Midwifery, Obstetrics and the Rise of Gynaecology: The Uses of a Sixteenth-Century Compendium 075465396X, 9780754653967

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MIDWIFERY, OBSTETRICS AND THE RISE OF GYNAECOLOGY

Women and Gender in the Early Modern World Series Editors: Allyson Poska and Abby Zanger In the past decade, the study of women and gender has offered some of the most vital and innovative challenges to scholarship on the early modern period. Ashgate’s new series of interdisciplinary and comparative studies, ‘Women and Gender in the Early Modern World’, takes up this challenge, reaching beyond geographical limitations to explore the experiences of early modern women and the nature of gender in Europe, the Americas, Asia, and Africa. Submissions of singleauthor studies and edited collections will be considered. Titles in this series include: Childbirth and the Display of Authority in Early Modern France Lianne McTavish Hermaphrodites in Renaissance Europe Kathleen P. Long Women and Poor Relief in Seventeenth-Century France The Early History of the Daughters of Charity Susan E. Dinan Midwiving Subjects in Shakespeare’s England Caroline Bicks From Wives to Widows in Early Modern Paris Gender, Economy & Law Janine M. Lanza

Midwifery, Obstetrics and the Rise of Gynaecology The Uses of a Sixteenth-Century Compendium

HELEN KING

University of Reading, UK

First published 2007 by Ashgate Publishing Published 2016 by Routledge 2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN 711 Third Avenue, New York, NY 10017, USA Routledge is an imprint of the Taylor & Francis Group, an informa business Copyright  2007 Helen King Helen King has asserted her moral right under the Copyright, Designs and Patents Act, 1988, to be identified as the author of this work. All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. British Library Cataloguing in Publication Data King, Helen, 1957Midwifery, obstetrics and the rise of gynaecology : the uses of a sixteenth-century compendium. – (Women and gender in the early modern world) 1. Midwifery – Great Britain – History – 16th century – Sources 2. Obstetrics – Great Britain – History – 16th century – Sources 3. Gynecology – Great Britain – History – 16th century - Sources 4. Midwifery in literature I. Title 828.3'0946181 Library of Congress Cataloging-in-Publication Data King, Helen, 1957Midwifery, obstetrics and the rise of gynaecology : the uses of a sixteenth-century compendium / by Helen King. p. ; cm. — (Women and gender in the early modern world) Includes bibliographical references. ISBN 978-0-7546-5396-7 (hardback : alk. paper) 1. Midwifery—Great Britain—History—17th century. 2. Obstetrics—Great Britain— History—17th century. 3. Midwives—Great Britain—History—17th century. 4. Gynecology—Great Britain—History—17th century. I. Title. II. Series. [DNLM: 1. Midwifery—history—England. 2. Genital Diseases, Female—history— England. 3. History, 16th Century--England. 4. History, 17th Century—England. 5. Medicine in Literature—England. 6. Obstetrics—history—England. WQ 11 FE5 K52m 2007] RG524.K54 2007 618.2'00941—dc22 2006102513 ISBN 9780754653967 (hbk)

Contents List of Illustrations Acknowledgements

vii ix

Introduction: Towards Gynaecology The Gynaeciorum libri The significance of gynaecology Authority over the womb A ‘century of change’?

1 1 8 16 26

1 Prefacing Women: Owners and Users Prefacing women Owners and annotators Treating menstrual disorders Sterility and the uterine mole

29 30 42 52 59

2 Medical History and Obstetric Practice in William Smellie Smellie vs Burton: haste, error and rivalry The making of a man-midwife Smellie and midwives The laboratory of lying-in Training men-midwives Looking to the past Using Hippocrates Smellie’s sources

65 67 72 73 76 79 83 91 100

3 Guilty of ‘Male-practice’? Burton’s Attack on Smellie Disputes in action Languages The lithopedion of Sens The case of the ass’s urine To cut or not to cut? Beyond the wicker woman The ‘noble instrument’ Avicenna Albucasis Ancient instruments

107 108 114 117 121 126 131 137 141 143 151

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Midwifery, Obstetrics and the Rise of Gynaecology

4 Delighting in a ‘Bit of Antiquity’: Sir James Young Simpson Collecting the past Defining gynaecology Simpson and the classics Performing the part both of man and woman: Simpson and gender Those most bitter pains: justifying chloroform

155 158 164 172

Conclusion

191

Bibliography Index

195 219

175 183

List of Illustrations Plate 1

Sir James Young Simpson, by Norman Macbeth. Photograph by Iain Milne. Reproduced with permission of the Royal College of Physicians, Edinburgh.

10

Plate 2

Title page of the copy of the 1586 edition owned by Crosse and Wildberg. Reproduced by courtesy of the University Librarian and Director, The John Rylands University Library, The University of Manchester.

46

Plate 3

Bookplate of Johan Karl Wilhelm Moehsen, from the same copy of the 1586 edition. Reproduced by courtesy of the University Librarian and Director, The John Rylands University Library, The University of Manchester.

47

Plate 4

Harvie’s certificate of attendance at Smellie’s course. Reproduced with the permission of the Royal College of Obstetricians and Gynaecologists.

97

Plate 5

Francis Clifton, Hippocrates upon Air, Water and Situation (London, 1734), frontispiece. Reproduced with permission of The Wellcome Library.

98

Plate 6

Spach, Gynaeciorum libri (1597), p. 446: selection of gynaecological and obstetrical instruments. Reproduced with permission of The Wellcome Library.

145

Plate 7

Loose sheet from William Smellie’s copy of Spach. Photograph by Paul Archibald. Image from the William Smellie Collection in Lanark Library, Lindsay Institute, Lanark, reproduced by permission of South Lanarkshire Council.

146

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Acknowledgements This book has been the result of a long process of research, mostly funded by a Wellcome Trust University Award at the University of Reading, from 1996–2001. The completion of this output of the project was funded by the AHRC Research Leave Scheme (award RL/ 111813), and I would like to put on record my thanks to both bodies for supporting my work. Many academics, librarians and archivists have played a central role in making possible the research I have undertaken. In particular I would like to thank for their enthusiasm and hospitality Roger Davidson, Monica Green, Iain Milne (Royal College of Physicians, Edinburgh), Marianne Smith (Royal College of Surgeons, Edinburgh) and Paul Archibald (Lindsay Institute, Lanark). I would also like to thank Carol Burrows and Dorothy Clayton (The John Rylands University Library, Manchester), Jack Eckert (Center for the History of Medicine, Francis A. Countway Library of Medicine), Véronique Dasen, George Ferzoco, Elaine Garrett and Lucy Reid (Royal College of Obstetricians and Gynaecologists), Stephen Greenberg (History of Medicine Division, National Library of Medicine), Robert Greenwood (Royal Society of Medicine), Ann Ellis Hanson, Christian Hogrefe (Herzog August Bibliothek Wolfenbüttel), Gertie Johansson (Hagstroemer Medico-Historical Library), Ian Maclean, Rosie McLure (Lothian Health Services Archive, Edinburgh University Library), Cathy McClive, Janet McMullin (Christ Church, Oxford), Lianne McTavish, Peter Mohr (Honorary Curator, University of Manchester Medical School Museum), Vivian Nutton, Julian Reid (Archivist, Merton College, Oxford), Julius Rocca, Emilie Savage-Smith, Amanda Saville (Librarian, The Queen’s College, Oxford) and Julianne Simpson and John Symons (Wellcome Library) I would also like to thank the audiences whose responses to various versions of my work have shaped this book. Parts of chapter 1 were first delivered at the conference ‘Secret Bodies: medical knowledge and early modern women’, held in July, 2000 at the University of Warwick; other parts were presented to the 15th Medieval, Renaissance and Baroque Symposium, ‘Where there was no sex or gender?’ at the University of Miami, February, 2006. An earlier version of parts of chapters 3 and 4 was presented as ‘Producing gynaecology: 18th and 19th century users of a 16th century gynaecological compendium’, 13th Berkshire Women’s History Conference, Claremont, CA, April 2005, and sections of chapters 2 and 3 were delivered as a seminar paper, ‘William Smellie vs John Burton: using the history of medicine in eighteenth-century obstetrics’, at the Department of History

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Midwifery, Obstetrics and the Rise of Gynaecology

and Philosophy of Science, University of Cambridge, December 2005. The University of Reading’s Research Endowment Trust Fund and the British Academy funded my attendance at Claremont and Miami (British Academy grant nos. OCG-40135 and OCG-41734). Finally, my thanks are due not only to my parents, for their patience with the demands of this project, but also to my husband Ralph Shephard, for finding the perfect balance between keeping out of my way and making me cups of tea. It is not an easy thing to marry a historian while she is completing a book.

Introduction

Towards Gynaecology ‘Why can’t a woman be more like a man?’ Henry Higgins, My Fair Lady

How far does female difference from men extend, and to what degree does the decision that gynaecology is necessary – that the difference is so great that women require their own medical field – relate to specific historical and cultural views on the nature of woman? In the late nineteenth century, Dr. Ludovic Bouland, a physician who also founded the French society for collectors of bookplates and artistic bindings, rebound a 1663 collection of five texts in Latin on virginity and on the diseases of women; looking for ‘a binding appropriate to the subject’, he chose a piece of female human skin, tanned by himself, decorated with gilt on the spine, borders, and cover ornaments.1 For him, skin – the wrapper of the female body – was also the most appropriate container for material on female difference. His decision implied that, even in its skin, the female body differs from that of the male.

The Gynaeciorum libri Extracts from two of the works included in this 1663 collection had also featured in versions of an earlier and far more extensive Latin compendium of ancient and contemporary texts on the medical treatment of women, first published in Basle in 1566. Edited by Hans Kaspar Wolf (1532–1601), but conceived by the great humanist scholar Conrad Gesner (1516–64), the full title of this compendium was 1

The book, now held at the Wellcome Library (shelfmark EPB Bindings 14), is I. Sever. Pinaei, De integritatis & corruptionis virginum notis: graviditate item & partu naturali mulierum, opuscula. II. Ludov. Bonacioli, Enneas muliebris. III. Fel. Plateri, De origine partium, earumque in utero conformatione. IV. Petri Gassendi, De septo cordis pervio, observatio. V. Melchioris Sebizii, De notis virginitatis (Amsterdam, 1663). A handwritten note at the front of the title page reads Ce curieux petit livre sur la virginité et les functions génératrices féminines me paraissant mériter une reliure congruente au suject est revêtu d’un morceau de peau de femme tanné par moi-même avec du sumac. The skin came from a woman who died in the hospital in Metz when Bouland was a medical student. For a discussion of the early history of bindings made with human skin, see John Symons, (accessed 28 December 2005).

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Midwifery, Obstetrics and the Rise of Gynaecology

Gynaeciorum, hoc est, de mulierum tum aliis, tum gravidarum, parientium, et puerperarum affectibus et morbis, libri veterum ac recentiorum2 aliquot, partim nunc primum editi, partim multo quam antea castigatiores; ‘Of matters pertaining to women, that is, concerning both the affections and diseases of pregnant women, those bringing forth and those in labour, and other [conditions] of women, some books of ancient and more recent [authors], partly now edited for the first time, others more carefully revised than before’. Here I will refer to this compendium as the Gynaeciorum libri, the ‘Books on [the diseases of] women’; the Latin gynaecia, like the Greek gynaikeia, has many meanings, extending from ‘women’s matters’ to ‘women’s diseases’, to the female genitalia, and also covers ‘remedies for women’s disorders’.3 A second, enlarged, edition followed in 1586/8 under the editorship of Caspar Bauhin (1560–1624) and a third, running to 1097 folio pages, was produced by Israel Spach (1560–1610) in 1597.4 Although the title page to Spach proudly claimed that the work was necessariis IMAGINIBUS exornati, ‘embellished with indispensable illustrations’, it contained very little beside text. The short extract from Felix Platter, which opened the collection from the second edition onwards, had some anatomical illustrations based on Vesalius, while instruments were shown in Ruf, Paré and Albucasis, and Ruf’s text also included fifteen foetal positions. Other than the full-page illustration of the ‘stone infant’ of Sens, which will be discussed in detail in chapter 3, this was the extent of the images used in the collection. Far from being an accessible work on the nature of the female, this was a confusing and intellectually challenging volume. Both the later editions of the Gynaeciorum libri stated in their titles the multiple origin of the works included – Greek, Latin and Arabic – here using not only the term Arabori (1597) but also, as a synonym, the derogatory Barbari (1586).5 In Greek, the collection included from its first edition the text of the sixth-century writer Muscio translated into Greek from what was believed to be its original 2

Ian Maclean, ‘The Diffusion of Learned Medicine in the Sixteenth Century through the Printed Book’, in Wouter Bracke and Herwig Deumens (eds), Medical Latin from the Late Middle Ages to the Eighteenth Century (Brussels, 2000), p. 105, points out that ‘recentior’ could at this time mean any writer after 1300. 3 Helen King, Hippocrates’ Woman: Reading the Female Body in Ancient Greece (London and New York, 1998), p. 23. 4 Once the 10-year privilege granted to the previous, 1586/8, edition ran out; Ian Maclean (pers. comm. 29 December 2000) says the 10-year privilege granted to Spach in 1597 still survives in Vienna. See his chapter, ‘The Diffusion of Learned Medicine’, p. 103, on how decisions were taken to reprint books. Online access to all three editions is provided by the Biblioteca Digital Dioscórides at the Universidad Complutense Madrid; see . 5 Israel Spach (ed.), Gynaeciorum sive de Mulierum tum communibus, tum gravidarum, parientium et puerperarum affectibus et morbis libri Graecorum, Arabum, Latinorum veterum et recentium quotquot extant, partim nunc primum editi, partim vero denuo recogniti, emendati (Strasbourg, 1597).

Towards Gynaecology

3

language, Latin, edited by Gesner and Wolf and, from the second edition, the text (with Latin commentary) of the first book of the Hippocratic Diseases of Women; in Greek, Gynaikeia, or ‘women’s matters’.6 When I began to study these collections, my initial research question was simply ‘Why?’: why were these different texts on women’s medicine put together and printed at this time (Table 1)? A further question followed from this one: of the works available on women’s diseases and on childbirth in the second half of the sixteenth century, why were some texts selected for these compendia, and others left out? The Gynaeciorum libri offered a pan-European group of texts, the authors of the contemporary works included being the Spaniard de Mercado, the Italians Bonacciuoli, Mercuriale, Bottoni and Trincavelli, the German-speaking Platter, Ruf, and Bauhin, and the French Akakia, de la Roche, Paré, Dubois, Rousset, le Bon and de la Corde. Some of the treatises included had already been available for a few years; some moved rapidly from publication as a separate volume, to inclusion in the compendium, while one was published without authorization in the Gynaeciorum libri, and appeared separately a year later.7 The production of the collection in Latin is a further aspect of its pan-European status. When Peter Murray Jones studied medical libraries in early sixteenth-century Oxford and Cambridge, he found that there was still very little that was not in Latin, even among non-professional owners, but by the mid- to late sixteenth century vernacular works were available in many European languages.8 For the Gynaeciorum libri, however, work which existed in French was translated into Latin so that the international learned community would have greater access to it; François Rousset’s treatise on Caesarean section, Hysterotomotokia, had first been published in French in 1581, but was translated into Latin for the 1586 Gynaeciorum libri, while the treatises on menstruation and generation by Jacques

6

Muscio translated Soranos’s (Greek) Gynaikeia into Latin, possibly in the sixth century AD; it was then translated back into Greek again later in the Byzantine period, before being translated into Latin once more early in the Renaissance. See further Ann Ellis Hanson and Monica H. Green, ‘Soranus of Ephesus: Methodicorum Princeps’, in Aufstieg und Niedergang der Römischen Welt 37.2 (1994): 968–1075, esp. pp. 1042–43, 1046, 1053– 57. The text in the Gynaeciorum libri reprints the separate publication of Wolf’s edition (Basle, 1566). 7 Maurice de la Corde’s commentary on the Hippocratic Diseases of Women 1 appeared separately in 1585 and entered the compendium in 1586, while Girolamo Mercuriale’s treatise appeared separately in 1587, the year after its inclusion. 8 Peter Murray Jones, ‘Medicine and Science’, in Lotte Hellinga and J.B. Trapp (eds), The Cambridge History of the Book in Britain, vol. 3, 1400–1557 (Cambridge, 1999), pp. 446–7.

4

Midwifery, Obstetrics and the Rise of Gynaecology

Table 1 The contents of the three editions of the Gynaeciorum libri Author

Short Title

First Publication Outside This Collection

First Entry into Gynaeciorum libri

Caspar Wolf (ed)

Harmonia Gynaeciorum

1566

Albucasis

Gravissimorum aliquot affectuum muliebrium … curandi ratio

1566

Trotula

De mulierum passionibus

1566

Nicholas de la Roche

De morbis mulierum curandis liber

1542

1566

Luigi Bonacciuoli

Muliebrium liber

1505*

1566

Jacques Dubois

De mensibus mulierum et hominis generatione

1555

1566

Muscio

De passionibus mulierum liber

Felix Platter

De mulierum partibus generationi

1583

1586

Jakob Ruf

De conceptu et generatione hominis

1554

1586

Girolamo Mercuriale

Muliebrium libros IV

1587

1586

Giovanni Baptista da Monte

De uterinis affectibus

1554

1586

Consilia de affectibus muliebribus

1554

1586

1566

Towards Gynaecology

5

Vittore Trincavelli

Consilia III muliebria

1586

1586

Albertino Bottoni

De morbis muliebribus

1585

1586

Jean le Bon

Therapia puerperarum

1571/7

Ambroise Paré

De hominis generatione

1573

1586

François Rousset

Hysterotomotokia

1581 (F)

1586

Maurice de la Corde

Gynaeciorum in quo Hippocratis Coi,… Liber prior de morbis mulierum

1585

1586

Luis de Mercado

De morbis mulierum communibus

1579

1588

Caspar Bauhin

Libellus variarum historiarum

1579

1597

Martin Akakia

De morbis muliebribus

1597

* Dated on the grounds that the dedicatee, Lucrezia Borgia, is referred to as the Duchess of Ferrara, a title she only took in this year. I owe this point to Monica Green.

Dubois had appeared in Latin in 1555, then in French translation in 1559, and entered the 1566 Gynaeciorum libri in a revised Latin version.9 Other questions raised by this compendium concern its specific cultural contexts. How significant is it that a collection on the female body, emphasizing its distinct nature, was created during the Reformation, and in a period identified by some scholars as one in which – at least in England – masculinity began to undergo 9

The printing history of Dubois’s work will be discussed further in chapter 1. As Jones points out, John Caius similarly published his work on the English sweat in Latin in 1552, but then produced a Latin version for the European market. However, here there was a clear reason for choosing the vernacular first. See Peter Murray Jones, ‘Medical Libraries and Medical Latin 1400–1700’, in Bracke and Deumens (eds), Medical Latin from the Late Middle Ages to the Eighteenth Century, p. 119. On translation into Latin see also Maclean, ‘The Diffusion of Learned Medicine’, p. 93 and n. 1.

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Midwifery, Obstetrics and the Rise of Gynaecology

a ‘crisis’?10 This sixteenth-century interest in women in which, as I shall show, Hippocrates came to be seen as the expert on the sex, may be related to the ‘crisis in patriarchy’ identified, at least in England, by scholars including Anthony Fletcher. As I have documented elsewhere, all over Europe there was considerable interest in issues of menstruation, virginity and marriage, perhaps linked to the rise of Protestantism, in which virginity was seen as problematic, or to the issues of women in power posed by queens such as Mary and Elizabeth I.11 At this time, what was thought to constitute a ‘woman’, and what did the texts in the Gynaeciorum libri take to be the main differences between the sexes? How were a woman’s physical characteristics thought to affect her mental capacity, and what were the implications for her life? Did the publication of these texts as a compendium have any effect on the medical treatment of women? The editor of the third edition, Spach, maintained that his enlarged volume was needed because of continued demand for these texts devoted to the diseases of women; he described the publisher, Zetzner, as being ‘influenced by the common good’, embarking on this project because the books were so sought after.12 Was that statement merely part of the rhetoric of medical publishing, or something more? Certainly, it was not only publishing on the diseases of women that took off in the second half of the sixteenth century. All three editions came out during a period in which the production of medical books was increasing rapidly; Ian Maclean has identified the years from 1565–1625 as ‘the heyday of the Frankfurt Book fair’, an event held twice a year and a key forum for publicizing, as well as selling, books.13 From 1590 onwards, the first specialist bibliographies of medical works were also published; Israel Spach was responsible not only for the 1597 Gynaeciorum libri but also for the first bibliography of medical books organized by subject, the Nomenclator scriptorum medicorum published in 1591, which included the work of a total of 1436 authors.14 But as I continued to study the Gynaeciorum libri, I could not help but be aware of its subsequent uses, and it is on these that the present book will concentrate. In its three editions, these were not particularly rare volumes; as the definitive works on the diseases of women, they were a ‘must have’ in the medical 10

E.g. Anthony J. Fletcher, ‘Men’s Dilemma: The Future of Patriarchy in England 1560–1660’, Transactions of the Royal Historical Society, 6th series 4 (1994): 61–81; ibid., Gender, Sex and Subordination in England, 1500–1800 (New Haven, 1995); Anthony J. Fletcher and John Stevenson (eds), Order and Disorder in Early Modern England (Cambridge, 1985). Mary Fissell locates in the late seventeenth century a crisis of both paternity and maternity; Vernacular Bodies: The Politics of Reproduction in Early Modern England (Oxford, 2004), p. 46. 11 Helen King, The Disease of Virgins: Green Sickness, Chlorosis and the Problems of Puberty (London, 2004), pp. 80 and 140. 12 Spach (ed.), Gynaeciorum libri, preface: Nunc autem cum eorundem desiderarentur exemplaria: tam precibus aliorum, quam etiam utilitate communi adductus et permotus. 13 Maclean, ‘The Diffusion of Learned Medicine’, p. 95. 14 See Jones, ‘Medical Libraries and Medical Latin 1400–1700’, pp. 132–3.

Towards Gynaecology

7

libraries of individuals and institutions, into the Victorian era.15 Copies of the three editions, and in particular of the large folio single-volume edition of 1597, were owned by doctors all over Europe, and handed down in their families; Ian Maclean has argued that publication in folio may be about an ‘externalization of knowledge’, if the book is to be displayed in the workplace, but was also ‘a matter of the physical expression of the excellence of the contents’.16 The folio publication of the 1597 Spach edition could therefore be seen partly as recognition of the worth of the compendium. In its later history, the collection was long regarded as being of far more than antiquarian interest. In 1891 Howard Kelly, Professor of Gynecology and Obstetrics at Johns Hopkins Hospital (1889–99), and subsequently Professor of Gynecology (1899–1919), was still able to write of it: This book is peculiarly interesting as one of the earliest special works, and as being the largest old collective work … it contains much of value, much in common with the teaching of today.17

As I will explore in chapter 1, many surviving copies, particularly of the first two editions, have some level of annotation, as owners interpreted the text, compared the different treatises collected in this compendium, studied the earlier sources from which the writers of the treatises supported their statements, and tried to find in their own countries plants equivalent to those recommended by the texts they read. In studying this long history, I was struck by two particular owners and users of the compendium, neither of them from a time when I would have expected much interest in either sixteenth-century medicine or the classical, medieval and Arabic treatises that make up the remainder of the Gynaeciorum libri. One of these users was the eighteenth-century Scottish man-midwife, William Smellie, responsible for training a generation of men-midwives in London; the other was another Scot, Sir James Young Simpson, Professor of Midwifery in Edinburgh from 1840 and most famous for discovering the anaesthetic properties of chloroform in 1847. Both were also book collectors, whose collections survive at least in part; in the case of Smellie, his library is almost intact.18 Although both lived in times when ancient medicine remained a part of medical education – even in the nineteenth century, it was normal for medical exams to include the requirement to comment on one of 15

Ibid., p. 121, comments usefully on the conservatism of those who collected a medical library; their ambition was ‘to put together as representative a collection as possible’ regardless of their individual specialist interests. 16 Maclean, ‘The Diffusion of Learned Medicine’, pp. 106–7. 17 Howard Kelly, ‘Israel Spachius’s Gynecology’, Johns Hopkins Hospital Bulletin 2, 1891, p. 164, cited in I.S. Cutter and H.R. Viets, A Short History of Midwifery (Philadelphia and London: 1964), pp. 29–30 n.3. 18 Smellie’s library is held at Lanark in the Lindsay Institute: much of Simpson’s collection is in the library of the Royal College of Physicians, Edinburgh. See below, chapter 2.

8

Midwifery, Obstetrics and the Rise of Gynaecology

the aphorisms of Hippocrates – I found it surprising that the compendium was still being read and used. The authority of ‘the classics’ had begun to wane, being replaced by commitment to observation and to the new values of the scientific method. In an important essay review published in 1996, Irvine Loudon characterized as the most striking features of eighteenth-century medicine ‘the surging spirit of enquiry, the faith in personal experience and powers of observation, and the rejection of “ancient authority”’.19 Both Smellie and Simpson went to grammar schools, where they received a classical education. Smellie used Latin translations of Greek medicine, although – as we shall see in chapters 2 and 3 – his competence to do so was questioned by his contemporary, the York man-midwife John Burton. Simpson, a keen antiquarian, often assembled classical authorities to back up his points, but eventually came to challenge the place of the classics in the school curriculum, regarding them not only as being of marginal importance in a scientific education, but also as morally dangerous. The portrait of Simpson by Norman Macbeth, now hanging over the stairs of the Royal College of Physicians of Edinburgh, shows him turning away from reading his 1597 Spach Gynaeciorum libri, which is open at the title page, towards the viewer. On the table is also a clearly labelled bottle of chloroform, while beside the table are an ancient inscription and a Greek vase. The items selected clearly represent his interests, and the grounds on which his reputation was based; for example, in 1856 he had published a piece entitled Notes on Some Ancient Greek Vases for Containing lykion.20 In the portrait, the red letters of ‘ISRAEL SPACH’ and the year of publication are shown larger than they really are, to make it even more obvious what Simpson has been reading, and thus making the book a clear statement of medical authority. [Plate 1]

The significance of gynaecology The origin of gynaecology is usually dated to within Simpson’s lifetime; for example, Roberta McGrath traced the use of the word to between 1820 and 1850, while Jeanne Peterson and Ornella Moscucci have shown that the institutional expression of the discipline, through specialist hospital departments and subject diplomas, did not occur until the second half of the nineteenth century.21 In the nineteenth century, the claim that gynaecology was necessary – that women were 19

Irvine Loudon, ‘Essay Review: The Making of Man-midwifery’, Bulletin of the History of Medicine, 70 (1996), p. 512. 20 Notes on Some Ancient Greek Vases for Containing lykion: and on the Modern Use of the Same Drug in India (Edinburgh, 1856). 21 Roberta McGrath, Seeing her Sex: Medical Archives and the Female Body (Manchester and New York: 2002), p. 34; M. Jeanne Peterson, The Medical Profession in Mid-Victorian London (Berkeley, CA and London, 1978); Ornella Moscucci, The Science of Woman: Gynaecology and Gender in England, 1800–1929 (Cambridge, 1990).

Towards Gynaecology

9

sufficiently ‘different’ to need a medical specialty – could have economic as well as theoretical implications; the treatment of women had become a contested field between surgeons, physicians, and the emerging hybrid of the gynaecologist.22 But what happened before Simpson’s lifetime? Michael Stolberg has traced an earlier use of the word ‘gynaecology’ in Latin, citing the German physician Johann Peter Lotichius’s work, advocating the education of women to the same level as men, entitled Gynaicologia, id est de nobilitate et perfectione sexus feminei (1630).23 This is a positive work on female difference, arguing not for exclusion but for equality; but gynaecology, in the sense of a separate branch of medicine, usually carried a far more negative charge. I will be arguing here that the intense interest in the diseases of women in the second half of the sixteenth century, stressing the difference of women from men, and noting the implications of this difference for their effective treatment, should make us revisit attempts to place the origin of gynaecology – in anything other than a narrowly institutional sense – as late as the nineteenth century.24 Furthermore, although Simpson’s portrait of a nineteenth-century Professor of Midwifery with a sixteenth-century compendium on gynaecology links these two historical periods in which the ‘invention’ of gynaecology can be situated, neither was the first time in Western medicine that women were considered so different from men as to warrant a separate branch of medicine. That claim was first made in fifth-century Greece, in the texts of the Hippocratic corpus; indeed, sixteenth-century writers on the diseases of women looked to Hippocrates as the man who had finally tied down into categories the shifting body of the female.25 By bringing these ancient texts into the debate, we can consider the explanations proposed for the nineteenth-century ‘origin’ of gynaecology – economic, social, political – more generally. Of course, the explanation of the emphasis on female difference does not have to be the same in every case, and it is valuable to take the long view while simultaneously looking for what is culturally specific. The existence of Hippocratic texts exclusively devoted to the female body, and the publication of three editions of a compendium of gynaecological texts in the sixteenth century, should therefore make us think again about the origin of

22

King, Hippocrates’ Woman, p. 2. Johann Peter Lotichius, Gynaicologia, id est de nobilitate et perfectione sexus feminei (Rinteln, 1630) cited in Michael Stolberg, ‘A Woman Down to her Bones: The Anatomy of Sexual Difference in the Sixteenth and Early Seventeenth Centuries,’ Isis, 94 (2003), p. 288. See also Winfried Schleiner, ‘Early Modern Controversies About the Onesex Model’, Renaissance Quarterly, 53 (2000), pp. 189–90. 24 Stolberg, ‘A Woman Down to her Bones’, pp. 288–9. 25 Helen King, ‘Hippocratic Gynaecological Therapy in the Sixteenth and Seventeenth Centuries’ in Ivan Garofolo et al. (eds), Aspetti della Terapia nel Corpus Hippocraticum (Atti del IXe Colloque hippocratique, Pisa, 25–29 settembre 1996) (Firenze, 1999), pp. 499– 515. 23

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Plate 1 Sir James Young Simpson, by Norman Macbeth. Photograph by Iain Milne. Reproduced with permission of the Royal College of Physicians, Edinurgh.

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gynaecology. One of the ways in which the model of female difference was given authority in the sixteenth century was through the selection of appropriate classical passages to cite on the title page of a new work, or to discuss in the preface; two passages, in particular, taken from Hippocratic treatises were used in this context. The first of these was Places in Man 47,26 which stated that ‘the womb is the cause of all diseases of women’ and was cited, for example, in Caspar Wolf’s Harmonia Gynaeciorum of 1566, a question-and-answer work based on several medieval texts that was included in all three editions of the Gynaeciorum libri.27 The same Hippocratic reference was also used as a key reference in Wolf’s dedicatory epistle included in both the 1566 and 1586 editions.28 The second passage used in these claims for greater attention to female difference was the Hippocratic Diseases of Women 1.62, which probably derives from the fifth century BC. It warned that women should not be treated as if they were men, because ‘the treatment (iêsis) of the diseases of women differs greatly from that of men’.29 This statement, suggesting that gynaecology should form a separate area of medicine, and which Paola Manuli memorably described as the founding act of ancient Greek gynaecology,30 appeared, for example, on the title page of Maurice de la Corde’s commentary on the text Diseases of Young Girls, published in 1574, and was discussed at length in 1597 in Israel Spach’s preface to the third edition of the Gynaeciorum libri.31 While the first passage suggests that the medical focus should rest on one organ – the womb – the second is more radical, arguing for a more extensive degree of difference, spreading throughout the female body. For sixteenth-century medical writers, these two Hippocratic passages suggested that women were particularly difficult to treat, and therefore needed a separate branch of medicine. While Places in Man concentrated the difference into one organ, Diseases of Women went further by claiming in addition that the diseases of women are difficult to recognize, because they are experienced only by women; these women do not understand what is wrong with them, if they lack experience of ‘the diseases coming from menstruation‘, but ‘time and necessity’ teach them the cause of their diseases. Spach’s preface summarized this passage. Women who fail to understand the origin of their illness call in a healer too late, 26

Loeb VIII, ed. Paul Potter (Cambridge, MA, and London, 1995), p. 94; Elizabeth Craik (ed.), Hippocrates, Places in Man (Oxford, 1998), p. 86. 27 The text has been translated into Italian: see Gino Fravega, Harmoniae gyneciorum: epitome di Gaspare Wolf su Moschione, Cleopatra e Teodoro Prisciano (Genova, 1962). 28 Caspar Wolf 1564 and 1586 Epistolaria dedicatoria: Atque hoc illud est, quod omnium bonorum autor Hippocrates, Laconica brevitate usus: UTEROS MORBORUM IN MULIERIBUS CAUSAM EXISTERE, alicubi commemorat. 29 Ed. Emile Littré (Paris, 1839–61), 8.126. 30 Paola Manuli, ‘Donne mascoline, femmine sterili, vergini perpetue. La ginecologia greca tra Ippocrate e Sorano’ in Silvia Campese, Paola Manuli and Giulia Sissa, Madre Materia. Sociologia e Biologia della Donna Greca (Turin, 1983), p. 154. 31 Maurice de la Corde, Hippocratis Coi libellus Peri Partheniôn, hoc est, De iis quae virginibus accidunt (Paris, 1574); Spach, preface to 1597 Gynaeciorum libri.

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while those who do understand are reluctant to talk to a healer. The healer must always bear in mind that the cause of women’s diseases is different, and therefore the treatment must also be different.32 Although the concept of ‘gynaecology’ – a medical approach focused on female difference – was thus invented in the Hippocratic Diseases of Women, there were no ‘gynaecologists’, as all physicians were supposed to have this knowledge in order to treat their female patients. Nor was belief in women’s difference a novel medical idea. Instead, it expressed deep-rooted cultural views on women, as the Greeks regarded them as a late creation, having their origin in the deceptive body of the first woman, Pandora.33 The Hippocratic corpus is a collection of treatises from different dates, their authors or compilers holding a range of theoretical positions on the nature and treatment of the human body; this variety was probably adaptive, as the Hippocratic healer was ‘materially dependent on a public with the broadest possible spectrum of religious and philosophical beliefs, and the less clearly he expressed himself about such matters, the better for him’.34 Nevertheless, common to many of these treatises was the idea that women are wetter than men, and that this in turn results from the flesh throughout their bodies being of a softer and more spongy texture, absorbing more fluid from their diet.35 Glands 16 explains that women’s bodies retain moisture because they are loosetextured (araios), spongy (chaunos) and like wool (eirion).36 In addition, social factors come into play; because women do not take as much exercise as men, they cannot use up any accumulated excess.37 Here the social is natural, because it was believed that women are specifically designed to live sedentary lives at home, while men are made to deal with the ‘things outside’.38 Women’s fluid collects in the body and eventually comes out as menstrual blood; the menstrual function is the evidence for, as well as the direct result of, the different texture of flesh throughout the female body. Hippocratic gynaecology, performed by men whose practice also included the diseases of men, therefore covered far more than the organs of generation, because every inch of female flesh was thought to be different to male flesh. This is not ‘the same’ flesh with different levels of moisture: it is ‘different’ flesh, which is why it responds to moisture in a different way. 32

DW 1.62, Littré 8.126. King, Hippocrates’ Woman, pp. 23–7. 34 Volker Langholf, Medical Theories in Hippocrates: Early Texts and the ‘Epidemics’ (Berlin and New York, 1990), p. 239. 35 Diseases of Women 1.1, Littré 8.10–14; Ann Ellis Hanson, ‘Fragmentation and the Greek Medical Writers’ in Glenn W. Most (ed.), Collecting Fragments (Göttingen, 1996), p. 307. 36 Glands 16, ed. Paul Potter (Cambridge, MA, and London, 1995), Loeb VIII, p. 124. 37 DW 1.1, Littré 8.14. 38 Ps-Xenophon, Oikonomikos, 7.22–23; ‘I believe that the god arranged that the work and supervision indoors are a woman’s task, and the outdoors are the man’s.’ 33

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The womb was seen as the collector of menstrual blood accumulated by the spongy texture of female flesh, but it was also believed capable of moving around the body to exert pressure on other organs. In such a situation, in addition to the local problems caused by the incorrect location of the womb, the blood would not be able to leave the woman’s body. Although the Diseases of Women treatises ascribe many disorders to the movement of the womb, the source of all diseases in women remains the accumulation of menstrual blood in the flesh, in contrast to Places in Man 47, where it is the womb itself. But the idea that the womb is the main problem found later support in the philosopher Plato, whose Timaeus (91c4) – written in around 360 BC – described the womb as wandering around the body if not impregnated. Tobias Smollett, who assisted William Smellie in editing his midwifery treatises, was still stressing the influence of the womb over the whole female body in 1760; he also sought support from the Anglo-Saxon ‘womb-man’, regarded as the origin of the word ‘woman’.39 It is also important to realize that the position we find in the Hippocratic Diseases of Women treatises was not the only one taken in the ancient world. Galen, writing in the second century AD and the first decades of the third, most famously considered that women and men had the same genital organs, but with women’s on the inside and men’s on the outside, due to the greater innate heat of the male, which is ‘Nature’s primary instrument’.40 This is the classical model best known to cultural historians today, due to its appearance in Thomas Laqueur’s Making Sex (1990), which argued for a shift from what he called a ‘one-sex’ to a ‘two-sex’ model. Following Galen, Laqueur argued that the dominant model from antiquity into the early modern period stressed not the difference, but the similarity, between male and female bodies. In this one-sex model, there was no such thing as the female body; instead, there was just one body, which if it was cold, weak and passive was female and if it was hot, strong and active was male. The reason why my model differs so radically from that of Laqueur – the strengths and shortcomings of whose work I have discussed in detail elsewhere – is that his model is based so heavily on Galen and, to a lesser extent, on a specific strand of the Hippocratic corpus.41 He used only the Hippocratic treatises On 39

[Tobias Smollett] ‘Review of Mrs Nihell, Answer to the Author of the Critical Review’, p. 39, reproduced in Philip Klukoff, ‘Smollett’s Defence of Dr. Smellie in The Critical Review’, Medical History, 14 (1970): 33–41. This originally appeared in Critical Review 9, pp. 187–97 for March 1760. The OED gives the standard etymology of ‘woman’ as derived from the Old English ‘wifmon’ (wife-man), which became ‘wimman’ in Middle English. ‘Womman’ emerged in the late thirteenth century; as the double ‘m’ was simplified to a single letter, the preceding vowel was lengthened, although in the sixteenth and seventeenth century both pronunciations existed. 40 Thomas Laqueur, Making Sex: Body and Gender from the Greeks to Freud (Cambridge, MA, 1990), pp. 25–6; Galen, Use of Parts, 2.630, cited Laqueur, p. 28. 41 Helen King, ‘The Mathematics of Sex: One to Two, or Two to One?’ Studies in Medieval and Renaissance History: Sexuality and Culture in Medieval and Renaissance Europe, 3rd series, 2 (2005): 47–58.

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Generation/Nature of the Child, and Regimen, which share a ‘two-seed’ theory suggesting that gender is a continuum, the degree of maleness or femaleness of the child depending on the balance between the seeds each parent contributes.42 The Hippocrates of Diseases of Women is absent from Laqueur’s story. However, the history of medicine from the sixteenth century onwards suggests that, for the female body, it is this Hippocrates who has always been invoked by those claiming radical difference from the male body and calling for a separate branch of medicine to treat women, on the grounds that there is not one sex, but two. I would therefore locate the sixteenth-century compilers of the Gynaeciorum libri within this tradition of the female body that could exist alongside a one-sex model, but which saw women as radically unlike men, their bodies so different that they demanded different therapies.43 In the creation of ‘gynaecology’, the advantage that the Hippocratic corpus had over Galen was that it contained works exclusively devoted to the female body. Galen, despite his extraordinary productivity, did not write a work on women. But Hippocrates and Galen did not represent the sum of ancient knowledge on sex and gender, and one other writer should be mentioned here, not least because he preserved, at least in outline, the different views of several ancient writers whose work would otherwise be unknown to us. Soranos of Ephesus, active in the second century AD, wrote a treatise on the diseases of women in which he explicitly considered the question ‘whether females have conditions that are specifically their own’ in order to decide whether they also needed ‘therapy specifically their own’.44 He looked at both ‘conditions according to nature’, such as childbirth and the production of milk, and ‘conditions contrary to nature’ such as illnesses.45 According to Soranos, writers of an empiricist slant – believing that medicine could never be a scientific discipline, as it could only be based on knowledge accumulated from experience – together with Diocles, Athenion, Miltiades, Lucius and Demetrius of Apamea believed that women have diseases specific to their sex. Erasistratos, Herophilos, Apollonios Mus, Asclepiades, Alexander Philalethes, Themison and Thessalos disagreed, although Soranos noted that not all his contemporaries agreed with placing Erasistratos, Herophilos and Asclepiades in 42

Laqueur, Making Sex, p. 39. Karen Harvey’s recent book, Reading Sex in the Eighteenth Century: Bodies and Gender in English Erotic Culture (Cambridge, 2004), p. 81, also wrongly refers to ‘the Hippocratic vision’ of a two-seed theory of conception in which both sexes produce seed of similar quality; within the Hippocratic corpus, this is found only in On Generation/Nature of the Child. A similar assumption that this was the only ‘Hippocratic’ model of gender is made in Ruth Gilbert, Early Modern Hermaphrodites: Sex and Other Stories (Basingstoke, 2002), pp. 35–6. 43 Karen Harvey, ‘The Century of Sex? Gender, Bodies, and Sexuality in the Long Eighteenth Century’, Historical Journal, 45 (2002): 899–916 has recently argued for a coexistence of the one- and two-sex models in the eighteenth century. 44 Soranos, Gynaecology 3.1.3–5 and 18–20 (Budé). On Soranos, see Hanson and Green, ‘Soranus of Ephesus’. 45 In Greek, para physin or kata physin.

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this list.46 Soranos noted that those arguing for conditions specific to women would argue that ‘we call some physicians “women’s physicians” because they treat the conditions of women’; this suggests a degree of specialization in the early Roman Empire. He describes others arguing for this position, who claimed that the fact that only women have a womb must mean that they have their own conditions related to that organ.47 Soranos himself followed the third-century BC writer Herophilos in arguing that even the wombs of women were made of the same material as the bodies of men, meaning that the only conditions specific to women are those ‘according to nature’ concerned with conception, pregnancy and lactation. Even for these conditions, the treatment of women will proceed on the same principles as that for men, because problems such as excess constriction or relaxation of the parts will be comparable in their effects.48 Although the text of Soranos’s Gynaecology was in circulation until the sixteenth century, it was then lost until the nineteenth century; while his name continued to be used, his ideas therefore played little part in the period under discussion here. There existed a body of writings composed in Latin, and attributed to Soranos, but these were composed much later. A set of letters placing Soranos at the time of Cleopatra was written by the book collector and notorious composer of forgeries, Melchior Goldast (1578–1635), in around 1606; in these, Mark Antony consults Soranos in order to manage Cleopatra’s insatiable lusts.49 The popularity of the name of Soranos as an authority on all matters concerning women, despite the absence of his authentic work, also appears in Jacques Guillemeau’s 1609 treatise on midwifery, translated into English in 1612 as Child-Birth or, the Happy Deliverie of Women. Here Guillemeau quoted from ‘la complaincte des femmes recitee par Soranus’: in English, this became ‘the complaints of Women, related by 46

Soranos, Gynaecology 3.1.21–30 (Budé). On Diocles, see Philip J. van der Eijk, Diocles of Carystus: A Collection of the Fragments with Translation and Commentary. Volume One: Text and Translation; Volume Two: Commentary, Studies in Ancient Medicine, vols 22 and 23 (Leiden and Boston, 2000–01); on Herophilos, Heinrich von Staden, Herophilus. The Art of Medicine in Early Alexandria (Cambridge, 1989); on Erasistratos, Ivan Garofolo, Erasistrati Fragmenti (Pisa, 1988). The other figures mentioned in this list are discussed briefly in the notes to the Budé edition, pp. 62–3. 47 Soranos, Gynaecology 3.1.31–3, 39–41 (Budé). I am grateful to Rebecca Flemming, ‘On Taking Pluralism Seriously: Sex and Sectarianism in Classical Medicine’, paper delivered at the Thirteenth Berkshire Conference on the History of Women, Claremont, CA, 3 June 2005, for elucidating the relationship between the sections of this chapter; see also Owsei Temkin, Soranus’ Gynecology (Baltimore, MD, 1956; reprinted 1991), p. 130, n. 5. 48 Soranos, Gynaecology 3.1.86–100 (Budé). 49 Ann Hanson, ‘The correspondence between Soranus, Antonius and Cleopatra’, unpublished paper. Hanson points out that Spach’s Nomenclator (Frankfurt, 1591) does not include Soranos as a gynaecological writer; it is noteworthy that this seems to change only at the beginning of the seventeenth century. On Goldast, see also Anne N. Baade, Melchior Goldast von Haiminsfeld. Collector, Commentator and Editor (New York, 1992), p. 37 dates the Cleopatra correspondence to 1608.

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Soranus’.50 Yet the passage he cited, an attack by women on men who ‘fill whole Libraries with large volumes and writings of everie light and triviall disease of your owne making little or no mention at all, of our cruell and insupportable torments’, is not from Soranos’s genuine works. Only in 1830 did Dietz find a fifteenth-century manuscript that combined chapters of Soranos with others from the later writer Aetius. The first publication of the genuine Soranos material took place in 1838, after Dietz’s death, and in the second half of the nineteenth century other editors also worked to disentangle the text of Soranos from the manuscript. While the existence of Soranos’ text would have answered the need for a manual exclusively dedicated to conditions affecting only women, its loss meant that the Hippocratic Diseases of Women treatises were the sole resource available to medical writers looking for such a work.51

Authority over the womb Bouland chose to rebind a book about the female body in female skin. In a rather less literal way, the line between the book and the body was constantly elided by sixteenth-century humanists, who regarded their activities with the Greek and Latin texts on which they worked in terms of the heroes of classical myth. In the preface to the separate edition of the Muscio treatise included in all editions of the Gynaeciorum libri, Wolf described Gesner’s efforts to establish the correct text as being like the fifth labour of Heracles, the cleaning of the Augean stables; this would suggest an apparently impossible task carried out in a very short time.52 They also used analogies with bodily processes, regarding discovering new manuscripts as ‘bringing into the light’ classical knowledge, terminology also applied to childbirth in the early modern world.53 In his preface to the 1597 edition 50

Jacques Guillemeau, De l’heureux accouchement des femmes (Paris, 1609); ibid., Child-Birth, or, the Happy Deliverie of Women (London, 1612), ‘An Introduction to the Reader’. I have not been able to trace the source of this passage. 51 The manuscript, BN Par. Gr. 2153, was apparently copied in two sixteenth-century manuscripts, Barberinus 1, 49 and Vossianus Graecus 8o, 18. The earliest editions are those of Friedrich Reinhold Dietz , Sorani Ephesii de arte obstetricia morbisque mulierum quae supersunt (Königsberg, 1838); Frans Zacharias Ermerins, Sorani Ephesii liber de muliebribus affectionibus (Utrecht, 1869); Valentin Rose, Sorani Gynaeciorum vetus translatio Latina (Leipzig, 1882). See further Paul Burguière, ‘Histoire du texte’ in Soranos d’Éphèse: Maladies des femmes 1.1 (Paris, 1988), pp. xlvii–lxv; Ann Ellis Hanson and Monica H. Green, ‘Soranus of Ephesus’, pp. 970–72. 52 Caspar Wolf, Moschionis medici Graeci de morbis muliebribus liber unus: cum Conradi Gesneri viri clarissimi scholiis et emendationibus, nunc primum editus opera ac studio Caspari Wolphii Tigurini medici (Basle, 1566), preface: quem quasi in Augiae stabulo repurgando subiit. The reference is to Apollodorus, 2.5.5. 53 Guillaume de Baillou, De Virginum et Mulierum Morbis liber, in quo multa ad mentem Hippocratis explicantur (Paris, 1643), title page: in lucem primum editus.

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of the Gynaeciorum libri, Israel Spach used this image in both senses, writing of the proper time for a child to come ‘into the light’ as well as describing this third edition as enabling the books to once again ‘gaze upon the light’.54 One of the treatises included in the compendium from the 1566 edition onwards, Nicholas de la Roche’s De morbis mulierum curandis liber, described its dedication to his wealthy patron Catherine d’Ambroise as being ne ancephalos in lucem prodiret, ‘lest a headless child should come forth into the light’.55 As well as being textual midwives, the humanists were also textual physicians. They described their emendations in terms of moving the text from damaged to complete, ‘purging’ the Greek manuscripts of the errors introduced by Arab translators, and thus converting textual ‘illness’ into ‘health’. In their professional lives, too, they combined the practice of medicine and the detailed study of classical texts in a way which to us may seem extraordinary; for example, Wolf, the editor of the 1566 Gynaeciorum libri, was Professor of Physic at Zurich, and later became Professor of Greek Language there. More surprising combinations of academic subjects were also found; Caspar Peucer, Professor of Mathematics in Wittenberg since 1554, was appointed to the medical faculty there in 1560, and at his death owned over 1400 titles, 29% of them being medical works.56 The present study concerns the relationships between texts and bodies in a rather different sense. I am aware that my decision to examine the reception of this sixteenth-century compendium and its classical, and other, contents may seem odd; in a climate in which medical history is increasingly done from the ‘bottom up’ and the patient’s voice is given priority, I am instead looking at the texts of learned medicine and at ‘great men’. But great men too saw patients, and interacted with the often grim realities of those patients’ lives, while texts were read by practitioners at all levels, as well as by those who were not medical professionals, and such texts often bear the marks of their readers’ engagement with their words. Although this is a book about books, and their users, it is not my intention to lose sight either of the practical uses of the material the books contained, or of the real debates in practice that continued to send people back to the historical texts. By looking in detail at the mid-eighteenth and mid-nineteenth century uses of the Gynaeciorum libri compendium, as slices through the historical process, I hope to show that, for midwifery and gynaecology, this period was not a straightforward ‘rejection of “ancient authority”’. I intend to provide a fresh perspective on four important questions in the history of medicine and beyond. The first concerns the creation of medical history itself. In the mid-eighteenth century, men argued that they were the best midwives, thus taking over an area of medicine traditionally controlled by women: normal childbirth. How did man54

Spach, 1597, preface; tempus quo in lucem edi deberet and atque sic rursum lucem aspicerent. Cf. in lucem prodierit for childbirth in Bonacciuoli, Spach 1597, pp. 122–3. 55 De la Roche, Wolf 1566, p. 317. 56 Robert Kolb, Caspar Peucer’s Library: Portrait of a Wittenberg Professor of the Mid-Sixteenth Century (St Louis, 1976), pp. 1 and 5.

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midwifery, a new branch of medicine, create a space for itself in the medical market place? William Smellie was writing at a critical point in the evolution of the man-midwife; he looked to both Hippocratic medicine and the Gynaeciorum libri in order to graft this apparently novel development on to the medical family tree. As I shall demonstrate in chapter 2, he and his fellow men-midwives created different versions of the medical past, with different implications for present practice. A hundred years later, proposing another novelty – childbirth without pain – James Young Simpson had to engage with the claims of his opponents that this pain was not only natural, but also essential to the success of the process. In rendering the parturient woman unconscious, Simpson could be seen as reducing her to an object from whom he could then produce a living child; one of the aspects of anaesthesia in childbirth that the women involved found so disturbing was that they would wake up with no memory of the process. This brings me to my second question: in terms of women’s history, what was the significance of these two dramatic stages in the male takeover of childbirth? By treating the woman as an object on whom the male operator performs his work, the introduction of anaesthesia recalls the earlier criticism that Smellie taught his students from ‘machines’ made from real women’s bones dressed up in clothing, from which the student would produce a doll-baby; Simpson, too, called his fake foetuses ‘dolls’.57 In both cases, the male practitioners could be seen as regarding the female body as a machine, with consciousness as an inconvenience. Could the sixteenth-century treatises, or the Hippocratic texts, provide any authority for this view? The use of drugs in childbirth also introduces a third question to which this book will return: who claimed authority over the female body in the period from the sixteenth century? In 1525, Marco Fabio Calvi published a Latin translation of the complete Hippocratic corpus, which brought the full text of the Diseases of Women treatises – only isolated chapters of which were known in the Middle Ages – to a new audience.58 This audience already admired Hippocrates for texts such as the Aphorisms, but had not previously thought of him as a gynaecologist. One exception to this was Luigi Bonacciuoli, who in his 1505 Enneas Muliebris, or ‘Nine Books on [the Diseases of] Women’, had managed to construct a Hippocratic gynaecology from Epidemics 5 and the Aphorisms. Bonacciuoli stressed his authoritative source by repeating in the text phrases such as ‘Hippocrates taught…’, ‘As Hippocrates confirmed…’ and ‘as noted down by 57

RCPE JYS 14, pp. 37 and 44. Marco Fabio Calvi, Hippocratis Coi medicorum omnium longe principis, Octoginta volumina… (Rome, 1525). The Aldine Greek edition of the text followed a year later; see Paul Potter, ‘The Editiones Principes of Galen and Hippocrates and their Relationship’, in Klaus-Dietrich Fischer, Diethard Nickel and Paul Potter (eds), Text and Tradition: Studies in Ancient Medicine and its Transmission Presented to Jutta Kollesch (Leiden, 1998). 58

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Hippocrates’.59 At the point of the rediscovery of the Hippocratic gynaecological works in 1525, in practical terms gynaecology was however already gendered as ‘male’. Soranos had mentioned ‘women’s physicians’ in the second century AD. As Monica Green has shown, following a decline in the involvement of male physicians in women’s medicine from late antiquity to the twelfth century, from then until the fifteenth century there was a gradual return to something resembling the level of male activity in women’s medicine seen in the ancient world.60 It is therefore misleading for Lisa Forman Cody to state that ‘By the sixteenth and seventeenth centuries, European physicians had begun specializing in gynaecology – a medical field that reached back to ancient practice, but one that offered enterprising early modern physicians routine access to female clients’. 61 Gynaecology had intermittently been an area of male practice, theorizing, and indeed specialization, over many centuries. What was new in the sixteenth century was not the male physician treating the diseases of women, but rather this image of Hippocrates as a gynaecologist. Calvi’s Latin Hippocratic corpus not only filled a gap that was perceived to exist because Galen had left no work devoted entirely to the diseases of women, but also provided a further rationale for the existing male control of gynaecology: namely, that the Father of Medicine had himself devoted several specialized works to the topic.62 Although it took many years for the implications of the specific practical and theoretical contents of the Diseases of Women texts to filter through into medicine, a process assisted by the publication of the commentary on the first volume by Maurice de la Corde in the 1580s (included in the Gynaeciorum libri a year after its first publication), the association of the name of Hippocrates with gynaecology was rapidly made.63 From the 1550s onwards, he was described as the expert guide to gynaecology; as the fullest authority on the diseases of the womb; and as more knowledgeable on the diseases of women than any subsequent writer.64 At the same time, a surge in publication of newly composed works on gynaecology began. As I shall show in chapter 2, in the eighteenth century Smellie 59

Luigi Bonacciuoli, Enneas muliebris (Ferrara, 1505): Hippocrates edocuit, Quod Hippocrates ita sanxit, Hippocrate exaranto, Idque ab Hippocrate ita sancitum est, etc. 60 Monica Green, Making Women’s Medicine Masculine: The Rise of Male Authority in Premodern Gynecology (Oxford, 2008). 61 Lisa Forman Cody, Birthing the Nation. Sex, Science, and the Conception of Eighteenth-century Britons (Oxford, 2005), pp. 41–2. 62 Galen does not appear to have written a text devoted to women, making the reconstruction of a ‘Galenic gynaecology’ a difficult task; see Rebecca Flemming, Medicine and the Making of Roman Women: Gender, Nature and Authority from Celsus to Galen (Oxford, 2000). 63 E.g. Vivian Nutton, ‘Hippocrates in the Renaissance,’ in Gerhard Baader and Rolf Winau (eds), Die Hippokratischen Epidemien: Theorie–Praxis–Tradition, Verhandlung des Ve Colloque international hippocratique, Berlin 10–15.9.1984, Sudhoffs Archiv, Beiheft 27 (Stuttgart, 1989), pp. 420–39. 64 King, The Disease of Virgins, p. 44.

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also invoked Hippocrates, but this time in defending man-midwifery against its critics, through the visual imagery of the certificates he gave to his successful students as well as in his lectures and published work. The Hippocratic texts suggested that the female body was the natural domain of the physician. However, in early modern terms, the Hippocratic physician was also both apothecary and surgeon. His assistance to the female body included drugs and surgical intervention; for example, in the short treatise On the Excision of the Foetus methods are described for removing in parts a foetus that cannot pass through the birth canal.65 In sixteenth-century England, the lines of demarcation between physicians (who were concerned with internal conditions, and who diagnosed disease), surgeons (who treated external conditions, and who used the knife) and apothecaries (who made up medicines) had been emphasized by the creation of separate Colleges. But, in practice, there was always overlap between their spheres; those famous cases in which the College of Physicians prosecuted those whom they considered to have broken their monopoly over internal medicine only serve to show how fragile that monopoly really was.66 Meanwhile, although the role of licensing her practice passed between the ecclesiastical and civil authorities in the early modern period, the work of the traditional female midwife knew no such restrictions in its scope. Handbooks directed at such midwives show that their role could extend far beyond birth and the care of the newborn child. For example, writing in 1671, Jane Sharp included in her The Midwives Book, or the whole art of midwifry discovered a section on women’s diseases in general, including those unique to virgins, aiming to give ‘as perfect an enumeration as may be of all diseases incident to our sex’ [my italics].67 Certainly from the seventeenth century onwards, midwives were paid for their services, although at that time ‘few women publicly sold medical drugs or advice’.68 While Doreen Evenden has argued that, in practice, the activity of London midwives in the seventeenth century was mostly restricted to childbirth, Adrian Wilson has found examples of midwives elsewhere in England in the seventeenth and eighteenth centuries practising surgery and blood-letting, and attending women suffering from a range of conditions unrelated to pregnancy as 65

Littré 8. 512–18. See, in general, Hal Cook, The Decline of the Old Medical Regime in Stuart London (Ithaca, NY and London, 1986); Margaret Pelling, Medical Conflict in Early Modern London: Patronage, Physicians, and Irregular Practitioners (Oxford, 2003), esp. pp. 152–3 and n. 57 for the four midwives, and other female ‘irregulars’, whose ventures into the area of medicine controlled by men are recorded in the Annals of the Royal College of Physicians, London. 67 The Midwives Book, or the Whole Art of Midwifry Discovered (London, 1671), ed. Elaine Hobby (New York and Oxford, 1999), p. 190. On Sharp’s uses of, and particular spin on, male authorities, see also Hobby, ‘“Secrets of the Female Sex”: Jane Sharp, the Reproductive Female Body, and Early Modern Midwifery Manuals’, Women’s Writing, 8 (2001): 201–12. 68 Cook, The Decline of the Old Medical Regime, p. 33. 66

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well as acting as their confidantes.69 Evenden concentrates on the ‘realities of midwives’ lives and practices’, using detailed archival research to uncover the names of over 1200 midwives in seventeenth-century London, and to reconstruct their training, fee structure and esteem.70 Wilson’s book concentrates instead on the men-midwives who entered this field at the end of the period which Evenden has illuminated, tracing their political affiliations and groupings and showing that, in London, whigs were generally opposed to the forceps while tories supported instrumental delivery; the lying-in hospitals founded from around 1740 onwards were whig initiatives and retained a female midwife for normal births, using men only in difficult deliveries.71 Again, outside London, the situation was very different. Like physicians, midwives would diagnose diseases in their patients; like surgeons, they would use instruments (in particular, the hook known as the crotchet, and a small knife) in childbirth; and they would recommend remedies to those they treated. The midwife could send out to have these made up by an apothecary, but many would often involve materials readily available in the home.72 Sharp includes details of numerous remedies, ranging from powders and fomentations to baths, oils and injections into the womb. One seventeenth-century writer mentions the ‘midwife’s powder’, used to help expel the child; this suggests that midwives carried some drugs ready-mixed.73 I shall argue in chapter 2 that one important effect of the rise of the manmidwife was its further challenge to the divisions that still existed, at least in 69

Doreen Evenden, The Midwives of Seventeenth-Century London (Cambridge, 2000), pp. 171–2; Adrian Wilson, The Making of Man-midwifery. Childbirth in England, 1660– 1770 (Cambridge, MA, 1995), pp. 37–8. 70 Evenden, The Midwives of Seventeenth-Century London, p. 170. 71 Wilson, The Making of Man-midwifery, pp. 72–4, 151. On p. 83, Wilson provides a table of the political affiliations of the most prominent men-midwives of this period. 72 T.C., I.D., M.S., T.B., The Compleat Midwife’s Practice (London, 1656), p. 124, a compilation by four midwives and claiming to be ‘Published with the approbation and good liking of sundry the most knowing Professors of Midwifery now living in the city of London, and other places’ (title page), presents a midwife advising her daughter in the art ‘You ought to give order for things to be had from the Apothecaries’; cf. R.C., I.D., M.S. and T.B., The Compleat Midwife’s Practice Enlarged… The Second Edition Corrected (London, 1663), p. 28. Evenden, The Midwives of Seventeenth-Century London, pp. 9–10 identifies two of the authors of the 1656 edition as the midwives Dina Ireland (licensed in 1638) and Catherine Turner (licensed in 1632). ‘Professors’ is here used in the sense of those ‘having a profession’, and is therefore a reference to these female midwives. The second edition has a different title page, foregrounding not women’s experience, but men’s knowledge. It refers to ‘the experience of our English’ and names ‘Sir Theodore Mayern, Dr Chamberlain, Mr Nich. Culpeper, and others of Foreign Nations’. However, the material of its preface is identical, including a condemnation of Culpeper’s ‘imperfect Treatise’, The Directory for Midwives, ‘the most desperately deficient’ of all previously published works on midwifery. 73 Percival Willughby, Observations in Midwifery (Wakefield, 1972; reprint of Warwick, 1863), pp. 60 and 82.

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theory, between medical men. In the classes William Smellie taught in London, members of all three professional groups were present. Surgeons had been involved with difficult childbirth from the classical world onwards, as their skills were needed in labours which would otherwise be fatal to the mother, in order to perform craniotomy; the puncturing and reduction of the foetal head that made its manual extraction possible. In 1555, Jacques Dubois wrote that damage only rarely occurred to the vessels of the womb, and when it did so it was due to the unskilled hand of a midwife, or the extraction of a dead child by a surgeon.74 From the seventeenth century onwards, an increasing number of surgeons also had access to the forceps. Many men-midwives were not surgeons, but physicians, often opposed to the forceps, but nevertheless wanting to extend their practice into childbirth. The fact that physicians, long associated with gynaecology, were also dealing with childbirth may have contributed to the view that it was a ‘disease’; for example, in the mid-eighteenth century Brudenell Exton stated that, during pregnancy, the woman ‘is to be considered as a sick Person’, recalling the early seventeenthcentury English translation of Jacques Guillemeau’s manual for midwives, which announced that ‘the greatest disease that women can have is that of the nine Moneths, the Crisis and cure whereof consists in their safe deliverie’.75 This brings me to the fourth question that this book will address, which is in many ways the most difficult to grasp: the changing relationship between the categories of midwifery and gynaecology. Gynaecology, in the sense of gynaecea or γυναικεια, implies radical disjunction between the sexes; it suggests that men are normal, and women are ‘different’. Childbirth is clearly an area in which this ‘difference’ is very obvious. But where do the borders of gynaecology with midwifery lie? The Royal College of Obstetricians and Gynaecologists currently defines the two areas it covers as follows: ‘An obstetrician deals principally with the management of pregnancy and childbirth; a gynaecologist deals with disorders of the female reproductive system excluding matters relating to pregnancy’.76 This forms a striking contrast with the title to the Wolf edition of the Gynaeciorum libri, quoted at the beginning of this Introduction, in which those diseases experienced outside and during pregnancy, as well as in labour, are combined into a single area: for the sixteenth-century compendia, what a gynaecologist deals with is, quite simply, the category of ‘woman’. But what makes a woman? Where is sex difference located? As I have already indicated, in one ‘Hippocratic’ view of gynaecology, such difference was seen not 74

Jacques Dubois, De mensibus mulierum, et hominis generatione, Iacobi Silvii medicae rei apud Parrhisios interpretis Regii, commentarius (Paris, 1555), p. 9v: Vasa autem ad uterum pertinentis raro vulnerantus, nisi ab imperita manu obstetricis, aut chirurgi foetum mortuum extrahentis. 75 Brudenell Exton, A New and General System of Midwifery in Four Parts (London, 1751), p. 19; Jacques Guillemeau, Child-Birth or, the Happy Deliverie of Women (London, 1612), p. 81. 76 Definition on , accessed 28.9.05.

