On April 13, 1804, Charles IV issued a royal cedula (admonition with the force of law) ordering the civil and religious officials in Spanish America and the Philippines to ensure that no pregnant woman was buried unless a postmortem cesarean section was carried out. The order was meant to assure that living fetuses received baptism (which the Roman Catholic church considered an indispensable requirement for salvation) and to save them from being buried inside their mothers.1 At the time, European monarchs generally were concerned with expanding the population. But this was also a period in which professional roles had a different definition than we now assign to them. If a surgeon were not quickly available, the operation was to be performed by anyone, following the instructions in the cedula (written by professors of the College of Surgery in Madrid). The overlap in medical and religious expertise was such that midwives and physicians could be trusted to give the correct instructions for baptism, and monks could be renowned for their ideas about physiology. The text provides significant insights into the tensions between the administrative, scientific, and religious spheres of the ancien régime Spanish dominions. It allows us to examine the route through which a request by a priest from Bogotá became law for the entire empire.
Because the cedula had to include the instructions for an operation, lawmakers requested them from the most authoritative body of academic surgeons in Spain. A response could not be denied, but it was dilatory, hesitant, and contradictory. The cedula was broadly promulgated by bishops and governors and passed on to parish priests. At the local level, at least in Puerto Rico, the cesarean operation was performed where a parish priest was interested, a surgeon was available, and law enforcement authorities were not distant. In those situations, the cedula was superfluous; it had been expected to remedy the absence of those officials. The collaboration between surgeon and priest at the deceased woman’s bedside suggests that the application of the surgical instruction may have provided an additional stimulus to the transition from midwife to surgeon as the attendant for deliveries, and may therefore be an instance of medicalization driven by theologians.2 Conversely, the arrival of the cedula can also be a means to examine the eighteenth-century application of unpopular church rules that were not derived from essential dogma.
The multifaceted text of this law also illuminates the antecedents of present-day social and cultural predicaments. In a broad context, it is an example of how concern for death, a general constant, is expressed in actions that reflect the particular functioning and beliefs of a society. It relates to the history of government efforts to involve the community at large in solving local problems (“community participation”) and the long development of legal and medical problems that still exist today, such as the definition of death and the acceptability of court-ordered cesarean sections.3 The cedula is, of course, also related to the concern for life; the identification of the beginning of sustainable, independent existence; and the competence of scientists, legislators, and theologians in giving an opinion that binds other segments of society. For all these reasons, the hybrid nature of the cedula, resulting from the combination of religious, legal, and surgical thought, recalls Goya’s Capricho number 43. A man is asleep in a chair with his hands and head bent over the pens and papers on a table. Surrounding him are a black cat, a lynx, and a cloud of owls and bats. One side of the table shows the inscription “The dream of reason produces monsters. ”4
The cedula has only been briefly mentioned or partially quoted in English.5 This essay presents the theological and legal genesis of the cedula in Europe and the immediate sequence of events that led to its arrival in America. It will outline the situation in Puerto Rico of the three groups most directly affected by the king’s command—surgeons, priests, and families—and then the geographic and temporal spread of compliance with the law. In the usage of the period, which this essay follows, “the cesarean operation” always refers to a postmortem procedure.
The cedula was issued in Puerto Rico by Bishop Juan Alejo de Arizmendi in January 1805. It consists of three sections organized in layers, in that the circular (the complete document) opens with the bishop’s prologue and closes with his orders for the manuscript’s delivery; these elements frame the king’s command (cedula), which in turn encompasses a surgical protocol. In different jurisdictions the bishop’s introduction differed, but the text of the cedula itself was invariant.6
Royal order. Circular of January 8, 1805, about the cesarean operation.
We, doctor don Juan Alejo de Arizmendi . . . bishop of Puerto Rico, of His Majesty’s Council etc.
. . . our . . . religious sovereign, . . . unable to look with indifference at the serious evils that derive to religion and the state for want of the celebrated cesarean operation . . . has ordered that the royal cedula, as follows, be issued:
= The King =
By report of don Juan Ignacio Gutiérrez, canon of the metropolitan church of Santa Fé [Bogotá], were declared on October 8, 1802, the many evils that in the spiritual and temporal [realms] followed from not practicing the cesarean operation with the proper learning, and that to avoid them he had printed at his own expense the method included for such operation by the Cistercian monk don Alfonso [sic] José Rodríguez in the fourth volume of his Aspecto de teología médico moral, of which method he sent a copy, asking that a brief and clear instruction to execute said operation be formulated, ordering its observance very strictly to magistrates and parish priests of the towns. And having been seen in my Council of the Indies with what was said by my fiscal [legal adviser], and consulting me about it on December 23 of the same year 1802, I saw fit to order that the College of Surgery of San Carlos produce the Instruction which, approved by the Proto-Cirujanato [Chief Surgeon’s Office], accompanies this my royal cedula, and it is my will that it be observed with the following precautions. First, that in towns where there be facultativos, whoever may attend any sick pregnant woman, as soon as she dies, give warning to the parish priest, and by himself, being a surgeon, and if not, by whichever [surgeon] there be in town, arrange to proceed with the cesarean operation, after having assured himself of the true demise of the pregnant woman, by the means and under the rules of the mentioned Instruction, which should be kept in view to be followed precisely.7 Second, that the parish priest as well as the facultativo who should be called for such ends shall, at any hour of the day or the night that they be called, go immediately to the house of the deceased woman, without any excuse for the journey or for the fulfillment of their respective charges, for any reason. Third, that in the towns where there be no facultativo, the parish priest, in agreement with the local magistrate, designate the person who they believe to be possessed of the best talent, dexterity, and aptitude to execute the cesarean operation in precise and exact accordance with the Instruction, which will be at hand in the act, and to which perfect execution the priest will collaborate, if necessary, with his advice and knowledge. Fourth and last, that with this regard the priests and the magistrates conserve in their possession, for the cases that occur, the order communicated to them by the ecclesiastical prelates and governors, because the former will not consent to the burial of any woman, of any class whatsoever, who died pregnant, unless they be certain that the operation has been performed on her. . . .
Given at Aranjuez, on April 13, 1804,
I the king.
= And the said instruction is as follows =
= Manner of performing the cesarean operation after the death of the mother =
It is not easy for the destitute of anatomical knowledge properly to perform the cesarean operation after the death of the mother, because the same learning is necessary as to execute it in the living woman, given that some apparently dead have been victims of the ignorance of those who have executed the operation; . . . for which the following must be kept in mind:
1st Before opening the belly one will examine whether the mother still lives, who seems dead, to which end one will apply volatile alkali [ammonia] to the mouth, nostrils, and eyes, will introduce a pin between the nail and flesh of any finger, or will stimulate her by other known means; but if, after all these measures are performed, she should give no sign of vitality, one will immediately proceed to the operation.
2d If the creature were presenting by the natural route [spontaneous, cephalic presentation], it should be extracted likewise.
3d Although it has been warned that the operation must be carried out as soon as possible, despite this, it must not be left undone even after many hours have passed.
4th It will also be performed even if the pregnancy be of very short duration, and the creature shall be baptized in such a way that the water will touch it immediately. The operation in this case requires more knowledge than may be possessed by one who is not a surgeon; . . .
Keeping these explanations in mind, . . . the operation must be performed in this manner:
Operation
A scalpel sharp on its convexity, and another ending in a button, and lacking those, a razor or penknife, are the only instruments needed. . . .
The incision will be made on the side where the belly is most bulging, or where the creature best shows. . . . And once the creature is uncovered, and the blood has been soaked up with a thin sponge or rags, one will proceed in the following manner:
If the creature should give no signs of life, it will not be extracted before it is baptized conditionally.
If it is alive and seemingly robust, it will be extracted holding it by the feet, or in the least laborious way, and will then be baptized pouring the sacramental water on its head. After retrieval, the cord will be tied one or two finger-breadths from the navel, and will be cut another two finger-breadths from the tie; . . .
It is dangerous to make any stitch to the mother’s belly; the margins of the wounds [sic] will only be opposed, and a moderately tight towel will be applied, from back to front.
Note. In the case of a miscarriage, the amnion must be opened with great care, and the creature being in view, even if it were like a grain of barley, if it has movement, will be baptized, and if it has not, the same will also be done, conditionally.
Another. There may be a hernia or rupture, the uterus be very low-lying, the placenta or the afterbirth be at the site of the incision, etc. These particulars, and others that are omitted, which require an able surgeon for proceeding with success, force us to say that all brief instruction, and comprehensible to those who lack the knowledge of the profession, will always be defective, such as is the one we present.
By assignment of the Board of Professors of the Royal College of San Carlos we have formed the present regulation.
Madrid, October 25, 1803
Dr. José Ribes = Dr. Manuel Bonafos
This is a copy of its original, which I certify. Madrid, November 12, 1803.
