Except for recent innovativework that provided insights into organized Catholic medicine in France and the United States, as well as into the therapeutic practices of Catholic medical st
Trang 1Medical compromise and its limits: religious concerns and the post-mortem caesarean section in nineteenth-century Belgium
Jolien Gijbels
In 1868, the Court of Appeal of Ghent sentenced a midwife and a priest for having performed
a caesarean section on a deceased woman to baptize the fetus Indignantly, the Belgian
Catholic newspaper Le Bien Public contested the court decision that prevented Catholics
from doing their “indeclinable and sacred duty”.1 In Liberal newspapers, by contrast, it wasargued that priests were not in a position to decide over an operation without a deathdeclaration beforehand and that the operation could not be trusted to unexperiencedpersons lacking formal medical training.2 The conviction of 1868 was the beginning of a legaldispute over whether post-mortem caesareans by non-medically trained Catholics forreligious purposes constituted a crime Succeeding court decisions inflamed publicdiscussions between supporters and opponents about the introduction of a law prosecutingthe performers of this operation Interestingly, some Catholic and liberal doctors engaged onboth sides of this debate
This article will use the post-mortem caesarean question as a means to investigatethe forms of negotiation between liberal and Catholic doctors, in relation to the wider publicdebate In this way, the article provides a new perspective on the medical historiography onthe intersection between medicine and Christianity that has developed since the 1980s.3 Inthe past years medical historians showed how mutual interactions stimulated new doctrinesand practices by, among other things, examining the involvement of Catholic nursing sisters
in health care, highlighting theological division over medical matters and delving into thecirculation of knowledge between both fields.4 The role of physicians’ religious beliefs inmedical debate in the Christian world, however, awaits research Except for recent innovativework that provided insights into organized Catholic medicine in France and the United States,
as well as into the therapeutic practices of Catholic medical staff, such as attending Mass,historical understandings of the ways in which physicians dealt with religious concerns in themedical profession remain limited.5 Especially ideological debate between Catholic and
1 “Bulletin télégraphique,” Le Bien Public, August 6, 1868, 1.
2 “Intérieur,” L’echo du Parlement, August 11, 1868, 1.
3 Some pioneering studies: W J Sheils, Church and Healing: Papers Read at the Twentieth Summer Meeting and
the Twenty-First Winter Meeting of the Ecclesiastical History Society (Oxford: Blackwell, 1982); Ronald L
Numbers and Darrel W Amundsen, eds., Caring and Curing: Health and Medicine in the Western Religious
Traditions (New York: Macmillan, 1986).
4 Respectively: Christopher J Kauffman, Ministry and Meaning: A Religious History of Catholic Health Care in the
United States (New York: Crossroad, 1995); Barbra Mann Wall, Unlikely Entrepreneurs: Catholic Sisters and the Hospital Marketplace, 1865-1925 (Columbus: Ohio State University Press, 2005); Emmanuel Betta, Animare la vita: disciplina della nascita tra medicina e morale nell’Ottocento (Bologna: Il mulino, 2006); Tine Van Osselaer,
Henk De Smaele, and Kaat Wils, eds., Sign or Symptom?: Exceptional Corporeal Phenomena in Religion and
Medicine in the Nineteenth and Twentieth Centuries (Leuven: Leuven University Press, 2017).
5 Hervé Guillemain, “Les débuts de la médecine catholique en France: La Société médicale Saint-Luc, Saint-Côme
et Saint-Damien (1884-1914),” Revue d’histoire du XIXe siècle 26–27 (2003): 227–58; Hervé Guillemain, Diriger
les consciences, guérir les âmes: une histoire comparée des pratiques thérapeutiques et religieuses (1830 - 1939) (Paris: La Découverte, 2006); Jessica Martucci, " Religion, Medicine, and Politics: Catholic Physicians'
Guilds in America,1909–32," Bull Hist Med 92, no 2 (2018): 287-316.