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as being concentrated in the organs of generation, but as more widely dispersed throughout the body and its spongy, water-retaining flesh. In the eighteenth century – the first of my detailed slices through history – such a generalized sex difference was largely being denied. In Laqueur’s terms, a ‘one-sex’ model dominated. For example, in 1764 Philip Thicknesse wrote that: ‘There is very little difference, except the sex, between men and women’,77 while lecture notes taken from one of Thomas Denman’s courses on midwifery stated that ‘it is not proved that there is any essential difference in those diseases of women to which men are equally subject, though there is some variety in the symptoms’.78 If women are not really all that different, then it could be argued that there is no need to go to a special person – whether midwife, or gynaecologist – if they are ill. This could suggest that all aspects of a woman’s life, including childbirth and its complications, should be dealt with by the surgeon or physician. If difference is thought to exist, but is seen as being restricted to the womb and sexual organs rather than extending all over the body, then what is needed is a specialist in the womb and its functions; but, since a major function is childbirth, this makes it difficult to distinguish such a specialism from ‘midwifery’. A further option would be the one taken now by the Royal College of Obstetricians and Gynaecologists, with gynaecology being concerned with the female reproductive system outside pregnancy, and midwifery with women in their pregnancy and labour, and its immediate aftermath. Can we map any of these alternatives on to the ancient world? The term ‘obstetrics’ was not used – obstetrix is simply the normal Latin word for a ‘midwife’ – but, as I have already mentioned, the extraction of a dead foetus was included in the normal range of an ancient physician’s work. Cody looks to the beginning of the eighteenth century as when gynaecology and obstetrics ‘began to meld’;79 but in fact the practices had been ‘melded’ in the classical world, overlapping in personnel as well as in content. On the personnel involved, Nancy Demand has argued that ancient Greek midwives worked alongside Hippocratic physicians, and that the status of the women rose as a result of being seen to collaborate with such men.80 But did the men also work with women, in what was considered their sphere, that of normal childbirth? In the Hippocratic corpus, there is very little on normal birth, although Diseases of Women does contain a description of the beginning of labour and of the problems that may arise during the process.81 Yet Lesley Dean-Jones argued that the silence is simply due to it being ‘so routine that the Hippocratics did not bother recording those [births] they 77

[Philip Thicknesse], Man-midwifery Analysed: and the Tendency of that Practice Detected and Exposed (London, 1764), p. 18. On Thicknesse, see Philip Gosse, Dr. Viper: The Querulous Life of Philip Thicknesse (London, 1952). 78 Denman lecture notes ms. KCL TH/PP5, pp. 103–4 on the uterus. 79 Cody, Birthing the Nation, p. 43. 80 Nancy Demand, Birth, Death, and Motherhood in Classical Greece (Baltimore, MD and London, 1994), p. 66. 81 DW 1.34 (Littré 8. 78–80).

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observed’, and Ann Hanson has also supported Hippocratic involvement in normal birth, pointing to those case histories in the Epidemics giving information about the birth or the events immediately after it.82 For the early Roman Empire, Hanson has also shown the way in which childbirth could become a ‘crowded scene’, with male practitioners entering while female midwives remained at the bedside. This is not the picture of ancient childbirth that many modern scholars expect to see; for example, Cody alleged that ‘For millennia, midwives and other women were the only sex allowed access to a mother’s childbearing body, with men invited into the birth room only in extreme medical emergencies’.83 In ancient Greece, therefore, it seems that some men claimed authority over the female body, extending the range of their ‘gynaecology’ to the whole of that body. Any symptom in any part of the body could prompt them to question their female patient about her menstrual cycle. This could include not only the treatment of pregnant women – since pregnancy was believed to be the best use of the same excess blood that formed the menses – but also labour itself, especially as the process of giving birth was seen in terms of a ‘purge’ very similar to that of menstruation.84 As for midwives, their activity was not restricted to the process of childbirth. Soranos, who as we have seen considered that the bodies of men and women suffered from the same general conditions, noted that the empiricists argued for women’s difference on the grounds that people tended to call in midwives when women are sick with ‘something unique to them, which they do not have in common with men’.85 Far from limiting midwifery to the management of childbirth, this suggests that the natural response of many lay people in the early Roman empire was to go to midwives for all disorders of the womb, the menstrual function, and the breasts, in both pregnant and non-pregnant women, because – regardless of Soranos’ personal opinion, which reflected his particular medical position as a follower of the ‘Methodist’ medical sect – women were still regarded as very different from men.86 Male gynaecology and female midwifery therefore covered almost identical ground; but how did they differ? I would argue that they differed firstly in the sex of the practitioner, and secondly in the level of explanation offered to the patients, with male gynaecology able to present itself as based in various theories about the 82

Lesley Dean-Jones, Women’s Bodies in Classical Greek Science (Oxford, 1994), p. 212; Ann Ellis Hanson, ‘A Division of Labor: Roles for Men in Greek and Roman Births’, Thamyris, 1 (1994), pp. 158, 171–2. 83 Cody, Birthing the Nation, p. 3. 84 DW 1.1 (Littré 8. 12–14); Nature of the Child 30 (Littré 7. 538); King, Hippocrates’ Woman, pp. 32 and 72. 85 Soranos, Gynaecology 3.1.33–6 (Budé). 86 On Methodist medicine and its implications for gynaecology, see Paola Manuli, ‘Elogia della castità: La Ginecologia di Sorano’, Memoria 3 (1982): 39–49; Danielle Gourevitch, ‘Situation de Soranos dans la médecine antique’ in Soranos d’Éphèse: Maladies des femmes 1.1 (Paris, 1988), pp. vii–xlvi. The ‘Method’ consisted of identifying a condition as due to tension/dryness, relaxation/wetness, or a mixture of the two.

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operation of the body, and female midwifery being more firmly grounded in practice. In his lectures delivered in Edinburgh in the 1770s, Thomas Young changed the terms of the debate by dividing ‘midwifery’ into two. He said that Midwifery is taken in two different senses, in a limited sense or in one more extensive, and it was very long taken in the former signifying the simple operation of delivering a pregnant woman, while the latter comprehending all that a man knows with regard to this branch, was not at all cultivated but long experience has now convinced mankind of 87 the usefulness of this study …[my italics]

He therefore contrasted a past in which midwifery was limited to normal deliveries with a present, covering difficult labours as well, for which a ‘more extensive’ use of the term was appropriate. His use of ‘man’ in ‘all that a man knows’ reveals the underlying assumption that women performed the limited midwifery of the past, while men control the more extensive midwifery of the present, a present beginning – for him – only in the mid-seventeenth century. His lectures, which will be discussed in more detail in chapter 2, also described the many centuries before this in which ‘ignorant women’ ‘blundered on’ repeating the same errors.88 For Young, both activities were ‘midwifery’, but the later male version was by far superior. His use of ‘knows’ here also recalls the point that women’s activity was thought to be based on experience, but that men’s theories were based on knowledge. But how extensive was Young’s vision of ‘all that a man knows’? His own title was Professor of Midwifery – presumably he thought of it in the ‘extended’ sense – but in 1824 the name of the Chair he had held was changed to ‘Professor of Medicine and Midwifery and of the Diseases of Women and Children’.89 In the seventeenth century, it therefore seems that the term ‘midwifery’ itself (as performed by women like Jane Sharp) could be understood as covering medical conditions of women who were not pregnant, and also the care of newborn children; but when men became involved in normal childbirth, while initially ‘midwifery’ was understood in this sense, it became narrowed down to assistance in childbirth, both normal and abnormal. This childbirth-focused midwifery then split into two: a basic midwifery, appropriate only for normal births, and still 87

Wellcome ms. MSL 105; ms. 5108, p.1 is almost identical. Very little biographical information is known about Young, and his lectures – many copies of which still survive – were not published. See Christopher Hoolihan, ‘Thomas Young, M.D. (1726?–1783) and Obstetrical Education at Edinburgh’, Journal of the History of Medicine, 40 (1985): 327–45. My thanks to Monica Green for adding additional nuances to my initial reading of this passage. 88 Wellc. ms MSL 105, ‘Lectures on Midwifery’, p. 1v. 89 Allen D. Simpson, ‘James Hamilton’s ‘Lying-in’ Hospital at Park House and the Status of Midwifery Instruction in the Edinburgh Medical School’, Book of the Old Edinburgh Club, 3 (1994), p. 138. I owe this reference to Alison Nuttall.

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considered within the abilities of women, and a more extensive form covering all births. By the 1820s, the label no longer automatically included all the areas of the diseases of women and children that had once been the domain of the ‘female’ midwifery, so these were once again combined with it in the revised name of the Chair.

A ‘century of change’? While the first chapter of this book looks at the origins of the Gynaeciorum libri and at the reasons why sixteenth-century writers wrote about women’s diseases, the final chapter will return to the changing definitions of midwifery and gynaecology in the nineteenth century. At the centre lie two chapters on the rise of the man-midwife in the eighteenth century. Since the publication of Laqueur’s Making Sex, the eighteenth century has been seen as ‘the century of change’: a watershed in gender relations and in the understanding of the body.90 For my argument, too, this was the critical period, but in different ways. Believing that the one-sex model was dominant from Greco-Roman antiquity to the eighteenth century, both Schiebinger and Laqueur have argued that it was not until the end of that century that the sexuality of the body was thought to extend to all its parts, not only to all aspects of anatomy, but also to the mind.91 Only then did the two-sex model emerge, and the uterus cease to be an internal analogue of the penis, becoming instead an organ with no male counterpart. Sexuality came to be seen ‘as penetrating every muscle, vein, and organ attached to and molded by the skeleton’.92 I disagree: already in the Diseases of Women treatises of the Hippocratic corpus we find a woman, every part of whose body is gendered female. Michael Stolberg has also shown that it was in a sixteenth-century text from which extracts were included in the two later editions of the Gynaeciorum libri – Felix Platter’s De corporis humani structura et usu (first published in 1583) – that differences between the male and the female skeleton were first systematically listed and illustrated, although the Gynaeciorum libri versions omitted the illustration of the female skeleton included in the original edition.93 To argue for the centrality of menstruation in women’s health, or to trace one’s professional roots to Hippocrates, as William Smellie did, are equally to support the two-sex model. If, as I am suggesting here, we accept a two-sex model as something existing, from antiquity, as a resource to be drawn on by those who wanted to stress female difference, then that will lead us to challenge explanations 90

Harvey, ‘The Century of Sex?’, p. 900. Londa Schiebinger, The Mind has no Sex? Women in the Origins of Modern Science (Cambridge, MA and London, 1989), p. 189. 92 Schiebinger, The Mind has no Sex?, p. 191; cf. Laqueur, Making Sex, pp. 4–5. 93 Stolberg, ‘A Woman down to her Bones’, p. 277. 91

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for its ‘rise’ in the modern period. For example, Roberta McGrath attributed the rise of the two-sex body to a renewed interest in women as ‘different’ because of the need of an industrializing society to increase the population of workers.94 Certainly, one version of the two-sex body, by focusing on the womb as the locus of difference, does bring reproduction to the fore, but this version was not ‘new’ in the nineteenth century. Similarly unsatisfactory is Laqueur’s claim that the longevity of the one-sex body was due to the dominance of the male in the public sphere: the two-sex body could send just as strong a message about the superior merits of the male.95 One further point needs to be made about the men who, from the sixteenth century onwards, used a Hippocratic two-sex model in order to support their right to treat the female body. Lisa Forman Cody, a pupil of Laqueur, has argued that, by showing ‘that women’s reproductive bodies and their maternal emotions were not inaccessible to men, but actually available’, the eighteenth-century menmidwives were responsible for a ‘revolution in western ideas about the differences and similarities between the sexes’.96 She claims that, by combining the traits of reasoning and accurate observation (gendered masculine), with those of sympathy and sensitivity (gendered feminine), such men transformed gender relations by suggesting that men and women are not in fact very different, at least with respect to their emotional lives.97 In many ways, Cody is going too far here; women’s reproductive bodies had been available to men, and had been the object of their authoritative pronouncements, since ancient Greece. But her analysis of the manmidwife as a hermaphrodite figure is highly relevant to my theme; as I will show in this book, there are many aspects of the man-midwife that drew on, and overturned, gender stereotypes. This was not, however, something restricted to the eighteenth century and, in my final chapter, I will also be arguing that James Young Simpson’s early interest in the medical understanding of hermaphrodites relates to the ambiguous gendering of the man-midwife; indeed, he later urged medical graduates to embrace the features of both genders in order to benefit their patients. By concentrating on my two main ‘slices through history’ – Smellie’s use of the Gynaeciorum libri, creating Hippocrates not only as the founder of gynaecology but also as the first man-midwife, and Simpson’s defence of painless childbirth – I therefore intend to show the role played by the early history of medicine in supporting innovations within the modern period. While demonstrating how a new branch of medicine could establish and defend itself, this discussion will also make it possible to approach issues of changes in authority over the female body, and shifting boundaries between midwifery and gynaecology, from a new perspective. 94 95 96 97

McGrath, Seeing her Sex, pp. 31–2. Laqueur, Making Sex, p. 61. Cody, Birthing the Nation, p. 14. Ibid., pp. 12–15.

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Chapter 1

Prefacing Women: Owners and Users Why were the texts included in the Gynaeciorum libri originally composed, and what did the collection mean to those who first encountered it? As Table 1 shows, virtually all of the works included were either composed or edited in the sixteenth century. Other works on the diseases of women were written at this time, but not included in the three editions of the compendium; it thus represents part of a wider interest in the nature of women, the diseases from which they suffer, and their treatment. As I have suggested in the Introduction, Calvi’s publication of the complete Hippocratic corpus in Latin, in 1525, made it possible to think of Hippocrates as a gynaecologist; it was a generation after this publication that there was a surge in publishing on both gynaecological and obstetrical matters. In this period, Hippocrates was praised as the great authority on the diseases of women even though it is clear that his admirers had not appreciated the detail of the theories put forward in the texts that bore his name. More immediately, Calvi’s translation was followed a year later not only by a reprint of the whole volume, but also by a separate, sextodecimo publication of the four main Hippocratic gynaecological works: Diseases of Women books 1–3 and Nature of Woman.1 Although I shall be drawing on evidence from all periods of ownership and use, in this chapter I shall mostly concentrate on those who encountered the book in the sixteenth and first part of the seventeenth centuries. In this period, medical readers would not have seen it as something of antiquarian interest, but rather as a work directly relevant to their practice. By the second half of the seventeenth century, the compendium was no longer seen as the cutting edge of medicine, but nor was it yet sufficiently old to be appreciated as a historic document. Even at the beginning of the seventeenth century, however, not everyone saw the Gynaeciorum libri as a valuable collection. In a 1603 discussion of the idea that menstrual suppression led to the womb drying up and moving around the body in search of moisture, the Galenist Castro denounced the compendium as ‘an amalgam of excellent doctrine and wild speculation which could easily mislead students of medicine’, a position possibly reflecting its mixture of established

1

King, Hippocrates’ Woman, p. 13; King, Disease of Virgins, pp. 11, 44.

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Galenic medicine with Hippocratic suggestions of a two-sex model.2 He noted that the four ‘huge volumes’ of the previous edition had, in 1597, been collected into a single volume, which he criticized as bringing together different views without any attempt at organization.3 In particular, he mentioned de la Corde’s Hippocratic commentary, and stated that the Hippocratic view of the womb seeking moisture is ‘clearly ridiculous’.4 Elsewhere in his treatise he attacked other writers whose work was included in the collection, especially Luis de Mercado.5 Yet in his preface to the reader, Castro praised Hippocrates as ‘the most wise Hippocrates’. How did sixteenth and early seventeenth century writers reconcile such general enthusiasm for Hippocrates with criticism of the medical details of the gynaecological texts of the Hippocratic corpus? As we shall see later in this chapter, one solution was to question the authenticity of Diseases of Women, while continuing to hail Hippocrates as the great expert on the subject. For those who insisted that it was genuinely by the Father of Medicine, anything that did not make sense to them could be explained away as being due to textual error. Practical uses of these medical treatises were thus complemented by textual work on them. The first part of this chapter will focus on the reasons for writing on the diseases of women given by those authors whose works were included in the various editions of the compendium: the second part will discuss how early readers, generally much more enthusiastic than Castro, engaged with the three editions, and will illustrate their engagement by briefly examining approaches to two important topics for sixteenth-century medicine: the treatment of menstrual disorders, and the materialization of sterility in the uterine mole. Both conditions were related to the different role of blood in the bodily economy of the female, and affected women’s social status.

Prefacing women The Gynaeciorum libri normally removed the prefaces originally supplied by many of the authors of the constituent texts. Often highly rhetorical in their presentation, 2

… hinc colligas, vulgatis illis gynaeciorum tribus voluminibus una cum praestanti doctrina, similes fabellas et prodigiosa multa figmenta contineri, quae facile possint tyronibus fucum facere, Roderico à Castro Lusitani, De universa mulierum medicina, novo et antehac a nemine tentato ordine opus absolutissimum (Hamburg, 1603), p. 12; translation by Ian Maclean, The Renaissance Notion of Woman: A Study in the Fortunes of Scholasticism and Medical Science in European Intellectual Life (Cambridge and New York, 1980), p. 29; Schleiner, ‘Early Modern Controversies about the One-sex Model’, p. 190. 3 Castro, De universa mulierum medicina, preface. 4 Castro, De universa mulierum medicina, p. 12. 5 Castro, De universa mulierum medicina, pp. 10 (with the marginal note, ‘another error by de Mercado’, Mercati lapsus alter), 17, 25. Mercurialis and Bonnaciolus are also attacked (e.g. pp. 8, 25).

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it is in these prefaces that we can find their authors’ reasons for writing about women’s diseases and for believing that such diseases need to be studied separately.6 Here I shall be discussing the original editions of the prefaces provided for three works published independently as well as being included in editions of the Gynaeciorum libri: the treatises of Luis de Mercado, Maurice de la Corde and, in its French translation, Jacques Dubois. Luis de Mercado (1525?–1611), a Jewish convert to Catholicism, and personal physician to Philip II and Philip III, first published his De communibus mulierum affectionibus in Spain, in 1579. First included in the Gynaeciorum libri in 1588, as the long fourth volume to the 1586–88 edition, it has been assessed as ‘arguably the most important work in Spach’s collection’.7 The text is very thorough, detailed and original in its combination of medieval and classical material, the latter only being available because of the Latin translations of the Hippocratic corpus that were published from 1525 onwards. Mercado adapted the medieval material from the Trotula texts edited by the humanist Georg Kraut and published in 1544; this edition of Trotula was included in all three versions of the Gynaeciorum libri.8 But he combined this with sections of the Hippocratic Diseases of Women and Nature of Woman.9 An example of how he did this, showing the ethical dilemmas posed by combining texts, comes from a section on recipes to restore virginity. Here, Mercado used two recipes from the 1544 version of the Trotula texts; one from what has now been established as On Women’s Cosmetics, the other from On Treatments for Women.10 These recipes also appeared in the Kraut edition within the Gynaeciorum libri, being marked as of particular interest to the owner of at least one copy.11 While the original Trotula texts had no qualms about passing off 6

Stolberg, ‘A Woman Down to her Bones’, p. 288 also notes the interest of these prefaces in exploring sexual difference. 7 On Mercado, see Winfried Schleiner, Medical Ethics in the Renaissance (Washington, DC, 1995), p. 119. References here are to the 1588 Gynaeciorum libri edition, and the first edition of 1579 can be consulted through the Biblioteca Digital Dioscórides at . 8 On the Kraut edition, see Monica H. Green, ‘The Development of the Trotula’, Revue d’Histoire des Textes, 26 (1996), tables 1–3; ibid., The Trotula: A Medieval Compendium of Women’s Medicine (Philadelphia, 2001), pp. 59–60. 9 E.g. in Book 1, ch. 9 (1588, p. 58) he quotes from both NW and DW using the translation of Cornarius. 10 Mercado, Bk 4, ch. 14 (Bauhin 1588, p. 556) may be compared to Trotula, ch. 35 (Bauhin 1586, vol. 1, pp. 111–12. The first recipe is given in Green, The Trotula, p. 188, section 307: the second, in ibid., p. 146, section 194. Mercado’s wording is very close, including the cure for the condition. However, the quantities in the first recipe differ, while Mercado has added more possible ingredients and has changed ‘warmed in water’ (in aqua calefacta) to ‘water containing salts of iron’ (aqua chalybeata), while in the second he refers to the pudenda being ‘warmed’ (foveantur) rather than ‘given a poultice’ (fomententur). 11 In one copy of Spach 1597 held in Manchester (Parkinson Coll./2320, M1,G67,F), p. 53, the annotator has marked this recipe.

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deflowered women as virgins, and gave a total of nine recipes to tighten up the vagina, Mercado followed the 1544 version and set these in an entirely licit context, that of helping a virgin who, through no fault of her own, has a wide vaginal opening. The section began, ‘Unless it were permitted to discuss tightening up the width of the [opening of the] womb for honourable reasons, we would make no mention of it’ and went on to explain that sometimes this tightening up was necessary if conception were to occur.12 Mercado developed this approach, and introduced the first recipe by suggesting that this looseness may even lead to uterine prolapse, referring to a discussion of this in the Hippocratic Nature of Woman. He thus further widened the context from promoting conception, to a broader context of gynaecological disorders. How did Mercado introduce this treatise, mixing as it did medieval and newlydiscovered Hippocratic material? The preface opened not with an appeal to the authority of the past, but with a claim of present need, a reiteration of what were by then becoming standard remarks about the dreadful state of medicine in Mercado’s day. Another of the Gynaeciorum libri authors, Jean le Bon, the short preface of whose Therapia puerperarum remained with the text when it entered the compendium in 1586, similarly claimed that pregnant women were often ‘torn to pieces’ by surgeons, midwives and barbers, who similarly savaged ‘little babies barely alive’; however, he did not include physicians like himself in his list of guilty parties.13 Mercado also expressed fears of the imminent collapse of the medical profession due to the financial self-interest and lack of education of those who practise it. On gynaecology specifically – ‘that other part of our art, which deals with what is special and peculiar to women’ – Mercado argued that it is ‘damaged and weakened, and so neglected that we see that women suffering from a thousand diseases are getting no help, or only that which is useless or inappropriate. This is because they are treated as if they were men’.14 His preface to the reader ended with a discussion of the word ‘Gynaecia’, in which he cited several classical writers – including Plutarch, Vitruvius and Procopius – in order to link the term to female seclusion in the ‘women’s quarters’ of the house; for him, gynaecology concerns separation. He noted that Hippocrates is ‘well known’ to have worked 12

Nisi de restrictione amplitudinis vulvae propter honestam causam liceret tractare, nullam de ea mentionem faceremus (Trotula, 1544): Nisi de restrictione amplitudinis uteri propter honestam causam liceret tractare; nullam profecta eius mentionem fecisse (Mercado). 13 Le Bon, Bauhin 1586, vol. 2, p. 387: Dilaniari enim non paucas gravidas mulieres à chirurgis, obstetricibus et tonsoribus, multosque; semivivos infantulos ab iis de dilacerari, saepius quam voluissemus, videmus. 14 Mercado, Ad lectorem: … alteram nostrae artis partem, quam foeminis propriam et peculiarem esse existimavi, mutilam esse, et defectam, ac incultam ita, ut missere foeminas ipsas mille morbis premi conspiciamus, nullo, vel inutili, aut alieno praestito auxilio; quod veluti viri curentur.

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very hard on the topic of those diseases which develop in women by reason of their sex; he thus presented himself as following what I would call a ‘Hippocratic imperative’ (based on the statement of female difference in Diseases of Women 1.62) driving him on to complete his study of the diseases of women. However, he did not believe that Hippocrates, at least as represented by the texts that have survived, was always right; far from it, he said, as this work too is damaged, due to ‘its antiquity, or the carelessness of posterity, or because of our own negligence’.15 Despite his extensive verbatim quotation from the Hippocratic Diseases of Women, his aim was therefore not to reproduce Hippocratic gynaecology, but to make its categories more distinct; as he put it, to ‘make more clear and more distinct the shining precepts of Hippocrates’, discussing the diseases which come from each of them.16 In particular, he divided his work into four books, according to four divisions of ‘woman’: those diseases to which all women are vulnerable; those restricted to virgins and widows; those affecting the sterile and the pregnant; and those conditions found in women who have just given birth or are nursing a baby.17 By the early seventeenth century, these categories were being found inadequate; François Ranchin’s Tractatus de morbis virginum (1627), for example, argued that the category ‘virgin’ should be divided into those prior to menarche, those who have experienced menarche but not yet been deflowered, and those who have just been deflowered.18 Similar classificatory issues are also found in the original 1585 preface to Maurice de la Corde’s commentary on the Hippocratic Diseases of Women – again, excluded from the version of this work included in the Gynaeciorum libri – but he put it the other way around. Writing only a few years after Mercado, de la Corde argued that plenty of books exist on the practical treatment of women’s diseases – how to provoke or restrain the menses, how to cope with a uterine prolapse, how to calm down an inflammation of the womb – but only ‘our divine Hippocrates, with a sure reasoning and purpose, has embraced the complexity of the diseases which affect woman throughout the whole course of her life’ and ‘has arranged his findings as is fitting’.19 In the whole mass of texts on the diseases of women found in Greek or Latin, in the ancients or in the more recent writers, or in the Arabic authorities, nothing, de la Corde insisted, was comparable to Hippocrates.20 De la 15

Mercado, Ad lectorem: Quem sane laborem, vel prae vetustate, aut posterorum incuria, vel nostri negligentia, veluti mutilum iudicamus. 16 Mercado, Ad lectorem: praeclara praecepta lucidiora reddere. 17 Mercado, Ad lectorem: in re foeminarum affectiones in quatuor partes dividens. 18 François Ranchin, Tractatus de morbis virginum in Opuscula Medica (Lyons, 1627), pp. 370–72; discussed by King, Disease of Virgins, pp. 53–4. 19 Maurice de la Corde, Hippocratis Coi, Medicorum principis, liber prior de morbis mulierum (Paris, 1585), pp. 8–9: Solus hic noster et quidem divinus Hippocrates certa ratione atque via disputationem instituit … de muliebribus ac cogitando est universa complexus, quae toto vitae decursu ad mulieres vicissim pertineant. 20 De la Corde, De morbis mulierum, preface, p. 7.

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Corde argued for an ‘immense gulf’ between the sexes, focused on the womb.21 In contrast to the Gynaeciorum libri version, the 1585 edition carried an index of body parts (giving the Latin and Greek names, with page and line numbers), thus making the Greek text a little more accessible, and also a separate index of materia medica, suggesting that Hippocrates should be read not just because of his comprehensiveness (the whole course of her life), and the organization of his work (arranged his findings as is fitting), but also because of the empirical value of the therapies listed. Although it was the theory and organization of Hippocratic gynaecology that de la Corde flagged up, the practical side was not to be neglected. While de la Corde’s commentary moved rapidly from separate publication to inclusion in the Gynaeciorum libri, other texts incorporated had a more complex history. For example, the work of Jacques Dubois (Sylvius, 1478–1555) on generation and menstruation was first published in Latin (1555) shortly after his death. It was then translated into French in 1559 by Guillaume Chrestien, who translated many works of Hippocrates, Galen and Dubois, and who died in around 1560. The Latin text was subsequently corrected by Alexander Arnaud in 1556, and included in the 1566 Gynaeciorum libri. It was only the French translation that included a preface, by the translator, justifying its appearance in the vernacular.22 Dubois had been a Galenist, basing what he wrote on women on highly traditional ancient, and later, authorities: he cited the Hippocratic Diseases of Women, Regimen and Aphorisms, Aetius, the Arabic writers Rhazes and Avicenna, Savonarola, Bernard of Gordon, but – above all – relied on Galen. Chrestien’s preface, too, was very Galenic in content, although he did refer to ‘Father Hippocrates, author of all those good things which we have in the art of medicine’.23 21

De la Corde, De morbis mulierum, preface, pp. 7–8: emicuit tandem discrimen ingens inter utrumque vel apparentissum. The womb is glossed as ‘a certain receptacle’, quidem uno conceptaculo. 22 Sylvius taught at Paris, his pupils including Vesalius, although they later quarrelled. See Yvonne Hibbott, ‘Medical Books of the Sixteenth Century’, in Alain Besson (ed.), Thornton’s Medical Books, Libraries and Collectors, 3rd edition (Aldershot, 1990), p. 49. The Latin first edition is De mensibus mulierum, et hominis generatione, Iacobi Silvii medicae rei apud Parrhisios interpretis Regii, commentarius (Paris, 1555: WIHM EPB/6179). The Latin text starts with the Privilege of the king giving permission to Jacques’ brother Jehan to have printed/sell/distribute various books by Jacques after his death. Among these books is this one, and nobody else in France is to print it for 5 years from 5 March 1555. It is in two parts, with the part on menstruation starting ‘Excrementum animalibus viviparis aut inutile est, idemque humidum et siccum’, and with De hominis generatione starting on p.20r (starts ‘Vir temperatus in muliere temperata foecundissimus est’). 23 Chrestien, preface to Jacques Dubois, Livre de la nature et utilité des moys des femmes (Paris, 1559), p. 103. On Chrestien and Dubois, see now Valérie Worth-Stylianou, Les Traités d'obstétrique en langue française au seuil de la modernité (Geneva, 2007).

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Today it may seem odd to link a text on generation to one on menstruation, as in our medical system to menstruate is to demonstrate the absence of conception; menstruation is ‘the weeping of the disappointed womb’.24 But in early modern terms the two were not polar opposites; instead, menstruation was essential in order to prove that there was sufficient blood to provide the raw material for a foetus. In Hippocratic medicine in particular, menstrual suppression was the main symptom, seen as potentially life-threatening, because – in the absence of any knowledge of ovulation – it was believed that blood was being produced all over the body, throughout the month, from the normal diet, and that it needed to find its way out of the body for the woman’s health to be kept in balance.25 Where the 1555 Latin edition of Dubois had opened with the section on menstruation, the 1559 French text changed the order and started with generation.26 There were pressing contemporary reasons for the primacy of generation, because of the importance of a child being born to the marriage, on April 21, 1558, between the future François II and the sixteen-year-old Mary Stuart.27 However, as we shall see at the end of this chapter, concerns about generation and its other side, sterility, are in any case a central feature of many of the texts included in the Gynaeciorum libri. Chrestien dedicated the treatise on menstruation to the mother-in-law of his employer, Robert de la Mark: the ‘tresillustre et tresprudente Dame’, Diane de Poitiers. Diane would have been nearly 60 when she received this dedication, and she died in 1566, the year the first version of the Gynaeciorum libri collection appeared.28 Menstruation treatises were not always dedicated to women, while treatises on medicine more generally could be dedicated either to men or to women. Nicholas de la Roche dedicated his treatise on the treatment of women’s diseases to Catharine d’Amboise (1481–1550), a woman of letters and daughter of Charles I d’Amboise, among others.29 Many humanist treatises were dedicated to 24

On (accessed 21.12.05), this formula is attributed to ‘older midwives’; (accessed 21.12.05), an article from the journal Marriage Hygiene, demonstrates its use in the 1930s. 25 King, Hippocrates’ Woman, pp. 28–31. 26 It consists of two separate works, Livre de la generation de l’homme, tres utile et tres necessaire à savoir, recueilly des antiques et plus leurs autheurs de medecine et philosophie, par Jacques Sylvius and Livre de la nature et utilité des moys des femmes, et de la curation des maladies qui en surviennent, composé en Latin par seu M. Jacques Sylvius (both Paris, 1559). In version held by the Herzog August Bibliothek (104.12 PHYSICA) these are bound together and numbered consecutively. 27 Chrestien, preface to Dubois, Livre de la nature et utilité des moys des femmes, p. 103. 28 Dedication mentioned by Georges Guiffrey, Lettres inédites de Dianne de Poytiers (Paris, 1866), p. 10, n. 1 and Ivan Cloulas, Catherine de Médicis (Paris, 1979), p. 123. 29 Wolf 1566, pp. 312–15. For further information on Catherine’s own literary outputs, see the dissertation of Ariane Bergeron-Foote, Les œuvres en prose de Catherine d'Amboise,

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Margaret of Navarre, as another particularly scholarly woman of her day: a further treatise included in the Gynaeciorum libri, Luigi Bonacciuoli’s Enneas Muliebri, was originally dedicated to Lucrezia Borgia.30 But Chrestien’s preface goes into far more detail than most about precisely why it is dedicated to Diane, best known in her role as mistress to Henri II, and acts not only as an illustration of the construction of sexual difference, but also as a window into the actual medical practice of elite women. In early 1542, when Henri’s marriage to Catherine de’ Medici was threatened by nine years of failure to produce an heir, Diane is supposed to have found the couple a doctor, Jean Fernel. Fernel came to be chief physician to both the king and queen, and saved Diane’s life when she was seriously ill in 1543 or 1545.31 The details of his fertility advice are not known. But he examined the couple’s ‘conformation intime’ and recommended a sexual position to be used; Diane then encouraged Henri to continue to sleep with his wife. According to sources written several decades later, what he diagnosed in Henri was a congenital abnormality (possibly hypospadias); some sexual positions would minimize the effect of this.32 Demonstrating the way in which concerns about fertility had allowed physicians to become involved in gynaecology, in his 1567 Physiologia Fernel went on to discuss the importance of ‘a cleansed womb, eager for semen, to clasp and hold around what has been drawn, with its mouth tightening on the whole’.33 He further noted that ‘The prime need is for the male semen to be ejected straight and in sufficient quantity, and to be fertile, and not thin like serum or water, not small in bulk’; in hypospadias, where the opening of the penis is not at the end, ejaculation would not be ‘straight’ into the womb. Finally, he assured his readers, ‘when all these factors coincide overall, conception occurs by the laws of nature’. In Catherine’s case, conception did indeed occur. In January 1544, she gave birth to François (later François II), and then went on to give birth nearly every year for 13 years. Diane helped in childbirth, choosing and supervising wet-nurses, dame de Lignières (1481–1550) (Thèses de l’Ecole nationale des chartes, 2002; , consulted 2 June 2006). 30 Luigi Bonacciuoli, Enneas muliebris (Ferrara, 1505), opening: Ludovici Bonacioli Ferrariensis medici illustris ad divam Lucretiam Borgiam Ferrariae Ducissam Enneas Muliebris incipit, followed by a dedicatory poem comparing the glory (Lat. decus) of Lucrezia to the wisdom (Gk. sophos) of Bonacciuoli. 31 Frederic J. Baumgartner, Henry II (Durham, 1988), p. 37; Guiffrey, Lettres inédites, p. 16; on Fernel, see Laurence Brockliss and Colin Jones, The Medical World of Early Modern France (Oxford, 1997), p. 129–33. 32 A relatively common abnormality of the penis, affecting about 3 in 1000 boys, that appears as an abnormal opening of the penis on the under side of the penis rather than at the end. This results in a downward curvature of the penis at erection. Princesse Sixte de Bourbon, Catherine de Medici (Paris, 1940), p. 73 suggests that this was Henri’s problem. 33 Jean Fernel, Universa medicina, tribus et viginti libris absolute (Paris, 1567), Book 7, ch. 8; tr. John Forrester, The Physiologia of Jean Fernel (Philadelphia, PA, 2003), pp. 570–71.

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and giving advice on child-care.34 Modern commentators on the relationship between king, queen and royal mistress assume that Diane’s assistance would have been unwelcome to Catherine; Baumgartner writes of the ‘domineering presence’ of Diane, while Castelot regards the relationship between the two women as one of ‘détestation … palpable’.35 Diane also nursed Catherine when she was ill; ambassadors to the court show some surprise at how much time the two women spent together, but we must remember that they were also cousins.36 Chrestien’s preface to his translation of Dubois also sheds light on the relationship between Queen and royal mistress. Chrestien stated that he was dedicating the translated ‘menstruation’ treatise to Diane partly because of the favour she showed to Chrestien when he served her son, partly because the book would carry more authority under her protection, and partly because he knew it would please her to see women’s ‘secrets’ revealed for the purely charitable purpose of helping women who would be reluctant to consult learned and experienced doctors for reasons of fear or embarrassment.37 ‘Secrets’ could refer not only to knowledge, but also to the external genitalia; women’s reluctance to see their ‘secrets’ in print is a literary topos going back to the classical world, and the language of secret knowledge shared among women also recalls that of the Hippocratic Diseases of Women 1.62.38 But here the topos is reversed: a woman is supposed to welcome the publication of these ‘secrets’ because it is done to help her fellow-women. Chrestien added that it is ‘the fault of today’ that women are too timid, and have recourse to ‘other, imprudent, women’ rather than to ‘knowledgeable and expert physicians’ who could help them without swindling 34

Guiffrey, Lettres inédites, pp. 49–50. André Castelot, Diane, Henri, Catherine: le Triangle royal (Paris, 1997), p. 262; Baumgartner, Henry II, pp. 98–100. 36 Sheila ffolliott, ‘Casting a Rival into the Shade: Catherine de’ Medici and Diane de Poitiers’, Art Journal, 48 (1989): 140 n. 23. On Diane nursing Catherine, see Chrestien, preface to Dubois, Livre de la nature et utilité des moys des femmes, p. 106; François de Rabutin, Commentaires des Guerres en la Gaule Belgique (1551–1559), ed. Honoré Champion, vol. 1 (Paris, 1932), p. 39; Guiffrey, Lettres inédites, pp. 96–7. In one documented illness in which she was nursed by Diane, in 1552 Catherine had ‘pourpre’, a term covering a range of skin conditions; Knecht, Catherine de Medici, p. 39, n. 17 translates as puerperal fever, while Cloulas, Catherine de Médicis, p. 110 argues for scarlet fever. 37 Chrestien, preface to Dubois, Livre de la nature et utilité des moys des femmes, pp. 104–5. 38 On ‘secrets’ as the external female genitalia, see Hobby, ‘“Secrets of the Female Sex”’, pp. 201–2. On the literature of ‘secrets’ more generally in this context, see Monica H. Green, ‘From “Diseases of Women” to “Secrets of Women”: The Transformation of Gynecological Literature in the Later Middle Ages’, Journal of Medieval and Early Modern Studies 30 (2000): 5–39. Chrestien, preface to Dubois, Livre de la nature et utilité des moys des femmes, p. 104: e.g. ‘à entendre tels secrets, qui ne sont communément congneus à tous … ne congnoistre leurs secrets maladies’. 35

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them; these points are very similar to those made in Mercado’s preface, attacking medical practitioners, except that here those giving bad advice are gendered female.39 This would suggest that the dedication to Diane is a way of showing women that they should rely on male practitioners for assistance in their problems. But there is much more to Chrestien’s preface than the repetition of these hackneyed themes. On Diane herself, he stresses the derivation of her name from the Greek dianoia, ‘right judgement’, arguing that the dedication is made particularly appropriate by her concern both for preserving the health of the king and queen and for treating them when they were ill. We know from a surviving letter from Diane to Jean d’Humières, the governor of the royal children’s household, that she would include remedies in her letters; for example, unicorn horn.40 She was by no means unique among elite women in caring for the sick. The correspondence between Catherine and her daughter Elisabeth de Valois, who married Philip II of Spain in 1560, reveals that Catherine was sending conduct advice and medical prescriptions to Elisabeth, in addition to Elisabeth having four French physicians with her at the Spanish court.41 Contemporary sources say that Elisabeth ‘placed little confidence in the Spanish doctors, or in their prescriptions’;42 she went on to die in childbirth. It is, however, significant that Chrestien tells us explicitly that Diane worked ‘alongside the physicians’ when treating the queen.43 Chrestien expresses his hope that Diane herself would learn from Dubois’ text about conditions that are especially difficult to define and to treat. He specifies that ‘sometimes where there is a suffocation or turning of the womb, or a female flux, causing unconsciousness and weakness of the heart, or corruption of retained seed, some will judge it to be lethargy, or apoplexy, or the deepest sleep, which we call Caros [taken from the Greek karos, ‘drowsiness’], or some other such disease, often assuming the opposite of the truth’.44 In other words, he accepts the Hippocratic point, from Diseases of Women, that women’s diseases should not be assimilated into the 39

105.

Chrestien, preface to Dubois, Livre de la nature et utilité des moys des femmes, p.

40 Guiffrey, Lettres inédites, p. 16; ‘Je vous envoye de la licorne pour luy en faire user ainsy qu’il fera ordonné’. Diane also suggested calling Fernel. See Cloulas, Catherine de Médicis, p. 74. 41 Elisabeth married Philip after the death of Mary Tudor. W. Prescott, History of the Reign of Philip the Second, King of Spain, vol. II (London, 1855), p. 343; vol. IV (London, 1859), p. 535; Susan Broomhall, ‘“Women’s Little Secrets”: Defining the Boundaries of Reproductive Knowledge in Sixteenth-century France’, Social History of Medicine, 15 (2002): 1–15. 42 William Prescott, History of the Reign of Philip the Second, King of Spain, vol. IV (London, 1859), p. 541. 43 Chrestien, preface to Dubois, Livre de la nature et utilité des moys des femmes, p. 106: ‘envers les medecins’. 44 Chrestien, preface to Dubois, Livre de la nature et utilité des moys des femmes, pp. 108–9.

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categories of men’s diseases, and he also appears to agree with other writers of the period that women’s diseases are difficult to treat because they are so difficult to classify. For all of these conditions, he insists, Dubois’s text provides simple remedies, and signs to distinguish between the different diagnoses; it is because of this that it was in such demand in Paris, where the book formed the basis of M. Duret’s lectures, in France more generally, and in the Latin countries.45 The stated audience for the French translation was thus women like Diane, concerned with healing in a domestic context, but at the end of the preface Chrestien also briefly mentioned its value for surgeons, most of whom could not read Latin.46 This dual audience may explain why the French translation had to explain to its readers technical terms which were not glossed in the Latin: comparing the French to the Latin text, these include vivipares and vita sedentaria as well as anatomical terms used in bloodletting, such as vena malleoli and vena poplitis.47 The French gave vernacular equivalents for the Latin names used for medicinal plants, although Chrestien seems to have been unable to cope with a Latin list of compound medicines and simply repeated the Latin: tryphera magna sine opio.48 His French version occasionally omitted some of the Latin text, perhaps because he did not agree with it. For example, Dubois wrote that women are generally happier if their menstrual flow occurs in a short space of time, ‘that is, if the menses flow in two or three days’; Chrestien, perhaps thinking this was unrealistic, omitted the reference to the number of days.49 Chrestien sometimes omitted the Hippocratic references included in the Latin, presumably because neither surgeons nor elite women were as concerned as physicians with the minutiae of the ancient authorities for Dubois’s statements. On one occasion, Chrestien missed out how long the woman should be left in the bath; the Latin reveals that this should be ‘about an hour’, hora circiter una.50 He also added a

45

Chrestien, preface to Dubois, Livre de la nature et utilité des moys des femmes, p. 109. This will be Louis Duret (1527–86). 46 Chrestien, preface to Dubois, Livre de la nature et utilité des moys des femmes, p. 110. 47 Dubois, De mensibus mulierum, p. 1r (Bauhin 1586, vol. 1, p. 304); cp. Livre de la nature et utilité des moys des femmes, p. 120, where ‘des animaux vivipares’ is glossed as ‘c’est adire qui produisent vifs leur petits faons’. Vena malleoli is explained in French as ‘la veine du malleole (c’est a dire de la cheville du pied)’; cp. Dubois, De mensibus mulierum, p. 6r and Livre de la nature et utilité des moys des femmes, p. 161 (Bauhin 1586, vol. 1, p. 311). 48 Dubois, De mensibus mulierum, p. 7r and 8r (Bauhin 1586, vol. 1, p. 314); Dubois, Livre de la nature et utilité des moys des femmes, p. 173. 49 Dubois, De mensibus mulierum, p. 2v, biduo vel triduo profluunt, foeliciores sunt; in Bauhin 1586, vol. 1, p. 307 this becomes only two days, hoc est, biduo profluunt; cp. Dubois, Livre de la nature et utilité des moys des femmes, p. 129, which omits the timing. 50 Bauhin 1586, vol. 1, p. 315; cp. Dubois, Livre de la nature et utilité des moys des femmes, p. 181.

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marginal note confirming, from his own experience in his native Orleans, Dubois’s remarks about women who continue to menstruate while pregnant.51 The text of this preface is therefore complex. Superficially, it may suggest that women prefer to consult other women, praising Diane’s skills as healer and carer: but, at a deeper level, it acts as a reminder that ‘doctors know best’ in many situations, and that the ideal woman healer respects this and works alongside them, as Diane is said to have done. In the story that she summoned Jean Fernel to deal with the royal fertility crisis, Diane was colluding in the version in which male learned medicine triumphed; there is an alternative account of the story in which a woman, Marie-Catherine de Pierrevive, wife of Antonio Gondi of Florence, was the salvation of the royal line.52 In this period, both gynaecology and fertility were being seen as men’s business. In the rhetoric of the prefaces, some doctors may misdiagnose the diseases of women, treating them as if they were men, but the fact that Diane is expected to learn from this book shows that other doctors do represent a valid source of knowledge. While the preface makes it clear that it is appropriate to dedicate this translation to Diane de Poitiers because of her interest in matters of health, it may seem odd that a text on menstruation is dedicated to a woman approaching 60. The sixteenthcentury writers included in the Gynaeciorum libri generally located menopause at 40, or 50 at the outside, on the grounds that older women lack the expulsive power to remove the blood.53 Wolf’s Harmonia Gynaeciorum, based on medieval texts, placed normal menopause at 40–45, but the Trotula treatises put it at 60 or 65.54 Dubois himself believed that most women stop in their fortieth year but, in women of a slighter build, those who continue to menstruate after 40 will go on doing it until they are 60; fatter women stop earlier, at between 35 and 50, while it is very rare in the sixtieth year.55 So, perhaps Diane was indeed still menstruant in 1559. But another explanation is possible. During her lifetime and beyond in festivals, literature and art – above all, in her chateau at Anet – Diane was represented as her mythical namesake, the Roman goddess Diana.56 This very deliberate identification evoked a complex set of images. In her Greek version, as Artemis, Diana was one 51 Dubois, Livre de la nature et utilité des moys des femmes, p. 126; cp. Bauhin 1586, vol. 1, p. 306. 52 Cloulas, Catherine de Médicis, p. 130; Guiffrey, Lettres inédites, p. 15. Also known as Mme Duperon, she too was in correspondence with Diane about the health of the royal children. 53 Akakia, De morbis muliebribus 1.1 (Spach 1597, p. 746); Mercuriale, De morbis muliebribus 4.1 (Spach 1597, p. 258). 54 Harmonia Gynaeciorum, p. 42. On the different versions of the Trotula manuscripts, based on the Viaticum and giving 60 or 65, see Green, The Trotula, pp. 20–21; 215–16, n. 85. 55 Dubois, De mensibus mulierum, p. 1v–2r; Livre de la nature et utilité des moys des femmes, pp. 123 and 125. 56 On Anet, see Daniel Leloup, Le Château d’Anet. L’amour de Diane de Poitiers et de Henri II (Paris, 2001).

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of the virgin goddesses, but associated with menstruation, childbirth and the raising of young children; never having menstruated, she was able to preside over this transition, just as she presided at childbirth without having given birth. In the Hippocratic treatise On the Diseases of Young Girls, girls dedicated clothing to her to acknowledge their menarche.57 In his commentary on this text, de la Corde criticized the practice of performing such dedications at menarche or in childbirth, and promoted a message similar to that of his commentary on Diseases of Women, emphasizing that parturient women in particular would be far better relying on doctors, who could help in childbirth ‘with both the hand and with hard work’.58 The identification with Artemis/Diana is normally seen as supporting the image of Diane’s chastity; she continued to wear mourning until her death, and when Henri was killed in a tournament he was carrying the colours of her late husband. As Diana the hunter, the imagery could suggest her hunting down her man, the king; but Diana is also the goddess most associated with the moon, seen as cooling and also wet, like a woman in an Aristotelian-Galenic model of the body.59 Sometimes Henri was presented as Apollo to her Artemis, the sun to her moon.60 Henri’s patronage of art depicting Diane can itself be seen as ‘a testament to the king’s potency’.61 The power of Diane’s classicizing imagery was such that, Sheila ffolliott has argued, even Catherine de’ Medici had to engage with it in order to subvert it. Catherine’s own iconography stressed that, despite Diane’s involvement in raising the royal children (in true Artemisian tradition), it was Catherine’s fertility that had actually produced the heir to the throne, and the revised iconography presented Diane’s symbols as in the shade rather than basking in the light of the royal sun.62 But in translating Dubois, Chrestien’s message to Diane, and to other women whose household role includes caring for the sick, is not only one warning them to call in physicians where appropriate and to work alongside them, but also one which reinforces the difference of women. The subsequent inclusion of the Latin text of Dubois in the Gynaeciorum libri throws into relief one of the problems of 57

Philippe Erlanger, Diane de Poitiers: Deése de la Renaissance (Paris, 1976), pp. 149–50: after the birth of Catherine’s children, ‘La vraie, la seule triomphatrice fut Diane, protetrice comme sa patronne mythologique des accouchements et des chaste amours’. On Artemis and menstruation, see King, Hippocrates’ Woman, pp. 75–88. 58 Maurice de la Corde, Hippocratis Coi libellus Peri Partheniôn, hoc est, De iis quae virginibus accidunt (Paris, 1574), p. 62v: medici … quo possint partus tempore uti manu et sua industria adiutare. 59 François Bardon, Diane de Poitiers et le Mythe de Diane (Paris, 1963), p. 5, using Boccaccio for the imagery of the moon. 60 Bardon, Diane de Poitiers, p. 79. 61 Katherine B. Crawford, ‘Love, Sodomy and Scandal: Controlling the Sexual Reputation of Henry III’, Journal of the History of Sexuality, 12 (2003): 513–42, p. 529. Crawford notes that this ‘exaltation of Diane’s adulterous union with Henry’ was also used by enemies to feminize him, showing that he could be dominated by a woman. 62 ffolliott, ‘Casting a Rival into the Shade’, pp. 140 and 142.

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studying this collection and its influence, showing the contradictions of including Galenic texts which say women are cold alongside Hippocratic texts which say women are hot; those which say their flesh is more dense than that of a man alongside those which say their flesh has a looser texture. But beneath these contradictions is a clear message, based on the ‘Hippocratic imperative’: women are different from men, so different that they require a separate branch of medicine to treat them effectively. Like Diane’s recommendation of unicorn horn, Chrestien’s reference to surgeons as a possible audience for his translation raises the question of who should be treating women. Before turning to the practical content of this text dedicated to the royal mistress, I will discuss questions of ownership and use in this period.

Owners and annotators Ownership of a book is often difficult to uncover. In Renaissance Italy in particular, evidence survives of the accumulation of very large collections even before the age of print. In the medieval period, libraries had been the possession of religious foundations, with some items available to read and others to loan. But in Italy, towards the end of the fourteenth century, individual aristocratic bibliophiles emerged, with extensive libraries being built up. The dream of their owners may have been to rival the libraries of the ancient world – above all, that of Alexandria – but in practice these were private collections. On their deaths, owners would often leave vernacular works to friends and family, but pass the classical and medieval works to a religious community.63 Coluccio Salutati, who was chancellor of the Florentine Republic until his death in 1406, owned around 800 books, but left them to his family. Some were bought by the merchant Niccolò Niccoli, who died in 1437; in his will, he then made arrangements for that part of his collection which was not in the vernacular to be made available to the public, but in fact his books went to San Marco, before forming the nucleus of the Laurentian library in Florence. As Petrucci has pointed out, Niccoli was unusual among the owners of large libraries in this early period because he was not a writer, just a reader and owner.64 In Britain, Peter Murray Jones has located a shift in the pattern of owning medical books after 1375; before this date, medical books were produced primarily for university medical education, but after it, medicine found a wider readership.65 63

Armando Petrucci, Writers and Readers in Medieval Italy. Studies in the History of Written Culture (New Haven and London, 1995), p. 215. 64 Petrucci, Writers and Readers in Medieval Italy, p. 217. On the library, see B.L. Ullman and P.A. Stadter, The Public Library of Renaissance Florence. Niccolò Niccoli, Cosimo de’ Medici and the Library of San Marco (Padua, 1972), pp. 60–73. 65 Jones, ‘Medicine and Science’, p. 433; ibid., ‘Medical Libraries and Medical Latin’, p. 121.

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This did not apply only to practical texts; works of theory were also being copied for non-university trained men. At the same time, translations from Latin into the vernacular took off.66 Jones gives the example of the London barber Thomas Plawdon who, in the first quarter of the fifteenth century, arranged for a friend to translate a range of theoretical medical texts into Middle English for him.67 This is a practical example of Monica Green’s work on the creation of a wider ‘textual community’; people who had access to the ideas transmitted through the universities without themselves holding a university degree.68 Members of this community may have used the learned books they owned to diagnose their own diseases and those of their households.69 In the sixteenth century, the account books of booksellers or stationers, and probate inventories, sometimes provide us with a glimpse of the context in which books were bought and sold in the first decades of the printing press.70 For example, the inventories of a bookseller in early sixteenth century Cambridge can tell us what stock he held, how much of it could be classed as ‘medical’, and how much it cost.71 But just because someone owned a book did not mean they had read it, while not owning a book did not prevent a person from borrowing it from someone else. Although it is rare that we have records of who borrowed what, from whom, there was an extensive culture of borrowing and lending in the early modern period. In Renaissance Florence, at the death of Niccolò Niccoli about 200 of his total collection of 600 or 800 books had been on loan.72 Unusually, for the Regius

66

On printed English vernacular medical literature from the sixteenth century onwards, see Paul Slack, ‘Mirrors of Health and Treasures of Poor Men: The Use of the Vernacular Medical Literature of Tudor England’ in Charles Webster (ed.), Health, Medicine, and Mortality in the Sixteenth Century (Cambridge, 1979), pp. 237–73; Mary E. Fissell, ‘Readers, Texts, and Contexts: Vernacular Medical Works in Early Modern England’, in Roy Porter (ed.), The Popularization of Medicine 1650–1850 (London, 1992), pp. 72–96. 67 Jones, ‘Medicine and Science’, p. 435; the manuscript is Gonville and Caius ms. 176/97. 68 Green, Making Women’s Medicine Masculine, using the model of ‘textual community’ developed by Brian Stock, Implications of Literacy: Written Language and Models of Interpretation in the Eleventh and Twelfth Centuries (Princeton, NJ, 1983). 69 Jones, ‘Medicine and Science’, p. 446. 70 Jones, ‘Medicine and Science’, pp. 443–6; ibid., ‘Medical Libraries and Medical Latin’, pp. 122–4. 71 Peter Murray Jones, ‘Reading Medicine in Tudor Cambridge’ in Vivian Nutton and Roy Porter (eds), The History of Medical Education in Britain (Amsterdam, 1995), pp. 159– 61. 72 Berthold L. Ullman and Philip A. Stadter, The Public Library of Renaissance Florence. Niccolò Niccoli, Cosimo de’ Medici and the Library of San Marco (Padua, 1972), pp. 59–60 and n. 4. The total number of books owned by this exceptional collector varies

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Professor of Physick at Cambridge, Thomas Lorkyn (c.1528–91), who left his books to Cambridge University Library a century later specifically for the use of its medical students, we know the names of 21 individuals who borrowed from his collection of medical books between 1563/4 and 1569.73 He owned a copy of the 1566 first edition of the Gynaeciorum libri, and as well as buying books he was given or left others by colleagues; his library was thoroughly up-to-date, including work published in the year before his death.74 At a lower level of ownership, there is often evidence that a book became the property of a family; both surgeons and physicians would hand down books within their families, as the tools of their trade. For example, in 1477 the surgeon John Dagvile left ‘all my bokes bilonging to my crafte of sirurgie and also all my bokes of phisik’, with his drugs and instruments, to his son Thomas, while the will of William Turner, proved in July 1568, left to his son Peter Turner ‘all my writen bookes and yf he be a preacher all my divinitie bookes yf he practise Phisicke all my physicke bookes’.75 Ownership within medical families continued into the nineteenth century. For example, the John Rylands library in Manchester holds a copy of the first two parts of the 1586 edition of the Gynaeciorum libri, bound into a single volume. This copy is in very poor condition, apparently due to use rather than neglect, as it is heavily annotated. It provides two examples of family ownership. In the nineteenth century, it was owned by John Windsor, who lectured in midwifery, and then by his son Thomas; both have signed the flyleaf, and they will be discussed in more detail in chapter 4. On the title page, the volume also bears the words ‘Ex libris R. Freeman’ – so far unidentified – and one of several annotators has written at the end of Rousset’s text that it was the gift of his uncle, dating this gift to 1702.76 However, as the donor cannot be identified, it is not

according to whether inventories, or orations given after his death, are used. See also Kolb, Caspar Peucer’s Library, p. 1. 73 Peter Murray Jones, ‘Thomas Lorkyn’s Dissections, 1564/5 and 1566/7’, Transactions of the Cambridge Bibliographical Society, 9 (1988): 211. On Lorkyn’s books at his death, see Elisabeth S. Leedham-Green, Books in Cambridge Inventories (Cambridge, 1987), pp. 492–508. She describes the collection as ‘very much a gentleman’s, as well as a physician’s, library’ (p. 494). 74 Jones, ‘Medical Libraries and Medical Latin’, pp. 128–9, 133. 75 Jones, ‘Medical Libraries and Medical Latin’, pp. 121–2; J. Britten, B. Daydon Jackson and W.T. Steam, William Turner Facsimiles (London, 1965), pp. 24–5, cited in McConchie, Lexicography and Physicke, pp. 82 and 95 n. 39. 76 Rylands Parkinson Coll./1114, M1,G64,Q; the annotation is on p. 562. ‘The Gift of Unkle Slanby (Glanby? Granby?) of Badgworth in Glostershire [i.e. Badgeworth, Gloucestershire] 1702’. The difficult capital letter is more like the annotator’s S than his G. The Rylands Library in Manchester now holds the books on obstetrics and gynaecology which were formerly in the Radford Library of St Mary’s Hospital for Women and Children there; the surgeon Sir Thomas Radford was the treasurer of the first Council of the Manchester Medical Society, which I will discuss further in chapter 4.

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certain that this was passed from one physician to another, as it may have been bought as a present for a nephew entering the medical profession in some capacity. The Gynaeciorum libri were not owned only in order to understand the female body and to treat women’s diseases. The volume for which there is most evidence of ownership is another Manchester copy of the first two volumes of the 1586 edition bound in one. The extremely packed title page [Plate 2] includes the signatures of the Norwich surgeon, obstetrician and book collector John Green Crosse and of ‘C.F. Wildberg, Dr.’77 This is Christian Friedrich Ludwig Wildberg (1765–1850), who published a bibliography of works on forensic medicine in 1819. This subject meant that he referred to topics with a legal dimension, such as extrauterine pregnancy, and the uterine mole.78 For the first of these, he cited one of the works included in the Gynaeciorum libri – Rousset – but in the 1591 first edition rather than in Spach. For the second, he listed two sixteenth-century works, 16 from the seventeenth century and 22 from the eighteenth century, but did not mention any of the works included in the Gynaeciorum libri, despite – as we shall see below – the importance of the mole for many of the writers. It is possible that he did not own Spach at the time when he was compiling his bibliography, or that he felt its writers had been superseded by later medical work; his willingness to include sixteenth-century texts more generally favours the former explanation. We do not know when Wildberg acquired the book, but it will have been after 1795, the year of the death of another famous owner of this copy, whose bookplate also appears in this volume [Plate 3]. This was the polymath Johan Karl Wilhelm Moehsen (1722–95), who obtained his MD from Berlin in 1757. Moehsen’s works included a discussion of five medical manuscripts lodged in Berlin, one of them being a copy of the Arabic writer Rhazes’ work Ad Almansorem. In his discussion of the manuscripts, Moehsen did not refer to the other ancient materials collected in Spach, but did show his awareness of the contemporary histories of medicine by Daniel Le Clerc and John Freind; these will be discussed further in chapter 2.79

77

This is Rylands Parkinson Coll./1115, M1,G65,Q, which came to the collection via the Radford Library, as did another copy of the same edition, with no evidence of ownership or annotation (Parkinson Coll./1115, M1,G63,Q). 78 Christian Friedrich Ludwig Wildberg, Bibliotheca medicinae publicae, in qua scripta ad medicinam et forensem et politicam facientia ab illarum scientiarum initiis ad nostra usque tempora digesta sunt (Berlin, 1819), p. 63 (extrauterine pregnancy) and pp. 80–82 (mole). On the mole, see below, and Cathy McClive and Helen King, ‘When is a foetus not a foetus? Diagnosing false conceptions in early modern France’, forthcoming. 79 Johan Karl Wilhelm Moehsen, Dissertatio epistolica prima de manuscriptis medicis, quae inter codices Bibliothecae Regiae Berolinensis servantur (Berlin, 1746); references on p. 18 to the work of John Freind, The History of Physick: from the time of Galen, to the Beginning of the Sixteenth Century. Chiefly with regard to Practice. In a Discourse written to Doctor Mead (London, 1725) and Daniel Le Clerc, Histoire de la medecine ou l’on void l’origine & le progrès de cet art… (Amsterdam, 1723) show that Moehsen saw Freind’s work as an excellent and clear continuation of the work of Le Clerc.

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Plate 2 Title page of the copy of the 1586 edition owned by Crosse and Wildberg. Reproduced by courtesy of the University Librarian and Director, The John Rylands University Library, The University of Manchester.

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Plate 3 Bookplate of Johan Karl Wilhelm Moehsen, from the same copy of the 1586 edition. Reproduced by courtesy of the University Librarian and Director, The John Rylands University Library, The University of Manchester.

