Wednesday, October 22, 2014

Did a Doctor of the Church Prescribe Abortifacients?


A medical student asks:
I am trying to choose/discern who is my Confirmation saint. A friend mentioned St. Hildegard of Bingen, and I thought she sounded really interesting. In doing more research, I found ... some "sources" [saying] that she was against abortion and contraception and some [saying] that she was in favor of these through certain herbs that are "menstrual regulators." Here are some of the articles I found.
I love St. Hildegard and jumped at the excuse to delve into her Physica and letters. Let's 1) examine her work, 2) review how Church doctrine develops, and 3) mention a fundamental issue at stake. Busy people read bold.

St. Hildegard and Abortifacient Herbs
Does St. Hildegard prescribe abortifacients? In the most relevant part of her Physica, she uses a large group of herbs in a concoction for "obstructed menses."
Let a woman who suffers from obstructed menses take tansy, an equal weight of feverfew, and a little more mullein than either of the others. ... And when she enters [the] bath, let her place these warm herbs on the bench and sit on them. ... Let her do this as long as she sits in the sauna so that her skin and flesh are softened on the outside and in her womb by the humors of these herbs and so that her closed veins are opened. Then let her take bearberries, a third as much yarrow, rue a third as much as the yarrow, birthwort as much as the bearberries and yarrow, and a little more dittany. ... Boil this in the best wine and mix this into the sack with the previously mentioned herbs and thus prepare claret. Let her drink this daily...until she is well.
First of all, the goal of therapy is to make someone well. I expect our medieval mothers were familiar with the subtle signs of pregnancy, and they did not share the modern mindset that it is an illness. But let's not guess at authors' intentions; let's look at the facts. Are these plants abortifacient?

Feverfew has been studied in patients with migraines and is thought to be a vasodilator. A review does not list miscarriage or menstrual effects among observed adverse effects over 245 patients. It caused as many menstrual disorders as a placebo did in a low-powered randomized controlled trial.

Mullein, besides its current uses as a fish poison, has been used for ulcers and pulmonary complaints. Natural Standard gives the evidence supporting its ability to relieve earache a "C."

Dittany has been used for hysteria and uterine hemorrhages in the past; Natural Standard has no evidence on these uses.

Bearberry (of kinnikinnick fame), has "C"-grade evidence for use in urinary tract infections and hyperpigmentation. Natural Standard warns that the berries "in large amounts may induce labor," but gives no evidence to support this.

In a single animal study, yarrow was associated with decreased fetal weight and increased placental weight, but no studies have investigated further. An ethanolic extract of yarrow (200 mg/kg/day, intraperitoneally, for 20 days) and a hydroalcoholic extract (300 mg/kg/day, orally, for 30 days) had severe effects on murine spermatogenesis (a male contraceptive effect).

The only study that mentions tansy as an abortifacient is a 1979 sociological narrative. Although it goes into great depth on some herbs, its short paragraph on tansy explains that it was not used much among the population studied, and the authors didn't know why.

Rue contains pilocarpine, an abortifacient used in horses. (An FDA-approved medication for dry eyes and dry mouth.) Natural Standard cites deaths in women who use rue as an abortifacient. Rue's inclusion in the potion may explain the addition of yarrow and mullein: rue causes a contact phytophotodermatitis, and perhaps the anti-inflammatory or wound-healing effects of the other herbs was thought to be prophylactic.
Contact dermatitis from rue.

Birthwort contains p-coumaric acid and aristolic acid. These are abortifacient in mice with a single oral doses of 50 mg/kg and 60 mg/kg (of the methyl ester), respectively. A sesquiterpene isolated from the roots is abortifacient in 91.7% of pregnant mice at a single oral dose of 100 mg/kg.