Trang 2liberal doctors remains largely unexplored Nonetheless, studies of mystical phenomena such
as the miraculous healings in Lourdes have shown deep divisions in the philosophicalpositions of physicians.6
In the historiography of the post-mortem caesarean section as well, the negotiationsbetween liberal and Catholic doctors hardly received any attention In recent years there hasbeen an increase in studies of the practice of post-mortem caesareans in the middle agesand the early modern period.7 Most research, however, has focused on the promotion of theoperation as part of a broader Catholic campaign for fetal baptism in the second half of theeighteenth-century Studies of the intervention in several European countries and Spanishcolonies have revealed that circulating clerical guidelines regarding the intervention took ondifferent meanings according to the political and religious context.8 The demise of thepractice and the ideological dimension of medical opposition to surgical interventions byunqualified Catholics in the second half of the nineteenth century need furtherinvestigation.9 In this respect, the contribution of Claire Fredj is of interest By analyzing amedical discussion in the Parisian Academy of Medicine in 1860-1861 that addressed theclerical obligation regarding medical staff and priests to perform post-mortem caesareansections for reasons of baptism, she pointed at the intermingling of religious and medicalarguments in scientific exchange.10
While arguments in favor or against the intervention were informed by travelingmedical ideas and circulating Catholic doctrine, the Belgian public debate of 1868 shows thatinstances of ideological conflict especially reflect the concerns specific to each nationalcontext The so-called culture wars between anticlerical and religious forces over the place ofCatholicism in different European countries had other outcomes depending on the politicalsystem and the extent to which Catholicism dominated society Belgium is a rather uniquecase to examine the dynamics of ideological debate because of its political culture ofcompromise Unlike elsewhere in Europe, the country had no State Church and was providedwith an exceptionally liberal constitution for the time (1831) which was above all supposed
to safeguard the liberties of Belgian citizens Liberals believed that free enlightened citizens –
6 For example, see: Ruth Harris, Lourdes: Body and Spirit in the Secular Age (London: Penguin, 1999); Jason Szabo, “Seeing Is Believing?: The Form and Substance of French Medical Debates over Lourdes,” Bull Hist Med
76, no 2 (2002): 199–230.
7 Katharine Park, “The Death of Isabella Della Volpe: Four Eyewitness Accounts of a Postmortem Caesarean
Section in 1545,” Bull Hist Med 82, no 1 (2008): 169–87; Alessandra Foscati, “‘Nonnatus Dictus Quod Caeso
Defunctae Matris Utero Prodiit’ Postmortem Caesarean Section in the Late Middle Ages and Early Modern
Period,” Soc Hist Med 2018.
8 Rosemary Keupper Valle, “The Cesarean Operation in Alta California during the Franciscan Mission Period
(1769-1833),” Bull Hist Med 48, no 2 (1974): 265–275; Paula de Demerson, “La Cesárea Post Mortem En La España de La Ilustración,” Asclepio 28 (1976): 185–233; Nadia Maria Filippini, “La Naissance Extraordinaire : La
Mère, l’enfant, Le Prêtre, Le Médecin Face à l’opération Césarienne : Italie, XVIIIe-XIXe Siècle” (EHESS, 1993); José G Rigau-Pérez, “Surgery at the Service of Theology: Postmortem Cesarean Sections in Puerto Rico and the
Royal Cedula of 1804,” The Hispanic American Historical Review 75, no 3 (1995): 377–404; Adam Warren, “An
Operation for Evangelization: Friar Francisco González Laguna, the Cesarean Section, and Fetal Baptism in Late
Colonial Peru,” Bull Hist Med 83, no 4 (2009): 647–75; Martha Few, For All of Humanity: Mesoamerican and
Colonial Medicine in Enlightenment Guatemala (Tuscon: University of Arizona Press, 2015), 96–132.
9 Daniel Schäfer, “Medical Practice and the Law in the Conflict between Traditional Belief and Empirical
Evidence: Post-Mortem Caesarean Section in the Nineteenth Century,” Med Hist 43, no 4 (1999): 485–501; Daniel Schäfer, Geburt aus dem Tod: Der Kaiserschnitt an Verstorbenen in der abendländischen Kultur
(Hürtgenwald: Guido Pressler, 1999), 136–66.
10 Claire Fredj, “Concilier le religieux et le médical: Les médecins, la césarienne post-mortem et le baptême au
XIXe siècle,” in Baptiser: Pratique sacramentelle, pratique sociale (XVIe - XXe siècles), ed Guido Alfani, Philippe
Castagnetti, and Vincent Gourdon (Saint-Etienne: Université de Saint-Étienne, 2009), 125–43.
