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Obstetrics at the Worth Library

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Obstetrics in Early Modern Europe

 

In early modern Europe, childbirth was a ceremony for women. There was an emphasis on female ritual rather than labor as a medical procedure. Local women, typically the mother’s close female friends, assisted the midwife for the birth and lying in process. These midwives gained power through the defining role of the midwife’s office within the community. Each “sizable town had at least one locally famous midwife” but more often, experienced women took on the role of midwives.[1] During the sixteenth century, a “desirable attribute was that she had had some children herself and so had been through the process of birth but this really did nothing to enhance her professional experience”. [2] They would assist with labors perhaps twenty times per year, being paid in gifts and tips from godparents at the child’s baptism. They were, however, unlikely to have “midwife” as their main social identity. Practitioners can be best understood has “having a skill rather than operating as a trade” for income and status. [3]

 

Hendrik van Deventer, Operationum chirurgicarum, novum lumen exhibentium obstetricantibus (Leiden, 1725), Figure 30.

 

 The medical men were only called in for difficult deliveries as a last resort.

“Official medicine had no concept of the mechanism of birth, and knew very little of the anatomy of the uterus or the function of the placenta. Medical men might criticize the skills of midwives, but they had no ambition to replace them; and they accepted without comment the customary procedures of women.” [4]

However, this began to shift, as obstetrics became an academic study in the seventeenth century. The scholarship of childbirth within medicine was growing although some previous problems still perpetuated. Issues with false modesty still arose, with objections to the publishing of gynecological details in the vernacular. Studies within embryology were still very primal, with very little actual understanding of how the fetus developed while in the womb. However, there were many strides made in the anatomical study of the female form. These texts are from before the Enlightenment, a time that ushered a medical study of the female form and changed the ideas of childbirth.

 

Jakob Rüff

Jakob Rüff, The Expert Midwife (London, 1637), title page.

 

One of Worth’s earliest texts on obstetrics was The Expert Midwife (London, 1637), which, as this image demonstrates, had belonged to his father, John Worth, Dean of St. Patrick’s Cathedral, Dublin (1648-1688). A number of Worth’s obstetric texts in English had originally been purchased by his father who may have purchased them in an effort to understand the deaths in childbirth of some of his children. Certainly the notes by John Worth in the Worth Family Bible included a number of early deaths.

 

Swiss surgeon and physician Jakob Rüff (1500-1558) originally published The Expert Midwife in Latin in 1554, attempting to expand on the famed midwifery manual Der schwangern Frauwen und Hebammen Roszgarten (A Garden of Roses for Pregnant Women and Midwives) by Eucharius Rösslin (d.1526). Rösslin’s text is often referenced as the precursor to the obstetric studies that Rüff created. Rüff was passionate about the education of rural midwives and allegedly distributed manuals to be read aloud in the countryside. This 1637 English translation focuses on maladies that affect women throughout their lives, not only just in childbirth. Rüff was a keen advocate of anatomy and is known for his anatomical treatises.

Jakob Rüff, The Expert Midwife (London, 1637), p. 79.

 

As this exhibition demonstrates, a number of themes present in Rüff’s treatise are reflected in later works. Here, for example, is his description of a birthing chair, a practice which would later be advocated by Hendrik van Deventer:

“Let her bring the laboring woman to the Stoole, which ought to be prepared in this fashion. Let the Stoole be made compasse-wise, underpropped with foure feet, the stay of it behind bending backward, hollow in the midst, covered with a blacke cloth underneath, hanging downe to the ground, by that means that the laboring woman may be covered, and other women sometimes apply their hands in any place if necessity require…. And after the laboring woman shall be set in her Chaire about to be delivered, the Midwife shall place one woman behind her back which may gently hold the laboring woman, taking her by both the arms, and if need be, the pains waxing grievous, and the woman laboring, may stroke and presse downe the wombe, and may somewhat drive and depresse the Infant downward…”[5]

 

Jakob Rüff’s The Expert Midwife was intended to be a handbook that was used in the countryside of continental Europe. Rüff’s 1554 text was one of the earliest published works to take into account knowledge from the Renaissance to inform anatomical studies. Read more on The Expert Midwife by viewing the Worth Library Book of the Month for August 2017.

