves may be true, if they exist at all, which is just the point to be proved. Giving Greek names to inventions does not turn invention into fact. These supposed determinants, he says, "may vary quantitatively if the elements of which they are composed vary; they ... and their variations may give rise to corresponding variations of the organ, cell, or cell-group which they determine." Professor Dwight said:[38] "This is what is palmed off on us for science!" Weismann assures us we must admit this farrago of clumsy fiction, otherwise we should be forced "to assume the help of a principle of design."[39] In the name of common sense, then, admit a principle of design, and be done with it!

Darwin's Gemmule Theory is the same guessing; and Weismann rejects it because he did not think of it first. As a theory the gemmule plot is just as good and just as bad scientifically as Weismann's. The chief objection to such imagining is that after its authors have put it into print a few times they lose all sense of humor, and mistake phantasms for facts.

Up to the present time we have discovered no living organism lower in grade than the cell. If life ever originated from inorganic matter, it appeared in an organized cell. The Weismann ids, biophors, and the rest, supposing they existed outside his own imagination, are not more capable of independent life than is a chromatin granule. In any event, these biophors could not have originated spontaneously in the first living being; and if they could not so have come into existence, life could never have begun. However primitive any organism is, it must be able to nourish itself and to develop into a higher specific form; but such a variety of functions supposes differentiated structure, composed of unstable chemical substances, a correlation of parts, a purposeful anticipation of ends. Inorganic substances, crystals, and the like are characteristically stable, not unstable; and these could not have been brought into the organic state on an earth burnt to a cinder and devoid of chlorophyl, which itself presupposes organic cells. Whence came also the absolutely essential form of energy, directive of vegetative life? The only possible explanation is that life was created, not evolved by a stranger miracle from a lump of lava.

We know the successive steps in the growth of the embryo from the time of fertilization to the end of gestation, but how this vital process is effected is not so evident. What we are certain of is that there is a vital principle of some kind from the beginning, and this is the matter of real importance in the present discussion. The old moralists held that this principle in the human being is at first vegetative; after a while that vegetative vital principle is expelled by a sensitive principle; and finally this sensitive soul is expelled by the rational vital principle, or human soul. St. Thomas[40] says: "Some tell us the vital acts that appear in the embyro are not from its soul, but from the soul of the mother, or from the primitive force in the semen. Both these statements are false. Vital operations, as sensation, nutrition, growth, cannot come from an extrinsic principle; therefore it must be admitted that a soul preëxisted in the embryo, nutritive at first, then sensitive, and finally intellectual." After showing that an intellectual soul cannot be evolved from lower forms, he concludes: "Therefore we say that since the generation of one thing is always the corruption of another, in man as in other animals, when a more perfect form comes in this supposes the corruption of any precedent form; so, however, that the sequent form has all perfection that was in the destroyed forms, and something in addition: and thus through many generations and corruptions the final substantial form is attained in man and other animals. This is apparent to the senses in animals generated from putrefaction. Therefore the intellectual soul is created by God at the end of human generation, and this soul is both sensitive and nutritive, all precedent forms having been destroyed."

There is no such thing as the generation of any animal or other living being from putrefaction; but that is irrelevant. St. Thomas's argument proves conclusively that if man has first a merely vegetative soul, and secondly a merely sensitive soul, which includes the power of the vegetative soul, and thirdly an intellectual soul, which does the work of all three, that this final intellectual soul is not an evolution of the first two, but a new form that replaces these after they have served their purpose and have been annihilated. It does not even attempt to prove that man really has first a merely vegetative soul, and secondly a sensitive, and lastly an intellectual soul; it supposes all this. It starts out with the erroneous Aristotelian theory and takes it for granted. The reason for this statement is that the rational substantial form requires disposed matter to work upon, and the Thomists suppose (again erroneously) that in the human embryo during the period immediately after conception there is not enough matter to be a receptacle for the rational soul.

The soul according to the Thomists, who use the Aristotelian definition, is the first entelechy of a natural organic body that has life in potency.[41] It is the determination that gives the body its specific and substantial being; the primal actuation of a body or matter, since only in matter is there a distinction between potency for substantial being and substantial actuality. An entelechy is a realization, actuality, full perfection; sight, for example, is the entelechy of the eye. This body is natural, not merely instrumental; it is energized by an immanent principle, not moved by an external force like a tool. The body is also organic; it must have organs, faculties, parts destined to perform definite functions. To say the entelechy has life in potency means that since life, or the operation of the soul, is an immanent act, there must be a receptacle within which it can be immanent, and the soul is the primal actualization of that organic body, which is in potency to produce those immanent actions in which life consists. A body might be in potency while it still has no principle of operation, or, secondly, while it has such a principle but is not using it. In the second condition the human body is in potency for life at the moment of actualization.

A form fixes a thing in its prχοντοσoper species, and the rational soul is such a form for the human body. This substantial form is the completion, perfection, in operability and existence, of the matter that receives it. It is the formal cause of man, not the efficient cause, although it is the efficient cause of subsequent vital operations. An efficient cause makes something numerically different from itself by its own real and physical action; a formal cause and a material cause do not make anything different from themselves numerically, but they intrinsically constitute the effect—they are intrinsic causes.

The human soul as the substantial form virtually contains vegetative and sensory faculties, and through these lower organic capacities it informs and animates the body. That form, together with the matter, the body, does the vital acts of the composite human nature. The rational soul enters the body at the beginning, and first uses its vegetative faculty until the fetus is far enough advanced to be a subject for the action of the sensory faculty of the soul. Later, some time after the birth of the child, when the body is sufficiently formed, the intellectual faculty comes into use.