Trang 3in their eyes the bearers of moral values – would produce progress Catholics equallyembraced the liberal constitution, yet their liberal orientation stemmed from a differentsociety model By appealing to the constitutional freedom of religion they aimed atstrengthening their Catholic hold on Belgian society Despite ideological divergence of views,both leading political forces united to consolidate the new nation state in the years followingBelgian independence Yet, Belgium’s political culture of negotiation could not prevent therise of ideological tensions surrounding specific issues Questions such as the secularization
of primary education exposed the divergent religious and secular world views of Catholicsand liberals However, even with rising tensions, liberal and Catholic politicians still remainedloyal to the liberal constitution and tried to avoid open political confrontations.11
The same dynamics of compromise and incidental ideological conflict marked Belgianmedicine The liberal government was barely involved in medical decision making, leavingroom for religious orders to expand without being opposed by the state Besides medicalcare, scientific medical debate also bears the imprint of Catholicism Within Europe, theprestigious Catholic University of Leuven (1834) and eminent Catholic medical professorssuch as Louis Hubert (1810-1876) were a point of reference for Catholic physicians inBelgium and abroad.12 After the foundation of the chair in Thomistic philosophy at theLeuven university in 1882 – with Désiré-Joseph Mercier, the later highly influentialarchbishop, as its first chair holder – Leuven undeniably became one of the world’s leadingcenters of the efforts to reconcile Catholicism with science.13 Yet, this significant impact ofCatholicism on Belgian medicine did not remain uncontested by anticlerical liberalphysicians As with Catholic physicians who followed courses at the Leuven university and
published in Catholic medical journals such as Revue médicale de Louvain, they ideologically allied with liberal institutions and liberal medical journals such as Journal de médecine, de chirurgie et de pharmacologie Liberal doctors were trained at the free-thinking university of
Brussels (Université Libre de Bruxelles) which was founded by anticlerical liberals in response
to the Catholic university in 1834 Apart from these universities there were two mixed state universities with medical faculties in Liège and Ghent where both Catholic andliberal doctors were appointed Despite this ideological division, physicians mostly exchangedmedical ideas in a conciliatory spirit Only at specific times of increasing polarization,ideological conflict threatened to complicate medical debate
ideologically-Situated on the intersection of medicine and religion, the case of the post-mortemcaesarean section profoundly challenged the culture of compromise in Belgian medicine Itexposed the ideological tensions surrounding the constitutional freedom of religion on a verypractical level It should be noted that nearly everyone in Catholic countries such as Belgiumwas baptized, liberal obstetricians included Hardly questioned by anyone, the baptismal ritefollowing birth was part of the day-to-day reality of doctors and priests present at childbirth.Other ideological debates in Belgium, such as the well-researched medical discussion aboutthe nature of the wounds of the Belgian stigmatic Louise Lateau, were held by a limited
11 Els Witte, “De constructie van België, 1828-1847,” in Nieuwe geschiedenis van België: 1830-1905, ed Els Witte et al (Tielt: Lannoo, 2005), 173–93; Henk de Smaele, Rechts Vlaanderen: religie en stemgedrag in
negentiende-eeuws België (Leuven: Universitaire pers Leuven, 2009), 212–21; Jan De Volder, Cardinal Mercier in the First World War: Belgium, Germany and the Catholic Church (Leuven: Leuven University Press, 2018), 16.
12 Betta, Animare la vita (n 4), 181.
13 Neo-Thomism provided Leuven philosophers with a Catholic philosophy in which science could be integrated :
Kaat Wils, “Les intellectuels catholiques et la sociologie en Belgique, 1880-1914,” Archives de Sciences Sociales
des Religions, no 179 (2017): 76–79.
Trang 4number of medical intellectuals.14 Still other ideological debates focused on allegedlyhygienic measures such as cremation which was not put into practice in nineteenth-centuryBelgium When it comes to actual practices, ideological division clearly marked internalmedico-ethical discussions about physicians’ appropriate surgical intervention to resolvedifficult births.15 Unlike the debate on the post-mortem caesarean section, however, none ofthese mentioned discussions concentrated on the intrusion of priests into what doctorsconsidered the medical domain.
In this article I will provide a first comprehensive study of the negotiations betweenCatholic and liberal physicians regarding operations on deceased women for reasons ofbaptism.16 On the one hand, I will look closely at how they incorporated religious concernssuch as baptism in the medical profession On the other hand, I will examine physicians’strategies for reaching agreement on doing away with the post-mortem caesarean byCatholics without medical training These research questions will be answered taking intoaccount Catholic doctrine in Belgian medical education, scientific exchange and broaderpublic debate Before analyzing this debate, the first sections will place the post-mortemcaesarean in a broader international and Belgian context Subsequently, I will analyze twomethods of negotiation that Catholic and liberal physicians used to settle the question While
a scientific treatment was favored in medical settings of academic debate in an atmosphere
of reconciliation around 1850, a second method of public debate was attempted during thepoliticization of the debate at the end of the 1860s By analyzing physicians’ strategies ofcompromise, I will show why most doctors preferred a scientific settlement over publicengagement both in times of ideological rapprochement and of polarization
The post-mortem caesarean in Catholic Europe and colonial settings
From the second half of the eighteenth century onwards post-mortem caesareans forreligious purposes received a lot of attention from theologians and Catholic leaders Thehistory of this operation, however, goes back to the Middle Ages, the first medical writingsmentioning post-mortem caesareans dating from the beginning of the fourteenth century.Research has shown that throughout the Middle Ages and the Renaissance midwives andsubsequently physicians were required by church authorities to operate on deceased women
to ensure the fetus’ salvation Yet, before the eighteenth century when caesareans mainlytook place on corpses, extracted newborns that survived were not considered as truly born.Rather they were described as “not of woman born” or “the unborn”.17
14 Sofie Lachapelle, “Between Miracle and Sickness: Louise Lateau and the Experience of Stigmata and Ecstasy,”
Configurations 12, no 1 (2004): 77–105; Clara Veronika Elisabeth Wurm, “Medizinische Konzepte zur religiösen
Stigmatisation im 19 Jahrhundert” (Ph.D diss., Köln, Univ, 2013), 117–77; Wannes Dupont, “Free-Floating Evils:
A Genealogy of Homosexuality in Belgium” (Ph.D diss., Universiteit Antwerpen, 2015), 137–44; Tine Van
Osselaer, “Stigmata, Prophecies and Politics Louise Lateau in the German and Belgian Culture Wars,” J Rel Hist.
