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Passive Trust or Active Application: Changes in the Management of Difficult Childbirth and the Edinburgh Royal Maternity Hospital, 1850–1890

Published online by Cambridge University Press:  16 November 2012

Alison Nuttall
Alison Nuttall
Affiliation:
School of History and Classics, University of Edinburgh, William Robertson Building, 50 George Square, Edinburgh, EH8 9JY, UK
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The history of the medical and nursing care given to parturient women has been approached in a number of ways. Early studies largely equated it with the development of obstetric technology that occurred from the early eighteenth century onwards, focusing on its potential to save maternal and foetal life, but without examining closely the frequency and significance of its actual use. Thereafter, feminist historians re-interpreted similar evidence to stress what they regarded as the degrading and invasive aspects of such technology, especially as it related to the increasing use of chloroform anaesthesia in the latter half of the nineteenth century. Interest then moved from the technology itself, to its effects on other aspects of care in childbirth, particularly on the eighteenth-century decline of the traditional midwife and the concomitant rise of the man-midwife.

Information

Type
Articles
Information
Medical History , Volume 50 , Issue 3 , 01 July 2006 , pp. 351 - 372
Copyright
Copyright © The Author(s) 2006. Published by Cambridge University Press

References

1 J M Munro Kerr, R W Johnstone and Miles H Phillips (eds), Historical review of British obstetrics and gynaecology, 1800–1950, Edinburgh, E & S Livingstone, 1954, pp. 3–40, 71–84; Walter Radcliffe, Milestones in midwifery, Bristol, John Wright & Sons, 1967.

2 See, for example, Jenny Carter and Thérèse Duriez, With child: birth through the ages, Edinburgh, Mainstream, 1986, p. 117; Lois N Magner, A history of medicine, New York, M Dekker, 1992, pp. 273–5.

3 See Jean Donnison, Midwives and medical men, 2nd ed., New Barnet, Historical Publications, 1988, especially pp. 42–44. However, midwives were not necessarily excluded from using instruments, and their use of them has been used to indicate their rising or falling status. See Christina Romlid, ‘Swedish midwives and their instruments in the eighteenth and nineteenth centuries’, in Hilary Marland and Anne Marie Rafferty (eds), Midwives, society, and childbirth, London, Routledge, 1997, pp. 38–60.

4 Adrian Wilson, The making of man-midwifery: childbirth in England, 1660–1770, London, UCL Press, 1995.

5 Judith Walzer Leavitt, Brought to bed: child-bearing in America, 1750–1950, New York, Oxford University Press, 1986, pp. 44–60; Patricia Jalland, Women, marriage and politics, 1860–1914, Oxford, Clarendon Press, 1986, pt. 2, pp. 131–85. See also Judith Schneid Lewis, In the family way: childbearing in the British aristocracy, 1760–1860, New Jersey, Rutgers University Press, 1986, for a similar approach to birth and medical men amongst the aristocracy.

6 Virginia A M Quiroga, Poor mothers and babies: a social history of childbirth and child care institutions in nineteenth century New York City, New York and London, Garland Press, 1989; Nancy Schrom Dye, ‘Modern obstetrics and working-class women: the New York Midwifery Dispensary, 1890–1920’, J. Soc. Hist., 1987, 20: 549–64; Janet McCalman, Sex and suffering–women's health and a women's hospital: The Royal Women's Hospital, Melbourne 1856–1996, Carlton, Melbourne University Press, 1998. Recent studies of early twentieth-century maternity institutions in the East End of London have taken a more medically-focused stance, and instead emphasized the local community's affection for care-givers, by looking at the benefits to it of the medical and social care provided, particularly through the London Hospital and its dispensaries. (Lara Marks, ‘Mothers, babies and hospitals: “The London” and the provision of maternity care in East London, 1870–1939’, in Valerie Fildes, Lara Marks and Hilary Marland (eds), Women and children first: international maternal and infant welfare 1870–1945, London and New York, Routledge, 1992, pp. 48–73; idem, Model mothers: Jewish mothers and maternity provision in East London, 1870–1939, Oxford, Clarendon Press, 1994.)