The nature of a vital principle is that in which it normally issues. If it issues as a rational substantial form, as in man, it was rational from the beginning. If it was not rational from the beginning, a rational principle replaced a sensory vital principle, and that sensory vital principle replaced a vegetative vital principle. The only reason for these replacements would be that the early human embryo, as has been said, lacks organization sufficient to sustain a form higher than a vegetative principle. If this were sufficient reason for deferring the advent of the rational soul, then a baby six months after birth would have no rational soul because it certainly lacks the supposedly requisite organs. However, as the rational soul is whole in each part of the adult body in the totality of its essence and perfection, but not in the totality of its virtue, because certain organs are lacking in particular parts of the body, it is in the embryo whole in the totality of its essence and perfection, but not in its virtue because certain organs are not yet formed, and it is thus from the moment of conception.

As to the soul itself, Kant held that the soul is not a real, but only a logical substance. The Pantheists, Transcendentalists, and Neo-Hegelians try to identify the soul with the divine consciousness. The Associationists (Hume, Davis, Höffding, Sully) say that the soul is a mere group of sensations. The Agnostics and Positivists (Locke, Herbert Spencer, James, Comte) write volume after volume on the soul to prove that they know nothing about it. Then the Materialists assert that there is no soul of any kind; that we secrete thought as a mule secretes sweat. Yet the vital operations of man are inexplicable as resultants of the physical and chemical properties of matter. There is an intrinsic energy that unifies the actions of man, directs processes, controls the tendency of organic matter to pass into the fixity of the inorganic, and effects metabolism. This intrinsic energy is the entelechy, substantial form, or what is popularly called the soul.

In any organic body there is a formal principle. We know that there are activities that proceed from organic bodies, and a formal principle of such activity is a substantial entity whence the organism derives basically its own kind of action, which determines and orders the activity. There are acts of perception in animals such that an external object becomes so internal to the organism of these animals that it is known by one expressed and immanent image, not only as something objectively existing but as good or hurtful to the perceiving animal. The innate and elicited appetites by which the animal tends toward or away from the object are recognized, as are the spontaneous motions which are directed by that knowledge. There must be a principle whence these actions proceed, and this is either an accident of matter or something substantial. It is not an accident of matter, because action can never arise from an accident; it must proceed from a substance. If you say this principle whence these actions arise is not an accident of matter, but matter itself, you would have an extended, composite, inert mass acting; but even if such thing could act, it could never effect a simple immanent image of an object or group of objects external to itself.

No mere machine can build up itself, can make any remote approach to metabolism as an organized body can; and the principle of this immanent action is not matter itself, because it uses, makes, subordinates matter to itself. That principle is positively one, not one by continuity as matter is. Matter as in a crystal grows by mere aggregation, an organism grows by assimilation; a crystal loses force in formation and growth, an organism accumulates force.

The theory that denies the existence of this formal principle does not explain the phenomena of life in organic beings. Uniformity of tendency toward an end is not a characteristic of mere matter; neither is a harmonious interaction of parts, nor the dependence of parts on the unit, nor motion, nor the reproduction of the species.

Moreover, most of the greatest physical scientists strongly maintain that there must be a formal substantial principle in all living things. Among these are Wallace, Nägeli, Askenasy, Preyer, Fechner, Agassiz, von Baer, E. de Beaumont, Blanchard, A. Braun, Brongniart, Bronn, Burmeister, Delff, Milne-Edwardes, Flourens, Goeppert, Griesbach, Heer, Koelliker, Mivart, Quatrefages, Quenstedt, Spiers, Volger, R. Wagner, Liebig, and Joseph Hyrtl.

The formal principle which coexists with matter in the organic body is really though not perfectly distinguished from matter. A formal principle which is necessary for sensation should be either perfectly simple, or at the least so one that its parts together make up one essence: matter, however, cannot have such unity, and as a consequence the formal principle must be distinct from matter. Anything is like its operation, and the parts of any sensitive activity always result in an activity that is essentially one. If we touch a table, by that single touch we at once know that the object is one, wooden, hard, angular, smooth, extended, and so on, and we also know that one subject perceives all these varied qualities. One eye can convey knowledge at once of a thousand objects miles apart, and these objects can be brought into one perception only by a simple subject. An extended complex subject like matter would get one impression (if it could perceive any impression) on one side, one on another, and so on, but it could not unite these.

The formal principle which is in organic bodies is a true substantial form, actuating the body both as to its nature and substance. Together with the body, this principle makes a being one in itself, such that the matter and the form separably are incomplete as regards operation and being. Now, a form is that principle through which anything is established in its own species; light, for example, is the form of a luminous body, heat of a hot substance. A body, however, is established in the human species by receiving a rational soul, and this soul, then, is its form. It is also a substantial form because the soul itself is a substance, not an accident dependent upon another subject. Moreover, from its union with the body another substance—man—arises, and not a thing added to a substance. Man's body is alive, therefore it is a living substance; but life in its secondary actuality is an operation; in its primary actuality it is an essence. The body is made a living substance, not from itself, but from the soul which is added to it. When the soul departs the body is no longer alive. Now, a principle which by a communication of itself determines the body in its essence and differentiates it as a living substance from everything else, is a substantial form. A substantial form, then, or a soul, exists.

The soul, however, must have disposed matter for most of its operations; it cannot exist as a substantial form bombinans in vacuo; but it does not need a human organism complete in all its parts as a necessary condition for its indwelling. There is organized matter enough in the first cell that comes into existence after the fusion of the germ-nuclei to hold this rational form, or soul, as perfectly as it needs to be held in this first stage of human life.