16 In this article I differentiate in my terminology of prepartum and postpartum by describing the former as a
“fetus” or “the unborn” and the latter as a “child” or “the newborn” I also followed this rule in describing the deceased women as the “women” pre-birth and the “mothers” post-birth In the nineteenth century, all these terms were used interchangeably.
Trang 5What distinguishes the eighteenth century from the earlier period is the far-reachingCatholic promotion of the caesarean in the eighteenth century, which was bound up with achanging theological perception of the fetus inside the womb Around 1700 it was commonlyheld that fetuses were endowed with the immortal soul after forty to eighty days ofpregnancy Rooted in the Aristotelian epigenetic theory of generation, most theologiansbelieved that ensoulment only took place once fetuses had acquired a distinct human shape.
In the mid-eighteenth century this view was challenged by theologians favoring a view ofimmediate ensoulment at the moment of conception, in this way responding to developingmedical ideas regarding reproduction Immediate ensoulment became the consensus view intheological thinking at the end of the nineteenth century.18 In the context of this theologicaldebate the salvation of each unborn specimen became important in the eyes of Catholics.Nadia Maria Filippini has demonstrated the success of the religious campaign for post-mortem caesarean sections along with baptisms of miscarriages and intrauterine baptisms inItaly after which it was picked up by Catholic leaders in other countries.19 Embriologia sacra,
a theological work and practical guide for priests by the Sicilian priest Francesco-EmanueleCangiamila, played a crucial part in the circulation of these baptism procedures It was firstpublished in 1745 and then approved by the pope in 1756, after which it appeared in manyEuropean countries and colonies in translations and abridged forms.20 Simultaneously otherinfluential publications about the importance of the post-mortem caesarean section shapedthinking, as shown in the circulation of the work of the Spanish priest Antonia José Rodriguez
in Spain and the Spanish colonies.21
Yet, the conditions in which the caesarean was promoted by the Church or evenlegally imposed on physicians were nationally specific In most Catholic countries includingthe Italian states and Spain as well as in the Orthodox state of Greece laws emerged thatwere to a greater or lesser extent inspired by the theological writings of Cangiamila; somelaws obliged physicians to perform caesareans on every deceased woman regardless of theviability of the fetus, others prescribed it in advanced stages of pregnancy.22 In the Spanishcolonies, both colonial elites and the Spanish Crown promulgated legislation mandating post-mortem caesareans on deceased pregnant women to save the spiritual and temporal life offetuses.23 Conversely, in Protestant territories such as the German states similar lawsregarding the duty of doctors existed, but they stemmed from a public health concern andwere more concerned with improving the success rate of the operation Protestant sources
17 Renate Blumenfeld-Kosinski, Not of Woman Born: Representations of Caesarean Birth in Medieval and
Renaissance Culture (Ithaca (N.Y.): Cornell University Press, 1990), 1; 24–38.
18 John Connery, Abortion: The Development of the Roman Catholic Perspective (Chicago: Loyola University Press, 1977), 211; Betta, Animare la vita (n 4), 313–25; Ivano Dal Prete, “Cultures and Politics of
Preformationism in Eighteenth-Century Italy,” in The Secrets of Generation: Reproduction in the Long Eighteenth
Century, ed Raymond Stephanson and Darren Wagner (Toronto: University of Toronto Press, 2015), 59–78.
19 Filippini, “La naissance extraordinaire” (n 8), 107–276.
20 Francesco E Cangiamila, Embriologia Sacra, Ovvero Dell’uffizio De’sacerdoti, Medici, E Superiori, circa
L’etherna Salute De’ Bambini Racchiusa Nell’utero (Palermo: Francesco Valenza, 1745); In Belgium the French
and Dutch translations circulated: Francesco E Cangiamila, Abregé de l’Embryologie sacrée: du traité du devoir
des prêtres, des médecins & autres, sur le salut éternel des enfans qui sont dans le ventre de leur mère, trans
Joseph Antoine Toussaint Dinouart (Paris: Nyon, 1762); Francesco E Cangiamila, Kort begryp van de
Embryologia Sacra ofte verhandelinge der plichten van de priesters, geneésheeren, chirurgyns en
vroedvrouwen, jegens de kinderen, die noch niet geboren zyn, trans J Stafford (Antwerp: Hubertus Bincken,
1780).
