Obstetrics and Gynaecology in Tudor and Stuart England

Audrey Eccles

• Publisher: Taylor & Francis
• Year: 2018
• Print ISBN: 9780367001940
• eBook ISBN: 9780429683909
• Edition: 1
• Topic: History
• Subtopic: World History
• Index: History

Originally published in 1982 Obstetrics and Gynaecology in Tudor and Stuart England traces the development of obstetrics and gynaecology over the past two centuries. Between the 16th and 18th century midwifery passed from a female mystery, employing traditional medicines and superstitions, to a scientifically-based clinical skill, with both gains and losses to the patient. The case-mortality was high enough to make the increasing involvement of male surgeons socially acceptable, despite sexual taboos. Thus, as scientific knowledge of anatomy and physiology developed and was applied in the form of new techniques, so the midwives, who had less opportunity and inclination to acquire the new knowledge and skills, lost esteem and by the mid-eighteenth century were increasingly relegated to the service of the poor. The book also examines ideas about sexuality, menstruation, conception, pregnancy and lactation and shows how the views of society about femaleness, marital relations and the management of pregnancy and childbearing were influenced by these notions.

Chapter One

English Obstetrical Textbooks Before 1740

Not much is known about the practice of obstetrics in the mediaeval period, although it is possible to form an idea of the theory from extant manuscripts. No doubt in some cases theory approximated to practice, but in others, especially among the unlettered classes, midwifery was a traditional women’s business, about the actual conduct of which it is unlikely much can now be discovered.

The standard mediaeval text on obstetrics was a Latin work generally called Trotula, after the name of its author. It was this book that Chaucer’s doctor of physic used, and the name at least seems to have been familiar to his audience. Trotula is said to have been a female doctor in the eleventh century at the then prestigious medical school of Salerno, and in her book claims to have specialised in women’s diseases out of sympathy for women too modest to consult male doctors about gynaecological problems.¹ Some of the details in her book show that if theory and practice agreed at all, the mediaeval woman may have fared better in some respects than her Tudor and Stuart counterpart.

The book is, for the period, highly scientific in tone, and recommends sensible practices such as the suture of perineal tears, and the treatment of prolapse by manual reduction, bed rest and a low residue diet. It is not helpful, however, in cases of abnormal births, which are mainly dealt with by medicines. The anatomy, physiology and therapy of the book generally, is firmly in the tradition of humoral medicine.

Manuscript translations of Libri Trotuli began to appear in English in the late fourteenth and fifteenth centuries, several of which are still extant.² However, the advent of printing made it possible to bring mediaeval works including those on midwifery, thought to be of current interest, to a far wider public despite a good deal of opposition on moral grounds.³ The earliest English textbook for midwives in print was The birth of mankind. First published in 1540, it was translated by Richard Jonas from De partu hominis, which itself was a translation made in 1532 by Christian Egenolph from a German original. This German original, Der swangern Frauwen und Hebammen Roszgarten, was published in 1513 by Eucharius Rosslin, state physician of Worms and Frankfurt-am-Main, for the instruction of the official town midwives.

Evidently The birth of mankind filled a need, for in 1545 it was revised and reissued under the same title by Thomas Raynald. Raynald styled himself ‘physician’, but it is doubtful if he had any practical experience of midwifery himself. He claimed that the book had already been of much use at labours, gentlewomen having taken to visiting confinements ‘carienge with them this booke in theyr handes, and causynge suche part of it as doth cheifly concerne the same pourpose, to be red before the mydwife, and the rest of the wemen then beyng present’, with such good effect that right-minded women were glad ‘to here the booke red by sum other, or els (such as could) to read it them selfes’.⁴ The birth of mankind ran into thirteen editions, the last in 1654, before it was finally superseded.⁵

There were also more popularly written texts aimed at a less-specialised public, which maintained their popularity at this level long past the period with which we are concerned. Quite when and where Aristotle’s complete masterpiece, Aristotle’s experienced midwife, and Aristotle’s last legacy originated is obscure. The earliest edition of the experienced midwife in the British library is dated 1700, and signed W. S. (possibly William Salmon, a prolific writer of medical books) but the contents are certainly derived from much older works. There is a copy of the masterpiece dated 1694, and of the last legacy dated 1690. They were reissued frequently, and the masterpiece had reached 26 editions by the middle of the eighteenth century, the experienced midwife ten.⁶ They are rare nowadays, and were, like many ephemera, clearly read to pieces and thrown away, not cherished as valuable textbooks.