 

Hendrik van Deventer

 

Hendrik van Deventer, Operationum chirurgicarum, novum lumen exhibentium obstetricantibus (Leiden, 1725), frontispiece portrait.

 

Hendrik van Deventer (1651-1724) is noted for his studies on the pelvis of the human body. As a Dutch obstetrician and orthopedic surgeon, Deventer was familiar with the current knowledge on anatomy while doing his own independent research. Operationum chirurgicarum, novum lumen exhibentium obstetricantibus, published posthumously in Latin at Leiden in 1725, features numerous illustrations of the pelvic bones that he believed to be the cause of many abnormalities within births. Rickets, along with many other bone weakening diseases, contributed to many difficulties in labor for young women. This idea was novel; at the time most physicians believed that the fetus propelled itself out of the womb.[6] Deventer may well have benefited from the fact that his wife was a practicing midwife.

 

Hendrik van Deventer, Operationum chirurgicarum, novum lumen exhibentium obstetricantibus (Leiden, 1725), Figure 1.

 

Deventer was one of the first to understand that there was a need for manually enlarging how the cervix opened. This figure can be found in the section titled “Midwifery Improv’d”.[7] Deventer’s obstetric theory included seven “concentric and interrelated zones” that he believed would help to decrease infant mortality.[8] As Wilson notes, one of the many practical implications of Deventer’s approach was to show how “mildly unfavorable turnings of the child” within the womb could be corrected by adjusting the mother’s posture.[9] Deventer likewise discouraged the usage of instruments. His eponymous maneuver adjusted the coccyx “to bend backwards (as it does naturally in normal labor), thereby slightly enlarging the diameter of the passage. The gain … must have been very small, perhaps only a centimeter – but this could give a huge advantage in the delivery.”[10] Some early modern midwives would attempt to separate the pelvises of newborn girls in order to ease their pains in future childbirth, thinking that by pressing and widening the bones, the pelvic structure would be more conducive to inevitable labor.

Hendrik van Deventer, Operationum chirurgicarum, novum lumen exhibentium obstetricantibus (Leiden, 1725), Figures 13 and 14.

 

Deventer’s version of the birthing chair was somewhat more complex than that of Rüff:

An Explanation of the Chair, perforated for the Use of Women in Labour

a          The Upper Part of the Back of the Chair, upon which the Woman in Labour lies with her Back or Loins, or resteth herself by leaning on it, which therefore properly is called the Support or Prop….

b          The lower Part of the Back of the Chair, which always remains immoveable, to which the upper Part a, and the Side Doors ee are fastned by Hinges, so that the Doors may shut and close upon on another, to which Purpose the Hinges must carefully be fitted…

c          One of the Hinges, which is lower near the Ground; but the other belonging to this Door (for each hath two) lies hid under the Seat….

dd        The perforated Seat on which the Woman sits, before from one broader Extreme than the other, is two Foot broad, and behind near the Prop, where it is narrower, it is a Foot and a half board: This perforated Seat made of a strong Oaken Board, is covered on the upper Side with Cloth stuffed with Horse-hair, that it may be full and soft…”[11]

 

The usage of birthing chairs in labor was commonplace up until the late eighteenth century. It was often a symbol of the midwife’s craft. [12] The mechanics of the chair allowed for the womb to easily open while the mother can press herself against the immoveable back of the chair. Deventer explains that the purpose of the birthing chair is to ensure the pains and pressures of labor are supported by the weight and strength of the chair. By the time of the Enlightenment, birthing chairs fell out of favor, replaced by beds. Numerous twentieth century studies claim that the usage of a birthing chair leads to a quicker and more natural birthing position.[13] The change from chair to bed was likely brought about to cater to the accouchers who were in charge of delivery, rather than focusing on the mother’s convenience.