By resolution of the Scholastic and Governing Board of this College. . . .8
Origins of the Cedula
The Church
How did this document come to be written? The Roman Catholic church since the Middle Ages had ordered the cesarean operation to allow the baptism of the unborn.9 In the eighteenth century, although successful cesarean sections had been performed on dead and living women and were widely discussed, the operation was not yet commonly practiced.10 To remedy this, many European countries included the cesarean operation in their legal codes as part of their public health oversight or “medical police” function.11 In Spain in 1742, Friar Antonio (not Alfonso) José Rodríguez, from the Cistercian (Benedictine) monastery of Veruela, near Zaragoza, published the first volume of Nuevo aspecto de teología médico moral, or New Views on Medical Moral Theology. In this collection of essays or “paradoxes” on polemical issues, Paradox 15 concludes: “the cesarean operation must be performed on the dead mother even in the absence of signs of life from the fetus.” Rodríguez presented testimony to prove that “undoubtedly the fetus may live, and has lived, inside its dead mother not only for an hour, but for hours, and even days.” He proposed that physicians should not be allowed to choose when to perform the cesarean, since “foolish physicians are abundant, and among the great number of them we would be happy if there were eight or ten in each art who could be believed anything.”12
The friar, entirely self-taught, gained approval from his superiors to practice medicine in the monastery and wrote several books on medical matters from 1738 to 1767. He became well known for his critical, eclectic views opposing medical systems, astrology, and all superstition. He advocated solid anatomical learning, even proposing that surgeons who did not have it should be denied absolution by confessors. Although an ardent supporter of experimentation, he espoused his controversial opinions on fevers, respiration, bloodletting, and intravenous infusions (many of which were eventually proven right) without any experimental basis. The critical assessment of his achievements has wavered between admiration and disdain. In his time, he was accused by Friar Benito Feijóo of being “little scrupulous” in the accuracy of his quotations and exposition of the opinions of others; more than a century later, the literary historian Marcelino Menéndez Pelayo found him “among the most daring renewers of the experimental method”; in the twentieth century, Dr. Gregorio Marañón decried his “radical mediocrity.”13 In our own day, historians have judged the monk’s work to have been more rigorous and much better informed than the work of his Spanish medical contemporaries.14
Almost simultaneously with Rodríguez, Father Francesco Cangiamila voiced similar arguments in Embriologia sacra, published in Sicily in 1745.15 This book advised priests on how to give pastoral care to pregnant women, how to prevent abortions, how to baptize miscarried or grossly malformed fetuses, how to perform the cesarean operation, and (another show of medical expertise) how to assist the drowned.16 It also discussed issues of theology (God’s love for unborn children), medical policing (the examination of midwives), and biology (new discoveries on the process of conception). Cangiamila quoted classical and modern authors with great erudition, and related credulously a large number of instances in which the cesarean operation was successfully performed.17 The book was praised by the bishops of Naples and Sicily, Pope Benedict XIV, and, in the next century, by Panckoucke’s Dictionnaire des sciences médicales.18
Cangiamila’s suggestions were adopted by the king of the Two Sicilies, Charles VII. His law of August 9, 1749, although similar in intent to the Spanish cedula of 1804, carried a stronger legal message: any transgressor would be guilty of homicide.19 Ten years later this king occupied the Spanish throne as Charles III, and two years after that (1761) he sent a copy of his law, along with a copy of Cangiamila’s second edition (in Latin), to the bishops of Spain.20 In 1767 Rodríguez published the fourth and last volume of his Nuevo aspecto, with instructions for performing the cesarean operation following the method of Mauriceau, the famous French obstetrician.21 But according to historian Paula Demerson, what provoked the more frequent use of the cesarean operation in Spain was the Spanish version of Cangiamila’s book, translated from a French abridgment of the original, published in 1774 and again in 1785. Demerson found 52 such cases from many provinces reported in two Madrid journals from 1777 to 1806.22
The Spanish clergy’s low educational level at the time may explain the different reaction to the Latin and Spanish editions of Cangiamila.23 Another important difference between the editions is that the latter included only the more practical sections of the original. The discussions on “a matter so delicate” as conception were printed in Latin (following the precedent of the French abridgment).24
Although Cangiamila’s arguments persuaded more of the clergy, gaining agreement from the relatives of pregnant women was a different matter. Even in the cesarean cases reported by Madrid newspapers, it is clear that the families of the deceased frequently opposed the operation. Demerson found 12 cases in which relatives neglected to call the surgeon or the priest promptly after the woman’s death. In 6 of those, town officials or police had to be summoned to overcome the relatives’ resistance. The Gaceta de Madrid repeatedly declared the need to oppose the horror, repugnance, or “lack of prudence” of fathers, mothers, husbands, and other family members who opposed operations that affected “not just the health of Religion and the salvation of souls, but also utility to the State.”25
In Mexico City, Cangiamila’s book, translated and also abridged, was published in Spanish in 1772, earlier than in Madrid.26 In response, the viceroy, Friar Antonio María de Bucareli, and Archbishop Alfonso Núñez de Haro both ordered the practice of cesarean section, but the first report of the operation in Mexico is dated 20 years later, in 1795. A booklet on the baptism of miscarried fetuses and the cesarean operation was published in Guatemala in 1784 and reprinted in 1807; an abridgment of Cangiamila’s and Rodríguez’ texts was published in 1788. In a similar fashion, vice-regal and episcopal orders fostered what apparently was the first cesarean section in Peru in 1794; and, as the cedula notes, Rodríguez’ text was reprinted and presumably in use in Bogotá by 1802.27
The Government
Father Gutiérrez, a canon of the Bogotá cathedral, petitioned the king for a surgical instruction to be used everywhere. The request from Bogotá would have gone through the bishop (Fernando Portillo y Torres) and the viceroy (Pedro Mendinueta), and then to the Council of the Indies, the fiscal, and the king.28 Charles IV may have supported the law because of its religious motivation or because it was a reenactment of his father’s dispositions (although the Neapolitan law of 1749 was an entirely different text). But the measure was also one of many designed during Charles’s reign to improve the survival rate of infants, in the context of government concern to expand the population as a means of increasing the wealth of the state.29 From the council, in December 1802, the request went to the minister of Gracia y Justicia (welfare and justice, approximately) for the Indies, and only then was it sent to the Superior Governing Board of Surgical Colleges.
The Surgeons
On March 3, 1803, the faculty of the College of Surgery of San Carlos, in Madrid, received the order to evaluate the published instructions received from Bogotá and commented on by the board, and to compose a “clear, succinct, and methodical instruction.” Eight months later, on November 3, the faculty received another letter from the board, demanding an answer “with utmost speed, to satisfy the higher authorities.” The delay is not explained, but probably reflects the surgeons’ mixed reaction—delight at being consulted by the king’s council, dismay at the order to prepare an instruction to simplify surgical technique, annoyance at the interference of priests in matters of clinical judgment, and eagerness to please the government, by the support of which, over the preceding 50 years, surgeons had risen in status from craftsmen to professionals.30
In practice, surgeons silently disagreed with Rodríguez and Cangiamila regarding the expected duration of the life of a fetus after the mother’s death, and therefore they not uncommonly disregarded the priest’s call to a deathbed.31 The professors in Madrid shared the concerns of community surgeons, but their disquiet also arose from doubts about current scientific knowledge (such as the diagnosis of death), the dexterity of impromptu dissectors at the periphery of the state, and the utility of the brief directions to be given in the law. The faculty “agreed to reply that they had already attended to the request, and that other professors were revising the text, to give it the last touches.” A week later (November 10), Drs. Ribes and Bonafos submitted the instruction to the faculty, and all agreed that “any instruction of this nature, no matter how clear, will always be obscure and almost incomprehensible” for someone who was not a surgeon.32
The reader can immediately notice the internal tension in the instruction. The medical authors repeatedly express dissatisfaction with their own text, which even starts with the words “It is not easy.” Surprisingly, it is the surgeons who show how to administer the baptismal water, not the king’s cedula or the episcopal “cover letter.” The instruction was forwarded from the surgeons to the Governing Board of Surgical Colleges on November 12, and the cedula was signed in Aranjuez on April 13, 1804. It arrived in Mexico by July and eventually traveled as far as the California missions and South America.33
Conditions in Puerto Rico
In early 1805, Puerto Rico’s new governor, Toribio Montes, was occupied with an outbreak of yellow fever in San Juan, war with England, revolution in Saint-Domingue, and a general scarcity of currency and imported basic goods, such as flour. The island had 175,000 to 180,000 inhabitants, distributed among about 40 municipalities but living mostly in rural areas.34 Bishop Arizmendi gave careful instructions on how to forward the document from town to town for copying in each parish’s book of decrees, a necessity because Puerto Rico had no printing press at the time. The island’s communication system (like that of the California missions) worked in the manner of a pony express.35 (The only surviving copy of the document in Puerto Rico is in one of those parish books.)
The elite (military, clergy, physicians) throughout the island had sufficient, though not abundant, access to Spanish and regional American publications, judging from how they learned about smallpox vaccination before it reached the island in 1803.36 Nevertheless, illiteracy was widespread. A municipal census ordered in San Juan in 1804 to identify candidates for smallpox vaccination was delayed for weeks until the alcaldes de barrio charged with its execution confessed “their very limited instruction in knowledge of reading and writing.”37 By 1765, only two towns, San Juan and San Germán (in the southwest), had schools for children. Governors Muesas (1770) and Montes (1805) gave orders to hire at least one teacher in each town, but “the general ignorance in reading and writing” was still evident in 1820.38
The Role of the Priests
Bishop Arizmendi’s circular became an additional proof of his professed concern for the health of children (the background of his official portrait represents a baptism, an unusual episcopal function).39 He had already (in 1803-4) given his strong support to the introduction of smallpox vaccination on the island by stepping forward as one of the first persons to submit to the procedure and by actively cooperating with government efforts to institutionalize routine vaccination in infants.40 In later years he would support the study of children with congenital malformations, commissioning the portrait of one and forwarding the wax model of another to the Madrid College of Surgeons. The latter consultation was written by a Franciscan friar, “lector of Arts” in that order’s convent in San Juan, who also modeled the wax effigy.41
Such paradigms of enlightened clergy could be found throughout the Spanish domains.42 Nevertheless, they were exceptional. The cultural level of the clergy in Puerto Rico was quite low. Several reports throughout the eighteenth century point to the poor knowledge of ethics, Latin, homiletics, and even reading among parish priests.43 These extremes in education corresponded with the economic basis of church administration. Convents received revenue from donations and landholdings. The ecclesiastical taxes on parishioners (diezmos and primicias) were assigned exclusively to the priests of San Germán and the cathedral chapter in San Juan (the island’s two parishes when church income was regulated in the sixteenth century). Curates in other towns had to depend on additional donations from (usually poor) parishioners and their own pursuit of agriculture. In addition, parish members were responsible for the costs of construction and maintenance of churches. Such an inequitable distribution of church income continued throughout the first third of the nineteenth century; the beneficiaries of the existing system, through judicial and political maneuvering, frustrated two royal dispositions (1786 and 1795) and the sustained efforts of island governors and bishops.44
The administration of the last sacraments to distant rural residents was a great hardship for priests. They had to travel such long distances (2 to 6 leguas, or 8 to 25 kilometers) that when they returned, some parishioner was already waiting to ask for another visit.45 Nevertheless, the priests insisted on being called, and on at least one occasion (in 1810) punished a careless parishioner with eight days in prison for failing to call the priest until a woman expired.46
The bishop’s circular instituted a new practice, because cesarean sections were not mentioned in the diocesan rules in effect at the time (the Constituciones sinodales of 1645).47 Surprisingly, even priests objected to this surgical procedure. The 1772 Mexican edition of Cangiamila’s book was designed to persuade priests to lay aside their scruples to authorize or actually perform the procedure.48 This researcher found no testimony of objections in Puerto Rico, but the cleric’s point of view is conveyed in Father Francisco Sarria’s instructions to California mission friars on how to perform cesareans (1830). Although his writing comes 25 years after the cedula, he also bases his recommendations on Rodríguez’ and Cangiamila’s books. Sarria left Spain in 1804, and his text, although grounded in the same theological and medical foundations as the cedula, is more practical, more extensive, and more considerate, with instructions for the care of the infant and more benign tests for death (except when it occurred suddenly and unexpectedly).