Although Paré’s work on obstetrics appeared in the original French in 1549 it was not translated into English until 1634, when T. Johnson produced a translation of his complete works; there were a number of subsequent editions of the works, but no separate issue of the midwifery part. But in 1612, a little book written in French in 1609 by Paré’s pupil Jacques Guillemeau, was translated into English as Childbirth, or the happy deliverie of women. In this book the first description of podalic version, popularised by Paré in cases of emergency, appeared in English.⁷

Shortly after Paré’s complete works were translated another much earlier work was published in English in 1637, namely Jacob Rueff’s The expert midwife, which had appeared in Latin under the title of De conceptu et generatione hominis in 1554. This interesting little book had illustrations, including anatomical diagrams, which were rather oddly left unlabelled, because ‘we accounted it a superfluous thing, to marke and point out every severall thing with Letters and Characters, because they are extant, and to be seene every where in the books of those which have written of Anatomies’.⁸ It is particularly important for the depiction of embryonic development as it was envisaged at the time.

The next midwifery title to appear in the shops was that by Nicholas Culpeper, an apothecary who practised in Spitalfields, a writer of many popular medical books, and a determined opponent of Popery and the Royal College of Physicians, which he thought were tarred with the same monopolistic brush. His Directory for midwives was published in 1651. It contains nothing whatsoever about practical midwifery because, as Culpeper ingenuously admitted, he knew nothing about it; ‘I have not medled with your Callings nor Manual Operations, lest I should discover my Ignorance like Phormio the Phylosopher, who having never seen Battel, undertook to read a Military Lecture before Hanibal.’⁹ A later author described his book as ‘desperately deficient … except he writ it for necessity, he could certainly have never been so sinful to have exposed it to the light’.¹⁰ Culpeper also bore the full brunt of the objections to such books on grounds of decency, which were continually raised from The birth of mankind onwards. One of his critics told a story of ‘a Gentleman and Scholars censure upon your Book, who perusing some passages in it in a booksellers shop, asked whether Culpeper made that obsceane book or no, and being answered he did, replied, truly Culpeper hath made Culpaper, paper fit to wipe ones breech withal’.¹¹

William Harvey’s work on obstetrics De partu was published in Latin in 1651 and in English in 1653. It appeared as part of his work on embryology, entitled Anatomical exercitations, concerning the generation of living creatures. To which are added particular discourses of births, and of conceptions etc. This work shows that Harvey, though not primarily an obstetrician, had practical knowledge of midwifery, and emphasises the value of Paré’s work on the management of difficult labours.

In 1656 an anonymous work signed C. T. appeared; this was followed closely in 1659 by an almost identical work signed C. R. Both were entitled The compleat midwife’s practice enlarged and contained material plagiarised from Observations sur la sterilite, written by the French Court midwife Louise Bourgeois. Dr. Chamberlain s midwives practice 1668, despite its preface signed P. C. was almost certainly not by Peter Chamberlen, but more likely by someone cashing in on the family reputation. If it had been by him it is hard to believe no reference would have been made to the family secret, the forceps. Certainly Hugh Chamberlen seized every opportunity to advertise them in the two versions he made of Mauriceau’s work.

1671 saw the publication of no fewer than three new books for midwives. The midwives book was by Mrs Jane Sharp, who claimed to be a midwife of thirty years’ standing, although if this is true it tends to show how ignorant midwives still were, and especially of Paré’s important ideas. A similar ignorance is shown by James Wolveridge in Speculum matricis. This book adopts the form of an instructional dialogue between a doctor and a midwife, though the author was most likely unaware that the dialogue form, but between a midwife and her deputy, had previously been used by Edward Poeton in his earlier seventeenth-century book The midwives deputie.¹² The dialogue form for didactic works is of course a very old device indeed; The midwives deputie was probably never published however. William Sermon’s book The ladies companion, or the English midwife, the third of the 1671 trio, is no more informative, and seems chiefly designed to advertise the author’s famous cathartic and diuretic pills, only to be had of a certain bookseller.

Hugh Chamberlen’s two versions of Mauriceau, The accomplisht midwife 1673, and The diseases of women with child, and in child-bed 1683 do not differ greatly from each other, though the second has a few additions. Francois Mauriceau was by far the most influential man-midwife of the day, and these are really the first satisfactory textbooks in English, since Percivall Willughby’s book, Observations in midwifery, which was probably written in about 1672, was not published until the nineteenth century. It certainly postdates the three 1671 books, from which he quotes, and probably antedates the Mauriceau translations, which he does not mention. It is unfortunate that this book went unpublished, as it was firmly based on practical experience, anticipating the popular case-history style of many eighteenth-century writers. But three manuscript versions existed, so it may have been circulated among a small number of practitioners.

