Man-Midwife, Male Feminist: The Life and Times of George Macaulay, M.D., Ph.D. (1716-1766)

Elizabeth Nihell's Treatise

If Thicknesse's critique tells us more about his fantasy life than about sensible objections to man-midwifery, a more reasonable though overlapping case on firmer and, one might say, on better medical and feminist grounds, was made by Elizabeth Nihell in A Treatise on the Art of Midwifery. setting forth Various Abuses therein, especially as to the Practice with Instruments: The Whole serving to put all Rational Inquirers in a fair Way of very safely forming their own Judgment upon the Question; Which is it best to employ, In cases of Pregnancy and Lying In, A Man-Midwife; or, a Midwife.[12]

A midwife herself and married to an apothecary, Nihell of course had a vested interest in trying to stem the rising tide of man-midwifery. Not only were men thronging into the profession, women seemingly cooperated in their incursion into a traditionally female realm by finding it fashionable to entrust themselves to the ministrations of the male practitioners. That her objections to what she perceived as a danger to lying-in women, however, were heartfelt and did not arise merely from pecuniary interest appears everywhere in her closely argued text. Nihell, having defended herself against the expected accusations of those who would reproach her for self interest, in part by reporting that she had delivered no fewer than nine-hundred women gratis, goes on to assert (probably fairly) that men-midwives are too rash in the application of their instruments (50). They often caused more problems than they solved, and they lacked the natural tenderness that one woman has for another. She admitted the justice of some of the accusations of ignorance often lodged against female midwives: "I own Page  109however there are but too few midwives who are sufficiently mistresses in their profession. In this they are some of them but too near upon a level with the men-midwives..."(viii). But, given equal ignorance in the practice of the men and the women, she draws a further distinction between them, one favoring the female practitioners:

Nihell continues by defending the historical preference evinced both by the general public and the medical profession for female midwives and by concurring with other critics in attributing the fashion for male practitioners to the French and their "eternal fondness...for novelties."

With trenchant irony, she doubts whether William Smellie, who had accused her and her husband of self-interest, had ever delivered a woman gratuitously unless he counted the pseudo-deliveries performed on the simulacrum he used to instruct his students in midwifery. "This," Nihell reports, "was a wooden statue, representing a woman with child, whose belly was of leather, in which a bladder full, perhaps, of small beer, represented the uterus. (Male midwives often administered beer as an anesthetic to women in labor.) "This bladder," she goes on to say, "was stopped with a cork, to which was fastened a string of packthread to tap it, occasionally, and demonstrate in a palpable manner the flowing of the red-colored waters. In short, in the middle of bladder was a wax-doll, to which were given various positions" (50). Nihell credits this "admirably ingenious piece of machinery" for the production of the "innumerable and formidable swarm of men-midwives, spread over the town and country. By [Smellie's] own confession, he has made in less than ten years nine hundred pupils, without Page  110taking into the account the number of midwives whom he has trained up, and formed in so miraculous a manner" (51).

Like Thicknesse, Nihell was a proponent of the ministrations of Mother Nature: "Lying-in women," she said, "principally require an early assistance. For unless they are pregnant of a monster with two heads...there need never be an occasion of recourse to a surgeon: or in this case, of a monster, it must be the affair of a most profoundly skilled operator, and not of merely a common man-midwife" (56-57).

Like Thicknesse as well, Nihell has her doubts about the objectivity of men—particularly young men—when they employ "the touch" as part of their diagnostic procedures. "In pure justice to all parties," she observed:

Although with respect to the motives of men in this particular she presents a much more balanced view than does Thicknesse, at root, the concerns of the two critics of male midwifery are essentially identical. Man-midwives were too often ignorant, rough, impatient, too stiff in the hands and fingers, and over-ready to use the injury-inflicting instruments of their trade, insensitive to the fears and concerns of their patients, and suspect in their objectivity toward their privileged access to the privy members of their female patients. Female midwives, by contrast,

Like Thicknesse, Elizabeth Nihell too has her horror stories to recount. Hers, however, savor more of fact than fancy. "Here," she tells us, "in the history of one single woman, I give the history probably of thousands."

She reports that a healthy woman who had experienced an easy delivery with her first child had trouble with her second. Over her objections, the male midwife, whom she had selected because he avoided the use of instruments, used them and accidently killed her baby (92-94). Nihell's description of the incident is detailed and graphic.

Nihell's objections to men-midwives, however, did not extend to female midwives' proper recourse to university-trained physicians and surgeons when circumstances called for them. She herself called on the men for assistance, as we learn from the case book that the then late George Macaulay's colleague at the Lying-in Hospital, Dr. Christopher Kelly, kept in 1771-72 concerning patients suffering from puerperal fever: "Mrs. Thane Aged abt 30 was taken labor with her first Child, Tuesday Morning Oct. 20, 1772 about 7 o'clock and continued lingering pain and with little rest till Thursday morning two o'clock when she was deliverd of a dead Child by Mrs. Nihile her Midwife."[13]

Not only did Nihell call on Kelly, she also called in Dr. William Hunter, and the two of them consulted with Dr. Garthshorn as well. Nihell probably chose to call these men because she knew them to be extremely conservative in their employment of instruments. William Hunter, though perfectly Page  112willing to employ instruments to save a mother's life, observed that his forceps had rusted from disuse in normal deliveries.[14]