As befits his supervisory position, Sarria explains to his friars the usual obstacles to the operation, such as the absence of a surgeon in the vicinity and the immoderate fee charged. Rut he also addresses the possible objections of the priests themselves. First comes the offense to modesty, with the suspicion of compromised chastity. Sarria reminds priests that saving the child’s soul by baptism, and perhaps also its corporal life, is urgent and immediate, while the danger of incurring some suspicion regarding chastity is remote, for during the operation there is no need to reveal any part that might offend the most delicate modesty. Another objection is the canonical prohibition of priests from exercising surgery; but according to Sarria, because the cesarean is carried out on a dead body it is, strictly speaking, not surgery. Finally, there is the fear of inadvertently injuring the live infant or of causing its death. Sarria answers that the purpose of the act is to give the child two lives, physical and spiritual, and vigilance in avoiding all mistakes is assumed.49
Episcopal dispositions regarding the burial of women who died in or after labor had been enacted in Puerto Rico since at least 1665. Bishop Benito de Rivas tried to stop slaveowners, who were ostensibly interested in gaining more workers, from tolerating or encouraging the sexual activity of unmarried female slaves. He ordered that slaves who died “of such guilty and sinful deliveries” should be buried with no ecclesiastical pomp (that is, the only participants in the burial could be one priest, an acolyte carrying a wooden cross, and four people to carry the bier). In addition, if any of these women were in danger during the delivery, church bells could not be rung, nor the faithful asked to pray for her, in this way “to avenge the offenses that such sorts of women make to God.” The prohibition of pomp in burials was extended to free dark-skinned women who lived scandalously. These dispositions were an addition to the measures that Bishop López de Haro had instituted in 1647, imposing fines on the owners who transgressed, or the obligatory sale of the slave.
Bishop López’ orders had no effect, and Bishop Rivas’ were equally fruitless, in addition to being completely devoid of charity, focusing blame and censure on the victim. Bishop Escanuelas reiterated Rivas’ orders in 1674, and Bishop Urtiaga not only repeated them in 1707, but enforced them in at least two instances. Then in 1711 a report to the king’s council from no less than the colonial governor, Danío Granados, denounced the bishops’ orders, claiming that unmarried pregnant women who died in childbirth were taken to burial with one unshod foot outside the coffin; with the corpse on one side of the street and the priest and sacristan on the other; without singing, praying, or ringing bells. The island’s residents were reportedly horrified and tormented by the decision to silence the bells, because it meant that the community would not be called to pray for the dying women. This news provoked such fright (pavor) in the council that a royal cedula was sent to Bishop Urtiaga in 1712 demanding an explanation.50
Urtiaga replied (with documentary evidence) that he had only ratified “most ancient” funerary dispositions ordered by his predecessors; but he immediately suspended the controversial clauses pending the king’s decision after examining all testimonies. In his letter, Urtiaga alludes to “blameful and criminal circumstances” surrounding those who reported to the king on this matter, and does not go into the offending incidents—leaving in doubt whether the grisly detail of the naked foot outside the coffin was an exaggeration by his accusers or another ancient custom not mentioned in the text of any of the previous episcopal rulings. His response, written in the town of Ponce on the island’s south coast during a pastoral visit itself marked by disagreeable incidents, implicitly justifies the harshness of the burial dispositions by referring to the “undevout souls” who populated the island. It then very pointedly blames this situation on the ignorance and negligence of the priests, compounded by the dispersion of the flock in rural areas. Urtiaga takes advantage of the opportunity to repeat his request for the establishment of a seminary, to produce
learned and God-fearing ministers to guide these towns, whose inhabitants are of a naturally fiery, haughty, and undevout temper for lack of education, so that all that they are commanded for the good of their souls, reformation of vices, and innumerable public scandals of all sorts of sins, they receive with incredible rudeness, especially the clergymen.51
Bishop Urtiaga’s experience clearly shows how the people’s unfamiliarity with church teachings and the clergy’s lack of education, discipline, numbers, or means to reach the dispersed flock could frustrate the application of episcopal commands. The same orders by other bishops had gone unheeded for more than 40 years. Even though it was the governor who wrote the complaint to Madrid, the people’s views on funeral practices and prayers for the souls of the dead are clearly discernible.52 A burial procession limited to a silent priest, acolyte, and four pallbearers was considered, by bishop and people alike, as offensive to their honor (afrentoso); the impediments to praying for the woman’s soul were intolerable.53 When Bishop Pizarro dealt again with this issue in 1729, he only reiterated the 1647 command applying to guilty slaveowners, that they be fined or even forced to sell the slave.54 Indeed, historian Angel Lopez Cantos, studying official documents from eighteenth-century Puerto Rico, has found many reports of moral transgressions but a uniformly staunch adherence to basic Catholic dogma.
The bishops’ orders met such obdurate resistance because the faithful were, in actual practice, greatly concerned with burial and prayers for the dead. Almost every parish had one or more sodalities (cofradías) under different advocations (that is, the protection of different saints), but all of them were required to participate in a member’s burial, including praying the rosary in community and providing alms to priests and to the poor who joined the funeral procession. The second most common sodality throughout the island’s parishes was dedicated to prayer for the souls in purgatory, with daily collection of alms for masses and candles for the Altar of the Blessed Souls.55
The bishops of Puerto Rico in the eighteenth century took repeated measures to assure that women of reproductive age received the sacraments when illness or pregnancy put their life at risk. In 1707 Bishop Urtiaga ordered that all women (under pain of excommunication and two hundred reales de plata) come to deliver in town. Bishop Pizarro repeated the order in 1729, expanding it to cover anyone ill for more than a day and women in the last month of pregnancy; but then rescinded his command in view of the great poverty of the population. Nevertheless, women were obligated, from the beginning of the expected month of delivery, to attend confession and receive communion in their parish and to give eight reales as alms. Bishop Antolino in 1750 canceled the requirement of a donation if the faithful delivered in their rural lodgings. To avoid omissions in baptizing infants in poor health, he ordered that priests should instruct four “of the ablest” residents in the distant sectors of the parish to fulfill this duty.56 Bishop Arizmendi repeated the order in his pastoral visits of 1808 and 1813.57
Effects on Families
Families were therefore, by 1805, accustomed to hearing of episcopal regulations regarding pregnant women and difficult deliveries. In the case of cesarean sections, noncompliance might have been due to ignorance of the rule, lack of a priest or surgeon, or illiteracy of the neighborhood, with no one able to read the surgical instruction. During this period, moreover, most inhabitants of remote areas were relatives.58 Kinship would have encouraged neighbors to conduct the simple and traditional ritual of infant baptism but would have inhibited them from performing a cesarean. The designated untrained lay person was probably not eager to follow an instruction that began with the words “It is not easy,” abounded in anatomical terminology, required, as the first step, sticking pins under the fingernail of a relative’s cadaver, and repeatedly stated that many things must be done that were not mentioned, rendering the instruction itself less than reliable. Family opposition also may have come from repugnance at the opening of the cadaver or from superstition, because placentas could be used for witchcraft.59
If a difficult delivery presented the need to choose between saving the mother’s life or the child’s, the priest generally would have insisted on letting nature take its course; but that choice might have run counter to a husband’s insistence on saving his wife.60 (The priest would not have exerted pressure to have the baby baptized at the expense of the mother’s life. This action was clearly opposed by church teaching, as Friar Rodríguez explained at length in his “Paradoxes.”) In a rural area, where consensual unions were common, the death of an unmarried pregnant woman who called the priest might have implied the donations for a marriage (10 reales), two burials (30 reales), and a baptism (4 reales).61 The shame of not being able to afford the customary “offerings,” which were usually not expected of the poor, may have been a strong reason for not calling the priest at all. There was also the surgeon’s fee for the operation, which in Barcelona in 1774 amounted to 10 pesos (80 reales), in Venezuela in 1793 was 4 pesos (32 reales), and in California in 1830 was described as “immoderate.”62 In theory (as contemplated by the royal cedula), the presence of a neighbor who could follow the surgical instruction for the operation would obviate the need to call a priest or surgeon, but in Puerto Rico there was little likelihood that outside the towns a priest or literate neighbor could be quickly found to carry out the operation.