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Earlier in the eighteenth century this copy appears to have been given to a successful candidate for the MD, possibly a Johannes Siegfried, while the date ‘Ao 1596 30 Sept’ also appears on the title page. Yet, despite so much evidence of ownership, this copy bears no annotation at all. Annotation and citation are as difficult to unravel as ownership. Just because a book was cited by others did not mean that they had read it. As McConchie has argued, in the sixteenth century citation was not about acknowledging intellectual debts, but rather was used ‘to demonstrate the respectability of a particular view or assertion’.80 This means that we should not necessarily assume that the lists of authorities printed at the beginning, or in the margins, of our texts prove that the author has read them all for himself. However, some copies of the three editions also bear evidence that the owners have compared the texts with other works in their personal libraries; in these cases we can be more confident that we are able to trace the reading habits of those contemporary with the editions of the Gynaeciorum libri, with the important caveat that the absence of annotation does not mean a work was ignored, since a wealthy collector could have owned most of the works included in the compendium as separately-published volumes, and already annotated these copies. A list of books cited by Caspar Bauhin in compiling his 1614 De hermaphroditorum monstrorumque was given as part of the text; the list includes books published up to 1613.81 At this point, he was clearly using Spach’s 1597 edition of the book he himself had edited in the 1580s; some of Bauhin’s own case histories also appeared in Spach. From Spach, he used Mercuriale, Ruf, Bonacciuoli and Akakia; all works which had appeared in earlier editions of the Gynaeciorum libri.82 His list also included two works which he could have cited from Spach, but instead cited from early seventeenth-century editions: Rousset and de Mercado.83 In the twelfth century, manuscript books had been created with wide margins intended for the reader’s comments; they functioned with a model ‘adapted to slow reading, to meditative and repetitive study’.84 Incunabula follow this pattern but, by the time when the books with which I am most concerned here were published, the format had ceased to be so conducive to marginal annotation.85 Nevertheless, some sixteenth-century owners did engage very closely with their texts. For them, the 80

R.W. McConchie, Lexicography and Physicke: The Record of Sixteenth-Century English Medical Terminology (Oxford, 1997), p. 84. 81 De hermaphroditorum monstrorumque (Frankfurt: Becker, 1614), pp. 12–36 – BL 1172.b.2. 82 Unhelpfully for the modern reader, the works cited are listed in alphabetical order by first name. The references are to Mercurialis (p. 22), Ruf (p. 23), Bonacciuoli (p. 28) and Akakia (p.29). All are identified as being consulted in Spach’s edition by the addition of ‘Argent. Zetzner 1597 fol.’. 83 See p. 20: ‘Franciscus Rossetus de partu caesareo… 1601. 8.’ and p. 29: ‘Ludovicus Mercatus de morbis mulier. Francof. Planthenius 1608 fol.’. 84 Petrucci, Writers and Readers in Medieval Italy, p. 171. 85 E.g. Luigi Bonacciuoli, Enneas muliebris (Ferrara, 1505).

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situation remained very similar to that described by Armando Petrucci for twelfthcentury Italy: ‘the scholar read to write: that is, he read to compose a text of his own that was largely made up of the citations of others; he read by writing, because he continuously annotated books in the margins and between the lines; and then he wrote in practice while reading or soon after having read’.86 We have already seen something of one sixteenth-century owner, Thomas Lorkyn. How did he use his copy of the 1566 edition? He not only annotated his books, but also left valuable indications of his thinking on the flyleaves; his notes were bibliographical, comparative and expository, but always practical.87 As Jones has shown, Lorkyn read comparatively; ‘he looked at one author’s statement in the light of statements made by others’.88 He published very little of his own; however, it is worth noting here that Jones has suggested that the circulation through loan of Lorkyn’s annotated books was ‘to help others who used his books as well as himself’, making them almost like a new work.89 Another identified owner of the 1566 edition contemporary with its publication was John Glover, who probably practised medicine (although his only degree was an M.A. from Oxford in 1568), and had just under 300 books at his death in 1578; around 60% of these were medical. His copy of the Wolf 1566 Gynaeciorum libri was appraised at 12d at his death.90 Further owners from this early period can be identified elsewhere in Europe, and their level of involvement with the text of the Gynaeciorum libri varies dramatically. Simon Berchelt, a German apothecary, moved to Stockholm where, from 1564, he served King Johan III. He wrote two plague tracts in 1588–89, and the tooled white pigskin binding of his copy of the first three volumes of the 1586 Bauhin Gynaeciorum libri bears the date of 1589. These signs of engagement with academic medicine therefore all date from before his treatment of the King in his

86

Petrucci, Writers and Readers in Medieval Italy, p. 204. Peter Murray Jones, ‘Reading Medicine in Tudor Cambridge’ in Vivian Nutton and Roy Porter (eds), The History of Medical Education in Britain (Amsterdam, 1995), p. 170. 88 Jones, ‘Reading Medicine’, p. 171. 89 Lorkyn’s only publication was a short regimen for scholars, made up of extracts from the ancient authorities, including Hippocrates, Galen and Celsus. See further Jones, ‘Thomas Lorkyn’s Dissections’, p. 222; ‘Reading Medicine’, p. 169. Celsus was used as the main authority for various growths; see Mercado, 1588, vol. 4, pp. 326–7, where he takes on board the analogies between the vagina and the anus, on which see Heinrich von Staden, ‘Apud nos foediora verba: Celsus’ Reluctant Construction of the Female Body’ in G. Sabbah (ed.), Le Latin médical: la constitution d’un langage scientifique (SaintÉtienne, 1991), pp. 271–96. 90 Elisabeth S. Leedham-Green (ed.), Private Libraries in Renaissance England: A Collection and Catalogue of Tudor and Early Stuart Book-lists. Vol. 5, PLRE 113–137 (Tempe, AZ, 1998), p. 230. 87

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final illness; some people attributed the King’s death to Berchelt’s treatments.91 Berchelt’s copies bear no sign of being read, apart from one annotation in the second volume, to Jean le Bon’s Therapia puerperarum; in the chapter on remedies for pica, where he has made a brief note in the margin beside the section on those who avoid food altogether while pregnant and give birth to weak children, and on vomiting while pregnant. The focus of his interest appears to have been practical, lying with the remedy to prevent vomiting.92 In contrast, the German physician Wolfgang Waldung (1554–1621), who was working in Jena in 1581, and was Professor of Physic in Altdorf in 1611, made extensive marginal notes in his books, cross-referencing them to others in his library, using highly scholastic annotation methods and with a strongly philological approach; his annotations were far less practical than those of Lorkyn or Berchelt. His copies of the four volumes of the 1586–88 edition of the Gynaeciorum libri survive in the Herzog August Bibliothek in Wolfenbüttel and show him to have been a very careful reader. For example, he realized that the chapter heading of book 4, chapter 16 of Mercuriale, given as ‘On inflammation of the womb’, should in fact be ‘On inflation of the womb’, and crossed out the letters ‘amm’; the chapter on inflammation is in fact chapter 18.93 This was also noted in a copy with sixteenth-century binding now held at the Edinburgh University Library.94 In the marginal references to the text of Dubois, Waldung noticed that the wrong book of Aetius was cited, and corrected it; on the following page, he identified an unattributed quotation in Dubois as coming from Vergil.95 On one occasion, in the list of ways to prevent a woman from conceiving listed in Wolf’s Harmonia Gynaeciorum, he neatly crossed out a section of the text. This, the third recommendation, marked already as ‘Magicae’ in the printed margin, is a spell to be said three times over coals extinguished in the woman’s blood.96 Although he assembled references, creating trails that can be followed through those of his books that survive at Wolfenbüttel, and marked his text as he read it, Waldung was usually simply following the argument of those he read, rather than making new connections. He used the margins to number points and to bring out 91 Ove Hagelin, Rare and Important Medical Books in the Library of the Karolinska Institute: An Illustrated and Annotated Catalogue (Stockholm, 1992), p. 72. This book was donated to the Institute in the eighteenth century by Abraham Bäck, a friend of Linnaeus. 92 Le Bon, Bauhin 1586, vol. 3, p. 391. 93 Mercurialis, 1586, vol. 2, pp. 164 and 169. 94 EUL 1586–88, *G 20.48–51, p. 164. The annotator of this edition was a particularly careful one, noting a large number of errors in the text; e.g. in the first volume, p. 4, where sunt magis vitales, quam illi, qui sunt munerosi, et hoc declarare possunt plurima bruta, ut sunt vulpes, canes et lupi should read numerosi rather than munerosi. This and the other errors noted were corrected in the 1597 edition; it is possible that the reader was performing this textual comparison for himself rather than noting errors from his own knowledge of Latin. 95 Dubois, in Bauhin 1586, vol. 1, pp. 326–7. 96 Harmonia Gynaeciorum, 1586, vol. 1, p. 12.

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the subdivisions of the text, or the main themes of what he read. A good example of this appears in his copy of the 1586 Gynaeciorum libri, where he marked a passage in Mercado with the words ‘Contradictio Hippocratis’.97 This was not something he had noted for himself, but was instead a response to a discussion of DW 1.2, where Hippocrates appears to be saying that menstrual suppression lasting for more than six months is incurable.98 Waldung’s annotation may show that, like other readers of the late sixteenth and early seventeenth centuries, he was particularly interested in apparent contradictions between the ‘authorities’, but the person who noted the problem with this text was nevertheless de Mercado himself. He expressed his doubt about it (‘nor is it to be believed’, nec credendum est), and went on to argue that these are not the true words of Hippocrates, citing in support of this view Epidemics 4.38; the case of a servant who did not have menses for seven years, but nevertheless menstruated at the end of the illness described in this passage.99 This section of de Mercado illustrates his method of dealing with contradiction, by setting up Epidemics as the ‘real’ position of Hippocrates; however, in some instances he was even able to place both it and Diseases of Women on the same side.100 As I have noted, despite its extensive evidence of different owners, the copy in Manchester of the 1586 edition once owned by Crosse, Wildberg and Moehsen contains no annotations, while that owned by the Windsors is heavily annotated, with the majority of the annotations apparently dating from the seventeenth century. In the same section of Mercuriale printed wrongly as concerning ‘inflammation’ of the womb, the annotator who referred to the book as the gift of his uncle made some attempt to give English translations for the Latin plants recommended in treatment, identifying artemisium as mugwort, and pulegius as pennyroyal. This has been done by underlining the Latin words and writing the English equivalents in the margin.101 A later volume of this edition has the annotator noting the identification of sassafras with foeniculum.102 This is characteristic of the pattern of annotation from this later period, and contrasts strongly with that of Wolfgang Waldung; the focus shifts to practical use of the texts rather than the scholarly debates within them. However, an interest in sexual difference and the possible explanations for it remained strong. For example, Bonacciuoli noted that female corpses float prone, male supine, in water, and the marginal note to the effect that this is because women have more water in 97

1588, vol. 4, p. 62. Littré 8. 17; Cornarius 1546: p. 84r. 99 Loeb VII, p. 132; Cornarius 1546: p. 118v. 100 E.g. Mercado, 1588, vol. 4, pp. 265–6, where he used Ep. 2.4.5 (the turning of the mouth of the womb in the servant of Stymarges) alongside DW 2.123 and 127 on the movement of the womb to the head and liver. Mercado, unusually for this period, separated movement of the womb from suffocation of the womb. 101 Parkinson Coll./1114, M1,G64,Q, Mercuriale, Bauhin 1586, vol. 2, p. 166. 102 Vol. 4, p. 285. 98

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their venter, or belly.103 The copy owned by the physician and Galenic scholar Theodore Goulston, which was donated to the library of Merton College, Oxford by his widow three years after his death in 1632, marked this passage as of interest. Goulston also numbered the three reasons given by Bonacciuoli for why women have the womb inside, while men have their testes outside.104 In studying annotation patterns, it is striking how frequently certain topics were of interest to their readers from the sixteenth and seventeenth century; above all, the treatment of menstrual disorders, and the manifestation of sterility in the uterine mole.

Treating menstrual disorders In a marginal note to Jacques Dubois’s Galenic comments on menstruation, Wolfgang Waldung picked up Dubois’s comment, Mulier maxime sanguine abundat, ‘Woman abounds with a great quantity of blood’.105 The sixteenthcentury texts and their users, particularly up to the end of the seventeenth century, showed great interest in the menstrual function, not only because failure to menstruate was seen as a dangerous symptom, but also because menstruation was believed to be essential if conception were to take place.106 Using the classical writers, they discussed in detail the theory of why menstruation occurred, whether menstrual blood was the same as other blood, and the circumstances in which the function could be suppressed. They also listed a huge range of remedies, focused on restoring absent menstruation, but also covering excessive bleeding, bleeding that occurred gradually throughout the month, and bleeding by means of other orifices.107 The significance of menstruation in gynaecology at this time can be seen from the preface to Spach’s edition of the Gynaeciorum libri, where his listing of the diseases of women began with menstrual disorders, mentioning excessive and insufficient flow, and noting that, while normal menses ‘bless them with many good things’, deficient menses lead a woman into danger and so are to be feared.108 In the Hippocratic texts, menstruation was presented as the centre of what it is to be a woman; in the words of the writer of the Hippocratic text On Generation/On the Nature of the Child it is ‘simply a fact of her original

103

Spach 1597, p. 110. Spach 1597, p. 112. 105 Note on Bauhin 1586, vol. 1, p. 305; from Dubois, De mensibus mulierum, p. 1v. 106 In the eighteenth century, the ‘fermentation’ theory of menstruation, associated above all with van Helmont, challenged the ‘plethora’ theory taken from classical texts. See King, Disease of Virgins, pp. 71–3. 107 On ‘vicarious menstruation’ see King, Hippocrates’ Woman, pp. 14–15. 108 Spach 1597, preface: quaerite si succedant, multis commodes ipsam beant mulierem: sin minus, in pericula adducunt ut inevitabilia, ita metuenda valde. 104

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constitution’.109 The Hippocratic terminology of menstruation stressed its ideally ‘monthly’ appearance, using the words katamênia, epimênia and emmênia.110 However, the medical writers also used expressions which show how fundamental it was considered to be for mature female identity: menstrual bleeding is gynaikeia, ‘women’s things’111 and ta hôraia, ‘the ripe things’.112 By referring to it as hê physis, ‘nature’, and ta kata physin, ‘the natural things’, the writers also underlined that it is an unavoidable part of being a woman.113 They believed that, if menstruation did not occur, then the surplus blood would come out through another orifice, or continue to build up in the body, putting pressure on different organs, until disease or even death resulted: ‘if the menses do not flow, the bodies of women become sick’, making regular heavy menstrual loss a necessity.114 Menstrual bleeding should occur every month, be sufficient in quantity, flow freely and in equal amounts, and occur on the same days of the month, according to Prorrhetic 2; in the Diseases of Women treatises, too, menstrual loss is expected to be both regular and heavy.115 For Soranos, similarly, menstruation was ‘the first function’ of the womb.116 The full list of uterine functions in Galenic medicine was somewhat longer, but still focused on menstruation. Dubois’s contemporary, Giambattista da Monte (Montanus, 1498–1551), known as the ‘second Galen’, was professor of medical practice at Padua from around 1540. In the De uterinis affectibus of 1554 he used Galen’s On the causes of symptoms 3 to argue that the womb was a privileged locus of the body, where the heart, the brain, the liver, the nerves and the belly were brought into sympathy each with the other, and where animal, natural and vital faculties were all affected. He listed as the functions of the womb the power to concoct, to make blood, to distribute it, attract it, retain it and expel it.117

109

Nature of the Child 15, Littré 7.494; Iain M. Lonie, The Hippocratic Treatises ‘On Generation’, ‘On the Nature of the Child’, ‘Diseases IV’ (Berlin and New York, 1981), p. 8. 110 Aphorisms 5.39, ed. W.H.S. Jones (London and New York, 1931), Loeb IV, 168; DW 1.58, Littré 8.116; Nature of Woman 8, Littré 7.322 and 16, Littré 7.334. 111 DW 1.20, Littré 8.58; Coan Prognoses 511, Littré 5.702; Epidemics 1.19, ed. W.H.S. Jones (London and New York, 1923), Loeb I, 174. 112 Superfetation 34, Littré 8.504–6. 113 Epidemics 7.123, ed. Wesley D. Smith (Cambridge, MA, and London, 1994), Loeb VII, 414; Epidemics 6.8.32, ed. Wesley D. Smith (Cambridge, MA, and London, 1994), Loeb VII, 288–90; DW 3.230, Littré 8.444. 114 On Generation 4, Littré 7.476; Airs Waters Places 21, ed. W.H.S. Jones (London and New York, 1923), Loeb I, 124. 115 Prorrhetic 2.24, ed. Paul Potter (Cambridge, MA, and London, 1995), Loeb VIII, 270; DW 1. 6, Littré 8.30. 116 Soranos, Gynaecology 3.2 (Budé). 117 On the Causes of Symptoms, 3.11 (Kühn VII, pp. 264 ff.) translated into Latin by Thomas Linacre (1524) and Niccoló Leoniceno (1528).

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In On the causes of symptoms Galen described how disturbances in the production of any excremental substance produce three types of symptoms – those acting through reduction, perversion and lack of completion – and arise from three types of cause: when the parts of the body have difficulty in drawing in food from the liver, when channels are narrowed by diseased organs, and when blood is thickened and moves slowly because of the wrong foods. When Galen turned to menstrual suppression, he followed closely this general model. It may be due to ‘weakness of the part’; specifically, of the womb itself, which can be unduly compact or hard.118 This is particularly difficult to cure, because it can be the natural condition of the womb, making it impossible to purge it fully without the use of drugs. Another possibility is ‘narrow channels’; again, this can be something present from birth, and thus very difficult to counter, but it may be the result of adjacent parts of the body putting pressure on the channels. Finally, retention may arise from the ‘menstrual material’ itself being too thick (crassus) or sticky (glutinosus), or from the presence in it of other humours. Galen then added conditions of the whole body predisposing towards menstrual suppression. Too much exercise or a light diet meant that less blood would be produced; too much leisure or an over-abundant diet led to more. Finally, if the other parts of the body were too strong, and attracted too much blood from the liver, less would reach the womb. The Galenic model of menstrual suppression was thus highly inclusive, making it necessary for the doctor to consider not just the womb, but also every other part of the body in his attempts to explain its cause. In the section of the twelfth-century Trotula texts included in the Gynaeciorum libri, the ‘Book on the Conditions of Women’, the Galenic division of causes of menstrual suppression as due to the womb, the channels, the consistency of the menstrual material, or the way of life of the woman was included.119 Sixteenth-century medical writers held different positions on the quality of menstrual blood. Following Galen, Dubois argued that only three forms of excrement are ‘useful’: menstrual blood, female seed and male seed. This was stated in contradiction to Aristotle, who argued that menstrual blood and female seed are the same thing. Dubois linked heavy loss to health, as well as to chastity and a low level of desire: a small loss was linked to ill health.120 Failure to menstruate was only acceptable in girls, pregnant women – although even they were believed to lose some blood in the first few months of pregnancy – and women past the menopause. For Dubois, seed was the excrement of the spermatic and solid parts, and blood of the sanguine parts. Menstrual blood was the 118

On the Causes of Symptoms, 3.3 (Kühn VII, pp. 221–2). Green, The Trotula, pp. 72–3; cp. Spach 1597, p. 42. 120 Dubois, De mensibus mulierum, p. 3v. Londa Schiebinger, Nature’s Body: Gender in the Making of Modern Science (New Brunswick, NJ, 2004), pp. 90–91 usefully examines eighteenth-century writers who used the heaviness of menstrual flow not only to distinguish between women and animals, but also to rank the races, with heavy loss being seen as a sign of civilization. 119

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excrement of the liver, coming from its second concoction and not its third, which is the concoction that nourishes all parts of the body.121 However, although this meant that it was not quite the same as ‘normal’ blood, menstruation was nevertheless ‘tres-utile’, very useful, in a variety of contexts. This Galenic view represented only one possible position in the debate over the quality of the menses, and here we see clearly the problems of the inclusion in the Gynaeciorum libri of texts holding contradictory views. As late as the 1580s Albertini Bottoni, whose De morbis muliebris was first published in 1585 and was included in the 1586 Gynaeciorum libri, was arguing that the blood is bad in quantity, because if it were good it would be retained rather than expelled, and that it is also bad in quality, the evidence for this being found both in the woman – period pains – and in the man, as sex with a menstruating woman leads to ulceration of the prepuce.122 The womb was seen as being like a drain, or sewer, to which humours travel from all over the body to be evacuated; this common image was found, for example, in Trincavelli and Mercuriale who, like da Monte, appeared in the 1586 edition of the compendium.123 In contrast, da Monte had raised the status of the womb, rejecting this image. Dubois too stressed the more positive view of menstrual blood: it provides ‘matter for the bloody and fleshy parts, serving to nourish the child in its mother’s belly, and holding the woman in a state of health if it is evacuated regularly, moderately and opportunely’.124 Like da Monte, Mercuriale privileged Galen in his detailed discussion of menstruation, examining what it is, how and where it is generated, what causes it, what makes it flow out of the body, and what its quantity is, as well as its quality.125 He began with the standard authorities, using ‘it is said … it is said’ before coming to the first person, ‘I say … I find’.126 Turning specifically to the generation of the menses, Mercuriale observed that ‘I find a certain amount of disagreement in the ancient authorities’.127 This included inconsistency on the relative temperature of the male and the female: Democritus and Parmenides regarded women as intensely hot, producing hot and acrid blood, the sharpness of which caused the womb to expel it, but Aristotle and Galen refuted this view, regarding women as ‘cold’. One of the problems with raising the status of 121

Dubois, Livre de la nature et utilité des moys des femmes, p. 116 (Bauhin 1586, vol. 1, p. 304). 122 Bottoni, Bauhin 1586, vol. 2, ch. 7. 123 Trincavelli, Bauhin 1586, vol. 2, p. 256, ad uterum quasi ad cloacam. Fissell, Vernacular Bodies, p. 60 is incorrect to have Edward Jorden usher in a ‘dire’ vision of the womb in which it is ‘a kind of sink, draining the superfluities of the body in menstrual blood’ in 1603. This was by no means a new view; the womb was seen as a sewer in the work of Avicenna, born in 980 AD, and was still very much alive in the sixteenth century. 124 Dubois, Livre de la nature et utilité des moys des femmes, pp. 120–21. 125 Mercuriale, 1586, vol. 2, p. 97. 126 Mercuriale, 1586, vol. 2, pp. 97–8; uses of dicitur, dico and invenio. 127 Mercuriale, 1586, vol. 2, p. 98: De Modo Generationis Menstruorum, invenio apud Veteres nonnihil dissensionis.

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Hippocrates and making him the best guide to the diseases of women was that Diseases of Women presents women, or at least their blood, as hot, when the established view since Galen had been that they were cold.128 For Dubois, the solution to this contradiction was to use a different ‘Hippocrates’ here, that of a text already well known to medical writers before the Calvi translation of the corpus: Regimen 1, which stated that woman is in all respects colder than man.129 For Mercuriale, the support of Diseases of Women for the ‘women are hot’ side meant that it could not be by Hippocrates, but must rather be attributed to his pupil Polybus: ‘in this book he writes that women are hotter than men, which is contrary to Hippocrates’.130 By setting aside Diseases of Women here, Hippocrates, Aristotle, Galen and ‘all physicians’ can be made to agree that women’s bodies are too cold to use up all their food, so that some collects in the uterus until it irritates it – not because of any malign quality, but rather its sheer quantity – to expel the blood.131 Mercuriale went on to note that ‘Three very elegant problems come to mind’ when considering the logic of menstruation.132 Here he showed some originality, going beyond the normal questions such as ‘If menstrual blood is normal blood, why is it expelled rather than being used in the body?’ or ‘Do women conceive at the start of the period (when more blood is available) or at the end (when the womb is purged and ready)?’133 His three questions were: first, if women are expelling blood which is not of an inferior quality, and therefore could have been used for nourishment, then why do they not lose weight? Second, why is Nature not able to expel a little blood every day, which would be less of a nuisance for women than a once-a-month expulsion? The answer he gave here included the suggestion that it would be truly repulsive and foul if they did, suggesting a strong revulsion towards menstrual blood even from a physician who argued that it was not inferior in quality to normal blood. His third question was in a similar vein, asking why, if menstrual blood is the same as other blood, should it have the malign powers attributed to it by Columella, Pliny and Aristotle? Here, he cited other writers who suggested that menstrual blood was formed of two parts, a pure and useful one, and an impure one like the dregs of wine; but he rejected this to argue instead that only unhealthy menstrual blood had such qualities. As the womb is a drain, something

128 Diseases of Women, 1.1 (Littré 8.12–14), ‘the woman has hotter blood than the man’. See further King, Hippocrates’ Woman, pp. 32–3. 129 Dubois, Livre de la nature et utilité des moys des femmes, p. 118 (Bauhin 1586, vol. 1, p. 304). 130 Mercuriale, 1586, vol. 2, p. 98: cum in eo libro scribat mulieres esse calidiores viris, quod contra Hippocr. est. 131 Mercuriale, 1586, vol. 2, p. 99. 132 Mercuriale, 1586, vol. 2, p. 99: tria occurrunt pulcherrima Problemata. 133 Mercuriale, 1586, vol. 2, p. 100 used Galen to argue that both times were appropriate, because they are when the womb is open to receive the seed.

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agreed upon by all physicians, unhealthy humours may pass out through it, and mix with the (otherwise pure) menses to make them damaging.134 How did readers of the compendium react to the material on menstruation and its suppression? As I have already noted, the Lorkyn bequest includes a copy of the Wolf Gynaeciorum libri of 1566; in this collection, the only text that has been annotated is that of Dubois. For example, Lorkyn underlined Dubois’s point that virgins not yet menstruating can conceive, and that conception can occur even while the menses are flowing.135 But it is questionable whether these arguments were in any way new to Dubois and, furthermore, it is possible that Lorkyn had a personal agenda when studying this text. Peter Murray Jones has suggested that he may have been considering marrying a much younger woman (as his second wife) at the point where he made these annotations, because other works from his library contain notes suggesting an interest in choosing a wife; for example, the rear flyleaf to Cardanus, Somniorum synesiorum (Basel 1562) has his notes on this topic, including the need to check whether she is able to conceive, while the first and second flyleaves to Gualterus Bruelus, Praxis medicinae (1589) contain lists, based on the classical authorities, of 12 reasons why an old man should marry, and another 12 reasons why he should not.136 The relationship between menstruation and conception was also of considerable interest to Lorkyn. A marginal note to Nicolaus Falcutius’s Sermones Medicales, next to a textual discussion of women who have given birth to many children without ever menstruating, reads ‘mulieres aliquas nota nunquam habuisse menstrua et tamen concepisse’ – ‘note that some women have never menstruated, yet have conceived’.137 The theory behind this was that, although menstruation was normally a sign that a woman was able to conceive, conception could take place if sufficient blood was available, before it had left her body. However, there are other possibilities. On the death of his first wife Catherine, Lorkyn was left with six daughters, so his concern about possible conception in the absence of menstruation may alternatively relate to them. Ian Maclean has suggested that these references to menstrual blood may reflect the religious debates of the day; did the Virgin Mary need to menstruate before conceiving Jesus, or was she exempt from the menstrual function?138

134

Mercuriale, 1586, vol. 2, pp. 99–101: Constat apud omnes Medicos, uterum esse veluti sentinam et cloacam. 135 CUL N*.9.50; Wolf, p. 776. On Lorkyn’s library, see C.E. Sayle, ‘The Library of Thomas Lorkyn’, Annals of Medical History, 3 (1921): 310–23; Jones, ‘Reading Medicine’. 136 Peter Murray Jones, pers. comm. 14 March 2000; see Hieronymus Cardanus, Somniorum synesiorum, omnis generis insomnia explicantes, libri iiii (Basel, 1562) (prova ad generatione); Gualterus Bruelus, Praxis medicinae theorica et empirica familiarissima (Lugduno-Bat., 1589). 137 Nicolaus Falcutius, Sermones Medicales (Venice, 1491), vol. 6, tractatus 3, ch. 4, p. r 34 . 138 Ian Maclean, pers. comm.

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Because, in mature women, the absence of menstruation was so often interpreted as a disease, there was great concern as to how best to treat it. Dubois’s treatise in particular contained many remedies for menstrual suppression. For this condition, Dubois warned against using anything strong at first, because the suppression may – paradoxically – be due to insufficient blood, if it is being lost by another route. One should in any case start with gentle remedies and only move on to something stronger if these fail.139 Unduly strong remedies were said to cause fever, and ulcerate the stomach (if taken orally) or ulcerate the womb (if given as a pessary, suppository, clyster or fumigation). He considered the safest mode of administration of drugs to be by applying them to the navel, the pubic bone or the thighs. He divided the drugs available into gentle emmenagogues, then stronger ones, and finally the strongest of all; his recommendations included items with a strongly ‘red’ message: red seeds, and also ruscus (butcher’s broom), which has very bright red berries. The use of colour associations such as these continued; even in 1759 it was said that, if the blood loss after childbirth was particularly severe, then red wine rather than white should be used in the caudle, the drink shared among the mother and those attending the birth.140 As for how these remedies should be administered, Dubois recommended as the safest method for pessaries the wrapping of herbs in loosely woven linen, with a strong thread attached so they could be removed again. His preferred remedies used a variety of means to the same end. He wrote that many roots could be cooked, and then shaped into a pessary as long as six fingers, and one finger wide, also tied to a thread. The pessary could additionally be oiled with the juice of an emmenagogue herb, such as the juice of mallow seeds, before insertion, and this oiled pessary could also be sprinkled with a powder to provoke the menses; several different drugs were thus used simultaneously. Concerned that the hymen should be preserved, he warned that neither of these types of pessary should be used in virgins, and even less should the metrenchyte – a type of syringe used for injections directly into the womb – be used for them.141 Where Dubois’s medicine differed from the remedies offered by women like Diane de Poitiers may have been to some extent in the total control he exerted over his patient. In addition to drugs, he offered a complete programme of treatment. Before using any emmenagogues, he recommended bloodletting, bathing, soaking the feet in hot water, and various herbal injections to the womb, all performed eight hours before the drugs were administered.142 He advised that care should be taken 139

Bauhin 1586, vol. 1, p. 313; cp. Dubois, Livre de la nature et utilité des moys des femmes, p. 168. 140 Edmund Chapman, An Essay towards the Improvement of Midwifery, chiefly with Regard to the Operation (London, 1733), p. xxxi. 141 Bauhin 1586, vol. 1, p. 314; cp. Dubois, Livre de la nature et utilité des moys des femmes, pp. 176-8. 142 Bauhin 1586, vol. 1, p. 315; cp. Dubois, Livre de la nature et utilité des moys des femmes, pp. 178–9.

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before using any of the treatments to ensure that suppression was not due to closure of the mouth of the womb, since in such a case they could actually increase the inflammation of the womb, by drawing more blood to it.143 Remedies to release suppressed menses were not, in this case, a coded message for abortion; if pregnancy should be suspected as a possibility, Dubois recommended a special recipe which would warm and strengthen a foetus without doing it any harm, or – if the women were not pregnant – would ‘move’ the menses.144 Many copies of the Gynaeciorum libri annotated in the early seventeenth century show that its readers continued to share a strong interest in menstruation and how to treat its disorders.145 In volume 4 of the 1586–88 edition held at Manchester, it is noteworthy that the attention of the annotator(s) of Mercado lay almost entirely in the remedies; the first page to be marked is in the chapter on menstrual suppression, and after that the annotation continues.146 It is not possible to say which of the owners of a copy of the 1597 Spach edition now held at Queen’s College Oxford marked the list of herbs to cure menstrual problems in Mercuriale, specifically drawing attention to the herbs which have the power to open, but it could be either Robert Smith, who owned the copy one year after its publication, Daniel Moller who owned it in 1604, or the priest Robert Eglesfield.147

Sterility and the uterine mole Monica Green has argued that, although already ‘the medical literati … had a pronounced interest in gynecological matters’ during the period from the ninth to the eleventh century, it was through an interest in sterility that twelfth-century physicians came to be so heavily involved in gynaecology.148 What we have 143 Bauhin 1586, vol. 1, p. 316; cp. Dubois, Livre de la nature et utilité des moys des femmes, p. 184. 144 Bauhin 1586, vol. 1, p. 315; cp. Dubois, De mensibus mulierum, p. 8r and Livre de la nature et utilité des moys des femmes, p. 182. This recipe is attributed to Rhazes, who is said to have taken it from Serapion. On the need to avoid interpreting ‘removing obstructions’ as procuring an abortion, see further King, Disease of Virgins, pp. 9–10, 107. 145 For example, Goulston’s copy at Merton College, Oxford, where sections of Mercado on a wide range of menstrual conditions are flagged up or annotated in more detail. 146 Parkinson Coll./1114, M1,G64,Q, Bauhin 1586, vol. 4, Mercado. 147 Oxford: Queen’s College NN.n.344; Mercuriale, p. 263 on the herbs quae vim aperiendi habent. A similar mark appears in the treatise by Mercatus next to a section on foetal formation; see p. 1003. This volume is one donated by Theophilus Metcalfe (1690– 1757), who was a member of Hart Hall (later Hertford College); the Metcalfe donation (over 1000 volumes) made Queen’s medical collection one of the largest at Oxford, as the library had already benefited from Floyer’s collection. Metcalfe owned many gynaecological works, including Spach, and many works are annotated. 148 Green, The Trotula, pp. 16–17; ibid., Making Women’s Medicine Masculine. See also Joan Cadden, Meanings of Sex Difference in the Middle Ages: Medicine, Science, and

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already seen in the sixteenth century demonstrates that this remained an important area of practice for men treating the diseases of women. As we have seen in responses to the prolonged failure of Henri II and Catherine de’ Medici to produce an heir to the French throne, clearly at least by the sixteenth century sterility was not always considered the fault of the woman; and in seventeenth-century New England, Thomas Foster has estimated, at least one in six divorce petitions in New England was instituted by a woman claiming that her husband was sexually incapable.149 In the preface to his edition of the Gynaeciorum libri, immediately after naming the absence of menstruation as a dangerous sign, Spach went on to mention sterility, asking ‘How many times does it happen, that women either do not conceive at all, or do so without success?’150 In an unusual comment on the emotional dimension of sterility, he wrote that husbands of women who could not conceive or suffered miscarriages would find their wives ‘less pleasing, and disagreeable’.151 In his list of the benefits offered by medicine he included ‘doing away with sterility’.152 It is noteworthy that annotation of one copy of the first two parts of the 1586 Gynaeciorum libri reveals that the compendium could be used as a source for male sexual problems, recalling the argument that Aristotle’s Masterpiece was largely used by its early owners as a sex manual.153 Here, Paré’s chapter on male sterility was heavily underlined, in contrast to his chapter on female sterility, which was left untouched.154 However, a comparison of the number of pages devoted to male and female sterility in the treatises included in the editions of the Gynaeciorum libri shows that it was still more commonly considered the fault of the female partner; de la Corde wrote that there are some women who never conceive, no matter how frequently they have sexual intercourse.155 Culture (Cambridge, 1993), pp. 228–53 on the terminology of ‘sterility’ in the period from the twelfth to the fourteenth centuries. 149 Thomas A. Foster, ‘Deficient Husbands: Manhood, Sexual Incapacity, and Male Marital Sexuality in Seventeenth-century New England’, William and Mary Quarterly, 56 (1999): 727. 150 Spach 1597, preface: Quoties accidit, ut foeminae vel non, vel infoeliciter concipiant, aut etiam alias feliciter conceptum foetum retinere haud queant… 151 Spach 1597, preface: unde saepe ipsius maritis minus gratae et odiosae redduntur. 152 Spach 1597, preface: sterilitatem abolere. 153 On the Masterpiece, see Vern L. Bullough, ‘An Early American Sex Manual, or, Aristotle Who?’, Early American Literature, 7 (1972–3): 236–46; Mary E. Fissell, ‘Hairy Women and Naked Truths: Gender and the Politics of Knowledge in Aristotle’s Masterpiece,’ William and Mary Quarterly, 60 (2003): 43–74. First published in 1684, Fissell (p. 43) characterizes it as having become the ‘best-selling guide to pregnancy and childbirth in the eighteenth century’. 154 Parkinson Coll./1114, M1,G64,Q, Bauhin 1586, vol. 2, p. 453: Paré ch. 37. The chapter on female sterility is ch. 38. 155 De la Corde, De morbis mulierum, p. 294.

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Like most writers of the mid-sixteenth century, when da Monte came to identify the most important writer on gynaecology from the classical world, it was not Galen, but Hippocrates, whom he chose as the fullest authority and the most careful of all ancient doctors in addressing the problems raised by disorders of the womb. In support he cited Diseases of Women 1.62; Hippocrates recognized that disorders of the womb are difficult to treat due to inexperience and ignorance, shame and fear, both on the part of the patient and the doctor. As Spach would do forty years later, da Monte singled out failure to conceive: ‘What in this world is more miserable than sterility?’156 This question would perhaps make us expect to find a particular interest in the third volume of the Hippocratic Diseases of Women, On Barren Women, with its lists of remedies for this condition; however, although his first consilium was indeed on the topic of sterility, the content of da Monte’s gynaecology remained resolutely Galenic. However, On Barren Women was not ignored by sixteenth-century writers; for example, Mercado used it when describing the use of a magnet, while de la Corde singled out for general praise the remedies for female sterility given in the Hippocratic gynaecological treatises.157 It was in the concept of the uterine mole that the central interest in the disorders of menstruation met the miseries of sterility. The first description of the mole in medical writing, the Hippocratic Diseases of Women 1.71, opened with the question of aition, or cause: ‘Concerning the aition of the mole of pregnancy…’ Its explanation concerned the polarities of abundance and lack, strength and weakness; the mole was caused when plentiful menses received a scanty and sickly seed.158 A second Hippocratic account, which was instead focused on treatments for the condition, said of the cause only that a mole ‘develops on account of the thickness of the retained seed’ (Diseases of Women 2.178);159 no alternative manuscript giving ‘thinness’ exists, suggesting that this is indeed a different tradition, in which the male seed is not too thin, but too thick. In both cases, however, the fault lay with the male seed, not with the female contribution to generation. Soranos later removed the mole entirely from childbearing and suggested it was due to a prior inflammation of the womb, or to an ulcer.160 He classified this as a difficult condition, believed by some to be incurable. He and his fellow Methodists treated it by distinguishing the acute phase from that of remission; in the former, warming, softening, raising the swollen belly, and removing blood were necessary, while in remission the whole body should be strengthened, heat applied and rubefacients employed. This suggests that Soranos saw the condition in terms of a hot/cold polarity, which is not prominent in the

156

Giambattista da Monte, De uterinis affectibus (Venice, 1554), p. 63v. The first passage was noted by an annotator of Parkinson Coll./1114, M1,G64,Q, Bauhin 1586, vol. 4, p. 381; de la Corde, De morbis mulierum, p. 294. 158 Littré 8.148–50. 159 Littré 8.360–62. 160 Soranos, Gynaecology 3.11.3–82 (Budé). 157

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Hippocratic texts on moles, although it features in Aristotle.161 However, the association of the mole with failed pregnancy continued in ancient medicine; for example, Oribasius made that connection in his fourth-century AD medical encyclopaedia.162 In the ancient world, the mole was not only the concern of medical texts. Plutarch’s Advice to the Bride and Groom assumed in his readers general knowledge of the mole when he drew an analogy between the need for male input into generation, and the importance of controlling the female mind: No woman can make a child without the part played by a man; the shapeless, fleshy masses formed in the womb as a result of corruption are called ‘moles’. One must take precautions against such developments in women’s minds also … they conceive many 163 strange and evil schemes and feelings on their own.

Ancient medical writers were most concerned to know how a mole could be distinguished from a true pregnancy. The symptoms were thought to mimic those of the early months of pregnancy; Soranos listed suppression of the menses, swollen breasts and abdomen, upset stomach and pains in the loins.164 Later in the course of the condition, it resembled hydropsy.165 However, it could be distinguished from pregnancy because of the absence of movement felt by the ‘mother’ of this mass. In the Hippocratic Diseases of Women 1.71, instead of there being a ‘genuine foetus’ (ithagenês kuêma), the belly was described as being full, as in a pregnant woman, but nothing moves there: movement was also the first sign of difference between normal and molar pregnancy in Soranos.166 The opposition between the moving and the static was revisited later in the Hippocratic passage, with the absence of movement becoming the key to the diagnosis; a male foetus moves after three months, a female after four, ‘so when this time has passed and there is no movement, it is obviously a mole’.167 The mole was therefore placed at the far end of a continuum formed of the mobile male, the less mobile female and the entirely immobile mole. This was picked up in the etymology of mole, in Greek

161

Aristotle, GA 776a2–4. Coll. med. 22. 6. 163 Plutarch, Advice to the Bride and Groom, 48, tr. S.B. Pomeroy, Plutarch’s Advice to the Bride and Groom, and A Consolation to his Wife: English Translations, Commentary, Interpretive Essays, and Bibliography (New York and Oxford, 1999), p. 13. This text was known in the 1580s. 164 Soranos, Gynaecology 3.11.14–17 (Budé). 165 Soranos, Gynaecology 3.11.22 (Budé). 166 Soranos, Gynaecology 3.11.19–20 (Budé); Littré 8.148–50. 167 Littré 8.148–50. This distinction (with 40 days for the male to move, and 90 for the female) was also used by Aristotle, and picked up by the early Church. 162

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mylê, which is given in Soranos lying in the word for millstone, because the millstone is ‘difficult to move, and because of its weight’.168 Early modern writers shared the concern with distinguishing between a false pregnancy, and a true one. The French royal family again provides an illustration here. In 1541, the fifty-year-old Marguerite d’Angoulesme et de Navarre, sister of King François I, noted the symptoms which she believed to be indicators of her condition: for the last ten or eleven days she had suffered pain in her heart, weakness and vomiting, symptoms that she associated with the end of the third month of previous pregnancies.169 In Hippocratic terms, this was before ‘quickening’, and thus the absence of movement would not have given her the clue that this was not a normal pregnancy. Several months later she wrote to her brother of her disappointment at not having been pregnant at all, and of being unable to provide a male heir to secure the family line and fulfil her duty to the King.170 A chronicler of the history of France noted in 1542 the rumour that Marguerite had been pregnant and ready to deliver, but that in fact ‘she only gave birth to what is called a mole’.171 Despite her advanced age, the symptoms Marguerite suffered had been sufficiently similar to those she had experienced in previous pregnancies that she had hoped that she was indeed pregnant again. In the preface to his edition of the Gynaeciorum libri, Spach named the mole as the first of the conditions generated in the womb praeter naturam, ‘contrary to nature’, and returned to it on the following page, raising as one of the questions the compendium would address why it was that, in place of a true conception, ‘a formless and lifeless piece of flesh’ should sometimes develop.172 He also claimed that medicine was able to show how to tell whether a ‘true’ foetus was being carried, rather than one which was ‘false and counterfeit’; in the context of Marguerite’s apparent pregnancy, this suggests the claim that male knowledge was superior to the sensations of the woman concerned.173 The contents of the compendium supported this contention. In one of the copies of Spach held in Manchester, in the contents list the annotator has singled out a number of chapters 168

Soranos, Gynaecology 3.11.5–6 (Budé). This is also cited by Ambroise Paré, Les œuvres d’Ambroise Paré, conseiller et premier chirurgien du Roy (Paris, 1585), p. 972. 169 F. Genin (ed.), Lettres de Marguerite d’Angoulême, sœur de François I, reine de Navarre, publiées d’après les manuscrits de la Bibliothèque du Roi (Paris, 1841), p. 377, letter 150 to M. d’Izernay à Nérac, 30 December 1541: depuis dix ou douze jours, j’ay eu aultant de mal de coeur, de faiblesse et vomissment que j’eus oncques: qu’est une maladie que j’ay toujours accoustumé d’avoir sur la fin du troisième mois que je suis grosse. I owe this reference to Cathy McClive. 170 Ibid., p. 381, letter 152 Au Roy, Nérac 1542. 171 Bernard de Girard, Histoire generale des Roys de France contenant les choses memorables, advenues au Royaume de France qu’es provinces estrangeres sous la direction des François durant douze cent ans (Paris, 1629), vol. 2, bk. 33, p. 408: elle n’enfanta seulement ce que l’on appelle une mole. 172 Spach 1597, preface: … informis et inanima caro. 173 Spach 1597, preface: … et falsi ac simulati foetus verique gestationem distinguere.

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of interest; these include the discussions of the mole in de la Roche, Ruf, Mercuriale and Mercado. Akakia too discussed this condition, but although his chapter on suffocation of the womb was noted here, his discussion of the mole was not. Suffocation of the womb was the other topic of interest to this annotator, with a total of ten references in ten different contributors.174 Together, these two conditions accounted for all the underlining in the contents list, apart from a single reference to one other condition: scabies, or mange. Turning to the sections used in the main text, it was the difficulty in distinguishing between the mole and true pregnancy which most interested the annotator.175 In the copy of Spach held at the Royal College of Physicians, Edinburgh, in the text of Mercuriale the chapter on uterine mole is particularly heavily annotated, as are the cures for sterility.176 Yet another annotator of this edition, this time in the copy held at Queen’s College, Oxford, used a marginal Greek chi to draw attention to cures for the uterine mole in Mercado, while an annotator of one of the British Library copies of the early sixteenth-century Enneas Muliebris of Bonacciuoli was also interested in the discussions of the mole and its causes given there.177 Bonacciuoli himself noted that the mole was ‘very common’ in Italy.178 In the next two chapters I will turn to eighteenth-century writers, whose views on earlier medicine ranged from enthusiasm to rejection. It is interesting, however, that existing views on the mole were singled out even by those who considered that the medicine of previous generations was no longer an adequate guide to gynaecology; for example, William Douglas singled out ‘cases of the dead Child, Mola or false conception’ as the only situations in which earlier medicine had made any headway.179 On the dead child, it may be this situation Spach had in mind when he included in his list of the achievements of medicine ‘driving forward on its way a child left behind [in the womb]’.180 However, where the main interests of sixteenth- and seventeenth-century writers lay with menstruation and sterility, eighteenth-century men interested in the diseases of women focused instead on difficult childbirth as the most significant part of their practice.

174

Parkinson Coll./2320, M1,G67,F. E.g. Harmonia Gynaeciorum, p. 7. 176 RCPE 1597 Spach: O 10.7. 177 NN.n.344, p. 1016; BL G.2202, chapter 6; Wolf 1566, column 591. Wolf reordered the chapters of the original edition to begin with the signs of conception. 178 … in Italia frequentissimum. 179 William Douglas, A Letter to Dr Smelle [sic] shewing the impropriety of his Newinvented wooden forceps: as also, the absurdity of his method of Teaching and Practising Midwifery (London, 1748), p. 6. 180 Spach 1597, preface: vel partum in via restitantem propellere. 175

Chapter 2

Medical History and Obstetric Practice in William Smellie Sixteenth- and seventeenth-century writers on the diseases of women, both medical men and female midwives, regarded the field as encompassing all that women experienced, from the diseases of virgins to the processes of childbirth, including the health of very young babies. A similar range existed in the works of eighteenthcentury men-midwives, which contain much information on the reality of childbirth and women’s diseases in the early modern period, making it clear that their apparent professional focus on the final stages of labour should not be seen as exclusive. For example, they could be asked to supply birth control information to a husband and wife exhausted by a series of births of dead children; William Smellie, approached in this way in 1730, attacked the ‘ridiculous opinion [that] prevails among the vulgar, that there are certain remedies to procure barrenness, and indeed such described by many of the oldest authors’ and warned that such remedies were just a way to ‘throw away money’.1 Rather than only being asked to cure sterility, medical men at this time were also invited to bring it about. In this and the following chapter, I want to consider the status of ‘the oldest authors’ more generally in the works of men-midwives, and in particular in that of Smellie. Adrian Wilson has identified the years immediately around 1750 as a time when some practitioners were still involved only in those obstetric emergencies considered too difficult by midwives, usually ending with the delivery of a dead baby, but others were now working as the first port of call in labours that were expected to proceed normally.2 I shall discuss how, in precisely these years of what Irvine Loudon has called the ‘obstetric revolution’ when one type of man-midwife was being replaced by another,3 a debate developed about obstetric practice in which the correct use of history became a mark of the good man-midwife, and the Gynaeciorum libri found new uses. In what Wilson has called this ‘unexplained revolution’, I will argue that the revolutionary propaganda involved the use of

1

William Smellie, A Collection of Preternatural Cases and Observations in Midwifery (London, 1764), pp. 258–9. 2 Wilson, The Making of Man-midwifery, p. 168. 3 Irvine Loudon, Medical Care and the General Practitioner, 1750–1850 (Oxford, 1986), p. 88.

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ancient medicine – focused on the person of Hippocrates – and of the sixteenthcentury compendia.4 Who were these men-midwives? The regular use of the term ‘man-midwife’, from around 1720, was supposed to suggest that men could now be involved in the delivery of live babies, rather than being called in only to remove one that had died, or that could not be delivered without killing it.5 But its use in a rape case brought to the Old Bailey in 1715 shows the level of sexual innuendo and general unease originally surrounding it. On 27 April 1715, Hugh Leeson was indicted for raping Mary May earlier that month. Immediately after the rape, Leeson’s codefendant Sarah Blandford is alleged to have opened the locked door to the room in which the crime was supposed to have taken place and to have said, ‘Captain, you are a Man Midwife, I hope you have grop’d her well; Come, come, Mrs. May, the Captain’s a handsome man, and you are a pretty woman, and I hope you have got a pretty child’. One of the witnesses in Leeson’s defence claimed that it had instead been Mary May who said to Leeson, ‘Come, Captain, they say you are a Man Midwife, pray feel my Body’. Two midwives called to give evidence said they found no evidence of rape, and each side called in a surgeon, one of them claiming that Mrs May had been injured, the other that she in fact had the clap. But the witnesses to Mrs May’s character were persuasive, and Leeson was found guilty of rape, with Blandford guilty of being an accessory to the crime; both were sentenced to death.6 This is an interesting source, not only for its suggestion that a man-midwife is sexually rapacious, but also because of its hint at his role in promoting fertility; here, however, from his own seed. Making the man-midwife a respectable figure, worthy of the trust of both the women he delivered and the men who fathered their children, was the achievement of those who practised this role in the generation after Mary May’s rape by Leeson. William Smellie (1697–1763) was one of the most famous men-midwives of this period, his particular claims to fame being the description of the mechanism of normal labour, the development of the midwifery forceps, and the institution of midwifery instruction in London. He practised in Lanark from 1720 onwards, moving to London in 1739 and beginning to teach soon after his arrival there, only returning to Lanark when his health began to fail in 1758 or 1759.7 His interest in the forceps went back to the publication of information on its use by Edmund 4

Wilson, The Making of Man-midwifery, p. 3. Ibid., pp. 164–5. Terminology preceded action; the label was used sporadically from 1626 (Cody, Birthing the Nation, p. 41). Loudon, Medical Care, p. 86 dates the actual emergence of the man-midwife to 1730. 6 Proceedings of the Old Bailey, T17150427–43. 7 R.W. Johnstone, William Smellie, the Master of British Midwifery (Edinburgh and London, 1952), p. 108 dates the return to Lanark to 1759 on the evidence of Smellie’s correspondence; however, one of the two letters he uses (the ‘letter from Tartarus’, on which see chapter 3 below) must be understood as dated 1758 because its recipient, John Clephane, died in that year. 5

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Chapman in 1733, the year in which Smellie gained his first professional qualification by becoming a member of the Faculty of Physicians of Glasgow. Wilson has shown that the entry of this previously-secret information into the public domain made midwifery ‘into a sphere of contest as never before’ because, in some situations, and if called sufficiently early, a forceps-user would be able to deliver a live child, without losing the life of its mother.8 The presence of a man in the birthing-chamber was no longer necessarily a signal that a death would take place.

Smellie vs Burton: haste, error and rivalry Smellie was far from being alone in his ownership of at least one edition of the Gynaeciorum libri. Other famous eighteenth-century practitioners who owned the book include Smellie’s successor as the leading man-midwife in London, William Hunter, responsible for The Anatomy of the Gravid Uterus. Hunter possessed one volume of the 1566 edition, and the 1597 edition; these are now in the Glasgow University Library collection. Smellie, however, engaged very directly with the compendium; he opened his A Treatise on the Theory and Practice of Midwifery (1752) with a seventy-page history of the field in which he referred at some length to Israel Spach’s 1597 edition, and listed its contents. As I shall show in this chapter, he held Hippocrates in particularly high regard, here and elsewhere in his work. His rival, John Burton of York, whose own treatise An Essay Towards a Complete New System of Midwifery had been published in 1751, then savaged him in print, in A Letter to William Smellie, M.D., containing critical and practical remarks upon his Treatise on the theory and practice of midwifery …(1753).9 Burton accused Smellie not only of misunderstanding specific details of Spach’s text, but also of sloppy research; however, many scholars consider that it is Burton who was immortalized by Laurence Sterne in Tristram Shandy as ‘Dr Slop’.10 8

Edmund Chapman, An Essay towards the Improvement of Midwifery, chiefly with Regard to the Operation (London, 1733). A second edition, giving 57 cases in which the forceps had been used, came out in 1735, and a third edition in 1753. Smellie, who later owned the third edition, cited Chapman in A Treatise on the Theory and Practice of Midwifery (London, 1752), p. 250. See further Wilson, The Making of Man-midwifery, pp. 100, 108–10 and 113. 9 This short work certainly did not sink without a trace; the copy held in the British Library bears the bookplate of Simmons & Kirkby’s Circulating Library, Canterbury, founded in 1780, while another copy, now held at King’s College London, was originally owned by Guy’s Hospital Physical Society. 10 On Burton as Dr Slop, see Walter Radcliffe, ‘Dr John Burton and his Whimsical Contrivance’, Medical Bookman and Historian, 2 (1948): 354; Arthur H. Cash, ‘The Birth of Tristram Shandy: Sterne and Dr Burton’ in R.F. Brissenden (ed.), Studies in the Eighteenth Century. Papers Presented at the David Nichol Smith Memorial Seminar, Canberra 1966 (Canberra, 1968), pp. 133–54. Cash shows how far Burton’s theories and

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Specifically, Burton alleged that Smellie was using Spach alone, while claiming to be reading far more widely; apart from a few pages based on published histories of medicine by Le Clerc and Freind, ‘the whole Substance of your Extracts, which you affirm to be taken from the Originals, may be found in one single Volume in Folio, collected by Spachius’.11 One of Smellie’s many pupils, Giles Watts, then entered the fray, publishing Reflections on slow and painful labours … Interspersed with remarks on Dr. Burton’s letter to Dr. Smellie (1755), where he said that Burton was accusing Smellie ‘of Male-Practice’. He admitted that Smellie made ‘several, and some of them pretty considerable, Mistakes’ but only within the historical part of the book, and offered his opinion that Burton was being ‘too unmercifully severe on a few Faults’. Some inaccuracies, he wrote, ‘are almost entirely unavoidable in a work of that Length, and are more especially to be excused in a Man, who is not possessed of the most happy Talent of expressing himself, [as] all will allow’.12 Watts also accused Burton of ‘scandalous Plagiarism’. In the following two decades, Smellie’s historical account met different responses. Where Watts thought that the greater part of Smellie’s book was accurate, but the historical parts contained some errors, a lecture given by Thomas Young, Professor of Midwifery at Edinburgh, in 1774 proposed the opposite: that Smellie’s history of the field was ‘a very perfect account’ but his practical methods were incorrect.13 Yet in the lectures he had given in the mid-1750s, Young had

practices were the basis of Sterne’s novel. The identification of Burton and Slop is attacked as ‘reductionist’ by Donna Landry and Gerald Maclean, ‘Of Forceps, Patents, and Paternity: Tristram Shandy’, Eighteenth-Century Studies, 23 (1990) (special issue, The Politics of Difference): 527–8. They stress ‘the limits of reading a one-for-one correspondence between Slop and Burton’ (p. 536). 11 Burton, A Letter to William Smellie, M.D., containing critical and practical remarks upon his Treatise on the theory and practice of midwifery. Wherein the various gross mistakes and dangerous methods of practice mentioned and recommended by that writer, are fully demonstrated and generally corrected (London, 1753), p. 7. 12 Giles Watts, Reflections on Slow and Painful Labours, and Other Subjects in Midwifery. Together with observations on several disorders incident to pregnant women. Interspersed with remarks on Dr. Burton’s letter to Dr. Smellie, in which the merits of the cause between these two authors are, in some measure, considered (London, 1755), pp. 40– 42. According to Watts, p. ix, several parts of this piece had already been published in the Gentleman’s Magazine. ‘Male-practice’ was not intended as a pun, instead being a legitimate spelling of ‘malpractice’. On Smellie’s alleged lack of literary finesse, and his use of Tobias Smollett’s editorial assistance, see below, chapter 3. 13 Wellcome ms. 5108, p. 16. The main role of the first man to hold this post, Joseph Gibson, who became Professor in 1726, had been to train midwives; there is no evidence that he or his successor in fact did this, and the first to teach there was the third holder of the Chair, Young; see Alison Nuttall, Change and Continuity in the Training of Midwives in Nineteenth-century Edinburgh (unpublished MSc thesis, University of Edinburgh, 1997), pp. 34–5.

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been nearer to Watts, describing Smellie’s history of midwifery as ‘not very correct, and [it] was compiled by different hands’.14 I will discuss further below this claim, and others like it, that Smellie passed responsibility for the historical section to someone else. In 1760 the midwife Elizabeth Nihell, whose husband was a surgeon-apothecary, attacked Smellie in her treatise on the subject, and criticised specific parts of his historical account of midwifery; for example, she noted that the ancient Egyptians were considerably more sophisticated than his description of their ‘simplicity’ would suggest.15 It is often suggested that Burton had gone to press in 1751 with his own midwifery treatise, An Essay Towards a Complete New System of Midwifery, in order to forestall Smellie, having heard of the progress of his work when imprisoned in London from 1746–47 because of his extreme tory views.16 It may be in reaction to this haste that Smellie insisted that his own treatise was not ‘cooked up in a hurry’ but instead was the fruit of six years’ work, commencing with writing down his lectures; not only the printed syllabus of 12 lecture topics, but also some students’ manuscript notes from his course, survive, dated from 1742 onwards.17 In 1748, a pamphlet defence of Smellie against attacks from William Douglas (another Scottish man-midwife working in London) announced that Smellie ‘has been employed for some Years past, in collecting every Thing, that was curious and useful in Midwifery, from the ancient and modern Writers, in order to contribute as much as in him lies, to the Perfection of that Art’.18 ‘Collecting every Thing’ included specimens; for example, in his 1754 book, A Collection of Cases and Observations in Midwifery, he referred to ‘a Uterus now in my possession’ of a woman who died in the eighth month of pregnancy.19 In 1770, 14

Wellcome ms MSL 105, p. 16r. Elizabeth Nihell, 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 it is best to employ, in cases of pregnancy and lying-in, a man-midwife or, a midwife (London, 1760), pp. 19–20. On Nihell, who was a French Catholic, see Cody, Birthing the Nation, pp. 184–6. 16 Radcliffe, ‘Dr John Burton and his Whimsical Contrivance’, pp. 350 and, on the ‘clear traces of hurried publication’ in Burton, p. 351. On Burton’s ‘anxiety’ on hearing not only of Smellie’s forthcoming publication, but also of other obstetric works in press, see for example Cash, ‘The Birth of Tristram Shandy’, p. 135. 17 On Smellie’s gradual progress towards publication, see William Smellie, A Treatise on the Theory and Practice of Midwifery (London, 1752), p. iv; William Smellie, A Course of Lectures upon Midwifery (NLM WZ 260 S638c 1742; Wellcome ms. 4630; RCPE, notes possibly made by a Mr Hepburn in 1750). As I will discuss below, the 1750 course begins at the pelvis, without a historical introduction. See also Johnstone, William Smellie, p. 93. 18 An Answer to a Late Pamphlet Intituled A letter to Dr. Smellie; Shewing the Impropriety of his New Invented Wooden Forceps (London, 1748), pp. 17–18. 19 Smellie, A Collection of Cases and Observations in Midwifery (London, 1754), p. 19. 15

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when his collection was sold at auction, it included a range of ‘wet’ and ‘dry’ preparations such as embryos from 10 days old, monsters, and ‘The Vagina and Uterus of a Young Subject’.20 The assembly of a personal collection was normal for both eighteenth- and nineteenth-century men-midwives; John Burton, for example, noted of a foetus that miscarried after being squashed flat in the womb by its normal size, full term twin, ‘…I have the Foetus now in Spirits, amongst my Collection’, while James Young Simpson published the catalogue of his own collection of specimens, wax casts, tables, oil paintings of the gravid uterus, instruments and machinery (assembled in a mere two years) as part of his candidacy for the Edinburgh Chair of Midwifery in 1840.21 These collections served as a way of creating a genealogy of great men-midwives; so, for example, Simpson’s collection included a set of Smellie’s leather-covered forceps, which will be discussed in more detail in chapter 3.22 However, despite his extensive preparations in lecturing, writing and collecting, Smellie himself admitted that there were errors in his historical account of midwifery, and went to press with a second edition, correcting some of these, in 1752.23 In his defence of Smellie, Watts argued that Burton wrote out of envy and jealousy that Smellie’s treatise was superior to his, and annoyance that Smellie had previously made no reference to Burton’s published work.24 However, Wilson’s analysis would suggest that Smellie, Watts and Burton were very different sorts of man-midwife, writing in the watershed years. Smellie and Watts had made the transition into the management of normal births, increasingly being ‘bespoke’ – 20 A Catalogue of the Entire and Inestimable Apparatus for Lectures in Midwifry, Contrived with Consummate Judgment, and Executed with Infinite Labour, by the Late Ingenious Dr William Smellie, Deceased (London, 1770); see especially pp. 4–5. 21 Burton, Complete New System of Midwifery, pp. 307–8; RCPE SMP–PPH 44.2, Simpson, List of the Preparations, Casts, Drawings, Instruments, Obstetric Machinery, & c. contained in Dr J.Y. Simpson’s Museum and Employed by him in the illustrations of his Lectures on Midwifery (Edinburgh, 1840). 22 Simpson, List of the Preparations, p. 59. 23 H. McClintock (ed.), Smellie’s Treatise on the Theory and Practice of Midwifery (London, 1876–8), vol. 1, p. 22, is wrong to say that the second edition was ‘only a reprint’. The DNB entry for Smellie puts his Theory and Practice as 1752, while that for Burton puts it at 1751; the volume is dated 1752, published in London, by D. Wilson, but a notice of it was given in the Monthly Review for December 1751, suggesting that it came out in November or December of that year. See Johnstone, William Smellie, p. 93; Wilson, The Making of Man-midwifery, p. 124. An unpublished letter from Douglas Guthrie to Miles Phillips, Professor of Obstetrics and Gynaecology at Sheffield, held at the RCOG in Guthrie’s copy of the 1770 sale catalogue, notes that any confusion over the year of publication is illuminated by a letter from Smellie to Camper dated December 1751 ‘with which he [Smellie] sent the emendations for his second edition’. 24 Watts, Reflections on Slow and Painful Labours, p. 39. Following the established line taken by medical historians in his time, Cash, ‘The Birth of Tristram Shandy’, p. 135 judged Burton’s 1751 treatise as ‘deficient in the standards and spirit of the new science’.

