article Jolien Gijbels_religious concerns and the post-mortem caesarean section

Medical 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” In Liberal newspapers, by contrast, it was argued that priests were not in a position to decide over an operation without a death declaration beforehand and that the operation could not be trusted to unexperienced persons lacking formal medical training The conviction of 1868 was the beginning of a legal dispute over whether post-mortem caesareans by non-medically trained Catholics for religious purposes constituted a crime Succeeding court decisions inflamed public discussions between supporters and opponents about the introduction of a law prosecuting the performers of this operation Interestingly, some Catholic and liberal doctors engaged on both sides of this debate This article will use the post-mortem caesarean question as a means to investigate the forms of negotiation between liberal and Catholic doctors, in relation to the wider public debate In this way, the article provides a new perspective on the medical historiography on the intersection between medicine and Christianity that has developed since the 1980s In the past years medical historians showed how mutual interactions stimulated new doctrines and practices by, among other things, examining the involvement of Catholic nursing sisters in health care, highlighting theological division over medical matters and delving into the circulation of knowledge between both fields The role of physicians’ religious beliefs in medical debate in the Christian world, however, awaits research Except for recent innovative work 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 the medical profession remain limited.5 Especially ideological debate between Catholic and “Bulletin télégraphique,” Le Bien Public, August 6, 1868, “Intérieur,” L’echo du Parlement, August 11, 1868, 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) 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) 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 (2018): 287-316 liberal doctors remains largely unexplored Nonetheless, studies of mystical phenomena such as the miraculous healings in Lourdes have shown deep divisions in the philosophical positions of physicians.6 In the historiography of the post-mortem caesarean section as well, the negotiations between liberal and Catholic doctors hardly received any attention In recent years there has been an increase in studies of the practice of post-mortem caesareans in the middle ages and the early modern period.7 Most research, however, has focused on the promotion of the operation as part of a broader Catholic campaign for fetal baptism in the second half of the eighteenth-century Studies of the intervention in several European countries and Spanish colonies have revealed that circulating clerical guidelines regarding the intervention took on different meanings according to the political and religious context The demise of the practice and the ideological dimension of medical opposition to surgical interventions by unqualified Catholics in the second half of the nineteenth century need further investigation.9 In this respect, the contribution of Claire Fredj is of interest By analyzing a medical discussion in the Parisian Academy of Medicine in 1860-1861 that addressed the clerical obligation regarding medical staff and priests to perform post-mortem caesarean sections for reasons of baptism, she pointed at the intermingling of religious and medical arguments in scientific exchange.10 While arguments in favor or against the intervention were informed by traveling medical ideas and circulating Catholic doctrine, the Belgian public debate of 1868 shows that instances of ideological conflict especially reflect the concerns specific to each national context The so-called culture wars between anticlerical and religious forces over the place of Catholicism in different European countries had other outcomes depending on the political system and the extent to which Catholicism dominated society Belgium is a rather unique case to examine the dynamics of ideological debate because of its political culture of compromise Unlike elsewhere in Europe, the country had no State Church and was provided with 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 – 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 (2002): 199–230 Katharine Park, “The Death of Isabella Della Volpe: Four Eyewitness Accounts of a Postmortem Caesarean Section in 1545,” Bull Hist Med 82, no (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 Rosemary Keupper Valle, “The Cesarean Operation in Alta California during the Franciscan Mission Period (1769-1833),” Bull Hist Med 48, no (1974): 265–275; Paula de Demerson, “La Cesárea Post Mortem En La Espa de La Ilustración,” Asclepio 28 (1976): 185–233; Nadia Maria Filippini, “La Naissance Extraordinaire : La Mère, l’enfant, Le Prêtre, Le Médecin Face 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 (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 (2009): 647–75; Martha Few, For All of Humanity: Mesoamerican and Colonial Medicine in Enlightenment Guatemala (Tuscon: University of Arizona Press, 2015), 96–132 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 (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 in their eyes the bearers of moral values – would produce progress Catholics equally embraced the liberal constitution, yet their liberal orientation stemmed from a different society model By appealing to the constitutional freedom of religion they aimed at strengthening 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 following Belgian independence Yet, Belgium’s political culture of negotiation could not prevent the rise of ideological tensions surrounding specific issues Questions such as the secularization of primary education exposed the divergent religious and secular world views of Catholics and liberals However, even with rising tensions, liberal and Catholic politicians still remained loyal to the liberal constitution and tried to avoid open political confrontations.11 The same dynamics of compromise and incidental ideological conflict marked Belgian medicine The liberal government was barely involved in medical decision making, leaving room for religious orders to expand without being opposed by the state Besides medical care, scientific medical debate also bears the imprint of Catholicism Within Europe, the prestigious Catholic University of Leuven (1834) and eminent Catholic medical professors such as Louis Hubert (1810-1876) were a point of reference for Catholic physicians in Belgium and abroad.12 After the foundation of the chair in Thomistic philosophy at the Leuven university in 1882 – with Désiré-Joseph Mercier, the later highly influential archbishop, as its first chair holder – Leuven undeniably became one of the world’s leading centers of the efforts to reconcile Catholicism with science 13 Yet, this significant impact of Catholicism on Belgian medicine did not remain uncontested by anticlerical liberal physicians 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 ideologicallymixed state universities with medical faculties in Liège and Ghent where both Catholic and liberal doctors were appointed Despite this ideological division, physicians mostly exchanged medical ideas in a conciliatory spirit Only at specific times of increasing polarization, ideological conflict threatened to complicate medical debate Situated on the intersection of medicine and religion, the case of the post-mortem caesarean section profoundly challenged the culture of compromise in Belgian medicine It exposed the ideological tensions surrounding the constitutional freedom of religion on a very practical level It should be noted that nearly everyone in Catholic countries such as Belgium was baptized, liberal obstetricians included Hardly questioned by anyone, the baptismal rite following 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 about the 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 number of medical intellectuals.14 Still other ideological debates focused on allegedly hygienic measures such as cremation which was not put into practice in nineteenth-century Belgium When it comes to actual practices, ideological division