To inform the embryo any principle, whether it is the rational soul or a force derived from the parental organism, must have organs; and if organs are present, then the embryo is fit to receive the human soul, as the only objection to its presence is a supposed lack of organs. To use other principles when the human soul itself could be present would be a multiplicatio entium sine necessitate, which is a condition repugnant to the universal method of the Creator.

It has been said that the vital activity in the fertilized ovum does not proceed from the rational soul because, "in the first place, it results from the fusion of two vital activities, neither of which is rational; secondly, it results in the formation, by fission, and differentiation, of two distinct and separate living cells, each containing within itself a principle of vital activity. Now this principle of vital activity cannot be a rational soul, for each cell has its own principle of activity, and in man there is but one soul."

In the first place, that vital activity does not result from the fusion of two vital activities neither of which is rational. It results after the nuclei come together, by particular creation, and replaces their activity—the generation of the last vital force is the corruption of the first that existed in the separate nuclei, not a derivative of that first force. Again, when the embryo is in the two, four, eight cell stage, and so on, there are not two, four, eight vital principles present, but one. Substantial unity is essential to life of any kind, no matter how low its grade; and if each cell had an independent vital principle, any form of resultant life in the mass would be impossible. An aggregation has no unity of substance; there would be as many substances or natures as there are individual beings in the aggregate, no matter whether ordered or in a mob, consequently no life at all as a life.

The embryo in the two-cell stage is not made up of two independent organisms, any more than the right and left halves of an adult man are two independent organisms. The cells in the two-cell stage of the embryo are the right and left halves of the body, not two individuals, as has been proved repeatedly by biologists. Roux[42] punctured with a hot needle one of the cells in the two-cell stage of a frog embryo without killing the embryo, and it grew into a half-frog larva. Analogous results were obtained by operating in the four-cell stage. Later, Pflüger, Schultze, Enders, and Morgan corroborated the work of Roux. Newport[43] discovered this fact sixty years ago.

In analyzing the structure and functions of the individual cell we regard it as an independent elementary organic unit, but this view is solely a matter of convenience, almost a convention. All the billions of cell's in an adult man are inseparable parts of the single living person. No cell exists as an independent organism in multicellular animals, except the germ-cells, and these only after separation from the gland of origin. Indeed, the biological theory of heredity, already mentioned here, wherein the germ-cell is supposed to carry forward the entire heredity, is now changing toward the view which makes all the somatic cells influence the germ-cells; that is, the body-mass of cells sends on heredity through the germ-cell as the instrument. Adult organisms do not make cells de novo. New cells are formed by division from preëxisting cells, but some biologists think the body-cells so affect the new germ-cells as to influence heredity.

The cells are organs, nodal points, of a single formative power which pervades the mass of cells as a whole. The protoplasm of each cell is not only in direct apposition with its neighbors, but nearly all biologists are now inclining to the opinion, which Heitzmann proposed in 1873, that division of cell from cell is incomplete in nearly all forms of tissue; and that even where cell-walls are present (an exceptional condition in mammals) they are traversed by strands of protoplasm, by means of which the cells are in organic continuity. The whole body, he contended, is thus a syncytium (a mass of continuous protoplasm stippled with nuclei), with the cells as mere nodal points in an almost homogeneous protoplasmic mass. There are cell-bridges between the sieve-tubes of plants. In 1879 Tangl discovered such connection between the endosperm cells of plants, and later Gardiner, Kienitz-Gerloff, A. Meyer, and many others demonstrated that in nearly all plant tissues the cell-walls are connected by intracellular bridges. Ranvier, Bizzozero, Retzius, Fleming, Pfitzner, and many other observers have found these protoplasmic bridges in animal epithelium. In the skin of a larval salamander they are quite conspicuous. They are known to occur also in smooth muscle-fibre, in cartilage cells, in connective-tissue cells, and in some nerve-cells. Harrison found, in 1908, that in frogs the nerve-fibres develop out of these intracellular bridges. Dendy in 1888, Retzius in 1889, and Palladino in 1890 have shown that the follicle cells of the ovary are connected by protoplasmic bridges, not only with one another, but also with the ovum; and similar connection between somatic cells and germ-cells has been found in a number of plants. Thus even the germ-cell is not independent until it has actually broken away from the gland. A. Meyer holds that both the plant and animal individual are continuous masses of protoplasm, in which the cytoplasmic substance forms a morphological unit, no matter what the cell is. That opinion is not finally settled as regards the animal after the fetal stage, but it is much stronger as regards embryos. In the early stages of many arthropods it is certain that the whole embryo is at first an unmistakable syncytium. This is almost established also for Amphioxus, the Echinoderm Volvox, and other animals. Adam Sedgwick holds that it is true for vertebrates up to a late embryonic stage. Mitosis, then, is a form of growth of a mass, not a generation of new individuals.

Whether chromatin or any other element in the germ-cell be the idioplasm in which heredity inheres, differentiation is a progressive transformation, through physical and chemical changes, of the substance of the ovum, and this transformation occurs in a definite order and a definite distribution in the ovum. The changes result in a cleavage of the egg into cells, the boundaries of which sharply mark the areas of differentiation. These cells take on specific characters. In the four-celled stage of an annelid egg these four cells contribute equally to the formation of the alimentary canal and the cephalic nervous system, but only one of them, the left-hand posterior cell, gives rise to the nervous system of the trunk and to the muscles, connective tissues, and germ-cells. The relation between the four original cells, or blastomeres, and the adult parts arising from them, is not fixed, because in some eggs these relations may be artificially changed. A portion of the egg which normally would develop into a fragment of the body will, if split off from the others, give rise to an entire body of a diminished size.