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booked in advance of the event – while Burton was still involved almost exclusively with emergency calls to difficult labours.25 In this, Burton was more like the men-midwives of the previous generation, such as Edmund Chapman. Chapman, an apothecary-surgeon, had mainly an emergency practice in midwifery, but was bespoke in one of his published cases, undated but presumably from 1733– 35; he mentioned ‘A woman, who had spoken to me to attend her’.26 However, in fact she began to bleed three weeks before the baby was due, and instead of calling Chapman she summoned an apothecary; it was to this error that Chapman attributed her death. Smellie was certainly being bespoke by 1741.27 According to Watts, in 1753 Burton was exasperated with Smellie because he had lost business to those of Smellie’s pupils who lived near him. But this seems to have been emergency business, as Watts specifically mentioned Henry Bracken of Lancaster; on Bracken’s own account, his practice was much like that of Burton, and he was only bespoke four or five times in sixteen years.28 Doreen Evenden has argued that economic motives were responsible for the enthusiasm of eighteenth-century surgeons and apothecaries to enter midwifery.29 But economic rivalry also lay behind the ill-tempered debate between Burton and Smellie, with books acting as valuable publicity for their services. The facts of this debate are well-known; Arthur Cash described the Letter as an ‘unprovoked attack, sometimes supercilious, sometimes vitriolic … motivated by nothing but Burton’s consuming envy’, while Cutter and Viets’s history of midwifery criticized Burton’s ‘ostentatious display of classical learning’.30 Ornelle Fife has similarly described the Letter as ‘an extremely detailed and vitriolic review’ of Smellie’s work in 25

Wilson, The Making of Man-midwifery, pp. 165 and 168–9. Edmund Chapman, A Treatise on the Improvement of Midwifery (3rd edition, London, 1753), p. 163. 27 Smellie, A Collection of Preternatural Cases, p. 389: 1741, ‘soon after I began to teach midwifery’. Of 19 cases given in Exton, A New and General System of Midwifery, he seems to have been bespoke in only four cases, usually because a previous labour had been so bad, or in one case (probably in 1748, as Exton writes ‘About three years ago’, p. 63) where a woman in her 42nd year was having her first baby; he ‘delivered her of a fine child’ (p. 64). In 1735 he had been a witness in a murder trial and referred to ‘his Master (an Apothecary)’s Shop’, while in October 1748 he was described as an apothecary in another law case; it appears that he did not take on the role of man-midwife until soon after this. See Proceedings of the Old Bailey, T17350911–69 and Hertfordshire archives DE/B664/29214, Title deeds and papers of the Duncombe family, landowners and solicitors of Northchurch, Herts; Chesham, Bucks; and Lincolns Inn, 1534–1895. 28 Watts, Reflections on slow and painful labours, pp. 39–40 and 64–5; Henry Bracken, farrier, physician and surgeon, was author of The midwife’s companion (London, 1737). Smellie’s ‘letter from Tartarus’, to be discussed in chapter 3, puns that, in Hell, there will be no danger of Burton ‘losing patients’. 29 Evenden, The Midwives of Seventeenth-Century London, p. 176. 30 Cash, ‘The Birth of Tristram Shandy’, p. 136; I.S. Cutter and H.R. Viets, A Short History of Midwifery (Philadelphia and London, 1964), p. 29. 26

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which ‘Burton quotes extensively from Smellie’s Treatise on the Theory and Practice of Midwifery, attempting to prove Smellie wrong point by point, beginning with Smellie’s incompetent scholarship and continuing with Smellie’s ignorance of anatomy and too frequent use of instruments’.31 But what precisely was thought to constitute ‘incompetent scholarship’ in this context, and were Burton’s criticisms valid or, as Smellie’s biographers put it, ‘elaborate and laboured’ (John Glaister) and ‘almost intolerably tedious … an unbroken sequence of carping criticisms and hypercriticisms’ (R.W. Johnstone)?32 In this and the following chapter, I will investigate in detail this debate, which covered both medical history and obstetrical practice and which placed considerable weight on the proper uses of the Gynaeciorum libri collection. Comparison of Smellie’s account of the obstetrical past with the sources available to him is made possible by the survival of his personal library, almost intact and including his copy of Spach, at Lanark.

The making of a man-midwife Adrian Wilson’s study of the rise of the man-midwife emphasised changes in female culture, with elite women trying to set themselves apart from their poorer sisters by employing men, and those of lower classes then trying to emulate those of higher classes; he concluded controversially that ‘The making of man-midwifery was the work of women’.33 Irvine Loudon responded to this claim by noting that men did not simply react to a demand from women; instead, they actively sought training in this new area.34 But how did a man-midwife train for, and establish himself in, the role? Smellie was born in 1697, and attended the Grammar School in Lanark, where he would have studied English, Latin, Greek, French and mathematics.35 Like most early men-midwives, he started out as an apothecary and a surgeon, a common combination by the eighteenth century; he was apprenticed to a prominent apothecary before serving as a surgeon’s mate in the Royal Navy from 1720–21, and then set up in practice in Lanark in the dual role.36 The techniques of 31

Ornelle Fife, ‘Gender and Professionalism in Eighteenth-century Midwifery’, Women’s Writing, 11 (2004): 185–200; p. 192. 32 John Glaister, Smellie and his Contemporaries: A Contribution to the History of Midwifery in the Eighteenth Century (Glasgow, 1894), p. 166; Johnstone, William Smellie, p. 94, followed by the New DNB which regards Burton’s comments as ‘mere carping’. Cash, ‘The Birth of Tristram Shandy’, p. 134 labels the Letter simply as ‘a blunder’. 33 Wilson, The Making of Man-midwifery, p. 192. 34 Loudon, ‘Essay Review: The Making of Man-midwifery’, p. 514. 35 Joan R. Butterton, ‘The Education, Naval Service, and Early Career of William Smellie’, Bulletin of the History of Medicine, 60 (1986): 1–18. 36 Johnstone, William Smellie, pp. 7–9; Butterton, ‘The Education of William Smellie’, pp. 8–9, was able to add considerably to the information available on Smellie’s early career by using local archives and Admiralty Records. The combination of surgeon and apothecary

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a surgeon included craniotomy and turning the child in the womb to reach a better position from which to achieve delivery, but still usually of a dead baby. Turning was developed by the Leiden practitioner Hendrik van Deventer – married to a midwife – at the beginning of the eighteenth century.37 Head-first was considered normal, and feet-first (breech) was, after the work of Ambroise Paré, regarded as acceptable, while all other presentations were turned to achieve a feet-first position. From 1724 or earlier, Smellie was called in by local midwives and families to help at the final stages of difficult births.38 Having become a member of the Faculty of Physicians and Surgeons of Glasgow in 1733, he started to concentrate exclusively on midwifery in 1737.39 He moved to London in 1739, quickly becoming one of a significant group of Scottish practitioners carving a lucrative niche in the London medical world. As part of a revolution in medical education by which lectures were given privately and were open to anyone who could afford to take them, without even a testimonial, Smellie taught midwifery to large numbers of students in London from 1742 to 1757; when his M.D. was awarded by the University of Glasgow in 1745, it was London practitioners who wrote the letters in support of his candidature.40 Smellie and midwives What was the relationship between midwives and the men they summoned to help when they were unable to deliver the child? Doreen Evenden has shown how, in the seventeenth-century when midwifery licensing was in the hands of the church, vicars often provided testimonials to enable London midwives to gain a licence to practise.41 In the eighteenth century, in the provinces, surgeons and physicians

is particularly linked to Edinburgh at this period; Andrew Cunningham, ‘The Transformation of Hippocrates in Seventeenth-century Britain’, in David Cantor (ed.), Reinventing Hippocrates (Aldershot, 2002), p. 93. 37 Wilson, The Making of Man-midwifery, pp. 79–87; Evenden, The Midwives of Seventeenth-Century London, pp. 178–9. 38 Butterton, ‘The Education of William Smellie’, pp. 12–13. 39 Glaister, Smellie and his Contemporaries, p. 15; Wilson, The Making of Manmidwifery, p. 123; Butterton, ‘The Education of William Smellie’, pp. 17–18. 40 Susan C. Lawrence, Charitable Knowledge: Hospital Pupils and Practitioners in Eighteenth-century London (Cambridge, 1996), p. 163; Glaister, Smellie and his Contemporaries, pp. 66–7. 41 Evenden, The Midwives of Seventeenth-Century London, e.g. p. 33. The church courts were suspended in 1641, and it is possible that the Company of Barbers and Surgeons took over the licensing of midwives in London from this point; Adrian Wilson, ‘A Memorial of Eleanor Willughby, a Seventeenth-century Midwife’, in Lynette Hunter and Sarah Hutton (eds), Women, Science and Medicine 1500–1700: Mothers and Sisters of the Royal Society (Stroud, 1997), p. 165.

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often wrote such testimonials.42 A man-midwife like Smellie would usually have ‘his’ midwives who would stay with a woman who had booked him and call him only when the final stage of labour was beginning; for example, Smellie referred to Mrs Maddocks as ‘my midwife’, and used her to monitor laborious cases when he had to be elsewhere.43 Another midwife he used, Mrs Moore (later Mrs Simpson), had been one of his female pupils; like other eighteenth-century men-midwives, Smellie took women as well as men to train, although it is not clear whether – like his contemporaries – he took them in separate classes.44 It is noteworthy how polite and respectful Smellie was to midwives in his case histories, regarding some as ‘first-rate’ and singling out one as ‘an old practitioner, in good repute’.45 He was not alone in this, as Edmund Chapman, for example, commended one midwife as ‘a very good Midwife, one of known Judgment and Modesty’ and another as ‘a very experienced Person’.46 But other writers of the period stressed the inadequacy of midwives; for example, Henry Bracken attacked midwives who had ‘read Aristotle’s Rules’ and therefore believed that it was good for women to take coach or horseback rides in the last month of their pregnancy.47

42

David Harley, ‘Provincial Midwives in England: Lancashire and Cheshire, 1660– 1760’ in Hilary Marland (ed.), The Art of Midwifery. Early Modern Midwives in Europe (London, 1993), p. 29. 43 William Smellie, Collection of Preternatural Cases, p. 382. On Mrs Maddocks/Maddox, also mentioned by Thicknesse, Man-midwifery Analysed, p. 25, see Glaister, Smellie and his Contemporaries, p. 48. In eighteenth-century midwifery language, ‘Laborious’ is usually the term for labour lasting for more than 24 hours. 44 On Mrs Moore, see Glaister, Smellie and his Contemporaries, p. 49; Smellie, Collection of Preternatural Cases, p. 349 says in a 1749 turning case, ‘Mrs Moore, now Mrs Simpson, whom I had taught, and kept on purpose to attend all the labours with the pupils in the teaching way, was first called. She assembled about ten of the gentlemen’. Nuttall, Change and Continuity, pp. 35–6 discusses ‘Margaret Reid Midwife’ whose certificate from taking 3 courses with Young in 1768 survives, and the midwife Christian Cowper who trained in 1786 under Alexander Hamilton. Young and Hamilton are known to have taught women separately, and in the case of James Hamilton, we know that men received certificates in Latin, women in English; see Simpson, ‘James Hamilton’s ‘Lying-in’ hospital’, p. 135 and 138–9. 45 Smellie, Collection of Preternatural Cases, p. 145. 46 Chapman, A Treatise on the Improvement of Midwifery (3rd edition), pp. 170 and 209. 47 Smellie, Collection of Preternatural Cases, p. 455; contrast Bracken, The midwife’s companion, p. 113. It is interesting that Bracken mentions this book – presumably a version of Aristotle’s Complete Midwife, which includes sections on the ‘rules proper for every month’ of pregnancy – as one of those read by midwives; see Aristotle’s Complete and Experienced Midwife (London, 1749?), pp. 28–36. However, Bracken’s wording cannot be found here, the text in fact proposing that walking, horse-riding and coach trips should only be done ‘very gently’. On the recommended reading for midwives in the seventeenth century, see Helen King, ‘“As if none understood the Art that cannot understand Greek”:

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For male practitioners at this time, what constituted a good midwife? Smellie was later to describe his ideal midwife as ‘a decent, sensible woman of a middle age’ who understood the structure of the pelvis and knew how to detect foetal position by touch; in other words, one who shared the knowledge on which menmidwives based their practice.48 In 1751 Brudenell Exton wrote to teach women midwives ‘what is their proper Business, and what not’, while all were agreed that, in the words of Edmund Chapman, writing in 1753, ‘The best Midwives commonly send for Advice upon the Appearance of Danger’.49 While agreeing that one of the features of a good midwife was that she would know when to call in a male practitioner, Smellie added that ‘this confidence ought to be encouraged by the man, who, when called, instead of openly condemning her method of practice, (even though it should be erroneous) ought to make allowance for the weakness of the sex, and rectify what is amiss, without exposing her mistakes’. If this were done, then she would come to ‘consider the accoucheur as a man of honour, and a real friend’.50 Smellie’s contemporary, Elizabeth Nihell, read this passage as an example of men-midwives keeping their female pupils in a subservient position, preventing them from achieving ‘any eminence in the profession’.51 Not all men-midwives responded to the midwife’s call, however. In a case in 1746, a woman suffered a heavy loss of blood in the eighth month of her pregnancy, and the man-midwife who had been bespoke refused to come out, on the grounds that he was expecting another call. The midwife who stood in before Smellie arrived regarded the male practitioner as ‘abandoning’ the woman. Smellie commented, ‘I understood afterwards, that the above gentleman thought himself above being in friendly correspondence with midwives, from too much selfsufficiency’.52 We should therefore understand the contrast of Smellie’s studied politeness to midwives as a shrewd move on his part in order to win their confidence and to gain more cases, learned from the time when a man-midwife would rarely be pre-booked, and needed good relationships with midwives so that they would recommend his name if an emergency developed, sometimes

The Education of Midwives in Seventeenth Century England’ in The History of Medical Education in Britain (eds V. Nutton and R. Porter) (Amsterdam, 1995), pp. 192–3. 48 Smellie, A Treatise on the Theory and Practice of Midwifery, p. 448. 49 Exton, A New and General System of Midwifery, p. 11; Chapman, A Treatise on the Improvement of Midwifery (3rd edition), p. xviii. 50 Smellie, Theory and Practice of Midwifery, pp. 448–9. 51 Nihell, A Treatise on the Art of Midwifery, pp. 213–14. 52 Smellie, Collection of Preternatural Cases, pp. 141–7. From a subsequent and very similar case that came to court in 1754, Glaister, Smellie and his Contemporaries, pp. 315– 22, identified the other man-midwife here as Matthew Morley. Morley was still in practice in London in 1763: see The Universal Director (London, 1763), p. 40, which lists him as a Fellow of the Royal College of Physicians and ‘Man-midwife’.

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remembering his help from cases a few years before.53 A century earlier, in his treatise aimed at midwives working in rural areas with little assistance, Percival Willughby had noted that even ‘modest rebuke’ of a midwife’s actions could lose both ‘the good will of this midwife, and, as much as might bee, her future practice’.54 His was largely an emergency practice.55 In 1773 John Leake was still advising men-midwives to treat female midwives ‘with becoming civility’.56 Further insight into the earliest interactions between men and women at the birth scene before it was common to be bespoke comes from one of Chapman’s cases, in which he was sent for by the patient, a gentlewoman, so that the midwife already engaged could consult with him ‘or, if the Case should require it, to Deliver her myself’.57 After the midwife explained the situation to him, he proposed calling in the family physician, who prescribed drugs to stop the bleeding, after which true labour began. The midwife remained in charge and, when she reported that the foetal head had moved down, ‘She then desired I would take her Seat’ in order to confirm her view. Chapman agreed, and it was he who then turned and delivered the child.58 In Smellie’s cases, he seems to have taken control once he arrived at the birth scene, although he did not send the midwife, or midwives, away. In delivering the (dead) child in the 1746 haemorrhage case, Smellie worked with the midwife exerting pressure on the abdomen under his supervision. A similar friendly situation existed with respect to nurses; in one case, the nurse was complicit with Smellie in concealing from the patient a small perineal tear.59 The laboratory of lying-in Smellie’s relationships with midwives and nurses were therefore good ones, and there were clear advantages to him in making certain that this was the case. I would now like to consider the women whom Smellie delivered, and in particular their relationship to his teaching. Smellie himself regarded the courses he offered as the 53

E.g. Smellie, Collection of Preternatural Cases, p. 4; see also Josephine M. Lloyd, ‘The “Languid Child” and the Eighteenth-century Man-midwife’, Bulletin for the History of Medicine, 75 (2001): 648 on midwives and men working together. 54 Willughby, Observations, p. 155. On Willughby and his daughter Eleanor, who sometimes practised as a team, see Wilson, ‘A Memorial of Eleanor Willughby’. Wilson, pp. 141–2, notes that calls from the midwife alone were unusual in his practice, but I would argue that the midwife could try to veto suggestions made by the woman, her family and her friends. 55 Wilson, ‘A Memorial of Eleanor Willughby’, p. 146: usually ‘to deliver a dead child, in an obstructed birth by the head, in order to save the mother’s life’. 56 John Leake, A Lecture Introductory to the Theory and Practice of Midwifery (London, 1773), p. 34. 57 Chapman, A Treatise on the Improvement of Midwifery (3rd edition), pp. 170–72. 58 Ibid., p. 172. 59 Smellie, Collection of Preternatural Cases, p. 24.

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combination of ‘my lectures and labours’.60 The syllabus for his 12-lecture course notes that ‘The Experience of being present at a real Labour, is One Guinea’.61 As the diary of Richard Kay, to be discussed shortly, shows, pupils were not expected to stop at a single ‘real Labour’. To provide opportunities for this experience, Smellie set up a fund to pay for the care of poor women who had recently given birth, thus giving himself and his students access to their births as teaching material in what Lisa Forman Cody has memorably described as ‘the laboratory of lyingin’; contributions from the students continued to support this fund.62 Adrian Wilson has argued that, although this innovation separated the women from their traditional support network of female friends and neighbours – the ‘gossips’ – they continued to be served by female midwives, who would only summon Smellie and his pupils if the labour did not proceed normally.63 There were certainly many cases where this order of events was followed. For example, in 1746, the midwife called for Smellie to help a poor woman in labour, where the child’s head was enlarged due to dropsy; in this case, Smellie wrote, the midwife ‘allowed me to bring one of my pupils as an assistant’.64 In some cases, usually where more than one pupil was attending, the woman also needed to give her consent.65 In 1747, a midwife asked for Smellie or a senior pupil; the first pupil to arrive, Mr Potter, was unable to turn the child and sent for Mr Chapman, who in turn sent for Smellie.66 Sometimes the request for one of the Smellie entourage came direct from the woman; in 1752 a poor woman sent for Smellie’s senior pupil, Mr Prosser.67 However, a story told by Smellie illustrates that Wilson may be overstating the pupils’ lack of exposure to normal births. On first reading, it would seem to 60

NLM ms. WZ 260 S638c 1742; handwritten note by Smellie. Roger L. Emerson and Paul Wood, ‘Science and enlightenment in Glasgow, 1690–1802’ in Charles W.J. Withers and Paul Wood (eds), Science and Medicine in the Scottish Enlightenment (East Linton, 2002), p. 86 list those from the Glasgow region who were in London at the same time as Smellie. Cody, Birthing the Nation, pp. 152–97 and p. 197 argues that midwifery, neglected by English Oxbridge-educated physicians, provided a way for various outsiders – Scots, younger sons, dissenters and provincials – to make their way in the medical marketplace; Scottish men-midwives could also use the English stereotype of the Scot as ‘emotional’ in order to create a bond with their women patients. 61 Smellie, A Collection of Cases and Observations. pp. 228–44, esp. p. 231; Smellie, A Course of Lectures upon Midwifery; Wellcome ms. 4630. 62 Cody, Birthing the Nation, p. 154; see also Cody, p. 174. As Evenden points out, this was by no means the first time that the bodies of poor women had become the raw materials of the aspiring man-midwife; see The Midwives of Seventeenth-Century London, p. 187. 63 Wilson, Making of Man-midwifery, pp. 124 and 153. 64 Smellie, Collection of Preternatural Cases, p. 1. 65 Ibid., p. 24. 66 Ibid., p. 26. 67 Ibid., p. 393.

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support Wilson: a former pupil ‘Mr. W. attended a woman in labour of her first child’ and, ‘this being the first time of his being bespoke to attend by himself, he was at a loss how to manage his patient in a natural case’. He therefore acted as if this were a difficult labour, lubricating and dilating the mouth of the womb.68 In 1760 Elizabeth Nihell alleged that Smellie’s pupils generally tended to break the waters too early; this may be true, but more commonly such an allegation was directed by men-midwives at traditional midwives who were unable to distinguish spurious from true labour pains, or were trying to speed up labour.69 An anonymous practitioner in Surrey, who used the forceps when necessary, described a case in 1739 or 1740 in which the midwife tried to hasten the delivery because she had heard that he had been called to assist; she ‘made use of all the Violence possible to Deliver her before I came’. Both mother and child died, ‘the consequence of the folly, rashness and selfishness of an Impudent Woman’.70 Although he criticized this midwife and others for ‘over officiousness and ignorance & c.’, this practitioner did not condemn all midwives, however; in another case, he ‘left the rest to the midwife’ after satisfying himself that the birth was about to take place, with the head presenting.71 Complaints about practitioners trying to speed up labour were not always directed at the opposite sex; Jane Sharp had warned her fellow midwives not to give ‘any thing inwardly to hasten the Birth, unless they are sure the Birth is at hand’.72 Nor were such attempts always the result of the men, or women, in attendance trying to further their own interests; they could be made at the request of the woman or her companions, and there are frequent references in the literature to pressure being put on men-midwives to speed up the birth. For example, in one case in 1753 Smellie prescribed ‘a mixture to amuse them’ when a woman and her friends felt that a perfectly normal labour was proceeding too slowly.73 One of the pharmacopoeias of the time owned by

68

Ibid., pp. 533–4. Guillemeau, Child-Birth or, the Happy Deliverie of Women, p. 94; Nihell, A Treatise on the Art of Midwifery, pp. 51–2. 70 RCPE ms. Anon. 24, ‘Cases and Observations in Midwifery by a Practitioner in Surrey’, p. 6, case 4 and p. 22, case 14. See also Chapman, A Treatise on the Improvement of Midwifery (3rd edition), p. 136. 71 RCPE ms. Anon. 24, ‘Cases and Observations in Midwifery’, p. 100. 72 Sharp, The Midwives Book (ed. Hobby), p. 159. 73 Smellie, Collection of Preternatural Cases, p. 19. A similar case suggesting that Smellie used placebos – here, ‘some innocent medicine’ – is used by Cody, Birthing the Nation, p. 189 (Smellie, A Treatise on the Theory and Practice of Midwifery, p. 137). RCPE ms. Anon. 24, ‘Cases and Observations in Midwifery’, p. 6 suggests it was ‘the women about her’ that encouraged the midwife to speed up delivery. In their lectures in the 1770s, Osborn and Denman also considered it was acceptable to give a medicine to ‘amuse’ a patient, in this case when there was uterine haemorrhage at full term, suggesting that it was patient expectation that drove them; see Wellcome ms. 2098, ‘Sketches of the Practice of Midwifery’, p. 189. 69

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Smellie included recipes ‘to promote delivery’, and these could have been used for social as much as clinical reasons.74 In the case handled by Mr W., there was no clinical need for the measures he took. Not only did he lack experience in normal labour, but he also appears to have faced considerable input from the patient’s female attendants. He and another manmidwife who was called in were unable to decide whether the child was presenting by the shoulder or the head, and disputed the facts of the matter with ‘the females, who were numerous’.75 But Smellie obviously did not expect such ignorance in his students; he included a section on ‘natural labours’ in his first collection of case histories explicitly ‘in order to make young practitioners acquainted with the common method of acting in natural labours’. He believed that, in normal labour, ‘in most cases we shall have nothing else to do but receive the child’.76 Although Mr W. had attended Smellie’s course, Smellie tells us explicitly that he ‘had not attended the labours’ because he had assumed he would only be involved in difficult births; this strongly suggests that the one-guinea labours would often have been normal births. Mr W.’s training would therefore have been limited to the experience of delivery using a ‘machine’ made to resemble a real pelvis, as part of Lecture 5 of the course.77 In this case, it was only Smellie’s timely arrival (interestingly, sent for by the woman’s husband on the suggestion of the nurse) that saved the woman and child, which was delivered naturally – presenting head-first – on the following day. While difficult births remained very much at the heart of Smellie’s practice and teaching, the shift towards men-midwives being bespoke for a birth which could turn out to be normal meant that he needed to equip his pupils to cope with normal deliveries as well. Training men-midwives Although the sheer quantity of students taught by Smellie is staggering – at his own estimate, 900 by 1751 – he was by no means the only person in London offering midwifery courses to those willing to pay for them.78 Sir Richard

74

The New Dispensatory (London, 1753), p. 590. One of four dispensatories owned by Smellie, this was a version of John Quincy’s published pharmacopoeia of the Royal College of Physicians, London. 75 Smellie, Collection of Preternatural Cases, p. 534. 76 Smellie, A Collection of Cases and Observations in Midwifery (London, 1754), p. 233. Pp. 228–44 are devoted to natural labours, although in many cases described here, the child is nevertheless stillborn. 77 Smellie, Collection of Preternatural Cases, p. 534; Smellie, A Course of Lectures upon Midwifery; Wellcome ms. 4630. On Smellie’s ‘machines’, see chapter 3. 78 Smellie, A Treatise on the Theory and Practice of Midwifery, Preface, p. v. Nihell’s claim, A Treatise on the Art of Midwifery, p. 50, to have delivered over 900 women may be

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Manningham opened a private lying-in hospital in Jermyn Street in 1739, and taught both men and women; men were given a course manual in Latin, women one in English.79 The English one was considerably shorter: 35 pages, compared to 96 pages in the Latin version. Further information on the courses Smellie taught survives in the 1744 diary of Richard Kay, a Lancashire surgeon who trained in London at Guy’s for one year after working as an apprentice to his physician father, but at the end of this year also attended two courses of lectures with Smellie, each lasting for several weeks.80 What became the normal pattern of taking a midwifery course only at the end of one’s London training was later condemned by John Leake, who wrote in 1773 that it was better to take it earlier, alongside one’s anatomy training.81 Kay’s fellow students included surgeons, apothecaries and physicians.82 He was training as an apothecary, but stressed in his diary that he wanted to practise as ‘both Surgeon and Physician’.83 This is an interesting contemporary reflection on the value of midwifery training. Smellie himself had functioned in each of the three roles and, in his classes, all three groups came together; men’s midwifery practice was becoming a bridge between the traditionally distinct roles. Back in Scotland, Thomas Young also merged the categories, as he had started as a surgeon, was appointed to the Chair of Midwifery in 1756, and then took his M.D. at Edinburgh.84 How much training did Smellie’s students receive? The first course taken by Richard Kay lasted for seven weeks; it began on 7 May 1744 and ended with a double lecture on 22 June, and on 27 June he recorded ‘Enter’d upon a second a deliberate comparison designed to demonstrate the superiority of experience in delivery over teaching. 79 Richard Manningham, Artis Obstetricariae Compendium (London, 1740); compare An Abstract of Midwifery (London, 1744). 80 See William Brockbank and Marjorie L. Kay, ‘Extracts from the Diary of Richard Kay of Baldington, Bury, Surgeon’, Medical History, 3 (1959): 58–68 and William Brockbank and F. Kenworthy, The Diary of Richard Kay, 1716–51: of Baldingstone, near Bury, a Lancashire Doctor (Manchester, 1968). As Loudon, Medical Care, p. 100, notes, we know far less about these ordinary doctors than about the great figures such as Smellie. 81 John Leake, A Syllabus of Lectures on the Theory and Practice of Midwifery (London, 1776), p. 2. 82 Brockbank and Kenworthy, The Diary of Richard Kay, p. 83: ‘in company with Mr Stead, Mr Ellington an Apothecary in the Burrough and a young Physician belonging to St Thos.’. Douglas’s reference to a ‘parlour or shop’ (below) also shows that apothecaries too were taking these courses. 83 Lawrence, Charitable Knowledge, pp. 137 and 140, citing Brockbank and Kenworthy, The diary of Richard Kay, p. 80. 84 Simpson, ‘James Hamilton’s “Lying-in” Hospital’, p. 135. See Juanita G.L. Burnby, A Study of the English Apothecary from 1660–1760, Medical History Supplement 3 (London, 1983), p. 22, 33, 76–7 for examples of the merger of roles of apothecary, surgeon and man-midwife in this period.

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Course of Lectures upon Midwifry [sic] with Mr Smelley’.85 This course was shorter, ending on 14 July. Kay was receiving instruction in midwifery at Guy’s as well, so that on 23 June he studied the subject with Mr Sharp at the hospital, then with Smellie in the afternoon.86 William Douglas claimed that Smellie’s courses of lectures were simply not long enough, his advertisements announcing ‘an universal Lecture in Midwifery for Half a Guinea’ or four lectures for a guinea.87 Since a guinea seems to have been the lowest standard fee a man-midwife would expect at this period for delivering a baby, even this would have been a good investment, but Kay, and other students, clearly took far more instruction than the bare minimum.88 A 12lecture course normally lasted two weeks and cost two guineas plus the extra guinea charged for attending a labour.89 On 3 July Kay noted ‘I attended a Birth with Mr Smelley’ before going to his lecture, while on 13 July, following the lecture, ‘We attended a Poor Woman in Labour; Mr Smelley deliver’d her about 11 o’th’Clock that Night it being proeternatural’.90 ‘Preternatural’ was at this time the 85

Brockbank and Kenworthy, The Diary of Richard Kay, p. 85. Lawrence, Charitable Knowledge, appendix 1 and p. 189 identifies this as the surgeon Samuel Sharp; without Kay’s diary, we would not have known that Sharp taught at Guy’s. 87 William Douglas, A Letter to Dr Smelle [sic] shewing the impropriety of his Newinvented wooden forceps: as also, the absurdity of his method of Teaching and Practising Midwifery (London, 1748), pp. 14–15; Wilson, The Making of Man-midwifery, p. 124. See below, n.89, for different versions of the price structure. 88 On the man-midwife’s fees in the mid-eighteenth century, see Harley, ‘Provincial Midwives’, p. 39. 89 On the 2-week norm, see P.H. Nankivell, ‘Certificate of Attendance at William Smellie’s Lectures, 1757’, Medical History, 1 (1957): 279. This price structure does not match that given by McClintock, Smellie’s Treatise, vol.1, p. 13, which puts one course at 3 guineas, plus 5–10 shillings for each labour attended, with two courses at 5 guineas, four courses (or two months’ attendance) at 9 guineas, and so on up to 20 guineas for a full year. In 1767, John Leake was charging three guineas for one course of lectures, and two for each subsequent course; Leake also had his ‘Ten Guinea pupils’ who were given access to all cases at his hospital. See John Leake, A Course of Lectures on the Theory and Practice of Midwifery (London, 1767). Both Leake and Smellie also took female pupils. So did Thomas Young, for his lectures in Edinburgh given from 1756; he charged 3 guineas for the first course, 2½ guineas for the second course, which was the one that actually taught pupils how to manage deliveries. See Lisa Rosner, Medical Education in the Age of Improvement. Edinburgh Students and Apprentices 1760–1826 (Edinburgh, 1991), p. 55. By the start of the nineteenth century, prices had risen, but the discount system was even more complicated; Henry Gore Clough, A Syllabus of a Course of Lectures on the Theory and Practice of Midwifery (London, 1808), p. iii, offered the first and second courses for 3 guineas each, and the third for 2 guineas, but booking two courses at once only cost 5 guineas, or three at once cost 7 guineas. His category of ‘perpetual’ subscribers were also entitled to ‘a double Share of Labours’. 90 Brockbank and Kenworthy, The Diary of Richard Kay, p. 85. 86

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term for births in which the child did not present by the head or the feet, and it was in such cases that – if turning the child to the feet-first position failed – the forceps would be employed. After the second course had ended, Kay continued to be summoned by Smellie to attend the labours of his ‘Poor Women’; it is not clear whether Kay was still asked to pay for the privilege.91 The relationship with his pupils was expected to continue after they had completed their courses; they were asked to let him know of any interesting cases they dealt with, and sent him specimens to inspect, even calling him to difficult cases if they were in his neighbourhood.92 Offering courses to anyone who was willing to pay for them made this a very different, and far more practice-based, mode of medical education than a classically based Oxbridge degree.93 Later in the century, students would take courses with more than one instructor on this basis, and many copies survive of the notes they took from the lectures. Before beginning his notes from the 1777 lectures of William Osborn (1736–1808), Francis Kingston made it clear that students were expected to take each course more than once; he wrote These are the Heads of each Lecture, and not Verbatim, tho’ nearly so; for it was not all taken down at one Course, but from several Courses revised and put in proper Order, and made as Plain, and Legible, as my time would permit: my not understanding 94 shorthand was a great Disadvantage but … I wrote very fast.

Many other students used shorthand and then wrote up their notes, sometimes in pencil afterwards reinforced by ink. In 1774 Thomas Young, who had been appointed to the Edinburgh Chair of Midwifery in 1756 and was the first in that university to offer a course of obstetrical lectures, explicitly recommended to his students that they should take ‘more than one course, as they in the first can scarce retain what they saw or heard’; he recommended leaving any study of Smellie’s Treatise until the second course, when it would make more sense.95 In the same course, Young showed that Spach was still considered worth mentioning in recommending reading for students, although the wording suggests that the status 91

Ibid., The Diary of Richard Kay, p. 87; ‘Mr Smelley sent for me to attend a Poor Woman in Labour, about 4 in the Afternoon she was deliver’d of a Boy’. 92 Smellie, Collection of Preternatural Cases, pp. 42, 49 (a foetus sent for Smellie’s inspection), 469 (a pupil calls for Smellie to help in 1751). 93 Cody, Birthing the Nation, p. 162. 94 Wellcome ms. 2099, no page numbers. Rosner, Medical Education in the Age of Improvement, p. 60 discusses the practice of making a fair copy of the notes. 95 Wellcome ms. 5108, ‘Lectures in Midwifery delivered in the University of Edinburgh, anno MDCCLXXIV by Mr Young, M.D. Prof’, pp. 1–2; also in RCPE ‘Notes on Midwifery’, Young, T. 8, pp. 11–12. On Young see Hoolihan, ‘Thomas Young, M.D. (1726?–1783)’. Based on his whereabouts in the late 1740s, Hoolihan (p. 331) speculates that Young had been a pupil of Smellie; this is quite likely, as Young also praised Smellie’s midwifery teaching and his use of real labours (Wellcome ms. MSL 105, p. 4v).

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of the Spach Gynaeciorum as a compilation was not fully understood, either by the lecturer or by his student: ‘One Spachius should be mentioned before Parry [i.e. Paré] as he wrote on all the diseases of women and gave directions in delivery and an account of all former authors, before him was one Wolphius who wrote on the same subject at the desire of Gesner Spachius being later is preferable’.96 Of what practical value were the courses taken by men-midwives? In one of his 1748 attacks on Smellie, William Douglas argued that, despite being framed, glazed and hung up proudly ‘in the Parlour or Shop’, the certificate awarded from the courses was no guarantee of competence, many holding it being ‘no more capable of performing a difficult labour, than I am able to carry St. Paul’s Church on my Back’.97 In most cases, this is clearly wrong; Smellie’s students were wellequipped for practice. A Mr Pearson, who took two of Smellie’s courses in 1742/3, ended his notes from the lectures with a ‘Memorandum when you are sent for before you proceed’ that included a list of drugs to take to the labour and an inventory of equipment, such as the forceps and crotchet. In a reminder of the lingering fear that the arrival of the man-midwife must automatically mean the death of the child, or mother, or both, in 1742 Smellie advised the students taking his course: ‘Important: send into the Room to acquaint the Patient with your coming in lest she be too much surprised’.98 Richard Kay was putting what he had learned into practice a year after his instruction from Smellie. On 22 June 1745 he ‘was sent for in haste to deliver a Woman in Rosendale’ but, as was often the case with emergency practice, he was too late: ‘I found a weak Mother, and a dead Child’.99 In October 1746 he successfully delivered twin girls, and two months later delivered a woman ‘in hard Labour and dangerous Circumstances’.100 His practice remained an emergency one, however, so in most cases the children he delivered were already dead.101

Looking to the past Many lectures on midwifery given in the eighteenth century began with a history of the field; the surviving student notes from a course given by Smellie in 1745 show that his lectures were no exception. However, the notes taken by a Mr 96 Wellcome ms. 5108, p. 8. Hoolihan, ‘Thomas Young’, pp. 335–6 notes from the many surviving copies of students’ lecture notes how ‘frequently revised’ Young’s courses were, up to the early 1770s when they ‘took on a more or less permanent form’. 97 William Douglas, A Second Letter to Dr. Smelle [sic], and an answer to his pupil, confirming the impropriety of his wooden forceps; as also of his method of teaching and practising midwifery (London, 1748), p. 20; Douglas, A Letter to Dr Smelle, p. 16. 98 NLM ms. WZ 260 S638c 1742. 99 Brockbank and Kenworthy, The Diary of Richard Kay, p. 97. 100 Ibid., pp. 114 and 116. 101 E.g. ibid., pp. 131 and 134.

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Hepburn from Smellie’s lectures given in around 1750 began instead with the structure of the pelvis.102 If this was not simply because Hepburn joined the course late, or did not regard this topic as relevant, then the omission could be taken to suggest that Smellie was no longer interested in the history of the subject, and therefore to support claims that the historical part of the 1752 book was written by a collaborator. Rather than making this assumption, I would like to investigate attitudes to the history of medicine in Smellie and his contemporaries, in order to understand the historical introduction to the treatise in the context of what we know of Smellie’s ownership and reading of classical medical works. Smellie’s construction of the past formed the introductory section of his magnum opus, which went into many editions, and was still being reprinted in the 1870s. The theoretical part, the Treatise on the Theory and Practice of Midwifery dated 1752, was published at the end of 1751, followed by a second edition, also dated 1752. A Set of Anatomical Tables, with Explanations was issued in 1754 and the two collections of case histories in 1754 and 1764.103 In the preface to the first volume, he explained that he had originally intended to include the case histories as he went along, following the model set by one of his heroes, la Motte, but then decided that this would interrupt the narrative; instead, he decided to follow the method of his other hero, Mauriceau, putting them into a separate volume to be published later.104 The inclusion of case histories may suggest the predominance of direct personal experience, but this is a little misleading; Smellie notes that the cases will be ‘partly culled from the most approved authors, but chiefly collected from my own practice, and that of my correspondents and former pupils, by whom

102

RCPE Smellie 1, p. 1. A second edition of the 1754 volume was published in 1758, and a second edition of the 1764 volume in 1766. Smellie’s own annotated copy of the first edition of the Anatomical Tables is held at the Lindsay Institute in Lanark. 104 William Smellie, A Treatise on the Theory and Practice of Midwifery (London, 1752), pp. iii–iv. Smellie’s practice contrasts with that of John Burton, An Essay Towards a Complete New System of Midwifery (London, 1751), where the case histories were included in the main text. See Glaister, Smellie and his Contemporaries, p. 130 and, on Smellie’s esteem for la Motte and Mauriceau, pp. 142 and 148. Thicknesse, Man-midwifery Analysed, p. 3 attacked Smellie specifically for his allegiance to these French writers. On the rivalry between French and English men-midwives, the English accusing the French of indecency, and the French accusing the English of excessive prudery, see Radcliffe, ‘Dr John Burton and his Whimsical Contrivance’, p. 355; Nihell, despite having trained for two years at the Hôtel Dieu, attacked ‘The native inconstancy and levity of the French nation’ in A Treatise on the Art of Midwifery, p. 3. The French continued to be a target of midwifery writers in the nineteenth century, who mixed a respect for French developments with a belief that they were more ‘reckless’ and ‘cruel’ in their approach to instruments; see for example William Tyler Smith, ‘Introductory Lecture to a Course of Lectures on Obstetricy’, Lancet, 50: October 9, p. 372. 103

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I have been consulted’.105 For example, in the third volume, within a few pages he gave cases from Mauriceau, Dr George Macaulay, the surgeon Mr Pinkstan, and an article in Medical Essays of Edinburgh from the surgeon Mr James Jamieson, as well as quoting from a letter received from Mr Lucas of Pontefract.106 As in the sixteenth century, case histories were often copied from others. Smellie omitted the names when recounting unsuccessful cases, but included the information as what he called ‘beacons’ warning of what may happen.107 It was in the introduction to the first volume, his Treatise on the Theory and Practice of Midwifery, that Smellie set out his 70-page version of the history of midwifery from ancient Egypt onwards.108 His approach to the ancient writers appears simple: ‘we find among the ancients several valuable jewels, buried under the rubbish of ignorance and superstition’.109 In fact, as we shall see, the amount of detail he gave from ancient texts suggests that he regarded ‘the ancients’ even more favourably than this summary suggests. Elsewhere he gave his views on superstition, passing on women’s belief in the magical properties of the caul; it was widely believed that being born with the caul meant you could not be drowned, nor your house set on fire, while it would be possible to tell if a child was ill by the moistness or dryness of their caul.110 Such beliefs survived into the 1840s, with cauls advertised for sale by midwives.111 But Smellie said that he never revealed to women whether or not this membrane was present on a newborn, ‘that they may not have an opportunity of indulging an idle superstition’.112 For Smellie, superstition was thus gendered female, and I would argue that the ‘jewels’ were correspondingly ‘male’. His motive for beginning with the history of his field was that he wanted to make the information available to ‘those who have not time or opportunity to peruse the books from which it is collected’, thus suggesting that such material is difficult to find, and time-consuming to read.113 He announced at the beginning of 105

Smellie, Theory and Practice of Midwifery, p. iv; Glaister, Smellie and his Contemporaries, pp. 286–7. 106 1764 Mauriceau (p. 504), Macaulay (p. 511), Pinkstan (p. 515), Medical Essays of Edinburgh (p. 514), Lucas (p. 516). The index to vol. 3 of McClintock, Smellie’s Treatise lists those practitioners Smellie named. 107 William Smellie, A Collection of Cases and Observations in Midwifery (London, 1754), p. vii. 108 Radcliffe, ‘Dr John Burton and his Whimsical Contrivance’, p. 353 suggests that the whole of this historical survey is by one of Smellie’s pupils: I see no evidence for this. 109 Smellie, Theory and Practice of Midwifery, p. lxii. 110 John Coakley Lettsom, History of the Origin of Medicine: an Oration to the Medical Society of London, January 19, 1778 (London, 1778), note to p. 48. Jane Sharp had written in 1671 ‘I know no wonders this Caule will work’; see The Midwives Book, p. 164. 111 Smith, ‘Introductory lecture’, p. 371. 112 William Smellie, A Collection of Cases and Observations in Midwifery (London, 1754), pp. 235, 238–9. 113 Smellie, Theory and Practice of Midwifery, p. ii.

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his history that he was ‘referring the curious to Le Clerc’s History of Physic’,114 but this was also a disputed source in this period. First published in French in 1696, the first part being translated into English by Andrew Baden (1666–99) and James Drake (1667–1707) in 1699, Daniel Le Clerc’s work was more an account of medicine in history than a history of medicine.115 It summarized in considerable detail the medical writings of authors up to, and including, Galen. In a new edition, published in 1723, Le Clerc included a 56-page outline taking his history from the second to the seventeenth century.116 In 1725–26 the physician John Freind (1675–1728) published his own history of the period covered by this outline, The History of Physick: from the time of Galen, to the Beginning of the Sixteenth Century, followed by a French translation in 1727, and a Latin translation in 1735.117 This treatise was also mentioned by Smellie, who had the works of both Le Clerc and Freind in his personal library.118 Freind, whose previous publications had included editions of both Greek and Latin texts and who had been the Oxford Reader in Chemistry before becoming a physician, was a strong supporter of Newtonian medicine; he regarded Hippocrates as a Newtonian.119 A tory, believing in tradition and in the hereditary rights of the monarchy, he disguised some of his more radical works – in particular, his views on the treatment of fevers – as editions of Hippocratic texts.120 As Julian Martin has convincingly shown, his history of medicine is as much a political as a historical document; deference to Hippocrates and Galen was used as shorthand for

114

Ibid., p. iii. Daniel Le Clerc, Histoire de la medecine ou l’on voit l’origine et le progrès de cet art (Geneva, 1696) and The History of Physick (London, 1699). 116 Daniel Le Clerc, Histoire de la medecine ou l’on voit l'origine & le progrès de cet art ... (The Hague, 1729), pp. 765 ff. The title page announced that the work went up to the seventeenth century but, as John Freind, The History of Physick: from the time of Galen, to the Beginning of the Sixteenth Century. Chiefly with regard to Practice. In a Discourse written to Doctor Mead, 2nd edition (corrected) (London, 1725), p. 2 rightly noted, it in fact ended with the sixteenth century. 117 In French, Histoire de la médecine depuis Galien, jusqu’au comencement du seizième siècle. Ou l’on voit les progrês de cet art de siècle en siècle, par raport principalement à la pratique ... Ècrite en forme de discours adressé au Docteur Mead (Leiden, 1727); Latin, Johannis Freind medicinae doctoris, Historia medicinae a Galeni tempore usque ad initium saeculi decimi sexti: in qua ea praecipue notantur quae ad praxin pertinent (Venice, 1735). On Freind’s life, see R.J.J. Martin, ‘Explaining John Freind’s History of Physick’, Studies in the History and Philosophy of Science, 19 (1999): 399–418. 118 References to Freind in Smellie, Theory and Practice of Midwifery, pp. xxi, xxxviii, xl; Haldane P. Tait and Archibald T. Wallace, ‘Dr William Smellie and his Library at Lanark, Scotland’, Bulletin of the History of Medicine, 26 (1952): 416, 417. 119 Martin, ‘Explaining John Freind’s History of Physick’, p. 406; Cunningham, ‘The Transformation of Hippocrates’, pp. 104–6. 120 New DNB. 115

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deference to the traditions of British political life.121 He became an MP in 1722, but was arrested in the following year because of his involvement in the Atterbury plot to restore the Stuart monarchy.122 Richard Mead (1673–1756), a physician and book collector, took along a copy of the 1696 first edition of Le Clerc when visiting the imprisoned Freind, and Freind began to write his history of medicine while in prison, being released on bail at the end of June 1723.123 He started the book with a letter dated May 10, 1723, describing his eagerness while in prison to see the new edition of Le Clerc, because he had so admired the parts previously published. But he attacked Le Clerc’s new plan for the centuries after Galen as generally ‘inaccurate and erroneous’ while, as a Newtonian, he found inappropriate the large amount of space given to the ‘obscure jargon and nonsense’ of Paracelsus.124 The worst error identified, still being noted by Smellie in 1752, was to place Diocles of Carystus at 500 AD rather than 300 BC; even Le Clerc’s defenders had to admit that this was a very serious mistake.125 Le Clerc was also criticised for the dating of Oribasius, Aetius, Alexander of Tralles and Paul of Aegina, to which he replied that this error was due to following the early seventeenth-century writer René Moreau.126 Where Moreau and Le Clerc dated Paul to the end of the fourth century BC, Freind corrected this to the seventh century.127 Le Clerc was defended in more general terms by John Baillie, who pointed out that it was unfair to criticise what was presented very clearly as a plan, rather than ‘a finished compleat work’.128 121

Martin, ‘Explaining John Freind’s History of Physick’, p. 412. Ibid., pp. 410–11. 123 New DNB. A reference to his imprisonment appears in Freind, History of Physick, p. 3: ‘but as I have not the opportunity of having much recourse to Books, tho’ indeed at present I have leisure enough …’ 124 Daniel Le Clerc, An Answer to what Dr Freind has written in his history of Physick concerning several mistakes which he pretends to have found in a short work of Dr Le Clerc’s intituled an Essay of a Plan, &c. Translated from the 8th article of Bibliothèque Ancienne et Moderne, vol. 27, part 2, by Mr Le Clerc, to which is added a preface by W. Cockburn (London, 1728), p. v; Freind, The History of Physick, pp. 1–2. 125 Smellie, Theory and Practice of Midwifery, p. viii; Freind, The History of Physick, p. 8; John Baillie, A Letter to Dr. - - - - - - - in Answer to a Tract in the Bibliotheque Ancienne et Moderne, relating to some passages in Dr Freind’s History of Physick (London, 1727), pp. 14–15; Le Clerc, An Answer to what Dr Freind has written, pp. 11–12. 126 John Baillie was particularly scathing about this excuse in A Letter to Dr. - - - - - - in Answer to a Tract in the Bibliotheque Ancienne et Moderne, relating to some passages in Dr Freind’s History of Physick (London, 1727), p. 11; Le Clerc, An Answer to what Dr Freind has written, p. 12. In Moreau’s De missione sanguine in pleuritide (Paris, 1622), pp. 9–10 he gave the following dates: Oribasius fl. c. 330; Aetius fl. c. 350, Alexander of Tralles fl. c. 360 and Paul of Aegina fl. c. 380. 127 Smellie, Theory and Practice of Midwifery, p. xxxviii. 128 John Baillie, A Letter to Dr. - - - - - - - in Answer to a Tract in the Bibliotheque Ancienne et Moderne, relating to some passages in Dr Friend’s History of Physick (London, 122

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The dispute between Freind and Le Clerc not only operated at the level of chronological detail, but also formed part of an ongoing debate about the merits of the medicine of the past. Some early modern physicians considered that diseases had changed so much that the remedies of the ancients would no longer work.129 This contrasted with a sixteenth-century approach, by which Galen and his remedies were right, and any situations in which he appeared to be wrong were explained by saying that human bodies had changed so much that the wisdom of the ancients was less effective on them. Some physicians considered that remedies effective in one country or climate would not work in others; this would mean that Greco-Roman medicine was inappropriate in northern Europe. However, other writers believed that ancient observations and remedies were still valid. John Burton strongly denied that ancient medicine would not work outside the Mediterranean, writing that it was wrong to ignore the Hippocratic Epidemics treatises on the grounds that they were ‘made in another Climate’.130 Writing in 1747 on the ‘agreement betwixt ancient and modern physicians’, John Barker also argued that climate made no difference; our fevers are the same as those of the ancients, and the same drugs will be effective on them.131 Smellie owned this book, and occasional corrections made in his hand show that he had read this section. Many writers of the mid-eighteenth century, stimulated by the attempts of both Le Clerc and Freind to provide narrative histories of medicine, had a strong awareness of the medical past and believed in the steady progress of the profession, to which their own discoveries were contributing. To use Andrew Cunningham’s term, they were ‘improving Hippocratics’, remaining committed to the past while regarding it as having room for improvement.132 Freind, in particular, insisted that medical progress did not end with Galen; instead, medicine went on ‘making a progress ’till the year 600’.133 Indeed, he regarded everything up to the sixteenth century as forming ‘a single learned tradition of accumulated knowledge about

1727), p. 8. Later in the century, Lettsom, History of the Origin of Medicine, pp. vii–viii described Le Clerc’s work as ‘the most learned history of medicine … excellent work’. 129 Cunningham, ‘The Transformation of Hippocrates’, p. 92; see also pp. 97–8 on Marchamont Nedham (1620–78), whose criticism of Hippocrates was particularly outspoken. 130 John Burton, A Treatise on the Non-Naturals. In which the great influence they have on human bodies is set forth, and mechanically accounted for. To which is subjoin’d, a short essay on the chin-cough: with a new method of treating that ... distemper (York, 1738), p. 96. 131 John Barker, An Essay on the Agreement betwixt Ancient and Modern Physicians: or a Comparison between the Practice of Hippocrates, Galen, Sydenham, and Boerhaave (London, 1747), pp. 37–9. 132 Cunningham, ‘The Transformation of Hippocrates’, p. 101. 133 Freind, The History of Physick, p. 295–6; Martin, ‘Explaining John Freind’s History of Physick’, pp. 413–14.

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practice’.134 There was also more support in the eighteenth century for Hippocrates, rather than Galen. This derived from a wider enthusiasm for Hippocrates initiated by the 1525 publication of the Hippocratic corpus in Latin, but was further deepened by a late-seventeenth-century shift towards observation, so that by around 1740 many writers were praising the empirical and practical approach of Hippocrates over the more theoretical approach of Galen.135 However, it is important to underline the point that looking to Hippocrates was in no sense incompatible with a belief in medical progress.136 What of men-midwives? A range of attitudes to the classical past and to medical progress can be found in their work. Henry Bracken, for example, writing from a perspective according to which the body is a hydraulic machine, stated in the dedication of his book that ‘it is ridiculously stupid, and equally absurd’ to say ‘that the Ancients cured as many Diseases as we’.137 Giles Watts’ account of the past gives a strong sense of one writer building on the hints of another in the previous generation, so that Watts, too, is ‘induced to contribute my poor Mite to the publick scientifick Fund of the Ars Medendi’.138 When these writers turned specifically to midwifery, some felt that their field was lacking in ancient founding figures. Giles Watts reflected that, despite massive improvements in the previous century, ‘the Obstetretick [sic] Art’ was ‘not yet at the utmost Perfection it is capable of admitting’.139 William Douglas (b.1710/11) practised as a man-midwife in London from 1739 onwards, and as a whig was employed as physician-in-ordinary to Frederick, prince of Wales, from 1746. After the publication of Smellie’s historical account of the profession, Douglas wrote two pamphlets, sold at 6d each, ridiculing Smellie and his pupils, whom he calls ‘mistaken young Gentlemen’; the second is a response to a defence of Smellie by 134

Martin, ‘Explaining John Freind’s History of Physick’, p. 414; see also Francis Clifton, The State of Physick, Ancient and Modern, briefly consider’d: with a plan for the improvement of it (London, 1732), where the title-page cites Freind as writing that ‘A thousand writers, perhaps, for a thousand years, have been improving this Art and Profession’. 135 Helen King, ‘The Power of Paternity: The Father of Medicine meets the Prince of Physicians’ in David Cantor (ed.), Reinventing Hippocrates (Aldershot, 2002), pp. 28–9; Wesley D. Smith, The Hippocratic Tradition (Ithaca, 1979), p. 21; 2002 revised edition available online at (accessed 19 August 2005); Andrea Rusnock, ‘Hippocrates, Bacon, and Medical Meteorology at the Royal Society, 1700–1750’ in David Cantor (ed.), Reinventing Hippocrates (Aldershot, 2002), p. 137. 136 Thomas Rütten, ‘Hippocrates and the Construction of “Progress” in Sixteenth- and Seventeenth-century Medicine’ in David Cantor (ed.), Reinventing Hippocrates (Aldershot, 2002), pp. 37–58. 137 Bracken, The Midwife’s Companion, dedication. On his hydraulic theories, W.C., ‘Some account of Henry Bracken’, pp. 178–9. 138 I.e. ‘the ‘healing art’; Watts, Reflections on Slow and Painful Labours, p. iv. 139 Ibid., p. iii.

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one of these pupils.140 Douglas’s views on the past are characteristic of writers on midwifery; while ancient medicine in general is still laudable, he believed that midwifery is the one area neglected by the ancients. ‘The Ancients, to whom we owe almost our All, for Reasons best known to themselves, quite neglected giving any Assistance to the Suffering Fair, but in cases of the dead Child, Mola or false conception’.141 They invented ‘a Parcel of lumbering Instruments’, used together with ‘an ill-concerted Farago of stimulating and forcing medicines’, but these were of very little use.142 In chapter 3, we shall investigate what he meant by tracing instruments back to ‘the Ancients’, and examine who counted as an ‘Ancient’ in this context. In similar vein, although the lectures of Thomas Young started with a historical introduction to the subject, the first of the four stages of history he identified was the ‘ignorance of the ancients’, and he regarded midwifery as a ‘very modern’ science, only beginning in the mid-seventeenth century. In particular, he stated, Hippocrates ‘understood nothing in the practice of midwifery: he gives no description of the parts of generation and from his book De Superfoetatione, it appears that he never saw a human uterus’.143 As reasons to challenge Hippocratic midwifery, Young singled out the belief in a mobile womb and the use of scent therapy. Comparing the hopelessness of Hippocrates on midwifery with the excellence of his work on diseases, ‘you would scarcely believe that it was the same person’.144 Elizabeth Nihell echoed this by stating that Hippocrates ‘understood so much of physic, and so little of midwifery’.145 For Young, the solution, was simple: in diseases, Hippocrates wrote from his own experience, but in midwifery he must have relied on what ‘ignorant women

140

Douglas, A Letter to Dr Smelle, p. 11. The full text of this is also given in Glaister, Smellie and his Contemporaries, pp. 74–84. 141 Douglas, A Letter to Dr Smelle, p. 6. On the mola, or mole, see above, chapter 1. 142 Ibid., p. 7. 143 Hoolihan, ‘Thomas Young’, p. 339; Wellc. ms. MSL 105, ‘Lectures on Midwifery’, pp. 6v–7v; ms. 5108, p. 2. Clough, A Syllabus of a Course of Lectures, p. iv also outlined ‘four remarkable periods in the history of the Science’, suggesting that he may have been one of Young’s pupils. 144 This was echoed by Leake, A Lecture Introductory to the Theory and Practice of Midwifery, p. 36, where he noted that the Hippocrates of the ‘midwifery’ treatises and the one who wrote on diseases in general was very different. Leake’s work echoes both Young and Smellie; on Smellie, compare Leake’s comment that the medicines in Hippocrates are ‘odd and indelicate, and his theory extremely erroneous’ (p. 36) with Smellie’s comment that the recipes are ‘very strange and uncouth’ while the theories are ‘frequently odd and erroneous’ (A Treatise on the Theory and Practice of Midwifery, p. iv). However, where Smellie has Galen publishing nothing on his topic, Leake (p. 39) says Galen ‘wrote several books on the subject of Midwifery’, counting in this category De semine, De formatione foetus and De uteri dissectione, works mentioned by Smellie but not as midwifery texts. 145 Nihell, A Treatise on the Art of Midwifery, p. 100. Echoes in her work of Young’s published lectures suggest that she may have studied with him.

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practitioners’ told him; such women ‘continued to blunder on from Century to Century’.146

Using Hippocrates What is most striking about Smellie’s views on medical history is that, in obvious contrast to Douglas, Young and Nihell, he held Hippocrates in very high esteem as an expert, not just on medicine in general, but on midwifery in particular. This did not mean that he never challenged anything in the Hippocratic corpus; lecture notes from around 1750 show that he did not believe in the signs given by Hippocrates in order to know whether, after a child has been born, there are further children remaining in the womb, and whether such children have already died: Smellie’s dismissive comment was simply ‘we find no such thing’.147 Before Hippocrates, in Smellie’s version of the history of midwifery, there was very little. He referred in passing to the story of Agnodike, an ancient Greek girl who disguised herself as a man in order to help women in childbirth. As Monica Green has noted, this story, set in classical Athens, is the first stage in the ‘mythography of the gendering of women’s medicine’; as well as having its heroine put on male clothing in order to treat her fellow women, it also introduces the motif of the mode of transfer of knowledge between the sexes, as Agnodike learns medicine from a male, Herophilos, but it is not clear how he in his turn was supposed to have discovered the secrets of the female body.148 Although he did not mention Agnodike’s name here, Smellie noted that the Athenians were supposed to have had a law forbidding women and slaves ‘from practising physick in any shape’ but said that ‘mistaken modesty’ meant that free women were later admitted to practising ‘this art’; he was, perhaps deliberately, ambiguous as to whether the ‘art’ here is midwifery or medicine more broadly.149 In the second edition, he added in the source of this story: Hyginus.150 As I have discussed elsewhere, Hyginus’s story of Agnodike was used historically to argue for restricting the practice of midwifery to women, and also – at a later date – to support women entering the medical profession; but, depending on the spin it was given, it could 146

Wellc. ms MSL 105, ‘Lectures on Midwifery’, p. 1v. RCPE Lecture notes by Mr Hepburn on Smellie’s course, p. 83. 148 Green, Making Women’s Medicine Masculine, ch. 1. 149 Smellie, Theory and Practice of Midwifery, p. ii. This section was picked up by Philip Thicknesse in his attack on Smellie, where he uses the story to claim that the current procedure is similar to that described in ancient Athens, in that they permitted free women to practise, while today free women encourage the practice of midwifery; Man-midwifery Analysed, p. 15. 150 Smellie, Theory and Practice of Midwifery, p. ii; the first edition starts ‘In Athens a law was made …’ while the second edition has ‘Hyginus relates, that in Athens a law was made …’. 147

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equally well be used in defence of their exclusion from both areas, since it included both a time when women were forbidden to practise, and a time when a limited group of them were given permission to do so.151 It was particularly influential in seventeenth-century midwifery because it was retold in the work of Guillemeau, one of the books recommended for midwives to read.152 In 1760, when Elizabeth Nihell gave her own version of the history of midwifery, she presented the story as a ‘feeble attempt’ to thwart women’s natural position as midwives, and later returned to it to suggest that the attempt was made because women had previously been encroaching on men’s territory by trying to practise physic.153 However, by naming Agnodike, she emphasises to a modern reader the significance of Smellie’s omission of the name of this central character. He does not want the first midwife to be a woman, but rather a man: Hippocrates. Although, in keeping with the view that medicine is a cumulative process, Smellie considered that Hippocrates ‘no doubt availed himself of the observations of those who went before him in the exercise of the same profession’, and although his theories may be ‘frequently odd and erroneous’, Smellie found Hippocratic ‘diagnostics, prognostics, and method of cure, often just and judicious’.154 He made the dramatic claim that he ‘may be styled the Father of Midwifery as well as medicine’, because all succeeding authors, as far down as the latter end of the sixteenth century, have copied from his works the most material things relating to the diseases of women and children, as well as to the obstetric art. I shall therefore give a succinct account of his practice, and in my detail of the other authors, only observe the improvements they have made, 155 and the circumstances in which they have deviated from his method and opinion.

Writing in 1760, Elizabeth Nihell insisted ‘I greatly respect Hippocrates’ but added that, although Smellie’s followers regarded him as ‘the first and father of the menmidwives’ ‘he can never pass for an able man-midwife’ due to his ‘violent remedies and strange prescriptions for women in labour’ and his insistence on turning all malpresentations to the head-first position. She argued that the sole 151

Helen King, ‘Agnodike and the Profession of Medicine’, Proceedings of the Cambridge Philological Society 32 (1986): 53–77; King, Hippocrates’ Woman, pp. 183–7. 152 King, Hippocrates’ Woman, pp. 183–4; Guillemeau, Child-Birth or, the Happy Deliverie of Women, p. 81. Another example of its use is in Charles Clay, A Cyclopaedia of Obstetrics, Theoretical, Practical, Historical, Biographical, and Critical, Including the Diseases of Women and Children (Manchester, 1848), p. 78 where the heroine starts by learning medicine, is taught midwifery – to which she becomes ‘particularly partial’ – by ‘Hierophilus’, and the law is eventually changed to allow free-born women only to study midwifery. 153 Nihell, A Treatise on the Art of Midwifery, pp. 3, 219–20. 154 Smellie, Theory and Practice of Midwifery, pp. iv and v. 155 Ibid., p. iv. On the significance of the title ‘Father of Medicine’, see King, ‘The Power of Paternity’.