clearly marked internal medico-ethical discussions about physicians’ appropriate surgical intervention to resolve difficult births.15 Unlike the debate on the post-mortem caesarean section, however, none of these mentioned discussions concentrated on the intrusion of priests into what doctors considered the medical domain In this article I will provide a first comprehensive study of the negotiations between Catholic and liberal physicians regarding operations on deceased women for reasons of baptism.16 On the one hand, I will look closely at how they incorporated religious concerns such 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 by Catholics without medical training These research questions will be answered taking into account Catholic doctrine in Belgian medical education, scientific exchange and broader public debate Before analyzing this debate, the first sections will place the post-mortem caesarean in a broader international and Belgian context Subsequently, I will analyze two methods 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 the politicization of the debate at the end of the 1860s By analyzing physicians’ strategies of compromise, I will show why most doctors preferred a scientific settlement over public engagement 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 for religious purposes received a lot of attention from theologians and Catholic leaders The history of this operation, however, goes back to the Middle Ages, the first medical writings mentioning post-mortem caesareans dating from the beginning of the fourteenth century Research has shown that throughout the Middle Ages and the Renaissance midwives and subsequently physicians were required by church authorities to operate on deceased women to ensure the fetus’ salvation Yet, before the eighteenth century when caesareans mainly took 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 (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 2018, 1–20 15 Karel Velle, Begraven of cremeren: de crematiekwestie in België (Ghent: Stichting mens en kultuur, 1992); Jolien Gijbels, “Leve de foetus: liberale en katholieke artsen over de keizersnede in België (1840-1914),” Handelingen der Koninklijke Zuid-Nederlandse Maatschappij voor Taal- en Letterkunde en Geschiedenis 71 (2017): 85–98 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 What distinguishes the eighteenth century from the earlier period is the far-reaching Catholic promotion of the caesarean in the eighteenth century, which was bound up with a changing theological perception of the fetus inside the womb Around 1700 it was commonly held that fetuses were endowed with the immortal soul after forty to eighty days of pregnancy Rooted in the Aristotelian epigenetic theory of generation, most theologians believed 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 of immediate ensoulment at the moment of conception, in this way responding to developing medical ideas regarding reproduction Immediate ensoulment became the consensus view in theological thinking at the end of the nineteenth century 18 In the context of this theological debate 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 postmortem caesarean sections along with baptisms of miscarriages and intrauterine baptisms in Italy 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-Emanuele Cangiamila, played a crucial part in the circulation of these baptism procedures It was first published in 1745 and then approved by the pope in 1756, after which it appeared in many European countries and colonies in translations and abridged forms 20 Simultaneously other influential publications about the importance of the post-mortem caesarean section shaped thinking, 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 even legally imposed on physicians were nationally specific In most Catholic countries including the Italian states and Spain as well as in the Orthodox state of Greece laws emerged that were to a greater or lesser extent inspired by the theological writings of Cangiamila; some laws obliged physicians to perform caesareans on every deceased woman regardless of the viability of the fetus, others prescribed it in advanced stages of pregnancy 22 In the Spanish colonies, both colonial elites and the Spanish Crown promulgated legislation mandating postmortem caesareans on deceased pregnant women to save the spiritual and temporal life of fetuses.23 Conversely, in Protestant territories such as the German states similar laws regarding the duty of doctors existed, but they stemmed from a public health concern and were 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 tended to emphasize the possible dangers of hasty operations for the woman’s life Rather than 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 before proceeding to the operation.24 Belgian and French laws differed from most European and colonial laws in the sense that there existed no legal obligation for physicians to perform the operation Filippini has explained the absence of French legislation by emphasizing the autonomy of the state vis-àvis the Catholic Church and the independent position of physicians 25 In nineteenth-century Belgium, there never was a discussion in medical or political circles regarding the legal obligations of physicians After all, the liberal government tended to keep aloof from medical decision making Despite voices calling for more government regulation, state intervention in medicine expanded slowly throughout the nineteenth century For instance, the first medical advisory board and scientific forum, the Royal Academy of Medicine, was created in 1841 to promote medicine and guide the national government in medical issues 26 Yet, the Belgian Academy had a less centralized character than its French counterpart, on which the institution was modelled The fact was that the foundation of the medical state institution attracted a lot of criticism of Belgian physicians, as many of them preferred voluntary scientific engagement above state-directed scientific study.27 In the second half of the nineteenth century, political and medical support for postmortem caesarean sections had ceased In European countries such as Italy, Spain and Germany where caesarean sections on deceased women were required by law, new legislation was introduced without references to mandatory caesarean sections on deceased women.28 At the same time, physicians increasingly lost faith in the operation Schäfer for instance explained mounting medical criticism by highlighting the rising authority of medical statistics, which provided mostly discouraging data about failing operations Critical medical voices especially raised the limited chances of fetal survival after the woman’s death 29 Catholic doctrine and the post-mortem caesarean in Belgian medicine In Belgium, the medical debate on the post-mortem caesarean section took place against the backdrop 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 time when moderate liberals allied with a new generation of more overtly anticlerical liberals In power between 1857 and 1870, the liberal governments headed by Charles Rogier and Walthère Frère-Orban worked towards the laicization of Belgian society, in this way repeatedly 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 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) 25 tensions 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, the ideological 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 In public hospitals, restrictive rules regarding the presence of religion were introduced, yet such processes of laicization occurred relatively late in Belgium and had less far-reaching consequences for Catholic nursing sisters and chaplains in comparison with other predominantly Catholic countries like France Catholic medicine maintained a strong footing in the existing Belgian medical institutions 33 After all, hostile anticlerical attitudes characterized 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 political Catholicism and liberalism in Belgium, 36 little is known about the different configurations of Catholicism and liberalism within the Belgian medical profession An historiographical emphasis on public health matters contributed to the fact that little attention was drawn to the 