I have no information on how much of these chemicals is contained in the raw or dried plant, so I have no idea how much of the plant parts a human being would need to consume to cause an abortion. Fortunately, it doesn't matter that I don't have this information, because St. Hildegard doesn't give absolute quantities, either. It is possible that the doses intended by St. Hildegard are lower than the doses required to produce an abortion.

Are some of the herbs that St. Hildegard uses abortifacient in certain quantities? YES.
Is she intentionally ending a pregnancy? DOUBTFUL.

Would her remedy end a pregnancy? DEPENDS ON DOSAGE.

A Doctor of the Church from the turn of the twelfth century composed an herbal remedy to bring on a late period; we now know this may be an early abortion. Should our adherence to the Humana Vitae come crashing down? Should we picket our chanceries for support of the HHS mandate?

The Church on Medical Ethics in General

No. This shouldn't ruffle any faithful Catholic feathers: it doesn't give us any reason to doubt the Church's teaching on abortion and contraception.

SNARE proteins at work in exocytosis.
(The same proteins underlie sperm-egg membrane fusion.)
St. Hildegard, like St. Thomas Aquinas, knew to protect human life as soon as she could detect it (more on this below the jump). Without microscopes, she could not observe that ovum and spermatid join, and the resulting zygote acts as an independent organism immediately after sperm-egg membrane fusion. If she was wrong about when human life begins and so thought that a remedy to "bring on the period" might be beneficial to a patient, she was invincibly ignorant.

Church teaching always develops as our knowledge develops. As embryology improved (with a French paper in 1879 describing "immediate animation") our mores responded (with protestant-based cultures like the U.S. outlawing abortions beginning in the 1800s), and so did Church teaching.

Female and male pronuclei in a zygote ready to divide
for the first time. Polar body at one o'clock. Src
We are freed by a more complete knowledge to better do what St. Hildegard was already doing: protecting unborn life.

Some still do not recognize that "bringing on a period" (and its more current equivalents) can result in loss of a human life. A Catholic who cannot see this can fall back on the Church's teaching, so that she can at least hold the truth. Unfortunately, those who are interested in potentially-deviant teachings by historical Catholics are often not open to falling back on the authority of the Church.

The Fundamental Issue: Catholic Docility
Something very fundamental is at stake in the discussion of whether St. Hildegard supports this or that. Faithful Catholic discussions about individual theologians must stand on docility. By "docility," I mean a an attitude of ready submission to the truth. This mentality is often missing from discussions of reproductive rights; however, without it, discussion and rights are meaningless.

Discussions are about truth, and rights are about happiness (or achievement of "the good," if you will). No human being can add or subtract to truth, and no human being can fabricate happiness. These are outside us, already determined by Someone else, and therefore "limited," in a way. The "limits" to truth and goodness are like bowling alley rails, helping our intellects and consciences reach perfection. If we bowl within the rails, we stand a chance of knocking down a pin. Without regard for the "limits" (docility) we bowl all over the building, pursuing apparent goods that aren't fulfilling according to opinions that aren't true.

Purely secular docility means regard for our inborn and universal human nature by forming our souls to achieve that nature's greatest good. It means informing our intellect with truths we or others can prove (e.g. that there is a God) or which need no proof.

Revelation adds to nature like General Relativity adds to Newtonian physics. There seem to be more limits, they are more complex, but this means greater freedom. Catholics are docile to the Truth as a God who loves us and left us an institution to help us apply the truth to our lives, so we expand our docility to include the Magisterium. A docile Catholic forms his conscience and intellect with the help of the Church, without which he cannot have faith. This formation and docility 1) helps us avoid sin in the advancement and application natural science; 2) makes conscience and the sensus fidelium accurate barometers of what will bring us happiness, rather than opinions and democratic whim; and 3) helps ground us when human persons say and write confusing things.