7 Margaret Connor Versluysen, ‘Midwives, medical men and “poor women labouring of child”: lying-in hospitals in eighteenth-century London’, in Helen Roberts (ed.), Women, health and reproduction, London, Routledge & Kegan Paul, 1981, pp. 18–49.

8 Bronwyn Croxson, ‘The foundation and evolution of the Middlesex Hospital's lying-in service, 1745–1786’, Soc. Hist. Med., 2001, 14 (1): 27–57.

9 Lothian Health Services Archive, Edinburgh University Library (hereafter LHSA), 1870 ERMH Special and Ordinary Casebook (hereafter SOCB) [LHB3/17/1], p. 38; 1890 ERMH Outdoor Casebook (hereafter OCB) [LHB3/18/5], case 52 (Dr Halliday Croom's quarter) [106/52hc/90so].

10Rules and bye-laws of the Edinburgh Maternity Hospital, Edinburgh, Andrew Murray, Printer, Milne Square, n.d., ‘House Surgeons’, Rule 2.

11 Sir James Young Simpson Bt (1811–1870), Professor of Midwifery and the Diseases of Women and Children at the University of Edinburgh, 1839–70.

12 James Y Simpson, Some remarks on the value and necessity of the numerical or statistical method of inquiry as applied to various questions in operative surgery, Edinburgh, Sutherland and Knox, 1848; and Report of the Edinburgh Royal Maternity Hospital from 1844 to 1846, Edinburgh, Sutherland and Knox, 1848, reprinted from Monthly Journal of Medical Science, Nov. 1848. However, much of the later ERMH material appears not to have been used at the time of its creation.

13 For further discussion of this, see Guenter B Risse and John Harley Warner, ‘Reconstructing clinical activities: patient records in medical history’, Soc. Hist. Med., 1992, 5 (2): 183–205.

14 This analysis forms the basis of the author's thesis: ‘The Edinburgh Royal Maternity Hospital and the medicalisation of childbirth in Edinburgh, 1844–1914: a casebook-centred perspective’ (PhD thesis, University of Edinburgh, 2003).

15 In 1856 Simpson lent money to the directors to enable them to purchase Chapel House. (LHSA, ERMH Directors' Minutes (hereafter DMERMH) [LHB3/1/2], 2 May 1856). Later fund- and status-raising efforts emphasized the link between the two hospitals.

16 A R Simpson, ‘Sketch of the history of the Royal Maternity and Simpson Memorial Hospital’, in G A Gibson, C W Cathcart, and D Berry Hart (eds), Edinburgh Hospital Reports, vol. 1, Edinburgh and Leeds, Young J Pentland, 1893, pp. 46–7.

17 LHSA, DMERMH [LHB3/1/4], 26 Sept. 1895.

18 LHSA DMERMH [LHB3/1/3], 8 Dec. 1876. The suggestion was rejected.

19 LHSA, ERMH Annual Report (hereafter ARERMH) [LHB3/7/57], 1901.

20 LHSA, ARERMH [LHB3/7/68, 69], 1912, 1913; DMERMH [LHB3/1/5], Memorandum for the National Insurance Commissioners, 29 Nov. 1912; ERMH Medical Board Minutes (hereafter MBMERMH) [LHB3/2/1], 24 Sept. 1913.

21 LHSA, MBMERMH [LHB3/2/1], 15 Jan. 1909.

22 LHSA, MBMERMH [LHB3/2/1], 1 Nov. 1871.

23 For example, David Stevenson, coachman, lived in Melrose, whilst his wife, from Stranraer, gave her address as 21, Queen Street (LHSA, 1850 ERMH Indoor Casebook (hereafter ICB) [LHB3/16/A], case 2007 [042/2007/50fi]); Sarah Jameson, whose husband William Hutchinson, a joiner, was “at sea”, was born in Jamaica (LHSA, 1850 ICB [LHB3/16/A], case 2164 [074/2164/50si]).