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 on Catholic medicine have nourished the idea of an anticlerical medical profession 37 This lack of knowledge about ideological diversity is also due to the fact that doctors were generally not inclined to share their religious views or political ideas about the entanglement of Catholicism and Belgian society in nineteenth-century medical debate Only exceptional cases such as the post-mortem caesarean section forced doctors to take a position regarding religious doctrine As this article will show, a minority of Catholic physicians overtly stated that they based their conduct on official clerical guidelines Probably most Catholic physicians 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 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 (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), 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 (2011): 113–128 36 For instance: Achille Erba, L’esprit laïque 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 (2014): 45–46 31 Liberals too were divided along religious lines Belgian liberal physicians could adopt a moderate, merely anticlerical position regarding the entanglement of Catholicism and Belgian society More radical, free-thinking liberal doctors also contested the supernatural claims 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 the Université Libre de Bruxelles and on positivism in Belgium, the approaches of liberal doctors toward 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 Medical professors attached to the Université Libre de Bruxelles thus did not necessarily distance themselves from religious concepts such as the immortal soul 38 As the case of the post-mortem caesarean shows, Belgian clerical leaders exerted special influence on Catholic medical education in Leuven In 1851, the Archbishop of Mechelen, Engelbert Sterckx, approved of vernacular clerical guidelines about baptism procedures that were targeted at physicians and midwives On the title page Sterckx recommended them to read the treatise, stating therein that they were the result of a collaboration with undefined members of the medical faculty of Leuven Although this was the first publication specifically addressed to medical staff, it built on an existing tradition of baptism instructions in Belgian seminaries since the eighteenth century 39 Physicians and midwives were held responsible for performing caesareans on deceased pregnant women, to conform to their religious duties if the fetus was about to die, and to save the child if it survived the operation.40 Interestingly, the guidelines contained medical ideas to underpin this obligation regarding medical staff They particularly referred to medical debate about the death of fetuses, questioning physiological conclusions of some well-known French obstetric works regarding their limited chance of survival Against the French doctors Alfred Velpeau and Franỗois-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 other contemporary medical authorities and the eighteenth-century work of Cangiamila to prove the opposite These conclusions formed the basis of the clerical obligation to never forego the operation, whether women had been dead for a couple of hours or a couple of days As the souls of even the smallest specimen awaited salvation, medical staff were instructed to operate on deceased women that had been pregnant for forty days and even advised to so at a term of about twenty days.41 Considering the limited number of sources concerning actual medical practices, it is difficult 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 obstetric professors of the University of Leuven appealed to it A comparison between the obstetric handbooks of Leuven, Brussels, Ghent and Liège in the second half of the nineteenth century shows that only Leuven medical students were explicitly reminded of their Catholic duty and instructed 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, l’usage des accoucheurs et des sagesfemmes (Mechelen: P J Hanicq, 1851), 10 41 Ibid., 11–12 baptized Conversely, students at the other faculties were only advised to perform caesareans to save the lives of viable fetuses 42 Preserved reports about post-mortem operations in the Brussels hospitals show that doctors intervened if they expected to find a living child of at least six or seven months Rarely did such operations produce children who lived longer than a few moments From the eighteen documented post-mortem caesareans performed between 1845 and 1889 found in the hospital records of Brussels, there is only evidence of one successful caesarean, in 1884 43 Despite poor results, nineteenth-century medical 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 pregnant woman and fetus in cases of difficult births – were known to have mortal consequences for most women.44 Medical practice in the public hospitals of Brussels clearly shows the limits of Catholic influence As Valérie Leclercq recently argued, Catholicism was indirectly yet efficiently organized through the daily interactions of Catholic nursing sisters and hospital chaplains with 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 public hospitals in Brussels in 1850 He complained about diverse “obstacles” preventing the chaplains from exercising their religious duties, such as administering sacraments and approaching patients In the letter he also addressed the fact that doctors only performed caesareans in instances of viable fetuses: “Physicians and surgeons refuse to perform an operation if the child is not viable or if it did not reach the term of seven months This is a severe abuse that caused a lot of pain considering the great number of children who have not been baptized and therefore deprived of heavenly bliss.” 46 After inquiry the board answered that caesarean operations on deceased women had always occurred in appropriate circumstances The response was supposed to maintain good relations with the Church, yet it was clearly stated that the hospitals were not religious institutions, but places for medical care Hospital chaplains were not allowed to forcibly impose their rites on patients, 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 l’université catholique de Louvain (Peeters, 1869), 126–27; 698; Adolphe C F Wasseige, Des opérations obstétricales: Cours professé 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 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, 18001900,” Bull Hist Med 76, no (2002): 461–94; Jacqueline H Wolf, “Risk and Reputation: Obstetricians, Cesareans, and Consent,” J Hist Med Allied Sci 73, no (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 From a legal perspective, the clerical guidelines regarding the post-mortem caesarean were confusing Catholic doctrine imposed it on midwives, while they were generally not allowed to perform operations Midwives faced the threat of being prosecuted for the illegal practice of medicine if they used specialized equipment such as a forceps When confronted with 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 on deceased 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 in question turned out to be alive at the moment of the operation because of a faulty death declaration, they could be accused of the illegal practice of medicine The confusing instructions about how to act in this matter in obstetrical handbooks for midwifes attest to this 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 children after a caesarean was not an issue of concern Whether a physician followed Catholic doctrine 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 clerical guidelines of 1851 the Catholic Church demanded an act of Catholic charity from everyone present at the deathbed in the absence of medical staff 50 Both before and after this publication Catholic doctrine inspired several priests to perform a post-mortem caesarean or incite midwives and others to so In the second half of the nineteenth century, a small number of incidents would gain a lot of public visibility Physicians considered these operations by Catholics without medical expertise as highly problematic with the specter of apparent death The development of medical ideas about death as a process rather than an instant in the eighteenth century made physicians