21 Warren, “An Operation for Evangelization” (n 8), 653–55; Few, For All of Humanity (n 8), 101.
22 Filippini, “La naissance extraordinaire” (n 8), 219–43.
23 Few, For All of Humanity (n 8), 97–100.
Trang 6tended to emphasize the possible dangers of hasty operations for the woman’s life Ratherthan paying special attention to the fate of the unborn, in German Protestant territories such
as Prussia there was a focus on the careful verification of the woman’s death beforeproceeding to the operation.24
Belgian and French laws differed from most European and colonial laws in the sensethat there existed no legal obligation for physicians to perform the operation Filippini hasexplained the absence of French legislation by emphasizing the autonomy of the state vis-à-vis the Catholic Church and the independent position of physicians.25 In nineteenth-centuryBelgium, there never was a discussion in medical or political circles regarding the legalobligations of physicians After all, the liberal government tended to keep aloof from medicaldecision making Despite voices calling for more government regulation, state intervention inmedicine expanded slowly throughout the nineteenth century For instance, the first medicaladvisory board and scientific forum, the Royal Academy of Medicine, was created in 1841 topromote medicine and guide the national government in medical issues.26 Yet, the BelgianAcademy had a less centralized character than its French counterpart, on which theinstitution was modelled The fact was that the foundation of the medical state institutionattracted a lot of criticism of Belgian physicians, as many of them preferred voluntaryscientific engagement above state-directed scientific study.27
In the second half of the nineteenth century, political and medical support for mortem caesarean sections had ceased In European countries such as Italy, Spain andGermany where caesarean sections on deceased women were required by law, newlegislation was introduced without references to mandatory caesarean sections on deceasedwomen.28 At the same time, physicians increasingly lost faith in the operation Schäfer forinstance explained mounting medical criticism by highlighting the rising authority of medicalstatistics, which provided mostly discouraging data about failing operations Critical medicalvoices especially raised the limited chances of fetal survival after the woman’s death.29
post-Catholic doctrine and the post-mortem caesarean in Belgian medicine
In Belgium, the medical debate on the post-mortem caesarean section took place against thebackdrop of an increasingly polarizing ideological environment From the end of the 1840s
on, Catholic dominance in Belgian society became subject to ideological clashes in a timewhen moderate liberals allied with a new generation of more overtly anticlerical liberals Inpower between 1857 and 1870, the liberal governments headed by Charles Rogier andWalthère Frère-Orban worked towards the laicization of Belgian society, in this wayrepeatedly provoking the anger of Catholics By the mid-1870s, under Catholic rule, the
24 Filippini, “La naissance extraordinaire” (n 8), 238–40; Schäfer, “Medical Practice and the Law” (n 9), 486.
25 Filippini, “La naissance extraordinaire” (n 8), 240–43.
26 Rita Schepers, De opkomst van het medisch beroep in België : De evolutie van de wetgeving en de
beroepsorganisaties in de 19e eeuw (Amsterdam: Rodopi, 1989), 81–95; 149–58; Karel Velle, De nieuwe biechtvaders: de sociale geschiedenis van de arts in België (Leuven: Kritak, 1991), 71–74; Evert Peeters and Kaat
Wils, “Ambivalences of Liberal Health Policy: Lebensreform and Self-Help Medicine in Belgium, 1890-1914,” in
Health and Citizenship, ed Frank Huisman and Harry Oosterhuis (Londen: Pickering and Chatto, 2014), 101–17.
27 Joris Vandendriessche, Medical Societies and Scientific Culture in Nineteenth-Century Belgium (Manchester:
Manchester University Press, 2018), 38–44.
28 de Demerson, “La Cesárea Post Mortem En La España de La Ilustración” (n 8), 231; Filippini, “La Naissance
Extraordinaire” (n 8), 632; Schäfer, Geburt aus dem Tod (n 9), 153.
29 Schäfer, “Medical Practice and the Law” (n 9).
Trang 7tensions had increased so much that even the slightest provocation could result in a polemic
in the Catholic and the liberal press.30 Eventually, under anticlerical liberal rule, theideological tensions culminated in the “school war” of 1878-84, which centered on the role
of the Catholic Church in public education.31
In this context, Catholic influence on Belgian medicine was questioned as well.32 Inpublic hospitals, restrictive rules regarding the presence of religion were introduced, yet suchprocesses of laicization occurred relatively late in Belgium and had less far-reachingconsequences for Catholic nursing sisters and chaplains in comparison with otherpredominantly Catholic countries like France Catholic medicine maintained a strong footing
in the existing Belgian medical institutions.33 After all, hostile anticlerical attitudescharacterized the medical profession in Belgium far less than in the French Third Republic.34
Anticlerical doctors remained a minority in Belgian medicine, operating mainly in the domain
of public health and referring to themselves as ‘hygienists’ (médecins hygiénistes).35
While historians have demonstrated the diversity of opinion within politicalCatholicism and liberalism in Belgium,36 little is known about the different configurations ofCatholicism and liberalism within the Belgian medical profession An historiographicalemphasis on public health matters contributed to the fact that little attention was drawn tothe diversity of medical sub-disciplines and ideological positions In this way, Belgian research
on the political and social roles of radical liberal hygienists and the absence of research onCatholic medicine have nourished the idea of an anticlerical medical profession.37 This lack ofknowledge about ideological diversity is also due to the fact that doctors were generally notinclined to share their religious views or political ideas about the entanglement ofCatholicism and Belgian society in nineteenth-century medical debate Only exceptionalcases such as the post-mortem caesarean section forced doctors to take a position regardingreligious doctrine As this article will show, a minority of Catholic physicians overtly statedthat they based their conduct on official clerical guidelines Probably most Catholicphysicians were more pragmatic and less inclined to refer to Catholic doctrine