 

François Mauriceau

 

François Mauriceau Traité des maladies des femmes grosses et de celles qui son accouchées (Paris, 1694), frontispiece portrait.

 

 

Worth owned texts by two of the most famous French accouchers of the early modern period: François Mauriceau (1637-1709) and Pierre Dionis (1643-1718). Mauriceau’s Traité des maladies des femmes grosses et de celles qui son accouchées published in 1668 in French and translated in 1683 into English is one of the first in depth studies of obstetrics as a science. Mauriceau, a leading French physician, wrote Traité des maladies des femmes grosses et de celles qui son accouchées as an extensive handbook for the study of women’s health, ranging from fertility and menstruation to conception and labor. Discover more about Traité des maladies des femmes grosses et de celles qui son accouchées by reading the Worth Library Book of the Month for July 2017.

 

François Mauriceau Traité des maladies des femmes grosses et de celles qui son accouchées (Paris, 1694), p.215 detail.

 

Pierre Dionis

 

Pierre Dionis’s Traite General Des Accouchemens (Paris, 1718), frontispiece portrait.

 

Pierre Dionis’s Traite General Des Accouchemens (Paris, 1718) focuses on the new field of man-midwifery. Having trained as a surgeon in France, Dionis (1643-1718) understood the usage of various instruments along with knowledge of anatomy. This book displays many diagrams of the birth of children in various stages of labor. Due to the time period, it is unlikely that even as a practicing accoucher Dionis would have attended any births that were uneventful. His skill of wielding instruments would be why he would be called to any labors.

 

Pierre Dionis’s Traite General Des Accouchemens (Paris, 1718), p. 309

 

The figure shows the varied instruments that were part of the kit of the accoucheur. They are listed as follows:

A. “A Crooked Needle to stitch the Perinæum.

B. The Thred of the Needle.

C. A Cannula, or Pipe, that is to be used.

D. Scissars to cut the Thred.

E. A Compress to be put under the Stitches.

F. An Astringent Plaster.

G. A Pessary, of the Shape of an Egg.

H. The Thred that is fasten’d to it.

I. A Round Pessary, with a Hole in the Middle.

K. An Oval Pessary, with a Hole in the Middle also.

L. The String to hold it by.

M. A Syringe for a Woman.

N. Its Crooked Pipe.

O. A Dilator with two Branches.

P. Another sort of Dilator.

Q. A Speculum Matricis, or Dilator, with three Branches.

R. A Skrew to open and shut it.

Δ   A Wax-Candle, like to a Cannula.”[14]

 

Though these tools would aid the birthing process, many are typical of any surgeon’s bag. The women who were provincial midwives would not have instruments of this sort as, “initially women were not considered able to handle machines; not even those which had no moving parts such as the obstetric forceps”.[15] The birthing process was supposed to be organic and a process that was done naturally without any anaesthetics or sophisticated medical tools.

 

 

Frederik Ruysch

 

Tractatio Anatomico, de Musculo in Fundo Uteri observato… (Amsterdam: Jansson-Waesberg, 1726), plate 1.

 

Finally, we end at the beginning – with an image of an embryo. Dutch anatomist and botanist, Frederik Ruysch (1638-1731), was famed for his studies of preservation of human organs along with the anatomy of men and women. His interest in preserving specimens was to counteract the need for corpses for students (supply of corpses for anatomical dissection was always a problem in the early modern period). Ruysch is probably best known for his Wunderkammern, or cabinet of anatomical specimens, that was a public attraction in Holland. In 1717, Peter I, Czar of Russia, purchased Ruysch’s anatomical collection. Ruysch taught anatomy at the Guild of Surgeons in Amsterdam along with demonstrating dissections to the public. In addition, Ruysch was the city obstetrician of Amsterdam, which entailed presenting information to the midwives of the city in an effort to improve their education and skills.