24 J Halliday Croom, ‘The systematic use of antiseptics in midwifery practice’, Edinburgh med. J., 1881, 26, no. 8, pt 2: 712–21, p. 714.

25 LHSA, DMERMH [LHB3/1/2], 3 July 1871.

26 LHSA, 1870 SOCB [LHB3/17/1], p. 40.

27 LHSA, 1890 OCB [LHB3/18/5], case 34 (Dr Underhill's quarter) [255/34u/90fo]; 1890 SOCB [LHB3/17/6], p. 76.

28 LHSA, 1912 Students' External Casebook (Leith Branch) [LHB3/18/29], case 22 [22/22/1912/Leith]; 1912 SOCB [LHB3/17/13], pp. 6–7; 1912 ICB [LHB3/16/3], case 74 (Dr Haultain's quarter) [74/074/hault/1912i].

29 LHSA, ‘Heads of lectures on midwifery etc. Delivered by J. Y. Simpson M.D. Professor of Midwifery in the University of Edinburgh; with remarks collated from notes taken by George Mackay M.D. during the Winter Session 1850–1’, p. 4. [LHB GD 1/1/4 A & B].

30 Mackay, op. cit., note 29 above; ‘Lectures on midwifery and the diseases of women given by J. Y. Simpson M.D., Professor of Midwifery in the University of Edinburgh and taken down by George Dickson M.D., 1862–3’ (Edinburgh University Special Collections, Gen.851); J Watt Black (ed.) Selected obstetrical and gynaecological works of Sir James Y. Simpson, Bart., Edinburgh, Adam and Charles Black, 1871.

31 Unfortunately, this is the area in which Casebook recorders had most trouble. Some felt the classification extended to the mode of delivery (see footnote 46), and some produced hybrid classifications by ticking two boxes.

32 Mackay, op. cit., note 29 above, p. 132.

33 Ibid., p. 160. Collins was Master of the Rotunda, 1826–33; Rigby (1804–60), the physician at the Lying-in Hospital, Lambeth.

34 Ibid., p. 158.

35 Ibid., pp. 158, 160. See also James Y Simpson, On the duration of labour as a cause of mortality and danger to the mother and infant; &c. in reply to a letter of Dr Collins, Edinburgh, Sutherland and Knox, 1848, extracted from the Provincial Medical and Surgical Journal, 1 Nov. 1848.

36 James Y Simpson, ‘On turning as an alternative for craniotomy and the long forceps, in deformity of the brim of the pelvis, etc.’, in Watt Black (ed.), op. cit., note 30 above, pp. 393–486, on pp. 409–19.

37 Mackay, op. cit., note 29 above, pp. 158, 160.

38 Ibid., pp. 207, 209.

39 Ibid., p. 134.

40 Ibid., p. 140: Simpson claimed “four-fifths of the papers he has published were written under these circumstances”.

41 Ibid., p. 6.

42 James Y Simpson, ‘On the mode of application of the long forceps’, reprinted in Watt Black (ed.), op. cit., note 30 above, pp. 387–93; James Y Simpson, Two notices of the obstetric air-tractor, Edinburgh, Sutherland and Knox, 1849; Myrtle Simpson, Simpson, the obstetrician, London, Victor Gollancz, 1972, pp. 176, 174.

43 Mackay, op. cit., note 29 above, p. 153.

44 Ibid., p. 205.

45 Dickson, op. cit., note 30 above, p. 108.

46 Three of these cases were entered as “laborious”, with “breech” written alongside, showing that the classifications were not always understood.