Activities of Surgeons
Surgeons on the island, moreover, were occasionally admonished to attend the poor free of charge (or even took the responsibility for granted).63 Soldiers were attended by their regimental surgeons and by the military hospital in San Juan, where the majority of soldiers were stationed. Civilians were cared for by civilian physicians, surgeons (occasionally émigré French army surgeons), practicantes (nonacademic practitioners), and midwives, as well as the military medical men. For all these, admission to practice involved simply the presentation of the required academic credentials to the local ayuntamiento.64 In 1804 the city of San Juan, with about seven thousand residents, had at least two physicians and one surgeon who cared for ordinary citizens, two regimental surgeons, and the physician-surgeon and four practitioners at the military hospital.65 For the rest of the island, the 1804 documents describing the distribution of smallpox vaccine mention only a physician (Adulfo de Ybio) in the Ponce area and a practitioner (Bernardo Sanchez) in Yabucoa.66
Similarly, the presence of midwives in early nineteenth-century Puerto Rico could only be surmised. They are mentioned as a group in the decisions of the Puerto Rico Synod of 1645; their examination was regulated by law on July 21, 1750, and a law of May 6, 1804, forbade midwives to “perform on their own any operation whatsoever.”67 Nevertheless, their actual presence at specific deliveries heretofore had not been documented. The review of parish burial records made for this study, however, revealed the names and locations of some of these women, recorded, curiously enough, not because of their obstetrical work but only because of their religious function, administering the sacrament of baptism to frail newborns.68
The royal cedula makes no allusion to midwives. Their absence may be due to the “surgical” authorship of the instruction, or to the assumption that in many of the cases under consideration the pregnant woman would have died before the onset of labor, thus before the midwife was called. Their complete omission from the considerations of the law is surprising, given that their training and licensure were prescribed by regulations issued a few weeks after the cedula. It must be seen as a reflection of the changes in the conditions of childbirth that had been occurring in Europe, not excepting Spain, since the previous century.69 In the second half of the eighteenth century, the creation of Royal Colleges of Surgery in Cadiz, Barcelona, and Madrid raised the professional and social status of Spanish surgeons by providing them with solid, modern scientific training, as well as government recognition and support in establishing their military or civilian practices.70 In Puerto Rico in 1805, their rarity enhanced their status. Their recent involvement in the introduction and distribution of smallpox vaccination throughout the island had gained them great prestige.71
Reaction to the Cedula in Puerto Rico
The governor informed the San Juan Municipal Assembly of the new law on July 17, 1804, and the bishop circulated the text six months later, in January 1805.72 In the mountain town of Cayey the cedula was quickly obeyed. On March 19, 1805, Father Felipe González recorded the inhumation in the third section of the burial grounds, with offices of entierro doble, of the
deceased body of Bibiana Malabé, who was married to Manuel de Burgos. She did not receive the holy sacraments because, in spite of my going to that effect, in the company of the physician, don Bernardo Sánchez, when we arrived she was already cadaver. To whom, because of being pregnant the cesarean operation was performed, as determined by royal order. I baptized the offspring sub conditione [that is, assuming the child was alive], not certain if it breathed, to whom I gave the name Maria, who seemed to have five months of gestation; [operated] about an hour after the mother expired, who left no will. Her age, 20 years.73
Eight months later (November 24) and again almost 13 months after that (December 16, 1806), Father González recorded the burials of two other women also subjected to the cesarean incision. Both infants were baptized and named María, the first sub conditione and the second living, of about six months’ gestation, but who soon died. Both women received the sacraments of penance and extreme unction (evidently well before their death). The first, Celedonia Días, wife of Manuel Suáres, did not receive last communion (viático) because the priest was unable to travel the distance on the dangerous road. The cesarean was carried out by the practitioner (curioso) don Bernardo Sánchez, in the presence of the justicia ordinaria of the town of Coamo, who happened to be there. Celedonia was about 20 years old. She “gave no testament, not having anything to bestow,” but was buried in the second section of the grounds.
The other deceased, Paula López, wife of Juan Caraballo, was assisted for two days and a night by the priest, a surgeon (don Federico Paret), and the teniente a guerra of Cayey, don Manuel Collazo. The surgeon performed the operation, presumably promptly after the mother’s death, because the child was judged to be alive when baptized. Paula López, aged about 30, left a will with three executors (including her husband). She was buried in the first section of the grounds, with offices of entierro doble; three masses and a funeral service were sung for her soul.74
Three weeks later (January 8, 1807), a priest in San Juan cathedral, Father Nicolás Ruiz y Peña, succinctly recorded the burial of a 36-year-old Frenchwoman (Juliana Leuillot, born in Nantes, wife of José Gancel) and the body of her “posthumous male child” baptized sub conditione on extraction from the uterus of his dead mother, who died of a “sudden accident.” No information is given on the person who performed the operation or the social condition of the woman, except that she had been married previously (to Francisco Soulase).75
The same week (January 13, 1807), Manuel Martínez Cepeda, rector of the church in Humacao, buried Juana Roldán, the 26-year-old wife of Gregorio González, a parishioner from the Candelero section of the parish. She died suddenly, without last sacraments. She was four or five months pregnant, which the priest found out only when the corpse was brought for burial. The ceremony was postponed “in obedience of His Majesty’s royal order,” the teniente a guerra was informed, and a cesarean was performed by surgeon don Luis Auxet, who “extracted a perfectly organized creature more than a third [of a Castilian vara; 1 vara equaled 83.59 centimeters] long, which manifested having died after the mother, because it exhaled no fetidness.” The child, being dead, was not baptized. The mother was buried in the third sector of the grounds as a charity case, with a simple ceremony.76
Twenty-one months later (October 5, 1808), Father Ruiz y Peña in San Juan recorded the burial of Felipa de Cárdenas, 32-year-old wife of Fernando Hernández. She was given the sacraments sub conditione, being out of her senses. “Being seven months pregnant, two hours after her decease, sufficiently certified that her body was cadaver,” the físico don Nicholas Nicol performed a cesarean operation and extracted a boy who was baptized sub conditione and given the name Francisco.77
Parish burial books survive from most of the 40 towns in Puerto Rico at the beginning of the nineteenth century, but burial books covering any portion of the period 1805 through 1810 exist for only 24 of them. A search of the records available on microfilm (11 towns) and in the archdiocesan archive (2 towns) revealed 6 cesarean sections in 3 towns (San Juan, Cayey, and Humacao) from March 1805 to October 1808.78 Even if all the parish burial records were still in existence and available for study, the data in them would not allow a firm conclusion on the acceptance and thoroughness of application of the cedula. We still would not know about the operations that should have been performed but were not.
In addition, the documentation of a cesarean section in a town can only be taken as evidence of a rare event. The situations addressed by the cedula (death of a pregnant woman, from any cause, before delivery) occurred in a very small proportion of pregnancies. Few such statistics are available throughout the world for this period; we must look to Maine and Sweden for comparisons. According to the records of a rural midwife in Maine, maternal mortality at the time of delivery (which says nothing about the death rate from injuries or illnesses during the pregnancy and includes deaths after the child has been born) was nearly four to five deaths per thousand live births, and in Sweden it was eight to nine per thousand.79
In Puerto Rico the figure was probably higher (given that rural Maine and Sweden had no significant slave population). Even so, “of those women who die in consequence of uterogestation,” wrote a British obstetrician in 1806, “very few are cut off during the time of pregnancy, and not many during the act of labor.”80 Puerto Rico in 1805 probably showed a maternal mortality rate during pregnancy or before completed labor of about one to two deaths per thousand live births. Such incidence, applied to the small populations of towns (San Juan had about seven thousand inhabitants and 550 births in 1804) and subject to the inherent variability of a rare event, would make the death of a pregnant woman an event uncommonly seen by parish priests.81 Therefore, the opportunity to follow the instructions of the law would occur seldom, if at all, in any municipality, and the few operations mentioned in the records could conceivably represent the totality of all opportunities for applying the cedula.