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sense in which Hippocrates was ‘the first’ was in discovering ‘that wonderful secret of killing the child and bringing it away piece-meal from the mother’s womb’; it was for this, she claimed, that Smellie had adopted him for the ‘father of midwifery’.156 These claims are exaggerated; far from stressing the surgical interventions in difficult births, Smellie discussed a range of Hippocratic gynaecology and midwifery. A very different view of the history of medicine and of its relevance to midwifery practice comes across from the private courses offered by Thomas Denman and William Osborn in London from 1770–78. The two men joined forces in around 1770 to purchase for £120 the ‘apparatus’ used to teach midwifery by a Dr Cooper; in addition to teaching on their combined private course, Denman was one of the men-midwives at the Middlesex Hospital.157 Denman was originally apprenticed as an apothecary, later passed his surgeon’s exams and served in the navy; an obituary was probably wrong to claim that, at the end of his naval service, Denman became another of Smellie’s pupils.158 Richard Hall completed a course of lectures on anatomy and surgery with William Hunter in May 1772, and received a certificate bearing a bust of William Harvey.159 But the certificate awarded to him on 1 July 1772 for completing Denman’s courses also survives.160 Rather than carrying a ‘modern’ image, this one states that the recipient ‘hath been present at many real Labors and also delivered several Women’, and it is decorated with a bust of Celsus. The image also bore the words Summam prudentiam moderationemque desiderant, from Celsus, De medicina, 7.29: ‘It requires caution and moderation’. This section, to be discussed in more detail in chapter 3 below, deals with instrumental interference in difficult presentations, and the operation which ‘requires caution and moderation’ is the vaginal extraction of a dead foetus; by using Celsus on the certificate, Denman was claiming antiquity for his profession, but also aligning himself with instruments and with emergency

156

Nihell, A Treatise on the Art of Midwifery, pp. 25, 24, 26–7. Wellcome ms. 5620, pp. 7–8. 158 Dates from Lawrence, Charitable Knowledge, appendix 3. Denman died in 1815; ‘Memoir of the late Thomas Denman, M.D.’, The Gentleman’s Magazine, 85 (1815): 566 claims that he attended Smellie’s lectures in midwifery, but dates this to between 1763 and 1764, after Smellie had stopped lecturing. See also Wellcome ms. 5620: Sophia Baillie (1818) Biography of Dr Thomas Denman (1733–1815), Accoucheur and Lecturer on Midwifery, p. 6, which also dates his attendance at midwifery lectures in London to 1763 or 1764. 159 Wellcome ms. 5193 (a). 160 Wellcome ms. 5193 (b). In the 1830s, certificates claimed authority not from the distant past, but from institutions. James Hamilton placed on his certificates the lying-in hospital founded by his father; see Allen D. Simpson, ‘James Hamilton’s “Lying-in” Hospital’. 157

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deliveries.161 Interestingly, Denman did not finish Celsus’s sentence, which continues et maximum periculum adfert: ‘and involves very great danger’. Osborn also quoted from Celsus, this time from the Preface, on the title page of his 1783 book, An Essay on Laborious Parturition: in which the division of the symphysis pubis is particularly considered: ‘They ask, too, does reasoning teach the same as experience, or something else?’162 The context here is Celsus’s assertion that, historically, experience came before reasoning, and medicine developed from actual experience; in the particular case of midwifery, this could be taken as a reference to the field being in the hands of women before men took it over and explained the theoretical background to what women had previously known only from experience. Interestingly, Elizabeth Nihell’s attack on men-midwives singled out Celsus when arguing that one should not be ‘too much carried away by the authority of a great name’; this suggests that Celsus had considerable authority in the 1760s.163 However, Celsus was normally noted more, in the words of the manmidwife John Leake, for his ‘true purity of style, than from anything remarkably instructive on the subject’.164 At some point in the 1770s Osborn changed his lecture topics, dropping his original opening lecture on ‘the History; the Rise, and Progress of Midwifery’ as it seemed ‘of very little Consequence’ and was in any case repeating material given in most midwifery treatises.165 Instead, Osborn and Denman began with menstruation or with a comparative study of parturition.166 In lectures given in 1776, they still deferred to ‘Hippocrates … as the fountain head’ and quoted the Hippocratic injunction ‘that if we can do no good for our patient, never to do harm’, while in 1788 Denman’s published work included the statement that ‘the very name of Hippocrates has filled with enthusiasm every succeeding writer’.167 However, his further comments show that it was the moral conduct and use of observation that were now seen as the main virtues of Hippocrates; he ‘ought not to

161

Celsus’s work was rediscovered in the 1440s, a commentary being published by Lommius in 1558. See Heikki Mikkeli, Hygiene in the Early Modern Medical Tradition (Helsinki, 1999), p. 30. 162 Requirere etiam, si ratio idem doceat, quod experientia, an aliud, Preface, 36; in modern editions, Requirere etiam se, ratio idem doceat quod experientia an aliud. 163 Nihell, A Treatise on the Art of Midwifery, p. 369. 164 Leake, A Lecture Introductory to the Theory and Practice of Midwifery, p. 38. 165 Wellcome ms. 2099, part 2, p. 1. 166 Menstruation: Wellcome ms. 2098, ‘Sketches of the Practice of Midwifery from the Lectures of Drs Osborn and Denman, London 1776’ (owned by a Mr Lovett). This set of lecture notes will be discussed further in chapter 4. A comparative study of parturition, beginning with the propagation of vegetables, followed by the lecture on menstruation: Wellcome ms. 2099, ‘Lectures in Midwifery by Dr Denman’, 1777–78. 167 Wellcome ms. 2098, ‘Sketches of the Practice of Midwifery’, pp. 7, 175; Thomas Denman, An Introduction to the Practice of Midwifery (London, 1788), p. iii.

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be considered as the guide of Physicians at the present time … but as an illustrious specimen of ancient medical knowledge and practice’.168 In striking contrast to Denman’s use of Celsus, Smellie underlined his insistence that Hippocrates was the father of midwifery by using his image on the certificates he issued to those completing his courses of midwifery instruction. It is not clear when the first such certificate was issued. Before the early 1750s, Smellie seems to have signed and dated copies of his syllabus in lieu of a certificate. One surviving copy of the syllabus for 1742 containing notes taken from the lectures was signed in this way by Smellie on 24 July 1743 to Mr Pearson ‘for attending my lectures and labours’.169 The earliest completed certificate that I have been able to locate is dated 4 March 1752, awarded to the Boston surgeon and obstetrician James Lloyd.170 The certificate awarded to the surgeon James Nankivell, who attended two courses, still survives, dated 13 June 1757; another certificate, awarded to John Harvie, is dated 1 Dec 1757 [Plate 4].171 On each certificate, it is striking that half of the page is taken up with a stone bust of Hippocrates, an engraving by Gerard Van der Gucht (1695 or 1696–1776) based on a drawing by Rubens. This image was used as the frontispiece to Francis Clifton’s Hippocrates upon Airs, Water and Situation; upon Epidemical Diseases; and upon Prognostics, in Acute Cases especially (1734), a book owned by Smellie [Plate 5].172 How seriously should we see Smellie as a Hippocratic? Overall, Smellie’s own approach to the body remained highly Galenic; for example, he discussed the six non-naturals and then gave a series of case histories to illustrate their role in obstetrics.173 Here he was no different from Burton, who published a book on the 168

Denman, Introduction to the Practice of Midwifery, p. iv. NLM ms. WZ 260 S638c 1742. 170 This one was in the Boston Medical Library and is now catalogued as B MS Misc. in the Boston Medical Library manuscript collection held at the Countway Library of Medicine; see Henry R. Viets, ‘Another Smellie’s Certificate’, Medical History, 2 (1958): 155–6. 171 William Smellie (1745) A Course of Lectures upon Midwifery (Wellcome ms. 4630); Nankivell, ‘Certificate of attendance’, pp. 279–80; Royal College of Obstetricians and Gynaecologists GB 1538 S52 (S52/1). Alfred McClintock owned another one, issued to Dr David McBride of Dublin, together with McBride’s lecture notes; see McClintock, Smellie’s Treatise, vol. 1, p. 15. The certificate states: ‘THESE are to certify, That … hath carefully attended my LECTURES on MIDWIFERY, by which he has had the Opportunity of being fully instructed in all the different Operations and Branches of that Art. Witness my Hand this … Day of … Teacher of Midwifery in London’. 172 Francis Clifton, Hippocrates upon Airs, Water and Situation (London, 1734), frontispiece; on Smellie’s ownership of this book, Tait and Wallace, ‘Dr William Smellie and his Library’, p. 417. The original image of the bust appears in the background of Rubens’ ‘Portrait of Ludovicus Nonnius’, dated to around 1627 , accessed 17 August 2005. 173 On the importance of regulating the non-naturals after childbirth, see RCPE Lecture notes by Mr Hepburn on Smellie’s course, p. 97. In the 1790 edition of the case histories 169

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non-naturals in 1738.174 But, Smellie argued – echoing the sixteenth-century rationale for welcoming the Latin translations of Hippocratic gynaecology – that Galen has his limits for the midwife, since he wrote ‘nothing de morbis mulierum … little or nothing to our purpose’.175 In contrast, What Hippocrates has written about the form of the uterus and its various motions, conception, the formation of the child, the seventh and eighth month’s births, was believed as infallible till the last century, when his doctrine of conception and nutrition of the foetus was overthrown; and many new and uncertain theories, on the same subject, introduced.176

He thus not only commended Hippocrates, but cast doubt on some of the theories that had recently replaced those of the ancient authorities. His very high opinion of Hippocrates is also clear from notes made in 1745 from the first lecture of his midwifery course. The History of midwifery – after we have reflected on the different turns that happen’d in several of the Eastern Nations, we shall not be surprized to find midwifery neglected as well as other sciences. In the early years instead of Learning Barbarism alone took place, Cruelty possessing every one’s breast. Hippocrates alone being possest of the Life and Spirit of Learning did not fail among other of his works, to communicate somewhat belonging to this noble science.177

The lecture then mentioned only Celsus, before moving on to Mauriceau. The sixteenth century is completely omitted; in 1745, for Smellie, ‘Hippocrates alone’ was already the Father of Midwifery.178 As we shall see in the following chapter, in addition to praising Hippocrates in general terms, Smellie also gave extensive quotations from the Hippocratic corpus. Here again his work stands in the tradition of Le Clerc and Freind. Le Clerc had summarised Hippocratic texts on the diseases of women, while Freind called for awareness of what earlier writers had actually said. While ‘reading all the books in (part 3 of the treatise), item XLI, pp. 458–64, is based on the non-naturals. The cases cover air; food and drink; sleep and watching; motion and rest; obstruction of urine, constipation, purging; passions of the mind. This relates back to the main text, part I, 4, pp. 124–6, ‘Of air, diet, sleeping and watching, motion and rest, retention and excretion, and the passions of the mind’, where Smellie specifically says that one must consider the non-naturals (p. 126). 174 Burton, A Treatise on the Non-Naturals. 175 Smellie, Theory and Practice of Midwifery, p. xxi. A similar argument – learned from Smellie? – is found in the 774 lecture of Thomas Young, Wellcome ms. MSL 105. 176 Smellie, Theory and Practice of Midwifery, p. xxiii. 177 Wellcome ms. 4630, p. 7. 178 It would be interesting to know what a later practitioner, John Leake, physician and man-midwife at the Westminster New Lying-in Hospital, meant by the ‘best Antient writers’ in the historical lecture opening his own course: see A Course of Lectures on the Theory and Practice of Midwifery (London, 1767).

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Plate 4 Harvie’s certificate of attendance at Smellie’s course. Reproduced with the permission of the Royal College of Obstetricians and Gynaecologists.

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Plate 5 Francis Clifton, Hippocrates upon Air, Water and Situation (London, 1734), frontispiece. Reproduced with permission of The Wellcome Library. the Faculty, without proper observation, and good judgment’ will never make a physician, and it will never be the case that ‘a man’s confining himself wholly to the study of the Ancients, will sufficiently qualify him to set up for Practice’, Freind believed that ‘knowledge can never be obtain’d in the degree it ought to be, without reading and comparing together the ancient and the modern writers: applying each of them as they serve best for any general notion, or present exigency’.179 In his decision to quote the ancient authorities at length, Smellie’s approach also contrasts with that of some other men-midwives. For example, Henry Bracken stated ‘I have watchfully shunn’d (as much as possible) any Quotations from Hippocrates or others, which would more embarrass than inform most of my Readers, choosing rather an easy and intelligible style’.180 This is not because 179

Freind, The History of Physick, pp. 309–10. Bracken, The Midwife’s Companion, preface. On p. 344 he does give a six-line quotation from ‘the divine Hippocrates’, on teething. 180

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Bracken questioned the authority of Hippocrates, but because he envisaged his readers as including women as well as men, midwives as well as surgeons; indeed, as he himself put it, ‘any one’.181 Smellie’s treatise was aimed at a more limited audience from within the medical profession. Proudly displaying their certificates bearing the image of the Father of Midwifery, Smellie’s pupils followed his enthusiasm for Hippocrates. Giles Watts duly praised ‘the great Dr Smellie’ but regarded Hippocrates as ‘the Good Old man’ worthy of ‘immortal Honour’.182 The lectures given at the General Lying-in Hospital in January 1770 by Colin Mackenzie – Smellie’s senior pupil in 1753, teaching midwifery in London from 1755–72 – praised Smellie’s machines and named Smellie as ‘the best practical writer’.183 However, he went beyond his master in giving Hippocrates the title of ‘the first Man-Midwife’, even though ‘It does not appear that Hippocrates ever deliver’d any woman, and what he asserts is from theory alone, and what he acquired by being conversant with those that had Practised which was Women only, in Former ages’.184 As Smellie had done, Mackenzie then stated that ‘there was little improvement made in Midwifery from the time of Hippocrates to the time of Celsus’.185 In another course, Mackenzie again stated that ‘Hippocrates was the first that wrote on this subject and therefore may be properly called the first Man Midwife tho’ it remains uncertain whether he ever delivered or not’.186 In a world in which experience mattered, one where students were expected to pay for ‘The Experience of being present at a real Labour’, Hippocrates managed to achieve a position of pre-eminence in the midst of serious doubts as to whether he had ever delivered a baby.

181

Bracken’s reasons for addressing such a wide audience are discussed by David Harley, ‘Ethics and Dispute Behavior in the Career of Henry Bracken of Lancaster: Surgeon, Physician, and Manmidwife’ in Robert Baker, Dorothy Porter and Roy Porter (eds), The Codification of Medical Morality (Dordrecht and Boston, MA, 1993), p. 50. 182 Watts, Reflections on Slow and Painful Labours, pp. vi and 15. Watts presents Smellie’s treatise on midwifery as being in the tradition of needing ‘a Compiler’ every century or so to ‘reduce the whole of the scattered and useful Particulars, Observations, & c, relating to it, into one regular, uniform Body or System’ (p. vii). 183 The dates for his teaching are taken from Lawrence, Charitable Knowledge, appendix 3. 184 Wellcome ms. 3392, ‘Dr MacKenzie’s Lectures’, pp. 65, 6, 1–2, dated to 1770 on internal evidence. Wellcome ms. MSL 110, ‘Ars Obstetricandi’, a further, undated, set of notes from MacKenzie’s lectures formerly incorrectly attributed in the catalogue to Thomas Young, repeats the ‘first Man-midwife’ claim, and regards Celsus as merely copying Hippocrates (pp. 1, 5). These notes may be earlier, as they refer to Giles Watts having ‘lately published a book on midwifery’ (p. 9); Watts’ book was published in 1755. Mackenzie is described as ‘senior pupil’ in Smellie, Collection of Preternatural Cases, p. 305. 185 Wellcome ms. 3392, p. 5. 186 Ibid., p. 60: this seems to be a second course, as the numbering of the lectures returns to ‘1’.

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Smellie’s sources In his very thorough biography, John Glaister suggested that Smellie ‘called forth the criticisms of those who believed and taught the traditional doctrines, and who supported them chiefly by quotations from the writings of the ancients’.187 Yet, in his 1752 history of midwifery, Smellie too chose to quote from the ancients; in particular, from Hippocrates and Aetius of Amida. Where did he find the sections that he quoted? As I have already noted, Smellie claimed that his treatise had been in preparation for six years. We know a great deal about Smellie’s own library, much of which survives today, having been left by him to his school, the Grammar School at Lanark; it is now held at the Lindsay Institute there. I have personally viewed the library; although it is impossible to be certain that marginal annotations and scraps of paper used as bookmarks reflect Smellie’s own use of the books, I shall argue here that these may provide useful supporting evidence on how Smellie worked. The fourth codicil to the will, dated 4 February 1763, explains why he bequeathed his books to the town: my collection of Medical Books are prettie complete, both as to the antient and modern practise and may be of use to the Medical Gentlemen of this place to improve and 188 consult on extraordinar emergencys.

Again, then, Smellie appears not as an antiquarian, but as someone who believed in the continued practical value of historical texts. His books have been described by his biographer as ‘his most cherished possessions’.189 The library included a range of classical authors, not all of them medical: for example, Homer, Pindar, Virgil, Persius, Caesar, Lucretius, Ovid and Lucian. Medical writers included Hippocrates, Galen, Celsus, and Pliny. Of the Roman writers, Smellie owned the works of many in both Latin and English, but English translations predominate. In his lifetime, Smellie compiled an ‘Alfabetical List’ of his books; this may have survived to be consulted by McClintock in 1876.190 Glaister made a catalogue between about 1880 and 1894, but this was lost when the books were moved in 1934.191 Another catalogue was compiled by the Lanark schoolmaster after the school was restored following a fire in 1888.192 The collection was recatalogued in 2005 by the current assistant librarian at the Lindsay Institute, Paul Archibald.

187

Glaister, Smellie and his Contemporaries, p. 68. Tait and Wallace, ‘Dr William Smellie and his Library’, p. 404. 189 Johnstone, William Smellie, pp. 8, 109–12; Antonia J. Bunch, Hospital and Medical Libraries in Scotland: An Historical and Sociological Study (Glasgow, 1975), pp. 65–72. 190 Tait and Wallace, ‘Dr William Smellie and his Library’, pp. 404 and 408. 191 Ibid., pp. 405 and 408; Bunch, Hospital and Medical Libraries in Scotland, p. 69. 192 Tait and Wallace, ‘Dr William Smellie and his Library’, p. 406. 188

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The oldest surviving catalogue is the manuscript list of the contents of the library now held at the Royal College of Physicians of Edinburgh. But what stage of the library’s development does it represent? Tait and Wallace thought it ‘was probably compiled by or for Sir James Young Simpson in 1858, from some older catalogue, possible Smellie’s own list itself’.193 However, the catalogue is certainly not in Simpson’s hand, and was probably copied in around 1830.194 It must represent the state of the library before 1770, as it includes books that were among the 50 or so which, together with some tracts, were sold at auction then; for example, Celsus, De medicina in both Latin and English.195 The auction partly explains why, when Hugh Davidson, a local retired lawyer, made a new card catalogue in 1936, about 70 volumes listed in the RCPE manuscript were no longer in the collection.196 As for the other losses, despite envisaging practical usage of his collection, Smellie had specified that the books could not be lent out; but borrowing was briefly permitted, and some volumes also disappeared in the period when the library was neglected before its transfer to the Lindsay Institute in 1934 and its subsequent renovation.197 In 1936 some books not listed in the RCPE manuscript were present in the collection. Some of the additions are due to the fourth codicil of Smellie’s will, which stated that, of the £200 he left to the Lanark Grammar School to establish his library there, ‘if any part of the two hundered [sic] pounds remains, the same is to be expended in furnishing the Liberary [sic] with the Classics and other useful books’.198 What of the specifically medical contents of Smellie’s library? The collection was described in the 1870s as being in a poor state of preservation but ‘pretty complete, both as to the ancient and modern practice’, with a ‘very considerable’ midwifery section containing ‘many of the old authors’.199 In 1953, Tait and

193

bid., p. 408. My thanks to Iain Milne, Librarian of the RCPE, for supplying me with a copy of this list. 194 Bunch, Hospital and Medical Libraries in Scotland, p. 71. 195 A Catalogue of the Entire and Inestimable Apparatus for Lectures in Midwifry, Contrived with Consummate Judgment, and Executed with Infinite Labour, by the Late Ingenious Dr William Smellie, Deceased (London, 1770), p. 2: James Greive, A. Cornelius Celsus. Of Medicine in Eight Books (London, 1756) and Theodoor Jansson ab Almeloveen, Aur. Corn. Celsi, De medicina libri octo (Amstelaedami, 1687) were sold at auction. Fielding Ould was sold at auction but later returned to the library; see Tait and Wallace, ‘Dr William Smellie and his library’, p. 419. Some items listed as being sold at auction are still in Tait and Wallace’s list; possibly these were duplicates. 196 Tait and Wallace, ‘Dr William Smellie and his Library’, pp. 408–9. 197 Johnstone, William Smellie, pp. 109–12; Tait and Wallace, ‘Dr William Smellie and his Library’, pp. 405–8; Bunch, Hospital and Medical Libraries in Scotland, p. 68. 198 Tait and Wallace, ‘Dr William Smellie and his Library’, p. 404. A full transcript of the will and all codicils is included in Glaister, Smellie and his Contemporaries, pp. 323–8. 199 McClintock, Smellie’s Treatise, vol.1, pp. 6 and 7. Extensive repairs to the bindings took place in 1936–39, paid for by Miles Phillips; see Bunch, Hospital and Medical Libraries in Scotland, p. 70. Phillips instituted the collection’s Visitors’ Book, being the first

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Wallace found a total of 407 volumes in the collection, 177 being ‘medical’. This number could be increased as, for example, they did not include the auctioned Celsus, On Medicine in their total. From the RCPE list, we can see that the library contained the 1597 Spach, listed as ‘Spachii Scripta de Morbis Mulierum’, as well as ‘Histoire de la Medecine’ (i.e. Le Clerc) and its English translation, and ‘Friend’s [sic] History of Physic’.200 All four volumes are still at Lanark. The books in Smellie’s library contain the inscription ‘Ex Bibliotheca Lanarkae’ (sometimes ‘Ex Bibliothica Lanarkae’) and some also carry his signature; clearly the collection absorbed his attention after his return to Lanark in 1758 or 1759, and it is possible that those volumes with a signature represent the earlier acquisitions.201 Very little was bought after 1751, the year in which his history of midwifery was published.202 What did Smellie’s library contain of relevance to compiling a history of midwifery? Specifically, other than the Spach Gynaeciorum libri, what did he have that would have helped him to construct Hippocrates as ‘Father of Midwifery’? While he was still practising at Lanark, a letter to Baillie Cullen, a Hamilton surgeon, demonstrates that he was already buying, and borrowing, books; Smellie asked Cullen to send him ‘Dr Clifton’s history of Medicine’ because he was unable to buy a copy in Glasgow or Edinburgh, but had sent to London for it.203 This would be Francis Clifton’s The State of Physick, Ancient and Modern, briefly consider’d: with a plan for the improvement of it (London, 1732).204 At his death, Smellie did not own a copy, but had Clifton’s edition of the Hippocratic Airs, Waters, Places, Epidemics and Prognostics; Clifton had planned a new edition of the entire Hippocratic corpus, to be funded by public subscription, but there was not enough support for this.205 In his history of medicine, Clifton used both Le Clerc and Freind, and made it clear that he saw Hippocrates as far greater than Galen; he is ‘by far the best Author among all the Ancients’.206 He recommended the correct order in which to read Hippocrates, starting with the Epidemics; like many writers of this period, he focused on Hippocrates as the expert practitioner of observation, based always in experience, versus Galen the philosopher.207 In to sign it on 17 July 1937; subsequently, he visited the collection with Douglas Guthrie in May 1948 and August 1954. 200 Spach is no. 159 in Tait and Wallace’s list. 201 The ‘Ex Bibliothica/Bibliotheca Lanarkae’ is in at least two different hands, neither of them Smellie’s. 202 After 1752, Smellie kept up with dispensatories and also with the work of his pupils. 203 McClintock, Smellie’s Treatise, vol.1, p. 2; New DNB, ‘Clifton’. 204 On Clifton, whose MD was from Leiden and who died in 1736, see Max Neuberger, ‘Francis Clifton and William Black. Eighteenth-century Critical Historians of Medicine’, Journal of the History of Medicine, 5 (1950): 44–9; Rusnock, ‘Hippocrates, Bacon, and Medical Meteorology’, pp. 139–42; New DNB. 205 Tait and Wallace, ‘Dr William Smellie and his Library’, p. 417. 206 Clifton, The State of Physick, p. 182. 207 Clifton, The State of Physick, pp. 87, 181, 184. As Volker Langholf, Medical Theories in Hippocrates: Early Texts and the ‘Epidemics’ (Berlin and New York, 1990)

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contrast to Smellie, however, for Clifton it was not Hippocrates, but Paul of Aegina, who was ‘the first upon record who profess’d midwifery’.208 Despite copying the image of Hippocrates for his certificates from Clifton’s frontispiece, Smellie’s enthusiasm for Hippocrates as Father of Midwifery was therefore not something that he copied from this author. One potentially useful work in the Lanark library for the writer seeking to show the value of Hippocrates in the treatment of women’s diseases was Hippocrates contractus, in quo magni Hippocratis ... opera omnia in brevem epitomen ... redacta habentur, an accessible summary of the Hippocratic corpus put together by Thomas Burnet and published in 1685 for the use of Edinburgh medical students.209 Smellie owned the 1743 edition. Extracts from the gynaecological treatises of the Hippocratic corpus were included here: from Superfoetation (two pages), Nature of Woman (two pages), Diseases of Women I (four pages) and On Sterile Women (two pages).210 But only one of the Hippocratic extracts used by Smellie can be found in this epitome: a section from Nature of Woman on fluor albus in which the discharge is described as being like an ass’s urine. This section will be discussed in more detail in chapter 3, where I shall argue that Burnet alone is not sufficient for Smellie’s discussion even of this single passage, as it stops before the details of therapy, which Smellie includes.211 Another possible source is Le Clerc’s medical history, to which Smellie referred his readers. However, Le Clerc’s account of Hippocratic work on midwifery is very different from that of Smellie, starting by attributing all diseases of the womb to its movement.212 Similarities only become apparent when Smellie tells us, of Hippocrates, that ‘In Suppressions of the Menses, he first of all orders

argued, the Epidemics do not in fact use the much-vaunted observation of individual cases in order to move from observation to theory, but instead demonstrate by them the applicability of pre-existing theories (p. 190; p. 210). Hippocrates the Observer is thus yet another later construct. 208 Clifton, The State of Physick, p. 95. 209 Cunningham, ‘The Transformation of Hippocrates’, p. 95. Another work in Smellie’s library giving a convenient version of many different works was the English translation of Mangot’s Bibliotheca Anatomica, Medica, Chirurgica, etc (London, 3 vols, 1711–14); however, this work, the preface of which states that it is aimed at ‘the Gentleman who is pleas’d to study Anatomy or Physick as an Accomplishment, and not a Profession’, does not contain any Greek or Latin authors on gynaecology or midwifery. 210 Thomas Burnet, Hippocrates contractus, in quo magni Hippocratis ... opera omnia in brevem epitomen ... redacta habentur (Edinburgh, 1685); Hippocrates contractus (London, 1743). The 1685 edition was approved by the Royal College of Physicians, Edinburgh. 211 Nature of Woman 15 (Littré VII, p. 332); Burnet, Hippocrates contractus (1743 edition), p. 124 gives Cum fluor albus subortus fuerit, urina qualis asini apparet, et dolor imum ventrem, lumbos ac laterum inanitates (κενεωνες) detinet. The Greek κενεωνες means the hollow between the ribs and hips, hence ‘flanks’, from κενος, meaning ‘hollow’. 212 Le Clerc, Histoire de la medecine, 1699, p. 326; 1702, p. 215; 1723, p. 225.

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vomits and purges’.213 This echoes Le Clerc’s ‘Il commençoit la cure de la premiere de ses maladies, en donnant des purgatifs et des vomitifs’; in the English version, ‘he cur’d by purgers [sic] and vomits’.214 But immediately Smellie diverges from Le Clerc. Where Le Clerc has simply ‘sharp pessaries’, Smellie develops these into ‘sharp pessaries in form of suppositories, composed of lint and wool, with divers kinds of deobstruant powders, wax, and oil, to be introduced into the vagina’, before returning to direct translation from Le Clerc with his recommendation for ‘fomentations, and hot baths, together with internal medicines’.215 It is therefore clear that very little of the Hippocratic material that he used derived from Clifton, Burnet and Le Clerc. John Burton accused Smellie of taking all his extracts from ancient medical writers from Spach, and he is clearly right to say that, by the time he wrote the Theory and Practice of Midwifery, Smellie had access to the Spach collection. In the next chapter I will argue that his research was by no means restricted to this one book. In particular, he owned, and can be demonstrated to have used, a thirteen-volume translation of the works of Hippocrates and Galen which included both the Greek and Latin texts: René Chartier’s Hippocrates Coi, et Claudii Galeni Pergameni Archiatrôn Opera (Paris, 1679). I shall examine some specific instances in which he used this edition. However, even if he was not using Spach for details, I believe that his uses of, and references to, this volume demonstrate that the mere existence of the Gynaeciorum libri collection had served to persuade Smellie of the importance of the sixteenth century in relation to midwifery and obstetrics. With regard to the Gynaeciorum libri, Smellie wrote in 1751: Several authors of note lived and wrote in the sixteenth century, or betwixt the years 1530 and 1590, upon the diseases of pregnant women, and the different methods of delivery. A collection of the most remarkable among these writers, who are called the old moderns, was published at Basil 1586, in a large quarto, intitled Gynaeciorum; and 216 afterwards, in 1597, republished at Strasburg in folio.

In later editions, the title of the work was more correctly given as ‘Gynaeciorum Commentaria’.217 The term ‘old moderns’ is an interesting one, suggesting that he regarded the sixteenth-century writers as inaugurating the ‘modern’ era.

213

Smellie, Theory and Practice of Midwifery, p. v. Le Clerc, Histoire de la medecine, 1699, p. 328; 1702, p. 216; 1723, pp. 226–7. 215 Le Clerc, Histoire de la medecine, 1699, p. 328; 1702, p. 216; 1723, p. 227; Smellie, Theory and Practice of Midwifery, p. v. Le Clerc wrote ‘Et après avoir mis en usage les pessaires les plus acres, les parfums, les fomentations, et les bain chauds, pratiquez deux fois chaque jour, il faisoit prendre intérieurement divers medicamens … à faire sortir le sang par les voyes ordinaires’. 216 Ibid., p. xlvi. 217 E.g. 1762 edition, p. xlvi, gives ‘entituled Gynaeciorum Commentaria’. 214

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Interestingly, Smellie did not mention the first, 1566, edition of the collection; it is possible that he did not know of its existence.218 In addition to commenting on obstetrics in Hippocratic medicine, Smellie discussed what we would consider gynaecological conditions, including imperforate hymen, excessively large labia, menstrual suppression, excess menses, fluor albus and the movement of the womb. Like other eighteenth-century men-midwives, he would be consulted if a girl failed to menstruate when she appeared to be old enough to do so.219 However, Smellie’s focus was obstetrical, and this contrasts with that of the 1566 edition of the Gynaeciorum, which is more ‘gynaecological’ in slant. The seriously obstetric works in which one would expect Smellie to be most interested – the works of Ruf and Rousset – were only included in the 1586 edition.220 Rousset, for example, argued that Caesarean section could be performed without losing the life of mother or child, while keeping future fertility. He made the analogy between a difficult birth and the Gordian knot; the answer to the seemingly intractable problem is to cut it.221 Although it is far from clear that he did in fact perform this procedure himself – he may have taken all his examples from other writers – this active and ‘heroic’ image contrasts powerfully with the tradition of women delivering live births and men only dead ones.222 Smellie, writing very much within the context of the territory debate over midwifery, found Spach’s collection useful in showing that men had been involved in the field for longer than a few post-forceps decades, and that their association with live births too had historical precedents. However, as I shall now show, this did not mean that Burton was right to accuse him of copying all his historical material out of Spach.

218

Unlike the 1586–88 Bauhin edition, the 1566 Wolf edition is not mentioned in Spach’s preface. 219 Wellcome ms. 2098, ‘Sketches of the Practice of Midwifery’, pp. 4–5. 220 For example, Jakob Ruf, De conceptu et generatione hominis et iis quae circa potissimum considerantur (1554), translated from German into Latin by Wolfgang Haller; François Rousset, Hysterotomotokia, first published in 1581, was translated from French into Latin by Bauhin in 1582. On the orthography of Ruf’s name, see now the project ‘Jakob Rufs Theater- und Heilkunst’, (accessed 23 May 2006) and the forthcoming work by Hildegard Elisabeth Keller, Andrea Kauer and Stefan Schöbi (eds), Jakob Ruf, ein Zürcher Stadtchirurg und Theatermacher im 16. Jahrhundert (Zürich, 2006). See also Viets’ supplementary notes to Cutter and Viets, A Short History of Midwifery, p. 183, where Viets suggests that Smellie ‘would have found little obstetrics in Spach’s book except for reference to cesarean section’; as I will show in the next chapter, this is not in fact the case. 221 The story of the Gordian knot is given by Arrian, Campaigns of Alexander, 2.3.7; Q. Curtius Rufus, History of Alexander, 3.1.18; Plutarch, Life of Alexander, 18.2 and Justin, Epitome, 11.7.16. See Waldemar Heckel, Alexander the Great: Historical Sources in Translation (Oxford, 2004), pp. 214–16. 222 See for example Renate Blumenfeld-Kosinski, Not of Woman Born: Representations of Caesarean Birth in Medieval and Renaissance Culture (Ithaca, NY, 1990), pp. 41–7.

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Chapter 3

Guilty of ‘Male-practice’? Burton’s Attack on Smellie In his attack on Smellie in 1753, Burton had made the use of the Spach Gynaeciorum into a touchstone of medical competence: … first, I shall shew that there was no occasion to have perused the Originals quoted, since the pretended Extracts, or the Places they are said to be taken from, may be seen in one single folio Volume collected by Spachius from Hippocrates’s Time (when Smellie begins his Account) down to Guillemeau, who published in 1582; a few Lines out of Le Clerc and Friend’s History of Physic excepted. Hence no great Time was requisite to read the Parts whence they are pretended to be collected. Secondly, it appears that Smellie has never read either the Originals or Spachius, or else did not understand them, or has wilfully misrepresented their Meaning to countenance some dangerous Methods of Practice. Otherwise it is impossible to account for the representing some of those Authors as laying down Rules or Methods of Practice, directly the Reverse of what is to be found in their Works.1

Burton suggests here that it was an easy task to find the ancient texts Smellie used for his history of medicine and, in his more detailed demolition of Smellie later in the book, alleged that most of the Hippocratic material came from Maurice de la Corde’s commentary on the Hippocratic Diseases of Women 1. He wrote, ‘the chief of what you give us, as taken from Hippocrates, is to be found in him, except the very first Part, which is taken from Le Clerc’, reiterating that ‘there is no Difficulty to extract all you have said, as taken from Hippocrates, out of that single volume of Spachius’.2 I disagree. The Hippocratic extracts in Smellie’s work depend neither on Burnet’s Hippocrates Contractus nor on Le Clerc’s summaries of Hippocratic texts, but nor do they derive from Spach. Burton’s own detailed account of which 1

John Burton, A Letter to William Smellie, MD, Containing critical and practical remarks upon his treatise on the theory and practice of Midwifery. Wherein the various gross mistakes and dangerous methods of practice mentioned and recommended by that writer, are fully demonstrated (London, 1753), p. iv. Note that Burton implies Guillemeau is included in the Spach collection; this is not, in fact, the case. His work was published not in 1582, but in 1609, 12 years after the final edition of the Gynaeciorum libri. 2 Burton, A Letter to William Smellie, pp. 21–2. The reference to an easy extraction may be intended to make the reader think of the extraction of a child from the womb.

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pages in Spach contain the classical texts cited by Smellie shows that far more is being used than de la Corde’s treatise but, in addition to this, the other classical material given by Smellie cannot be located as easily as Burton suggests. Although one can find much of it by looking for the chapters on difficult childbirth in the Spach authors, there are more straightforward ways of gaining access to the nonHippocratic classical materials, and these were available to Smellie. Smellie and Burton were, in many ways, very different animals. Burton was English and Cambridge-trained, graduating with his M.B. in 1733, and was an active tory. His M.D. was from Reims. The Scot Smellie was trained as an apprentice, never took an M.B., and received his M.D. from Glasgow in his late forties. Politically, he was a whig, although unlike most whigs he would sometimes use the forceps.3 It is difficult to know how confident Smellie was in either modern or classical languages, while Burton ostentatiously displayed his knowledge of both Latin and Greek. But, although Burton’s own knowledge of languages was evidently superior, the passage above makes clear that his objections to Smellie’s use of ancient texts went far beyond mere pedantry; ‘dangerous Methods of Practice’ follow on from Smellie’s construction of the past.4 This point picks up the full title of Burton’s Letter to William Smellie, which refers to Smellie’s ‘various gross mistakes and dangerous methods of practice’. Previous studies of the debate between these two men have often missed this point. For example, Johnstone’s comment on Burton’s ‘carping criticisms and hypercriticisms’ does his detailed footnotes attacking Smellie a disservice; they are not mere pedantry. For example, in a passage recalling Dubois’s discussion of the order of administering drugs, Burton argued that Smellie caused real harm to real patients by reversing the order of drug administration given in Hippocrates: Hippocrates started with the mildest and, only if this failed, moved on to stronger remedies, whereas Smellie started with the strongest.5

Disputes in action Before looking at some specific debates about practice in which there was a difference of opinion centred on the meaning of classical texts, I would like to look at such clashes more generally. The dispute between Smellie and Burton was unusual in being played out on the stage of the 1597 Gynaeciorum. At this period, 3

Wilson, The Making of Man-midwifery argues for a significant difference in approach between whigs and tories both in the use of the forceps and in their approach to setting up institutions in which poor women could give birth. 4 The supplementary notes by Viets to Cutter and Viets, A Short History of Midwifery, pp. 182–3 acknowledge that Burton is ‘cantankerous but scholarly’ and rate his reputation as a man-midwife as ‘deservedly high’. 5 See chapter 1, above; Johnstone, William Smellie, p. 94; Burton, A Letter to William Smellie, p. 9.

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disputes between men-midwives more commonly happened at the bedside, and often hinged on whether and when intervention with the forceps was appropriate. This did not mean that they were divorced from textual evidence; if midwifery were indeed a progressive science, with each generation building on the experience of those who had gone before, then it was possible that the situations in which men-midwives found themselves could be discovered in the Hippocratic corpus, and the experience of the Father of Midwifery added to what Giles Watts had called the ‘publick scientifick Fund of the Ars Medendi’.6 Later in this chapter, I will show how Smellie used his construction of medical history to add the weight of Hippocrates to very real debates in contemporary practice; first, however, I want to look at how the pamphlet wars in which he was involved focused on specific cases. The rhetoric of early modern childbirth had long featured attacks by women practitioners on men usurping their traditional roles; these commonly contrasted the useless theoretical knowledge possessed by men, with the practical knowledge enjoyed by women. In the 1670s, the London midwife Elizabeth Cellier ridiculed the male practitioner whose knowledge is restricted to theory, comparing him to the philosopher Phormio who had been foolish enough to read a lecture on military tactics to the great Carthaginian general Hannibal.7 A century later, in a very different climate in which men-midwives had become fashionable, Elizabeth Nihell claimed that she was able to demonstrate knowledge of both theory and practice.8 From the seventeenth century onwards, the emerging men-midwives were using similar rhetoric to attack each other. Like many such practitioners, William Douglas argued against ‘a strictly theoretical approach to childbirth’, saying that ‘Midwifry depends upon Practice’, and made the exaggerated claim that the large number of men-midwives currently working in London – ‘there now are more Men-midwives than Streets’ – meant that none of them would be able to obtain sufficient practical experience.9 In his second ‘Letter to Dr Smellie’, Douglas was forced to respond to criticisms of his own midwifery practice made in An answer to a late pamphlet intituled A letter to Dr. Smellie; shewing the impropriety of his new invented

6

Giles Watts, Reflections on Slow and Painful Labours, and Other Subjects in Midwifery. Together with observations on several disorders incident to pregnant women. Interspersed with remarks on Dr. Burton’s letter to Dr. Smellie, in which the merits of the cause between these two authors are, in some measure, considered (London, 1755), p. iv. 7 Elizabeth Cellier, To Dr … an Answer to his Queries, Concerning the Colledg of Midwives (London, 1688), see King, ‘“As if None Understood the Art that Cannot Understand Greek”’, p. 193. The story, set in 189 BC, comes from Cicero, De oratore 2.75, and was well known in the seventeenth century. 8 Nihell, A Treatise on the Art of Midwifery, p. xi. 9 McTavish, Childbirth and the Display of Authority, p. 187; Douglas, A Letter to Dr Smelle, pp. 5–6.

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wooden forceps.10 This anonymous piece of 1748 presented itself as the work of one of Smellie’s pupils who resided outside London, but the bulk of it was a letter by Smellie defending himself against Douglas’s allegations made earlier in the same year. Smellie insisted that he would ‘never use any Instrument but when it is absolutely necessary for the Safety of the Mother or Child’. In answer to a specific allegation by Douglas that his wooden forceps, to be discussed further below, had been responsible for the death of eight women within a few months, Smellie responded that he had only used the instrument twice before the publication of Douglas’s attack, with no loss of life to either mother or child.11 Several specific cases were disputed by the two men. The first is the case of the wife of the King’s coachman, who died in childbirth. Douglas accused Smellie of malpractice in leaving her with ‘floodings’ for a month before her delivery.12 Smellie responded that the situation was in any case perilous because she was 40, it was her first pregnancy, and she had a ‘gross Habit’. To make matters worse, a fall in the seventh month had led to a continued loss of blood, weakening the patient.13 Douglas said that, when Smellie opened the dead woman to remove the child, it lived for ‘about two Minutes’: on Smellie’s account of the situation, the child had already been dead for some time, countering any suggestion that it could have been saved.14 Smellie then turned to a second case, that of Mrs Price, where he said that he was called in after ‘a Gentleman’ – Douglas – who had wanted to deliver the child immediately because he was certain that it was dead. This had scared her so much that he was paid, and sent home. Only after this was Smellie called in and, with the help of the midwife, he safely delivered a living child.15 In his second pamphlet, Douglas replied to this allegation of his incompetence, saying he did not remember predicting that the child would be born dead; in any case, he argued, there was no point in staying after he had been insulted, and when such a small fee had been offered.16 It is the third case that gives us most insight into the relationships between different professional groups in the birthing room. In his treatise introducing the use of forceps to a wider public in 1733, Edmund Chapman had insisted that he would give no information on medicines because that was an area exclusively for physicians.17 But on their arrival in the birthing chamber, men-midwives could 10 An Answer to a Late Pamphlet Intituled A letter to Dr. Smellie; shewing the impropriety of his new invented wooden forceps (London, 1748?). 11 Ibid., pp. 4–5. 12 Douglas, A Letter to Dr Smelle, p. 22. 13 An Answer to a Late Pamphlet, p. 8. 14 Douglas, A Letter to Dr Smelle, p. 23. Smellie emphasizes that he had called in physicians who approved his course of (in)action in this case. 15 An Answer to a Late Pamphlet, pp. 9–10. 16 Douglas, A Second Letter to Dr. Smelle, pp. 6–7. 17 Chapman, An Essay towards the Improvement of Midwifery, preface.

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discover that their patients were already drugged. In the third disputed case, Douglas was dealing with a woman in labour suffering from ‘a lethargy’, and who had received opiate drugs. He did not clarify on whose authority they had been administered, simply using the passive: ‘an opiate had been given’.18 Smellie himself often prescribed; in a case from 1753 already mentioned, he had ordered something ‘to amuse’ a woman and her friends who considered that the labour was not proceeding as quickly as they thought it should.19 These prescriptions could include opiates; for example, when a woman was unable to sleep after her baby had been delivered, Smellie administered a gentle opiate which unfortunately caused hallucinations in which she thought she saw ‘the witches in the tragedy of Mackbeth [sic]’.20 Elizabeth Nihell later quoted from Macbeth, using Macduff’s lament for the death of his children – ‘All my pretty ones? Did you say all? What all?’ – in the context of the number of babies killed by men-midwives.21 Here, however, the opiates had been given before he arrived. Smellie said that Douglas was sure that the woman would not live, as ‘there was no Room to attempt the Delivery; but that he had a Knife in his Pocket, with which he proposed to open her immediately after Death, that the Child, if possible, might be saved’. Smellie did not accept the prognosis, and called as witness ‘Mr Bromfield, Apothecary’.22 This was already a crowded birth chamber, with two men-midwives and an apothecary, but a fourth player then entered: a physician, Dr Wilmot.23 On Douglas’s version, he had been the first on the scene, called for by the woman’s husband, and had sent for Dr Wilmot to assist him, but in the interim somebody else had already called Smellie.24 When Wilmot arrived, he advised the delivery of 18

Douglas, A Second Letter to Dr. Smelle, p. 7. Smellie, Collection of Preternatural Cases, p. 19. A similar case suggesting that Smellie used placebos – here, ‘some innocent medicine’ – is used by Cody, Birthing the Nation, p. 189 (Smellie, A Treatise on the Theory and Practice of Midwifery, p. 137). In their lectures in the 1770s, Osborn and Denman also considered it was acceptable to give a medicine to ‘amuse’ a patient, in this case when there was uterine haemorrhage at full term, suggesting that it was patient expectation that drove them; see Wellcome ms. 2098, ‘Sketches of the Practice of Midwifery’, p. 189. 20 Smellie, A Collection of Preternatural Cases, p. 460. See also Lloyd, ‘The “Languid Child” and the Eighteenth-century Man-midwife’, pp. 666–7, for one of the cases of William Hey, surgeon and man-midwife (1736–1819), in which opiates were given in labour. 21 Nihell, A Treatise on the Art of Midwifery, p. 196–7, citing Macbeth, act 4, scene iii, 256–9. 22 An Answer to a Late Pamphlet, pp. 11–12; his presence is also noted in Douglas, A Second Letter to Dr. Smelle, p. 10. 23 In this high-profile case, this was probably Edward Wilmot, who was physician to the household of Prince Frederick from 1742–51; the role had been held by Francis Clifton from 1730–34. See the list of the Prince’s household in , accessed 14 November 2005. 24 Douglas, A Second Letter to Dr. Smelle, pp. 7–10. 19

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the child, which was stillborn; Smellie insisted that the child could have been saved if delivery had been attempted sooner, but Douglas pointed out that, although the child was born dead, at least the mother survived to the time of writing.25 Douglas ridiculed Smellie’s contribution at the bedside, as consisting simply of saying that a mouthful of warm wine would be useful after the delivery. Smellie’s account makes it clearer what was going on here; he did indeed advise wine, but also ‘warm Bricks to be applied to her Feet and Hands, a Blister, and a cordial Mixture’, thus trying a range of remedies to restore her, while Douglas – he claims – was not interested in the mother, and ‘thought of nothing but letting her expire without any further Assistance’.26 This care for the mother, taken with those occasions on which Smellie sent for food when he realised that the sheer weakness of a poor woman lay behind her problems in labour, should make us question recent analyses of Smellie in which he is held responsible for exploitation of the poor, and the ‘virtual silencing of indigent women’.27 Men-midwives certainly felt that some of their patients were uncooperative; for example, Giles Watts’s patient ‘E.W.’, an unmarried woman of 24 who retired to bed ill after attending the morning service at church, was exposed as having secretly given birth but, when challenged by Watts, ‘positively denied she had ever been with Child, adding withal, “no more than yourself”’.28 But it would be inaccurate to represent them as lacking any sympathy for the women they delivered. The ‘lethargy’ case can be illuminated further by what appears to be an account of the same events of 1748, published in Smellie’s collection of case histories in 1764. Smellie died shortly before this volume was published and, as with the earlier volumes, the novelist and physician Tobias Smollett helped him prepare it; because of Smellie’s death, the editorial input from Smollett may have been at its greatest in this volume.29 Like Smellie, Smollett was a Scot with a classical

25

An Answer to a Late Pamphlet, p. 12; Douglas, A Second Letter to Dr. Smelle, p. 8. An Answer to a Late Pamphlet, p. 12. 27 Pam Lieske, ‘Configuring Women: William Smellie’s Obstetrical Machines and the Poor’, Studies in Eighteenth-Century Culture, 29 (2000): 77. 28 Watts, Reflections on Slow and Painful Labours, p. 66. 29 The unsigned ‘Advertisement’ at the beginning of the 1764 collection of case histories states that at the time of Smellie’s death ‘The manuscript was presented to the person who prepared the two former volumes for the press, and even delivered to the printer’. McClintock, Smellie’s Treatise, vol.1, p. 6; Glaister, Smellie and his Contemporaries, p. 314; Cutter and Viets, A Short History of Midwifery, p. 28. McClintock, Smellie’s Treatise, vol. 3, p. 2 considered that either Smollett or John Harvie wrote this ‘Advertisement’. Cody, Birthing the Nation, pp. 152–3 calls Smollett Smellie’s ‘ghostwriter’, a view supported by Thicknesse, Man-midwifery Analysed, p. 5: ‘the matter by Smellie, and the language said to be that of Dr Smollet’ and by an undated letter from Smollett to William Hunter where he refers to ‘petulant queries upon the Margins of Smellies Manuscript’ and insists that he has control of the text; see Lewis Mansfield Knapp, ‘More Smollett Letters’, Modern Language Notes, 48 (1933): 247. See further Philip 26

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education who had served in the navy as a surgeon’s mate. He practised as surgeon in London in 1741, before writing novels, and in the early 1750s he purchased an M.D. degree from Aberdeen and briefly tried to establish himself as a physician.30 Smollett also contributed at least one case history to Smellie’s 1754 collection of cases.31 In this second version of the story, in 1748 Smellie was called to a woman by her former mistress; unknown to him, the husband had already booked another man-midwife. On arrival Smellie found this man ready to proceed: His dress was as forbidding as his countenance, consisting of an old greasy matted wrapper, or night gown, a buff broad sword-belt of the same complection about 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 32 on his head a large periwig.

This image of a man in a woman’s apron but with an oversized wig reproduces the concerns of the popular press at this time with the monstrous, cross-dressing, category-bending figure of the man-midwife; it was agreed that they tended to have larger wigs even than other physicians.33 Who was this bizarre apparition? If we follow the order of arrival of the dramatis personae given by Smellie (or his pupil) in the 1748 pamphlet, then Smellie’s alarming and strangely-dressed rival must be Douglas, who immediately ‘damned all midwives for ignorant b_____s’.34 William Douglas worked at the Middlesex Hospital from 1749, first as a man-midwife and then as physician; he resigned in 1752.35 His date of death is not known; however, if it was prior to 1764, it would have enabled Smellie – or Smollett – to retell the story of the events of 1748 without holding anything back. Evidence that Douglas had indeed died before then comes from the ‘letter from Tartarus’, an extended joke from Smellie to another Scottish physician with classical interests working in London, John

Klukoff, ‘Smollett’s Defence of Dr. Smellie in The Critical Review’, Medical History, 14 (1970): 31–41. 30 Ian Campbell Ross, ‘Smollett, Tobias’, The Literary Encyclopedia, 30 Jun. 2003, The Literary Dictionary Company; , accessed 15 November 2005. 31 The case history from Smollett appears in A Collection of Cases and Observations in Midwifery, p. 4. 32 Smellie, Collection of Preternatural Cases, p. 537; McClintock, Smellie’s Treatise, vol.3, p. 320 has ‘a large tie periwig’ here. 33 Cody, Birthing the Nation, p. 205. 34 Smellie, Collection of Preternatural Cases, p. 538. 35 New DNB; the editor of the entry, James Sambrook, takes the ‘letter to Tartarus’ to imply that Douglas was in Scotland by 1758, but when the letter says ‘here’ it means the underworld.

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Clephane.36 It is dated ‘July 1 era of Chinese Pluto 41758’, which I would understand as a reference to 1758, the year of Clephane’s death. The letter purports to have been sent from the underworld, and in it Smellie notes ‘Poor Douglass is here but wont speek to me: I suppose he thinks I was the occation of his madness’.37 In the 1764 rewriting of this case, it transpires that the woman’s lethargy was due to the dose of opiates administered by Douglas, the dosage being confirmed to Smellie by the apothecary who was also present.38 As in the first version of events, the woman’s physician was then called as well, and agreed that the lethargy was due to opiates. On Smellie’s advice, the woman was given a night to sleep off the effects of the drugs, and then gave birth to a dead child on the following day, assisted only by the midwife.39 The woman survived. This story shows not only the range of authorities at the bedside of an eighteenth-century woman in labour, but also the difficulties of timing. The disagreement between Smellie and Douglas hinged on whether a lethargic woman should be left in the hope that normal contractions would resume, or intervention with the forceps should be tried immediately, although it would not necessarily save the child. If labour was not proceeding normally, delay could mean not only the death of the child, but also that of the mother. The combination of opiates and difficult labour here looks forward to the nineteenth century and to Sir James Young Simpson’s career; as we shall see in chapter 4, while opiates were known to halt contractions, effective analgesia led to further changes in the management of labour.

Languages Medical history gave those involved in disputes such as these a different way of validating their practice; it provided a neutral, authoritative voice. Burton’s claim that Smellie had simply lifted from Spach the quotations from almost all early works, including Hippocrates, and that he had misunderstood what he read there, threatened Smellie’s authority as a man-midwife. In the remainder of this chapter I shall examine a small selection of the sections identified by Burton as coming from Spach, in order to show how and why Smellie used them. I shall begin by discussing some of Burton’s minor claims about Smellie’s use of French and Latin, 36

On Clephane, see New DNB. He had an extensive correspondence up to his death on 11 October 1758. 37 Johnstone, William Smellie, p. 119 and figs 23–4. Supporting the dating, Elizabeth Nihell, who did not die until after 1760, is clearly ‘Lucina’ in this letter, described as not yet having ‘favourd us with here [sic] presence’, while John Burton (d.1771) is also not yet dead (‘when he comes … for I expect him soon’). 38 Smellie, Collection of Preternatural Cases, p. 539. 39 Ibid., pp. 541–2.

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before examining the appeal to classical and later material in support of Smellie’s position on the condition known as fluor albus, the correct time to cut the umbilical cord and, finally, instrumental intervention in childbirth. In his second edition, Smellie did not correct the many specific and detailed errors listed exhaustively by Burton; was this because he considered that Burton was wrong, or because Smellie was not interested in detail? In discussing the second version of the 1748 lethargy case, I noted the contribution to Smellie’s published work made by Tobias Smollett. Burton referred to this at the end of his book, suggesting that Smellie used Smollett to ‘draw up’ his treatise and someone else to compile the 70-page history of medicine: he alleged that Smellie ‘employed one Person to make those pretended Extracts (which however by Adoption you have made as your own) as you did another to draw up your Treatise’, and recommended to Smellie that he should ‘either discard him, or lay an Injunction upon him to be more cautious for the future’.40 This is because this person ‘neither understood the Subject, nor the Language of the Authors quoted’; Burton hinted that, conveniently, the errors provided support for Smellie’s own views.41 As we have already seen in the previous chapter, Thomas Young’s lectures in the mid-1750s also claimed that Smellie’s history was ‘compiled by different hands’.42 Many subsequent writers, even those on Smellie’s side, have similarly assumed that Smellie could not have read all the books he quotes from; for example, R.W. Johnstone followed Burton in suggesting that he ‘got somebody to “devil” for him’.43 It is perfectly possible that one of Smellie’s pupils assisted him in collecting references from Spach. If so, then clearly this pupil was good at Latin; a possible candidate would be the German obstetrician Johann Georg Roederer (1726–63) who studied with Smellie in 1748, and went on to become Professor of Medicine in Göttingen, composing his own treatises in Latin.44 However, after

40

Burton, A Letter to William Smellie, pp. 232–3. Ibid., A Letter to William Smellie, p. iv. 42 Wellcome ms. MSL 105, p. 16r. 43 Johnstone, William Smellie, p. 41. However, Johnstone’s own comments on the issue of the use or misuse of the Gynaeciorum collection do not inspire confidence; he dates Spach to 1586 rather than 1597, and states that he ‘collated the works of many old Greek, Arabian and Roman physicians which would otherwise have been lost’. This partially translates the title of Spach’s collection, …libri Graecorum, Arabum, Latinorum veterum et recentium quotquot extant… but omits the inclusion of sixteenth-century authors in the collection, and also misses the point that, far from risking being lost, many of the works included by Spach were already in circulation in vernacular and Latin editions. 44 McClintock, Smellie’s Treatise, vol.1, p.15 describes him as an illustrious pupil; see also Charles West, A Brief Sketch of the More Important Fluctuation in Opinion … with Reference to the Performance of Turning, and the Application of the Forceps (London, 1850), p. 8; John Glaister, Smellie and his Contemporaries: A Contribution to the History of Midwifery in the Eighteenth Century (Glasgow, 1894), p. 166. 41

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examining the books in Smellie’s library, I would argue that his own direct involvement in writing this history of medicine was very significant. Before attacking Smellie for his use of the Latin Gynaeciorum collection, Burton first criticized Smellie’s knowledge of French. He complained that ‘Part of the second and third page of your Introduction is taken from Le Clerc, but with what Propriety you (or the Person you take it from) can translate, divers Fragmens des Livres, into some Chapters, I am at a loss to know’.45 Smellie’s copies of both the French 1723 edition of Le Clerc’s Histoire de la Medecine, which contained a section on ‘Des maladies des Femmes’, and the English translation of 1699, remain in his library.46 Burton’s reference to ‘p. 136’ of the second part of Le Clerc’s work enables us to identify the edition he was using as another one, that of 1702. Burton has here identified a poor translation in Smellie’s text, although it is a very minor matter; Le Clerc stated ‘On trouve dans Aetius divers fragmens des livres d’une Aspasie’, whereas Smellie has ‘Aetius transcribes some chapters from the works of one Aspasia’.47 But Burton then alleged that parts of pp. 4–6 of Smellie constitute ‘an Exact Translation’ of Le Clerc’s words. This is not the case. When discussing whether or not the ‘Cleopatra’ mentioned as the author of a work on midwifery is the famous one, Smellie noted in support of this identification that ‘in a preface supposed to be written by her, she mentions her sister’. In the second and subsequent editions, he expanded this to ‘because in the preface Arsinoe is mentioned as the author’s sister’.48 This comes closer to the wording of Le Clerc, who argued in favour of the famous Cleopatra, ‘puis qu’elle dit elle-mème dans cette preface, qu’elle est soeur d’Arsinoë’.49 Here, then, if anything, Smellie seems to have amended his history of medicine to make it even closer to Le Clerc. But Le Clerc gives far more evidence in support of the identification of Cleopatra, citing Plutarch’s comments on her ability to learn languages, and other suggestions in the classical authorities that she was ‘une Princesse extremement curieuse et savante’. Smellie, however, seems to know nothing of this positive tradition, instead describing the queen as ‘a gay voluptuary’ who was ‘not at all suited’ to practising

45

Burton, A Letter to William Smellie, p. 7. Part 1, book 3, ch. 27; in the English edition, Daniel Le Clerc, The History of Physick (London, 1699), this is ch. 24. This is listed in the RCPE manuscript catalogue only as ‘History of Physic’. 47 Daniel Le Clerc, Histoire de la medecine ou l’on voit l’origine & les progrès de cet art. De siecle en siecle, les sectes, qui s'y sont formées, les noms des médecins, leurs découvertes, leurs opinions, & les circonstances le plus remarquables de leur vie (Amsterdam, 1702), p. 136; Histoire de la medecine ou l’on voit l’origine & le progrès de cet art… (Amsterdam, 1723), p. 433; cp. Smellie, Theory and Practice of Midwifery, p. iii. 48 Smellie, Theory and Practice of Midwifery, p. iii; for later editions, see for example that of 1762, p. vi. 49 Le Clerc, Histoire de la medecine, 1702, pp. 216–17; 1723, p. 431. 46

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as a midwife.50 Despite using Le Clerc, Smellie constructs a very different Cleopatra, and Elizabeth Nihell rightly criticized him for his negative picture.51 If Smellie indeed used an assistant in summarizing Le Clerc, then the prime suspect would be his pupil Thomas Tomkyns, responsible for the 1746 translation of La Motte’s midwifery work from French into English.52 However, although an assistant would be useful in saving time, there is no reason why Smellie would have needed one on linguistic grounds. He spent time in France studying the use of machines in delivery – although it is not clear how much French he would have needed in order to do this – but also, when Tomkyns translated La Motte, he credited Smellie with having checked the translation. It is therefore likely that Smellie’s own knowledge of the language was very good, and that he used Le Clerc selectively.53 Specifically, his negative evaluation of Cleopatra, taken with his omission of the name of Agnodike, should be understood alongside his promotion of a man, Hippocrates, rather than a woman, as the first ‘midwife’.

The lithopedion of Sens When female midwives attacked their male rivals, at the heart of their disagreement lay the classical languages that formed the basis of men’s education. Jane Sharp had pointed out in 1670 that ‘it is not hard words which perform the Act’ of delivering babies.54 Elizabeth Nihell referred to men’s ‘hard words and harder hearts’ and their ‘cloud of hard words and scientific jargon’, using ‘hard Latin and Greek words, so fit to throw dust in the eyes of the ignorant’.55 What of Smellie’s own abilities in Latin and Greek? His library contains classical grammars published in 1740 and 1742, many years after he would have left the Lanark Grammar School; neither shows signs of use.56 He also owned a school textbook

50

Smellie, Theory and Practice of Midwifery, p. iii. Nihell, A Treatise on the Art of Midwifery, p. 34. 52 Guillaume Mauquest de la La Motte, A General Treatise of midwifery ... illustrated with upwards of four hundred curious observations and reflexions concerning that art, tr. Thomas Tomkyns (London, 1746). Tomkyns also translated Jacques Daran’s treatise on the urethra, published in English in 1750 as Chirurgical Observations on the Disorders of the Urethra (London). 53 McClintock, Smellie’s Treatise, vol.1, p. 10. His library included the 12th edition of Abel Boyer, The Compleat French Master for Ladies and Gentlemen (London, 1737); this could have been purchased to help him when in France in 1739 studying artificial machines to teach midwifery. 54 Sharp, The Midwives Book (ed. Hobby), pp. 3–4; see King, ‘“As if None Understood the Art that Cannot Understand Greek”’. 55 Nihell, A Treatise on the Art of Midwifery, pp. 11, 77, 147. 56 J. Milner, A Practical Grammar of the Greek Tongue, 2nd edition (London, 1740) and A Practical Grammar of the Latin Tongue, 2nd edition (London, 1742). 51

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on classical grammar.57 His training at the Grammar School in Lanark had certainly included Latin to a high standard, but one of his errors made Burton doubt whether Smellie was confident in reading this language – or whether someone else had written this section. This is when Smellie ‘palm[s] upon us an Author that never existed’; Burton gleefully announced that, despite six years of preparing the book, Smellie had managed to convert ‘an inanimate, petrefied Substance, into an Author’.58 This, the most blatant and least disputed example of misunderstanding in Smellie’s historical section, concerns the calcified foetus known as the lithopaedion of Sens.59 When Colombe Chatry, a tailor’s wife, died in May 1582 at the age of 68, her body was opened up to discover what had happened to a pregnancy she had started 28 years earlier, which had never come to anything but had left her with years of abdominal pain and loss of appetite. A petrified female foetus was discovered, and was first described by one of those who saw it immediately after its discovery, the physician Albosius (Jean d’Ailleboust), in the Portentosum Lithopaedion of 1582; Siméon de Provanchères translated this work into French. The Spach Gynaeciorum included a picture of the prodigy after the text of Rousset, and an accompanying epigram linked it to the ancient Greek myth of the flood, in which the two survivors, Deucalion and Pyrrha, repopulated the world by walking over the earth and throwing stones behind them, which were transformed into living beings.60 Roughly translated from the Latin, this epigram read as follows: ‘Deucalion cast stones behind him and thus fashioned our tender race from the hard marble. How comes it that nowadays, by a reversal of things, the tender body of a little babe has limbs more akin to stone?’61 While the stones thrown by Deucalion softened to become mortal, the lithopaedion had hardened from flesh to stone; contemporary medical writers explained this by suggesting that the cause of the phenomenon was the coldness of the womb. Horatius Augenius discussed the case in detail in 1597.62 When Rousset’s treatise on Caesarean 57

Grammatica Busbeiana, rudimentum grammaticae Graeco-Latinae metricum in usum nobilium puerorum in Schola Regia Westmonasterii (London, 1696); an earlier owner was William Colman, in 1700. This was one of many Greek and Latin school texts by Richard Busby (1606–95), headmaster of Westminster School. 58 Burton, A Letter to William Smellie, p. 1. 59 Johnstone, William Smellie, p. 94 rates this as ‘Perhaps Burton’s most telling and unanswerable “score”’. Glaister, Smellie and his Contemporaries, pp. 270–71 admits that Burton ‘caught Smellie napping’, and that this was ‘a very stupid mistake’. 60 Spach 1597, p. 479; Joannes Albosius, Portentosum lithopaedion, sive embryon petrefactum urbis Senonensis (Sens, 1582). The myth of Deucalion was best known through its version in Ovid, Metamorphoses, 1:375–90. 61 Finxit Deucalion saxis post tergo repulsis/Ex duro nostrum marmore molle genus:/ Quî fit ut infantis, mutatâ forte, tenellum./Nunc corpus saxis proxima membra gerat!/Flectebat Priscos diuina potentia mores,/Nostra ferunt nullum fera colla iugum. 62 Horatius Augenius, Epistolarum ex consultationum medicinalium libri XXIIII in duos tomos distributi (Frankfurt, 1597), book 2.