St. Hildegard was a great defender of docility to the Church and her headship. In an early letter to Pope Eugenius, she describes the Church as:
...a useful institution, tending toward God (and therefore assisting mankind), providing a light for man’s benefit. ...[M]any teachings and the fragrance of orthodox writing flow from the vigor of truth to it, but some people frequently reject them without justification.
She elaborates on those "people" in another letter to the same pope, complaining that they "disparage everything that prelates do, because they scorn the notion that they are inferior to their prelates...because they are full of the poison of envy." St. Hildegard herself had imperfect superiors; nevertheless, she encourages us to love the Church and be submissive to our superiors.

This attitude of submission grounds us, so that we're not easily ruffled by the behavior, speech or writings of individuals. "Keep calm and carry on," is the docile Catholic's mantra, and St. Teresa of Avila summarizes it well:
Let us look at our own faults and leave aside those of others, for it is very characteristic of persons with...well-ordered lives to be shocked by everything. Perhaps we could truly learn from the one who shocks us what is most important even though we may surpass him in...our way of dealing with others. ...[T]he Lord will take care of these souls.
Maybe St. Hildegard prescribed abortifacient herbs. With St. Teresa, I say "So what?" We can surpass St. Hildegard in our protection of human life. We shouldn't be so scandalized that we fail to learn the more important lessons St. Hildegard has to teach: that human life should be protected, and that we must be docile to the Church.

In conclusion, I am uncertain that St. Hildegard knowingly recommended certain herbs to end an early human life. One of her herbal remedies included chemicals that are certainly abortifacient, though I can't comment on what quantities would be required to cause an abortion and whether St. Hildegard used these quantities. Even if she did, she 1) protected the intrauterine life she recognized and 2) vehemently demanded docility to the teaching Church. If we value St. Hildegard, we would do well to imitate these two choices.

Replies to objections (including more on St. Hildegard's protection of the unborn) and recommended reading below the jump.

Replies to Objections
  1. You are not an authority on any of this.

    No, I'm not. I am a compiler of facts. So, if I am wrong in any part of this, please adopt a holy nonchalance and let me know my mistake in the combox. Error is NBD; sin is what we should worry about.

  2. How do you know St. Hildegard was anti-abortion?

    St. Hildegard says that hazelwort
    is very poisonous and...its warmth and dangerous power actually rush to harm a person. Therefore, it destroy's a person's nature more than it leads to health. ... And if a pregnant woman were to eat it, either she would die or she would abort the infant with great danger to her body. If a women [sic] who had not yet had a menstrual period were to eat it, it would afflict her more.
    St. Hildegard regards hazelwort as "poisonous" and she calls unborn fetus an "infant," including him in the category of "persons" the herb rushes to harm. 

  3. You didn't address all the herbs that Questions from a Ewe mentioned.

    Asarum is the genus of hazelwort; tenacetum is the genus of tansy and feverfew. Questions from a Ewe also mentions fern (a.k.a farn), of which St. Hildegard writes:
    And so when a woman gives birth to a child, let fern be placed around her and around the infant in its cradle, and the devil will lie in ambush so much less, since the devil hates the [fern-surrounded] infant when he first looks at its face.
    Here, St. Hildegard advises fern for the protection of human life. White hellebore and oleaster are not listed in my searchable translation, although I look for Latin, English, and other common names.

  4. Some say St. Hildegard supported the use of "menstrual regulators," which sounds a lot like modern hormonal contraceptives. You didn't address St. Hildegard's prescription of contraceptives.

    I saw no evidence that any of the chemicals listed could act as a contraceptive, except for yarrow's anti-spermatogenic effect in males. Questions from a Ewe discusses the possibility of St. Hildegard's support of emmenagogues, which I understand as only problematic when those emmenagoges are abortifacient.

  5. You didn't address herbs outside the remedy for "obstructed menses." What other herbs of hers could affect the female reproductive system?

    Great question! When I get off my gynecological oncology sub-internship, remind me to look up some more.