Nevertheless, the common features in these few instances indicate that the royal cedula in Puerto Rico had a limited effect on the behavior of priests and surgeons. Five of the six cesareans were performed in 2 of 13 parishes studied. The operations were all performed on married women, aged 20 to 36, with singleton pregnancies (twin pregnancies are more dangerous, and therefore would have been expected to be mentioned more often). All the women were white (or at least free), with status ranging from poor to affluent (judging from the location of their interment in the three sectors of burial grounds).82 The absence of instances among unmarried, black, or slave women; the preponderance of professionals (surgeons, physicians, or practitioners) performing the operation; and the frequent occasions when law enforcement officials were present or consulted suggest that the cedula was applied in the more accessible cases, within convenient reach of church or civil authority, in the absence of popular acceptance. In contrast to Puerto Rico, no cesarean sections are reported to have followed the proclamation of the law in Venezuela; and while six were performed in the California missions from 1799 to 1803 (before the cedula was issued), only two (1805 and 1808) are documented between 1804 and 1819. In Guayaquil, an apothecary who treated a pregnant woman who died was prosecuted in 1818 for not knowing how to perform a cesarean to extract the child and give it the baptismal waters.83
After the first decade of the nineteenth century, postmortem cesarean sections continued to be performed occasionally. The last reports of cesarean operations carried out by priests come from Rincon, on the west coast of Puerto Rico, in 1829, and from Mission San José, California, in 1832.84 The 1804 cedula was not included in the compilation of laws for Spain published in 1807, but it survived in the law codes for the Spanish colonies until sometime between 1845 and 1868, and in the laws of some of the new republics, such as the Mexican regulations for midwives of 1852.85 In 1870, the Holy Office forbade priests, especially missionaries, to promote the operation or to perform it themselves.86 Nevertheless, the church and Catholic physicians continued to recommend the practice at least until the middle of the twentieth century, as demonstrated by publications from Barcelona in 1903, St. Louis, Missouri, in 1906, and Madrid in 1954.87
At present, the Roman Catholic church considers that the unbaptized infant “can only be entrusted to divine mercy,” and will achieve salvation.88 Postmortem cesarean sections are rare only because prepartum deaths are uncommon, not because the operation has been discredited. In our society, violence against women is so frequent, and ambulance response may be so swift, that surgeons or paramedics occasionally perform postmortem cesarean sections to save infants, such as happened in the notorious Stuart case in Boston in 1989, and in Wheaton, Maryland, in January 1991.89
Conclusions
As an object for the study of the development of medical knowledge and practice, the royal cedula of 1804 highlights the contemporary difficulties in certifying a death and the tests to obtain such assurance. The text makes explicit the violence to which a woman’s body would be subjected before the postmortem cesarean section was conducted. This violence resulted from a characteristic of the period: the controversy, and the unusual level of concern, about the diagnosis of death.90 At the time and long afterward, “only putrefaction” was “an infallible signal that a person was truly dead.”91 At that stage, regardless of Cangiamila’s hyperbolic anecdotes, most surgeons would have considered it too late for any operation to retrieve a living fetus from the womb. The actual technique proposed for the operation requires no comment, because it was not a novelty. The method for performing cesareans was published before this cedula in many texts. In Spain it had been published in the works of Rodríguez and Cangiamila, and more recently circulated in an anatomy textbook printed in 1800.92 The instruction’s warning about suturing the cadaver’s wound has been interpreted as alluding to the danger of puncture with a contaminated needle, which could be lethal to the surgeon.93
As a source for the study of the development of professions, the cedula presents an event that, in the late eighteenth and early nineteenth centuries, cast priests, surgeons, and midwives as expert practitioners in areas almost completely foreign to their present-day roles. Of the six cesareans documented in Puerto Rico from 1804 to 1807, the person who operated (a man) was identified in five. Two were performed by Bernardo Sánchez, a curioso licensed to practice without an academic degree after an apprenticeship in the San Juan Military Hospital.94 The present research also found two previously unidentified surgeons (Paret in Cayey, 1806, and Auxet in Humacao, 1807) and another (Nicol) whose activity was not documented until 1821, and then only as a regimental surgeon.95 The fortuitous identification of midwives and some surgeons in Puerto Rico through their participation in urgent infant baptisms or cesareans, as documented in burial records, may serve as a lesson to the investigator. The search for evidence of a profession’s activities must look beyond the present-day definition (just as with titles such as fiscal or república and ideas such as liberal or indio) into the conceptions and routines of the past.
The striking characteristic of the bishop’s circular is that the logic behind it, in inverse order to the actual text, has a core of theology, wrapped in law and overlaid with a veneer of technique. This was a time when monks’ opinions had stronger political influence than the judgment and passive resistance of surgeons. Paradoxically, however, the surgeons may have profited. The legal protection of the cedula would have encouraged practitioners such as Sánchez to practice a more invasive procedure than any performed in his training or usual practice. The application of the surgical instruction may have aided the transition from midwife to surgeon as the attendant for deliveries.96
The royal cedula of April 13, 1804, may strike us as a gruesome or repellent document; but it was not ignored, and it does not reflect an aberration localized in place, time, or even culture. Countries with different established religions (Prussia and Russia, for example) promulgated similar laws. The cedula illustrates the methods of communication among different governmental and social spheres in Spain and from the center of the state to its farthest reaches, even in locations without a printing press. In a wider context, the inclusion of a surgical instruction in this law illustrates the so-called “practical” approach of the Enlightenment. This practicality, imposed from the top without regard for the objections or resources of those affected, validates the epigram that enlightened despotism was all for the people, but without the people.97
Francisco Peiro, Deontología médica, 5th ed. (Madrid: Marbán, 1954), 319. A contemporary statement of this belief can be found in the obstetrical treatise of José Ventura Pastor, Preceptos generales sobre las operaciones de los partos, 2 vols. (Madrid: Joseph Herrera, 1789-90), 1:21, n. 1: “Religion teaches us that it is necessary to be washed by the salutary waters of baptism to be able to enjoy the glory of Paradise, says Astruc.” Note that Astruc was a physician, not a theologian.
In the history of medicine, medicalization refers to the process through which medicine redefines or takes control of certain formerly routine human events. Where, e.g., once women, later midwives, assisted childbirth in the home, male midwives and ultimately obstetricians handled the “labor and delivery” in hospitals. “This process owed not so much to technical progress as to collective professional strategies destined to assure a monopoly on health care.” Josep María Comelles and Angel Martínez Hernáez, Enfermedad, cultura, y sociedad (Madrid: EUDEMA, 1993), 8; their reference is Michel Foucault, “Historia de la medicalización,” in La vida de los hombres infames (Madrid: La Piqueta, 1990), 121-52.
Lenore Manderson, Luzviminda B. Valencia, and Ben Thomas, Bringing the People In: Community Participation and the Control of Tropical Disease ([Geneva:] World Health Organization, 1992), 6. For another example, from earlier in our century, of scientists asking residents of rural areas to allow the postmortem examination of a relative’s internal organs, see Fred L. Soper, E. R. Rickard, and P. J. Crawford, “The Routine Post-mortem Removal of Liver Tissue from Rapidly Fatal Fever Cases for the Discovery of Silent Yellow Fever Foci,” American Journal of Hygiene 19 (1934), 549-66; and E. R. Rickard, “The Organization of the Viscerotome Service of the Brazilian Cooperative Yellow Fever Service,” American Journal of Tropical Medicine 17 (1937), 163-90. For recent discussions of the problems of defining death and of who can order cesarean sections, see Jeffrey R. Botkin and Stephen G. Post, “Confusion in the Determination of Death: Distinguishing Philosophy from Physiology,” Perspectives in Biology and Medicine 36 (1992), 129-38; Jim Holt, “Sunny Side Up: When Do We Die? A Case Study,” New Republic 210 (Feb. 21, 1994), 23-27; Lawrence J. Nelson and Nancy Milliken, “Compelled Medical Treatment of Pregnant Women: Life, Liberty, and Law in Conflict,” Journal of the American Medical Association 259:7 (Feb. 19, 1988), 1060-66; Thomas E. Elkins et al., “Court-Ordered Cesarean Section: An Analysis of Ethical Concerns in Compelling Cases,” American Journal of Obstetrics and Gynecology 161 (1989), 150: William J. Curran, “Court-Ordered Cesarean Sections Receive Judicial Defeat,” New England Journal of Medicine 323:7 (Aug. 16, 1990), 489-92.
Francisco de Goya, Los caprichos 43, 1799; Sarah Symmons, Goya: In Pursuit of Patronage (London: Gordon Fraser, 1988), 159.
Rosemary K. Valle, “The Cesarean Operation in Alta California During the Franciscan Mission Period (1769-1833),” Bulletin of the History of Medicine 48 (1974), 268; Michael E. Burke, The Royal College of San Carlos: Surgery and Spanish Medical Reform in the Late Eighteenth Century (Durham: Duke Univ. Press, 1977), 130; John Tate Lanning, The Royal Protomedicato: The Regulation of the Medical Professions in the Spanish Empire, ed. John Jay TePaske (Durham: Duke Univ. Press, 1985), 314-18.
Pedro A. Gutiérrez Alfaro and Ricardo Archila, La obstetricia en Venezuela (Caracas: Editorial Ragon, 1955), 50-56. One copy of the original printed cedula is in the Archivo Histórico Nacional, Madrid, Consejos, libro 1502, cedula 41. The printed text has two errors, carried over to the manuscript copies. Friar Rodríguez’ name is given as Alfonso instead of the correct Antonio, and pares (afterbirth) is consistently misspelled paries.
Facultativos is a comprehensive appellation for physicians or surgeons who hold academic degrees.
Archivo Histórico Diocesano, San Juan (AHD), Fondo San Pedro Apóstol (parroquia del pueblo de Toa Baja), sección Disciplinar, Serie Circulares (1802-1823), caja P-80, fols. 8r-1ov. For the full text in Spanish, see José G. Rigau-Pérez and Marta Villaizán, “Cesáreas post-mortem en Puerto Rico, 1805-1807,” Boletín de la Asociación Médica de Puerto Rico 83 (1991), 91. The other archive of burial records in Puerto Rico mentioned in this article is the Centro de Investigaciones Históricas, Univ. de Puerto Rico, parish records of the Ponce and Caguas dioceses, microfilmed by the Genealogical Society of the Church of Jesus Christ of Latter-Day Saints, Salt Lake City, Utah, microfilms of the Isabela parish records. Only the burial records are cited, and will be quoted as CIH-Burials.
Ruperto Sánchez Areas, “La operación cesárea postmortem (disposiciones eclesiásticas),” Acta Ginecologica 1 (1950), 409; Jordi Pau i Roigé, “Cesáries ‘post-mortem’ al priorat entre els segles XVI i XVIII,” Gimbernat (Revista Catalana d’Historia de la Medicina i de la Ciencia), 1992 (Actes VII Congrés d’Historia de la Medicina Catalana, vol. 1, Tarragona, 1992), 257-59. See also Renate Blumenfeld-Kosinski, Not of Woman Born: Representations of Caesarean Birth in Medieval and Renaissance Culture (Ithaca: Cornell Univ. Press, 1990).
Mireille Langet, “Childbirth in Seventeenth- and Eighteenth-Century France: Obstetrical Practices and Collective Attitudes,” in Medicine and Society in France: Selections from the Annales, Economies, Sociétés, Civilisations, Volume 6, ed. Robert Forster and Orest Ranum, trans. Elborg Forster and Patricia M. Ranum (Baltimore: Johns Hopkins Univ. Press, 1980), 171-12. An example of a report of a successful cesarean on a living woman was published by Jaime Alcalá Martínez, Disertación médico-chirúrgica, sobre una operación cesárea executada en muger y feto vivos, en la ciudad de Valencia (Valencia, 1753).