Conklin says[44] that in the ascidian Styela "there are four or five substances in the egg which differ in color, so that their distribution to different regions of the egg and to different cleavage cells may be easily followed, and even photographed, while in the living condition. The peripheral layer of protoplasm is yellow and it gathers at the lower pole of the egg, where the sperm enters, forming a yellow cap. This yellow substance then moves, following the sperm nucleus, up to the equator of the egg on the posterior side, and there forms a yellow crescent extending around the posterior side of the egg. On the anterior side of the egg a gray crescent is formed in a somewhat similar manner, and at the lower pole between these two crescents is a slate-blue substance, while at the upper pole is an area of colorless protoplasm. The yellow crescent goes into cleavage cells which become muscle and mesoderm, the gray crescent into cells which become nervous system and notochord, the slate-blue substance into endoderm cells, and the colorless substance into ectoderm cells. Thus within a few minutes after the fertilization of the egg, and before or immediately after the first cleavage, the anterior and posterior, dorsal and ventral, right and left poles are clearly distinguishable, and the substances which will give rise to ectoderm, endoderm, mesoderm, muscles, notochord, and nervous system are plainly visible in their characteristic positions." Conklin followed these cells in every division until the embryo was developed, making a complete genealogy up to the ovum proper.

De Vries[45] assumed that the character of each cell is determined by "Pangens" that migrate from the nucleus into the protoplasm. Driesch and Oscar Hertwig held that the peculiar development of a given blastomere is a result of its relation to the remainder of the cell-mass, an outcome of the action upon it by the whole system of cells of which it is a part. Hertwig said:[46] "Each of the first two blastomeres contains the formative and differentiating forces not simply for the production of a half-body, but for the entire organism; the left blastomere develops into the left half of the body only because it is placed in relation to a right blastomere." Wilson[47] and Driesch[48] came to the same conclusion about the time Hertwig wrote. Driesch said:[49] "The relative position of a blastomere in the whole determines in general what develops from it; if its position be changed it gives rise to something different; in other words, its prospective value is a function of its position."

A discussion of this matter will be found in Wilson,[50] but the many experiments made in the study of this subject show conclusively that the cells, singly, grouped, and in mass, are a morphological unit, not an aggregation of distinct individuals. They are not, of course, absolutely homogeneous, because such a body could not have organs. The substantial form, therefore, is not confined to the first cell.

The cell-mass, then, has a unity sufficient to be the receptacle of a human vital principle; again, the basic vital operation of the human body at any age is metabolism, and this is actually carried on in the first somatic cell of the embryo as in the cells of the adult man. In the development of the human body in the embryonal stage the energy of cell-division is most intense in the early cleavage stage, and this diminishes as the limit of growth approaches because further division is not needed. When that limit is attained a more or less definite equilibrium is established. Some of the cells in the fully formed body cease to divide, the nerve-cells, for example; others divide under special conditions, as the blood-cells, the connective-tissue cells, gland-cells, epithelial and muscle cells; others continue to divide throughout life and thus replace worn-out cells of the same tissue, as the Malpighian layer of the skin. Cells grow, divide, function, reproduce themselves, and so on, all through their vital activity, sustained by the material brought to them by the blood. Weismann[51] and other biologists think that the vital processes of the higher animals are accompanied by a renewal of the morphological elements in most tissues. The material is carried to the fetus in the womb by various agents, but mostly by the maternal blood after the embryo uses up the yolk; and when the fetal circulation has been established the nutritive material is taken from the maternal blood into the fetal circulation through the placenta, and then carried to the cells by the fetal circulation itself. After the child has been born the stomach and intestines take in the food. The stomach does very little with it except in a preparatory manner; the intestines further prepare it, pass it into the body, where it is again modified by other organs, and finally it is carried by the blood to the cells. The cells really use it; the other organs are the farmers, grocers, railways, and the like; the cells are the consumers. So far as the essential processes are concerned, the embryological cells act as do the adult cells.

The first cell has contractility, protoplasmic motion; it can absorb perfectly all food-stuffs necessary for it from the deutoplasm of the ovum, and the water that passes in from without to the ovum. In a few days the embryonic cells have used up the deutoplasm and are taking up food from the maternal blood as perfectly as any adult cell does, and are exercising their function of building up and sustaining whatever part of the body they are destined for; and this with all the complicated metabolism of the adult cell. Cell metabolism is the fundamental, chief, organic act of any human body at any age. That the embryo does this impelled by the virtus formativa transmitted from the parents is a mere gratuitous assumption to fit the theory that the embryonic cell lacks organic power. The fundamental organ that conserves the body in its very existence under the government of the soul is the apparatus which effects metabolism. Incessant chemico-vital change is a characteristic of all living substances, from the single cell up to the adult man; and in all cases this activity has to do with a transformation of the complex molecules which build up the protoplasm or are associated with its operations. The totality of the chemical changes, or exchanges, in living cells, the transformation of unorganized food materials so that these may be assimilated, and the chemical processes in the tissues themselves, all are metabolism. Growth and repair (anabolism) occur side by side with the destruction of elementary tissue substance (katabolism), and the duration of life rests on these processes; and all are mere cell activities. Food-stuffs (water, inorganic salts, proteids, albuminoids, carbohydrates, and fats) undergo more or less combustion or oxidation. Oxygen unites with carbon to form carbon dioxide, and with hydrogen to form water; the nitrogen of the highly complex proteid substances reappears in combination with carbon, hydrogen, and oxygen as urea, uric acid, and other compounds; and other ingesta are thus transformed through oxidation. All maintain the temperature of the body, replace outworn parts, and accomplish the body's work. Oxidation occurs to a slight extent in the blood, but the specific reactions are intracellular. Even when nothing exists but the cells and the blood, as in the beginning embryo, the cells really do the work, and they do the work as they do in the adult.