30 Witte, “De constructie van België, 1828-1847” (n 11), 275;286-308; 366–70.
31 The “school war” was an intense struggle between Catholics and liberals on the divisive issue of education Following the liberal bill of 1879 ridding public primary schools from Catholic control, not only the high clergy, but also local clerics, Catholic politicians and civil servants conducted a mass mobilization campaign against public schools In 1881, the anticlerical liberal government voted a similar law on secondary education.
32 An overview of several conflicts between Belgian medicine and the Church: Karel Velle, “De geneeskunde en
de R.K Kerk (1830-1940): Een moeilijke verhouding?,” Trajecta: Tijdschrift Voor de Geschiedenis van Het
Katholiek Leven in de Nederlanden 1 (1995): 1–21.
33 Valérie Leclercq, “Guérir, travailler, désobéir: Une histoire des interactions hospitalières avant l’ère du ‘patient autonome’ (Bruxelles, 1870-1930)” (Ph.D diss., Université Libre de Bruxelles, 2017), 135–42.
34 Jack D Ellis, The Physician-Legislators of France: Medicine and Politics in the Early Third Republic, 1870-1914,
(Cambridge: Cambridge University press, 1990), 2.
35 Some studies on public health in Belgium: Velle, De nieuwe biechtvaders (n 26); Liesbet Nys, “Nationale plagen Hygiënisten over het maatschappelijk lichaam,” in De zieke natie Over de medicalisering van de
samenleving 1860-1914 (Groningen: Historische Uitgeverij, 2002), 220–41; Joris Vandendriessche, “Medische
expertise en politieke strijd De dienst medisch schooltoezicht in Antwerpen, 1860-1900,” Stadsgeschiedenis 6,
no 2 (2011): 113–128.
36 For instance: Achille Erba, L’esprit lạque en Belgique sous le gouvernement libéral doctrinaire 1857-1870:
d’après les brochures politiques, Bibliothèque de la Revue d’histoire ecclésiastique 43 (Leuven: RHE, 1967);
Vincent Viaene, Belgium and the Holy See from Gregory XVI to Pius IX (1831-1859): Catholic Revival, Society and
Politics in 19th-Century Europe (Leuven: Leuven University Press, 2001), 37–137.
37 Joris Vandendriessche, “Wetenschapsbeoefening en belangenbehartiging: naar een nieuwe geschiedschrijving
van negentiende-eeuwse medische genootschappen in de Lage Landen,” Studium: Tijdschrift voor
Wetenschaps- en Universiteits-Geschiedenis 7, no 1 (2014): 45–46.
Trang 8Liberals too were divided along religious lines Belgian liberal physicians could adopt amoderate, merely anticlerical position regarding the entanglement of Catholicism andBelgian society More radical, free-thinking liberal doctors also contested the supernaturalclaims of Catholicism Yet, this last group of free-thinkers was not represented in the debate
on the post-mortem caesarean section As is shown by some studies on liberalism within theUniversité Libre de Bruxelles and on positivism in Belgium, the approaches of liberal doctorstoward religion were often ambiguous Liberals could for instance combine spiritual notions
of God with critiques of Catholic doctrine and of the institution of the Church Medicalprofessors attached to the Université Libre de Bruxelles thus did not necessarily distancethemselves from religious concepts such as the immortal soul.38
As the case of the post-mortem caesarean shows, Belgian clerical leaders exertedspecial influence on Catholic medical education in Leuven In 1851, the Archbishop ofMechelen, Engelbert Sterckx, approved of vernacular clerical guidelines about baptismprocedures that were targeted at physicians and midwives On the title page Sterckxrecommended them to read the treatise, stating therein that they were the result of acollaboration with undefined members of the medical faculty of Leuven Although this wasthe first publication specifically addressed to medical staff, it built on an existing tradition ofbaptism instructions in Belgian seminaries since the eighteenth century.39 Physicians andmidwives were held responsible for performing caesareans on deceased pregnant women, toconform to their religious duties if the fetus was about to die, and to save the child if itsurvived the operation.40
Interestingly, the guidelines contained medical ideas to underpin this obligationregarding medical staff They particularly referred to medical debate about the death offetuses, questioning physiological conclusions of some well-known French obstetric worksregarding their limited chance of survival Against the French doctors Alfred Velpeau andFrançois-Joseph Moreau, who had declared that it was unlikely that a fetus lived longer than
a quarter of an hour inside a woman’s corpse, the clerical instructions appealed to othercontemporary medical authorities and the eighteenth-century work of Cangiamila to provethe opposite These conclusions formed the basis of the clerical obligation to never foregothe operation, whether women had been dead for a couple of hours or a couple of days Asthe souls of even the smallest specimen awaited salvation, medical staff were instructed tooperate on deceased women that had been pregnant for forty days and even advised to do