Medizinischen Polizei meant both a policy and the practice of disease and risk-factor surveillance. The state had an interest in the health of its subjects; therefore its policy should include establishing such regulations. See Johann Peter Frank, System einer vollständigen medicinischen Polizey. A System of Complete Medical Police: Selections from Johann Peter Frank, edited by Erna Lesky, translated by E. Vilim ([1779-1819] Baltimore: Johns Hopkins Univ. Press, 1976). Many German principalities, Prussia up to 1851, the Austrian Empire (1757), and Russia followed this practice. See Ruperto Sánchez Areas, “Cesárea post-mortem,” Medicina e Historia 59 (1969), 4-5. See also George Rosen, “Cameralism and the Concept of Medical Police,” Bulletin of the History of Medicine 27 (1953), 21-42.
Antonio José Rodríguez, Nuevo aspecto de teología médico-moral, y ambos derechos, 3d ed., 4 vols. (Madrid: Benito Cano, 1787), 1:146-48.
Luis Sánchez Granjel, “El pensamiento médico del padre Antonio José Rodríguez,” Publicaciones del Seminario de Historia de la Medicina de la Univ. de Salamanca, 1957, serie A: Estudios, vol. 1, no. 4, pp. 235-36, 266, 297-79, 250-51.
Ibid., 251-52; José María Rodríguez Merino, “Del biomecanicismo al biotecnologismo en la biomedicina ilustrada española,” Asclepio 42 (1990), 167.
Francesco Emmanuele Cangiamila, Embriologia sacra (Palermo: Francesco Valenza, 1745), published later in Latin as Embryologia Sacra (Palermo: F. Valenza, 1758); abridged and translated into French by Joseph Antoine Toussaint Dinouart, Abregé de l’embryologie sacrée (Paris: Nyon, 1762; enlarged ed., 1766); translated from the French into Spanish by Joaquín Castellot, Embriología sagrada, o tratado de la obligatión que tienen los curas, médicos, comadres, y otras personas, de cooperar a la salvatión de los niños que aún no han nacido, de los que nacen al parecer muertos, de los abortivos, de los monstruos, etc., 2 vols. (Madrid: Pedro Marín, 1774; 2d. ed., 1 vol., Madrid: Pantaleon Aznar, 1785). For a biography, see Andrea Vitello, “Francesco Emanuele Cangiamila e la sua opera ostetrica,” Atti e Memorie della Accademia di Storia dell’Arte Sanitaria (Rome) 21 (1955), 110-27, 165-77.
Bianca Rosa D’Este, “Regulation for ‘Saving’ the Drowned in Italy (XVIII-XIX Centuries), with Particular Reference to the Republic of Venice,” Medicina nei Secoli 2 (1990), 61–73.
E.g., the following egregious anecdote: “In Segovia, after Francisco Arévalo left on a long journey, his wife died. He was sent a message to announce the death; he set out at once on the road, but when he arrived she had already been buried. His excessive pain and the love he had for his wife inspired in him the thought of having her disinterred, and [he] ordered the coffin brought into his presence, persuaded that such a sad spectacle would console him in his pain. He was humored, granting him his petition, and Heaven presented him, in the midst of his bitterness, the object of the most sensible joy. He put his eyes on the cadaver, and by the movement he observed in the belly, and by certain muffled groans, noticed that the deceased was delivering. The situation was examined, and a child was seen with the head outside its mother’s womb. He was brought out, lived, and in time governed a province.” Cangiamila, Embriología, trans. Dinouart/Castellot, 2d ed., 100. I do not mean to suggest that Cangiamila was especially gullible; but as has been said of William Cullen, a famous medical theorist of the period, “he was hobbled by the modes of thinking that pervaded his entire era—the passion for comprehensive explanation, the reliance on logical inference without any empirical confirmation, and the facile generalization from one or two instances.” Lester S. King, Transformations in American Medicine: From Benjamin Rush to William Osier (Baltimore: Johns Hopkins Univ. Press, 1991), 46-47. Hagiography and literature also mention similar cases. See the biography of St. Raymond Non-natus (Ramón Nonato), born ca. 1200 in Catalonia, in Enciclopedia universal ilustrada europeo-americana (Madrid: Espasa Calpe, 1923), 49:550; and recall Macduff, “from his mother’s womb untimely ripped” (Shakespeare, Macbeth [New York: New American Library, 1963], 5.8.15-16, p. 129).
“One couldn’t praise him too much for having taught, even against the authority of the physicians of his time, the soundest principles of private hygiene and medical police relating to pregnant women.” C. L. F. Panckoucke, ed., Dictionnaire des sciences médicales: biographie médicale (Paris: C. L. F. Panckoucke, 1821), 3:140-41.
Ruperto Sánchez Arcas, Historia de la Operación Cesárea en España (Madrid: Marbán, 1950), 32-38.
Cangiamila, Embriología, trans. Dinouart/Castellot, 2d ed., xv. It was sent to “the bishops of these reigns” without making clear whether it included the American colonies. The missive was purely informational, as it is not listed in the text or chronological index of the Novísima recopilación de las leyes de España, 6 vols. (Madrid: n.p., 1805-7).
Rodríguez, Nuevo aspecto, 4:40-46. On p. 11 he mentions that Cangiamila published his book “three years after my first volume arrived in Italy.”
Paula Demerson, “La cesárea post mortem en la España de la Ilustración,” Asclepio 28 (1976), 185-233.
William J. Callahan, Church, Politics, and Society in Spain, 1750-1874 (Cambridge: Harvard Univ. Press, 1984), 15.
According to the Gaceta de Madrid (1799), at least one other book (Directorio moral, by Father Félix Eguía) insisted on the use of cesareans and incorporated a surgical instruction; but this may be an eighteenth-century case of spurious attribution by a newspaper. Eguía was a physician or surgeon who practiced in mid-eighteenth-century Madrid. See Demerson, “La cesárea,” 217, case 36; and Luis S[ánchez] Granjel, La medicina española del siglo XVIII (Salamanca: Univ. de Salamanca, 1979), 33.
Demerson, “La cesárea,” 210-21.
Laiming and TePaske, Royal Protomedicato, 309-11. The translation, by Father José Manuel Rodríguez, was titled La caridad del sacerdote para con los niños encerrados en el vientre de sus madres difuntas: y documentas de la utilidad, y necesidad de su práctica.
Lanning and TePaske, Royal Protomedicato, 312-15; Víctor Ruiz Velasco and José Luis Pérez de Salazar, “Evolución de la cesárea en México,” Ginecologta e Obstetricia de México 27 (1970), 116-17, 121; Broadside announcing Archbishop Núñez de Haro’s order, Mexico City, Dec. 4, 1772, National Library of Medicine, Bethesda, Md.; Valle, “Cesarean Operation in Alta California,” 268; Pedro José de Arrese, Rudimentosfîsico canónico morales . . . sobre el bautismo de fetos abortivos y operación cesárea de las mujeres embarazadas (Guatemala: Imp. de la Viuda de Arévalo, 1784; Nueva Guatemala: Imp. de Manuel José Arévalo, 1807), quoted in Demerson, “La cesárea,” 196, n. 61; Fernando Sánchez Torres, “La operación cesárea en Colombia,” Revista Colombiana de Obstetricia y Ginecología 22 (1971), 101-5. A copy of the booklet printed by Canon Gutiérrez is in the Biblioteca Nacional, Bogotá, Fondo Quijano Otero, 115: Modo de hacer la operación cesárea después de muerta la madre, sacado del tom. 40 del Nuevo Aspecto de Teología médico-moral del R.P.M.D. Antonio Joseph Rodríguez, Monge Cisterciense: Paradoxa 2. n. 48, 2 sheets (4 pp.), n.p., n.d.
Pedro M. Ibáñez, Las crónicas de Bogotá y de sus inmediaciones (Bogotá: Imp. La Luz, 1891), 179-212.
Antonio Carreras Panchón, El prohlema del niño expósito en la España ilustrada, Cuadernos de Historia de la Medicina Española 32 (Salamanca: Instituto de Historia de la Medicina Española, Univ. de Salamanca, 1977), 41-42; and Rosen, “Cameralism and the Concept of Medical Police.”
Burke, Royal College of San Carlos, 62-63.
Demerson, “La cesárea,” 208-18.
Univ. de Madrid, Archivo de la Biblioteca de la Facultad de Medicina, Antiguo Colegio de San Carlos, Libro de Acuerdos, 1787-1804, Juntas ordinarias, Mar. 3 and Nov. 3, 1803, pp. 55, 622-23.
Valle, “Cesarean Operation in Alta California,” 272-73; Gutiérrez and Archila, La obstetricia en Venezuela, 55; Julio Estrada Ycaza, El hospital de Guayaquil (Guayaquil: Archivo Histórico del Guayas, 1974), 93.
Pedro Tomás de Córdova, Memorias geográficas, histáricas, econámicas, y estadísticas de la isla de Puerto Rico, 6 vols. (San Juan; Oficina del Gobierno, 1831-33; facsimile ed., Instituto de Cultura Puertorriqueña, 1968), 3:135, 146-53; Archivo General de Indias (AGI), Audiencia de Santo Domingo, leg. 2288, census of 1807; Héctor A. Negroni, Historia militar de Puerto Rico (Madrid: Colección Encuentros, 1992), 520.
Maynard Geiger, The Franciscan “Pony Express” of California in 1803 (Santa Barbara: Whitney T. Genns, 197a), 3.
José G. Rigau-Pérez, “La difusión en Hispanoamérica de las primeras publicaciones españolas sobre vacuna, 1799-1804,” Asclepio 44 (199z), 165-79.