The cells also from the very beginning are the organs that make the animal heat necessary for life. Rubner[52] proved that the source of at least 90 per cent. of the animal heat in the body is a result of the chemical changes—oxidation—in the food ingested: the other 10 per cent. is caused by muscular contractions, the flow of blood, the friction of joints, and like motions. This oxidation is more active in young animals than in adults, and in each it is, of course, a cellular process.

Living matter contains hydrogen, oxygen, sulphur, chlorine, iodine, fluorine, nitrogen, phosphorus, carbon, silicon, potassium, sodium, calcium, magnesium, and iron. The removal of one of these elements causes the death of the body. They must be arranged in a definite, prescribed order to constitute cellular protoplasm, and any disarrangement of this order causes intoxication, disease, or death. Hydrogen is a constant product in the putrefaction of animal matter, of animal food, and is present in the intestinal tract. Oxygen is found dissolved in water and loosely combined in blood as oxyhemoglobin. All the elements, except fluorine, combine with oxygen, forming oxides, and the process is called oxidation. The production of heat and all vital motion depend on oxidation, decomposition of matter. In the nuclei of cells there is a so-called "oxygen-carrier," a nucleo-proteid, which contains iron, and this appears to be the chief oxidizing agent in the body. Chlorine, which in hydrochloric acid is essential to digestion, is ingested as chloride, and leaves the body chiefly through the urine and sweat. Iodine is a necessary part of the thyroid gland, an indispensable vital organ. Fluorine is found in all cells. Nitrogen goes into the body combined in proteids; and phosphorus, combined in the alkalies and alkaline earths of the foods. Carbon occurs in all cells and leaves them through the lungs as carbon dioxide.

The amount of energy set in action in the body in the decomposition of any food is equal to the energy that had been expended in the synthesis of that food from its organic elements, and the liberated energy set free in the body appears as heat, work, and nervous impulse. In a plant the chlorophyl and the sun's rays combine water and the carbon dioxide of the air into sugar and free oxygen. This sugar is changed in a plant into starch, cellulose, and fat, and also, when combined with some nitrogen, into proteid. An animal eats this plant, which contains starch, cellulose, fat, and proteid, and it either adds these ingredients to its own substance or oxidizes them so as to prevent the destruction of its own substance. These are the ends of all food. Broadly speaking, plants synthesize elements; animals analyze them, reduce them into simpler bodies.

Such processes, and those of the other elements of the body, which have to do with the changing constituents of the human organism, are all cellular processes—metabolism. Hence the chief organic act of the body is metabolic; the basic organ of man is the cell. Arms, legs, heart, brain, stomach, and similar organs are secondary, though some of the latter are essential for certain operations. Now, one cell is an organ amply sufficient for metabolism, for the chief organic act of the body; hence it is a fitting receptacle for a substantial form, a soul. Therefore there is no reason why the soul may not be present in the one-cell stage of the embryo; and since there is no reason why it should not be present, but many why it should, it is present.

Conklin says:[53] "The fertilized egg of a star-fish, or frog, or man is not a different individual from the adult form into which it develops, rather it is a star-fish, a frog, or a human being in the one-celled stage. This fertilized egg fuses with no other cells, it takes into itself no living substance, but manufactures its own protoplasm from food substances; it receives food and oxygen from without and it gives out carbonic acid and other waste products; it is sensitive to certain alterations in the environment, such as thermal, chemical, and electrical changes—it is, in short, a distinct living thing, an individuality. Under proper environmental conditions this fertilized egg-cell develops, step by step, without the addition of anything from the outside except food, water, oxygen, and such other raw materials as are necessary to the life of any adult animal, into the immensely complex body of a star-fish, a frog, or a man. At the same time, from the relatively simple reactions and activities of the fertilized egg there develop, step by step, without the addition of anything from without except raw materials and environmental stimuli, the multifarious activities, reactions, instincts, habits, and intelligence of the mature animal."

An objection to the opinion that the soul is in the embryo from the beginning is made from a consideration of the facts that there appears to be an aptitude for life in certain animal cells and tissues after removal from the original host, or after the death of the host; and, secondly, that in other separated tissues life is undoubtedly made evident under proper conditions. Some parts of the human body can be grafted upon another human body, and human sarcomatous cells have been made to grow in vitro. Hair often lengthens after the death of a person, if no embalming fluid has been injected. Dr. Alexis Carrel[54] substituted a piece of a popliteal artery, taken from an amputated human leg and kept in cold storage for twenty-four days, for a part of the aorta of a small bitch, and the dog lived for four years afterward and died in parturition. Magitot of Paris, in 1911, took a piece of the cornea from an extirpated human eye, and with it replaced a part of an opaque cornea on another man, and this second man could see through the new cornea. Surgeons now remove skin, bone, and other tissues from still-born infants and accident cases, preserve these, for weeks if necessary, in petrolate and Ringer's solution in cold storage, and then graft them on patients to repair lesions in skin, bone, cartilage, or other parts of the body.

If these separated tissues are alive, what is the origin and nature of the life? Again, if there is a low form of life in these separated tissues, remaining after the departure of the human soul, why could not such a low form of life precede in the embryo the advent of the human soul?

