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    Chapter Seven: The Midwifery Controversy

    If by dint of his birth and education and by virtue of his character Macaulay seemed destined to become embroiled in the political disputes of the medical profession, because of his specialty within that profession he also played a role in the centuries-long professional controversy surrounding female midwives. Unlike many of the male members of the medical profession, who strove alternately to control or supplant the women, George Macaulay took pains to cooperate with the women, to train them, and to share with them some of his medical expertise.

    As we have seen, as early as the 1650s but especially from the late 1720s onward there was in Scotland and England increasing pressure to "improve" the qualifications of persons who attended lying-in women. The traditional means of certifying women as midwives involved having witnesses testify to the competence and good character of a woman before a bishop, who then certified her as a midwife. While many of these women, who had perhaps apprenticed to their mothers or other relatives, were very competent at their profession, some among them surely constituted a danger to the mothers and infants in their care. Another class of midwife, however, included highly professional women who had received extensive training in their art before entering practice. Such a woman was Elizabeth Nihell whose work we discuss later and who was trained at the Hôtel Dieu in Paris.

    Pregnancy and Childbirth: Science and Folklore

    In the natural process of giving birth, if all goes well, the necessity of a midwife's assistance may well be minimal. In that qualification "if all goes well," of course, exists a world of room for accident dependent on multiple variables. For women in the eighteenth century, pregnancy and childbirth were rarely easy. Little was known about antiseptics or anesthetics, and Page  98the treatments and pharmaceutical specifics for conditions associated with parturition remained largely those from the practice and pharmacopoeia of ancient and medieval medical lore. For lying-in and post-partem women the remedies most often recorded included bleeding, enemas, laxatives, and sweating mixtures. The renowned surgeon and man-midwife William Smellie's casebook advises that one can administer food and drink in labor, including brandy and water.[1] Smellie goes on to describe a "portable mixture" he carried with him on country calls. This consisted of separate bottles of laudanum (a mixture containing opium), hartshorn, and tincture of castor. Hartshorn was literally taken from the horns of stags, made into shavings, boiled in water, and flavored for drinking. With brandy and water he would give these potions as cordials to alleviate pain during childbirth. If women suffered from excessive vomiting during pregnancy, Smellie advised bleeding and sedation, along with peppermint water and claret.

    During the post-partem period, The London Practice of Physic recommended a spare diet and chicken-broth, with warm caudle.[2] If the breasts began to be uneasy from milk stagnating, gentle diaphoretics were prescribed along with applied plasters with camphor. Pain and inflammation of the breasts were treated with a poultice of bread, milk, and oil (153-5). A fever "required the utmost caution in bleeding," rarely necessary; keeping the body open by gentle cooling cathartics, with the use of antiputrescents and large quantities of diluting liquors, and rest. "Let those who value their Lives...be sure to lie in Bed, and not rise and sit up, till the tenth Day at least after Delivery" (84). Clearly, bottom-line oriented, managed-care companies were not consulted about this schedule.

    While Macaulay was in Padua at medical school, an anonymous physician in London published "A Practical Discourse on Barrenness in Women, and Impotency, Infertility, and Seminal Weakness in Men," as an addendum to an earlier book devoted to women's health issues.[3] The addendum's preface chides women for their medical ignorance and for their hesitancy in seeking help from a physician: "The slender knowledge the Fair Sex have of their own infirmities and Disorder is the Reason they seldom call for Assistance, Page  99till their Illnesses are arrived at too grat [sic] a Height, for the Management of those they commonly apply to for Help..."(Directory, "Preface" A2).

    Of course, most women were accustomed to requesting help from midwives. The physician goes on to lament that:

    ...those who chiefly undertake the Cure of the Secret Indispositions of the Female Sex, and who are generally, or for the most Part, only advis'd with on those Occasions, are notoriously ignorant of them; I mean Midwives, Nurses, and other good Women, who, however well they may mean, are so little acquainted with the Nature and various Causes of the Weaknesses and Diseases I have treated of, or of any rational Method of curing them, that what they commonly advise to, are mere insignificant Trifles, and those frequently wrong-timed.

    ISINGLASS boil'd in Milk, Turpentine Pills, Clary fry'd with Eggs, Archangel Flowers, Armenian Bolel, vulgarly call'd Bole Armonic, Sperma Ceti, Confection of Alkermes, Penny-Royal Water, Dr. Stephens's Water, and compound Bryony Water, commonly call'd Hysterick Water, are in a manner their whole Magazine of Remedies, and while the Patients are amused and drilled on by such kind of Practice, their Distempers gain Ground, and too often become deplorable. (Directory, "Preface" A2)

    This book proposed to help women and the midwives gain a better knowledge of women's health issues and to acquaint them with helpful remedies whose sales would line its author's pocket. The unknown doctor says he "has arranged for all recommended medicines to be sold by the Gentlewoman at the Two Blue Posts in Haydon-Yard in the Minories London, at as moderate Prices as any Apothecary would make them" (A2-A3).

    A fair assessment of the efficacy of this physician's contribution to the pharmacopoeia of midwifery may be inferred from his detailed instructions for making uterine drops by mixing in a glass vessel iron filings with artichoke hearts and other substances, placing them in a "hot bed of horse Page  100dung" for a month, and using them to cleanse the womb (20). Nevertheless, aside from his financial interest in dispensing his nostrums, this physician also wished, at least, to benefit the women who practiced their craft on other members of their sex. His object was not to control or supplant them.

    Another effort with similar motives appeared after Macaulay had begun his London practice. This work, Nicholas Culpeper's A Directory for Midwives: Or, A Guide for WOMEN, In Their Conception, Bearing, and Suckling their Children, promulgated and helped perpetuate a number of superstitions and misapprehensions widely held among his contemporaries.[4]

    Culpeper wrote that the clitoris is that which "causeth Lust in Women, and gives delight in Copulation" but went on to repeat the ancient misapprehension that without pleasure one does not conceive, and that "the bigger the clitoris is in Women, the more lustful they are" (17-18).

    Conception, Culpeper explained, occurred when the female egg, referred to as a "seed," united with the male seed. A child's sex, however, was determined by the comparative strength of the father or mother's seed: "If a Man's Seed be strongest, a Male is conceived; if the Woman's, a Female..." Thus, "weakly Men get most Girls, if they get any Children at all" (38).