believe that persons often looked dead but could suddenly awaken Putrefaction was thought to be the only reliable sign of death In medical historiography, this transnational debate about apparent death has been researched with particular attention to medical and popular anxiety regarding premature burials.51 With respect to post-mortem operations, physicians advocated their expert role in determining whether someone had really died The risks for women and the lack of medical expertise of priests were the objects of heavy discussion 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 (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 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 (1995): 27–47; George K Behlmer, "Grave Doubts: Victorian Medicine, Moral Panic, and the Signs of Death," J Brit Stud 42, no (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) 10 absolutely necessary that priests be educated in specific medical domains during their time at seminary In this way they could evaluate the death of a person and think of possible alternatives to the caesarean section such as a baptism through the vagina in cases in which the fetus had almost reached the end of the birth canal Nevertheless, Thirion was far from asserting that this selection of medical courses would enable priests to perform caesareans Rather, they would realize that it was “absurd, inhuman and criminal” to handle the knife themselves.52 Thirion was also the instigator of the first thorough medical discussion on the postmortem caesarean in Belgium At the end of December 1843 he launched the debate with a proposition – the manuscript was published afterwards – regarding an improved model for in utero baptisms.53 By asking the prestigious and ideologically-mixed Belgian Academy of Medicine, consisting of both liberal and Catholic doctors, to formulate a conclusion with respect to the medical suitability of this new instrument, Thirion tried to gain broad medical support for an alternative method of baptism Thirion’s instrument built on similar models that were used from the eighteenth century onwards to baptize the unborn by injecting water through a syringe in the birth canal Contrary to these existing tubes, his model was supposed to be able to lead water to the fetus’ body regardless of the term of pregnancy In this way, Thirion argued, in utero baptisms had to replace operations for religious purposes that could lead to the woman’s death His publication was in other words an attempt to abolish caesareans by Catholics without medical expertise by providing a medical solution for the theological problem of a valid baptism The words on the title page of the publication clearly express his conciliatory approach: “It is always good to reconcile medical science with the commandments of religion and the needs within society.”54 The same spirit marked the discussion in the Academy, yet it took the members eighteen months to reach consensus and adopt the proposition of Thirion, with minor changes One of the main issues preventing agreement was the question whether the proposition, which was bound up with the theological preoccupation of baptism, was to be judged by a scientific medical board According to the anticlerical physician Louis-Joseph Varlez, it made no sense from a medical point of view, since in utero baptisms were not aimed at prolonging or saving the lives of woman and fetus 55 Controversial in this respect was the part of Thirion’s tract where he raised the theological concern and anatomical question whether the membranes surrounding the unborn should be considered as part of the body of the woman or of the fetus In the first case theologians could not consider the baptism as valid since the baptismal water was unable to reach the fetus 56 Questions such as these not only confronted doctors with the limits of medical knowledge on the beginnings of human life, but also with the hierarchical relation between medicine and religion Religious considerations could be integrated in medical debate, as long as they were in line with physicians’ professional missions and codes For the sake of humanity most of the members of the Academy were willing to regard the proposition as a scientific physiological question, and to focus on the safety of the application of the instrument inside the woman’s body In this way, they could prevent persons without medical training from performing medical operations Conversely, unlike Thirion, most physicians 52 Eugène Thirion, “Opération césarienne, faite par un curé,” Annales Médico-légales Belges (1843): 98–100 Eugène Thirion, Du baptême intra-utérin sans opération césarienne préalable, mémoire destiné au clergé (Namur: Douxfils, 1846) 54 Ibid 55 Bulletin de l’Académie Royale de Médecine de Belgique (1845): 481–83 56 Thirion, Du baptême intra-utérin (n 53), 23–25 53 11 present abstained from providing medical solutions for theological problems That is why they considered it not their task to medically prove whether a baptism was valid 57 Physicians at both ends of the ideological spectrum took the most outspoken positions On the one hand, the overtly liberal Varlez ridiculed the debate because he did not consider the Academy competent to answer questions of theological nature, while on the other hand, the Leuven medical professor Martin Martens declared himself in favor of priests performing operations According to him, in the absence of physicians, priests should be allowed to perform post-mortem caesareans He primarily argued that they could save lives in their attempts to baptize fetuses To the astonishment of his fellow members, he even asserted that priests were used to see people dying, which made them capable of judging the signs of “normal” deaths Martens was the only Catholic doctor present who, at least to a certain extent, ascribed medical expertise to priests 58 While Martens remained convinced of the benefits of exceptional interventions by priests throughout the discussion, and even remarked that in utero baptisms were not always valid, he was also pragmatic He had no objections in principle to a favorable conclusion regarding the use of the syringe 59 In the end, the scientification of the problem proved a successful strategy for reaching agreement By approving Thirion’s instrument on scientific grounds on June 1845, the physicians present believed they could prevent bloody operations on (apparently) dead women by unqualified men They adopted Thirion’s proposal, concluding that people with “a trained hand”, including priests, were allowed to handle the syringe to baptize the unborn in the womb.60 In medical settings intrauterine baptism became a standard procedure in Belgium every time a fetus was in danger At the Catholic University of Leuven, the intrauterine baptism was part of the baptism procedures taught during the obstetric courses of professor Louis Hubert For the Catholic professor, it was self-evident that doctors and midwifes saved the souls of fetuses.61 Yet, there exists considerable evidence that the in utero baptism can be considered a medico-religious procedure that crossed ideological boundaries throughout the nineteenth century In the widely read liberal Journal de Médecine, de Chirurgie et de Pharmacologie, Thirion’s device was embraced as a satisfactory “scientific solution”.62 In the following decades medical articles and meeting reports in the same journal occasionally mention the practice of procuring in utero baptisms in passing.63 Historical evidence further shows that emergency baptisms – the administration of baptism by a doctor, midwife or family member, during or immediately after birth, when newborns faced the risk of dying before being baptized by a priest – were commonplace in maternity departments of Belgian hospitals such as those in Liège and Brussels in the second half of the nineteenth century Whether baptism was administered depended on the religion of the mother Often in utero baptisms happened when obstructed labor prevented the passage of a full-term fetus through the birth canal Confronted with such occasions, physicians mostly baptized the fetus in utero before turning to surgical operations with an uncertain outcome.64 Interesting in this respect is the fact that in utero baptisms did not 57 Bulletin de l’Académie (n 55), 488–450 Ibid., 485 59 Ibid., 502 60 Ibid., 517 61 Bulletin de l’Académie Royale de Médecine de Belgique, 3e série (1867): 626 62 Journal de Médecine, de Chirurgie et de Pharmacologie (1846): 286 63 Journal de Médecine, de Chirurgie et de Pharmacologie 38 (1864): 603, 605 ; Journal de Médecine, de Chirurgie et de Pharmacologie 82 (1886): 343 64 In the maternity departments of Brussels and Liège intrauterine baptisms were common practice: Dossier concernant la question de la suppression de frais du culte l’hospice de la maternité, 35, Affaires générales, 58 12 become contested in the context of increasing ideological tensions surrounding post-mortem caesareans around 1869 Political figures such as the medical professor and liberal Senator Arsène Pigeolet for instance saw no harm in emergency baptisms In an article about artificial delivery after the woman’s death, he mentioned the in utero baptism as part of the doctor’s code of conduct in the case the woman was dying or had already died.65 Unlike doctors, however, theologians and Belgian religious leaders alike never fully approved of baptisms in the uterus Theological uncertainty about whether the water could reach the fetus’ head made this type of baptism only suitable as a first conditional ritual in cases when a fetus was in mortal danger If possible, baptism had to be repeated after delivery In other words, clerical leaders and theologians still demanded a post-mortem caesarean to ensure a valid baptism In this respect, the Belgian clergy was mainly influenced by the French priest and physician Pierre Jean Corneille Debreyne whose theological work was reprinted in Brussels under the auspices of the Archbishop of Mechelen In his essay Debreyne clearly stated that baptisms in the uterus did not exempt Catholics from reiterating baptism after birth According to him, it was necessary to perform a post-mortem caesarean section for reasons of baptism on every deceased pregnant woman regardless of the term of pregnancy.66 In practice, however, the clergy struggled with the assessment of a valid baptism considering its connection with the burial question In Belgium as in other Catholic regions religious families attached high importance to a Catholic burial, but children could only be buried in holy ground if they had been baptized before death Otherwise they ended up in the dishonorable separate corner of the cemetery 67 The Belgian Nouvelle Revue Théologique, which provided interpretations of Catholic doctrine and answers to questions for priests, advised Catholic burials after doubtful emergency baptisms.68 In cases of postmortem caesareans the problem of unbaptized stillborns could be solved by burying mother and child together, though there was no theological consensus on this issue In 1849, the editors of the predecessor of that theological journal stated that there was no profanation of the cemetery in the case of unbaptized lifeless children that had been extracted by means of a caesarean They recommended putting the child back in the mother’s belly and burying mother and child in holy ground.69 The politicization of the post-mortem caesarean section (1867-1870) Throughout the nineteenth century theological concerns regarding valid baptisms and medical ideas about apparent death and the intrauterine life of fetuses continued to be discussed in theological and medical circles While this circulation of ideas was transnational, actual moments of ideological conflict depended on context-specific factors such as national ASSB; “Maternité de Liège: Opération césarienne post mortem.”, Journal d’accouchements: Écho de la Maternité de Liège (1884) : 285-6 65 Journal de Médecine, de Chirurgie et de Pharmacologie 49 (1869): 458–59 66 Pierre J C Debreyne, Essai sur la théologie morale considérée dans ses rapports avec la physiologie et la médecine: Ouvrage spécialement destiné au clergé (Brussels: Vanderborght, 1843), 245-248; 258-259 67 On emergency baptisms: Vincent Gourdon, Céline Georges, and Nicolas Labéjof, “L’ondoiement en paroisse Paris au XIXe siècle,” Histoire urbaine, no 10 (2004): 141–79; Vincent Gourdon and Catherine Rollet, “Stillbirths in Nineteenth-Century Paris: Social, Legal and Medical Implications of a Statistical Category,” Population 64, no (2009): 601–34 68 “Consultation II”, Nouvelle Revue Théologique ou série d’articles et de consultations sur le droit canon, la liturgie, la théologie morale, etc (1872): 311-313 69 “Examen de quelques thèses théologiques”, Mélanges théologiques ou série d’articles sur les questions les plus intéressantes de la théologie morale et du droit canon (1848-1849): 599-603 13 politics and existing legislation In France, for instance, the post-mortem caesarean stirred up emotions in a medical debate regarding the responsibility of doctors to carry them out in 1860 As the debate progressed, operations by unexperienced persons for religious purposes also entered the discussion in 1861.70 In Belgium, the first question never was the subject of medical debate On the whole, Belgian physicians agreed that they were supposed to perform caesareans or post-mortem deliveries if they believed they could extract a viable fetus out of a dead woman The idea that it was cruel for the relatives of the woman to refrain from liberating the fetus informed medical practices 71 The second question, regarding post-mortem caesareans by Catholics without medical experience, however great of a concern for Belgian liberal physicians, did not provoke conflict before the end of the 1860s In 1866, for instance, the provincial medical commission of Hainout was consulted to advise the public prosecutor of Charleroi about the dangers of operations by priests and possible solutions After consideration the commission indicated that a death declaration by a qualified medical practitioner was necessary before the performance of a post-mortem operation for reasons of baptism 72 In 1868 by contrast, the same question suddenly became subject to unprecedented ideological controversy following a much debated post-mortem caesarean that was already mentioned at the start of this article The caesarean had happened in 1867 in the locality of Aertrycke, where the midwife Mme Vandenbussche was persuaded by a local priest to make a double incision with a pocket knife in the belly of a deceased pregnant woman Without extracting the fetus and determining if it was viable, the priest had administered baptism after which the midwife had sutured the belly When brought to the Court of Appeal of Ghent, the plaintiff underlined the “atrocious” circumstances of the caesarean and the fact that the operation had occurred without a declaration of death beforehand The midwife was found guilty of violating the grave of the deceased woman and the priest of complicity 73 Yet, the final decision of the Court of Cassation dismissed those arguments According to the advocate general, the law on the violation of graves could only be applied to graves, not to unburied corpses 74 He further declared that legal decisions in the past had shown that there existed no legal framework to prosecute the performers of post-mortem caesareans The only other court case (from 1847), he argued, had shown that legal experts could not appeal to the laws on premature burials and on the illegal practice of medicine The first law only verified if the burial had taken place after twenty-four hours of death, according to the law The law regarding the illegal practice of medicine applied to operations on living persons Infractions on corpses appeared to be unpunishable by law because of a gap in Belgian legislation According to the advocate general it was up to the government to create a law protecting corpses.75 More than the caesarean itself, it was this last conclusion that received attention in newspaper articles and legal fora Public debate was also fueled by a few other incidents that happened shortly after the caesarean of 1867 and where a local priest had performed a post70 Fredj, “Concilier le religieux et le médical” (n 10) Bulletin de l’Académie (n 55), 515–16 72 Rapports des commissions médicales provinciales sur leurs travaux pendant l’année 1866 (Brussels: Hayez, 1866), 194–95 73 “Cour d’appel de Gand Opération césarienne Violation de sépulture Liberté des cultes”, La