What is the nature of the "life" in the parasitic sarcomatous tissue which has been seen to proliferate for a short time in vitro? We do not know, nor is it relevant to the question. That there is life of any kind in the cold-storage graft of bone and skin is certainly not evident; rather every evidence points to the absence of all life. When taken out of cold storage, and the ordinary forces which corrupt a dead body are permitted to work, these grafts corrupt exactly as any part of a corpse does. That there is life of any kind in these grafts is a gratuitous assumption. In cold storage they are kept ready for assimilation into the body as food may be kept. Bone and skin grafting is merely a peculiar form of assimilation. Food taken into the body through the stomach and entrails is prepared in the body and assimilated into the substance of the bones or skin or other tissues; the graft is ready for assimilation without this preparation because it is already bone or skin.

The vital principle in a man, or in anything else, is at the end, when it normally issues, of the same nature as it was in the beginning. If it is at perfection a substantial primary form, it always was such—a substantial form cannot issue from an accidental form. If the substantial form is the form of the cells in the completed organism, it was such before that organism was perfected, unless it replaced a lower substantial form; but there is, we repeat, absolutely no need for such a secondary form at the beginning. If the cells of the embryo (not the infused germ-cells, which are not the embryo) had a forma corporeitatis, or cellularis, or whatever you wish to call it, the human soul when it did come would not confer primal existence, would not be a forma substantialis, but an accidental form. "In proof of which," says St. Thomas,[55] "we must consider that a substantial form differs from an accidental form in this, that an accidental form does not give being simply, but such or such being; as heat does not give being simply, but heated being. So when an accidental form comes in, a thing is not said to come into existence or to be generated, simply, but to become such or such an object, or to find itself in such or such a condition. So, also, when an accidental form disappears, a thing is not said to be destroyed simply, but only to a certain degree. A substantial form, however, gives being simply; and therefore by its advent a thing is said to be generated simply, and by its recession to be destroyed simply. If, therefore, it happened that any substantial form other than the intellectual soul preëxisted in matter, by which the subject of that soul would come into actual being, it would follow that the soul would not confer being simply, and therefore would not be a substantial form; also that the coming of the soul would not be a generation simply, but only secundum quid—all of which is evidently false." Again, St. Thomas says:[56] "Some tell us the vital acts that appear in the embryo are not from the soul, but from the soul of the mother, or from the primitive force in the semen. Both these statements are false."

An application of the opinion offered here—that is, that the human soul is infused at the instant of conception—to multiple and monstrous embryos offers no real difficulty. There are two kinds of human twins—those from two distinct ova and those from one ovum. Two ova may come from one or different ovaries, or even from one Graafian follicle, be fertilized at the same time and develop synchronously. If the ova are placed at some distance apart in the uterus, two placentas appear; if the ova are near each other the placentas may fuse, but their circulations do not. Each child will have its own fetal envelope.

In twins from two distinct ova there is no difficulty in seeing that the souls are placed in these in the same manner as the soul is put in the normal single embryo. When the twins come from one ovum the condition is not so simple. The oval nucleus is the essential part that goes from the maternal side, and human ova at times contain two nuclei, as occasionally hens' eggs do; a double-yoked hen's egg has two nuclei, and two nuclei have been found in a single yolk. Kölliker, Stöckel, and von Franque have observed double germinal vesicles in single human ova. In such a condition two spermatozoa could fecundate the two nuclei and the development go on as in the case of twins from distinct ova.

There is a theory which holds that homologous twins (uni-oval) can develop from a single germinal vesicle which splits into two primitive streaks and two gastrulas. According to this opinion, if the germinal vesicle divide entirely, two fetuses develop which are always of the same sex, and which resemble each other so closely in appearance that it is very difficult to differentiate them. This theory holds also that should the germinal vesicle not split fully, the lack of fission causes the various kinds of double monsters. The germinal vesicle that supposedly splits into two is not fecundated by two spermatozoa, they say, because where there is only one nucleus in the beginning, the entrance of a second spermatozoön commonly kills the ovum. This last assertion has been disproved of late.

Some followers of the splitting theory hold that double monsters arise from the union of two originally separate primitive traces (Verwachsungstheorie). Others say that a single primitive trace of blastoderm cleaves more or less thoroughly and makes the double monster (Spaltungstheorie). The earliest human double monster (Ahlfeld's case) was in the fourth week of gestation; therefore whatever is held in these theories as regards human monsters is only through analogy with lower animals.

Gerlach[57] saw bifurcation at the cephalic end of a chicken embryo sixteen hours old. In this case the first change was a broadening of the anterior end of the primitive streak; next a forked divergence appeared, and by the twenty-sixth hour the bifurcation was half as long as the undivided posterior part. Whether this was a case of two nuclei or not is not known.

What seems to make for the fission theory is that in non-parasitic double terata, no matter how unequally nourished or how variable in extent, the union between the halves of double monsters is symmetric, and the same part of each twin is joined. This fact is used as a reason to exclude a fortuitous growing together of dissimilar areas of cell-masses, at least in non-parasitic cases. Born,[58a] in a study of fish ova, found that eggs which produce double monsters begin with a segmentation like that of the simple normal ovum. Composite spermatozoa have been observed with two and three heads and one body and tail-piece, but the significance of these abnormal cells is not known.

Embryos of sea-urchins in the two-cell and four-cell stages can be separated by shaking into isolated blastomeres, and the segments will grow into full though dwarfed larvae. The same division with the growth of dwarfed larvae has been made in Amphioxus, in the teleost Fundulus, in Triton, in a number of Hydromedusae and several other low forms of life. When the division is not made completely double monsters result.

