In 1752, Dr William Smellie published A Treatise on the Theory and Practice of Midwifery. This is the earliest document on the subject of pregnancy, labour and birth that I have read, and it is interesting to note the similarities (as well as the differences) between 18th century practices and our own.
Dr Smellie’s publication seems quite an exhaustive one for the era, especially when so much of one’s “trade” was usually learnt through an apprenticeship-style of learning during this time. In the Preface, the doctor explains how he generally teaches the subject matter in lecture style to his students, but because so much of the information can only be experienced while assisting a woman in labour, he felt a manual on the topic was required.
He begins by outlining the “Structure and Form of the Pelvis” and giving a description of the female reproductive organs. Then he gives information on menstruation and conception, from which it is clear that the biological causes of these are both incompletely known to medicine at this time.
The Minutiae, or first principles of bodies [presumably human conception], being without the sphere of human comprehension, all that we know is by the observation of their effects; so that the modus of conception is altogether uncertain, especially in the human species, because opportunities of opening pregnant women so seldom occur.
However, Dr Smellie does describe one most probable theory, whereby an ovum is “squeezed out” of the ovary to the waiting Fallopian tube and then “conveyed into the Uterus”. The male semen is described as abounding “with Animalcula [the sperm], that swim about in it [the semen] like so many tadpoles”, which demonstrates that they had some understanding about the microscopic nature of genetic material. However, he supposes that the ovum would be ripe for pregnancy immediately after menstruation, and that the sperm may impregnate the ovum whilst it was still in the ovary, both of which are false.
Following these general foundations of reproduction, Dr Smellie delves into a multitude of subjects, covering nausea and vomiting, haemorrhoids, diseases in pregnancy, venereal disease, miscarriages, stages of labour, dealing with difficulties in labour, how to tie the umbilical cord (or navel-string), using forceps and other medical equipment, breech labours, after pains, violent flooding (haemorrhage), milk fever (possibly mastitis), dealing with the newborn, and the necessary qualifications of a midwife and wet nurse.
Some of the more interesting items I have reproduced below.
Delivering “Monsters” (Siamese twins)
Two children joined together by their bellies, (which is the most common case of monstrous births) or by the sides, or when the belly of the one adheres to the back of the other, having commonly but one Funis [umbilical cord], are comprehended in this class and supposed to be the effect of two Animalcula [sperm] impregnating the same Ovum.
In fact, conjoined twins are the result of a single fertilised egg dividing into two separate embryos incompletely, rather than two sperm fertilising the same ovum. The doctor then describes how a successful delivery can occur if the conjoined babies are small, but advises the practitioner to consider separation of the babies within the womb (Jeepers!) if they are large and the pelvis narrow and the babies are consequently stuck. If the separation is not successful, the practitioner must endeavour to “diminish the bulk in the best manner he can think of” so that the babies are delivered in pieces. Whilst something about that makes me want to cry, I can only hope that such a delivery at least would have spared the life of the woman in labour!
When a woman cannot be delivered by any of the methods hitherto described … in such emergencies, if the woman is strong, and of a good habit of body, the Caesarian operation is certainly advisable, and ought to be performed; because the mother and child have no other chance to be saved, and it is better to have recourse to an operation which hath sometimes succeeded, than leave them both to inevitable death. Nevertheless, if the woman is weak, exhausted with fruitless labour, violent floodings, or any other evacuation which renders her recovery doubtful, even if she were delivered in the natural way: in these circumstances it would be rashness and presumption to attempt an operation of this kind, which ought to be delayed until the woman expires, and then immediately performed with a view to save the child. The operation hath been performed both in this and the last century, and sometimes with such success that the mother has recovered and the child survived.
I cannot imagine the horror of a caesarian procedure in the 18th century. It could only be surpassed by the horror of a c-section in the 17th century!
Washing an Infant
The child being delivered, the navel-string being tied and cut, a warm cloth or flannel cap put on its head, and its body wrapped in a warm receiver, it may be given to the nurse, or an assistant, in order to be washed clean from that scurf [vernix], which sometimes covers the whole scurf-skin, and is particularly found upon the hairy scalp, under the arm-pits, and in the groins. This ablution is commonly performed with warm water, mixed with a small quantity of Hungary water, wine or ale, in which a little pomatum, or fresh butter, hath been dissolved. […] nevertheless, milk and water, or soap and water, is preferable to this mixture.
Yes, I imagine bathing your newborn baby in alcoholic beverages might just dry their skin out a tad!
Treating an Infant’s Misshapen Head
If the head is kept long in the Pelvis, and the child not destroyed by the compression of the brain, either before or soon after delivery, it commonly retains more or less the shape acquired in that situation, according to the strength or weakness of the child. When the bones begin to ride over one another in this manner, the hairy scalp is felt lax and wrinkled; but, by the long pressure and obstructions of the circulating fluids, it gradually swells and forms a large tumour [probably a cerebral haematoma]. In these cases, when the child is delivered, we ought to allow the navel string, at cutting, to bleed from one to two or three spoonfuls, especially if the infant be vigorous and full grown; and to provoke it by whipping and stimulating: for the more it cries, the sooner and better are the bones of the Cranium forced outwards into their natural situation…
I suppose “whipping” the baby would just be the 18th century version of the more recent practice in the early 20th century of holding the baby upside down and smacking it. Still, it does sound a bit violent!
Children commonly begin to breed their fore teeth about the seventh, and sometimes not before the ninth month; and in some, the period is later. […] When the teeth shoot from the sockets, and their sharp points begin to work their way through the Periosteum [membrane of the bone] and gums, the frequently produce great pain and inflammation, which, if they continue violent, bring on feverish symptoms and convulsions, that often prove fatal. In order to prevent these misfortunes, the swelled gum may, at first, be cut down to the tooth, […] but if the child is strong, the pulse quick, the skin hot and dry, bleeding at the jugular will also be necessary, and the belly must be kept open with repeated glysters.
Now, bleeding at the jugular sounds a bit excessive to me! Especially for teething problems! However, it seems that bleeding at the jugular was a common way of blood-letting for babies, rather than the more common practice in adults of cutting the vein in the crook of the arm.
Interestingly, the image reproduced above was used as a frontispiece to the publication, Man-Midwifery dissected; Or, The Obstetric Family-Instructor, by John Blunt (1793). This book contained “A Display of the Management of every Class of Labours by Men and Boy-midwives; also of their cunning, indecent and cruel Practices”, with “Instructions to Husbands on how to counteract them.” There was also included “A Plan for the complete Instruction of Women who possess promising Talents, in order to supersede Male-practice” (maybe the origin of the word “malpractice”?) and “Various Arguments and Quotations, proving that Men-midwifery is a personal, a domestic, and a national Evil.” I have yet to properly read this informative document, but it sounds promising for a future post!
Reading the early practices of doctors and midwives in their occupation of delivering babies makes me quite grateful for modern medicine! Whilst it is nice to be able to deliver a baby more-or-less naturally, it is comforting to know that maternal and infant deaths are incredibly low when compared to the hazardous births of the 18th century, and this is largely due to the medical interventions that are now available in cases of complications in labour, such as obstructed labours, excessively long labours, and non-progressive labours.
Sources and Relevant Links
Image Source, The British Museum
A Treatise on the Theory and Practice of Midwifery, 1752, by Dr William Smellie – read online
Man-Midwifery dissected; Or, The Obstetric Family-Instructor, 1793, by John Blunt – read online (incomplete scan)
Dr Johnson’s London: Everyday Life in London 1740-1770, by Liza Picard – buy on Amazon