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section was separately published in various editions from 1588 onwards, Albosius’s description of the stone child was added at the end of it, with a long verse debate between the characters Pirologistes and Palaeomanes.63 The lithopaedion of Sens was very famous, discussed extensively in its own day, and included in the literature of the monstrous thereafter.64 The foetus was exhibited in several cities of Europe – the midwife Louise Bourgeois, for example, saw it before 1636 in Paris where it was in the possession of a merchant, M. Pretesegle. At this stage, she noted that it was missing one hand, which had remained stuck to the placenta.65 In 1653 the lithopaedion was in Italy, from where it passed to the cabinet of curiosities of King Frederick III of Denmark, and remained there until its disappearance from the Danish Museum of Natural History some time after 1826.66 In Smellie’s first edition, he listed the title of the image in Spach – Lithopedus Senonensis – as an author.67 In 1753, Burton ridiculed this as follows: The seventeenth Author [included in the Gynaeciorum], collected, as you tell us, by Spachius, is Lithopedus Senonensis, which instead of being an Author, is only the Drawing of a petrefied Child, when taken from its Mother, after she was opened; and this is evident from the Title, Lithopaedii Senonensis Icon, which, with the Explanation, is contained in one single Page only. The Account of it, as published by Albosius in 1582, in Octavo, may be seen at the end of Cordaeus’s Works in Spachius, whence 68 again, I think, it is evident you must have taken your Extracts from some bad Copier.

63 E.g. François Rousset, Exsectio foetus vivi ex matre viva sine alterutrius vitae periculo, et absque foecunditatis ablatione (Frankfurt, 1601). 64 See, for example, Thomas Bartholin, Historiarum anatomicarum rariorum centuria I et II (Amstelodami, 1654), pp. 319–26; Henri Stofft, ‘Un lithopédion en 1678’, Histoire des Sciences Médicales, 20 (1986): 267–85; George M. Gould and Walter L. Pyle, Anomalies and Curiosities of Medicine: being an encyclopedic collection of rare and extraordinary cases, and of the most striking instances of abnormality in all branches of medicine and surgery derived from an exhaustive research of medical literature from its origin to the present day (Philadelphia, 1901), p. 50, where Spach is wrongly dated to 1557. The Sens case is discussed at length by Jan Bondeson, ‘The Earliest Known Case of a Lithopaedion’, Journal of the Royal Society of Medicine 89 (1996): 13–18. For other lithopaedia in the medical literature, see the extensive survey of Friedrich Küchenmeister, ‘Über Lithopädien’, Archiv für Gynaekologie, 17 (1881): 153–259 with the detailed account in Grace Parkhurst Bernard, ‘Lithopedion from the Case of Dr. William H.H. Parkhust, 1853’, Bulletin of the History of Medicine, 21 (1947): 377–89. On prehistoric cases, see Bruce M. Rothschild, Christine Rothschild and Leland C. Bement, ‘Lithopedion as an Archaic Occurrence’, International Journal of Osteoarchaeology, 4 (1994): 247–50. 65 Louise Bourgeois, Les Observations de Louise Bourgeois, book 2 (Paris, 1626), p. 99. 66 Bondeson, ‘The Earliest Known Case of a Lithopaedion’, pp. 14–16. 67 Smellie, Theory and Practice of Midwifery, p. l. 68 Burton, A Letter to William Smellie, p. 21.

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The error and Burton’s attack on Smellie were sufficiently well known to form the basis of a passage in Sterne’s Tristram Shandy, which appeared in instalments between 1759 and 1767. In what has been described as ‘the most amusing footnote in Tristram Shandy’, Sterne described how Tristram’s father, ‘who dipp’d into all kinds of books’, looked into ‘Lithopædus Senonesis de Partu difficili, published by Adrianus Smelvgot’ – clearly meant to be Smellie.69 The footnote states ‘The author is here twice mistaken; – for Lithopædus should be wrote thus, Lithopædii Senonensis Icon. The second mistake is, that this Lithopædus is not an author, but a drawing of a petrified child. The account of this, published by Albosius, 1580, may be seen at the end of Cordæus's works in Spachius. Mr. Tristram Shandy has been led into this error, either from seeing Lithopædus’s name of late in a catalogue of learned writers in Dr. ---- , or by mistaking Lithopædus for Trinecavellius, – from the too great similitude of the names’.70 The Jean d’Ailleboust/Siméon de Provanchères account of the lithopaedion does indeed appear in Spach after the text of Maurice de la Corde’s commentary on Hippocrates, Diseases of Women I; it was also part of the original, 1585, printing of de la Corde’s work.71 One of the annotators of a copy of Spach held in Manchester cross-referenced de la Corde’s text to the image.72 But, as Glaister rightly points out, Smellie caught this embarrassing error in time to correct it for the second edition published later in 1752, before Burton’s criticisms had come out; in this sense, Burton’s attack is unfair.73 In this and subsequent editions, Smellie wrote: There is also the figure of a petrified child, extracted from the womb after the death of the mother; a particular account of which is added to Cordaeus’s comment upon 74 Hippocrates.

While the second part of this section is a little misleading, the phrasing does suggest that Smellie had by now certainly looked at a copy of Spach. But the reference to de la Corde’s text as a ‘comment upon Hippocrates’ suggests that Smellie had only looked at the running header, where ‘comment.’ is an abbreviation for ‘commentary’; the text has ‘In Hippocr. Lib. I de’ on one page, and the continuation ‘Muliebr. Comment.’ with the section number on the facing 69

Cash, ‘The Birth of Tristram Shandy’, p. 137. Vol. 2, ch. 19. The date given, 1580, is of course incorrect. 71 Spach 1597, pp. 742–3; Maurice de la Corde, Hippocratis Coi, Medicorum principis, liber prior de morbis mulierum (Paris, 1585), 359–61. 72 Parkinson Coll./2320, M1,G67,F, Spach 1597 pp. 479 and 740: the first is marked historia invenis pg. 740, the second figuram invenies pg. 479. 73 Glaister, Smellie and his Contemporaries, p. 271; Cash, ‘The Birth of Tristram Shandy’, p. 136. Burton did note places where Smellie had made changes between the first and second edition; for example, A Letter to William Smellie, p. 15, n. (g), ‘This Mistake the Author has corrected in the 2d [sic] edition’. 74 Smellie, Theory and Practice of Midwifery (second edition), p. l. 70

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page. Not only the error concerning the lithopaedion, but also the phrasing of the correction, could thus be used to support Burton’s claims that Smellie was not confident with Latin, or had used someone else to summarize Spach. But it is also possible that ‘comment’ for ‘commentary’ was simply a printer’s error rather than Smellie’s own. I shall now turn to some detailed examples of medical practice in which Latin and Greek lay at the heart of the dispute between Smellie and Burton.

The case of the ass’s urine One of the many conditions taken from classical Greek medicine that remained part of the early modern catalogue of women’s diseases was the fluor albus, the ‘white flux’, also known as the flores albi or ‘white menses’. It was regarded as a fluid ‘neither menstrual nor seminal’; virgins did not have it and, following a comment in the Hippocratic Diseases of Women, some thought it more common in older women.75 However, because the ancient texts were not unanimous in this, another group of practitioners regarded it as affecting young women.76 Rejecting Astruc’s attempts to classify the disease into several ‘different species’, Thomas Young described it as ‘a disease that often baffles the prescriptions of the ablest physicians’ and warned that it was not necessarily always a disease; it could be due to nature purifying the blood.77 This condition was one of those singled out by annotators of the Gynaeciorum libri collection, and was also one to which Smellie devoted particular attention in his history of medicine.78 He was impressed by the sheer amount of Hippocratic material on the diseases of women, noting that Hippocrates ‘prescribes more medicines for the relief of the suffering fair, than are to be met with in the rest of all his works’, a point made more recently by commentators on the Hippocratic texts, who believe that the gynaecological works derive from a female oral

75

Mercuriale, in Spach 1597, p. 277: neque menstruae sunt, neque semen; Diseases of Women 2. 110 (Littré 8. 234). 76 E.g. Dubois, De mensibus mulierum, et hominis generatione, Iacobi Silvii medicae rei apud Parrhisios interpretis Regii, commentarius (Paris, 1555), p. 1v; Livre de la generation de l’homme, tres utile et tres necessaire à savoir, recueilly des antiques et plus leurs autheurs de medecine et philosophie, par Jacques Sylvius, Livre de la nature et utilité des moys des femmes, et de la curation des maladies qui en surviennent, composé en Latin par seu M. Jacques Sylvius (Paris, 1559), p. 122. 77 Thomas Young’s lectures, RCPE p. 76; RCPE ‘Notes on Midwifery’, Young, T. 8, pp. 135–6. 78 Copy Parkinson Coll./1114, M1,G64,Q, Bauhin 1586–88, vol. 4, Mercado bk. 2, ch. 6 was of considerable interest to one annotator, who underlined its equivalence to ‘love fever’ (p. 215) and made marginal notes.

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tradition of remedies.79 Such remedies, Smellie considered, were ‘very strange and uncouth … but a number of them are still accounted excellent in the present practice’.80 As part of a section designed to give a ‘succinct account’ of Hippocrates’ practice by showing that the ‘diagnostics, prognostics, and method of cure’ used by Hippocrates ‘are often just and judicious’, Smellie stated In a Fluor Albus, he [Hippocrates] says the urine is like that of an Ass; the patient labours under a pain in the lower part of the Abdomen, loins and ilia, together with a swelling in the hands and legs; her eyes water, her complexion becomes wan and 81 yellow, and in walking she is oppressed with a difficulty of breathing.

Burton argued that this was based on a mistranslation, and that in fact Hippocrates described not the sufferer’s urine, but the appearance of the peccant substance itself, as flowing ‘white like the urine of an ass’. In support of this translation, he raised the scholarship stakes by referring to two works by Anuce Foës: Oeconomia Hippocratis (1588), and his edition of the Hippocratic corpus, which has the works of Hippocrates laid out with the Greek column on the left, and the Latin on the right of each page.82 Most importantly, the Foës edition also includes notes on the text, explaining difficult words, at the end of sections which cover one or more treatise. These were not books owned by Smellie, and Burton displayed his superior classical training by using them; while his argument may appear pedantic to modern eyes, I would argue that here he is acting more like a sixteenth-century reader comparing textual variants. The question is simple: in this condition, is it the woman’s urine, or her discharge, that resembles the urine of an ass? Smellie argued for the first, while Burton supported the second. However, a third option also existed, namely that the discharge simply looks like ‘urine’, with no mention of an ass. In criticizing Smellie, Burton first cited a passage from Diseases of Women 2.116, ‘De morbis mulierum 2, p. 641. line 8’. The page reference is to Foës, who indeed gave the Latin as in fluore albo effluit quid album velut asini urina, ‘In the white flux there

79

Smellie, Theory and Practice of Midwifery, p. v. Compare Aline Rousselle, ‘Images médicales du corps. Observation féminine et idéologie masculine: le corps de la femme d’après les médecins grecs’, Annales E.S.C., 35 (1980): 1089–1115. 80 Smellie, Theory and Practice of Midwifery, p. v. 81 Ibid., pp. v–vi. 82 Anuce Foës, Oeconomia Hippocratis, alphabeti serie distincta (Frankfurt, 1588); Tou megalou Ippokratous Panton ton iatron koryphaio ta euriskomena, Magni Hippocratis Medicorum omnium facile principis, opera omnia quae extant (Frankfurt, 1624). George Sarton, The Appreciation of Ancient and Medieval Science during the Renaissance (1450– 1600) (Philadelphia, 1955), p. 12 rates these two extraordinary works as ‘the climax of the Renaisssance Hippocratic tradition’.

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flows something white, like the urine of an ass’;83 DW 2 thus supports Burton rather than Smellie, as it is the discharge that looks like an ass’s urine. Burton then turned to another Hippocratic text which also discusses the fluor albus, On the Nature of Woman 15, and suggested that Smellie’s error could have been caused by ‘the Copier’s not understanding the Original’ of this. The Latin of Foës here read Cum fluor albus subortus fuerit, urina qualis asini apparet.84 The urine is thus the subject of the second clause, and so it could indeed be read to suggest that it is the woman’s urine that resembles that of an ass. Burton then noted that one of the works in Spach – that of Luis Mercado – gave a slightly different rendition of NW 15, reading cum fluxus albus obortus fuerit, velut urina asinina apparet; here, as in DW 2, it is once again the discharge that looks ‘like the urine of an ass’.85 In this instance, then, Burton seems to be arguing that the readings of the text in Spach are superior to those of other Latin translations available. However, Foës’s Latin text was not his final word on the subject, and Burton went on to quote from the notes to Foës’s edition. There, looking at the Greek original of NW 15, Foës noted that his Latin was not simply a translation of the Greek, as this original had simply ‘like urine’ (οί[ον ου]ρον); it was the decision of Foës to read this as ‘ass’s urine’ (ο!νειον ου]ρον).86 These disagreements derive from the manuscript tradition on which the printed editions were based. Latin translations derived from the manuscript ms. Marc. Venet. 269 (the more common ‘M’ tradition) omitted the word for ‘of an ass’, making the sentence of On the Nature of Woman 15 state that the white flux ‘appears like urine’, but manuscripts of the superior ‘V’ tradition, based on ms.

83

Burton, A Letter to William Smellie, p. 7, n. (e). In the Littré edition, this is DW 2.116 (L 8. 250). Leah Patton of the American Donkey and Mule Society (pers. comm. 1 December 2005) tells me that the urine of a donkey is not visibly different from that of a horse – strong smelling, dark yellow, tending to froth at the edges of the puddle – but, because it contains ammonia, it dries to whitish crystals. However, the London Zoological Library (pers. comm. 2 December 2005) points out that donkeys have a low water requirement, and in comparison to similar animals they can cope with a relatively high level of dehydration. When there is a need to conserve water, their urine can become very concentrated, having a thick, syrupy and whitish colour. In a Mediterranean climate, it is therefore likely that the ‘ass’s urine’ would indeed be whiter than that of a horse. 84 Burton, A Letter to William Smellie, p. 8; Foës ‘De natur. muliebr. p. 567, l. 51’ (Littré VII, p. 332); Burton’s Greek is not identical to the edition of Littré, and this too is ambiguous, as it could be translated either as ‘the urine appears, as it were, of an ass’ or ‘it [the fluor albus] appears as it were the urine of an ass’. 85 Spach, Gynaeciorum libri, p. 856. On p. 857, Mercado cites DW 2, as Fluxus albus fluit, veluti alba asini urina … 86 This is wrongly referenced on p. 8 by Burton to the Oeconomia Hippocratis; in fact it comes from Foës, Magni Hippocratis Medicorum omnium facile principis, opera, p. 706, n. 52.

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Vat. Graec. 276, included this word.87 The Greek text used by Foës was from the ‘M’ tradition and thus omitted the analogy with the ass’s urine, and he commented that all previous published versions were also based on this, thus giving ‘appears like urine’. However, he noted that the Vatican manuscript included the word for ‘ass’, and preferred this reading because it would make the text closer to the other description of the condition in DW 2.88 Burton, in arguing that the fluor albus looks like an ass’s urine, was following the best Greek manuscripts here, and made it clear that he realized there were two different Hippocratic accounts of the condition; the writers in Spach also recognized this. In supporting the option that the woman’s urine looks like that of an ass, Smellie was clearly relying entirely on the inferior manuscript tradition for the passage from NW 15; the rest of the symptoms he listed come from this. But which printed book was he using here? As I noted in chapter 2, although this section was included in a book which he owned – Burnet’s Hippocrates Contractus – Smellie went on to give the details of therapy for the condition, which Burnet omitted, so it is clear that he was not using Burnet here; at the end of the section, Smellie recommended remedies ‘to deterge and strengthen the genitals’.89 It therefore appears that Smellie used another book as his source for the NW 15 version of fluor albus. Was this Spach? How would a user of Spach find the relevant passages, and what would he find there? As I noted in chapter 1, in addition to a list of chapter headings at the beginning of the volume, the 1597 edition contains a very detailed index; it included entries such as ‘what are the white flowers?’ and ‘the white flux of women’.90 Here, as in many other situations, the problem of the Gynaeciorum 87

Littré VII p. 333. See Helga Trapp, Die hippokratische Schrift De natura muliebri: Ausgabe und textkritischer Kommentar (PhD thesis, Hamburg, 1967). For a concise discussion of the manuscript tradition of the corpus, see Jean Irigoin, ‘Tradition manuscrite et histoire du texte: quelques problèmes relatifs à la Collection hippocratique’, La Collection hippocratique et son rôle dans l’histoire de la médecine, Colloque de Strasbourg, 23–27 October 1972 (Leiden, 1975), pp. 8–9. My thanks to Ann Hanson for discussing these textual problems with me. 88 Foës, Magni Hippocratis Medicorum omnium facile principis, opera, p. 706: Sic legunt exemplaria omnia publicata, sed Vaticana ονου ουρον φαινεται legunt, quam lectionem cum Interpretibus sequor ex lib.2 περι γυναικ. scribitur … With regard to printed editions, Foës is not correct here; the 1525 Calvi Latin translation of the complete Hippocratic corpus rendered the phrase as the muddled Cum autem albus fluor, rhoosue intus gignitur, tanquam lotium asinum exit …(p. lxxiii), the 1546 Cornarius edition included the ass’s urine, giving Quum fluxus albus obortus fuerit, velut urina asinine apparet (p. 291). 89 Burnet, Hippocrates contractus (1743 edition), p. 124 gives Cum fluor albus subortus fuerit, urina qualis asini apparet, et dolor imum ventrem, lumbos ac laterum inanitates (κενεωνες) detinet; Smellie, Theory and Practice of Midwifery, p. vii. In his second edition, this was altered to ‘… the parts affected’. 90 Spach 1597, index (no page numbers): flores albi quid; albus fluxus muliebris, etc.

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libri collection is that it is a compilation; different contributors have different opinions, and there is no way for the reader to judge between them. Hippocrates was so important because, if he said something, then it had the authority of antiquity; but, in this case, the Hippocratic texts said different things. Looking at the authors included in the Spach Gynaeciorum libri, the section used by Smellie is close to a passage from the work of Martin Akakia, who used NW. However, Akakia took the side of Burton rather than Smellie, going for the option that the white flux is like the urine of an ass, in both its colour and its consistency.91 All the symptoms given by Smellie are here, but if he based his text on this passage, then he has clearly compressed it; Akakia gave a much fuller, and thoroughly referenced, account explaining why each symptom occurs, and ranging across the Hippocratic corpus for support. A shorter account of the white flux, citing both NW and DW 2, can also be found through the index to Spach; this is from Mercuriale, who listed one of the signs of the condition as Hippocrates … scribit, urinas harum esse, veluti sunt asininae (‘Hippocrates … writes, that their urines are like those of an ass’).92 Using Akakia would suggest to Smellie that the white flux itself looked like an ass’s urine: but if he used Mercuriale then he would indeed think that it is the woman’s urine that looks like that of an ass. However, if he had indeed used Mercuriale, then he would have immediately seen that a discussion of the fluor albus requires reading of both the NW and the DW passages; Mercuriale cited both. A third possibility is the passage of Mercado to which Burton referred, which gives a translation of the entire section of NW 15 quoted by Smellie. But Smellie did not need to look in Spach to find these passages from Hippocratic gynaecology. As we have already seen, his library also included the 13-volume set of the works of Galen and Hippocrates in both Greek and Latin edited by Chartier in 1679. In volume VII, on the causes and symptoms of diseases, both On the Nature of Woman and Diseases of Women 2 could be found, and ink underlining on the chapter heading and in the text itself indicates that a user – I would argue, Smellie himself – had read NW 15.93 The complementary passage in DW 2 is not marked.94 Supporting the argument that Smellie used Chartier, not Spach, is one further clue; his use of the Latin word ilia, meaning the side of the body from the hips to the groin, in his description of the sites of the woman’s pain, a word not found in the Mercado version, but present in the Chartier translation.95 Smellie’s phrase concerning remedies ‘to deterge and strengthen the genitals’ provides the clue enabling us to identify one further source in his library being used here. One of his medical dictionaries, the fifth edition of John Quincy’s 91

Akakia chapter 5, in Spach 1597, pp. 757–8. Mercurialis, in Spach 1597, p. 278. 93 René Chartier, Hippocrates Coi, et Claudii Galeni Pergameni Archiatrôn Opera (Lutetiae Parisiorum, 1679), p. 688. 94 Chartier, Hippocrates Coi, p. 799. 95 … dolor imum ventrem, lumbos ac ilia detinet … 92

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Lexicon physico-medicum (1736), included an entry on fluor albus. While this was very different from the Hippocratic discussions of the condition – regarding it as much like gonorrhoea – and contained nothing on the analogy with an ass’s urine, it did note that the cure ‘requires deterging and strengthening’.96 I would therefore argue that, while Smellie could have investigated Spach for his section on the fluor albus, there is no reason why he needed to do this. His own edition of the Hippocratic texts, with a dictionary entry on the condition, gave him everything he needed, and there is the evidence of annotation supporting his use of the former. It is significant that he privileged the Hippocratic discussion of Nature of Woman over the contemporary description given by Quincy. The dispute between Burton and Smellie here can be reduced firstly to which of two Hippocratic passages is preferred, and secondly to its proper translation.

To cut or not to cut? Another Hippocratic text, On Superfoetation 15, describes what to do in a labour which is difficult because the child ‘does not come out of the womb easily’ but only ‘with hard work (Gk ponos) and with the contrivances (Gk mêchanêisin) of the physician’.97 Even then, the writer warns, such children have few chances of survival. He goes on to instruct the practitioner not to cut the umbilical cord before the child passes water, sneezes or cries, and adds that one should not touch the child; the mother should ‘draw near to the child, as near as possible’. For eighteenth-century physicians, this text was relevant to one of the liveliest debates of the period, revolving around when to cut the cord if a child was born weak; quite simply, should Hippocrates be followed here? For Burton and Smellie, another question concerned the precise meaning of mêchanêisin in this passage. Smellie’s version of this passage translated it as ‘machines’, reading as follows: He [Hippocrates] afterwards observes, that if the woman has had a difficult labour, and could not be delivered without the help of machines, the child is generally weak, and therefore the navel-string ought not to be divided, until it shall have either urined, sneezed, or cried aloud; in the mean time, it must be kept very near the mother; for though the child does not seem to breathe at first, nor to give other signs of life, the navel-string, by remaining uncut, may be in a little time inflated, and the life of the 98 infant saved. 96

John Quincy, Lexicon physico-medicum: or, a new medicinal dictionary (London, 1736), p. 171. 97 Superfoetation 15 (Littré VIII p. 484). On ponos, see King, Hippocrates’ Woman, pp. 123–6. In early printed editions of this Hippocratic text, the chapter divisions are placed differently than in Littré, so that in some cases the instructions on cutting the cord only when the child has passed urine, sneezed or cried are taken as equally applicable to all births, rather than being restricted to the child born after a difficult labour. 98 Smellie, Theory and Practice of Midwifery, p. xiii.

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The debate over whether to cut the cord immediately was not a new one caused by man-midwifery; however, because this action had long been part of the work of the traditional midwife, sometimes the different procedures possible were grouped on one or other side of the gender divide. For example, in 1671 the midwife Jane Sharp had recommended cutting the cord immediately: ‘so soon as ever the Child is born’.99 Henry Bracken described how, if the child were weak, midwives would apply the afterbirth to its belly ‘to comfort and revive it’, a custom which he condemned as ‘ridiculous and stupidly foolish’; however, this practice had been recommended by Guillemeau in 1612.100 A variant was to warm the afterbirth to revive the child.101 Bracken also warned midwives not to squeeze the blood from the cord back into the child’s body. This practice of ‘put[ting] the blood back by the Navel vein’ was recommended by Jane Sharp in order to ‘refresh a weak child’, while a ‘very weak’ child could be revived ‘like one awak’d out of sleep’ by this process; she also added that blood from the cord should be squeezed out and given to the child to drink.102 The first part of this advice, at least, is not some sort of folk wisdom; it comes from no less an authority than Aristotle, who in Historia animalium described how ‘certain midwives’ had the skill to squeeze the blood back into the child, reviving it.103 The information was also repeated in the popular manual, Aristotle’s Masterpiece.104 But it was widely condemned by menmidwives. Like Bracken, Giles Watts condemned midwives who squeezed back the blood, saying that it sends blood which is ‘half clodded, and destitute of its natural Heat’ to the child’s liver, where it mixes with the rest of its blood. If the child is already weak, then this practice will be even more dangerous.105

99

Sharp, The Midwives Book (ed. Hobby), p. 164. Bracken, The Midwife’s Companion, p. 207; Guillemeau, Child-Birth or, the Happy Deliverie of Women, p. 96. See also Lloyd, ‘The “Languid Child” and the Eighteenthcentury Man-midwife’, p. 650. 101 KCL TH/PP5, pp. 365–6. The lecturer, Denman, commented that it was clear that Nature was ‘very stubborn’, as children survived despite contradictory approaches taken by midwives. 102 Sharp, The Midwives Book (ed. Hobby), pp. 164 and 166. See Lloyd, ‘The “Languid Child” and the Eighteenth-century Man-midwife’, p. 649. Other seventeenth-century midwives sometimes had their own special procedures to revive a languid child; see Evenden, The Midwives of Seventeenth-Century London, p. 84. 103 Aristotle, Historia animalium 587a19–24. 104 London, 1753 edition; pp. 72–3 states that, if the child is weak, the midwife should ‘gently put back part of the vital and natural blood in the body of the child by the navel, for that recruits a weak child, the vital and natural spirits being communicated by the mother to the child by its navel string’. If the child appears dead, it can be revived by oral administration of 6–7 drops of blood from the cut cord. This material is repeated in Aristotle’s Complete and Experienced Midwife (London, 1749?), p. 67. 105 Watts, Reflections on Slow and Painful Labours, pp. 37–8 and 40–41, following Mauriceau. 100

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In a normal birth, men-midwives tended to cut the cord at once, and then manually deliver the placenta, a manoeuvre known as ‘passing the hand’.106 The issue of whether or not to do this when the child was weak was framed in terms of the belief that the mother and child shared a blood circulation system; it was therefore thought that the child should not be separated until enough of the mother’s blood had passed into its body. It was not until 1754 that William Hunter realized that the maternal and infant blood systems were entirely separate. In this debate in the years immediately before this discovery, Smellie believed in waiting: Burton argued that the cord should be cut at once, and accused Smellie of having ‘misconstrued’ the Greek of the passage from On Superfoetation. On the general issue of whether the On Superfoetation passage should be taken seriously, the opinion of Smellie’s pupil, Giles Watts, was that Hippocrates on his own was not enough; anything he said needed to be proven in practice: It would, I presume, be to little purpose now, that the Obstetric Art is so extremely improv’d, to propose the laying any stress on the preceding Precept of Hippocrates in Practice; unless it is at the same Time demonstrated to be no random Expression thrown out at a Venture, but to be a Maxim probably derived from long Experience, and to admit of the strongest Arguments on its behalf; deduced from Practice, and the laws of 107 the Circulation in Natis and non Natis.

The value of observation and experience was something agreed upon by both sides of the dispute; Burton, when supporting immediate cutting of the cord, stated that ‘’Tis plain that, by observation, the Ancients had found the Child’s life in Danger, while the Passage through the umbilical Chord [sic] was open, and permitted the Blood to pass to the Placenta’.108 But, in his comments on this passage, Watts used Hippocrates to trump all other ‘Ancients’, saying Here the Dr. [Burton] would urge the observations and experience of the Ancients in this Case, as an insuperable Argument against deferring the tying the Navel-String for a while after Birth: But, unluckily for him, Hippocrates, the very Father of Physick, and most ancient Writer on the Subject, expressly orders … the tying of the Navel-string to 109 be deferred till the Child has made Water, sneezed, or cried.

Watts went on to interpret the passage further, arguing that Hippocrates really meant that one should wait until the child breathes; he tried to demonstrate that neither modern theories of the circulation, nor experience, contradict Hippocrates. 106

Exton, A New and General System of Midwifery, pp. 129–30; RCPE Anon. 24 ‘Cases and Observations & c. in Midwifery by a Practitioner in Surrey’, pp. 135–6, case 120 ‘A Natural Birth’. 107 Watts, Reflections on Slow and Painful Labours, p. 14. 108 Burton, Letter to William Smellie, pp. 22–3; discussed in Watts, Reflections on Slow and Painful Labours, pp. 32–3. 109 Watts, Reflections on Slow and Painful Labours, p. 33.

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However, while waiting for the child to breath, he believed that it was perfectly acceptable to apply ‘volatile Spirits to the Nose’ or to inflate the lungs with a pipe.110 This view clearly came from his attendance at Smellie’s lectures. In notes taken from lectures given in 1745, it is evident that Smellie strongly recommended not only delay in cutting the cord if the child was not breathing easily, but also stimulation to encourage it to do so: The Child now being laid in your Lap, if it does not breath freely and yet the Pulsation of the Umbilical Chord be strong, you may let it lay some minutes before you cut it, which will very much strengthen the Child, and it may be proper to Whip it, or give it 111 any sort of uneasiness that may make it cry stoutly.

In his published work, Smellie advised that, unless the child ‘cries and breathes’, one should always wait to tie the cord, while shaking or whipping the child, rubbing it with spirits, garlic, onions or mustard, and blowing into its mouth. 112 Burton, in contrast, recommended tying the cord immediately so that the blood would not pass back into the mother, but would go into the child’s lungs to enable it to breathe.113 In support of his own position, Burton noted that Smellie’s insistence on waiting went against the advice of a range of authorities represented in the Spach Gynaeciorum, namely Bonacciuoli, Akakia and Mercado; for example, ‘Mercatus tells you, delaying to tie and cut the string is dangerous’. 114 Mercado was here citing On Superfoetation and also Diseases of Women. Akakia, in a chapter on the role of the midwife, quoted from Aristotle in recommending that the cord should be cut if the child is weak, and commended Aristotle’s account of the midwifery practice of squeezing the blood from the cord into the body; approving, Burton cited the relevant passage, in Latin, in full.115 It is clear from later in the same section of On Superfoetation that what really mattered was whether or not the infant had taken a breath; the practitioner was advised to cut the cord if it becomes swollen, so long as the infant is breathing. By the end of the eighteenth century, Osborn and Denman recommended waiting to cut the cord for ‘a few seconds till the change in the circulation has freely taken place, and consequently the pulsation in the Navel String stopped’; they believed 110

Ibid., p. 30. Smellie, Lectures, Wellcome ms. 4630, p. 5 (Lecture 5). 112 Smellie, Theory and Practice of Midwifery, pp. 225–6. 113 Burton, A Letter to William Smellie, p. 26; it should be ‘immediately tyed to prevent the Blood from passing that Way’. 114 Ibid., pp. 22–3; Mercatus in Spach, p. 1058. 115 Akakia in Spach pp. 787–8 = Burton, A Letter to William Smellie, p. 22: Saepe visus est puer semimortuus nasci, cum ei infirmo priusquam deligaretur umbilicus, sanguis a puero ad umbilicum et circa afflueret, unde obstetrices peritiores reprimunt intro de umbilico sanguinem, quo facto statim infans, qui modo exanguis deficiebat, recreatur, vitaeque restituitur; based on Aristotle, Historia animalium 587a19–24. 111

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that it was necessary to accomplish the gradual change from ‘uterine life’ to ‘breathing life’.116 The meaning of mêchanêisin in this passage was one of those points of translation on which Smellie and Burton disagreed. In the standard Greek lexicon, mêchanêsis is listed as the equivalent of mêchanê, a contrivance or artificial means; the former term is used, for example, of the famous ‘Hippocratic bench’, a rack-like device for reducing fractures.117 Where did Smellie get his translation? This section of the text is not included in Le Clerc; he may have used his edition of the Hippocratic corpus, which gave him access to the Greek text, or he could have used Spach. It was Burton’s contention that he had not only copied Spach, but also mistranslated the text. Here is Burton: The first paragraph of your 13th Page may be found in Spachius (p.789, 1057, 1058) and in your next Paragraph the Original is misconstrued. For you have made Hippocrates say, “If the Woman could not be delivered without the Help of Machines, the Child is generally weak;” but that Author says (p.261, 1. the last) - και µηχανησιν ιητρου, et sine ope medici [and without the labour of the doctor]. How you could commit such a 118 Mistake I cannot conceive.

He added, ‘Your translating µηχανησιν into Machines, puts me in mind of the story of Pallet the Painter in Peregrine Pickle, who hearing the Swiss pronounce the Word Magnifique, mistook it for Manufac, as he did Un Bon morçeau, for a Painter’.119 Smellie owned this novel by Smollett who, as we have already seen, worked with Smellie on his own publications in some capacity. It was published in 1751, although we cannot know whether Smellie bought or was given it on publication, or bought it after Burton’s attack on him. He clearly read it. The novel includes an account of a barber who accidentally killed a patient but was pardoned. When the hero, Peregrine, ‘mentioned this assassination to his own trimmer’ he was told ‘that such vivacity is never punished in France’. Smellie wrote beside this ‘X a lie’.120 The first passage to which Burton referred comes twenty pages later, and the second, in which Pallet thinks that ‘un beau morçeau’ is a painter called Bomorso, shortly after.121 116 Wellcome ms. 2098, ‘Sketches of the Practice of Midwifery’ lectures of Osborn/Denman, p. 159 (1776); KCL TH/PP5, 1782 lecture notes, p. 369. 117 LSJ, comparing On Joints 72 (Loeb III, p. 372), where the Hippocratic bench is a mêchanêsis. 118 Burton, A Letter to William Smellie, pp. 9–10. 119 Ibid., p. 10. 120 Tobias Smollett, The Adventures of Peregrine Pickle (London, 1751), vol. 2, pp. 40– 41. In the RCPE catalogue, all four volumes are listed, but the library at Lanark now contains only volumes 2 and 3. 121 Smollett, Peregrine Pickle, vol. 2, pp. 61 and 63–4.

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The comparison with Pallet the Painter suggests that Burton thought Smellie had seen the Greek word µηχανησιν, and had read it as the very similar English word ‘machines’. Certainly, the use of ‘machines’ here may suggest that Smellie had access to the Greek text, which was included in the edition of the works of Hippocrates and Galen that he owned. But in fact it was not necessary for him to look at the Greek, because the edition of the Hippocratic corpus which he owned – the 1679 edition of Chartier – used the same term in Latin, translating the phrase in question as sed cum labore ac Medici machinamentis, ‘but with the hard work or instruments of the physician’.122 Nor was this the only such interpretation around. The origin of this Latin translation lay in the 1546 edition of Cornarius, and the 1525 printed edition of Calvi had also used the word machinamentis.123 Well before the forceps controversy, the English translation of Guillemeau’s 1612 text gave the phrase as ‘by the Chirurgians help, and instruments’.124 Burton’s sensitivity to this translation, and his insistence on understanding the Greek in order to show how very misleading it was here, is therefore noteworthy. Burton argued against Smellie on both linguistic and historical grounds, pointing out that Foës, too, gives sine ope medici, without the labour, or work, of the doctor, and adding that, if Smellie really knew anything about the history of medicine, then he would know ‘that we read of no Machines wherewith to deliver a Woman, but what killed the Child, (except the Fillet) till Avicenna’s Time’.125 Burton is here alluding to the debate among his contemporaries as to whether the forceps was known before the seventeenth century, as well as drawing the distinction between instruments used to deliver a dead child (or to save the life of the mother by ending a labour where the pelvis was too small or the child’s head too large, killing the child in the process of removing it) and the forceps of his own day, which could be used to deliver a live child in some situations. This error of translation – which is, however, far from unique to him –was not corrected by Smellie, but remains in all subsequent editions of the Treatise on the Theory and Practice of Midwifery. Beyond the wicker woman126 Before turning to the use of history in validating the use of instruments, I want to examine one other aspect of Smellie’s choice of the word ‘machines’ here. It has a very special meaning for him, as it is the word he used for one of the innovations 122

Chartier, Hippocrates Coi, p. 863. Calvi 1525, p. xcvii: Si puer i locellis retinet, nec facile, sed cum labore, medicique machinamentis exit …; Cornarius 1546, p. 67: ... sed cum labore ac medici machinamentis... 124 Guillemeau, Child-Birth or, the Happy Deliverie of Women, p. 99. 125 Burton, A Letter to William Smellie, p. 10. 126 Wellc. ms. MSL 105, p. 4v and Wellc. ms. 5108, Thomas Young lectures, 1774, p. 5, on the machines used in France; ‘there they had only a wicker woman and a dead child before it began to spoil’. 123

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of which he was most proud, the models of the pelvis on which he demonstrated to his pupils the mechanism of labour and the correct method of dealing with malpresentations. He was by no means alone in trying to find a way of creating a visual representation of what, in reality, remains unseen; many newspaper advertisements of the 1750s–60s mention ‘machinery’ on which lecturers will demonstrate and machines were also used, for example, by Sir Richard Manningham in 1744.127 Smellie’s own interest in the visual included using Jan van Rymsdyck to illustrate his Anatomical Tables of 1754.128 Like waxworks, machines representing the body were part of the culture of fairs and curiosities in which, as Anita Guerrini has argued, science and street performance overlapped not only to spread information, but also to instil a sense of wonder.129 In London in 1736, a display at the Royal Exchange included a wax womb ‘laid open at the Top, and therein you see the little inhabitant endeavouring to quit his Prison, and be released’, a reference to the ancient belief that labour is initiated by the child’s attempts to escape from the womb, a model which makes the labouring woman passive.130 In 1747 the public could pay a shilling to see the model of a woman in the eighth month of pregnancy ‘chained down upon a Table, supposed to be opened alive’ as one of the main attractions at Benjamin Rackstrow’s museum.131 The link between entertainment and education was close. In France, Mme du Coudray used machines to teach midwifery in around 1760; hers included clear and red fluids to make for greater realism, which recalled the 127

Lawrence, Charitable Knowledge, p. 187. Richard Manningham had earlier used a ‘Glass machine’ to teach midwifery; see his An Abstract of Midwifery, p. 21. 128 William Smellie, A Sett of Anatomical Tables, with explanations, and an abridgment, of the practice of midwifery, with a view to illustrate a treatise on that subject, and collection of cases (London, 1754); on the visual side of Smellie’s teaching, see Cody, Birthing the Nation, pp. 167–70, who points out that van Rymsdyck’s images, which stress the unborn child rather than its mother, were given wider circulation in the Encyclopaedia Britannica of 1771. 129 Anita Guerrini, ‘Anatomists and Entrepreneurs in Early Eighteenth-century London’, Journal of the History of Medicine, 59 (2004): 219–39: p. 224. 130 A Catalogue and Particular Description of the Human Anatomy in Wax-Work, and several other preparations to be seen at the Royal-Exchange (London, 1736), p. 13. On the wax-works of the period, see Bonnie Blackwell, ‘Tristram Shandy and the Theater of the Mechanical Mother’, English Literary History, 68 (2001), pp. 88–91. 131 On the public display of the model of a pregnant woman, see An Explanation of the Figure of Anatomy, wherein the Circulation of the Blood is made visible thro’ Glass Veins and Arteries, with the Actions of the Heart and Lungs. As also, the Course of the Blood from the Mother to the Child, and from the Child to the Mother (London, 1737); the same leaflet was used in 1747 when the model was displayed at Benjamin Rackstrow’s museum. The model arrived in London in 1733; see Maritha Rene Burmeister, Popular Anatomical Museums in Nineteenth-century England (PhD thesis, Rutgers University, 2000), pp. 33 and 54 n. 31. Lieske, ‘Configuring Women’, pp. 71–2, wrongly dates the model to 1739. On Rackstrow, see Richard D. Altick, The Shows of London (Cambridge, MA and London, 1978), pp. 55 ff; Guerrini, ‘Anatomists and Entrepreneurs’, pp. 236–7.

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glass veins and arteries of the model of the circulation of the blood between the foetus and mother in the eight-months pregnant woman exhibited in London in the previous decades.132 Smellie took realism in a different direction. From a visit to Paris in 1739, when he watched the Grégoire family using such models, he learned to use a model pelvis to demonstrate delivery positions.133 But his own ‘Machines’ were very different; whereas the Grégoire machines were based on a real pelvis covered in leather, within a basket-work structure, Smellie added to a real pelvis ligaments, muscles and skin in artificial materials, and used cloth dolls to simulate the foetus. The aim was to ‘exactly imitate real women and children’, different machines being used for different problems that the man-midwife may encounter, such as the ‘Circumstances of the Child’, ‘the Narrowness of the Bones of the Mother’ and so on.134 The syllabus to Smellie’s course shows that the ‘Machines’ were in regular use, alongside ‘wet and dry Preparations, and other artificial Contrivances’ to add to the accuracy of what was shown to the students.135 He also developed artificial wombs with hinges, some also having glass windows.136 However, all these aids alone were not supposed to be sufficient to teach midwifery; as noted in chapter 2, students were also expected to attend ‘real labours’. Accounts survive from contemporaries who saw these machines in use, and his students and successors praised them because they meant that ‘every material circumstance might be laid open to the naked Eye’; on the advantages of ‘ocular demonstration’ over words, one admirer commented that ‘Were we to describe the method of buckling our own shoes it would puzzle a Philosopher to understand

132

Nina Gelbart, ‘Midwife to a Nation: Mme du Coudray Serves France’ in Hilary Marland (ed.), The Art of Midwifery. Early Modern Midwives in Europe (London, 1993), p. 138. Hoolihan, ‘Thomas Young’, pp. 336–7 argues that he too probably used machines. Pam Lieske, ‘Configuring Women: William Smellie’s Obstetrical Machines and the Poor’, Studies in Eighteenth-Century Culture, 29 (2000): 65–86 attempts to trace the origin of such machines to the wax and ivory models of the body found in Europe from the fifteenth century, in particular describing Jan Swammerdam’s wax uterus made in 1672. 133 Johnstone, William Smellie, pp. 16–17; Hibbard, The Obstetrician’s Armamentarium, pp. 28–30. 134 Smellie, A Collection of Cases and Observations, p. 354; Anon., A Catalogue of the Entire and Inestimable Apparatus for Lectures in Midwifry, Contrived with Consummate Judgment, and Executed with Infinite Labour, by the Late Ingenious Dr William Smellie, Deceased (London, 1770), p. 6. 135 Wellcome ms. 4630. Some of the ‘wet and dry preparations’ were also sold in 1770; see A Catalogue of the Entire and Inestimable Apparatus for Lectures in Midwifry, pp. 4–5. They included ‘A complete pelvis united by its natural ligaments’, ‘The Vagina and Uterus of a Young Subject’, and many embryos, the youngest being 10 days old. There was also ‘A very curious Monster, or double child’. 136 A Catalogue of the Entire and Inestimable Apparatus for Lectures in Midwifry, p. 6.

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us’.137 By 1747 Smellie had three machines, with six ‘artificial Children’.138 He continued to develop the dolls, one for example having a head that separated from the body so that he could demonstrate the difficult situation in which the head remained in the uterus after the rest of the body had been extracted with instruments.139 Four machines and eight of the dolls were sold at auction in June 1770 by one of his heirs, Dr John Harvie, the husband of Smellie’s niece.140 One machine, bought by William Hunter, was subsequently sold to Smellie’s pupil Edward Foster of the Rotunda Hospital in Dublin, where he was using it in 1774.141 Opponents found various aspects of Smellie’s teaching machines unconvincing. By 1760, Elizabeth Nihell famously dismissed them as ‘a mere wooden machine’ or ‘a wooden statue’, and the babies as ‘a wax-doll’ or ‘an artificial doll’.142 William Douglas correctly described the machines as based on those used in Paris, where ‘Madam is a Piece of Basket-work, covered with a Kind of Silk, in Imitation of her Skin, and appears in her Buff’. But as well as being made of ‘natural Bones’, in the Smellie machines ‘she has the Addition of Shoes, Stockings, and the common Apparel of Women, but of what Use are these to the Learner?’143 The quest for realism, then, included female clothing. As for the dolls, Douglas compared Smellie unfavourably with the French, who ‘use a natural Foetus in their Machines’, rather than his ‘little stuffed Babies’.144 While some preferred them to the unpleasant tendency of real corpses to shed skin when touched,145 the ‘stuffed

137

RCPE ‘Notes on Midwifery’, classified as Young, T. 8, pp. 2–3. Colin Mackenzie praised the machines, and also continued to use them (Wellc. ms. 3392, pp. 6 and 122). 138 An Answer to a Late Pamphlet, p. 17. 139 A Catalogue of the Entire and Inestimable Apparatus for Lectures in Midwifry, p. 6. 140 Ibid., p. 6. The certificate of Harvie’s attendance at Smellie’s course, dated 1 December 1757, was found in an attic in Carlisle and is now preserved at the Royal College of Obstetricians and Gynaecologists, GB 1538 S52 (S52/1). On this certificate, Smellie adds that ‘Mr John Harviey, Surgeon, lived with me several years and helped me with my practice’. 141 Manuscript note on RCOG copy of the sale catalogue, A Catalogue of the Entire and Inestimable Apparatus for Lectures in Midwifry; T. Percy C. Fitzpatrick and Henry Jellett, The Book of the Rotunda Hospital (London, 1913), pp. 81–2; Blackwell, ‘Tristram Shandy and the Theater of the Mechanical Mother’, pp. 95–6, citing advertisements in 1774. Machines continued to be used by men-midwives in teaching; they are included in the 1808 work of Clough, A Syllabus of a Course of Lectures, p. iv. 142 Nihell, A Treatise on the Art of Midwifery, pp. 50, 51, 71. 143 William Douglas, A Second Letter to Dr. Smelle [sic], and an answer to his pupil, confirming the impropriety of his wooden forceps; as also of his method of teaching and practising midwifery (London, 1748), pp. 24–5. Glaister, Smellie and his Contemporaries, pp. 89–97 summarizes the bulk of this pamphlet. Blackwell, ‘Tristram Shandy and the Theater of the Mechanical Mother’, p. 91 misleadingly describes Smellie’s machines as ‘basket-weave women’. 144 William Douglas, A Second Letter to Dr. Smelle, pp. 25 and 19. 145 Lieske, ‘Configuring Women’, p. 73.

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Babies’ were held responsible by Douglas for the alleged inability of Smellie’s pupils to detect by touch which part of the foetus is presenting for delivery. Douglas’s criticism is not valid; not only was touch regarded as the most important of the senses in midwifery, but the third lecture of Smellie’s midwifery course was devoted to it.146 He was by no means the first to stress ‘the Touch’, and like many other men-midwives he regarded it as not only the most reliable, but also the most socially acceptable, way of detecting pregnancy and foetal position. Exton praised its assistance in distinguishing true labour pains from spurious ones.147 In one of Chapman’s cases, a child delivered by the anus in 1723, he found that ‘the Touch’ was not sufficient, called for a candle, and – in the presence of two midwives and several ‘other Matrons’ – used instead ‘the Assistance of my Sight’.148 But this was a highly unusual case; normally, touch was enough. In his own case histories, it was always other men-midwives whom Smellie presented as unable to distinguish between, for example, the foetal head and shoulder, but he demonstrated his own sense of touch to be highly reliable.149 The next generation of men-midwives continued to refine the teaching of touch. For example, Thomas Young gave detailed instructions to his students on the best position in which to examine ‘the genteeler sort of people’ and warned that, in locating the mouth of the vagina, ‘You must not do this hastily, as you will hurt the woman, and she will entertain a bad opinion of you … according to your doing, this so is their judgement of you’. He went on to boast that he was so gentle that no lubrication was needed to assist his touch.150 Thomas Denman described how to distinguish the foetal hand from the foot, on the basis that the hand has a thumb, and also the fingers are longer than toes.151 In a climate in which sight, rather than touch, was becoming the prime sensory access to the body, and practitioners were invited to use the evidence of their eyes over the authority of the book, it is striking how far men-midwives continued to insist on the importance of touch. Brudenell Exton – who taught the subject privately in London from 1753–5 – stated that midwifery knowledge comes ‘not by the Sight, but by the Feel’.152 At the early stages of this shift in practice, issues of 146 Smellie, Lectures, Wellcome ms. 4630. On p. 28 it is argued that, for example, the elbows can be distinguished from the knees because knees are larger and more rounded. Brudenell Exton, A New and General System of Midwifery in Four Parts (London, 1751), p. 80 discusses the possibility of confusion between the head and the knee. 147 Exton, A New and General System of Midwifery, p. 44. In true pains, the mouth of the womb is found open. 148 Chapman, A Treatise on the Improvement of Midwifery (3rd edition), p. 207. 149 William Smellie, A Collection of Preternatural Cases and Observations in Midwifery (London, 1764), pp. 534–5. 150 Young, lecture notes, RCPE pp. 4 and 7. 151 Thomas Denman, Aphorisms on the Application and Use of the Forceps (London, 1783), p. 23; cp. Young, RCPE pp. 8–9. 152 These dates are taken from Lawrence, Charitable Knowledge, appendix 3. See Exton, A New and General System of Midwifery, p. 8.

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decency meant that it was important to minimize the impact of the change. Lianne McTavish’s study of the visual representation of midwifery in early modern France has shown how commonly late seventeenth-century men-midwives showed themselves with small, delicate hands. Sometimes these hands write, drawing attention to the theoretical knowledge of their possessors, or point to a child, but in other images of the chirurgien accoucheur the hand suggests ‘loyalty and nobility’ as well as manual dexterity.153 Touch is also emphasized by images of the disembodied hand inside the womb.154 In Britain, Sir Richard Manningham’s midwifery courses stressed the ‘forming’ of students’ hands for midwifery practice, while ‘He has rare midwife’s fingers’ was a proverbial (and not usually flattering) phrase.155 But in the contentious climate of eighteenth-century British obstetrics, the rhetoric of the hand often became far more crude. Douglas’s ‘Letter to Dr Smelle [sic]’ attacked his rival’s ‘monstrous Hands’ many times; he has ‘an unfit Hand for Midwifry’, and ‘a man that has a large Hand, is neither fit to introduce an Instrument, nor turn a Child’.156 Douglas joked lewdly, ‘but this I can say for your Hand, that it has the Advantage of making Matters exceeding easy for the Husband, wherever it is employ’d’.157 Similar rhetoric was used in Philip Thicknesse’s 1764 attack on the man-midwife, Man-Midwifery Analysed, in which he attacked Smellie specifically, and argued that touching to detect the presence and stage of pregnancy was performed only ‘to see if any emotions arise in the touched lady’s breast, that the Doctor may take advantage of’.158 In response to Douglas’s allegations, Smellie stated that the ‘strength and size’ of his hands had positive benefits, adding that they were not as big as some in the profession; in particular, those of Mingot of Caen ‘were remarkably big’.159 But in 1760 the size of men-midwives’ hands was still being ridiculed; Nihell compared the hands of female midwives to the ‘hard hand, as big as a shoulder of mutton, the hand of some lusty he-midwife’.160

153 Lianne McTavish, Childbirth and the Display of Authority in Early Modern France (Aldershot, 2005), p. 137. 154 Ibid., p. 194, fig. 6.6. 155 Richard Manningham, An Abstract of Midwifery (London, 1744), title page and p. iii; Nihell, A Treatise on the Art of Midwifery, p. 111. 156 Douglas, A Letter to Dr Smelle, pp. 18, 3 and 17. 157 Ibid., pp. 5 and 3. 158 Thicknesse, Man-midwifery Analysed, pp. 6–7, citing Smellie, A Treatise on the Theory and Practice of Midwifery, p.180. 159 An Answer to a Late Pamphlet, p. 9. Here he is citing Guillaume Mauquest de la Motte, A General Treatise of Midwifery ... illustrated with upwards of four hundred curious observations and reflexions concerning that art (London, 1746); see p. 7 on the ‘large thick hand’ of Mingot. I owe this reference to Lianne McTavish. 160 Nihell, A Treatise on the Art of Midwifery, p. 44.

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The ‘noble instrument’161 Writing on William Hunter, Wilson noted that ‘“delicacy” dictated minimal use of even the hands, let alone of instruments’.162 However, many men-midwives used a range of instruments, and some tried to create a lineage for these going back to antiquity; the instruments were commonly referred to as ‘artificial hands’.163 When he wrote of a woman who could not be delivered ‘without the help of machines’, Smellie would have been thinking of three instruments: the fillet (a fabric noose, or a fabric sheath containing whalebone, sometimes on a handle, slipped around the child’s head and then pulled to exert traction), the crotchet (a hook to be fixed into the foetus) and the forceps. The first two of these were regarded as having a long history, and could be used by midwives: the third was far more controversial in terms of its history, and was only used by men-midwives. Kept in the family as a secret technique by the Chamberlens for some decades, the forceps was first described in print by Edmund Chapman in 1733, although he had been using it since at least 1720;164 however, Brudenell Exton denied that the Chamberlens’ ‘secret’ had really been the forceps, and argued instead that it was ‘a manual Operation’, probably suggesting a method of turning in the manner of Deventer.165 Although it had made it possible for them to intervene in labours which traditional midwives were unable to resolve, and although they were associated with it in the popular imagination, not all men-midwives saw the forceps as the centre of their practice. Chapman, although describing the use of the forceps in print, continued to regard turning as the best solution in most foetal malpresentations. He also used the fillet, regarding both it and the forceps as ‘perfectly safe’ if turning was not effective.166 He claimed that his use of the fillet to take hold of the foetal head was ‘entirely an invention of my own’, previous users having applied it to grasp a foot and turn the child.167 In the 1740s, the fillet was being recommended in Aristotle’s Complete and Experienced Midwife for taking hold of the foetal head ‘as a sling doth a stone’.168

161

The term is used by Chapman, A Treatise on the Improvement of Midwifery, pp. 82

and 86. 162

Wilson, The Making of Man-midwifery, p. 177. E.g. Nihell, A Treatise on the Art of Midwifery, p. 254; ‘those “artificial hands” of which they boast so much their invention’. On the term see further below, chapter 4. 164 Wilson, The Making of Man-midwifery, pp. 69–70 discusses other early users of the forceps in England. 165 Exton, A New and General System of Midwifery, p. 5. 166 Chapman, An Essay on the Improvement of Midwifery (London, 1733), p. 7. On the fillet, see Burton, A Letter to William Smellie, p. 133; with the whalebone fillet, after the grip on the child’s head is secure, the whalebone is pulled out of the fabric tube before traction is exerted. 167 Chapman, A Treatise on the Improvement of Midwifery, pp. 81–2. 168 Aristotle’s Complete and Experienced Midwife (London, 1749?), pp. 79–80. 163

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Many would-be users disagreed with Chapman on the safety of forceps. Even his pupil, Brudenell Exton, who studied under him in London in 1737 and 1738 as well as taking a course with the anti-forceps Sir Richard Manningham in 1747, came to regard his first teacher as ‘rather too fond of the Use of the Forceps’, describing Chapman’s instrument as too large, giving the patient ‘considerable pain’.169 Exton preferred to deliver with ‘my Hands alone’.170 In criticism of instruments as well as in their development, practical considerations played a large part; while Chapman recommended the forceps without a screw as a ‘noble Instrument’, most found it difficult to keep a firm grip on the baby’s head.171 Some men-midwives tried one handle rather than the whole instrument; for example, an anonymous practitioner in Surrey commented on one of his cases attended between 1739 and 1750, ‘I could by no means fix the Forceps, or make any use of one of the Branches … I was obliged to open the Head and lessen it’.172 Variations on the forceps were proposed by all its supporters, who explored different materials, handle length, blade width and whether to employ a hinge or a lock. Writing in 1737, Henry Bracken argued that instruments were all about display, only being used in order to command a higher fee, ‘by making a flourish with a Train of terrible Hooks, Tire-tetes, Dilaters, and such like’.173 Burton regarded Mauriceau’s ‘tire-tête’, a type of fillet, as superior to the crotchet, although it still risked ‘wounding the Mother’.174 But the successful use of an instrument to end an otherwise interminable labour and to save the life of the mother and, in an increasing number of cases, the child as well, would be very impressive and would be rewarded accordingly. Those who used the forceps were all too aware of the fear that it aroused in the women they delivered, due to the patients’ association of instruments of any kind with death; for example, discussing instruments before the forceps was in the public domain, Dionis wrote that ‘The very sight of ’em fills not only the Mother, but all who are present with Horror’.175 Chapman described a case in which he wanted to use the forceps, but the woman was so scared that he had to use the fillet instead – successfully.176 To try to overcome such fears, Denman and 169

Exton, A New and General System of Midwifery, p. 4. Manningham is praised on p. 9. See Wilson, The Making of Man-midwifery, p. 74. 170 Exton, A New and General System of Midwifery, pp. 6–7. 171 Chapman, An Essay towards the Improvement of Midwifery, pp. 13–15. 172 RCPE Anon. 24 ‘Cases and Observations & c. in Midwifery by a Practitioner in Surrey’, p. 111, case 101. The writer makes it clear that such ‘lessening’ was unusual in his practice. 173 Bracken, The Midwife’s Companion, pp. 133–4. 174 Burton, Complete New System of Midwifery, pp. 220–23. Smellie, Theory and Practice of Midwifery, pp. 369–70 describes the tire-tête of Mr Leveret, with ‘two sides which turn on a pivot’. Exton, A New and General System of Midwifery, p. 109 regarded the crotchet as very dangerous and preferred to make any incision with ‘an Instrument well guarded with Tow to the Point’. 175 Pierre Dionis, A General Treatise of Midwifery (London, 1720), p. 247. 176 Chapman, A Treatise on the Improvement of Midwifery, p. 180.

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Osborn told their students ‘you must explain the use of instruments to the mother, husband and friends … and never conceal the instrument’. Before use, it was to be dipped in warm water and smeared with lard. In particular, they warned against its ‘clandestine’ use under the bedclothes, for this would prevent the operator having a proper view of what he was doing.177 What was Smellie’s approach to the forceps, and how did his history of medicine address the question of the novelty, or antiquity, of this instrument? One of the reasons why the 1597 Spach Gynaeciorum was important to Smellie was because it provided valuable ammunition for forceps-users. John Burton claimed that the forceps was Smellie’s ‘favourite instrument’, but although the early 1750s were certainly years when Smellie was experimenting with different designs, his approach to the forceps had already changed over his career.178 At one stage, Smellie was entirely opposed to the use of instruments, relying on turning to feetfirst, and using mechanical principles to ascertain the best method of delivery.179 By 1737 he was complaining that the French forceps, used to deal with cases where the baby’s head was too low in the pelvis for turning to be successful, were too ‘long and ill-formed’, so that he could not place them in a safe position from which to take hold of the head, and needed to resort to the crotchet instead.180 From 1742 to 1744 he started to use the forceps again, possibly because he realized that, if the child’s head has already moved very low down the pelvis, then there is no way that turning can be achieved.181 His final conversion to its use occurred when he recognized that he could apply the forceps to mimic the natural rotation of the child’s head as labour progresses, entering the pelvis facing sideways, and then turning again (normally to face the mother’s back) to be delivered.182 In 1748 he developed his own forceps, made of wood rather than steel, the wood being ‘to make them appear less terrible to the Women; besides, they are portable, and make no clinking Noise when used’.183 He soon realized that this was likely to break; the revised versions were made of steel, with the blades covered in leather, and Smellie also reduced the length of the handles.184 Thomas Young later described these enthusiastically because they could ‘be used without the woman knowing, they being sometimes averse to the use of these’.185 A pair used in 1750, with 177

KCL TH/PP5, pp. 114–16. Burton, A Letter to William Smellie, p. vi. 179 Wilson, The Making of Man-midwifery, p. 126. An autobiographical account of Smellie’s changing approach to instruments appears in Smellie, A Collection of Cases and Observations, pp. 351–5. 180 Smellie, Collection of Preternatural Cases, pp. 14, 25–6, 28. 181 Ibid., p. 127. 182 Ibid., pp. 128–9. 183 An Answer to a Late Pamphlet, p. 26. 184 Smellie, A Collection of Cases and Observations, p. 501 and Collection of Preternatural Cases, pp. 129–30. Smellie, Theory and Practice of Midwifery, p. 290 describes the covering of the blades, to be changed between deliveries. 185 RCSE lectures of Thomas Young, 1771, pp. 60–61. 178

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straight blades and some scraps of leather on both these and the handles, survives.186 The use of leather would clearly increase the risk of infection, and Burton argued that the leather would soak up the body fluids and ‘it will corrupt and stink’.187 Smellie moved to a version in which only the handles had the leather covering, while a disposable material was used to wrap the blades.188 By 1754 Smellie was using ‘a long pair, curved to one side, which I contrived several years ago’, finding these ‘more convenient than the short and straight sort’.189 Smellie referred to situations in which, had he known about the forceps, he could perhaps have delivered a living child; for example, in a case from 1730 published in his 1764 collection.190 However, his advice remained that the forceps should only be used if all else failed.191 In this he was not as far as all that from anti-forceps writers such as Philip Thicknesse, whose Man-midwifery Analysed attacked the ‘indecent and destructive practices of Men Midwives’ and argued for the power of ‘that excellent, and never failing female midwife, Goody Nature’: ‘Nature left to herself scarce ever errs’.192 Many of Smellie’s rivals remained unconvinced even of limited usage of the forceps where Nature had indeed erred. William Douglas regarded Smellie’s forceps as not only impossible to employ, but also unnecessary, and suggested that difficult labours could be successfully concluded with the use of no instruments other than the fillet.193 Some writers continued to believe that the crotchet alone could suffice in all difficult births, even those where the foetal head would not pass. William Osborn, writing to challenge the brief fashion in the 1780s for the division of the symphysis pubis as a safer alternative to the highly dangerous Caesarean section, argued that one should crush 186

Melissa Campbell, ‘William Smellie’s Obstetric Forceps’, Australian and New Zealand Journal of Obstetrics and Gynaecology, 44 (2004): 184–5. See Johnstone, William Smellie, fig. 16. 187 Burton, An Essay Towards a Complete New System of Midwifery, p. 216. 188 Radcliffe, ‘Dr John Burton and his Whimsical Contrivance’, pp. 353–4; see Lloyd, ‘The “Languid Child” and the Eighteenth-century Man-midwife’, p. 662 on covering blades of Smellie’s forceps with a disposable material so that venereal infection was not passed on. This passage is based on Bryan M. Hibbard, The Obstetric Forceps: A Short History and Descriptive Catalogue of the Forceps in the Museum of the Royal College of Obstetricians and Gynaecologists (London, 1992), p. 19. 189 Smellie, A Collection of Cases and Observations, pp. v–vi. 190 Smellie, Collection of Preternatural Cases, pp. 258–9. 191 Smellie, A Collection of Cases and Observations, p. 259. The ‘Advertisement’ that opens A Collection of Preternatural Cases and Observations in Midwifery (London, 1764) defends Smellie against allegations that he was too enthusiastic about the forceps and states that he ‘never had recourse to them without reluctance’. 192 Thicknesse, Man-midwifery Analysed, pp. 1, 3, 11. On pp. 11–12, Thicknesse claimed that forceps were never necessary in a first confinement, or in poor women, a contention that Smellie’s published case histories alone would prove wrong. 193 Douglas, A Letter to Dr Smelle, pp. 9–13; Wilson, The Making of Man-midwifery, p. 149.