  6. Your translation is very different from Question from a Ewe's. You need to look to the original text.

    I think an expert should look into the original text (my medieval Latin/German/everything is... nonexistent). Until then, I encourage the reader to adopt an attitude of docility to the Truth and an holy nonchalance toward mistakes of canonized sinners.
Suggested Reading (in part from Sandra Meisel)
  1. Riddle, John M. Contraception and Abortion from the Ancient World to the Renaissance. Harvard University Press: Cambridge, MA, 1992.
  2. Riddle, John M. Eve's Herbs: A History of Contraception and Abortion in the West. Harvard University Press: Cambridge, MA, 1997.
  3. Aquinas on Abortion. Wordpress, 2012.
  4. Haldane, John, Patrick Lee. Aquinas on Human Ensoulment. Philosophy 78(2003), 255-278.
  5. Sabina Flanagan, Hildegard of Bingen: A Visionary Life. 2nd ed. Routledge: New York, 1998.
  6. Hildegard of Bingen, The Book of the Rewards of Life. Trans. Bruce W. Hozeski. Oxford University Press: New York. 1994.
  7. ___, The Letters of Hildegard of Bingen. Ed. Baird, Joseph L., Ehrman, Radd K. Oxford University Press: New York. 1998. 
  8. ___, Scivias. Trans. Columba Hart and Jane Bishop. Paulist Press: Mahwah NJ, 1990.
  9. ___, Symphonia. Trans. Barbara Newman. Cornell University Press: Ithaca NY, 1988. 
  10. Barbara Newman, Sister of Wisdom: St. Hildegard’s Theology of the Feminine. University of California Press: Berkley, 1987.
  11. Voice of the Living Light: Hildegard of Bingen and Her World. Ed. Barbara Newman. University of California Press: Berkley, 1998.

6 comments:

  1. Just a thought, but one of the purposes to regulate the menses, absent obvious signs of pregnancy, could also be to restore an infertile woman's cycles so that she *could* conceive.

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    1. Thank you for reading. That is a great point; I have no doubt that regular cycles were associated with fertility in St. Hildegard's time, even without the knowledge of ovulation and pathophysiology that we have today. I am so glad you pointed that out.

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  2. Has anyone considered that the woman may have had an ECTOPIC pregnancy so no period and may have felt very very unwell and been at the most serious and extremely likely risk of death? Perhaps 'blocked menses' was how an ectopic pregnancy was described and perhaps there was not knowledge that the blocked menses was because of a conceived human in the fallopian tube- the foetus would have been smaller than most of the blood clots or lumps from the lining of the womb which we seen in our menses. I suggest that the symptoms of ectopic pregnancy were labelled as blocked menses. I think this is a little rare but not that unusua,l and I do not believe the baby ever survives and the mother is at grave risk of death from having her fallopian tube ruptured and is in serious agonizing pain. This is why post ovulative relations are recommended for family planning and this is why the Bible says to wait seven days after the end of the period. Relations at this time would most likely result in a child conceived in the womb as opposed to in the fallopian tube.

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    1. Ursula, thank you for reading and commenting. You're right, an ectopic pregnancy wound cause a missed period, then pain (occasionally vaginal bleeding, but sometimes not). And as you say, ectopic pregnancy is also literally a blockage, which may be what St. Hildegard was referring to. I'm not sure how many ectopic pregnancies she would have seen in situ (meaning, where they are in the body, as at autopsy) because I'm not sure how common autopsy was at her time.

      Your idea makes me think that she might also have been treating missed abortion (incomplete, retained miscarriage). The truth is, she may have been treating a whole set of different things that present similarly, wih irregular cycles or missed menses.

      I've never seen any research or heard any explanation for post-peak intercourse resulting in fewer ectopic pregnancies. That would be fantastic to research! I'm at the Pope Paul VI Institute right now and can ask the faculty, if you like.

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  3. This comment has been removed by a blog administrator.

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    Replies
    1. Duplicate comment, no offensive content. (As I said above, good idea.)

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