    Children were considered both a blessing and a curse. Besides suggesting remedies for infertility, Culpeper's chapter on what hinders conception, along with remedies, states that all men and women desire children, "partly because they are Blessings of God," or else because they are pretty things to play with. Since lust is probably the cause of begetting more children than the desire for the Blessings of God, the "Pleasure in the Act moves an hundred...It being apparent by the Curse of God upon Eve, I will exceedingly multiply the Conception, that many Children come into the World as a Curse" (53). This same precept—that pleasure, not procreation was the principal motive of sexual intercourse—moved Jonathan Swift's Lilliputians in the first book of Gulliver's Travels to remove children from parental care and turn them over to state nurseries for rearing and education.

    Culpeper lists four possible causes of infertility: 1. lack of love between man and wife ("this is the Reason there never comes conception upon Rapes"), 2. similar complexions of man and wife, 3. the letting of blood from a virgin's Page  101arm before menstruation, for "the blood comes not down to the womb as it doth in other Women, but the Womb dries up, and becomes for ever barren;" and 4. too much carnal copulation (54-55).

    While today sophisticated medical tests, like amniocentesis and ultrasound, can identify the sex of the baby a woman is carrying, both in Macaulay's era and even now for the majority of pregnant women who do not undergo such procedures, having friends predict the baby's sex is common—particularly since the chances of being right are fifty percent.

    Signs presumed to indicate a male in utero included using one's right rather than left hand to steady oneself when rising from a chair, a belly rounder and higher than when carrying a female, feeling the baby's movement on the right side, carrying the baby "not so heavily, but... more nimble in moving," having a right breast that is more plump and harder than the left with the right nipple redder, and finally, a mother's clear—not swarthy—complexion (80-81).

    Culpeper blamed having sexual intercourse during menstruation as the greatest cause of birth defects, suggesting that it "was not for nothing God himself forbad a Man not to touch a Woman at such a time" (86).

    In an intellectual and clinical climate where ancient and medieval medical knowledge was rapidly being supplemented by the discoveries of empirical science, but where both continued cheek by jowl with popular belief and Biblical fiat, it is little wonder that expectant mothers and women contemplating childbearing sometimes gave themselves over to a kind of fearful and resigned fatalism.

    Other than coitus interruptus and nursing one's own baby—practices with limited effectiveness—women could do little to prevent pregnancy. Macaulay's first wife, Leonora, had five babies in six years, and such serial, closely spaced pregnancies were clearly matters of grave concern for many. Lady Stafford in a letter of 1793 was obviously worried after the arrival of her daughter's new baby: "This is the third child in 21 months; that is too much for the strongest constitution."[5] It seems altogether likely that Leonora Macaulay's Page  102numerous pregnancies had undermined her health, for she died seven months after her last infant's birth.

    Licensing and Male Pressure

    To reduce the risks attendant upon childbearing, the Edinburgh Town Council, as noted earlier, took pains to assure the better qualification of midwives, requiring licensing procedures and hiring a city professor of midwifery, Joseph Gibson (ETCM, 9 Feb 1726). As we also mentioned above, as there is no evidence of Gibson's ever having taught at the university, one can only conclude that he had as his province the training of female midwives. Nevertheless, in Edinburgh, the traditional feminine province of midwifery was in process of subjection to the town council's (and therefore increasingly to male) licensure.

    In Scotland and elsewhere the exclusively male medical profession also asserted pressure to bring obstetrical practice under its control—an effort that has been closely studied by Jean Donnison in her admirable Midwives and Medical Men: A History of Inter Professional Rivalries and Women's Rights.[6] In 1688, Donnison reports, a midwife, Elizabeth Cellier, petitioned James II for the re-establishment in London of institutional lying-in for "destitute parturient women" (31). Cellier was convinced that the episcopal licensing of midwives was "no more a guarantee of skill than it had ever been."[7] She proposed incorporating all the skilful midwives of London into a Midwives' College, which would provide for the instruction and supervision of members and furnish a forum for the discussion of professional matters. Besides this, she wanted the Midwives' College to finance a Royal Foundling Hospital and twelve associated lying-in houses for female paupers to be cared for by women sent by the Overseers of the Poor.[8] Predictably, the scheme foundered, as did other proposals for incorporating female midwives into a professional, quasi-autonomous body, on the objections of physicians and on the novel idea that the women might be capable of governing themselves. Donnison Page  103recounts that in 1736 John Douglas, a well-known London surgeon, and brother to James Douglas, an eminent man-midwife, "demanded the establishment of lying-in hospitals in all the principal cities of England" (24).

    Beyond the attempts by female midwives to organize themselves into a professional body, there were also efforts by male surgeons and accouchers to organize the women under their administration and tutelage. Some of these attempts, like that of Dr. Hugh Chamberlen (d. 1720), whose family controlled the secret of the obstetrical forceps and who attempted to gain control of all London midwives, were patently self-serving schemes whose principal advantage would have been the production of income for their proposers; they were never seriously entertained—at least, not for long. Others, with a view to improving skills, proved useful. In 1739, for instance, a prominent London man-midwife, Sir Richard Manningham, instituted a "Charitable Infirmary for the relief of poor married women in two wards of St. James' Infirmary, Westminster," where both men and women would be trained as midwives (25).

    One of the most successful, though at the same time controversial, of the methods employed by men to establish control over the profession, however, was precisely the training of "men-midwives," a phrase first used in the mid-seventeenth century. The oxymoronic nature of the phrase gave rise to a good deal of satirical screed and several graphic images. The most renowned example, perhaps, of the latter is Isaac Cruikshank's etching, "A Man Midwife," that portrays a bifurcated male-female figure surrounded by the nefarious instruments of the trade: forceps, crotchets, scalpels and saws. [See Plate 10: Isaac Cruikshank's etching "A Man-Midwife."][9]

    Just as there were two classes of female practitioners, two sorts of men-midwives engaged in obstetrical practice. The first included men who, like Macaulay and his friend the famous and controversial Dr. William Smellie, Drs. John and William Hunter, Richard Manningham, Thomas Denman, and Christopher Kelly, had been trained in medicine, anatomy, surgery, and midwifery in the principal universities of Europe. These men, whose surgical qualifications in fact did equip them with specialized skills—including the use of instruments like the forceps, hook, and crotchet—could in cases of Page  104difficult birth sometimes make the difference between a mother's or a child's life or death. A second order of man-midwife, however, was comprised by men with no medical training except a crash course in midwifery. Instead of specializing at universities, this class of practitioner attended lectures and demonstrations afforded them by doctors like Smellie, who had actually invented a contrivance—a kind of artificial mother—by means of which to demonstrate for the edification of such pupils the birth process.

    Man-midwives of this second sort all too often gained practical experience by casually accompanying their mentors to births where, having first observed, they next assisted, and then, armed with a certificate, struck out on their own. Like their female counterparts, some of these practitioners were doubtless well trained and competent. Many, however, acquired their experience at the expense of the lives and health of mothers and infants. Most disturbingly they also sometimes undertook to instruct others in their scant knowledge.