The anonymous The English midwife enlarged 1682, is clearly a publisher’s pot-boiler, and is an amalgam of Wolveridge and Mauriceau, some passages copied verbatim. James McMath’s The expert midwife 1694, was published in Edinburgh, presumably for a Scottish public, and is remarkable chiefly for its turgid style.

The two books published by John Pechey, A general treatise of the diseases of maids, big-bellied women, child-bed women, and widows 1696, and The compleat midwife’s practice enlarged 1698, are heavily indebted to the previous anonymous works of 1656 and 1659, including the section copied from Louise Bourgeois, but with the addition of a new section purporting to be taken from the private papers of Sir Theodore de Mayerne, personal physician to Charles I. Pechey claimed to be a near relation of Sir Theodore. He was a member of the Royal College of Physicians, but was prosecuted by them for advertising cut-price attendance and medicine on a guaranteed ‘no cure, no fee’ basis, and also for not paying the college’s fees. It is not known whether he practised as a man-midwife.

However Robert Barret’s A companion for midwives, childbearing women, and nurses 1699, probably is by a man-midwife, since some case-material is introduced by way of example.

During the seventeenth century several other books appeared, intended less for midwives than for women in general, namely J. Sadler, The sicke womans private looking-glass 1636; N. Fontanus, The womans doctour 1652; the anonymous A rich closet of physical secrets probably also 1652;¹³ N. Sudell, Mulierum amicus, or the woman’s friend 1666; and R. Turner, De morbis foemineis 1686.

Throughout the sixteenth and seventeenth centuries there were also, written in English or translated into it, a large number of popular and semi-popular books on physic and surgery, often with sections relating to gynaecology and obstetrics, and often claiming to be expressly intended for midwives and surgeons as well as the general reader. There was a fair amount of opposition to be overcome to publishing such subjects in English, especially in the case of physic, since anyone with a claim to a good education could at this time read Latin.¹⁴

By the end of the seventeenth century however, the battle was largely over, since there was no law of copyright and thus nothing to prevent booksellers with an eye on a good popular market from publishing translations of anything they chose. Thus in 1682 T. Gibson wrote The anatomy of humane bodies epitomiz.’d in English, ‘to avoid the injury of a paltry Translator, if it should be well accepted. For we see there is no Man that publishes any thing in the Latin tongue, that is received with any applause, but presently some progging Book-seller or other finds out an indigent Hackney scribler to render it into English. But with what dis-reputation and abuse to the worthy Authors, every learned person cannot but observe’.

The principal books on midwifery in the early-eighteenth century were also translations, chiefly from French, where the surgeons were foremost in obstetrics until about the middle of the century, when English men-midwives began to be equally esteemed. Paul Portal’s La practique des accouchemens 1685, was translated into English, in 1705, as The compleat practice of men and women midwives.¹⁵ Hendrik van Deventer’s Latin book of 1701 appeared in English in 1716 as The art of midwifery improv’d, and Pierre Dionis’ French treatise in 1719 as A general treatise of midwifery. In 1746 M. Mauquest de la Motte’s case-book was translated by Thomas Tomkyns, surgeon, as A general treatise of midwifery, originally published in French in 1722.

Three authors contributed about this time in English; John Maubray’s The female physician, heavily indebted to Deventer, appeared in 1724, and Edmund Chapman’s A treatise on the improvement of midwifery; chiefly with regard to the operation in 1733. The operation in question was the application of the obstetric forceps, first explained in this book. In...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Original Title Page
• Original Copyright Page
• Contents
• Preface
• Acknowledgements
• 1. English Obstetrical Textbooks Before 1740
• 2. The Legacy of the Ancients, and William Harvey
• 3. The Legacy of the Ancients, and the Anatomists
• 4. The Female Reproductive System
• 5. Sexuality and Conception
• 6. Development and Birth of the Foetus
• 7. Diagnosis of Pregnancy and Ante-natal Regimen
• 8. Pregnancy Prevention and Promotion
• 9. Gynaecology
• 10. Normal Childbirth
• 11. The Management of Obstetric Complications
• 12. ‘The Manuall Practize’ — Operative Delivery
• 13. Two Centuries of Obstetric Change Reviewed
• Appendix: Maternal Mortality: Some Notes on the Willughby Cases
• Notes
• Index