 

Ruysch published predominately in Amsterdam, and Worth’s copy of his Tractatio Anatomico, de Musculo in Fundo Uteri observato… (Amsterdam: Jansson-Waesberg, 1726) is no exception. This text, which is unbound, and covered only with a marbled paper cover, was either imported by one of the Dublin booksellers or purchased from a Dutch auction. Though it is possible that it was bought by a traveling member of the Worth family it is unlikely that it was Worth himself since he was ill for the last few years of his life. However, Worth had studied at nearby Leiden in the period 1699-1702 and was heavily influenced by Dutch anatomy and physiology in general and continued to buy works of Dutch anatomy throughout his life.

 

Printed in Latin in 1726, Ruysch’s treatise shows the difficulty of illustrating the uterus and embryo. Fetal development was one of the hardest things to study at this time, as there was no way to study the internal proceedings without harming the mother or child. This is likely the cause of the lack of detail in the figure that Ruysch chose to depict in this piece. The labels describe the membranes and the circular ways that an embryo exists, which is fairly sophisticated for the time of publishing.

 

Hugh Chamberlen, Diseases of Women with Child (London, 1683), foldout plate 2.

 

Works Consulted:

 

Chamberlain, Geoffrey. From witchcraft to wisdom: a history of obstetrics & gynaecology in the British Isles. London: RCOG Press, 2007.

Drife, J. “The start of life.” Postgraduate Medical Journal, no. 78 (2002): 311-15.

Dundes, Lauren, MHS. “The Evolution of Maternal Birthing Position.” American Journal of Public Health 77, no. 05 (May 1987): 636-41.

Dunn, Peter M. “The Chamberlen family (1560-1728).” Archives of Disease in Childhood, Neonatal Edition, no. 81 (1999): 232-35.

Dunn, Peter M. “Francois Mauriceau (1637-1709) and maternal posture for parturition.” Archives of Disease in Childhood, no. 66 (1991): 78-79.

Evenden, Doreen. The midwives of seventeenth-century London. Cambridge: Cambridge University Press, 2006.

Fee, Elizabeth, Theodore M. Brown, and Roxanne L. Beatty. “Early Modern Childbirth.” American Journal of Public Health 93, no. 03 (March 2003): 432.

French, Roger Kenneth, and Andrew Wear, eds. The medical revolution of the seventeenth century. Cambridge: Cambridge University Press, 2008.

Grell, Ole Peter., and Andrew Cunningham, eds. Medicine and religion in Enlightenment Europe. Aldershot, England: Ashgate, 2007.

Harvey, Karen. “Visualizing Reproduction: A Cultural History of Early-Modern and Modern Medical Illustrations.” Journal of Medical Humanities, no. 31 (2010): 31-37.

Jackson, Mark. The Oxford handbook of the history of medicine. Oxford: Oxford University Press, 2013.

Karamanou, M., G. Creatsas, T. Dementriou, and G. Androutsos. “Practising Obstetrics in the 17th Century: Francois Mauriceau (1637-1709).” Journal of Obstetrics and Gynaecology 33, no. 1 (2013): 20-23.

Lindemann, Mary. Medicine and society in early modern Europe. Cambridge: Cambridge University Press, 1999.

Longo, Lawrence D., and Lawrence P. Reynolds. Wombs with a View Illustrations of the Gravid Uterus from the Renaissance through the Nineteenth Century. Cham: Springer International Publishing, 2016.

Marland, Hilary. The art of midwifery: early modern midwives in Europe. London: Routledge, 2005.

McTavish, Lianne. “Practices of Looking and the Medical Humanities: Imagining the Unborn in France, 1550-1800.” Journal of Medical Humanities, no. 31 (December 5, 2009): 11-26.

Mori, Hiroyuki, MD, Shin-Zon Chen, MD, Kozo Aisaka, MD, Ryo Matsuoka, MD, and Tomonori Kigawa, MD. “The Physiological Role of the Sitting Parturient Posture.” Asia-Oceania Journal of Obstetrics and Gynecology 11, no. 1 (March 1985): 47-53.

Nicopoullos, JDM. “Midwifery is not a fit occupation for a Gentleman.” Journal of Obstetrics and Gynaecology 23, no. 6 (2003): 589-93.