so at a term of about twenty days.41
Considering the limited number of sources concerning actual medical practices, it isdifficult to assess the effect of this clerical publication on the Belgian medical profession Yet,there are good reasons to believe that Catholic doctors and especially the Catholic obstetricprofessors of the University of Leuven appealed to it A comparison between the obstetrichandbooks of Leuven, Brussels, Ghent and Liège in the second half of the nineteenth centuryshows that only Leuven medical students were explicitly reminded of their Catholic duty andinstructed about the different ways in which the newborn and unborn needed to be
38 Pierre F Daled, Spiritualisme et matérialisme au XIXe siècle: l’Université Libre de Bruxelles et la religion, Spiritualités et pensées libres (Brussels: Ed de l’Université de Bruxelles, 1998), 88–107; Kaat Wils, De omweg
van de wetenschap: Het positivisme en de Belgische en Nederlandse intellectuele cultuur, 1845-1914
(Amsterdam: Amsterdam University Press, 2005), 114–17.
39 Pierre Dens, Tractatus selectus de sacramento baptismi (Leuven: L J Urbran, 1776).
40 Instructions sur la manière de baptiser les enfants nouveau-nés, à l’usage des accoucheurs et des
sages-femmes (Mechelen: P J Hanicq, 1851), 10.
41 Ibid., 11–12.
Trang 9baptized Conversely, students at the other faculties were only advised to performcaesareans to save the lives of viable fetuses.42 Preserved reports about post-mortemoperations in the Brussels hospitals show that doctors intervened if they expected to find aliving child of at least six or seven months Rarely did such operations produce children wholived longer than a few moments From the eighteen documented post-mortem caesareansperformed between 1845 and 1889 found in the hospital records of Brussels, there is onlyevidence of one successful caesarean, in 1884.43 Despite poor results, nineteenth-centurymedical staff in hospitals were reluctant to intervene earlier before the women had died.Caesareans on living women – in theory the only operation that could save the pregnantwoman and fetus in cases of difficult births – were known to have mortal consequences formost women.44
Medical practice in the public hospitals of Brussels clearly shows the limits of Catholicinfluence As Valérie Leclercq recently argued, Catholicism was indirectly yet efficientlyorganized through the daily interactions of Catholic nursing sisters and hospital chaplainswith patients, but Catholic leaders did not have a say in administrative or medical matters.45
This was shown in an extensive letter of Archbishop Sterckx to the board of the publichospitals in Brussels in 1850 He complained about diverse “obstacles” preventing thechaplains from exercising their religious duties, such as administering sacraments andapproaching patients In the letter he also addressed the fact that doctors only performedcaesareans in instances of viable fetuses: “Physicians and surgeons refuse to perform anoperation if the child is not viable or if it did not reach the term of seven months This is asevere abuse that caused a lot of pain considering the great number of children who havenot been baptized and therefore deprived of heavenly bliss.”46 After inquiry the boardanswered that caesarean operations on deceased women had always occurred inappropriate circumstances The response was supposed to maintain good relations with theChurch, yet it was clearly stated that the hospitals were not religious institutions, but placesfor medical care Hospital chaplains were not allowed to forcibly impose their rites onpatients, nor did they have special rights in comparison to other religions.47
42 Léon J G Hyernaux, Manuel pratique de l’art des accouchements: Avec figures (Brussels: Tircher, 1857), 300; Charles Van Leynseele, Résumé du cours d’accouchements donné a l’université de Gand (Ghent: Muquardt, 1866), 444; Louis J Hubert and Eugène Hubert, Cours d’accouchements professé à l’université catholique de
Louvain (Peeters, 1869), 126–27; 698; Adolphe C F Wasseige, Des opérations obstétricales: Cours professé à l’université de Liège (Paris: Delahaye et Lecrosnier, 1881), 377.
43 Central commission of social services to Archbishop Engelbert Sterckx, February 19, 1850, Dossier culte Saint Jean, C393, Conseil des hospices et secours, Archives Social Services of Brussels; Dossier concernant l’opération césarienne pratiquée à St Pierre par Charlier sur l’épouse Segers, Dossier concernant l’opération césarienne pratiquée sur le cadavre de Marie Cortvriend, Dossier concernant Sophie Thieffry, 130, Affaires générales, Archives Social Services of Brussels; Dossier concernant une opération césarienne pratiquée sur Louise Clarys,
114, Affaires générales, Archives Social Services of Brussels; “Relevé des opérations césariennes pratiquées dans les hôpitaux de St Pierre et de St Jean sur des cholériques en 1866”, 31, Affaires générales, Archives Social Services of Brussels.