47 LHSA, 1870 SOCB [LHB3/17/1], p. 38.

48 LHSA, 1850 ICB [LHB3/16/A], case 2205 [115/2205/50si].

49 LHSA, 1850 ICB [LHB3/16/A], case 1191 [026/1191/50fi].

50 LHSA, 1850 OCB [LHB3/18/2], case 3009 [031/3009/50fo].

51 LHSA, 1850 OCB [LHB3/18/2], case 3009 [031/3009/50fo].

52 LHSA, 1870 OCB [LHB3/18/2], case 594 [060/594/70fo].

53 “[T]he room in which she was, did not seem so well ventilated as to enable one to give a prognosis at all favourable”. (LHSA, 1870 SOCB [LHB3/17/1], p. 39–40).

54 LHSA, 1850 OCB [LHB3/18/2], case 3407 [216/3407/50so]. George Harley was then a house surgeon: presumably he was being instructed by Simpson.

55 LHSA, 1870 ICB [LHB3/16/A], case 1615 [031/1615/70fi].

56 LHSA, 1870 ICB [LHB3/16/A], case 1599 [015/1599/70fi].

57Rules and Bye-Laws, op. cit., note 10 above, “Ordinary Medical Officers”, Rule 4.

58 See the comments of Dr Lombe Atthill (later Master of the Rotunda): Br. med. J., 1873, ii: 261; and also of Thomas More Madden, ‘On certain improvements in the construction and use of long and short midwifery forceps’, Br. med. J., 1874, i: 829–32, p. 831.

59Rules and Bye-Laws, op. cit., note 10 above, “House Surgeons”, Rule 3; “Pupils”, Rules 4–8.

60 This point was made first in Leavitt, op. cit., note 5 above, pp. 84–5, and re-iterated in Quiroga, op. cit., note 6 above, pp. 41–2. Nancy Dye's work on the New York Midwifery Dispensary provides a vivid illustration of this in Dye, op. cit., note 6 above, especially pp. 553–6.

61 Irvine Loudon, Death in Childbirth, Oxford, Clarendon Press, 1992, p. 183, Table 12.1, p.187.

62 Jalland, op. cit., note 5 above, p.142.

63 In 1869 Mr Charles Amsden addressed the Edinburgh Obstetrical Society on his modification of the fillet, which he presented as an alternative to forceps, claiming that these “present a very formidable appearance … frequently objected to strongly by both patients and friends,” (Edinburgh med. J., 1869, 15: 81–2, p. 82). See also Leavitt, op. cit., note 5 above, p. 48.

64 LHSA, 1870 SOCB [LHB3/17/1], pp. 36–44. She was one of only two patients to die in the care of the hospital in 1870, out of a total of 588.

65 Kennedy felt “the best course … would have been to turn the child before allowing the liquor amnii to escape” (Simpson's apparent method of choice). However, “the House Surgeon … is not allowed to perform an obstetric operation on his own responsibility unless there is immediate danger to mother or child”, and he therefore trusted that “owing to the strength the pains had now assumed, the head might be enabled to enter the brim”. (LHSA, 1870 SOCB [LHB3/17/1], p. 38.)

66 See, for example, that of Dr Cross of Scarborough, Lancet, 1860, ii: 274.

67Br. med. J., 1870, i: 312–14, p. 313.

68 James More MD, ‘On the use of the forceps in midwifery’, Lancet, 1873, ii: 590–1, p. 591.

69Br. med. J., 1873, ii: 261.

70 Ibid.

71 Ibid.

72 See, for example, the presentations made by Dr Edward Rigden to the East Kent District meeting of the BMA (Br. med. J., 1874, i: 787), and by Dr Cooper Rose to the London Obstetrical Society (Lancet, 1876, i: 776–7, p. 777).

73Br. med. J., 1876, i: 4–8.

74 See, for example, the descriptions of London Obstetrical Society meetings in 1877 in both the British Medical Journal and the Lancet (Br. med. J., 1877, i: 426–7; Lancet, 1877, i: 461–2).