Belgique Judiciaire 26 (1868): 152-4 74 The law on the violation of graves punished everybody who was guilty of violating the tomb or who treated the human remains disrespectfully during and after the burial (article 453 of the penal code of 1867) 75 “Cour de cassation de Belgique Sépulture Violation Opération césarienne Art de guérir”, La Belgique Judiciaire 26 (1868): 1457-68 71 14 mortem caesarean, or had someone else perform one In a series of articles that appeared in La Belgique Judiciaire powerful emotionally loaded metaphors – virgins being cut open or the covering up of crimes such as rape by means of post-mortem caesareans – were evoked to emphasize the atrocious fate of women’s corpses In this context, the advocate general’s call for a law punishing the violation of dead bodies was brought to Parliament 76 On December 8, 1868 the liberal anticlerical doctor Jean-Franỗois Vleminckx pleaded in the legislature for a new law ensuring respect for dead bodies and the safety of human life 77 With great anger, he ridiculed the clerical instructions of Archbishop Sterckx He particularly emphasized the absurdity of sacrificing the corpses of women in favor of embryos after 40 days of pregnancy: “40 days, that is disconcerting! There is no physician in the world that can confirm a pregnancy on day 40, and one is not anxious to recommend opening up a girl, a woman, a mother who might not only be alive, but who might even not be pregnant And why? With the sole goal to baptize embryological rudiments?” Once again Vleminckx raised the question why clergy did not abandon post-mortem caesareans for religious purposes and turn to in utero baptisms instead Yet, in contrast to the preceding discussion in the academy, his discourse left no place for reconciliation According to the liberal doctor, the stubbornness of clerical leaders in supporting caesareans after death made a law necessary 78 The bodily integrity of the dead – often an argument in physicians’ discourses – could be used against physicians as well Catholic parliamentarians such as Barthélemy Dumortier, who defended the interests of clerical leaders, altered Vleminckx’ argument by presenting medical post-mortem examinations as an assault on the human body: “Does he [Vleminckx] with ‘violation of cadavers’ also refer to the dissection of men and women in anatomical theaters? To accuse a poor priest, a poor acolyte, who has helped to extract a child from the mother’s belly, while you protect the actions of immature medical students [carabins] who dissect corpses?”79 Dumortier’s contribution to the parliamentary debate shows that the fate of corpses became a strong metaphorical weapon in the ideological debate between liberals and Catholics Rather than being a straightforward concern of Catholics, they tended to bring it up during moments of ideological conflict For instance, recent research on Belgian anatomy in the nineteenth century has shown that the destructive nature of dissections was mainly contested by Catholics whenever liberals questioned Church rituals such as Catholic burial.80 At the start of 1869, the liberal Minister of Justice Jules Bara announced the submission of a bill in Parliament Physicians were placed in a rather difficult position On the one hand, they were in favor of legislation sentencing unexperienced persons who operated on deceased women On the other hand, there was the specter of a law that applied to the rather broad category of assaults on dead bodies If such a law were passed, autopsies and 76 “Variétés De l’opération césarienne”, La Belgique Judiciaire 26 (1868): 1229-1232; Eugène Defacqz, “De l’opération césarienne”, La Belgique Judiciaire 26 (1868): 1313-6; “De l’opération césarienne pratiquée par les prêtres”, La Belgique Judiciaire 26 (1868): 1273-6; Théophile Bormans, “De la violation des cadavres: étude sur la nécessité d’une réforme de la loi pénale avec un projet”, La Belgique Judiciaire 28 (1870): 481-6 77 Nevertheless, his participation in the contentious medico-ethical debate about medical abortion in 1851-1852 makes clear that Vleminckx did consider himself a Christian: Gijbels, “Leve de foetus” (n 15), 91 78 Belgian chamber of representatives, Proceeding of the plenary session, December 8, 1868 Available at: http://www.dekamer.be/kvvcr/showpage.cfm? section=/cricra&language=nl&cfm=/site/wwwcfm/cricra/cricragen.cfm?sess=1868690&type=plen 79 Ibid 80 Tinne Claes, “Nobody’s Dead: The Trajectories of the Corpse in Belgian Anatomy, ca 1860-1914” (Ph.D diss., KU Leuven, 2017), 88–91 15 dissections by physicians would also be restricted by law 81 Such a nightmare scenario of government interference was fueled by the contributions of some liberal legal experts to the debate In the juridical journal La Belgique Judiciaire, the liberal jurist Théophile Bormans presented a reform plan to safeguard the bodily integrity of dead bodies His arguments showed strong similarities with those of physicians like Vleminckx, but also contained unfavorable conclusions for physicians To cope with “fanatic” doctors who operated on dead women for reasons of baptism, Bormans suggested only allowing doctors to start performing post-mortem caesareans no sooner than 24 hours after the death of a woman In exceptional cases, one could proceed to the operation before that time, when there were important medical reasons to so and when at least two doctors agreed upon an intervention 82 Responses of Catholic and liberal doctors The aversion of doctors to government interference probably prevented liberal doctors from aligning with a broader liberal group of politicians and legal experts In important medical societies Belgian doctors remained silent on the legal question, as seen for instance in the meeting reports and articles of the ideologically-mixed Academy of Medicine and the liberal Society of Medical and Natural Sciences of Brussels Instead, in 1869 and 1870 there was an extensive medical debate on artificial delivery – the use of manipulative and surgical methods to dilate the cervix and extract the fetus – after the woman’s death as a medical alternative to the post-mortem caesarean section Following Italian propositions to abandon the post-mortem caesarean in favor of artificial delivery in case of deceased and dying women, Belgian, French and Italian doctors exchanged ideas about the benefits and disadvantages of both practices in the liberal Journal de Médecine, de Chirurgie et de Pharmacologie Overall, most doctors in this debate concluded that each doctor could decide for himself which procedure was to be preferred according to the circumstances A prominent position was taken by the Université Libre de Bruxelles medical professor and future liberal senator Pigeolet who argued against absolute principles regulating the medical practice Like other Brussels university professors he adhered to the ideal of individual liberty and medical self-regulation.83 By analogy with the medical discussion on intrauterine baptism it seems that physicians preferred to treat the post-mortem caesarean and its medical alternatives as a purely scientific question This time, the scientification of the debate made it possible to avoid politically charged statements regarding operations by unqualified Catholics The postmortem caesarean for reasons of baptism was only raised once in the liberal Journal de Médecine, de Chirurgie et de Pharmacologie In one article, the French doctor Joseph Putegnat criticized the clerical guidelines of Archbishop Sterckx regarding priests’ religious duty to carry out post-mortem caesareans.84 Belgian doctors by contrast did not touch upon the question As cultural historian Joris Vandendriessche has argued with respect to the issue of cremation, the scientification of delicate medical topics provided a solution for liberal members of academic medical societies who did not want to engage in a broader public 81 This article by an anonymous physician raises doctors’ fears of government intervention and states that physicians have to guard against laws damaging physician’s interests: “De l’opération césarienne pratiquée par les prêtres” (n 76) 82 Bormans, “De la violation des cadavres” (n 73), 485-6 83 Journal de médecine, de chirurgie et de pharmacologie 50 (1870): 292; Vandendriessche, Medical Societies