Municipio de San Juan, Actas del Cabildo de San ]uan Bautista de Puerto Rico, 1803-1809 (San Juan: Municipio de San Juan, 1970), 70 (Oct. 3, 1804), 98.
Gerardo Sellés Solá and Juan José Osuna, Lecturas históricas de la educación en Puerto Rico (San Juan: Bureau of Supplies, Printing, and Transportation, 1943), 40-48; Angel López Cantos, Miguel Enríquez, corsario boricua del siglo XVIII (San Juan: Ediciones Puerto, 1994), 24.
The baptismal scene in the portrait is interpreted as a reference to the miraculous baptism of another exemplary bishop, St. Julian of Cuenca. René Taylor, José Campeche and His Time (Ponce: Museo de Arte de Ponce, 1988), 202-3.
José G. Rigau-Pérez, “The Introduction of Smallpox Vaccine in 1803 and the Adoption of Immunization as a Government Function in Puerto Rico,” HAHR 69:3 (Aug. 1989), 393-423.
Idem, “Monstruos, mártires, o ejemplos: teratología en Puerto Rico, de 1798 a 1808,” Boletín de la Asociación Médica de Puerto Rico 77 (1985), 326-33.
Karl Schmitt, “The Clergy and the Enlightenment,” in The Roman Catholic Church in Colonial Latin America, ed. Richard E. Greenleaf (New York: Alfred A. Knopf, 1971), 155.
López Cantos, Miguel Enríquez, 24.
Cristina Campo Lacasa, Historia de la iglesia en Puerto Rico, 1511-1802 (San Juan: Instituto de Cultura Puertorriqueña, 1977), 164; Almudena Hernández Ruigómez, La desamortizacián en Puerto Rico (Madrid: Ediciones Cultura Hispánica, 1987), 42-66.
Iñigo Abbad y Lasierra, Historia geográfica, civil, y natural de la Isla de San Juan Bautista de Puerto Rico, ed. José Julián Acosta y Calbo ([San Juan] Puerto Rico. Acosta, 1866), 407. These difficulties are also documented in the burial records by the priests themselves. See, for example, AHD, Libro 2 de defunciones de la parroquia de Nuestra Señora de la Asunción en Cayey (1801-1812), Oct. 22, 1805, Oct. 23, 1806, and Jan. 22, 1807; and CIH-Burials, Yauco, June 16, 1805, and Guayama, Feb. 26, 1809.
CIH-Burials, Juncos, Aug. 17, 1810. Careless relatives are also mentioned in AHD, Libro 2 de defunciones, Cayey, Oct. 11, 1806.
Constitución 43 gives instructions only for baptizing babies in danger of dying in the middle of a delivery, “already having an extremity outside their mother’s womb.” Damián López de Haro, Constituciones sinodales de Puerto Rico (Ponce: Univ. Católica de Puerto Rico, 1989), 77.
Lanning and TePaske, Royal Protomedicato, 309-11.
Sherburne F. Cook, “Sarria’s Treatise on the Cesarean Operation, 1830,” California and Western Medicine 47 (1937), 107-9, 187-89, 248-50.
Francisco Danío Granados, report to the Council of the Indies, Aug. 13, 1711, AGI, Audiencia de Santo Domingo, leg. 2295, quoted in J. Gil Bermejo, “Los rigores de un obispo contra las malas costumbres,” Revista del Instituto de Cultura Puertorriqueña 5:14 (1962), 45-47. For the 1712 cedula, see Angel López Cantos, “Historia de una extraña normativa,” Revista del Instituto de Cultura Puertorriqueña 18:68 (1975), 9-12.
Vicente Murga Sanz and Alvaro Huerga, Episcopologio de Puerto Rico (Ponce: Univ. Católica de Puerto Rico, 1990), 4:256-59.
Gil Bermejo, “Los rigores de un obispo,” 46.
López Cantos, “Historia de una extraña normativa,” 11.
María de F. Barceló Miller, “De la polilla a la virtud: visión sobre la mujer de la iglesia jerárquica de Puerto Rico,” in La mujer en Puerto Rico: ensayos de investigación, ed. Yamila Azize Vargas (Río Piedras: Ediciones Huracán, 1987), 62.
Angel López Cantos, La religiosidad popular en Puerto Rico (San Juan: Centro de Estudíos Avanzados de Puerto Rico y el Caribe [hereafter CEAPRC], 1992), 20, 31-32, 58–59; Mariano Errasti and Victorio Beaín, Los franciscanos en Puerto Rico (San Juan: Ramallo Bros. Printing, 1994), 51-53, 57.
Barceló Miller, “De la polilla a la virtud,” 64-66.
CIH-Burials, Fajardo, Feb. 20, 1808, Humacao, Mar. 18, 1808, Juncos, Mar. 23, 1808. Also AHD, Libro 2 de defunciones, Cayey, May 8, 1813.
Fernando Picó, Libertad y servidumbre en el Puerto Rico del siglo XIX: los jornaleros utuadeños en vísperas del auge del café, 2d ed. (Río Piedras: Ediciones Huracán, 1982), 108, 170; Félix Manuel Ortiz Medina, “Análisis de los registres de matrimonios (1813-1850) de la parroquia de Yabucoa,” Anales de Investigación Histórica (Univ. de Puerto Rico) 1:1 (1974), 73-92, esp. 83; Nilsa I. Pérez Cruz, “Estudio basado en los registres de matrimonios de la parroquia de Moca, 1787-1836,” Ibid., 2:2 (1975), 1-47, esp. 28.
Teodoro Vidal, Tradiciones en la brujería puertorriqueña (San Juan: Ediciones Alba, 1989). 127.
Peiro, Deontología médica, 294-304.
These were the officially sanctioned offerings to the priest for rites performed in church, and it is unclear what they would have been (if any) for sacraments given in extremis. See “Arancel de los derechos y obenciones que deben conllevar los párrocos de Puerto Rico,” established by Bishop Jiménez-Pérez in 1773 and incorporated in the book of decrees still kept in the town parish of San Lorenzo, Puerto Rico (1812-1826, folios 13V-16); transcribed with minor inaccuracies in Generoso Eduardo Morales Muñoz, Orígenes históricos de San Miguel de Hato Grande (San Juan: Imp. Venezuela, 1943), 230-39.
Gutiérrez and Archila, La obstetricia en Venezuela, 49; P. Piulachs, “Honorarios de los trabajos y operaciones de cirugía según tarifa redactada en 1774 por el Colegio de Barcelona,” Medicina e Historia 66 (May 1970), 11; Cook, “Sarria’s Treatise,” 188. The procedure is not mentioned in a list of operations and standard fees drawn up in Puerto Rico in 1829. Francisco Oiler, “Prospecto para regularizar a tasación las operaciones chirúrgicas, que las ciencias médicas traen por necesarias en el cuerpo humano,” Revista del Instituto de Cultura Puertorriqueña 10 (1967), 60-63. A peon bricklayer earned 3.5 reales a day in San Juan in 1797. Angel López Cantos, Fiestas y juegos en Puerto Rico (siglo XVIII) (San Juan: CEAPRC, 1990), 222, n. 28.
They did so, e.g., during the 1792 smallpox epidemic in San Juan. See Municipio de San Juan, Actas, 1792-98, no. 1589, Apr. 8, 1793. Also during the initial distribution of smallpox vaccine throughout the island in 1804, when Bernardo Sanchez asked for permission to charge the well-off, and not the poor, for the procedure. AGI, Santo Domingo, leg. 2322, no. 32, doc. 4.
Salvador Arana Soto, Prontuario de leyes españolas relativas a la medicina, hasta el 1807 (San Juan: Asociación Médica de Puerto Rico, 1975), 53.
Respectively, Emigdio Antique and Francisco Brignonis; Louis Rayffer; José Dorado and Juan Antonio Castella; Francisco Oiler; and Miguel Chavarría, Ambrosio Infante, Miguel Coto, and José María Rodríguez. See AGI, Santo Domingo, leg. 2322, no. 31, doc. 6, Feb. 28, 1804; Municipio de San Juan, Actas, 1803-9, no. 60, Aug. 6, 1804.
AGI, Santo Domingo, leg. 2322, no. 32, docs. 2, 4.
López de Haro, Constituciones sinodales, Constituciones 38, p. 73, and 43, p. 77; Novísima recopilación, book 8, title 10, law 10, title 12, law 12.
Newborns baptized by the midwife are mentioned in the CIH burial records of Guayama, Aug. 16, 1808; Caguas, Mar. 29, 1810; and Coamo, Dec. 24 [sic, Nov. 24], 1814. The baptizing midwives in San Juan are named in AHD, Fondo Catedral, seccion Sacramental, serie Actas, subserie Defunciones, libros 17, 1805-1806, and 18, 1807-1809. Midwife Serafina Roxas, July 27, 1805; Tomasa Villarán, Oct. 22, 1806; Ana Francisco, Mar. 29, 1809. In CIH, Humacao: Martina Camacho, Apr. 4, 1808; Paula Rodríguez, at the site of Yeguadilla, Sept. 13, 1808. Fajardo: Maria Roman [Rivera?], Nov. 24, 1808; Ana Alexandra, Nov. 26, 1808; Ana Felix, Dec. 28, 1810. Yauco: Maria Feliciano, Feb. 4, 1809.
Irvine Loudon, Death in Childbirth: An International Study of Maternal Care and Maternal Mortality, 1800-1950 (Oxford: Clarendon Press, 1992), 166; Luis S[ánchez] Granjel, La medicina española del siglo XVIII (Salamanca: Univ. de Salamanca, 1979), 219-24.
Burke, Royal College of San Carlos, 188-96.
Rigau-Pérez, “Introduction of Smallpox Vaccine,” 421-22.