75 P M Dunn, ‘Stéphane Tarnier (1828–1897), the architect of perinatology in France’, Arch. Dis. Child Fetal Neonatal Ed., 2002, 86: F137–F139.

76 Sir Alexander Russell Simpson (1835–1915), Professor of Midwifery and the Diseases of Women and Children, University of Edinburgh, 1870–1906.

77 ‘Lectures on midwifery and the diseases of women given by Alexander R. Simpson, 1873–4’, taken down by an unknown student, lecture 77, 3 Mar. 1874, p. 278 (Edinburgh University Special Collections, Dc10.35 1-2).

78Edinburgh University Calendar for 1874–5, Edinburgh, James Thin Booksellers and Publishers, 1874, pp. 99–100. Analysis of the ERMH casebooks suggests that in 1850 and 1870 efforts were made to show interventions and the use of instruments to the house surgeons (who paid larger fees) whenever a suitable opportunity presented (see, for example, footnote 54). However, in all years studied, medical students saw instruments in actual use only if they were necessary to deliver the woman to whom the student had previously been allocated.

79 ‘Lectures on midwifery’, op. cit., note 77 above, p. 278.

80 However, it should be noted that his successor as professor, John Halliday Croom, was recommending to his students at the Extra-Mural School in 1887–8 that they should take forceps routinely. (LHSA, ‘Lectures on midwifery and the diseases of women given by John Halliday Croom, 1887–8’, taken down by Frederick W Mann, lecture undated, p. 137 [LHB G&D 1/1/5 A&B]).

81 ‘Lectures on midwifery and the diseases of women given by Alexander R. Simpson, 1890–1’, taken down by an unknown student, lecture of 11 Feb. 1891 (no pagination) (Edinburgh University Special Collections, Dk 4.5). Whilst Simpson praised axis-traction forceps, and even produced his own variation, the type of forceps used in 1890 is mentioned only once, when, at Mrs Morrison's delivery in November 1890, the “[a]xis-traction forceps [were] applied by Dr. Duncan but they failed to move head”. (LHSA, 1890 OCB [LHB3/18/5], case 7 (Prof. Simpson's second quarter) [214/7ss/90so]).

82 David Jones Hughes, ‘Lectures on midwifery and the diseases of women given by Alexander R. Simpson, 1897–8’, lecture of 13 Jan. 1898 (no pagination) (Edinburgh University Special Collections, MS2641–MS2642).

83 LHSA, 1890 ICB [LHB3/16/2], case 64 (Dr Berry Hart's quarter) [064/38bh/90fi].

84 LHSA, 1890 OCB [LHB3/18/5], case 70 (Dr Underhill's quarter) [291/70u/90fo].

85 LHSA, 1890 OCB [LHB3/18/5], case 52 (Dr Halliday Croom's quarter) [106/52hc/90so].

86 Although see LHSA, 1890 SOCB [LHB3/17/6], p. 73.

87 See, for example, LHSA, 1890 SOCB [LHB3/17/6], p. 61; ARERMH [LHB3/7/48], 1893, p. 9.

88 Whilst sick Indoor patients were described as being nursed by 1870, in 1862 the Directors responded to the suggestion that they should hire a nurse to assist the matron by stating that the antenatal patients looked after the postnatal patients. (DMERMH [LHB3/1/2], 6 Dec. 1862).

89 For example, W John Kennedy passed his finals in July 1870 and took up his post in August; in 1850 George Harley took his final examinations whilst in post; the 1871 census describes Joseph Vincente Forfar as both house surgeon and medical student.

90 LHSA, 1890 OCB [LHB3/18/5], case 52 (Dr Halliday Croom's quarter) [106/52hc/90so].

91 Loudon, op. cit., note 61 above, p.184.

92 Jalland, op. cit., note 5 above, p.142.