and Scientific Culture (n 27), 191–93 84 Journal de Médecine, de Chirurgie et de Pharmacologie (n 83), 1870, 108 16 debate between liberal and Catholic parties Most doctors favored a debate on an exclusively scientific level and adopted a skeptical attitude toward public engagement 85 Not surprisingly, the responses of clerical leaders and Catholic doctors to a possible law were straightforward The then-archbishop of Mechelen Victor Auguste Dechamps addressed an open letter to Minister Bara, explaining the crucial importance of the salvation of each soul in the eyes of the Catholic Church He once again argued that clergymen only had to perform caesareans on deceased women in the absence of medical staff 86 More remarkable was the publication of an article of the Leuven physician and later professor Eugène Hubert in the Revue Catholique, a journal run by professors of the Catholic University of Leuven Together with his father Louis Hubert, he gave classes in obstetrics from 1869, and in the long term he would succeed him as professor in obstetrics and as a prominent medical spokesperson on medico-ethical questions such as abortion In his article, Hubert made a case against a law that would force religious persons and priests to choose between a prison sentence and their religious duty to secure the spiritual salvation of the unborn More than ever before in this debate a Catholic doctor introduced a conflict model in which he emphasized the dichotomy between so-called materialists who only intervened in case of viable fetuses of at least seven months’ gestation, and Catholics who also performed operations to baptize unviable fetuses.87 By arguing in favor of priests who fulfilled their Catholic duty in the absence of medical staff, Hubert defined medical expertise in a rather broad way by constantly referring to the shared competences of doctors and priests He asserted for instance that medical guidelines provided in seminary and in theological books enabled priests, who were after all scholarly and intelligent men, to at least recognize the likely signs of death Apart from their education, he asserted that priests were familiar with dying people, even more so than doctors: “Their place is at the deathbed of dying people and they are still there when the doctor, considering further care redundant, pulls back to concentrate on other preoccupations.”88 Hubert even went as far as comparing the skills of physicians and priests He stressed for instance that isolated incidents where clerical mistakes might have caused the actual death of a woman did not justify a general prohibition According to him, it also happened that physicians made mistakes during surgical operations Elsewhere in his text, he compared the level of medical knowledge of priests with that of medical students who had just begun their medical education Whereas medical students at that stage had no more experience with assessing the signs of death than priests, the existing laws authorized them to participate in dissections In the end, there never was a bill brought to a vote in Parliament Most likely, liberals such as Bara and Vleminckx did not find enough support among politicians in a tense ideological climate where Catholics successfully united their forces against a possible law With the electoral defeat of the liberal party and a Catholic Minister of Justice succeeding Bara in 1870 it seems there was no politician willing to take on a leading role in promoting such a bill Furthermore, after 1870 the matter faded into the background during a period with fewer instances of caesareans reported The loosening of ideological tensions was for instance visible in a second article from Hubert in 1878 that was published as a response to a 85 Vandendriessche, Medical Societies and Scientific Culture (n 27), 191 The letter was published in several Belgian journals and newspapers, among others: “Variétés”, La Belgique Judiciaire 27 (1869): 462-3; “Lettre de S G Mgr l’Archevêque de Malines”, Le Bien Public (12-03-1869): 87 Eugène Hubert, “Quelques mots sur l’opération pratiquée post mortem”, Revue Catholique (1869): 280-90 88 Ibid., 289 86 17 French medical article with what he called “priestophobic language” 89 Appointed professor since 1874, he had not changed his mind on the right of priests to perform operations on dead women Yet, both the tone of his discourse and his argumentation differed from his previous article Rather than referring to the shared qualities of doctors and priests, he focused on the effect of caesareans Like Martens had argued earlier, he pragmatically emphasized that priests saved lives in their attempts to baptize the unborn In 1899 the Holy See provided a final answer to the question whether clergymen had to perform caesareans on deceased women in the absence of doctors The new ecclesiastical rule was especially targeted at missionaries in the Chinese province of Sichuan who apparently faced problems in convincing the local population of the value of the postmortem caesarean section It once again emphasized the call of Christian charity to extract the unborn from the woman’s belly Clergy were supposed to everything within their reach to encourage physicians to perform the operation However, the Holy See warned them against and explicitly forbade them from interfering in the actual operation, let alone doing it themselves.90 Nevertheless, it remains unclear how this rule affected the disappearance of the post-mortem caesarean section in most Catholic countries In Spain, for instance, the church and Catholic physicians still recommended the operation until the middle of the twentieth century.91 The Belgian case equally shows that Catholics did not necessarily take the prohibition of the Holy Office too literally In Nouvelle Revue Théologique, priests were told that although they were not particularly obliged to perform a post-mortem caesarean in the absence of physicians, the urgent spiritual situation of the fetus still demanded their intervention 92 The same ambiguity was present in clerical instructions of 1902 regarding baptism that referred to the holy decree On the one hand, priests who had done everything possible to persuade doctors of a post-mortem caesarean could not be accused of anything, on the other hand, they could not be criticized either after having performed an operation themselves.93 At any rate, it seems that in practice post-mortem caesareans by unexperienced persons disappeared in the twentieth century Considering the lack of medical and theological discussions on this subject it is difficult to know how this practice survived A lucky finding in the archiepiscopal archive is one of the only preserved sources that testifies to an actual operation in the 1900s, although it is unclear who had handled the knife In a letter, the cousin of the secretary of the Archbishop of Mechelen informed him of lots of things and casually mentioned a post-mortem caesarean that had happened for reasons of baptism.94 In the eyes of Catholic medical staff, the post-mortem caesarean continued to be seen as a necessary means to baptize the fetus in the first decades of the twentieth century In 1903 the free-thinking doctor and representative Modeste Terwagne indignantly recalled a memory in Parliament that went back to his time as an intern in the Saint Elisabeth hospital in Antwerp in the 1880s There, a Catholic nursing sister had – probably in vain – asked him 89 Eugène Hubert, “Autopsie et baptême”, Journal des Sciences Médicales de Louvain (1878): 329-333 The text was discussed in the Belgian theological journal Nouvelle Revue Theologique: “Etendue de l’obligation de pratiquer la section césarienne après la mort de la mère”, Nouvelle Revue Theologique 32 (1900): 544-551 91 Rigau-Pérez, “Surgery at the Service of Theology,” (n 8), 401 92 “Etendue de l’obligation” (n 87), 548-551 93 Tractatus de sacramentis in genere et de sacramentis baptismi et confirmationis in specie, ad usum alumnorum seminarii archiepiscopalis mechliniensis (Mechelen: H Dessain, 1902): 169-171 94 M De Coninck to secretary of the Archbishop Paul Vrancken, September 9, [1908], Archive of Paul Vrancken, Archiepiscopal Archives Mechelen 90 18 to execute a post-mortem caesarean to baptize a fetus of about five months of gestation when the