    In her Complete Practice of Midwifery (1737) Sarah Stone writes: "More mothers and children had died at the hands of raw recruits just out of their apprenticeship to the barber surgeon than through the worst ignorance and stupidity of [female] midwives." Yet by adopting a 'finished assurance,' and claiming that their knowledge exceeded any woman's, these young 'Gentlemen-Professors' so secured their position that "if Mother, or Child, or both, die, as it often happens then they die Secundum Artem [in keeping with the best medical practice]; for a Man was there, and the Woman-Midwife bears all the blame" (Cited in Donnison 26).

    Objections to male midwifery; Philip Thicknesse's Polemic Satire

    Not surprisingly, other objections to man-midwifery arose in multiple quarters on several grounds. Some objected on the grounds of female modesty. These ranged from a settled preference on the part of some women for female attendance in intimate circumstances to heartfelt objections on religious and moral grounds to male intrusion into the most private of female domains. Other objections particularly arose from women's well-founded fear of the instruments the men used in delivery. Some who objected fanatically accused men-midwives of wholesale seduction of their patients and of salacious liberties with women's breasts and genitalia.

    Page  105

    The most fanatic of the last sort was typified by P. Thicknesse's pamphlet, Man-Midwifery Analysed: and the Tendency of the Practice Detected and Exposed.[10] This pamphlet responded satirically to William Smellie's great 3-volume work on the practice of midwifery that first appeared in 1752. Thicknesse was principally incensed about a male practitioner's handling the female generative and excretory organs on the grounds that doing so cuckolded husbands and debauched wives. But he also blamed men-midwives for their use of surgical instruments: levers, boring scissors, hooks, forceps with the attendant sacrifice of the lives of children and women.

    Thicknesse considered the man-midwife an unnatural monster, and he listed 1745 as the year of the monster's birth. This date corresponds to the founding of Westminster Hospital, but also to the year in which the female midwives of London again applied for and failed to obtain an organizational patent that would have institutionalized their profession on the same footing with barbers, surgeons, and other historic guilds—a failure that can principally be attributed to the Royal College of Physicians' self-interested and patriarchal mode of thinking.

    In his zeal to condemn man-midwives, Thicknesse told the following probably apocryphal story as true:

    A gentleman of the faculty (i.e. a country surgeon, apothecary and man-midwife) being sent for in great haste to deliver a woman, did, as soon as he arrived, in order I suppose to shew his dexterity, by the means of a hook, deliver her instantly from her pain, and the child from a life it could scarcely be said to have entered into: and having so done, took his fee and his leave; but before he had got two miles off, he was pursued and overtaken by the husband, who desired his immediate return, as the pains of this wife were come on again in a more violent manner than ever; but before the husband and doctor got back, she was delivered of another child, by the help only of that excellent, and scarce ever failing female midwife, Page  106Goody Nature! This old Lady, who had practised the art of midwifery in every corner of the globe, for many generations, with amazing success; was, about fifty years ago, stifled in France between two featherbeds, by Messrs. Doctor La Motte and Mauriceau: and no sooner was the good old lady interred, than these, and many other male impostors in that fantastical country, endeavoured to intrude themselves on the public as her legitimate sons; nay, to be able by their art, and with the help of hooks, crotchets, fillets, forceps, and scissars [sic], to surpass the good old lady. (2-3)

    La Motte and Mauriceau wrote notable treatises on midwifery. Smellie modeled his reference on that of La Motte, and Mauriceau wrote of the diseases of women.[11] The male writers of the anti-man-midwife party blame the French for founding of the movement. This view, as we shall see below, was also shared by female practitioners of the art.

    Both Thicknesse's satirical tone and his (probably fictive) illustration found reasonable grounds in the practices and attitudes of the worst of the male midwives. Thicknesse's reading of Smellie's text, which had had the benefit of Tobias Smollett's editing, suggests, however, a high degree of prurient projection into a physician's manual examination of a woman to determine pregnancy and the degree of its advancement. Based on Smellie's instructions for conducting such an examination, Thicknesse imagined as habitual a seduction in which he takes on a first person, physician-roué's persona. "The touch" to which he alludes involves palpation of the rectum and genitals. His man-midwife imagines a home call and examination:

    Upon my arrival, if her husband happens to be present, he must retire; for I know too well, the pain that he must feel, on hearing even the first necessary question: Therefore nothing but an affected, stiff air, a grave face peeping Page  107out of a profound wig, and my hand kept warm in my muff, must transpire, till the husband is gone out of the room; and from that instant, the dressing-room becomes sacred to me and my patient. I then proceed to ask such questions, with an air of gravity and importance, that must confound a woman of modesty beyond imagination: upon perceiving her embarrassment, I get up, take her by the hand, and tell her how very unlike her conduct is to my lady Lucy Likeit, whom I have just left; that her ladyship thought she was with child, but that I could perceive no circle around her nipples, [cf. Smellie], nor by the touch had I any reason to believe she was breeding: This reconciles my new patient; she hears, and wonders at lady Lucy's conduct; but believing it no more than is common, and that the Doctor has a licence to take, and she to grant these liberties, she acquiesces. I then proceed to examine her breasts, nipples, &c. by which I am soon able to discover, what further liberties I may proceed to, under the sanction of my great wig, and my grave face; and if once admitted to the touch, all difficulties for five or six months after, are removed; my patient and I understand one another; secrecy is the word; my character, and her honour seal it.

    If men-midwives under these circumstances stand unmoved, they are a part of the human species I am a stranger to! Suppose then, for it is no more than natural to suppose it, that I should, after the Touch, offer some further liberty, (a more indelicate liberty I cannot offer) suppose then, I say, my patient should fly out, and ask me what I mean by such insolent and unwarrantable conduct? and go towards the Bell, in order to call her husband and servants: what must be done? why, step in between her and the bell, drop on my knees, and implore her pardon; telling her that my profession does not emas- Page  108culate me; that my own, and my family's bread, depends upon my character in my profession; that I never was so unfortunately overcome upon any former occasion; that what had happened, was more my misfortune than my fault; and that I must have been more or less than man; to have stood unmoved, on such an occasion with such a woman. Here is a full and certain pardon obtained; for a sensible woman would be too wise to tell her husband, and a foolish woman too vain. (9)

    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:

    They are incapable of doing so much actual mischief as the male-ones, oftenest more ignorant than themselves, but who with less tenderness and more rashness go to work with their instruments, where the skill and management of a good midwife would have probably prevented the difficulty, or even after its coming into existence, prove more efficacious towards saving both mother and child; always with due preference however to the mother. (ix)