44 Some recent articles about the role of Catholicism and consent in the medical debate about the
appropriateness of the operation on living women: Joseph G Ryan, “The Chapel and the Operating Room: The Struggle of Roman Catholic Clergy, Physicians, and Believers with the Dilemmas of Obstetric Surgery, 1800-
1900,” Bull Hist Med 76, no 3 (2002): 461–94; Jacqueline H Wolf, “Risk and Reputation: Obstetricians, Cesareans, and Consent,” J Hist Med Allied Sci 73, no 1 (2018): 7–28.
45 Leclercq, “Guérir, travailler, désobéir” (n.32), 95–96.
46 Archbishop Engelbert Sterckx to the central commission of social services, January 17, 1850, Dossier culte Saint Jean, C393, Conseil des hospices et secours, Archives Social Services of Brussels.
47 Central commission of social services to Archbishop Engelbert Sterckx, February 19, 1850, Dossier culte Saint Jean, C393, Conseil des hospices et secours, Archives Social Services of Brussels.
Trang 10From a legal perspective, the clerical guidelines regarding the post-mortem caesareanwere confusing Catholic doctrine imposed it on midwives, while they were generally notallowed to perform operations Midwives faced the threat of being prosecuted for the illegalpractice of medicine if they used specialized equipment such as a forceps When confrontedwith a difficult delivery, midwives had to call a doctor A court case of 1847 shows, however,that these restrictions did not apply to cases where midwifes performed caesareans ondeceased women, since surgical procedures on supposedly dead bodies were not regarded
as medical practices.48 Midwifes could in fact operate on dead women, yet if the woman inquestion turned out to be alive at the moment of the operation because of a faulty deathdeclaration, they could be accused of the illegal practice of medicine The confusinginstructions about how to act in this matter in obstetrical handbooks for midwifes attest tothis dilemma.49
Reconciling medical and religious concerns in medical academic debate (1843-1845)
In Belgian medical exchange the religious duty of physicians and midwifes to baptize childrenafter a caesarean was not an issue of concern Whether a physician followed Catholicdoctrine depended on his conscience and the beliefs of the deceased woman’s family.Conversely, physicians denounced the clerical obligation regarding unexperienced Catholics –also taught in seminaries since the end of the eighteenth century According to the clericalguidelines of 1851 the Catholic Church demanded an act of Catholic charity from everyonepresent at the deathbed in the absence of medical staff.50 Both before and after thispublication Catholic doctrine inspired several priests to perform a post-mortem caesarean orincite midwives and others to do so In the second half of the nineteenth century, a smallnumber of incidents would gain a lot of public visibility
Physicians considered these operations by Catholics without medical expertise ashighly problematic with the specter of apparent death The development of medical ideasabout death as a process rather than an instant in the eighteenth century made physiciansbelieve that persons often looked dead but could suddenly awaken Putrefaction wasthought to be the only reliable sign of death In medical historiography, this transnationaldebate about apparent death has been researched with particular attention to medical andpopular anxiety regarding premature burials.51 With respect to post-mortem operations,physicians advocated their expert role in determining whether someone had really died Therisks for women and the lack of medical expertise of priests were the objects of heavydiscussion in Belgian medical journals and societies In 1843, the Namur physician Eugène
Thirion published his reflections in the Annales Médico-légales Belges after having acted as a
coroner in a court case regarding a caesarean performed by a priest He stated that it was
48 “Tribunal correctionnel de Tongres, art de guérir, inhumation précipitée, opération césarienne”, La Belgique
Judiciaire 6 (1848): 27-30.
49 Alexis C Lados, Lessen over de verloskunde, gegeven aen de leerlingen-vroedvrouwen in de verloskundige
school te Gent (Ghent: I S Van Doosselaere, 1854), 336; H De Moerloose, Lois et réglements en vigueur en Belgique dans leur application à la profession de sage-femme (déontologie) (Brussels: Berqueman, 1889), 61.
50 Instructions sur la manière de baptiser (n 40), 13.
51 Claudio Milanesi, Mort apparente, mort imparfaite: médecine et mentalités au XVIIIe siècle (Paris: Payot, 1989); Sean M Quinlan, “Apparent Death in Eighteenth-Century France and England,” French Hist 9, no 1 (1995): 27–47; George K Behlmer, "Grave Doubts: Victorian Medicine, Moral Panic, and the Signs of Death," J
Brit Stud 42, no 2 (2003): 206-235; Anne Carol, Les médecins et la mort: XIXe-XXe siècle (Paris: Aubier, 2004);
Rüve Gerlind, Scheintod: Zur kulturellen Bedeutung der Schwelle zwischen Leben und Tod um 1800 (Bielefeld:
Transcript, 2008).