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the foetal head and then leave the body to putrefy for at least 30 hours in order to reduce its size, finally extracting it with the crotchet.194 By the end of the eighteenth century, some men-midwives believed in ‘spontaneous evolution’; that is, that in some malpresentations the foetus, if left alone, would turn on its own.195 Smellie’s reference to delivery using ‘machines’ in Hippocratic medicine was clearly not to devices used to demonstrate what could happen during labour, but does it mean that he regarded the forceps as an ancient instrument? In the generation after Smellie, Osborn and Denman were telling their students that ‘the forceps is a very old instrument’, while Thomas Young was telling his that ‘This is a modern instrument, invented about a century ago’.196 Elizabeth Nihell also regarded it as new, saying that the midwives of her time were ‘indebted to the moderns for it’.197 There is an interesting correlation here, in that Osborn and Denman believed in being open about using the forceps, while Young was most comfortable employing them without the knowledge of the patient. Does this suggest that part of the problem with the forceps was the perception of it as something ‘new’ and therefore dangerous, so that research proving its antiquity would also reassure patients?

Avicenna As we have seen, John Burton dated the development of ‘Machines wherewith to deliver a Woman’ to the tenth century AD, the time of Avicenna.198 He believed that the fillet was used before Avicenna, as well as by him; Smellie would have known of Avicenna’s use of the fillet, as among his books was the 1608 Junta edition of Avicenna’s Canon, which included a section in which the fillet (Lat. pannus) was described, used to pull out a dead foetus presenting by the 194

See William Osborn, An Essay on Laborious Parturition: in which the division of the symphysis pubis is particularly considered (London, 1783), p. 252. There are various candidates for the position of first successful (i.e. both mother and child survived) Caesarean in Britain. One was that performed by the illiterate Irish midwife Mary Donally or Dunally in 1739; see Duncan Stewart, ‘The Caesarean Operation Done with Success by a Midwife’, Medical Essays and Observations 5 (1752): 360–62. James Young Simpson mentioned this case in RCPE 53.8. Another was the 1793 operation by Dr Barlow on Jane Foster; see Edward Mansfield Brockbank, A Centenary History of the Manchester Medical Society (Manchester, 1934), pp. 56–7. 195 John C. Douglas, An Explanation of the Process of the ‘Spontaneous Evolution of the Fœtus’ ; with some remarks, intended to induce an inquiry, whether the usual mode of delivery be the more eligible, in arm-presentations (Dublin, 1811) challenged this view, arguing that the best method of proceding if the arm presented was to empty the child’s abdominal cavity, take hold of the pelvis and pull. 196 KCL TH/PP5, p. 110; Young, RCSE p. 60. 197 Nihell, A Treatise on the Art of Midwifery, p. 42. 198 Burton, A Letter to William Smellie, p. 10.

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abdomen.199 Avicenna also explained how a lancet (Lat. phlebotomus) or small serrated knife (Lat. cultellus spinosus) must be used to perforate the head of a dead foetus when the head is too swollen to pass through the birth canal, and described how the midwife should insert her hand to apply hooks (Lat. uncinus) to the foetal head in order to obtain a firm grip on it.200 In all of these cases, however, the foetus was dead before any instruments were employed, and the section, chapter 14 of the third book of his surgical treatise, is explicitly labelled as ‘How the ancients extracted a dead foetus’. The material on instrumental intervention in removal of a dead foetus, then, is marked as ‘ancient’ in the Latin editions of Avicenna available to Smellie and Burton. Smellie argued that the forceps had as long a history as the fillet, and that it was used to extract a living foetus in the Arab world. His copy of Avicenna shows where he found his evidence; he drew attention to pp. 941–2 with a folded lower corner, and pencil marks beside passages on both pages.201 Both references are to chapter 28 on the extraction of the foetus, and the second is part of a discussion of a difficult childbirth in which the foetus is very large; extraction with the forceps is mentioned after a fillet has been tried and failed, and before the foetus is cut prior to extraction.202 Smellie argued that the use of the fillet meant that, at that stage, the foetus was alive and that, because the forceps were employed before the decision was made to open the foetal head in order to reduce its size and achieve its delivery, it was still alive at this stage too.203 Since Avicenna’s section on ‘How the ancients extracted a dead foetus’ has the fillet being used to remove dead foetuses,

199

Burton, Letter to William Smellie, pp. 136–7; Avicenna, Canon Medicinae (Venice, 1608), lib. 3, fen 21, tract 1, ch. 14, p. 937. See Nancy Siraisi, Avicenna in Renaissance Italy. The Canon and Medical Teaching in Italian Universities after 1500 (Princeton, NJ, 1987), p. 365 on the origins of the 1608 Junta reprint. 200 Avicenna, Canon Medicinae (Venice, 1608), lib. 3, fen 21, tract 1, ch. 14, pp. 936–7. 201 P. 941, mark opposite et antiqui quidem primi dixerunt in extrahendo goetum ingenium in capitulo motuum eius; p. 942, pencil mark next to Quod si illud non confert, administrentur forcipe, et extrahatur cum eis. He paid five guineas for the two volumes. 202 Avicenna, Canon Medicinae (Venice, 1608), lib. 3, fen 21, tract 2, ch. 28, p. 942: liget eum cum margine panni, et trahat eum [subtiliter valde cum quibusdam attractionibus]. Quod si illud non confert, administrentur forcipe,et extrahatur cum eis. Si vero, non confert illud, extrahatur cum incisione, secundum quod facile fit, et negatur regimine foetus mortui. 203 Smellie, Theory and Practice of Midwifery, p. lxx. This is also the argument used by Francis Adams in his 1844 edition of the works of Paul of Aegina, where he states that the Avicenna reference to forceps ‘puts it beyond a doubt that the Arabians were acquainted with the method of extracting the child alive by the forceps’; see Francis Adams, The Seven Books of Paulus Aegineta, 3 vols (London, 1844), vol. 1, p. 650, commenting on Paul, 3.76. Kedarnath Das, Obstetric Forceps: its history and evolution (Calcutta, 1929), p. 17 insists that Avicenna only used the forceps for craniotomy.

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this logic does not really work. However, at least one of Smellie’s pupils continued to use the argument; in his lectures Colin Mackenzie told his students: Avicenna … would first recommend the use of the Fillet, and if it fail’d, the Forceps, and if both were insufficient, he then orders the head to be open’d, and extracted by 204 sharp Instruments.

John Leake also believed that the forceps of Avicenna ‘was manifestly intended to save the child’.205 For Smellie, then, Avicenna provided clear evidence for the use of the forceps to extract a live child. In the passage on the ‘help of machines’, Burton did not disagree, instead implying that this was correct – ‘we read of no Machines wherewith to deliver a Woman, but what killed the Child, (except the Fillet) till Avicenna’s Time’. What mattered for him here was that Avicenna was still ‘1400 Years after Hippocrates’s Death’, so that it remained highly unlikely that ‘machines’ were being used to deliver a living child in the time of Hippocrates.206 Later in his attack on Smellie, however, Burton challenged the idea that Avicenna had used the forceps to deliver a living child. He cited Mercuriale’s chapter on difficult childbirth, given in Spach’s Gynaeciorum, which used this same passage of Avicenna.207 Burton argued that the forceps mentioned cannot have been intended to save the child, precisely because ‘Avicenna does not mention it as a secret that he had, but speaks of it as a thing well known’.208 In other words, he assumes that forceps to deliver a living child must always have been kept a secret, in the Chamberlen fashion. This particularly poor argument is very much a product of his time. Albucasis For those who wanted to show that the forceps was used to extract a living foetus in the Arabic world, part of the problem was that, alongside the forceps of Avicenna, which Smellie thought were ‘plainly intended to save the Foetus’, Arabic medicine also had an entirely different sort of instrument: the forceps of the Arab physician az-Zahrawi, known in Latin as Albucasis. Described by Smellie as ‘furnished with long sharp teeth’, these were only used to break up and extract a

204

Wellc. ms. MSL 110, p. 5. As noted in chapter 5, in the catalogue this manuscript is wrongly attributed to Thomas Young. 205 Leake, A Lecture Introductory to the Theory and Practice of Midwifery, p. 41. 206 Burton, Letter to William Smellie, pp. 10, 136–7. 207 Mercuriale in Spach, Gynaeciorum, p. 236. The translation here states that, if the fillet does not work, then habent obstetrices quaedam tenacula quibus circumligant pannos ne laedant vel offendant foetum, iisque educant. The tenacula, literally ‘holders’, are here taken to be forceps. 208 Burton, A Letter to William Smellie, p. 136.

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dead foetus. Illustrations of them could be found in the gynaecological and obstetrical chapters from Albucasis’s On Surgery, based largely on Paul of Aegina, but also using Celsus. Composed in Spain at the end of the tenth century, these chapters were soon removed from the larger work of which they originally formed a part to become a treatise circulating independently, translated into Latin by Gerard of Cremona in twelfth-century Toledo, part of which (book 2, chapters 71– 8) was eventually included as one of the texts in all three editions of the Gynaeciorum libri.209 The manuscripts included various different illustrations of the surgical equipment described [Plate 6]. These illustrations allowed eighteenthcentury male practitioners to argue for the antiquity of the forceps – although the wrong kind of forceps – and also reinforced the gender division in the use of instruments. For eighteenth-century writers opposed to the forceps, their Arab origins fed into a general distaste for Arab medicine, in which it was associated with ‘cruel operations’ comparable to the instruments of torture, and seen as the product of ‘servile translators or copyists of the Grecian [physicians]’.210 In his section on foetal extraction, Albucasis described two instruments for opening the womb, the first being a combination of screws and cross-pieces designed to be inserted in the closed position, and then opened up, as in a

209

Tewfick Makhluf, L’Oeuvre chirurgicale d’Abul Cassim Khalaf Ibn Abbas EzZahrawi dit Abulcasis (Paris, 1930), p. 36 summarizes the printed Latin translations of Albucasis, from the 1500 Venice edition; for the manuscripts, see David Trotter, ‘Les manuscrits Latins de la Chirurgia d’Albucasis et la lexicographie du Latin médiéval’, Archivum Latinitatis Medii Aevi 59 (2001): 181–202. The Latin translation, surviving in around 30 manuscripts, remains unedited, although some of the vocabulary used is actually transliterated Arabic (Trotter, ‘Les manuscrits Latins’, p. 188) but the original Arabic has been edited by M.S. Spink and G.L. Lewis, Albucasis, On Surgery and Instruments. A Definitive Edition of the Arabic Text with English Translation and Commentary (London, 1973). On the French edition, see Trotter, Albucasis: Traitier de Cyrurgie. Édition de la traduction en ancient français de la Chirurgie d’Abū’l Qāsim Halaf Ibn ‘Abbās al-Zahrāwī du manuscrit BNF, français 1318 (Tübingen, 2005). 210 Nihell, A Treatise on the Art of Midwifery, pp. 37 and 104. In the nineteenth century, it was more commonly the French men-midwives who were seen as ‘cruel’; see above, chapter 2.

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Plate 6 Spach, Gynaeciorum libri (1597), p. 446: selection of gynaecological and obstetrical instruments. Reproduced with permission of The Wellcome Library.

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Plate 7 Loose sheet from William Smellie’s copy of Spach. Photograph by Paul Archibald. Image from the William Smellie Collection in Lanark Library, Lindsay Institute, Lanark, reproduced by permission of South Lanarkshire Council. speculum.211 Illustrated in the Gynaeciorum libri, this was explicitly based on the design of a book press: Albucasis wrote, ‘This is the type of instrument with which books are pressed. It has two screws at either end of two pieces of wood; but this instrument should be more slender than a book press, and should be made of ebony or boxwood’.212 In the text of Albucasis it was the male operator who opened the

211

Spach, p. 445; Spink and Lewis, Albucasis, pp. 483–6. Charles Clay, A Cyclopaedia of Obstetrics, Theoretical, Practical, Historical, Biographical, and Critical, Including the Diseases of Women and Children (Manchester, 1848), p. 51 says that no representation of Albucasis’s forceps survives, but they were probably like those of Avicenna; he seems to have his Arabic authors round the wrong way. 212 Spach, p. 445; Abdul Salam Schahien, Die geburtshilfe-gynäkologische Kapitel aus de Chirurgie des Abulkassim, inaugural dissertation, Friedrich-Wilhelm-Universität (Berlin,

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womb, but in order to allow the midwife ‘to do what she wants’.213 Smellie described Albucasis’s instruments in detail, including the impellens to hold the body of the child in place while the ‘operator’ moved the head to a better position for delivery, and ‘Two kinds of forceps, of a circular form, furnished with teeth on the inside, to squeeze and crush the head, when it is of an extraordinary bigness; the large he calls Almisdach, the other Misdach: And two different kinds of crotchets’.214 This is a clear description of p. 446 of the Spach Gynaeciorum, and a loose sheet in his copy of Spach suggests that he was examining the illustrations closely; it consists of two and a half pages with the left hand column reproducing the illustrations as given on p. 446, and the right hand column comparing these to versions in an unnamed manuscript.215 Emile Savage-Smith has confirmed to me that this manuscript is in fact Bodleian Library ms. Hunt. 156.216 For the ‘book press speculum’, for example, the right column reproduces what is distinctively Hunt’s version of the instrument, in which what appears to be the entrance to the vagina is represented at the centre of the speculum.217 The handwriting on the loose sheet does appear to be that of Smellie.218 But how did he see this manuscript? The first published edition of the Arabic Albucasis, that of John Channing, which used ms. Hunt. 156 as well as the older manuscript held in Oxford, ms. Marsh 54 (which forms the basis of the Latin printed editions of the text, including the version published in the Gynaeciorum libri)219 did not appear until 1778, although he was working on it in the late 1750s; no catalogue of any Arabic manuscripts held in the Bodleian was published until 1787.220 Marsh has drawings executed ‘with an intense black ink, strongly 1937), p. 31; Spink, ‘Ancient Gynaecological, Obstetrical and Genito-urinary Practice’, p. 659. 213 Latin donec faciat obstetrix quod uult. The speculum was described in Aetius who cites a second-century author, Archigenes, on the dioptra. 214 Smellie, Theory and Practice of Midwifery, pp. xliii–iv. 215 The loose sheet is between pp. 340 and 341. The Misdach is understood by Spink and Lewis, Albucasis, pp. 488–9 as a ‘cephalotribe’, or crusher, used to reduce the size of the foetal head. Makhluf, L’Oeuvre chirurgicale, p. 128 notes that it not only breaks the bones, but is also used to extract them. 216 Emilie Savage-Smith (pers. comm. 21 December 2005). 217 Martin S. Spink, ‘Ancient Gynaecological, Obstetrical and Genito-urinary Practice Illustrated from Albucasis’, Proceedings of the Royal Society of Medicine, 30 (1937): 659, 661. 218 The Lanark librarian, Paul Archibald, confirms this (in particular, the capital C and M are characteristic), but against this identification is the fact that the headings are in Latin; I have found no other examples of Smellie using Latin for notes. 219 For example, the 1500 Latin edition, Cyrurgia (Venice, 1500/01), p. 25r. The second of the specula illustrated on Spach p. 446 reverses the drawing that appears on the same page of this edition of the Cyrurgia. 220 John Channing, Albucasis, De Chirurgia. Arabice et Latine (Oxford, 1778), vol. 1, p. v describes the Oxford manuscripts.

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outlined, but with the outlines often only roughly filled in’, in contrast to Hunt which, although being better drawn, does not appear to have been done from the actual instruments.221 How would Smellie even have known of these manuscripts? John Burton provides a clue; his accusations against Smellie included one that he took his material on Albucasis from Freind’s history of medicine ‘where your Reader may find what is mentioned in the Arabian Manuscripts, that is lodged in the Bodleian Library, without going to Oxford to consult the Original’.222 Freind, in the second volume of his History of Physick, discusses whether Albucasis and Alsaharavius were one person, and writes: I desired the favour of Mr Gagnier, who has very great skill in the Oriental languages, to enquire whether the Arabick original of Albucasis cou’d be found in the Bodleian library. Upon searching, he met with one Manuscript in Archbishop Marsh’s collection No. 54, with this title (translated into Latin thus) Tractatus x libri ZAHARAVI dictus operatio manus (i.e.) Chirurgia et ars medica… but not finding the name of Abulcasim, (which is the name given him in a Latin M.S. there by Gerardus Caromensis [sic], who translated him) he went further, and found another Manuscript among Dr Huntington’s No. 156, with this title at large – Pars xi libri Al-Tafrif, Authore Abul-casem Chalaf Ebn-Abbas Al-Zaharavi – and at the end of the Manuscript were these words translated out of Arabick thus, Explicit hic Tractatus de Chirugia, estque conclusio totius libri 223 Practices medicinae cujus Author est Ab’ul-casem, &c.

Later in his discussion of Albucasis, Freind mentioned the illustrations of instruments, and commented on his obstetrics: ‘The observations he makes about delivering Women, either of a live or a dead child, are many, and proper’.224 The existence of the Bodleian manuscripts was thus known in the 1720s, and Smellie had this information in his library. However, Freind did not include the illustrations from either manuscript, and their presence on the loose sheet suggests that Smellie had seen the manuscript, or notes taken from it. It is possible that he met Channing; they were in London at the same time. Channing was a London apothecary, trained there and practising in Essex Street, probably from the early 1760s; he became Master of the Society of Apothecaries in 1771. He somehow learned Arabic and, with the support of the Professor of Arabic at Oxford, Thomas Hunt, he began to use the Bodleian in 1759 – possibly the year in which Smellie left London – travelling to Oxford for a few days each year, usually in October.225 Channing’s

221

Spink, ‘Ancient Gynaecological, Obstetrical and Genito-urinary Practice’, pp. 653–4. 222 Burton, Letter, p. 17 citing Friend (sic), part 2, p. 66; in fact the passage is on p. 127 in the 1727 edition. 223 Freind, History of Physick (London, 1727), pp. 127–8. 224 Ibid., pp. 130 (illustrations) and 151 (obstetrical instruments). 225 Emilie Savage-Smith, ‘John Channing: Eighteenth-century Apothecary and Arabist’, Pharmacy in History, 30 (1988): 67; pp. 73–4 list Channing’s times in Oxford. Savage-

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only son had been born in 1746, when Mrs Channing was 41, so it is remotely possible that Smellie and Channing met each other as a result of this birth; Channing is known to have corresponded with William Hunter.226 The illustrations from Albucasis given in Spach were reproduced in other eighteenth-century works; for example, table 18 in Burton’s 1751 treatise, a work which contains a great deal on instruments, although focusing largely on the danger they pose to the mother.227 Burton’s position on instruments is interesting; he used various designs of forceps, and an instrument with ‘long, straight, unfenestrated blades articulated with a removable pin’ was found in his possession at his death.228 Although he considered that turning was always to be preferred to the use of instruments,229 what he perceived as the shortcomings of all instruments to date led Burton ‘to contrive some more safe and expeditious Method of relieving the Fair-Sex’ to be used if the child is already dead, or needs to be killed in order to be delivered. The effect of this instrument, a forceps of a ‘lobster-claw’ design, rather like Albucasis’s almisdach and misdach, was to break the skull and then get a firm grip in order to pull out the child.230 A surviving example of this forceps is now at the University of Edinburgh; Burton boasted that it was ‘better than any yet contrived’.231 The rhetoric of instruments inevitably tended to be that those used by others were dangerous and inappropriately applied, while the writer’s own inventions are beyond criticism; as Charles Clay wrote in 1856, ‘Almost every obstetrician has had a hobby of this sort to ride, by exercising his inventive powers in having a forceps of his own’.232 The sections of Albucasis used by eighteenth-century writers on forceps are also interesting in terms of the gendered division of labour they envisage. How far Smith suggests he was self-taught in Arabic, Hebrew, Persian, and Greek, although his training would have given him some Latin (pp. 72–3). 226 Savage-Smith, ‘John Channing’, p. 69. 227 Burton, Complete New System of Midwifery, facing p. 285. The Table has been wrongly inserted; it should be bound opposite p. 385, where the details of the instruments are given. See also Burton, A Letter to William Smellie, table facing p. 234. 228 Cash, ‘The Birth of Tristram Shandy’, p. 149. 229 Burton, Letter to William Smellie, p. 136. 230 Burton, Complete New System of Midwifery, p. 231. See Bryan Hibbard, The Obstetrician’s Armamentarium: Historical Obstetric Instruments and their Inventors (San Anselmo, CA, 2000), pp. 37–8. The instrument is best known as ‘the machine which crushed the infant Tristram Shandy’s nose’; see Cash, ‘The Birth of Tristram Shandy’, pp. 136–7. As Cash pointed out, Burton’s warnings about damage to the nose during birth probably inspired Sterne. See further Radcliffe, ‘Dr John Burton and his Whimsical Contrivance’, p. 352. 231 Burton, Letter to William Smellie, pp. 141–3; Cash, ‘The Birth of Tristram Shandy’, plate IV; Burton, Complete New System of Midwifery, p. 389. 232 Charles Clay, The Complete Handbook of Obstetric Surgery (London, 1856), p. 94; See Landry and Maclean, ‘Of Forceps, Patents, and Paternity’, p. 538 on the connections between patents and paternity here.

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was it acceptable for a male birth attendant to go in touching the labouring woman? Chapter 76 of Albucasis concerned the extraction of a dead foetus, while chapter 77 described and illustrated the instruments recommended; however, it is interesting that chapter 75 was aimed at instructing midwives in how they should turn ‘living foetuses’ presenting in abnormal positions, suggesting that someone had to decide if the foetus were alive or dead, before deciding whether this was a job for a midwife or for a surgeon.233 However, women were not forbidden to use instruments, nor were men absent from normal deliveries; in a difficult labour but where the child was presenting normally, Albucasis told his reader to order the woman to sit on a chair, with women holding her there, and then to apply a fumigation to the womb, but added that the midwife was to use a small scalpel to cause the waters to break.234 The surgeon who was the reader of this text was envisaged as directing the midwife; the chapter used a mixture of ‘the midwife should’ and ‘you should’. In the section on presentation by the knees and hands, it was explicitly the midwife who inserted her hand to reposition the foetus, while in presentation on the back with hands outstretched it was again she who took the hand of the child to turn it.235 In contrast, chapter 77, on instruments, was directed at the surgeon: throughout, it used ‘you’ rather than ‘the midwife should’. It is possible that the midwife only had access to a very limited range of instruments; this was also the case in the eighteenth century, where midwives would use the hook and the crotchet in order to grip a dead foetus and pull it out in parts. In Avicenna, it is the midwife who opens the womb and inserts her left hand to dilate the mouth of the womb prior to the extraction of the dead foetus.236 In the middle ages, Monica Green has shown that the insertion of any part of the male hand into the female body remained forbidden; in western Europe this could only be performed by midwives or other female assistants, acting under the authority of the male attendant.237 The insertion of instruments by a man was not, however, regarded in the same way as the introduction of his hand. By the early modern period, male hands were permitted to enter the womb, not only to turn the baby to the feet-first position, but also inserting the whole hand and arm for the common practice of ‘sweeping the womb’ to ensure none of the afterbirth remained, performed three or four days after delivery; the retention of the placenta or even of a second child was a constant concern in the publications of eighteenth-century 233

Spach 1597, p. 443. The chapter is headed Ad docendum obstetrices. Ibid., p. 443: tunc iube eam sedere super sedem, aut mulieres teneant eam, et vapora vulvam eius cum foenugraeco decocto, et cum oleis humidis, deinde intromittat obstetrix inter digitos suos spatumile parvum … 235 Ibid., p. 444: Primum conetur obstetrix in locum reponere foetum …; Oportet ut teneat obstetrix manum foetus, deinde revoluat eum paulatim et componat eum sicut naturalis locatio exigit. Channing, Albucasis, De Chirurgia, p. 329 too gives Oportet ut obstetrix prehendat manum infantis … 236 Avicenna, Canon Medicinae (Venice, 1608), lib. 3, fen 21, tract 2, ch. 14, p. 937. 237 Green, Making Women’s Medicine Masculine. 234

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men-midwives.238 Midwives used the expression ‘not being a clean woman’ for retention of the placenta.239 Men-midwives were aware of the pain that insertion of the hand could cause; Brudenell Exton advized his readers – who included both male and female practitioners – to ‘Keep the Fingers quite straight’ when putting a hand into the womb, as the sensation of the knuckles touching the womb would ‘give the Woman great Uneasiness’.240 Ancient instruments Could Smellie have pushed back the history of the forceps any earlier than Avicenna? What of the very ancient Ancients? While the Hippocratic texts contained much information on gynaecological conditions, they gave little on the process of labour; however, they did include an entire treatise On the Excision of the Foetus. Oddly, Smellie did not use this treatise, an omission commented upon by Burton.241 The crotchet (Gk. helkystêr) featured in the Hippocratic Diseases of Women, as did the compressor (Gk. piestron), an instrument used to break up the head of a dead foetus; crushing a foetus in order to remove it and save the life of the mother was thus a very early procedure.242 A generation after Smellie, his pupils were correctly telling their midwifery students that Hippocrates used instruments to ‘reduce the substance’ of the foetus.243 However, as Burton correctly noted, in no case were these instruments used to take hold of and pull out a living child.244 The first-century AD Latin encyclopaedist Celsus, describing medical procedures for a Roman elite audience, also described the use of crotchets, and tools to decapitate a foetus that presented in a transverse position, enabling it to be

238 ‘Sweeping the womb’: Thicknesse, Man-midwifery Analysed, p. 23; Cody, Birthing the Nation, pp. 172–3. Men-midwives performing manual extraction of the placenta: Exton, A New and General System of Midwifery, pp. 130, 137, 139. 239 Chapman, A Treatise on the Improvement of Midwifery, p. 211; RCPE Anon. 24 ‘Cases and Observations & c. in Midwifery by a Practitioner in Surrey’, p. 5 case 3 in which the midwife ‘could not make her (as she term’d it) a clean woman’. The lochia are called ‘Cleansings’ in the English translation of Dionis, A General Treatise of Midwifery, p. 288. 240 Exton, A New and General System of Midwifery, pp. 71–2. 241 Burton, Letter to William Smellie, p. 13, citing Anuce Foës, Tou megalou Ippokratous Panton ton iatron koryphaio ta euriskomena, Magni Hippocratis Medicorum omnium facile principis, opera omnia quae extant (Frankfurt, 1624), p. 914. It was included in the list of Hippocratic writings on midwifery given by Leake, A Lecture Introductory to the Theory and Practice of Midwifery, p. 35. 242 Spink and Lewis, Albucasis, p. 490, Burton, A Letter to William Smellie, p. 136 citing Foës, Tou megalou Ippokratous, p. 618. 243 Wellc. ms. 3392, ‘Dr MacKenzie’s Lectures’, p. 3 (Colin Mackenzie). 244 Burton, Letter to William Smellie, p. 136 citing Mercuriale in Spach, Gynaeciorum, p. 236 and Diseases of Women 1.70 (Littré VIII, p. 146).

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removed in parts.245 In other presentations, he recommended the insertion of the physician’s fingers one by one until the whole hand – or even both hands – could be inserted in the womb, so that an attempt could be made to move the foetus to either head or feet presentation. If the head was nearest, he suggested that a smooth hook with a sharp point should be inserted and fixed into the eye, ear, mouth or forehead before traction was exerted. He noted that the foetus should only be pulled while the mouth of the uterus is dilated, with the right hand pulling and the left hand remaining in the uterus to guide the foetus.246 This passage was repeated by Le Clerc, but Smellie’s version gave far more detail.247 Although Burton tried to claim that the extracts from Celsus given by Smellie were simply lifted from Spach, in fact Smellie also gave far more material from Celsus than was included in the sections of Spach which he was supposed, by Burton, to be copying, even though some of Celsus’s specific points are omitted; although the books were sold at auction after his death, we know that he owned both Latin and English editions of Celsus.248 Very similar material on the manual removal of a foetus was given by Aetius of Amida in the sixth century and Paul of Aegina in the seventh; and when Avicenna talked about the practice of ‘the ancients’, he based this on Aetius, showing that a type of forceps was in use in the sixth century AD. Aetius in turn atributed some of his material to Philumenos, who dates to before the third century AD.249 One of the points on which Burton attacked Smellie as ignorant was his dating of Aetius; he noted that Le Clerc placed him at the end of the fourth century, and Freind at the end of the fifth century.250 Freind had criticized Le Clerc for putting Aetius in the fourth century, when instead he should be placed at ‘the very end of the fifth, or the beginning of the Sixth Century’ because he refers to St Cyril who died in 444, and is himself mentioned by Alexander of Tralles.251 Smellie had the works of both Aetius and Paul in his library. In Smellie’s history of midwifery, he gave extensive extracts from Aetius: translations of the whole of book 16 chapter 22, on the causes of difficult delivery; the whole of chapter 23, on extraction and dismembering of the foetus; and sections of chapter 24, on the delivery of the afterbirth.252 For this, he could have used a copy of the 1567 collection Medicae artes principes, which contained the 245

Celsus 7.29.7. Celsus 7.29.1–5. 247 Smellie, Theory and Practice of Midwifery, pp. xvi–xix; Le Clerc, Histoire de la medecine, 1702, p. 217. 248 On the editions owned by Smellie, see above, chapter 5. Burton, A Letter to William Smellie, p. 13 claimed that Spach p. 796, Akakia’s chapter on removing a dead foetus, was being used by Smellie for this section. He also noted that Smellie omitted the list of places where the hooks should be attached. 249 Aetius 16.23, in turn taken from Philumenos. 250 Burton, Letter to William Smellie, p. xxi. 251 Freind, The History of Physick, pp. 3–4. 252 Smellie, Theory and Practice of Midwifery, pp. xxiv–xxxvii. 246

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Latin text of Aetius, and which he owned.253 The text given by Smellie sometimes seems to have been a good one, and his translations appear far more persuasive than, for example, those given in the 1950 edition of James Ricci; in particular, in chapter 22, Ricci has the unlikely phrase ‘where the foetus has two heads or three feet’, whereas Smellie gave ‘from the crowding of two or three foetuses’.254 Where Ricci gives ‘the midwife’, Smellie had ‘the operator’ and used masculine pronouns throughout for this individual.255 Smellie also owned an edition of Paul of Aegina.256 In Paul, we see the use of the crotchet (Gk. embryoulkos) for taking hold of the body before removal.257 This section seems to come from Soranos, in turn used by Aetius.258 Soranos’s description of embryotomy makes it clear that, although it is the physician’s assistants who separate the labia, it is the physician himself who introduces his hand into the womb and finds the best places to fix the crotchets so that they will not come loose.259 The line of transmission of information on the use of instruments in difficult birth is thus a complicated one, going from the Hippocratics to Celsus, Soranos and Philumenos, and on to Aetius and Paul, before reaching Avicenna and Albucasis, with variations in how they could be used by men and women present at such a birth. Although crotchets and manual intervention were used, with instruments to break up the foetal head, as early as the Hippocratic corpus, the forceps was not used to remove a live baby; there was no expectation that the instruments in use could achieve such a result. The interest of Smellie and his pupils in arguing that the Arabs used the forceps to deliver live babies, and Smellie’s interest in studying early illustrations of such ‘machines’, shows how the past was being used in the service of the present. Burton’s main objections to Smellie thus revolved around the interpretation of passages in the Spach Gynaeciorum libri and, even more, around the allegation that the only book Smellie used was this ‘one single Volume in Folio’260; in Burton’s 253

He paid three guineas for this work; Medicae artis principes, post Hippocratem et Galenum, Graeci latinitate donati: Aretaeus, Ruffus Ephesius, Oribasius, Paulus Aegineta, Aetius, Alex. Trallianus, Actuarius, Nic. Myrepsus. Latini: Corn. Celsus, Scrib. Largus, Marcell. Empiricus ([Paris, 1567). 254 James V. Ricci, Aetios of Amida: the Gynaecology and Obstetrics of the VIth century A.D. (Philadelphia, 1950), p. 30; Smellie, Theory and Practice of Midwifery, p. xxv. Ricci based his translation on the Latin of Cornarius. 255 Ricci, Aetios of Amida, p. 31; Smellie, Theory and Practice of Midwifery, p. xxvi. 256 Basel, 1532. 257 Paul 6.74. Diseases of Women 1.70 (Littré VIII, p. 148). This is fixed to the clavicle, and gradual pressure exerted until the shoulders emerge; the arms are then severed, and the rest of the body pulled out. See also Diseases of Women 3.249 (Littré VIII, p. 462) and Excision of the Foetus (Littré VIII, pp. 512–18). 258 Soranos, Gynaecology 4.5 (Budé IV, pp. 17–18); Aetius (16.23). 259 Soranos, Gynaecology, 4.5.22 (Budé IV, p. 17). 260 Burton, A Letter to William Smellie, p. 28–9.

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words, ‘To have perused all the Works of so many Authors, would indeed require much Time and Opportunity’ when in fact ‘…no great Time was requisite to read the Parts whence they are pretended to be collected’.261 Burton further argued that Smellie’s neglect of authors between the 1597 Spach and Mauriceau (published in 1668) was simply ‘for want of another Collector like Spachius’; ‘for want of another Spachius to assist you’.262 I have shown here that such allegations were unfounded; while not having access to such important works as the Foës edition of the Hippocratic corpus, Smellie was nevertheless doing his research, comparing texts and perhaps even looking at a manuscript. His reason for focusing on the Spach compendium was that it provided important ammunition for a man working in the fields of gynaecology and midwifery, but he did not use this book alone. Burton’s allegations show that one reason for owning the Gynaeciorum libri compendium at this time was simple convenience, here criticized as not being true research, because true research takes time. Smellie himself owned a copy of Burton’s Letter alleging that his research was inadequate but, possibly as a deliberate statement of contempt by his heirs, this copy is no longer in his library; it was included in those books sold at auction in 1770.263

261 262 263

Ibid., p. iv. Ibid., A Letter to William Smellie, pp. v and 28. A Catalogue of the Entire and Inestimable Apparatus for Lectures in Midwifry, p. 2.

Chapter 4

Delighting in a ‘Bit of Antiquity’: Sir James Young Simpson When a portrait of the nineteenth-century obstetrician Sir James Young Simpson was painted, a year after his death in 1870, Simpson was pictured with a 1597 copy of Spach’s edition of the Gynaeciorum. The 1871 portrait, by Norman Macbeth, FRSA, hung in Simpson’s house before being presented to the Royal College of Physicians of Edinburgh in 1916, since when it has been placed over the main staircase there [PLATE 1]. It is not unique; a copy is held at the Royal Infirmary, and it is possible that this was placed to mark the opening of the Simpson Memorial Hospital on 1 May 1879.1 Simpson, Professor of Midwifery in Edinburgh from 1840 and President of the RCPE from 1850–52, is best known for his discovery of the use of chloroform in obstetrics, which was given the imprimatur of Queen Victoria in 1853. Like Smellie, he was a keen collector of medical books, and his depiction with a sixteenth-century book marks this fact. What was once thought to be his catalogue of medical works survives in eight exercise books at the Royal College of Physicians, Edinburgh; listed are over 2200 books and 2000 pamphlets, but Spach’s Gynaeciorum is not included.2 The RCPE also holds two bound manuscript volumes, which certainly do represent Simpson’s own library; one contains information on his extensive collection of pamphlets, the other being devoted to printed books.3 The second of these manuscript volumes includes a so far unidentified work, ‘MIDWIFERY An Ancient Book on’, but also ‘SPACHIUS De mulierum morbis 1697 [sic]’; it is thus clear that at one stage he did indeed own 1

Discussions with Rosie McLure of Lothian Health Services Archive and Iain Milne at the RCPEd have failed to reveal any more information on the early history of the two paintings. 2 K.F. Russell and F.M.C. Forster, A List of the Works of James Young Simpson 1811–1870. A Centenary Tribute (Melbourne, 1971), p. 3. The Catalogue is classified at the RCPE as Simpson 23. It was clearly not composed in Simpson’s lifetime, as it includes works published up to 1882; it may represent Sir Alexander Simpson’s library – it includes in vol. 3 shelf II ‘The Manuscripts of A.R. Simpson’s Lectures’ – while largely being made up of James Young Simpson’s collection. However, although vol. 4, Section I, shelf VII includes the second volume only of the 1586–88 Gynaeciorum, and the 1566 edition, there is no Spach listed. 3 Alphabetical Catalogue of Library, J.Y. Simpson M.D.

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the book. Nor is this the only image in existence of Simpson with a book: his statue on Princes Street, by William Brodie, also shows him with one; another portrait, by John Watson Gordon, at Edinburgh University, shows him with his right arm leaning on an unidentifiable open book; and a photograph by John Moffatt presents him with an open book behind him.4 In Simpson’s portrait at the RCPE, however, the 1597 Gynaeciorum is more than just a sample of his collection. It is open at the title page where, as I pointed out in the Introduction, the letters of ‘ISRAEL SPACH’ are represented larger than they really are, as is the date of 1597 that encloses the vignette of Athena/Minerva bearing the words ‘scientia immutabilis’, the imprint of the publisher Lazarus Zetzner. These changes to the real title-page make it even more obvious what Simpson is reading and how old it is. The book in the portrait appears to be unbound, and is also substantially damaged in the bottom right-hand corner; this adds to its ‘ancient’ appearance. Although the RCPE library holds one copy of Spach, there is no evidence that it was Simpson’s copy; however, all four volumes of the 1586–88 edition are in the library, with Simpson’s signature.5 We may speculate why the volume selected is the 1597 rather than the original 1566, or subsequent 1586–88, edition; this suggests that the age of the volume was not its most important quality. But, as a single large folio volume rather than several smaller ones, the Spach version is more visually impressive. The portrait thus transforms the Gynaeciorum libri into a clear statement of medical authority, given the stamp of antiquity; but is this in the sphere of gynaecology (the topic of the book, at least as implied in its title) or that of midwifery (the title of Simpson’s Chair)? As we saw in the previous chapter, Smellie too ignored the 1566 edition. Although he discussed a range of conditions that we would now consider 4 In Gordon’s portrait, ‘A large book lies upon the table behind his arm’, D. Talbot Rice, The University Portraits (Edinburgh, 1957), p. 191. The Moffatt photograph is RCPE Album 2.1; I owe this reference to Iain Milne. 5 RCPE – SMP – GYNAECIORUM. They were formerly owned by Henry Gore Clough, whose bookplate they bear. The RCPE holds another copy of the 1597 Spach (catalogued at TL – O 10.7), which is annotated. The annotator is likely to have been the seventeenth century owner, who bound the work in plain calf with the covers stamped D.G.MK. In addition to a practical focus on obstetrical matters, texts in the collection which have received particular attention are Mercuriale, particularly on cures for sterility and in the chapter on uterine mole; Akakia on the role of the midwife; and sections in several texts on excessive bleeding in pregnancy. The annotator has, for example, compared the text of Jakob Ruf, book 4, with that of Guillemeau’s Child-birth, or the Happy Delivery of Women, linking chapters in Ruf to the different numbering of the diagrams of fetal presentations in Guillemeau; clearly the book has been used, rather than simply admired. The outstanding feature of this RCPE copy of Spach is that it is the only one I have so far found with a numbered loose sheet in the text of Jean Le Bon (d.1583?), Therapia Puerperarum (first published 1571/7), between pp. 396 and 397, showing 2 natural and 17 unnatural fetal presentations.

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‘gynaecological’, Smellie considered that what he was doing was ‘midwifery’; and, although he used the Gynaeciorum collection, he was not attempting to separate out ‘gynaecology’. In some ways, little had changed a hundred years later: Simpson, like Smellie, owned a copy of Spach, referred to the past to justify the present, and taught a large number of students using, among other methods of instruction, machines.6 Simpson was a particularly lively lecturer, making the most of visual aids of many kinds. His own notes included lists of the equipment needed for each of his lectures, such as ‘Acephalous foetus from jar in large box’.7 He was never distant from his students, who noted with approval that he did not read his lectures.8 In one set of student notes retained in his own collection, he reminded his audience that he was combining teaching with obstetric practice, ending a lecture with ‘Gentlemen, as I had very little sleep last night, I shall give you the rest of this subject next Monday’.9 However, as I shall discuss in more detail below, between Smellie and Simpson the relationship between ‘midwifery’ and ‘gynaecology’ had shifted significantly. This reflected a return to the ‘Hippocratic imperative’; whereas an eighteenthcentury writer like Thicknesse had been able to assert that ‘There is very little difference, except the sex, between men and women’, mid-nineteenth century medical writers resurrected the idea that sex differences are radical, and therefore looked at the need for gynaecology rather differently.10 In this chapter, taking the portrait as a starting point, I want to examine how the sixteenth-century collection and its classical antecedents fared in Simpson’s time, and specifically in his own work; not only his published books and pamphlets, but also in his lectures to colleagues and students. I shall be arguing that, alongside a continued interest in using the past to make changes in medicine seem less novel, shifts in nineteenthcentury ideas about midwifery and gynaecology made the Gynaeciorum libri collection of relevance to debates on the nature of gender, and the proper gender of the birth attendant. I am also examining Simpson’s use of the chloroform that was presented alongside Spach as a symbol of his work, focusing on how he assembled biblical and classical precedents for anaesthesia. The further reduction of the woman to a passive object, into whose womb the male’s hand can be freely inserted, develops still further eighteenth-century uses of the ‘machine’ to teach delivery. I am looking at Simpson’s early work on hermaphrodites. This is an interesting choice of topic for a man working in midwifery, since eighteenth-century 6

Testimonials in Favour of James Young Simpson (Edinburgh, 1840), pp. 10–11; List of the Preparations, Casts, Drawings, Instruments, Obstetric Machinery, & c. contained in Dr J.Y. Simpson’s Museum and Employed by him in the illustrations of his Lectures on Midwifery (Edinburgh, 1840), pp. 61–2. 7 RCPE JYS 14, p. 32. 8 Letter from his students; RCPE SMP – PPH 44.3. 9 JYS 7 ‘Lectures on Diseases of Women’, p. 158. 10 Thicknesse, Man-midwifery Analysed, p. 18.

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opponents of the man-midwife, such as Elizabeth Nihell, had represented such individuals precisely as hermaphrodites themselves. This could focus on their ridiculous appearance; for example, Nihell referred to the term ‘man-midwife’ as ‘that hermaphrodite appellation’, and ridiculed the ‘great-horse-godmother of a hemidwife’ in his feminine attire of ‘flowered calico, or his cap of office tied with pink and silver ribbons’.11 Chapter 3 demonstrated that the eighteenth-century man-midwife was seen more generally as crossing categories. His identity lay between physician and surgeon, but also, in a very well-known engraving of the ‘man-mid-wife’ from 1793, he was shown split laterally between man and woman, the male side accompanied by instruments, the female side only by a pot of boiling water.12 However, another aspect of the figure of the hermaphrodite from the early modern period was the association with sexual promiscuity.13 As we saw in the previous chapters, the banter reported in 1715 in the rape trial of Hugh Leeson shows that the man-midwife too was easily associated with sexual excess, while Philip Thicknesse’s attacks on men-midwives focused on their sexual access to their clients and ‘wanton’ behaviour.14 This aspect of the hermaphrodite as promiscuous was one that the man-midwife would particularly need to challenge.

Collecting the past Born in West Lothian in 1811, his mother’s eighth child, Simpson became Professor of Midwifery at Edinburgh when he was still in his twenties, occasioning much resistance from his colleagues. Before this, he had worked with his predecessor in the Chair, Hamilton, who had taught him in 1829 and again in 1833–34 and who – as Simpson said in a lecture delivered in the year in which he became Professor – ‘gratuitously threw open to me his hospital and his classroom’.15 This was a key point in the development of midwifery, as it was in 1833 that midwifery training became a compulsory part of medical training in Edinburgh, with all graduates expected to have taken a six-month course of ‘100 lectures in midwifery and the diseases of women and children’, and to have either spent 3 months at a maternity hospital or performed six deliveries; in England, the subject did not become compulsory for medical students until 1886.16 In 1836, before the death of Dr Macintosh, it had been arranged that Simpson was going to lecture alongside him with a view to eventually taking over his classes, but instead 11

Nihell, A Treatise on the Art of Midwifery, pp. 110, 325. Isaac Cruikshank, A Man-Mid-Wife (1793); see for example Cody, Revolutionary Bodies, p. 206, plate 7.1. 13 Gilbert, Early Modern Hermaphrodites, pp. 29–30. 14 Thicknesse, Man-midwifery Analysed, p. 5 ‘act wantonly’. 15 Letter from JYS to the Lord Provost of the City of Edinburgh; RCPE JYS 2, p. 3. 16 Nuttall, Change and Continuity, p. 37; ibid., The Edinburgh Royal Maternity Hospital, pp. 55–6. 12

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he became house surgeon at the Lying-in Hospital as well as having a private practice.17 A scrapbook kept by Simpson in his late teens to early twenties shows the range of his interests; many of these continued into his adult life. It included accounts of curiosities such as ‘the Infant Lyra’, a child who played the harp accompanied by her 13-month old brother; an experiment in mirror-writing; advertisements for quack remedies and flea circuses; reports of multiple and monstrous births; medical curiosities; statistical information; anecdotes and jokes; and poems.18 A devout Christian, Simpson included Christian literature and advertisements for lectures in his scrapbook, and later in his classes and public lectures he would often quote from the Bible. He also wrote poetry, and used Shakespeare and other secular poetry – particularly Longfellow, whom he judged ‘the greatest lyric poet of our age’, and Byron – in his lectures.19 Like Smellie, Simpson took his book collecting very seriously, and for a man with a history of financial problems, particularly around the years in which he gained the Chair, he seems to have spent a significant amount of money not just on medical books, but also on valuable historical and antiquarian works. In 1850, for example, a bookseller’s account reveals that he spent £12 6s. 3d; this sum included 10s 6d on the Antiquities of Denmark, 7s on Thucydides and two guineas for the works of Disraeli.20 It is not known when he acquired his copy of Spach. 17

RCPE JYS 2, p. 1. RCSE ms. 1865. 19 Shylock’s ‘It is not writ so in the bond’ was quoted with reference to the unwritten contract between doctor and patient in Simpson’s ‘Midwifery Introductory Lecture 3rd Nov. 1840’, RCPE, p. 30; Cymbeline, act 1, scene v, 48–50 (‘there is no danger in what show of sleep it makes’) in ‘Superinduction of Anaesthesia in Natural and Morbid Parturition’, read to the Medico-Chirurgical Society of Edinburgh, 1 December 1843; reprinted in William O. Priestly and Horatio R. Storer (eds), The Obstetric Memoirs of James Y. Simpson, 2 vols (Edinburgh, A. and C. Black, 1855–56), vol. 2, p. 590; Othello, act 3, scene iii, 375–8 (‘Not poppy, nor mandragora/Nor all the drowsy syrups of the world/Shall ever medicine thee to such sweet sleep’) in ‘On the Inhalation of Sulphuric Ether in the Practice of Midwifery’, Edinburgh Monthly Journal of Medical Science (March 1849); reprinted in Priestly and Storer (eds), The Obstetric Memoirs of James Y. Simpson, vol. 2, p. 578; Longfellow, A Psalm of Life (1839) in ‘Address to the Edinburgh Medical Graduates’, Edinburgh Medical Journal, 14 (1868): 203; while Byron, Sardanapalus was used at the end of the ‘Midwifery Introductory Lecture 3rd Nov. 1840’, RCPE, p. 44 and Simpson wrote alongside his notes here the reminder for oral delivery, ‘slow’. 20 John A. Shepherd, Simpson and Syme of Edinburgh (Edinburgh and London, 1969), pp. 157–8. Although the library was not kept together after his death, many books were bequeathed to the College of Physicians by Simpson’s nephew Alexander, who succeeded him to the Chair of Midwifery. Shepherd, Simpson and Syme, p. 274 n. 148 notes that he himself owns a copy of the 1658 Franciscus Arcaeus with Simpson’s signature, found by his father for sale in Edinburgh in around 1910. Simpson’s copy of William Douglas, A Letter to Dr Smelle is held at the Wellcome, bearing his catalogue number E.II.23; this was a gift from the RCPE in 1963 when they were removing duplicates from their collection. Simpson 18

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Many other nineteenth-century medical men were enthusiastic book collectors, and owned a copy of at least one edition of the Gynaeciorum libri. Here they resemble those collectors from the early modern period who have been characterized by Peter Murray Jones as ‘fossil hunters, trying to obtain specimens of every era to represent a continuous tradition, the earlier the specimen the more precious’.21 In mid-nineteenth-century Britain, there was also an increase in the number of local medical societies offering lending libraries to their members, the records of which show what literature was sought by medical practitioners; some societies eventually published catalogues of their holdings.22 At the beginning of the nineteenth century, in addition to allowing borrowing, typically for a few hours a week, libraries would be open before society meetings.23 By the end of the century, hours were significantly extended; for example, in 1884 the library of the Obstetrical Society of London was opening from 1.30–6 on weekdays, and on Saturday mornings from 9–11, as well as for half an hour before evening meetings.24 Meetings would open with the presentation of books donated by members or by other societies, and some London societies also had a significant budget for book purchases; for example, in 1848 the Royal Medical and Chirurgical Society of London ordered 432 books at a cost of £253 10s. 9d.25 But when its first catalogue was printed four years earlier, it already owned five different copies of the three editions of the Gynaeciorum libri; presumably the result of several donations from members.26

made a few minor annotations, such as the correction of the spelling of ‘Sizars’ to ‘Sizers’ on p. 14. 21 Jones, ‘Medical Libraries and Medical Latin’, p. 121. 22 The earliest was Liverpool Medical Institution Library, founded in 1779. Although the Manchester Medical Society was not founded until 1834, its parent organization, the Literary and Philosophical Society (founded 1781) had, in terms of its membership and presidency, already been very heavily ‘medical’; see Edward Mansfield Brockbank, A Centenary History of the Manchester Medical Society (Manchester, 1934), pp. 2–3. In the records of some such institutions, such as the Nottingham Medico-Chirurgical Society Library, founded in 1828, book plates and archives can reveal borrowing patterns. 23 E.g. Norman Moore and Stephen Paget, The Royal Medical and Chirurgical Society of London Centenary 1805–1905 (Aberdeen, 1905), p. 14; in 1808 the society’s library was open for two hours a week on Tuesday lunch-times, and an hour before meetings, with a maximum loan of two books per reader. 24 TOSL 26 (1884). 25 Moore and Paget, The Royal Medical and Chirurgical Society of London, p. 92. Of these, 57 books were in English, 42 in Latin, 153 in French and 175 in German. 26 The Catalogue of the Royal Medical and Chirurgical Society of London (London, 1844), under ‘G’ and ‘S’ listed one copy of the 1566 edition, 3 of the 1586–88, and one of the 1597 Spach edition. The later catalogue of 1879 – Catalogue of the Library of the Royal Medical and Chirurgical Society of London (London, 1879) states that the copy of Spach bears the autograph of Guillotin – physician and inventor of the guillotine – on the fly leaf.

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In the provinces, the majority of books were donated by members, often with a single local bibliophile making a huge impact. Taking only Manchester as an example, some copies owned by identifiable practising physicians who also collected show signs of significant use. The John Rylands Library holds two separate copies of the 1586 edition of the Gynaeciorum libri, together with one of the previous 1566 edition, owned by the Norwich surgeon John Green Crosse (1790–1850), an enthusiastic book collector and practising obstetrician.27 In chapter 1 I briefly mentioned another Rylands copy of the first two volumes of the 1586 edition, in a much poorer condition than Crosse’s books. This bears on the flyleaf the address ‘65 Piccadilly John Windsor’s’, in one hand, and ‘Thomas Windsor Manchester’ in another hand. The Windsors, John (father: 1787–1868) and Thomas (son: 1831–1910) were very active in the Manchester Medical Society (MMS), founded in 1834. John, who lectured in midwifery, was the Society’s President in 1859 and his collection formed the basis of the Society’s library, together with the books of John Hull, who specialized in midwifery after being apprenticed to a Mr Lancaster, a surgeon/man-midwife/apothecary, and then gaining his MD in Leyden in 1792.28 Thomas, an eye surgeon, joined his father’s practice at 65 Piccadilly in 1858 and continued to work there after his father’s death, only moving in 1871. As well as being President in 1866, Thomas Windsor was honorary librarian of the Society from 1858–83, presiding over the creation of the first catalogue, in 1873. He was an enthusiastic collector of old medical and science books who ‘often returned from his annual holiday abroad with a sackful for which he had paid five pounds’.29 He also encouraged donations to the MMS library; for example, Samuel Crompton, active in the 1840s, gave them a copy of Richard Manningham’s Latin obstetrical manual in February 1860.30 Windsor resigned from the Society in 1883 because of a row over whether it should buy old books or contemporary books; he then collected for the library at Washington.31 This was not the first such disagreement over acquisition policy at the MMS; in 1853, for example, the Council decided not to accept donations of homeopathic works. In the MMS, interest in book collecting and in the history of medicine was by no means restricted to the Windsors. Between the presidency of John and Thomas, 27

Rylands Parkinson Coll./115, M1,G66,F. Judging by the booksellers’ marks, Crosse appears to have assembled his collection by purchase. 28 Brockbank, Centenary History, p. 39. See also Ethel M. Parkinson and Audrey E. Lumb, Catalogue of Medical Books in Manchester University Library 1480–1700 (Manchester, 1972). 29 W.J. Elwood and A.F. Tuxford, Some Manchester Doctors (Manchester, 1984), p. 6–7. 30 Richard Manningham, Artis Obstetricariae Compendium (London, 1740), Wellcome Library copy inscription. In 1929 many duplicates from the Manchester collection were acquired by Sir Henry Wellcome; see Brockbank, History of the Manchester Medical Society, p. 43. 31 Elwood and Tuxford, Some Manchester Doctors, p. 214.

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in 1861 Charles Clay (1801–93) held that office; originally apprenticed as a surgeon, in 1857 he had become the Senior Medical Officer at St Mary’s Hospital for Women and Children in Manchester, and Lecturer in the Principles and Practice of Midwifery from 1859. In 1842 he had been the first in England to perform ovariotomy, on a 17 lb tumour, and in 1863 he performed the first technically ‘successful’ hysterectomy; however, the woman died two weeks later.32 In his study of the relationship between the age of the woman and the length of gestation, he challenged Aristotle’s belief in pregnancies longer than eleven months, and used such examples as the harrowing 1847 case of a girl aged twelve and a half who gave birth after being raped by her 47-year-old uncle.33 As a pioneer in his field, he was in contact with Simpson. In 1848 he published a treatise on Hippocrates’ ‘obstetric aphorisms’; this choice of topic suggests that the image of Hippocrates as man-midwife, created by Smellie, continued to find support within the profession. Clay also tried to start up an encyclopaedia of obstetrics, to be funded by subscription.34 In the sections of this which appeared, covering the letter ‘A’ up to ‘Aurelius Cornelius Celsus’, he referred to his ‘extensive library’ and thirty years of experience.35 The project had Simpson’s support, and the entry on ‘Anaesthesia’ was a condensation of Simpson’s published work on the topic from the previous two years. Clay’s later handbook of obstetric surgery, published in 1856, was organized alphabetically, but he broke this format

32

Clay, The Complete Handbook of Obstetric Surgery, p. 158; ibid., ‘Observations on Ovariotomy, Statistical and Practical: Also, a Successful Case of Entire Removal of the Uterus and its Appendages’, TOSL 5 (1863): 58–74; Elwood and Tuxford, Some Manchester Doctors, p. 194; New DNB. Moscucci, The Science of Woman, pp. 139–40 shows that Clay’s innovations were not taken particularly seriously by London surgeons because he was seen as ‘a provincial’. 33 Charles Clay, Observation on the Term of Utero-gestation. With a view of correcting the opinions generally entertained in respect to prolonged gestation, etc. (London, 1855), pp. 8–9. 34 Charles Clay, The Obstetric Aphorisms of Hippocrates: with short comments on each, by Galen, Fuchius, and others. Translated from the best edition of Aldus, A.D., 1526, and compared with the beautiful Latin edition of Vicentino, also of 1526, expressly for the ‘British Record’ (Manchester, 1848). 35 Charles Clay, A Cyclopaedia of Obstetrics, Theoretical, Practical, Historical, Biographical, and Critical, Including the Diseases of Women and Children (Manchester, 1848), preface. One of the two copies held at the Wellcome library only goes up to p. 8 (Pamphlets W 6.2.6) while to other goes to p. 100, ‘Aorta’ (EPB Tracts T 175.26). Simpson’s copy, now at the RCPE, catalogued at SMP – PPH 34.19, is the most complete I have found, going up to p. 144, ‘Aurelius’. Simpson also wrote the entry on ‘Anaesthesia’ for the Encyclopaedia Britannica edition of 1855 (vol. II, pp. 627 ff.).

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to open it with a section on chloroform in which he praised Simpson as a ‘worthy, indefatigable, and energetic Professor of Midwifery’.36 Clay was a major donor to the MMS; for example, in 1860 he donated approximately 1500 gynaecological and obstetrical books, and that may not have been the final extent of his donations, as in January 1861 he apparently presented the library with his copy of Alfred McClintock and Samuel Hardy’s Practical Observations on Midwifery.37 In his published work, he mentioned the Wolf and Spach editions of the Gynaeciorum libri, and the copy of the 1586 Wolf edition donated to the MMS, bearing his signature on the first two volumes with the date ‘1853’, is now in the Rylands library.38 He also donated another copy of the 1586 edition to the Obstetrical Society of London (OSL), a society of which he was a founder member at its inception in 1859, together with a copy of the 1597 edition; only the latter is now at the Royal Society of Medicine, and the front end-paper is signed ‘Chas Clay MD, Manchester 1850’.39 Founder members of the OSL, fully aware that midwifery was compulsory in the Edinburgh medical curriculum, expressed their concern over the need to go outside England for training, and stated 36

Clay, A Cyclopaedia of Obstetrics, pp. 125–43; idem, The Complete Handbook of Obstetric Surgery, p. 1; the work is dedicated to Simpson ‘for his personal kindness to the author’. 37 Brockbank, History of the Manchester Medical Society, p. 40; bookplate in Wellcome Library copy of Alfred H. McClintock and Samuel L. Hardy, Practical Observations on Midwifery, and the Diseases Incident to the Puerperal State (Dublin, 1848). It is possible that the January 1861 date is simply due to a cataloguing delay. 38 Clay, A Cyclopaedia of Obstetrics, p. 79, where he correctly noted that only about one thirtieth of the work of Albucasis is included in the collection. Of the two copies of the 1586 edition, one has two volumes, the other only vol. 1. The list is given in TOSL 4 (1862: 302). The Rylands copy is Parkinson Coll./1115, M1,G66,Q vols 1 and 2; the signature is on the page facing the title page, which has been lost in vols 3 and 4. 39 On these societies, see Moscucci, The Science of Woman, p. 66. When it split off from the Royal Medical and Chirurgical Society, the OSL enrolled 350 Fellows (Transactions of the Obstetrical Society of London 2, 1860: 1), and by 1864 there were 535 (TOSL 6, 1864: 14). In 1805 the Medical and Chirurgical Society had itself separated from the Medical Society of London; see Moore and Paget, The Royal Medical and Chirurgical Society of London, p. 2; Bernice Hamilton, ‘The Medical Professions in the Eighteenth Century’, Economic History Review, 4 (1951): 157. The MSL was founded by John Coakley Lettsom, himself the owner of 12,000 books, in 1773, because – as a Quaker – he could not go to Oxford or Cambridge and so was not eligible to join the Royal College of Physicians; see Finola Hickey, The Library of the Medical Society of London (thesis, College of Librarianship, Aberystwyth, 1969), p. vii; Penelope Hunting, The Medical Society of London 1773–2003 (London, 2003). The OSL library passed to the Royal Society of Medicine when they merged in 1907. There is no evidence that Clay ever took an M.D. yet, in his autographs in the books he owned and on the title pages of those he published, he signed himself with one. An early biographer, writing in 1925, hinted at a London M.D. taken before 1848, but there is no record of this. My thanks to Peter Mohr for discussing this with me.

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that a new Society was required in order to ‘to raise the character of English midwifery in the estimation of our foreign brethren’.40 As we shall see shortly, the use of the term ‘Obstetrical’ rather than ‘Midwifery’ in their name was significant. These men were plainly interested in upward mobility within the medical profession. As we saw in chapter 2, there were obvious economic advantages for an eighteenth-century medical man in being able to include man-midwifery in his repertoire. Already in the 1770s Thomas Young had been discussing in his opening lecture on midwifery why a gentleman should want to learn this branch of medicine, concluding that it was ‘in order to introduce himself to business’.41 This theme continued to be equally explicit a century later. Henry Oldham’s presidential address to the OSL in 1864 noted that, within a medical career, ‘It is at a later period, when a man feels that it is often the stepping stone to practice, and the centre of his success, that obstetrics claim his earnest attention’.42

Defining gynaecology When Clay’s Gynaeciorum libri volumes were included in the catalogue of the library of the OSL, compiled in 1865, they were placed under the heading ‘Women’, suggesting that at this time ‘Gynaecology’ was still not the most obvious category into which to put the collection.43 McGrath has recently traced the emergence of the word ‘gynaecology’ to between 1820 and 1850; it appears in dictionaries from the 1840s.44 But in institutional terms, the origin of gynaecology in Western medicine must be dated even later, to the end of the nineteenth century, when journals and courses were first devoted to the specialty.45 Looking at the British scene, gynaecology and obstetrics were two of the last medical subjects to be separated out and established as specialties; most specialist medical periodicals in gynaecology were set up in 1870–79 and dedicated departments in hospitals, with diplomas in gynaecology and obstetrics, were not established until even later.46 Before this time, gynaecology and obstetrics remained not only 40

The words of the first President, Edward Rigby; TOSL 2, 1860: 2. Wellcome ms. 5108, p. 1. See further Loudon, ‘Essay Review: The Making of Manmidwifery’, pp. 513–14. 42 TOSL 6, 1864: 14; Irvine Loudon, Medical Care and the General Practitioner, 1750–1850 (Oxford, 1986), pp. 94–9. 43 TOSL 7, 1865. 44 Roberta McGrath, Seeing Her Sex: Medical Archives and the Female Body (Manchester and New York, 2002), p. 34. 45 Ornella Moscucci, The Science of Woman: Gynaecology and Gender in England, 1800–1929 (Cambridge, 1990). 46 M. Jeanne Peterson, The Medical Profession in Mid-Victorian London (Berkeley, CA and London, 1978), pp. 270–71. For example, James Hobson Aveling set up the Obstetrical Journal in 1874; Peterson, The Medical Profession in Mid-Victorian London, p. 279. 41

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conceptually but also institutionally united. The interests of the OSL, the exclusively male members of which ran the examinations for women midwives from around 1870, covered matters related to childbirth but also encompassed the treatment of conditions of the uterus and vagina; as in Smellie’s day, all disorders of the female generative organs came under the remit of its members.47 Only in 1886 did a further split occur, with James Hobson Aveling and Robert Barnes forming the British Gynaecological Society from, initially, seventy members of the OSL.48 But those who broke away did not want to restrict their field, from ‘all diseases of women surrounding childbirth’ to ‘women’s diseases excluding childbirth’; on the contrary, these men wanted to extend their remit to include abdominal surgery on women, removing this work from the sphere of the general surgeon. They wanted this newly constituted ‘gynaecology’ to have its own dedicated wards and even hospitals.49 As the boundaries of gynaecology and obstetrics were adjusted over the nineteenth century, what happened to ‘midwifery’? Redefined, and expanded in scope, it survived throughout Simpson’s career; but not, however, unchallenged. As we have already seen, some eighteenth-century writers had acknowledged both a narrow, and a broad, definition. For example, John Burton’s comment on Smellie’s definition of midwifery regarded it as extending beyond childbirth: you mean not only the Art of delivering Women; but also the Science or Knowledge how to treat them during and after the Time of Labour, and in the pregnant State, in all 50 the Disorders they are therein subject to.