    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:

    ...besides many other points to be learned only by ocular inspection and manual palpation, of which no theory by book or precepts can convey satisfactory or adequate notions, that great and essential point in our profession, a skill in what we call the Touching, is not be acquired without a frequent habit of recourse to the sexual parts whence the indications are taken. And in this nothing but personal experience can perfect the practitioner. But this admitted only proves the more clearly the utter impropriety of men addicting themselves to this occupation. (85)

    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,

    ...have more patience and sympathy for other women. They feel for those of their own sex so much, that that feeling operates in them like an irresistible instinct, both Page  111in favor of the pregnant mother and of the child. Thence it is, that a woman-practitioner will employ, without stint, or remission, all that is necessary to predispose the passages, for the least pain, and the greater safety; she will patiently, even to sixteen, to eighteen hours, where an extraordinary case requires so extraordinary a length of time, keep her hands fixedly employed in reducing and preserving the uterus in a due position, so as that she may not lapse the critical favorable moment of extraction, or of assisting the expulsive effort of nature. (90)

    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]

    Late Term Abortion: Cranial Reduction: The Petition of Unborn Babes

    The late twentieth-century debate concerning late term abortions was anticipated in the mid-eighteenth century in the discussion of an operation, alluded to above, euphemistically termed "reduction of the cranium." Responsible physicians had recourse to this desperate measure only in cases where the mother's pelvic structures were too narrow or too deformed to permit a normal delivery with a resultant threat not only to the infant's life, but also to the mother's. Contemplation of the deliberate termination of the life of a healthy child who had been brought to term occasioned precisely the same sort of public horror that it does now.

    The critics of man-midwifery seized on that horror to try to incense the public against its practitioners. In doing so, at least one of them singled out as principal objects for his vituperative scorn the British Lying-in Hospital for Married Women in Brownlow Street and its staff. This tract, The Petition of the Unborn Babes to the Censors of the Royal College of Physicians of London, appeared shortly before George Macaulay joined the hospital's staff.[15] [See Plate 11: The Petition of Unborn Babes.] It begins by asserting the right of the unborn to the protection of the law. We quote from it at length because it frames the debate and because it directs its attack specifically against the hospital and staff where George Macaulay was to serve:

    To the Censors of the Royal College of Physicians of London; The Petition of the Unborn Babes. Humbly Sheweth, That, although your Petitioners are not his Majesty's natural-born Subjects, nevertheless, being resident within his Dominions, they are by the Laws and Constitutions of his Kingdoms intitled to Protection. (1)

    The pamphlet continues in a broadly satirical, indeed Swiftian vein, excoriating men-midwives and anticipating many of the arguments of the Page  11321st century's right-to-life movement. Dr. Pocus seems to have lampooned Dr. Daniel Peter Layard; Maulus, Dr. William Hunter; and Barebone, Dr. William Smellie.

    But so it is, that we your Petitioners have of late Years been grievously ill-treated by Dr. Pocus, Dr. Maulus, and other evil-minded Men their Followers and Confederates; who, not haveing the Fear of God before their Eyes, nor Abilities to get an honest Livelihood, have assumed the Character and Discourse of Old Women; and takeing advantage of the Fears and Ignorance of our Mothers, persuade them, that we your Petitioners are their avowed Enemies; and that our Appearance in the World will be to their utter Ruin and Destruction. By which wicked Persuasions our Mothers are led into a Confidence and Reliance on the Friendship and Assistance of these ignorant Men; and hire them at extravagant Rates to distress, bruise, kill, and destroy your Petitioners, contrary to the Peace and good Order of his Majesty's Government.

    And we your Petitioners particularly charge, that, if we cannot leave our Dwellings, and make our appearance, so soon as is expected, either from the unwieldyness of our Gates, or by means of any other Obstacle requireing time for Its Removal, or if through Fear of the Cruelties commonly exercised by the said Pocus, Maulus, and their Confederates, your Petitioners are unwilling to leave their Habitations, the said Pocus, Maulus, and their Confederates, being present, charge your Petitioners with a Riot tending to the Murder of our Mothers; for which Crime we are forthwith drag'd out our Habitations by Hooks, Pincers, and other bloody Instruments, whereby we are sometimes most miserably torn and bruised, and at other times our Heads are so squeezed, that we are ever after subject to Fits, and Convulsions, unless (as by God's Page  114Goodness it often happens) we die under the Operation. And in case of any the least Resistance, whether on our part, or from the Nature, and Situation of our Habitations, we are sentenced to Death as guilty of Rebellion, and in consequence of such Sentence we are sometimes beheaded, and at other times our Brains are torn out by Instruments wickedly contrived for that Purpose. Or if your Petitioners happen to put an Arm out of Doors, whether in our own Defence, or to feel our way, the said Pocus, Maulus, and their Confederates, immediately cut off such Arm as high, as they can reach; by which means your Petitioners bleed to Death in great Misery and Torture.

    And we your Petitioners likewise charge, that, if when drag'd out of our Habitations we are either already dead, and cannot, or so weak and terrified, that we dare not, cry for Mercy, we are then by the Directions of the said Pocus, Maulus, and their Confederates, shook and whip'd; contrary to that Humanity, which is due to the Distres'd, or that Decency, which is due to the Deceased.


    Whereas we your Petitioners deny, that we ever had any Intention to destroy, or that we of our own Motion ever do injure our said Mothers: but on the contrary we do aver, that such Bruises, Wounds, and injuries, are wholly owing to the Ignorance, Impatience, and savage Disposition, of the said Pocus, Maulus, and their Confederates. And we your Petitioners are ready to prove such our Averment, as well by compareing the Bills of Mortality in former Times, wherein good Women only attended our Affairs, with those of later Years, in which these wicked Men have exercised their Barbarities; as by the Printed Accounts of the Hospital of Lying-in Women in Brownlow-Street: By which Accounts it is admitted, that one in Fifteen of all the Children there born, are drag'd dead Page  115into the World; and it is reserved a Secret, how many more of the Fifteen die soon after of the Wounds and Bruises there received, as also how many of the Mothers remain alive, after passing through such Experiments, as are there try'd on miserable Mortals (1-3)

    After charging the doctors with malpractice and lying, and after making other unfounded charges, including the usual ones about sexual misconduct and about the complicity of the nurses in the physicians' malfeasance,in an extended footnote to pages 4 and 5 of the petition, its author alleges that the Censors of the Royal College of Medicine had recently been required to sit as a court of inquest into the deaths of six children who had died in deliveries attended by a man-midwife. It may very well be the case that this inquiry, if it indeed took place—we can find no record of it—together with the Petition and the publicity surrounding both played some part in the resignation of Macaulay's predecessor, Dr. Daniel Peter Layard. The author of the anonymous Petition, very likely a physician, was certainly displeased with the outcome of the inquiry, whose putative proceedings he scornfully recounts:

    The Discourse was open'd by Dr. Pocus in a labour'd Harangue, by which he endeavour'd to prove, that unborn Children neither being Christians, nor having taken the Oaths, cou'd by no means be intitled to Protection either from the Church or the State. He endeavor'd likewise to shew, that a Child in the Womb might be consider'd as a Wart or a Wen; but at most it could only be look'd on as a Twig of a Tree, or a Leaf of a Plant, which might reasonably, and according to common Usage, be sacrificed to the Preservation or Convenience of its Parent. He enforced his Opinion by the Example of a Cow with Calf, in buying which the Butcher takes a Receipt only for a Cow, whereas, if the Calf were a distinct Creature, and Action would still lie against him for the Calf. In like manner, he said, if a Thief is indicted for stealing Page  116a Mare, and is acquitted, if the Mare proves with Foal, the Thief might be again indicted for the Foal, which, according to his Law-readings the affirm'd, cannot be. Sir William seconded the Opinion of Pocus; but at the same time gave it another turn. He thought, that a Child in the Womb, in the full Signification of the Word, was properly an Abscess, being design'd abcedere a matre, to go from the Mother, and as such the Operator had a right to let it out (according to the learned Daniel Turner) in such manner, as he should judge best. The Chairman smiled his Approbation of this Conceit, and Sir Edward, who had sat musing upon a Dirty Barbain of Assiento Tobacco cry'd, Aye, aye, why not?

    In response to this clearly fictive, logic-chopping rationalization, the pamphlet's author invokes the spirit of the renowned discoverer of the circulation of blood, Gabriel Harvey, whose bust had overlooked the Royal Society's proceedings. With the ire of a patriarchal prophet, Harvey's offended ghost admonishes the assembly:

    The Assembly were rising when astonish'd at such wild discourse the immortal Harvey spoke from that Marble-Bust, which overlook'd them. He explain'd to them, that Life and the Circulation were inseparable; that, as these Children had their distinct Circulations and Motions, so it cou'd not be deny'd, that they were distinct Beings, that they had a Life of their own, and were equally intitled to Preservation with their Mothers. That their Lives were under the Protection of God and the Laws; and that the Man, who on any pretence took away the Life of a Child, was guilty of Murder both Law and conscience. That, as to what had been foolishly suggested about the Oaths, he could only say, that, if duly tender, he believed, they wou'd not be found to refuse them. And as to their not being Chris- Page  117tians, the Crime in taking away their lives might be doubled on that Account; as they were not only robb'd of Life in the World, but, according to the Doctrine of many Christians, are prevented from attaining that eternal Felicity, to which they wou'd otherways soon have been intitled.

    Surprized and confounded at a Discourse so strangely deliver'd, the Assembly stood amazed, and began to look with contempt on Pocus and themselves; when Sir Edward starting up, cry'd: Poh! Poh! what Suff [sic] is all this about Circulations and Felicities! I know of no Circulation but Bank Circulation, nor any Felicity but in Gold: and don't believe they have any thing to do with either. A Speech so well adapted to the Genius of the Assembly soon brought them back to their former Sentiments; when the immortal Harvey spoke again and said: Ye are a Race of Men much degenerated from those, whom I once knew here, whom I Loved and whom I honoured. Ye have neither the Learning, nor the Virtues, consistent with the Character which ye profess. Ye contemn Knowledge, and ye are despised by the Princes and the wise Men of the Land. Ye shall become Slaves to Apothecaries, they shall direct your doings, and ye shall be a Scoff at their Meetings. Ye shall be visited with shame and Confusion, and this your Dwelling shall be divided among the Scots.

    Facts against Polemics: The Hospital's Response

    To this scathing condemnation of the charity's practice (not to mention the xenophobic assault on Scotch physicians) the board of Governors of the British Lying-in Hospital felt itself obliged to respond. At its weekly meeting of 23 January 1752, the board authorized publication of a simple recital of the facts that the Petition had distorted so polemically.

    The board reported that 545 women had delivered 550 babies between November 1749 and January 1752. Of these babies, 29 had been stillborn. Page  118On the 20th of January, the previous year, the board continues, four women (not six), included in the above numbers did have stillborn children. Three of those four were assisted in easy deliveries, not by men-midwives, but by one of the two resident female midwives. The fourth mother had indeed been delivered by one of the men, and she had borne twins, one of whom was born alive. The other had evidently been killed when the woman fell three weeks before coming to the hospital.

    The men-midwives assisted in delivery, the board carefully explained, "only in any appearance of Danger, about once in 30 or 40 cases" (MB, 23 January 1752). Finally, the board's report makes clear that of the 545 deliveries, only two required the use of instruments capable of hurting—both times on children already dead and then only after both men-midwives agreed the procedures were necessary to save the lives of the mothers. In both cases, the mothers were in fact saved.

    Beyond that, Thomas Yewd, the charity's secretary, caused the following retort to be printed in The General Advertiser, for Saturday, 18 January 1752 (NUMB. 5382):

    Lying-in Hospital for Married Women in Brownlow Street, Long-Acre, January 17, 1752 The Quarterly General Court held this Day at the Hospital having taken into Consideration the following Charge brought against this Charity, in an anonymous Pamphlet, intituled [sic] the Petition of the Unborn Babes to the Censors of the College of Physicians of London, etc. viz. as well as by the Printed Accounts of the Hospital for Lying-in Women in Brownlow-street, by which Accounts it is admitted that one in fifteen of all the Children there born are dragg'd dead into the World, and it is reserved a Secret, how many more of the fifteen die soon after of the Wounds and Bruises there received, as also how many of the Mothers remain alive after passing through such Experiments as are there tryed on miserable Mortals. And having made a Strict Enquiry into the Facts alledged [sic], do find them to be greatly misrepresented—as the Author himself might have known, had Page  119he thought proper to have taken the trouble of visiting the Hospital, and examining into the Affair, before he published this unjust and uncharitable Accusation.