ODowd, Michael J., and Elliot Elias Philipp. The history of obstetrics and gynaecology. New York: Informa Healthcare, 2011.

OMalley, Charles Donald, ed. The history of medical education: an international symposium held February 5-9, 1968 ;. Berkley, Calif.: Univ. of California Press, 1970.

Park, Katharine. Secrets of women: gender, generation, and the origins of human dissection. New York: Zone Books, 2010.

Scholz, HS, C. Benedicic, MG Arikan, J. Haas, and E. Petru. “Spontaneous vaginal delivery in the birth-chair versus in the conventional dorsal position: a matched controlled comparison.” Wien Klin Wochenschr, no. 113 (September 17, 2001).

Shannahan, Mary K., RN, PhD, and Barbara H. Cottrell, RN, MSN. “The Effects of Birth Chair Delivery on Maternal Perceptions.” Journal of Obstetric, Gynecologic, & Neonatal Nursing , July & aug. 1989, 323-26.

Simpson, Donald. “Pierre Dionis and the Franco-British Dialogue in Surgery.” Australia and New Zealand Journal of Surgery 73, 2003: 336-340

Stolberg, Michael. “A Woman Down to Her Bones: The Anatomy of Sexual Differences in the Sixteenth and Early Seventeenth Centuries.” Isis: University of Chicago 94, no. 2 (June 2003): 274-99.

Tatlock, Lynne. “Speculum Feminarum: Gendered Perspectives on Obstetrics and Gynecology in Early Modern Germany.” Signs 17, no. 4 (Summer 1992): 725-60.

Thomas, Samuel S. “Early Modern Midwifery: Splitting the Profession, Connecting The History.” Journal of Social History, Fall 2009, 116-38.

Wear, Andrew. Health and healing in early modern England: studies in social and intellectual history. Aldershot, Hampshire ;: Ashgate, 1998.

Wear, Andrew. Knowledge and practice in early modern English medicine, 1550 – 1680. New York: Cambridge Univ. Press, 2000.

Wilson, Adrian. The Making of Man-Midwifery: Childbirth in England 1660-1770. London: University College London Press , 1995.

 

Footnotes

 

[1] Marland, Hilary. The art of midwifery: Early Modern Midwives in Europe (London: Routledge, 2005), p. 27.

[2] Chamberlain, Geoffrey. From witchcraft to wisdom: a history of obstetrics & gynaecology in the British Isles (London: RCOG Press, 2007), p. 23.

[3] Marland, The art of midwifery, p. 28.

 

[4] Wilson, Adrian. The Making of Man-Midwifery: Childbirth in England 1660-1770 (London: University College London Press, 1995), p. 1.

 

[5] Rüff, Jakob, The Expert Midwife (London, 1637), pp 78-80.

[6] Longo, Lawrence D., and Lawrence P. Reynolds. Wombs with a View Illustrations of the Gravid Uterus from the Renaissance through the Nineteenth Century (Cham: Springer International Publishing, 2016), p. 98.

[7] All English quotations from Deventer are from the later English translation The Art of Midwifery Improved (London, 1728).

[8] Adrian Wilson, The Making of Man-Midwifery. Childbirth in England 1660-1770 (London: University College London, 1995), p. 81.

[9] Ibid.

[10] Ibid., p. 82

[11] All English translations from Deventer are taken from The Art of Midwifery Improved (London, 1728), pp 111-112.

[12] Marland, The art of midwifery, p. 155.

[13] See for example Scholz, HS, C. Benedicic, MG Arikan, J. Haas, and E. Petru. “Spontaneous vaginal delivery in the birth-chair versus in the conventional dorsal position: a matched controlled comparison.” Wien Klin Wochenschr, no. 113 (September 17, 2001).

[14] All English translations are taken from the English translation of 1719: A General Treatise of Midwifery (London: A. Bell et al, 1719), pp 248-9.

[15] ODowd, Michael J., and Elliot Elias Philipp. The history of obstetrics and gynaecology (New York: Informa Healthcare, 2011), p. 175.

 

Text: Ms Mallory McFall (University of Kansas).

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