Up to a certain stage of development the blastomeres of the Medusa embryo are totipotent, or capable of developing into any part of the body. The limitation of development in a particular case lies in the cytoplasm rather than in the nuclei of the cells. If frogs' eggs are fastened in abnormal positions, inverted or on the side, a rearrangement of the egg material results, wherein the nucleus and cytoplasm rise and the deutoplasm sinks. This change of axis shifts the embryo. If an egg is turned upside down in the two-cell stage, a whole embryo, or half a double embryo, may arise from each of the two blastomeres, instead of a normal half-embryo. A half-embryo or a whole dwarf may arise according to the artificial position of the blastomere. Each of the two blastomeres contains all the materials potentially for the formation of the whole body, and these materials build up a whole body or a half body according to the grouping they take on. Primarily the egg cytoplasm, in low forms of animal life, is totipotent; it has no fixed relation with the parts to which it gives rise, and may be artificially modified or differentiated. These effects, from position and traumatic dislocation, suggest explanations for teratic forms in higher animals.

Human terata are now commonly classified in four groups: (1) Hemiteratic; (2) Heterotaxic; (3) Hermaphroditic; and (4) Monstrous. Hemiterata are giants, dwarfs, persons showing anomalies in shape, color, closure of embryonal clefts, in absence or excess of digits, or like defects. The Heterotaxic group are persons whose left or right organs are reversed in position. A true Hermaphrodite would have the complete reproductive organs of both sexes, but such an individual has not been observed. There is never any question of double personality in hermaphrodites.

Terata more properly so called may be single, double, or triple; and single monsters may be autositic or independent of another fetus, or they may be omphalositic, dependent upon another which is commonly well developed and which supplies blood for both through the umbilical vessels. There are four genera of autositic single monsters, with eight species and thirty-four varieties. Of the monstra per defectum the commonest are caused by a failure of closure in the embryonal medullary canal, which leaves part of the brain and spinal cord or their bony covering lacking. Some terata, as the Acephalia, have no brain or spinal cord, but they die in the fetal stage. The Anencephalia may have a spinal cord, a medulla oblongata, and parts of the basal ganglia, but the cerebral hemispheres are wanting. Such monsters are sometimes born at term and live for several days: they cry, suckle, show some reflexes and a sense of pain, and move the arms and legs.

I described the various kinds of terata in Essays in Pastoral medicine,[58b] and of these the most important in the matter under discussion here are the double and triple monsters. Many of the double monsters evidently were two persons. There is only one well authenticated case of a triple human monster, and this happened in Italy in 1831. It had a single broad body with three distinct heads and two necks, and was killed in delivery. There is no proof as to whether it was one or more persons. The standard of judgment in such cases as regards the presence of one or two souls in the monster is the evidence of one or more distinct consciousnesses. A monster double from the navel or breast downward (terata anadidyma) is, I think, one person. There was an example of a monster in this group which was divided from the foreheads downward; or better, the distinct twins were united by their foreheads only; but such a form is very exceptional. In my article on "Human Terata and the Sacraments," in Essays in Pastoral Medicine, in 1906, I expressed the opinion that a monster which is single to the navel and double below is composed of two persons, but I now am of the opinion that such a monster is only one person, because there is apparently only one consciousness. There are about eight cases of two-headed monsters known which were evidently two persons in each case, and several terata kata-anadidyma, divided above and below but joined at the sternum, abdomen or sacrum. Several ischiopagic twins, joined at the pelvis with the heads at the opposite ends of the double body, are grouped with either the katadidyma or kata-anadidyma. It is commonly not difficult to recognize individuality or duality of personality in monsters, but it is not easy to explain the origin of life, to point out the moment the second soul enters these fused or undivided twins.

We can artificially obtain double embryos of frogs by inverting the blastomeres in the two-cell stage.[58c] We thus get united twins with heads turned in opposite directions, twins united back to back like the Blazek Sisters, twins united by their ventral sides, and double-headed tadpoles, but we have no knowledge of how similar doubling in human monsters takes place; we must guess vaguely from analogy. There was one soul, at least, present from the one-cell stage of the human monster; when the second soul is created and infused we do not know, but the moment of the creation of this second soul has no practical significance in this discussion.

The presence of certain kinds of monsters in the uterus can be diagnosed before labor, but double monsters are mistaken for ordinary twins. A woman who has given birth to a monster is likely to have subsequent monstrous fetuses. Where the intrauterine existence of a single monster is suspected the X-ray will at times clear up the diagnosis. Women gravid with monsters commonly abort early in pregnancy, but even united twins may go on to term. Those monsters that offer an obstacle to delivery by the abnormal bulk of one or the other end are mostly twins joined above or below the navel; those joined at the middle are easier of delivery. Monsters that are joined at the pelves are commonly in a straight line, and may not be difficult to deliver. Most double monsters cannot be delivered alive except by cesarean section, and the fact that the content of the uterus is monstrous is, as a rule, not diagnosed until it is impossible to attempt cesarean section without killing the mother through infection. In such a condition the double monster would, in the ordinary medical practice, be delivered by craniotomy, exenteration, cleidotomy, or the like operation.

The Rituale Romanum Pauli V[59] gives the following directions for the baptizing of human terata:

"18. In monstris vero baptizandis, si casus eveniat, magna cautio, adhibenda est, de quo si opus fuerit, ordinarius loci, vel alii periti consulantur, nisi mortis periculum immineat.

"19. Monstrum, quod humanam speciem non praeseferat baptizari non debet; de quo si dubium fuerit, baptizatur sub hac conditione; Si tu es homo ego te baptizo, etc.