pregnant woman was dying In response to this story, the Catholic doctor and representative Victor Delporte stated that, the case being, as a doctor he would first try to save the woman and, immediately after her death, he would fulfill his Christian duty by performing an operation to save the fetus’ soul 95 In the interwar years as well, this Catholic doctrine regarding post-mortem caesareans survived in instructions targeted at Catholic doctors One of the first articles on emergency baptisms in the Bulletin de la Société Médicale Belge de Saint-Luc, the journal of the first lasting Catholic medical society in Belgium, mentioned the post-mortem caesarean as a way to both baptize and save the unborn.96 Although never frequent, the post-mortem caesarean for medical reasons became an obsolete medical operation in the beginning of the twentieth century Improvements to the caesarean section on living women, until the turn of the twentieth century a rather unusual operation in medicine because of its mortal consequences for women, made the operation more acceptable in the eyes of physicians Following medical success stories about women surviving the operation if carried out in favorable conditions, physicians were encouraged to improve the caesarean section from the end of the nineteenth century onwards Other factors in the disappearance of post-mortem operations were depressing statistical data about failed operations and rising physiological knowledge about fetal death 97 After 1900 physicians did gradually abandon caesareans on deceased women They still appealed to it in cases of emergency, yet they did not harbor illusions about its outcome 98 Conclusion The negotiations about the post-mortem caesarean by Catholics without medical training in Belgium show that most Catholic and liberal doctors integrated religious concerns in medical debate As long as the Catholic Church did not intrude into what they considered the medical domain, Belgian physicians were prepared to compromise A case like this provides a new promising avenue for historical research on ideological diversity in medicine, because it touches on day-to-day concerns of physicians present at birth Lengthy intellectual discussions in the nineteenth century on questions concerning mystic phenomena have perhaps concealed more common practices such as emergency baptism The salvation of the soul of fetuses and newborns interested every doctor and priest, as nearly everyone was baptized in Catholic territories and relatives attached a great deal of importance to the Catholic burial of their deceased children Since liberal and Catholic doctors in Belgium did not question the baptismal rite as such, they seem to have taken the performing of in utero baptisms as a matter of course and allowed priests to perform them as well Not coincidentally they adopted a flexible attitude toward religion in a time when physicians were divided over the nature of the physiological bonds between the fetus and the pregnant woman, and the length of time a fetus could survive after the woman’s death 95 Belgian chamber of representatives, Proceeding of the plenary session, March 31, 1903 Available at: http://www.dekamer.be/kvvcr/showpage.cfm? section=/cricra&language=nl&cfm=/site/wwwcfm/cricra/cricragen.cfm?sess=1902030&type=plen 96 R Vermeulen and Dr Schoofs, “Le baptême d’urgence”, Bulletin de la Société Médicale Belge de Saint-Luc (1923), 39 97 Schäfer, “Medical Practice and the Law” (n 9) 98 Not a single successful operation was carried out in the maternity department of Liège: Nicolas Charles, Cours d’accouchements donné la Maternité de Liège (Paris: Baillière, 1903), 567 19 For some Catholic obstetricians it was a more difficult task to navigate between their religious doctrine and medical responsibilities In contrast to anticlerical liberal and freethinking liberal doctors who could easily distinguish the medical incompetence of priests from the surgical expertise of physicians, the Leuven medical professors used professionally accepted reasoning to tolerate post-mortem caesarean sections by Catholics By stating that priests saved lives in their attempt to baptize fetuses, they for instance justified clerical operations without claiming that priests had medical expertise Only in times of politicized debate and ideological conflict at the end of the 1860s, did Catholic physicians such as Hubert have to choose between their medical responsibilities and religious beliefs In his defense of the Catholic position he defined medical expertise in a rather broad way by pointing out the capabilities of priests to perform post-mortem caesareans The arguments of Belgian doctors also offer insights into the strategies of physicians to compromise in ideologically diverse settings A first method in the Belgian debate of the post-mortem caesarean section was to turn the issue into a matter of science in exclusively medical fora such as medical societies and journals A scientific quest for a medical solution fitted in with the professional ambitions of physicians regardless of their religious beliefs In the discussion in the Academy of Medicine in 1844-5, theological reasoning regarding valid baptism was deliberately excluded, yet physicians agreed to approve intrauterine baptism on physiological grounds A second, less successful way to reach agreement was to work towards a law on post-mortem caesarean sections in Parliament In theory a place where political solutions can be reached, the atmosphere of ideological conflict at the end of the 1860s clearly shows the limits of medical compromise Not only did the emotionally charged language and the polarization of Catholic and liberal positions hinder compromise, most physicians seemed unwilling to pursue a political solution In the light of ideological conflict, scientificizing contentious questions appears to be a rewarding strategy to deal with politicized debate in medical settings This type of medical discourse compels historians to identify larger patterns of negotiation in ideological medical debate To understand how religion was dealt with, there lies a research agenda in comparing rhetorical differences and similarities in a broader sample of context-specific ideological discussions concerning diverse issues Comparative research can reveal to what extent negotiations were driven by traditions of medical debate, ideological boundaries and political power relations In a liberal country as Belgium with an influential Catholic Church and a strong tradition of negotiation, it was clear that most physicians preferred balanced academic debate over conflict and medical self-regulation over government interference Author acknowledgements: This article is part of the project IMPRESS “Beyond ideological conflict: religion and freethought in the Belgian medical press, 1840-1914”, supported by the Belgian Science Policy Office (Belspo) I would like to thank Kaat Wils, Joris Vandendriessche, Michèle Goyens, Henk de Smaele, Hervé Guillemain, the members of the Cultural History since 1750 Research Group and IMPRESS project, as well as the editors and reviewers of the Bulletin of the History of Medicine, for their valuable comments on earlier versions of this article I am also grateful to Christophe Geudens for his help in translating Ecclesiastical Latin Short biographical note: Jolien Gijbels is a doctoral researcher attached to the Cultural History since 1750 Research Group at the University of Leuven (Belgium) She investigates the religious beliefs and ideological convictions of Belgian physicians in the nineteenth 20 century Her research interests are in the history of gynecology and obstetrics, mental health and medical ethics 21 ... back in the mother’s belly and burying mother and child in holy ground.69 The politicization of the post-mortem caesarean section (1867-1870) Throughout the nineteenth century theological concerns. .. dilate the cervix and extract the fetus – after the woman’s death as a medical alternative to the post-mortem caesarean section Following Italian propositions to abandon the post-mortem caesarean. .. survival after the woman’s death 29 Catholic doctrine and the post-mortem caesarean in Belgian medicine In Belgium, the medical debate on the post-mortem caesarean section took place against the backdrop