Municipio de San Juan, Actas, 1803-1809, 83. The San Juan municipal clerk was ordered to “inform practitioners instructively.”
AHD, Libro 2 de defunciones, Cayey, f. 82v. Entierros dobles had two processions, from house to church and from church to cemetery. See Luis De la Rosa Martínez, Lexicón histórico documental de Puerto Rico, 1812-1899 (San Juan: CEAPRC, 1986), 53.
AHD, Libro 2 de defunciones, Cayey, ff. 103, 116v. No book of protocolos notariales (where López’ testament might be recorded) has survived for that year in Cayey.
AHD, Catedral, Defunciones, libro 18 (1807-1809), ff. 4v-5.
CIH-Burials, Humacao, Jan. 13, 1807.
AHD, Catedral, Defunciones, libro 18 (1807-1809), f. 179v.
Mario A. Rodríguez León, Los registros parroquiales y la microhistoria demográfica en Puerto Rico (San Juan: CEAPRC, 1990). A search of the protocolos notariales covering any portion of the period 1805-1810 at the Archivo General de Puerto Rico, San Juan (AGPR), produced no information on cesarean cases. Adam Szaszdi studied exhaustively the protocolos of San Juan and found no reference to cesarean sections. Personal communication; see also Szaszdi, “El movimiento del puerto de San Juan reflejado en los protocolos, 1799-1813,” in Primer congreso de historia económica y social de la cuenca del Caribe, 1763—1898, ed. Ricardo E. Alegría (San Juan: CEAPRC, 1992), 375-410. Of the 22 existing volumes from the rest of the island, 13 could not be consulted; 2 were illegible, due to their poor state of conservation; and only 7 (for Aguadilla, Barranquitas, Coamo, and Juana Díaz) could be examined, but they made no mention of cesarean operations.
Laurel Thatcher Ulrich, A Midwife’s Tale: The Life of Martha Ballard, Based on Her Diary, 1785-1812 (New York: Vintage Books, 1991), 171; Loudon, Death in Childbirth, 553. For comparison, the maternal mortality rate for Puerto Rico in 1991 was 20.2 per 100,000 live births, or 0.202 per 1,000 live births. See Puerto Rico, Oficina de Estadísticas de Salud, Informe annal de estadísticas vitales, 1991 (San Juan: Departamento de Salud de Puerto Rico, 1993), 320.
John Clarke, Practical Essays on the Management of Pregnancy and Labour; and on the Inflammatory and Febrile Diseases of Lying-In Women, 2d ed. (London: [Johnson], 1806), quoted by Loudon, Death in Childbirth, 21.
AGI, Santo Domingo, leg. 2288, census of 1807; Bishop Arizmendi to City Council, Dec. 1, 1804, AGPR, Fondo Municipio de San Juan, Sanidad, leg. 124, exp. 4a, indicating that San Juan had 496 baptisms from Jan. to Nov. 1804. Even in an area controlled by a monastery, such as Catalonia’s Priorat, the 30,391 burial records from the sixteenth through the eighteenth century mention only 5 cesareans (2 in 1755, one each in 1759, 1760, 1786). See Pau i Roigé, “Cesáries,” 257-59.
De la Rosa, Lexicón histórico, 113-14. The tramos de sepulturas: the first, behind the apse; the second, to the sides of the church; and the third in front, with the south side assigned to slaves and paupers.
Gutiérrez and Archila, La obstetricia en Venezuela, 50; Valle, “Cesarean Operation in Alta California,” 267; Estrada Ycaza, El hospital de Guayaquil, 80.
Gaceta del Gobierno de Puerto Rico 10:205 (Aug. 27, 1829), 819; Valle, “Cesarean Operation in Alta California,” 267.
Novísima recopilación, José María Zamora y Coronado, comp., Biblioteca de legislation ultramarina en forma de diccionario alfabético, 6 vols. (Madrid; Alegría y Charlain, 1844-49), 4:556; Joaquín Rodríguez San Pedro, Legislatión ultramarina, 16 vols. (Madrid: Imp. de los Señores Viote, Cubas, y Vicente, 1865-1869); Ruiz Velasco and Pérez de Salazar, “Evolutión de la cesárea en México,” 117. A postmortem cesarean was performed by Dr. Tomás Rin (sic; perhaps Dr. Riu Barnés) in Puerto Rico in 1856 to try save the life of a child whose mother had died of cholera. Reported by Manuel Quevedo Báez, Historia de la medicina y cirugía de Puerto Rico, 2 vols. ([San Juan] Puerto Rico: Asociación Médica de Puerto Rico, 1946-49), 1:183.
Peiro, Deontología médica, 335.
José Blanc y Benet, “De la muerte aparente con relación a los sacramentos,” El Criterio Católico en las Ciencias Médicas 6 (1903), 131-38, 171-72, 197-238; Juan B. Ferreres, Death Real and Apparent in Relation to the Sacraments: A Physiologico-Theological Study, trans. from 3d ed. of Spanish (St. Louis: Herder, 1906). Ferreres’ book was translated from Spanish to English, French, German, and Italian, and his opinions were still being quoted in the 1950s; at least in Spain, by Peiro, Deontología médica, 336.
José Manuel Estepa Llaurens, ed., Catecismo de la iglesia católica, 2d ed. (Madrid: Asociación de Editores del Catecismo, 1992), 293, par. 1260.
Charles E. Weber, “Postmortem Cesarean Section: Review of the Literature and Case Reports,” American Journal of Obstetrics and Gynecology 110 (1971), 158; Centers for Disease Control and Prevention, “Physical Violence During the 12 Months Preceding Childbirth: Alaska, Maine, Oklahoma, and West Virginia, 1990-1991,” Morbidity and Mortality Weekly Report 43 (1994), 132-37; “Baby of Slain Mother Is Near Death,” New York Times, Oct. 26, 1989, p. A18; “Shooting Victim’s Baby Dies,” Washington Post, Jan. 26, 1991, p. B4.
Martin S. Pernick, “Back From the Grave: Recurring Controversies over Defining and Diagnosing Death in History,” in Death: Beyond Whole-Brain Criteria, ed. Richard M. Zaner (Norwell, Mass.: Kluwer Academic, 1988), 60. Even in present-day Puerto Rico, Madrid, or New York, concern over premature burial can provoke newspaper headlines. See P. J. Ortiz, “Hundreds Keeping Vigil at Río Grande Cemetery,” San Juan (P.R.) Star, Dec. 12, 1991, p. 16; idem, “Río Grande Coffin Opened; Family Satisfied Man Was Not Alive,” ibid., Dec. 13, 1991, p. 2; José Antonio García Andrade, “El diagnóstico de la muerte,” Ya (Madrid), May 4, 1993, p. 17; and Tom Hays (Associated Press), “N.Y. ‘Corpse’ Shows Signs of Recovery,” San Juan Star, June 17, 1993, p. 23. Recent books by surgeons at academic centers also reflect our own present-day efforts to understand all aspects of death. See Sherwin B. Nuland, How We Die: Reflections on Life’s Final Chapter (New York: Alfred A. Knopf, 1994); and Kenneth V. Iserson, Death to Dust: What Happens to Dead Bodies? (Tucson: Galen Press, 1994).
Cangiamila, Embriología, trans. Dinouart/Castellot, 2d ed., 80; also explicitly stated in Gerhard Van Swieten’s proposals of 1756 regarding regulations for burials, quoted in Erna Lesley, “Van Swieten über Kriterien des Todes,” Wiener Klinische Wochenschrift 84 (1972), 245. José Celestino Mutis, a priest and physician, reported in his diary his discomfort at having to certify the death of a fellow priest in Bogotá after a sudden collapse in 1761. See Marcelo Frías Núñez, ed., José Celestino Mutis. Viaje a Santa Fé (Madrid: Historia 16, 1991), 171. For the social effects of these concerns in nineteenth-century Paris, see François Delaporte, Disease and Civilization: The Cholera in Paris, 1832 (Cambridge: MIT Press, 1986), 42-43. Gustave Flaubert’s entry for “Burial” in his Dictionary of Platitudes (Emmaus, Pa.: Rodale Books, 1954), 18, is “too often hasty: relate stories about corpses that devoured their own arms to appease their hunger.”
It mentions that the immediate opening of the cadaver is allowed only in the case of pregnant women, because for any other death one must wait at least 24 hours, “and in certain cases one must wait much more. Jaime Bonells and Ignacio Lacaba, Del modo de practicar la operaeión cesárea en una preñada recién muerta,” Curso completo de anatomía del cuerpo humano, 5 vols. (Madrid: Sancha, 1796-1800), 5:484-85. The operation is also described in 1790 by Ventura Pastor, Preceptos generales sobre . . . partos, 2:184-87, with an engraved illustration (between pp. 182 and 183) and a lengthy mention of the proponents of (and indications for) performing this surgery on living pregnant women (2:174, 179-81).
Gutiérrez and Archila, La obstetricia en Venezuela, 51, quoting the editors of the Venezuelan Revista de Obstetricia y Ginecología 1:2 (1941), n.p.
AGI, Santo Domingo, leg. 2322, no. 32, doc. 2.
Salvador Arana Soto, Catálogo de médicos de P.R. de siglos pasados (con muchos de éste) (San Juan: Salvador Arana Soto, 1966), 310.
“The campaign to perform the cesarean . . . had one unforeseen but saving grace: all those writing pamphlets to advocate and explain the cesarean took the occasion to comment upon the horrors of childbirth in America . . . [and] how backward was obstetrics.” Lanning and TePaske, Royal Protomedicato, 318-19.
Attributed to the French historian Charles Seignobos, in Angeles Cardona de Gibert, “Estudio preliminar” to Nicolás Maquiavelo, El príncipe [Nicolo Machiavelli, The Prince] (Barcelona: Editorial Bruguera, 1979), 69.