"20. Illud vero, de quo dubium est, una ne, aut plures sint personae non baptizetur, donee id discernatur: discerni autem potest si habeat unum vel plura capita, unum vel plura pectora; tune enim totidem erunt corda et animae, hominesque distincti, et eo casu singuli seorsim sunt baptizandi, unicuique dicendo: Ego te baptizo, etc. Si vero periculum mortis immineat, tempusque non suppetat, ut singuli separatim baptizentur, poterit minister singulorum capitibus aquam infundens omnes simul baptizari, dicendo: Ego vos baptizo in nomine Patris, et Filii, et Spiritus Sancti. Quam tamen formam in iis solum, et in aliis similibus mortis periculis, ad plures simul baptizandos, et ubi tempus non patitur, ut singuli separatim baptizentur, aliis nunquam, licet adhibere.

"21. Quando vero non est certum in monstro duas esse personas, ut quia duo capita et duo pectora non habet distincta; tune debet primus unus absolute baptizari, et postea alter sub conditione, hoc modo: Si non es baptizatus, ego te baptizo in nomine Patris, et Filii, et Spiritus Sancti."

Any kind of monster coming from the human womb, if it is only a head and lacks a body (Acardiacus Acormus), or is a body and lacks a head and heart (Acardiacus Acephalus), or is a Foetus Anideus, which is a shapeless mass of flesh covered with skin, should be baptized, provided it shows signs of life. Number 19 in the Ritual would be liable to an interpretation which is too narrow if it were not that very monstrous fetuses, which appear to a lay observer to be not human, are as a rule delivered dead. Here it may be worth while to mention that a hybrid between a human being and a lower animal is impossible. As to number 20, the rule for differentiating unity or duality of personality is not the number of heads, but the number of evident consciousnesses, and this differentiation commonly cannot be made at birth. There have been examples of two-headed monsters delivered alive, which were single as to soul because the consciousness evidently was one.

[CHAPTER IV]

When Does Human Life End?

The moment human life begins in the human fetus is a subject of dispute, but the moment human life ends is a mystery—we have no method of determining exactly just when the soul leaves the body. Daily throughout the world the priest reaches a patient who has just died. Conditional absolution, extreme unction, baptism might have been administered if there were signs of life, but the heart and lungs are still, "the patient is dead," and the priest leaves without doing anything. Yet it is always probable that the patient does not die at once even in a case of decapitation.

Bichat, at the beginning of the last century, called the brain, lungs, and heart "the tripod of life," and from time immemorial we have based our judgment of the presence of somatic death on the lack of consciousness, respiration, and circulation in the patient. The heart, however, beats after consciousness and respiration cease (and sometimes respiration continues after the pulse cannot be felt), and this cardiac activity may go on for more than a half hour after all the normal clinical signs of death have appeared—after respiration has quit, when no heart-sounds can be heard by the stethoscope and muscular relaxation indicates death.

The stimulus of the heart-beat probably starts at the juncture of the superior vena cava with the right auricle of the heart. Some biologists think that in this spot life takes its last stand before the final retreat, but that fact is disputed of late. In the hospital of the Rockefeller Institute for Medical Research in New York, Dr. G. Canby Robinson[60] made records from about eight patients before and during the actual stopping of the heart, using the electrocardiograph, which can be employed without disturbing the patient. He thus found—only in one case, however—that the heart may beat for a half hour after all vascular and circulatory sounds have ceased to be audible. In a letter to me Dr. Robinson said: "Undoubtedly the heart continues to show activity sufficient to be recorded by the string galvanometer very frequently after respiration has ceased, both in man and the lower animals; but this does not necessarily mean that it continues to be an efficient pump, maintaining the circulation. Undoubtedly also in other instances the cardiac activity ceases before the respiration, but I have never obtained electrocardiographic records of such cases."

Crile's experiments upon dogs show that it is possible to resuscitate these animals after they have been apparently dead for periods of time up to seven and a half minutes. The cessation of the blood circulation causes degenerations in the nerve cells and fibres, and these lesions may last even if the animal has been resuscitated. Crile thinks the human respiratory centre may survive anemia from thirty to fifty minutes; the vasomotor and cardiac centres, about twenty to thirty minutes; the spinal cord, eight to ten minutes; the motor cortex, eight to ten minutes; the portion of the brain used in conscious activity as such, six to seven minutes. The higher neurons have been stimulated into reflex activity twenty-five minutes after complete clinical cardiac cessation of activity.

In any attempt to resuscitate a person apparently dead the maintenance of the blood circulation is the chief end. If, however, the blood is not oxygenated the circulation will not go on automatically. Artificial respiration is used, and the active principle of the adrenal gland is injected to stimulate the heart. If the heart has stopped in diastole,—that is, when distended with blood,—this distention must be relieved by cardiac massage, commonly through an opening in the thoracic wall. Intratracheal insufflation of oxygen is also to be employed, as a rule.

In Essays in Pastoral Medicine[61] I mentioned several cases of resuscitation after what had appeared to be certain death. Two of these had been "dead" for forty-five minutes before they were revived temporarily. Wayne Babcock[62] reported a number of new cases of his own. One was a resuscitation which lasted for forty-three hours, and which was begun twenty-five minutes after respiration had ceased. The patient was a very fat negress who had collapsed after the use of scopolamine. A man whose arm had been torn off died from shock in the operating-room. After fifteen minutes of artificial respiration the circulation started again, and he was kept alive for six hours in this manner, but he died as soon as the artificial respiration was discontinued. An exactly similar case was kept alive for seven hours by artificial respiration. One of Babcock's cases was a woman of eighty-seven years of age, who apparently died on the table during an operation for strangulated hernia. After ten minutes of cardiac and respiratory cessation she was revived. She died four days later of peritonitis. A man fifty-six years of age undergoing the same operation ceased breathing and his heart stopped. He was completely revived and cured.