    Nonetheless, a procedure that involved opening a baby's head, even to save a mother's life, horrified and repulsed the public. We must understand that Caesarian section in cases where the pelvic structures were either too narrow or too deformed to admit an infant's passage was not an eighteenth-century option—at least not if the mother's life were to be preserved. Though the child might live, Caesarian section almost invariably proved fatal to the mother. It was only ordinarily attempted in an effort to save a child whose mother had already expired or was irretrievably moribund. William Smellie in his career attempted the operation three times after the death of a mother, but in each case the child, too, had already died. Smellie reports and Spenser following him confirms only one case in the British Isles where both mother and child survived, and that seems to have been a case of pure luck. The operation was performed by Mary Donally, an illiterate but widely respected Irish midwife, in January 1738/39. This was the first successful Caesarean section in the British Isles with both mother and child surviving.[16]

    The second part of Nihell's treatise devotes itself to an examination of the difficulties that various male authorities report concerning cranial reduction, preternatural and difficult births, and their unhappy results. She also discusses what she, in her experience as a carefully trained and much practiced midwife, would do either as a precaution against just such difficulties, or as a palliative when they occur. Her attempt—variously successful—is to undermine the authority of the authorities. Advising the use of bare hands in circumstances where surgeons generally employed instruments, she catalogues in horrifying detail the various methods the men had proposed for bringing away the head when it is too narrow to pass naturally and those for extracting the head of the Fetus, severed from the Body, and remaining in the uterus and offers advice.

    Page  120

    Macaulay and "The English Operation"

    There is little wonder that the doctors of London thought it a good idea to devise a way for obviating the necessity of cranial reduction and inducing labor before a child was too fully developed for an easy delivery through narrow or deformed pelvises. Partly as a response to the public outcry against this particular procedure, and partly, surely, from purely humanitarian motives, George Macaulay was among those instrumental in convening a conference of eminent London surgeons and physicians to consider alternatives.

    They met in 1756 to discuss the implications, moral and medical, of inducing early labor. If a child were born before its head grew too large for narrow or slightly deformed pelvises, the necessity for cranial reduction would be obviated. The members of the committee discussed the issue of whether or not intervening in the natural process was ethical. Concluding that, in view of the enormous benefit such a procedure would produce, it was indeed ethical, they appointed Macaulay himself to perform the first such operation when it became necessary, and this he did in 1756, successfully delivering the wife of a London linen draper in the Strand.[17]

    Macaulay's procedure itself involved carefully puncturing the amniotic sac with a silver wire and drawing off approximately a spoonful of amniotic fluid. This operation had the same effect as the water breaking in triggering the mechanisms that induce labor—usually within forty-eight hours. Macaulay's method for encouraging early labor became known as "the English operation," and over the next century and a half was responsible for saving the lives of many women and children who otherwise would have been lost either to Caesarian section or to cranial reduction. Macaulay's "English operation" passed next to Christopher Kelly and from him to Thomas Denman. As more doctors learned to perform it, the procedure became dissociated from Macaulay's name. Surely, it was his greatest contribution to obstetrical practice.

    The Science of Anatomy

    In the ongoing debate between the midwives and the physicians, the latter frequently alleged their superior knowledge of anatomy as grounds for preferring their services. As commentators like Jean Donnison remind us, except Page  121in Italy, women had no access to the universities and the dissecting theaters of places like Padua and Edinburgh or to the medical degrees they offered.

    Nihell, however, remained unconvinced by these arguments from a superior knowledge of anatomy: "It may be true," she said,

    that anatomy...much conduces...to ground the student in mechanical principles of great assistence to him in practice...yet that truth is not incompatible with another quite as much a truth, that midwifery can have no occasion but for a general notion of the configuration of those parts upon which it is exercised. A midwife, for example, may be a very safe and a very good one, without knowing whether the uterus is a hollow muscle, or purely a tissue of membranes, arteries and veins; but if that ascertainment is necessary, she must wait for it till the anatomists have settled among them that point, which, like many other capital points of anatomy, is not however yet done. In short, once more, a woman in labor requires a midwife to lay her, not an anatomist to dissect her, or read lectures over the corpse, he will be most likely to make of her, if he depends more on the refinements of anatomy, that on the dexterity of hand, and the suggestions of practical experience and common sense. (102-03)

    Vis-a-vis anatomy, her final recommendation calls for public spirited physicians to share their specialized knowledge with the female midwives:

    Let the physicians, the surgeons instruct the midwives in so much of anatomy as is necessary to their function; let them afford them, either in writing or verbally, their guidance and direction in the consequences or occasionally in the preliminaries of management of the lying-in; all this is right, salutary, and in due course: but that men should pretend to the manual operation in these cases, it certainly neither is nor can be their business. Nor is this Page  [plates]Page  136negation of propriety a reproach to them. Will any man think it an indignity to be told, he cannot clear-starch, hem a ruffle, or make a bed as handily as a woman? The exceptions are the shame; and in this department of art it would be truer to say, that there are no exceptions than that there are only a few. (251)

    On the limitations of men-midwives, she continues:

    The men-midwives, in general, have never, at the most, carried their studies beyond the disorders commonly incident to pregnant women: the knowledge of all the other possibly collateral ones, is what even the least modest of them will hardly claim, unless to the profoundly ignorant, and is in fact scarce less than impossible to one who has applied himself essentially to the manual function. [A midwife's] consciousness of her own want of sufficient light, will engage her readily to state the exigency to some able and experienced physician, whom she must allow, in such cases, to be her superior judge: whereas the other, the man-midwife, acknowledges no greater authority than that with which he is pleased to invest himself. (117-18)

    With all too certain justification, Nihell accuses men-midwives of a particularly inexcusable arrogance: prescribing general physic though they have never studied medicine.

    But where there is a complicated case, dependent on the physician's art, then the trusting to those men-dabblers in midwifery is a folly that may be fatal to both mother and child, or, at the best, the delivery will have been rendered more painful, more laborious, more big with danger, for those precautions having been neglected, which can be so little supposed to occur to the common run of men-midwives in cases foreign from their rote of practice. (132-33)

    Page  137

    The justice of this accusation Smellie himself confirms in his report of a patient whom he found under the "care" of just such a man-midwife.[18]

    In 1748, Smellie tells us, a lady asked him to visit a woman who had formerly been her servant. "On my arrival," he reports, "I found another practitioner there, who seemed much surprised, and with a very surly countenance scolded the husband for bringing another without his knowledge" (III, 486). From the ensuing report, it becomes clear that Smellie as much as Nihell despised the pretensions of untutored practitioners who insolently exceeded their capacities. The man-midwife's dress, Smellie says, "was as forbidding as his countenance, consisting of an old greasy matted wrapper, or night-gown, a buff broad swordbelt of the same complexion round his middle; napkins wrapped round his arms, and a woman's apron before him to keep his dress from being daubed. At the same time, to make him appear of consequence, he had on his head a large tie periwig" (III, 486).

    Smellie pacified the man-midwife by apologizing and explaining his presence. The husband, too, excused himself, explaining the lady's interest in his wife. Somewhat mollified, the man-midwife blamed the lady who had summoned Smellie and "began to abuse the lady's ignorance of his importance, and damned all midwives for ignorant b[itche]s" (III, 487).

    Having pacified the fellow, Smellie "begged he would tell me how his patient was, that I might inform and satisfy the person who had desired me to call" (III, 487). "By this calm reasoning," Smellie continues, "his surly aspect unbended. He told me he was just going to deliver his patient, and, if I pleased, I was welcome to be present at the operation; for he could wait no longer, as he had already lost one patient by waiting two days on this; and now he was called to another" (III, 487).

    In other words, this unnamed practitioner was about to use instruments to hasten dangerously the birth of one child in order to enhance his income. He then admitted to Smellie that two nights before the woman had gone into labor, "but as he was then uncertain how the child presented, and she had got little sleep for two nights before, he had ordered her repeated doses of opium, which had produced little or no effect; but that last night she Page  138had been quite stupid and often convulsed; and that nothing could save her life but present delivery" (III, 487).

    Eventually, having described the woman's condition in detail, and excusing himself for a time, the practitioner invited Smellie to examine his patient. This Smellie did, and found the woman much as she had been described, except that the head of the fetus had descended to just above the Ossa Pubis, which the practitioner had not observed. The practitioner left for a while, and in his absence, the apothecary, who was also present, advised Smellie that the patient had taken a total of about 15 grains of opium; "this was the occasion of the convulsions and stupidity" (III, 487).

    On the quack's return, Smellie tactfully convinced him, considering the patient's stupor and her convulsions, that the case was no longer straightforward midwifery, and that "it would be proper, for the safety of all concerned, and in order to prevent reflections, that the husband should go to the lady, and beg of her to send her own physician to our assistance" (III, 487).

    This all agreed to, and when the physician came he inquired, "minutely about the quantity of opium which had been administered.... The man-midwife and the apothecary disagreed in their accounts," and when the latter went for the bills as proof, the man-midwife suddenly remembered another patient elsewhere, and asked Smellie to take over. This Smellie declined to do. The physician enraged the fellow by telling him that "if the woman was kept quiet, she would sleep off her large dose of opium" so that "he left the house muttering revenge against the apothecary." (III, 487). Smellie and the physician agreed that as the opium wore off the woman would resume labor. They therefore sent for a female midwife to attend the birth. Unfortunately, though the mother survived the overdose of opium, the child was born dead.

    Frequently, as previously noted, Nihell blames the foolish whimsicality of the French (a national characteristic she thinks) for introducing man-midwifery as a fashion to which the gentry have at their peril subscribed.

    This novelty then appeared to practitioners despairing of business enough in their own way, an excellent scheme for eking out their scanty cloth with this bit of a border, of which by degrees they have made to themselves a whole cloak. In Page  139short novelty joined, to the much exaggerated objections to perhaps a few insufficient midwives, brought in and established a remedy yet worse than the disease. Their success encouraged others; and now behold swarms of pupils pullulating, and forming on the models before mentioned. Thus two or three maggots have produced thousands. Iron and steel are not tender: and yet it was by the pretended necessity of resorting to instruments made of these metals, that these out-casts of either profession effectuated their introduction into a business so little made for them. Then it was, that not with the least squinting view to filthy lucre, but purely out of stark love and kindness of the women, that these redressers of wrongs, armed with their crotchets, and other weapons of death, took the field on the hardy adventure of rescuing the fair sex out of the dreadful hands of the ignorant midwives.

    But why do these gentry then so much insist on the absolute necessity there is of sometimes having recourse to instruments? -Why? The motive for that insistence is so transparent, that not to see through it would indeed be blindness. It is the capital, and perhaps the only plea that has the least shadow of plausibility for the men to intrude themselves into the women's business of midwifery. The women do not pretend to the art of handling those instruments, and would be very sorry to pretend to it. Nor do the midwives, who are sufficiently skilled in their art, ever need the supplemental aid of them: whatever is done with them is as well, and infinitely more safely done without them: so that the only grounds of introducing men into that female practice is essentially false...making...the surgeon's art a pandar [sic] to a sordid interest, by the incorporation of midwifery with it, is in fact, engrafting on a noble stock, a scion of another one, both which would bear very well separate, but, thus joined, can produce nothing but a vile poisonous fruit. (143-44)

    Page  140

    Based on the misjudgments of even the most famous and fashionable men-midwives, however, the gentry sometimes came to share Nihell's views. In May 1755, Mrs. Delaney wrote to her sister of Lady Gore's unhappy time as a patient of Sir Richard Manningham, one of the best-known London accoucheurs:

    The night she came to her mother's house she was so very ill that Sir Richard Manningham was sent for, who declared that her disorder would soon be over, and left her! Almost as soon as he had left her, her pains increased; he was sent for again, found her in violent convulsions, and she had a dead child! She was for some days despaired of, but is now in her senses and better, but knew nothing of what had happened. Is not this like some old novel we have read and thought impossible?"[19]

    In her scorn for the entire profession of man-midwifery, Nihell tars the learned and the quasi-learned with the same brush:

    Look into Deventer, Peu, La Motte, Mauriceau, Levret, Smellie, &c. and you will find that, except their accounts of the innocent manual function, in which midwives must so much excel them; except their pernicious practical part, on which they so tediously insist, by way of recommending each some particular instrument that is to usher him into employment, and increase his profit, in which noble view he takes care to decry the instruments of all others, or at least prefer his own; except the scientific jargon of hard Latin and Greek words, so fit to throw dust in the eyes of the ignorant, and give their work an air of deep learning; except what they have pillaged from regular physicians and surgeons, who have treated upon these matters: except in short all the quacking verbose- Page  141ness of the various histories of their exploits and deliverances of distressed women, and you will find the merit of their whole works shrink to little or nothing, under the appraisement of common sense and true practical knowledge. (146-47)

    Nihell expands her attack to include the parishes for their allegedly insidious practices with respect to orphaned children. She accuses the parishes, which were responsible for the support of the children, of regularly substituting dry-nurses for wet-nurses with the result that the child dies and that the parish is spared the expense of its sustenance. She then links this "Violence offered to Nature" with that of the men-midwives as both attributable to "exactly the same common parent, interest," with "exactly the same common effect, the destruction of infants" (200). And she reminds the public of the sheer numbers of ill-trained male practitioners that the physicians have loosed upon the public:

    Think of an army, if but of barely Dr. Smellie's nine-hundred pupils, constantly recruiting with the pupils of those pupils, let loose against the female sex, and of what an havock they may make of both its safety and modesty, to say nothing of the detriment to population, in the destruction of infants, and I presume, it will not appear intirely in me a suggestion of private interest to wish things, in this point, restored to the old course of practice of this art of midwifery by women. A course which Nature has so self-evidently established, in her tender regard to the female sex, and to its darling offspring, and in which she has not less consulted one of her primary ends.... (243-4)

    Nihell is clearly a highly skilled debater. In part I of her book, she uses the medieval method of questiones—the statement of an objection and the answer to it—to argue her case. Her arguments are full of understated irony—a much more effective weapon that the broad slapstick of Thicknesse's treatise. She regularly gets her best arguments from the texts of her adversaries, Page  142and she employs both "difference" and "likeness" theory to argue her case against the men. When it comes to the question of aptitude for learning the necessary, the women are as capable as the men; when it comes to that of emotional suitability for the work, the women are by nature better suited than the men. Women are more patient, she argues, more sympathetic, naturally disposed to be care givers, etc. They are also, being smaller and more flexible, physically equipped to do the work better. Generally, she gets the best of the argument. As is so often the case, though, where power is involved, the better debater loses to the stronger opponent. Fortunately for the women who required the services of both female midwives and male physicians, the disagreement between the sexes often, at least among the competent of both genders, turned to professional cooperation in the lying-in chamber.

    The Midwifery Debate Versus Midwifery Practice

    Though feelings on both sides of the midwifery issue ran high, and though much invective both in print and in conversation was exchanged on both sides of the issue, the case books of physicians make clear that responsible persons, both male and female, both midwife and surgeon, in practice relied on one another to assist women in labor, to deliver the infants, and to preserve the health and lives of both mother and child, if possible. If that was not possible, if a choice had to be made, then saving the mother took precedence. To those ends, in fact, midwives like Nihell and obstetrical physicians like Macaulay, William Hunter, William Smellie and Christopher Kelly cooperated effectively within their capacities and to the degree that the science of their day allowed.

    The Critical Review, edited at this date by Tobias Smollett and a company of anonymous reviewers, predictably savaged Nihell's book. Smollett was himself a physician. George Macaulay, though sympathetic with some of Nihell's positions, was also intimately connected with the Review, as we shall later see. William Smellie was a close friend of both men, and all were Scots.[20] The reviewer suggests that Mrs. Nihell take as her motto: "Nihilo ex nihil fit" (A recondite pun: Nothing can be made from nothing, and [Mrs.] Nihell can do nothing). Then for the next ten pages, he trashes everything she says. Page  143The combativeness of the reviewer's stance suggests that Smollett, who was renowned for his temper and bellicosity, may well have written this review himself. He faults Nihell's style:

    We must own, however, we have seldom known so much crepitation in a nurse's lecture, except when she had made too free with the caudle, and mixed some extraneous ingredients in the composition for the expulsion of wind. As we cannot, in charity, suppose this was the case with Mrs. Nihell, or her husband, we cannot help conjecturing, that this good gentlewoman has employed some eructatious disciple of Paracelsus Bombast, to inflate her stile, and bouncify her expressions. (Critical Review 87)

    We need not detail the sustained invective with which the reviewer treats the work. He suggests Nihell is ignorant, mistaken, verbose, self-interested, sexist, a threat to charitable institutions and unworthy of attention. Despite the reviewer's unflagging scorn, however, Nihell's suggestion that the doctors share their anatomical knowledge with the female midwives with a view to improving patient care reflects a position with which George Macaulay fully agreed. When, shortly after his arrival on staff, the British Lying-in Hospital became a teaching hospital and established a program to instruct midwives, only female students were accepted into the program. The sensitivity to female capacities and opinion that Macaulay elsewhere evinced was once again apparent in this decision. It may also reveal a tacit agreement with Nihell's concern that too many ill-trained men were taking up the art of midwifery.


    1. See, "Case Book of 200 Years Ago," Midwife Health Visit, 1966, 2, Feb. 68-70.return to text

    2. London: Robinson, Baldwin, and Goldsmith, 1792.return to text

    3. In, The Ladies Physical Directory, 7th ed. (London, 1739).return to text

    4. London: 1755.return to text

    5. Lord Granville Leveson Gower, Private Correspondence, 1781-1821, ed. Castalia, Countess Granville (2 vols. London, 1916), vol. 1, p. 71, cited in Joan Lane, "The Doctor Scolds Me: The Diaries and Correspondence of Patients in Eighteenth Century England," in Roy Porter, ed., Patients and Practitioners 217, Note 31. return to text

    6. London: Heinemann, 1977.return to text

    7. E. Cellier, To Dr. ...: An Answer to his Queries Concerning the Colledg [sic] of Midwives, London, 1688. Cited in Donnison 31, Note 75. return to text

    8. Cellier, 'A Scheme for the Foundation of a Royal Hospital', Harleian Miscellany, Vol. 4 (London, 1745). Cited in Donnison 31, n. 76. return to text

    9. Courtesy of the Clements C. Fry Collection, the Cushing-Whitney Medical Library, Yale University.return to text

    10. London: Davis and Caslon, 1765.return to text

    11. Guillaume Marquese de La Motte, Traitè complet des accouchemens naturels, non naturels, et contre nature, explique dan un grand nombre d'observations et de rèflexions sur l'art d'accoucher (Paris: L. d'Houry, 1722), and Francois Mauriceau, Dernières observations sur les maladies des femmes grosses et accouchèes (Paris: David fils, 1712).return to text

    12. London: A. Morley, 1760 (Wellcome Institute, 38758/B).return to text

    13. Christopher Kelly, Casebook "1771-72, Puerperal Fever." Royal College of Obstetricians and Gynecologists, MS.return to text

    14. "Dr. William Hunter's lectures on midwifery," Royal College of Physicians, MS. 186. return to text

    15. 2nd ed. London: M. Cooper, 1751.return to text

    16. William Smellie, Medical Essays and Observations, vol. v., Part I (London: 1784) 117. See also Herbert R. Spenser, The History of British Midwifery from 1650 to 1800, (London: John Bale, Sons & Danielsson, 1927) 60.return to text

    17. See Thomas Denman, An Introduction to the Practice of Midwifery, 2 vols. (London: J. Johnson, 1795) vol. 2, 215-217.return to text

    18. William Smellie, A Collection of Preternatural Cases and Observations in Midwifery, vol. III (London: W. Strahan, T. Cadell, and G. Nichol, 1779).return to text

    19. The Life and Correspondence of Mrs. Delaney, ed. Lady Llanver, 6 vols., (London, 1862), vol. 3, p. 351. Cited by Lane, 219, n. 40. return to text

    20. Critical Review, Vol. 9, 87 - 97, Art. 4. return to text