A set of lecture notes from the lectures of Thomas Young at Edinburgh in the 1770s, mentioned already in the Introduction, expressed the ‘limited’ sense as ‘the simple operation of delivering a pregnant woman’ and the ‘more extensive’ sense as ‘all that a man knows with regard to this branch’.51 Young’s lecture courses covered not only delivering babies, but also the nature of menstruation, the diseases of pregnant women, treatment of women after delivery, and diseases of children after delivery.52 This was a very broad definition of the ‘extensive’ sense of midwifery, and nineteenth-century definitions were no different. In 1845 James Arnott continued to use ‘midwifery’ as the umbrella term covering both obstetrics and gynaecology, and also some paediatric medicine; he wrote in his Appendix to an Essay on Therapeutical Inquiry that ‘The term midwifery has not been 47

TOSL 7, 1865: 42; Nuttall, The Edinburgh Royal Maternity Hospital, p. 62. Moscucci, The Science of Woman, p. 174. The initial meeting to discuss the foundation of the BGS took place in December 1884. 49 Alice Domurat Dreger, Hermaphrodites and the Medical Invention of Sex (Cambridge, MA, 1998), pp. 65 and 217 n. 39. 50 Burton, Letter to William Smellie, p. 6. 51 Wellcome ms. MSL 105; ms. 5108, p.1 is almost identical. 52 RCPE Notes from Thomas Young’s lectures. 48

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restricted to the subject of labours; it comprehends besides the consideration of the diseases of women and children’.53 These very comprehensive uses of ‘midwifery’ recall the second-century AD writer Soranos, who noted that ‘The public is accustomed to call in midwives in cases of sickness when the women suffer something specific to their sex (Gk idia) which they do not have in common with men’; the ancient ‘midwife’ dealt with a wider range of female disorders than those concerned with childbirth and, as I showed in the Introduction and in chapter 1, ancient gynaikeia too covered many conditions, not least because the disturbance of the menstrual function was thought to affect the whole body.54 The view that ‘midwifery’ began with the study of menstruation was also one found in the latter part of the eighteenth century. The London lectures of William Osborn and Thomas Denman in 1776 and in 1782 began, not with the structure of the pelvis, but with the menstrual function, on the grounds that the purpose of menstruation was ‘to keep vessels of womb pervious, ready for conception’; the lecturer stated that ‘we see plainly’ that a woman cannot conceive without menstruating, menstruation being ‘the sine qua non of conception’.55 Simpson too discussed the nature of menstruation, menarche and menopause at considerable length.56 John McFarlane’s notes from Simpson’s 1839 lectures on midwifery show that, shortly before he gained the Chair, he was defining midwifery as ‘that department of Medical Study relative to the Physiol. Pathology of Reproductive Organs of Hum. Females’.57 In 1840, in the notes for his introductory lecture as Professor of Midwifery at Edinburgh, Simpson referred to midwifery ‘or obstetric medicine (as it is now very frequently termed)’ as ‘the highest branch of medicine’.58 His definition of its range, extending his remarks in his lectures of the previous year, deserves to be quoted at length: midwifery represents the Sum of our existing knowledge – physiological, pathological and therapeutical – relative to the organs, processes and products of generation and parturition in the human female … that branch of Medical Science which treats of the structure and functions of the sexual organs of the human female in relation to reproduction and disease, – which 53

James Arnott, Appendix to an Essay on Therapeutical Inquiry… (Brighton and London, 1845), p. 18. James Young Simpson’s published lectures were issued a few years later as ‘Clinical Lectures on Midwifery and the Diseases of Women and Children’ (Russell and Forster, List of the Works of James Young Simpson, pp. 28–9; my italics), suggesting that he was moving the categories a little further apart. 54 Soranos, Gynaecology 3.1.33–6 (Budé). 55 Wellcome ms. 2098, ‘Sketches of the Practice of Midwifery from the Lectures of Drs Osborn and Denman, London 1776’, pp. 12–13, 14; King’s College London ms. TH/PP5, p. 1. 56 RCPE JYS 4 (10). 57 RCPE JYS 3, p. 2. 58 Simpson, ‘Midwifery Introductory Lecture 3rd Nov. 1840’, RCPE, pp. 6 and 33.

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discusses the phenomena, mechanisms and management of natural labour, – which included the pathology of the various species of morbid parturition … with the measures … that may be appropriate to the treatment of each, – which considers the nature, character and cure of the different classes of maladies that are peculiar to the female sex 59 in the puerperal, in the pregnant and in the unimpregnated state.

It also included diseases of infancy and childhood. This is a very broad definition indeed, based on the organs that separate women from men; while centred on childbirth, to the extent that a woman who is not pregnant is defined in relation to pregnancy as ‘unimpregnated’, it manages to cover all that is ‘peculiar to the female sex’. In his introductory lecture, Simpson went on to argue that women’s diseases were rarely life-threatening, but should be seen as ‘affections which drug and embitter rather than fatally poison the cup of life’.60 What was the attitude of these writers of the mid- and late nineteenth century to women practising midwifery, and to what extent did this differ from eighteenthcentury ideas? As I showed in chapter 3, Simpson’s predecessor Thomas Young, appointed to the Edinburgh Chair of Midwifery in 1756, had explained what he perceived as the inadequacy of Hippocratic writings on midwifery by arguing that he must have based what he wrote on what ‘ignorant women practitioners’ told him.61 But Elizabeth Nihell stated in 1760 that, while most surgeons and many apothecaries believed midwifery to be men’s business, ‘the best part of the able physicians’ considered that it was the business of women.62 However, Irvine Loudon has argued that there were differences according to social rank. At the upper levels of mid-eighteenth-century society, it was physicians rather than surgeons who were most interested in entering man-midwifery; at this time the elite surgeons were more concerned with developing surgery itself, as something separate from the earlier activities of the barber-surgeon.63 To what extent could female ‘ignorance’ be overcome if women were properly trained? According to John Leake, in the introductory lecture to his 1773 lecture course, there was no problem. He wrote, ‘I think there does not appear sufficient reason for setting female practitioners aside; provided that they are properly instructed, and … sending for further assistance in time’.64 This recalls Edmund Chapman’s statement in 1753 that ‘The best Midwives commonly send for Advice upon the Appearance of Danger’.65 As we saw in chapter 2, eighteenth-century men-midwives had indeed offered courses for women as well as for men. Thomas Young flagged up what other European nations had done to train women. In a set 59

Ibid., RCPE, pp. 6–8. Ibid., RCPE, p. 17. 61 Wellc. ms MSL 105, ‘Lectures on Midwifery’, pp. 6v–7v; ms. 5108, p. 2. 62 Nihell, A Treatise on the Art of Midwifery, p. 13. 63 Loudon, ‘Essay Review: The Making of Man-midwifery’, p. 508. 64 Leake, A Lecture Introductory to the Theory and Practice of Midwifery, p. 34. 65 Exton, A New and General System of Midwifery, p. 11; Chapman, A Treatise on the Improvement of Midwifery (3rd edition), p. xviii. 60

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of lecture notes held at the RCPE which probably derive from one of Young’s courses in the 1770s, the student note-taker stressed that, in the past, women’s ‘Genius too often was little better than their education’, and noted that the establishment of the Hôtel Dieu in Paris in the mid-seventeenth century involved training women as both midwives and nurses. He added that ‘After the French the Dutch were the next who considered the importance of having women properly educated’.66 Nineteenth-century medical writers were less certain. English writers were more interested in establishing midwifery education for men, on the Scottish model, rather than in improving that of women. Trying to separate out their institutional field while seeking to overcome the public’s concern about the moral dimensions of men treating women’s diseases, they tended to disparage the work of female midwives, both in their own day, and in the past. In 1845, James Arnott looked back in amazement to remind his readers that ‘uneducated persons of the same sex with the patients, were, until a modern period, deemed competent attendants on them’.67 He could, of course, have used this to lead into a call for educated female attendants, but he did not. Instead, he used the claim to dissociate himself from the ignorant (female) past. By tying ignorance so completely to women, he automatically divorced himself from it. Two years later, William Tyler Smith called for the eventual abolition of the female midwife in favour of ‘the more modern birth of obstetricy’.68 The American physician, Augustus Gardner, gave a lecture in 1851 on the history of midwifery in which he attacked ‘the past inefficiency and present natural incapacity of females in the practice of obstetrics’.69 In contrast to eighteenth-century willingness to train women alongside men-midwives, ‘natural incapacity’ was clearly not something that could be overcome with the correct training. Simpson’s use of the phrase ‘obstetric medicine’ was another step towards taking midwifery out of women’s hands. ‘Obstetric’ or ‘obstetrical’ had been used as adjectives from the second half of the seventeenth century, but the nominal forms were not used until the nineteenth century. Calling midwifery ‘obstetric medicine’ was only one way of taking women out of the picture; around the 1840s ‘obstetric medicine’, ‘obstetrics’ and ‘obstetricy’ were all terms being explored, showing that the choice of name of the Obstetrical Society of London was largely about creating a midwifery that was gendered male.70 In 1847, William Tyler Smith commenced a course of lectures on ‘obstetricy’ at the Hunterian School of 66

RCPE ‘Notes on Midwifery’ classified as Young, T. 8, pp. 1–2. Arnott, Appendix to an Essay on Therapeutical Inquiry, p. 1. 68 Smith, ‘Introductory Lecture’, p. 371. 69 Augustus Gardner, A History of The Art of Midwifery, a Lecture Delivered at the College of Physicians and Surgeons, November 11th, 1851 (New York, 1851), p. 26. 70 Clay, A Cyclopaedia of Obstetrics, preface uses ‘obstetricy’; the earliest example of this use appears to be James Blundell, The Principles and Practice of Obstetricy (London, 1834). 67

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Medicine; by 1849, he was stating that obstetrics was the science, midwifery the art.71 He argued that the level of obstetrics in any country should be seen as ‘a measure of the respect and value of its people for the female sex’.72 In the process of delineating an ignorant female past, and again in contrast to earlier eighteenth-century writers, commentators from the late eighteenth century onwards often ceased to acknowledge male contributions from the classical writers; while the midwifery of the present was all male, the midwifery of the past was newly constituted as an all-female field. In 1875, Charles Crombie quoted extensively from Franz Karl Naegele (1778–1851), Die Lehre von Mechanismus der Geburt, including the following: Midwifery, as is well known, has no classical antiquity, like its associated department, Medicine; it has no Hypocrates [sic], no Galen, of whom the physician may boast with justifiable pride; no Celsus, like surgery; no Aristotle, like anatomy to point at – our art, 73 until recent times, was confined, for the most part, to rude and untrustworthy hands.

Midwifery was thus constructed as a subject that lacked a respectable past; this striking claim contrasts with eighteenth-century writers such as Le Clerc, or indeed Smellie, who had found no difficulty in selecting several pages on Hippocrates for his version of the history of midwifery. Hippocrates and Celsus were no longer rivals for the title of ‘the first man-midwife’; instead, some writers expressed the hope that ‘the very term midwifery will be rejected on account of its derivation’.74 Picking up a tendency that began at the end of the eighteenth century, where Hippocrates was mentioned, it was usually to contradict him. Thus, for example, Thomas Young had said in his 1771 lecture course that ‘Hippocrates says, if a woman labour under a fluor albus she will never conceive. But this is false, for we have many instances of women being delivered of very fine children when they had the fluor albus’; Simpson mentioned the name of Hippocrates in a list of

71 Smith, ‘Introductory Lecture’, pp. 371–4; ibid., ‘Obstetrics a Science, Midwifery an Art’, Medico-Chirurgical Review, 4 (1849), p. 510, cited by Mary Poovey, ‘“Scenes of an Indelicate Character”: The Medical “Treatment” of Victorian Women’, Representations, 14 (1986), p. 158, n. 12. 72 Smith, ‘Introductory Lecture’, p. 371. 73 Charles M. Crombie, On the Cause of Commencement of Parturition (London, 1875), p. 8. Comparing this with the original German (Ueber den Mechanismus der Geburt, Heidelberg, 1822, p. 4) and even with Edward Rigby’s 1829 English translation of the German (p. 2) it becomes clear that Crombie is, to some extent, paraphrasing. Naegele did not mention Celsus or Aristotle, only saying daß die Geburtshülfe keine Hippokrate, keine Galene aufzuweisen hat. When Naegele was writing, the Paris manuscript BN gr.2153, which preserves Soranos’s Gynaecology with sections of Aetius of Amida, had not been published; it was only identified in 1830. 74 Smith, ‘Introductory Lecture’, p. 371.

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historical figures who had – wrongly – claimed that the symphysis pubis relaxes in labour.75 For Simpson, denial of Hippocratic involvement in midwifery was matched by a rejection of any Arab use of forceps in live births. Simpson’s own notes for his lecture on the history of the fillet did mention Hippocrates, and in his lectures on the forceps – described as ‘Artificial or iron hands’ or ‘thin iron hands’ – he argued that they were invented ‘at a comparatively early stage’.76 Yet by ‘early’ he apparently meant seventeenth century at the earliest; he regarded the Arab examples as only ‘somewhat like the forceps’, differing in that they were ‘of a fatal nature’, unable to deliver a live child, since they were ‘toothed’ or ‘bearded internally with sharp hooks for the purpose of being fixed upon the infant’.77 Simpson gave considerable detail on different versions of the modern forceps, including those of Smellie and Burton. He described Burton’s as ‘a very curious kind of Crab’s claw forceps, but this form has never been applied by anyone except Dr Slop himself (see Tristram Shandy)’.78 It is clear from Simpson that there had also been a shift in the patient perceptions of the forceps in the century since Smellie and Burton had been in dispute, although the accounts of forceps-users suggest that their own convenience was paramount in more ways than simply the timing of the procedure. In the early 1830s, James Blundell, Professor of Obstetricy at Guy’s Hospital, was confidently telling his audience that, for a forceps delivery, ‘it is proper to place the woman in a convenient position – that position being selected which may be the most commodious to yourself’.79 By Simpson’s day, most patients were now able to cope with the news that the forceps would be used, and some were even asking for it, especially after a previous good experience. Simpson advised his students: You will then in most cases tell the patient, but explain to her that it is not a cutting instrument, and if she wish to see it I should have no objection in allowing it, and have done so frequently … in France they have now an advantage over us in this respect, that they have most of their instruments gilded, which renders their appearance somewhat 80 less formidable and more agreeable. 75

Young, RCSE lecture notes, p. 77; Simpson, RCPE JYS 3, p. 36. Young also believed that the symphysis pubis does not separate, even in a difficult delivery. 76 As noted in chapter 3, Nihell, A Treatise on the Art of Midwifery, p. 254, had dubbed them ‘those dreadful “artificial hands”’, in contrast to the ‘natural hands’ of the female midwife. 77 RCPE JYS 3.8 ‘Fillet or Lac. Its History. Hippocrates’; RCPE ‘Notes of a Series of Lectures on Natural and Morbid Parturition delivered by Professor Simpson’, 1843–44, taken by William A. Harland, p. 303. 78 RCPE ‘Notes of a Series of Lectures on Natural and Morbid Parturition delivered by Professor Simpson’, p. 311. 79 Blundell, The Principles and Practice of Obstetricy, p. 499. 80 RCPE ‘Notes of a Series of Lectures on Natural and Morbid Parturition delivered by Professor Simpson’, p. 317.

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He went on to give an anecdote which tells us as much about the theatrical selfpresentation of men-midwives as it does about the attitude to the instrument in the mid-nineteenth century: I used to know an old practitioner who prided himself upon having a good leg of his own and was in the habit of showing it off by grasping his thigh with the forceps when 81 exhibiting their mode of action to a patient.

In the midst of these centuries construed as dominated by female ignorance, a few male figures were allowed into the history of midwifery, but none before the seventeenth century. Arnott singled out for praise the seventeenth-century practice of dilatation of the urethra in women to extract bladder stones, a practice which he says then fell into disuse for over a century; Edward Rigby, the first president of the OSL, trained at Edinburgh, praised the advances of Smellie in advancing knowledge of the position of the foetal head on entering the pelvis; while Crombie deplored the fact that, on those occasions when there had been ‘a famous name’ in the field, his influence had never been a lasting one.82 Naegele also wrote very generally of ‘men of talent’ who were ‘nearly approaching to the truth’ but were not able to exploit the opportunity ‘of penetrating into the mystery’ because they ‘turned their backs on nature, and puzzled themselves with inventing instruments & c.’83 Of course, the invention of some sort of ‘instrument’ was virtually de rigueur for Victorian medical men; Simpson invented a long forceps (1848) and a sort of ventouse he called the suction tractor (1849), and was one of the first in Britain to use the vaginal speculum.84 Simpson too praised some specific figures of the past. For example, in his 1841 study of face presentation, he commended in particular Paul Portal’s 1685 work, saying that ‘in this and in several other matters [he] far outstripped the age in which he lived’.85 Three years later, in a lecture to the Medico-Chirurgical Society of Edinburgh, he referred to ‘my former researches among the older authors’ and concluded that he should have paid more attention to ‘the work of the celebrated Paul Portal’, going on to spend several pages discussing two of Portal’s case 81

Ibid., pp. 317–18. Arnott, Appendix to an Essay on Therapeutical Inquiry, p. 17; Rigby, preface to F.C. Naegele, An Essay on the Mechanism of Parturition, tr. Edward Rigby (London, 1829); Crombie, On the Cause of Commencement of Parturition, p. 8. Rigby was a pupil of Naegele in Heidelberg. 83 Naegele, Essay on the Mechanism of Parturition, pp. 2–3. 84 Russell and Forster, List of the Works of James Young Simpson, pp. 2–3. On the importance of inventing instruments within the conduct of the Obstetrical Society of London, see King, Hippocrates’ Woman, p. 251 n. 5. 85 James Young Simpson, ‘Treatment of Face Presentation’, British and Foreign Medical Review (October 1841), pp. 473 ff.; reprinted in W.O. Priestly and Horatio R. Storer (eds), The Obstetric Memoirs of James Y. Simpson, 2 vols (Edinburgh, 1855–56), vol. 1, p. 483. 82

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histories, comparing the English translation with the French original, and arguing that Portal’s material was ‘in various aspects, not only historically, but practically, interesting’.86 In contrast to some of his contemporaries who were trying to classify all women as poor midwives, nor was it exclusively the men of the midwifery past whom he cited; in the notes for his lectures on natural and morbid parturition he referred to Jane Sharp for recipes to make the vagina ‘glib’ and to dilate the os.87 However, this was again a seventeenth-century reference; it was this period where, Simpson believed, an informed midwifery really began.

Simpson and the classics What of Simpson’s attitude to history before the seventeenth century? Always aware of the opposition to his support of anaesthesia in childbirth, he looked to the more distant past mostly to show that innovations originally ‘bitterly decried and denounced’ – such as the practice of ligating the arteries to stop bleeding, developed in the sixteenth century – had by his own day become widely accepted.88 In one of his publications for 1848 he used the printing of books on midwifery as an example of another innovation of the past, quoting a long passage of Raynalde’s Birth of Mankind, and commenting Long ago Raynalde, in sending forth the FIRST work on midwifery ever published in the English language, seems to have foreseen that, against the utility of publishing any book or books on midwifery, the same argument would be used as we have found in our 89 own day used against the application of anaesthesia to midwifery.

But his wider historical interests should not be underestimated. He would often start any essay with what he would quite disarmingly call a ‘slight historical

86 ‘On the Spontaneous Expulsion and Artificial Extraction of the Placenta before the Child, in Placental Presentations’, lecture to the Medico-Chirurgical Society of Edinburgh, 4 December 1844, revised; in Priestly and Storer (eds), The Obstetric Memoirs of James Y. Simpson, vol. 1, pp. 758–64. Simpson’s case XXX (pp. 759–60) reproduces Portal’s observation XLIII (The Compleat Practice of Men and Women Midwives: Or, the True Manner of Assisting a Woman in Child-bearing (London, 1763), pp. 148–50) while his case XXXI (pp. 761–3) is Portal’s observation LXIX (pp. 214–17). 87 RCPE JYS 6 (1–2) ‘Lectures on Natural and Morbid Parturition’ (2 vols) I, p. 207. This may be a reference to Sharp, The Midwives Book (ed. Hobby), p. 158, where duck fat, oil of lilies, and almond oil are recommended, or to p. 161 where decoctions of feverfew and mugwort, oils, and orally-administered powders are also described. 88 ‘Superinduction of Anaesthesia in Natural and Morbid Parturition’, p. 590. 89 Simpson, Anaesthetic Midwifery: Report on its Early History and Progress (Edinburgh, 1848), p. 47.

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sketch’,90 or would summarize the work of authors of the seventeenth and early eighteenth centuries.91 In his study of syphilis in fifteenth- and sixteenth-century Scotland he insisted that he was working not ‘to gratify mere antiquarian curiosity’, but to understand the spread of the disease in Europe more generally.92 He cited there a range of ‘Greek, Roman and Arabic writers’,93 and for his piece on the medical officers of the Roman army noted that he had ‘in vain searched among Roman medical authors and among the writings of the Greek physicians who practiced at Rome’ for evidence on the care of the army.94 He speculated that British folk medicine may retain remedies originally introduced to the country by the Roman invaders, and suggested that ancient writers on inflammatory eye conditions were ‘little or not at all behind [the precision] of similar writers on the same subject in our own day’.95 He appears to have owned a large number of classical works, often in sixteenth-century editions, and quoted from them in Latin where appropriate.96 Although his biographer Duns insisted that Simpson liked to go back in time to find ancient or unusual sources, Burnet has more recently argued that Simpson’s interests were more antiquarian than classical, which would make him more like John Burton than William Smellie.97 Certainly there is an element of the antiquarian collector in Simpson; Archibald Smith, one of the wide range of correspondents to whom he turned for advice, and who read his work in advance of publication or oral delivery, wrote to him in April 1858 with a reference to a passage of Herodotus which he thought Simpson would find useful 90

James Young Simpson, ‘Mechanism of Natural Labour’, British and Foreign Medical Review (October 1841), 462 ff; reprinted in Priestly and Storer, The Obstetric Memoirs of James Y. Simpson, vol. 1, p. 357. 91 Simpson, ‘Treatment of Face Presentation’, p. 482. 92 James Young Simpson, ‘Antiquarian Notices of Syphilis in Scotland in the Fifteenth and Sixteenth Centuries’, Transactions of the Epidemiological Society of London, vol.1, part ii (1862), p. 19. 93 Ibid., p. 21. 94 James Young Simpson, ‘Was the Roman Army Provided with Any Medical Officers?’ (Edinburgh, 1851), p. 5. 95 RCSE ms. 1123. 96 For example, Simpson, ‘Was the Roman Army Provided with Any Medical Officers?’ used Vopiscus, Modestinus, the Codex of Justinian, Galen, Celsus, Homer, Pliny, Herodotus, Hippocrates, Paul of Aegina and a range of inscriptions; he alluded to the ‘Hippocratic question’ (p. 8, n. 2) and used the Greek term for physicians (p. 6). A note preserved as RCSE ms. 1832 gives the basic biographical information on Vopiscus. In his work ‘On the Alleged Infecundity of Females Born Co-Twin with Males’, Edinburgh Medical and Surgical Journal (January 1844): 107 ff., reprinted in Priestly and Storer, The Obstetric Memoirs of James Y. Simpson, vol. 1, 315 ff. he noted that the Romans knew about the phenomenon of sterile cows, but did not make the link to their being twins; here he cited ‘Varro, Quae sterilis est vacca taura appellatur’ (p. 316). 97 J. Duns, Memoir of Sir James Young Simpson, Bart. (Edinburgh, 1873), pp. 470–71; J. Burnett, ‘Simpson: the outsider?’, History of Anaesthesia Society Proceedings, 29 (2001): 88.

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in lecturing on ‘percussion and auscultation’, adding ‘I send you this bit of antiquity, as I believe you delight in such things’.98 What is known of Simpson’s classical education? He arrived in Edinburgh at the age of 14 or 16 with his grandfather’s copy of Homer’s Iliad, and began the arts course at the university under James Pillan, who believed in the value of Latin and Greek in ‘strengthening the memory, attention, imagination and judgement’. 99 His own knowledge of Latin was very good; he won a bursary on the basis of his Latin prose at the beginning of his second year in Edinburgh. His surviving papers include an extended spoof commentary in Latin by Sir George Cornwall Lane, dated 1862, that treats the nursery rhyme ‘Hey diddle diddle, the cat and the fiddle’ as if it were a newly-discovered Latin inscription.100 In 1827, without completing the arts course, Simpson started a medical degree. In later life, however, it remained not the classical authors but those of the late seventeenth century that he most admired. Although in his private life he continued to enjoy classical jokes, by 1867 his views on the Classics in public life were far from supportive; in a lecture given in that year at Granton School in Edinburgh he expressed his opinions on a classical education, arguing that French and German were of more use than the languages spoken 2000 years ago. He took issue with the view that Latin and Greek trained the mind; on the contrary, he argued, study of these languages ‘tended to make the mind stunted and deformed, instead of developing it. They cultivated memory chiefly, and left uncultivated the higher powers of observation, so necessary for science’.101 In rough notes made for this lecture, he called for the teaching of classics to be restricted to ‘those whose tastes or pursuits render it desirable or necessary’, with modern languages being taught in small classes and with a focus on ‘practical utility in correspondence, in travelling, and in general society’.102 In preparation for his Granton lecture, Simpson had clearly read the evidence submitted by Michael Faraday to the Public Schools Commission in November 1862; a copy formed part of his personal library. Faraday had claimed that a classical education left people with very little 98

RCSE ms. 1131. RCSE ms. 1841, a note by his grandson, says he was 16 when he arrived in Edinburgh; Myrtle Simpson, Simpson the Obstetrician (London, 1972), p. 29 gives 14. See also p. 30. 100 RCSE ms. 1834. The ‘article’ argued, for example, that THE was related to Latin deus and Greek theios, and therefore meant ‘god’, meaning that THE MOON was a version of deus mundi. Florence Nightingale also enjoyed this piece, sent to her by the Dean of St Paul’s, writing ‘It amused me very much’; see Lynn McDonald, Florence Nightingale on Society, Politics, Philosophy, Science, Education and Literature (Waterloo, ON, 2003), p. 796. 101 Duns, Memoir of Sir James Young Simpson, p. 481; H. Laing Gordon, Sir James Young Simpson and Chloroform (London, 1897), p. 199; ‘He had personally felt the want of a mastery over French and German, both in the course of his studies and during his travels; nor did he feel the want compensated for by his ability to write and talk in Latin’. 102 RCSE ms. 1077. 99

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knowledge of natural science; those whose education was restricted to the Classics were not only ‘totally ignorant’, but also ‘ignorant of their ignorance’ and ‘not particularly apt to receive instruction’. In particular, he singled out those who ‘talk to me about things that belong to natural science; about mesmerism, table turning, flying through the air, about the laws of gravity; they come to me to ask me questions, and they insist against me, who think I know a little of these laws, that I am wrong and they are right, in a manner which shews how little the ordinary course of education has taught such minds’.103 Simpson’s devout Christian faith also led him to oppose the study of the classics, as being morally dangerous. One would only encounter what he called ‘the seething sea of demoralization [i.e. immorality] which prevailed in ancient Greece and Rome’. He said that he ‘once asked a gentleman, who was at the head of the Law here, what he would do with them [Horace, Ovid, Martial, Juvenal etc.] if they had originally been published in England. He replied that he would have been obliged, he feared, to stop their sale as obscene. If mothers knew the improprieties in some of the works that had been put into their children’s hands as text-books and prizes they would rise in rebellion’.104 However, what Simpson appears to have regarded as most authoritative were statistics; his lectures included tables giving comparative figures on the percentage of cases involving instruments, the numbers suffering different diseases of infancy in the Hôpital des Enfants in 1833–34, the duration of menstruation and the average age at menopause.105 He quoted figures for deaths of mother and child in different hospitals in an ill-tempered debate with Dr Collins, the former Master of the Dublin Lying-in Hospital and, orienting himself towards the future rather than the past, wrote that ‘every day I feel more and more the vast amount of work that yet remains to be done by us all in midwifery’.106

Performing the part both of man and woman: Simpson and gender Despite his later opposition to the Classics, and his views on the history of midwifery as only beginning in the seventeenth century, in his earliest work Simpson was more than happy to use classical and sixteenth-century texts to 103

RCSE 1826: [N.D.] Copy of Public Schools Commission, Paper 381, Volume XXI. Duns, Memoir of Sir James Young Simpson, p. 480. Simpson also wrote ‘Notes on some ancient Greek vases for containing lykion’ (1856). 105 RCPE JYS 53.8, ‘Instrumental Labour’ showed that the number of instrumental deliveries ranged from 1 in 13 (Carus) to only 1 in 183 (Boivin); RCPE JYS 4 (14), ‘Diseases of Infancy’; RCPE JYS 4 (10) ‘Diseases of Women (General)’. 106 Simpson, On the Duration of Labour as a Cause of Mortality and Danger to the Mother and Infant (Edinburgh, 1848), 17. This comment recalls accusations that Simpson was too young for the Chair of Midwifery in Edinburgh which he gained in 1840 at the age of 29. 104

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support his arguments.107 His interest in gender is clear from one of his first publications, the section on ‘Hermaphroditism’ in Robert B. Todd’s Cyclopedia of Anatomy and Physiology (1839, part xvi), for which his bibliography began in 1549, and where he cited a case of 1519 used by one of the Gynaeciorum libri authors, Jakob Ruf, as well as going even further back to classical authors including Martial, Pliny and Ovid.108 He could have used other Gynaeciorum libri authors for hermaphroditism – sections on it are included in Bonacciuoli and Mercuriale – but he did not, so it is possible that he did not own this large book at this early stage of his career. As we shall see shortly, however, he was certainly using the compendium by 1847. Throughout his discussion of hermaphrodites, he cited historical authorities and quoted Latin phrases from them; his footnotes show that he was using the Latin originals as well as English translations. His papers contain evidence that he collected materials with a view to writing on this topic; for example, he owned an extract from the Sheriff Court Book of Elgin and Nairn, dated 3 November, 1654, in which a marriage was annulled because the wife, Isobell McKewin, was found to be ‘Ane creature callit ane hermaphrodite’.109 ‘Borne ane hermaphrodite, haiffying members of both sexes’, she was unable to consummate her marriage in the female role; she ‘did confess that god had not (in his providence) sooted her for the use of the Mariage bed’. The case involved testimonies from a physician and a ‘Professor of Physic’.110 Scholars working on hermaphroditism have argued that there was a shift in understanding of their bodies a few decades after Simpson wrote his study of the condition. What of earlier understandings of hermaphrodites? Ruth Gilbert has argued for the coexistence in the Renaissance of an Aristotelian ‘rigid system of sex-gender differentiation’ alongside the more Hippocratic ‘idea that sex and gender were insecure categories which could always potentially slide and merge into each other’.111 Like Laqueur, she focuses here on the ‘Hippocrates’ of On Generation/Nature of the Child, at the expense of the Hippocratic view of the Diseases of Women treatises, where women are entirely different from men. Albucasis, basing his work on Paul of Aegina, argued that their condition was due to excess, and that ‘the superfluous growths must be cut away so that every 107

For a full list of Simpson’s publications, see Russell and Forster, List of the Works of James Young Simpson, supplemented by the fuller list of manuscripts at the Royal College of Physicians, Edinburgh (www.rcpe.ac.uk). My thanks to the librarian, Iain Milne, for his assistance. 108 James Young Simpson, ‘Hermaphroditism’, in Robert B. Todd (ed.), The Cyclopaedia of Anatomy and Physiology (London, 1836–39), vol. 2, DIA–INS, pp. 691 (Ruf); 686 (Martial, Seneca, Athenaeus); 692 (Pliny); 732 (Ovid), etc. Simpson also referred to the hermaphrodite in Greek and Roman art (p. 728). 109 RCSE 1827: [N.D.]. 110 John Innes, physician, and John Neill, Professor of Physic gave evidence in the case. 111 Ruth Gilbert, ‘Probleme of Sexes’: Representing the Renaissance Hermaphrodite (PhD thesis, Dept of English, University of Southampton, 1996), p. 12; ibid., Early Modern Hermaphrodites: Sex and Other Stories (Basingstoke, 2002), pp. 36–7.

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trace is destroyed’.112 In a contrasting approach, however, it could instead be due to a perfect balance. The section on the hermaphrodite in Ambroise Paré’s treatise on monsters attributed the cause to equal amounts of seed being provided by both parents, using the Hippocratic idea from Generation/Nature of the Child that men and women both provide seed, and that sex is therefore a continuum.113 He set up four categories of hermaphrodite: the male hermaphrodite, capable of impregnating a woman; the female hermaphrodite, who produces female seed and menses and, although she has a penis, cannot achieve erection; hermaphrodites who are ‘neither one nor the other’ sex, because they have no functioning sexual organs; and finally the ‘male and female hermaphrodite’ who has two sets of organs, both of them capable of use.114 This final group was clearly the most disturbing, and Isobell McKewin fell into this category. In the 1634 English edition of Paré, such individuals were described as ‘those who are able in both sexes, and thoroughly performe the part both of man and woman, because they have the genitalls of both sexes compleat and perfect’.115 For them, physicians and surgeons were able to decide with which sex they should choose to identify according to other features, such as body hair, facial features and character. Although legally the individual could decide for him/herself, this must be within certain limits set by the visible bodily organs. An even earlier French physician, Jacques Duval, is often described as having written ‘on hermaphrodites’.116 But in fact his book of 1612 was a midwifery text; hermaphrodites were only reached after over 280 pages on the male and female genitals, signs of defloration, the formation of the child, care of the pregnant women, childbirth, and the care of both mother and baby.117 Like Paré, he had argued that a hermaphrodite resulted from the perfect balance of the contributions of seed from both parents.118 Gilbert sees the hermaphrodite as a figure that ‘troubled Renaissance ideas about gender, sexuality and the sexed body’, but one could argue the reverse: that 112

Spink and Lewis, Albucasis, p. 454 (section 2.70, based on Paul of Aegina, 6.69). Ambroise Paré, Les œuvres d’Ambroise Paré, conseiller et premier chirurgien du Roy (Paris, 1575), p. 811 (English, On Monsters and Marvels, tr. Janis L. Pallister, Chicago, IL and London, 1983, p. 26). The English is abbreviated from 1575 French edition, the latter including a section on same-sex female behaviour. There is also a fairly loose seventeenthcentury English version, The Workes of that Famous Chirurgion Ambrose Parey translated out of Latine and compared with the French, tr. Thomas Johnson (London, 1634). 114 Paré, Les œuvres, p. 811; Pallister, pp. 26–7. Jenny C. Mann, ‘How to Look at a Hermaphrodite in Early Modern England’, Studies in English Literature, 46 (2006): 67–91 argues that, as physicians became increasingly interested in the detail of the hermaphrodite genitalia, sixteenth-century poets kept the hermaphrodite’s sexuality blurred, neither one thing nor the other. 115 Johnson, pp. 972–3. 116 E.g. Gilbert, Early Modern Hermaphrodites, p. 35. 117 Jacques Duval, Des hermaphrodits, accouchemens des femmes, et traitement qui est requis pour les relever en santé, et bien élever leurs enfants (Rouen, 1612). 118 Ibid., p. 328. 113

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the hermaphrodite was an essential part of any system in which both sexes were thought to contribute seed.119 Indeed, Gilbert herself also regards the hermaphrodite as ‘both the logical effect of a fundamental sexual similarity and an impossible bridge between radically opposed sexual differences’.120 Prefiguring the approach of Simpson, some early modern writers, such as Ruf, regarded the condition of the hermaphrodite as an illusion; individuals were really one or the other sex, rather than being ‘of both kinds’, and a medical expert could assign them correctly.121 Paré’s approach, too, suggested that the ‘male hermaphrodite’ and the ‘female hermaphrodite’ at least could easily be removed from the category and assigned to one sex. By the seventeenth century, hermaphrodites were on display as curiosities for close inspection, as well as being the subject of scientific discussion; rather than it being seen as a stable condition, hermaphrodites’ stories came to emphasize change over their lifetimes.122 While Paré’s classification reduced the number of those seen as fully hermaphrodite, eighteenth-century writers often went further still, assigning all to one sex. Writing as the result of the display in London in June 1740 of an Angolan hermaphrodite, James Parsons argued that all so-called hermaphrodites were really female. He dismissed the ancient view that somebody could have the features of both sexes if the seed provided by both parents was entirely equal in quality and quantity, instead claiming that ‘an extraordinary Elongation in the Clitorides of Females’ had led to the myth of the hermaphrodite.123 But in his 1771 lectures, Thomas Young asserted the reverse: ‘I am of the opinion that such as go under this name are all male’. He argued that what appeared to be an enlarged clitoris should more properly be identified as a penis; this recalled discussions a century earlier in which ‘not over-expert Midwifes [sic]’ were blamed for classifying as female a child who was really male, but who had only a small penis.124 But Young cast further doubt on the existence of hermaphrodites by describing the possibility of altering the body to create one. He had seen a person who ‘had been manufactured when young, in order to make more money of him by making him resemble both sexes’; this individual’s testes had been removed, the scrotum divided to create ‘labia’, and a small ‘vagina’ formed by making a hole just large enough to admit a little finger.125

119

Gilbert, ‘Probleme of Sexes’, abstract. Ibid., p. 48. On Lefort, see Dreger, Hermaphrodites, pp. 54–7. 121 Gilbert, Early Modern Hermaphrodites, pp. 40–41. 122 Ibid., pp. 144–58. 123 James Parsons, A Mechanical and Critical Enquiry into the Nature of Hermaphrodites (London, 1741), pp. 7–9, 31. Gilbert, Early Modern Hermaphrodites, p. 33. On the Angolan woman (?), see ibid., p. 154. 124 R.C., I.D., M.S. and T.B., The Compleat Midwife’s Practice Enlarged, p. 274. 125 RCSE vol. 2, p. 8. 120

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Simpson shared Parsons’s belief that a so-called hermaphrodite could simply be a woman with an enlarged clitoris.126 He also returned to the Renaissance interest in the hermaphrodite as promiscuous, to discuss the relationship between such enlargement and sexual desire. In his later lectures on the subject, he cited ‘the stories of the Ancients, Martial Juvenal and the Apostle Paul of those called Tribades and Confricatrices’ who showed an enlarged clitoris, but cited the contemporary writer Parent-Duchatelet as saying that his research showed that prostitutes in Paris had unusually small ones. Simpson had checked this out locally, adding in his notes ‘(confirmed in Lock’s Hospital here)’.127 His interest in the clitoris also formed part of his attempts to draw up a full table of analogies between the male and female sexual organs, a recurrent feature of his lecture notes which probably appeared in tabular form for students to copy down; we know from the catalogue of his collection that Simpson used magnified tables as a visual aid, and also wrote tables out on the board.128 In this list of analogies, the anomalous organ is the womb, and Simpson was not convinced by the attempts of some of his contemporaries to classify the womb as equivalent to the prostate gland. Working on the latter half of the nineteenth century, Alice Domurat Dreger has dubbed that period the ‘Age of Gonads’, a time when the exterior body took a back seat to very specific internal organs of generation. Developing this idea, Anne Fausto-Sterling has argued that hermaphrodites were eventually classified almost out of existence by a new insistence that only people with both ovarian and testicular tissue should count as ‘true’ hermaphrodites.129 Such attempts to erase hermaphrodites were not, however, unique to the late nineteenth century. While Parsons and Young had already argued against the reality of the hermaphrodite in the eighteenth century, by 1829 Simpson was working to reduce still further the number of people to be counted as ‘true’ hermaphrodites. For him, true hermaphroditism was to be distinguished from spurious hermaphroditism because in the spurious form the organs only look like those of the opposite sex, while in the true form there is a blending of ‘more or fewer of both the male and female organs’. Unlike in the later ‘Age of Gonads’, however, these organs did not 126 RCPE, ‘Notes from Dr Simpson’s Lectures on Midwifery by John McFarlane 1839’, vol. 1, p. 54. 127 1838 lecture, p. 3; RCPE JYS 54 (3) I; Alexandre-Jean-Baptiste Parent-Duchatelet, De la prostitution dans la ville de Paris, 2 vols (Paris, 1837), vol. 1, pp. 214 and 219 in fact says that there is no difference between the size of the clitoris in a prostitute and in a respectable married woman. He uses the word ‘tribade’ on p. 222. 128 RCPE, ‘Notes from Dr Simpson’s Lectures on Midwifery by John McFarlane 1839’, vol. 1, p. 98. On the use of tables in his teaching, see Simpson, List of the Preparations, Casts, Drawings, Instruments, Obstetric Machinery, & c. Contained in Dr J.Y. Simpson’s Museum and Employed by him in the Iillustrations of his Lectures on Midwifery (Edinburgh, 1840), p. 53 and RCPE, ‘Notes of a Series of Lectures on Natural and Morbid Parturition delivered by Professor Simpson’, p. 318. 129 Anne Fausto-Sterling, Sexing the Body: Gender Politics and the Construction of Sexuality (New York, 2000), pp. 37–8, following Dreger, Hermaphrodites, p. 143.

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have to be the testicles and ovaries; other combinations of male and female organs still qualified the individual as hermaphrodite, and he listed the clitoris, uterus, penis, urethra and bladder, in addition to testicles and ovaries. However, his specific decisions about gender assignment show that, even before the Age of Gonads, he was regarding some physical signs as more important than others; for example, if a beard is accompanied by even one ovary, then the patient is female.130 In general, he regarded menstruation as significant because it would indicate a concealed uterus. Simpson asked the reader to imagine the body upright, in which case one could draw a line vertically, seeing whether the two lateral halves differ – recalling the 1793 image of the ‘man-mid-wife’ – or make the line horizontal, so that the upper and lower halves may not match; or one could have the presence of a double set of organs. Here he cited a number of sixteenth- and seventeenth-century writers, including Colombo, De re anatomica (1559), de Graaf, Paré, Portal and Duval.131 Having a functioning penis was obviously important in defining masculinity, but ‘character and appearance’ were also seen as critical. In his investigation of a number of well-documented historical cases, in many Simpson rejected the classification of ‘hermaphrodite’ altogether, instead assigning the individuals to one sex or the other. Combining the views of Parsons and Young, he argued that many so-called hermaphrodites were simply women with an enlarged clitoris or a prolapsed womb: others were really men. So, in assessing the true sex of Maria Nonzia, born in 1694 and twice married as a woman, the statement that ‘the visage was bearded’ carried more weight for him than ‘the mammae were as fully developed as in the adult woman’, or even than the alleged presence of the menses; Simpson decided that Maria only claimed to menstruate, because she ‘was necessarily greatly interested in maintaining the reputed female character’ and concluded that she was in fact ‘a malformed male’.132 This could be seen as his insistence on forcing individuals into one sex or the other making him disregard anything that did not fit his chosen category. The case of Maria E. Arsano of Naples, who lived as a woman until her death at the age of 80, is very different. Here, while all external organs appeared female, autopsy revealed that inside she was entirely male. She therefore did not menstruate, but nevertheless married; and, Simpson noted, ‘from being constantly employed in domestic occupation, the mental character was feminine’.133 This suggests that feminine behaviour should be ignored as a clue to sex; gender and sex did not coincide here. In assigning sex, Simpson also placed little weight on the 130

Simpson, ‘Hermaphroditism’, p. 689. Ibid., pp. 685 (Colombo; de Graaf), 692 (Paré), 693 (Portal), 708 (Colombo). 132 Simpson, ‘Hermaphroditism’, p. 695. If Maria did indeed have a ‘menstrual’ discharge, Simpson insists that it should have been analyzed to discover if it was really menstrual fluid, or rather ‘pure blood’. On ignoring patients’ claims as exaggerations, see also Dreger, Hermaphrodites, pp. 90–91. 133 Simpson, ‘Hermaphroditism’, pp. 703–4. 131

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sexual desires of the individual, unless those conformed to his view of the balance of the organs; so Marie Madeline Lefort, exhibited in Paris in 1814 at the age of 16, ‘considered herself a female, and preferred the society of men’; but more important were the facts that she had menstruated from the age of eight, and that she had no testicles. These points ‘can leave no doubt as to the nature of her sex’.134 So where was Laqueur’s two-sex body, supposedly dominant from the eighteenth century, in this narrative? Maria Arsano appeared to challenge the model, because her maleness had not been sufficiently powerful to push itself to the outside. Towards the end of his article, Simpson specifically referred to the one-sex model, citing Aristotle, Galen, Rhazes and Avicenna as having ‘The female being regarded as an inverted male, with the testicles and penis turned inwards to form the ovaries and uterus. This doctrine of analogy between the male and female sexual organs has, with various modifications, been very generally admitted by modern physiologists’ and ‘particularly of late years’ has been ‘the subject of considerable discussion’.135 For him, therefore, the one-sex model was actually the ‘modern’ one. In his own lectures, as I have already mentioned, he discussed the analogies and came to a total of ten. Here, as in his later lectures, he went back to the anomaly of the womb, noting that ‘A considerable difference of opinion, however, still prevails as to the prototype of the female uterus in the male system’.136 This is significant wording; the male was regarded as the prototype, the female as the copy. He concluded that, although the testis and ovary are parallel, as are the penis and the clitoris, while the vagina may correspond to the sheath of the penis – as St Hilaire argued – there is no analogue for the womb; it is ‘peculiar to the female’. Later in the nineteenth century, writers went further still in their focus on the womb. In 1847, William Tyler Smith waxed lyrical on the womb as ‘the organ of circulation to the species… Parturition is the systole of the uterus, the unimpregnated state its diastole’.137 Martin Holbrook – a proponent of the ‘fruit diet’, which he believed could lead to ‘painless parturition’ – quoted from a Professor Hubbard of New Haven, who had said in a lecture to a medical society in 1870 that it was ‘as if the Almighty, in creating the female sex, had taken the uterus and built up a woman around it’.138 Holbrook also quoted the dictum of Jan Baptista van Helmont (1577–1644), propter solum uterum mulier est quod est,

134

Ibid., pp. 688–9. Ibid., p. 724. 136 Ibid., p. 724. 137 William Tyler Smith, ‘Lectures on Parturition, and the Principles and Practice of Obstetricy: Lecture III’, Lancet, 50 (20 November 1847): 544. 138 Martin L. Holbrook, Parturition without Pain: A Code of Directions for Escaping the Primal Curse (1874), p. 15, cited in Poovey, ‘“Scenes of an Indelicate Character”’, p. 145, n. 45. This is probably George H. Hubbard. 135

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‘woman is what she is on account of the womb’, altering this to propter uterum est mulier, ‘Woman exists for the sake of the womb’.139 In his lectures ten years later, Simpson changed some of his earlier analogies, for example suggesting that the vagina was the equivalent of the pelvic urethra.140 But in both sets of analogies, we can see that the one-sex model survived into the nineteenth century, except for its failure when confronted with the womb.141 And after his comment on difficulty of finding an analogy for the uterus, Simpson immediately reverted to a one-sex model again, noting that ‘Some organs that are, as far as regards their functions, peculiar and essential to one sex only, are nevertheless found to be repeated in the opposite sex in the form of an analogous rudimentary type of structure’; for example, the mammary gland in males.142 Why did Simpson pay so much attention to the hermaphrodite? In addition to reflecting a wider interest in classification and in organs, there is another aspect of Simpson’s interest that should be explored here. In the words of Robert Barnes, who succeeded Henry Oldham as President of the OSL a few years before Simpson’s death, the ‘obstetric physician seemed a sort of hybrid, sprung from the impure union of the pure physician and the pure surgeon’; by covering all diseases of the female generative organs, performing surgical procedures as well as recommending drugs, the nineteenth-century practitioner of obstetrics and gynaecology was seen as crossing the boundaries between surgeon and physician established in the seventeenth century.143 This had also been an eighteenth-century concern. As we have seen, Smellie’s classes united these different groups. Burton’s An Essay towards a complete new system of Midwifry (1751) noted that midwifery is both art and science; it needs both ‘manual Operation’ and ‘medical Skill’, both ‘Dexterity’ and ‘Learning’ ‘… and where they are united in one and the same Person, happy it is for the Patient’ (1751, xi). Was it good, or bad, to hover between categories in this way? The hermaphrodite was in a similar position. As I noted in the Introduction, Lisa Forman Cody has argued that the man-midwife deliberately claimed female traits of sensitivity alongside his masculine abilities to reason; however, as we have already seen, he was also represented by his opponents as a hermaphrodite. In his comments on the qualities required of members of his profession, however, Simpson did not seem to be aware of any 139

Holbrook, Parturition without Pain, p. 14. Chandak Sengoopta, ‘The Modern Ovary: Constructions, Meanings, Uses’, History of Science, 38 (2000): 428 argues for a shift in focus from the womb to the ovary after the discovery of the ovum in 1827, but I would argue that in some sections of medicine the womb remained the center of attention. 140 RCPE JYS 54 (3), vol. 2. 141 Schiebinger, The Mind has no Sex?, pp. 189–90 also argued that the increased emphasis on difference between the sexes led to the end of attempts to make the womb into an analogue of any male organ. See also Schleiner, ‘Early Modern Controversies about the One-sex Model’, on seventeenth-century discussions of whether the best analogue for the penis was the womb, or the clitoris. 142 Simpson, ‘Hermaphroditism’, p. 725. 143 TOSL 7, 1865: 42.

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risks of category-crossing. In an address delivered in 1868 to the Edinburgh medical graduates – who would all have taken midwifery training – he suggested that they too should be hermaphrodites, not just in midwifery but in all their medical activities. He advised them to aim at ‘steady manliness of hand and head’ but also not to ‘despise that gentle womanliness of heart’ which gave great benefit to the patient. He went on allude to St Luke, the ‘Beloved Physician’, saying ‘Be to every sick man his beloved, as well as his trusted physician’.144 In his papers is preserved a poem ‘Inscribed by a servant girl on a book presented to Dr Simpson’, which opens: Well may woman hail thy name Gratefully, and with acclaim, Whose Diploma, held of God, Of her sorrows lights the load.

Later the poem refers not only to Simpson’s possession of the ‘keys’ to ‘Things mysterious, dark and deep’ – a reference to the masculine unveiling of the female body, reminiscent of Ludmilla Jordanova’s work – but also to Simpson’s ‘tender heart’.145 It is interesting that Simpson chose to keep this tribute to his professional hermaphroditism.

Those most bitter pains: justifying chloroform Most famous for his use of pain relief in childbirth, Simpson was interested in many other aspects of pain. In his discussions of uterine contractions, he argued that labour pain was not an independent entity, but was a symptom of such contractions, and may not even be present; the converse was also true, as pain could occur in the absence of contractions, being ‘spurious pains’.146 Such pains should be suppressed with opiates, a view also held by eighteenth-century menmidwives such as Brudenell Exton.147 Simpson also recognized period pains as a real condition, to be treated with bleeding, warm baths and fomentations, enemas and sedatives (including opium and valerian), but with further treatment between the periods to deal with the underlying inflammation or congestion. 148 What of labour pain? Eighteenth-century naturalists had regarded labour pains as one of those features separating female human beings from the beasts.149 It was 144

Simpson, ‘Address to the Edinburgh Medical Graduates’, p. 195. RCSE ms. 1839; Ludmilla Jordanova, Sexual Visions: Images of Gender in Science and Medicine between the Eighteenth and Twentieth Centuries (London, 1989), pp. 87–110. 146 RCPE JYS 54 (3) vol. 1. 147 Exton, A New and General System of Midwifery, p. 46. 148 RCPE JYS 4 (10). 149 Schiebinger, Nature’s Body, p. 94. 145

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widely considered that these pains were the most terrible a person could suffer. In his preface to the 1597 Gynaeciorum libri, Spach had described the terrible pains suffered by women in childbirth, noting that Christ referred to these in the gospel – a reference to John 16 v.21, ‘A woman giving birth to her child has pain because her time has come’ – but in his list of achievements of medicine in the diseases of women he included ‘in the midst of labour, even to ease or lessen those most bitter pains’.150 The book thus not only recognized the severity of labour pain, but also acknowledged that they did not need to be suffered unaided by medicine. In both the eighteenth and nineteenth centuries, men-midwives continued to wax lyrical on the horrors of childbirth. William Osborn wrote in 1783 of ‘the calamitous condition of the Sex, who at all times of parturition, are exposed to the severest bodily pain’.151 Lettsom suggested that, rather than drugs, it was ‘the obstetrical art’ which was the best means of alleviating the pain which came into the world with the curse imposed upon Eve, ‘In sorrow thou shalt bring forth children’.152 In 1847 William Tyler Smith noted that ‘No human suffering, perhaps, exceeds in intensity the piercing agonies of child-bearing’, describing the final stage of labour as ‘the mingled agony and exhaustion of which obstetricians have exhausted their descriptive powers’.153 Before the late 1840s, however, some men-midwives believed that labour pain was to be encouraged rather than relieved, even giving remedies ‘to encourage Pain’.154 Smith too saw pain as a ‘preservative’ with a ‘benign and salutary part’ to play in causing the woman to cry out, reducing the pressure on the uterus.155 In contrast, Simpson, while agreeing about the severity of labour pain and quoting from Naegele on the extreme suffering of the final stage of labour, held that birth could proceed without the woman suffering.156 Rather than alleviation, he offered the complete absence of pain. He explicitly took his pain vocabulary from the words used by his patients, who spoke to him of their sensations of ‘grinding’, ‘cutting’ and ‘sawing’. Nor did he accept the by-now traditional definition of ‘laborious’ labour as anything extending beyond 24 hours, noting that ‘some women suffer as much in 6. as others in 24 hours’.157 150 Spach 1597, preface: in mediis nixibus vel acerbissimos illos dolores lenire ac minuere. 151 William Osborn, An Essay on Laborious Parturition: In which the Division of the Symphysis Pubis is Particularly Considered (London, 1783), p. ix. 152 Lettsom, History of the Origin of Medicine had argued that midwifery was a means of reducing the pain of the ‘primeval curse’ on Eve, namely to bring forth children in sorrow (Genesis 3 v.16). On Simpson’s interpretation of this passage, see below. 153 William Tyler Smith, ‘A Lecture on the Utility and Safety of the Inhalation of Ether in Obstetric Practice’, Lancet I (March 27 1847): 321. 154 Recipe ‘to encourage Pain’, based on cinnamon, in Chapman, A Treatise on the Improvement of Midwifery, p. xxxii. 155 Smith, ‘A Lecture on the Utility and Safety of the Inhalation of Ether’, p. 321. 156 Naegele cited in ‘On the Inhalation of Sulphuric Ether’, pp. 587–8. 157 RCPE JYS 54 (3) vol. 1.

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But how should pain be relieved? An anonymous man-midwife whose casebooks from 1739–50 are preserved at the RCPE was regularly giving opiates to ensure a good night’s sleep between the stages of labour, and also gave them after birth to prevent the ‘after-pains’.158 For labour pain, in his lectures delivered in 1843–44 Simpson, too, recommended the ‘good effect of Opium’ in giving the parturient woman a few hours of sleep between the first and the final stages of labour, but recognized that opiates would probably stop the contractions; he therefore suggested their use only if the mother was exhausted, or if the contractions were hurting the mother more than they were expelling the child.159 Another agent of pain relief was therefore needed. Before discovering chloroform, some obstetricians – including Simpson – had tried ether but, although it removed the pain, its use in childbirth raised concerns because it was thought to cause strange mental sensations. In 1847, William Tyler Smith agreed that ‘The relief of the pangs of travail would indeed be an invaluable boon’, and referred to the Roman goddess of childbirth, writing that Lucina was ‘fabled … to have been born without pain’, but observed that women under the influence of ether showed ‘the occasional incitement of the sexual passion’, including what appeared to be orgasm.160 In another of his lectures, Smith identified traditional ‘out of date’ midwives with Lucina, and the modern obstetrician with Apollo.161 Two years later, he used another classical image, warning that anaesthesia in childbirth was ‘but a cup of Circe’; referring to Circe, the witch in Homer’s Odyssey famed for her powerful drugs, aligned anaesthesia with women’s remedies. Smith went on to call it ‘a wild therapeutics’.162 Simpson discovered the properties of chloroform by personal experience a few months after Smith’s article referring to Lucina was published, and he moved rapidly to make public his own findings. The initial event, backed up by a description of his first use of it in labour, was described in a paper read to the Medico-Chirurgical Society of Edinburgh on 10 November 1847, published in the Lancet on 20 November, and was then issued in a pamphlet that came out on 15 November.163 He continued to publish updated descriptions as he tried it out on 158 RCPE Anon. 24 ‘Cases and Observations & c. in Midwifery by a Practitioner in Surrey’, pp. 135–6, case 120 ‘A Natural Birth’; p. 100 case 88; p. 101 case 89, ‘Gave the opiate and no after pains at all’. 159 RCPE JYS 6 (1–2) ‘Lectures on Natural and Morbid Parturition’, vol. 1, p. 201; RCPE JYS 4.5; RCPE ‘Notes of a Series of Lectures on Natural and Morbid Parturition delivered by Professor Simpson’, 1843–44, taken by William A. Harland, pp. 166–7. 160 Smith, ‘A Lecture on the Utility and Safety of the Inhalation of Ether’, pp. 322 and 323. 161 Smith, ‘Introductory Lecture’, p. 371. 162 Smith, Parturition, and the Principles and Practice of Obstetrics (London, 1849), p. 168. 163 Simpson, ‘A New Anaesthetic Agent, More Efficient than Sulphuric Ether’, Lancet, 50 (20 November 1847): 550–51; ibid., Account of a New Anaesthetic Agent, as a Substitute for Sulphuric Ether in Surgery and Midwifery (Edinburgh, 1847), p. 7 (Simpson’s inhalation

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more patients. In December, he was able to add two more cases of normal labour as well as ‘operative’ deliveries, and encouraged his audience to try the drug; several members of the Medico-Chirurgical Society took up his invitation.164 In parallel with his practical investigations, he was also working on possible historical precedents. In the same month he also corresponded with William J. Mackie, who checked through his references to the Hebrew word used in the Genesis passage condemning the descendants of Eve to ‘bring forth in pain/labour/sorrow’; perhaps this was also when he received information from a Mr McDougall discussing Mr Robertson’s comments on the gall and bitter herbs given to Christ on the cross.165 When defending chloroform against religious and other objections, Simpson assembled historical precedents, not only from the Bible. For example, in his paper for the Medico-Chirurgical Society, he noted that the thirteenth-century work of Theodoric of Bologna included a spongia somnifera which was soaked in opiates before being applied to the patient’s nostrils during surgery, and noted that mandragora was recommended to be drunk before surgery in Dioscorides, Pliny and Apuleius, while Herodotus described the Scythians inhaling hemp.166 He also suggested that ‘the gall and vinegar, or myrrhed wine offered to our Saviour before his crucifixion, was probably at that time generally employed with the same

of the substance) and p. 12 (its first use in labour). The Wellcome copy of this pamphlet was sent by Simpson to Dr Alfred McClintock of Dublin; McClintock was later to become the editor of a new edition of Smellie’s work. See Poovey, ‘“Scenes of an Indelicate Character”’, p. 137. 164 James Young Simpson, ‘Anaesthetic and Other Therapeutic Properties of Chloroform’, Monthly Journal of Medical Science (December 1847): 3, 7. 165 RCSE ms. 1122, letter from William Mackie; RCSE ms. 1825, note from Mr McDougall. In Matthew 27 v.34, wine mixed with gall is given to Christ; in Mark 15 v.23, it is drugged wine. 166 Simpson, ‘Anaesthetic and Other Therapeutic Properties of Chloroform’, pp. 5–6; ibid., Anaesthetic Midwifery: Report on its Early History and Progress (Edinburgh, 1848), p. 5. The sponge method of anaesthesia, possibly learned from the Arabs, is the subject of a considerable literature. Marguerite L. Baur, ‘Recherches sur l’histoire de l’anesthésie avant 1846’, Janus, 31 (1927): 29–39 gives the texts of both Theodoric and Ugo. I owe this reference to Michael McVaugh, who follows Baur in arguing that the sponge was never used, merely being copied between texts; see his book The Rational Surgery of the Middle Ages (2006). For a recent medical discussion, see Eric M. Deshaies, Darryl DiRisio, and A. John Popp, ‘Medieval Management of Spinal Injuries: Parallels between Theodoric of Bologna and Contemporary Spine Surgeons’, Neurosurgical Focus, 16 (2004). Doubt is cast on the efficacy of the sponge in Robert S. Holzman, ‘The Legacy of Atropos, the Fate who Cut the Thread of Life’, Anesthesiology, 89 (1998): 241–9. It is however possible that, if used, it would have been effective in terms of the limited expectations of the times; see Philippe Juvin and Jean-Marie Desmonts, ‘The Ancestors of Inhalational Anesthesia: The Soporific Sponges (XIth–XVIIth centuries): How a Universally Recommended Medical Technique was Abruptly Discarded’, Anesthesiology 93 (2000): 265–9. The Herodotus reference is to Book 4.

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object’.167 He used the Spach Gynaeciorum, citing Mercuriale in support of his point that, even 300 years ago, the level of pain in childbirth was thought unacceptable.168 This use of Spach emphasizes the relevance of the past to the present – the medical attitude to pain was seen as directly comparable – but also the void between then and now because, although Spach’s authors acknowledged pain, they were unable to ease it effectively. By the 1860s, Simpson’s rehearsals of the historical precedents for the use of pain relief in childbirth seem to have taken on a very different feel; chloroform was sufficiently well established that it was no longer necessary to treat the various religious and moral objections entirely seriously. In 1847 he had addressed the specifically religious objections, quoting on the title page I Timothy 4 v.4, ‘For every creature of God is good’ and James 4 v.17, ‘Therefore to him that knoweth to do good and doeth it not, to him it is Sin’.169 These two verses clearly told him that chloroform counted as part of creation, and so must be good, while not to use it would count as sin. In this pamphlet, he used the Old Testament but also stressed that Christ, the ‘Man of Sorrows’, had taken upon himself the pain of the world. Classical authorities were referred to only in passing, as was appropriate for an audience basing their objections on Christianity; Simpson merely mentioned Hippocrates, Galen and Aetius in discussing the terminology of coma, in the context of a discussion of God placing Adam in a deep sleep before removing his rib to create Eve.170 He analyzed the ‘primeval curse’ visited on Eve, interpreting Genesis 3 vv. 16–17 to show that what was often taken to mean ‘in sorrow thou shalt bring forth children’ was better taken as ‘in labour/toil’, and suggesting specifically that it meant the muscular efforts of the womb rather than the sensations accompanying them.171 Contractions were necessary: the sensation of pain was not. He also argued that the curse was ‘not immutable’, since God had taught the use of the plough, despite the curse including the words ‘in sorrow shalt thou eat of it (the ground) all the days of thy life’.172 In his 1864 lecture on chloroform – part of a series of six lectures on aspects of pain relief in childbirth – he made the same point about the religious objections, telling his students that, if the passage were taken to forbid pain relief, then ‘the same objection would hold good in regard to steam plough reaping machines, preaching and all attempts to

167

Simpson, ‘Anaesthetic and Other Therapeutic Properties of Chloroform’, p. 6. Simpson, Remarks on the Superinduction of Anaesthesia in Natural and Morbid Parturition (Edinburgh, 1847), p. 7, n. 2 citing Mercurialis, in Spach, Gynaeciorum, p. 233: Mulier, in partu, maximos et fere intolerabiles sustinet dolores. 169 Simpson, Answer to the Religious Objections advanced against the Employment of Anaesthetic Agents in Midwifery and Surgery (Edinburgh, 1847). 170 Ibid., p. 21. The reference is to Genesis 2 v.21. 171 Simpson, Answer to the Religious Objections, pp. 8–12, 13–14. 172 Ibid., p. 5. 168

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banish evil from the work are endeavours to obviate the first cause’.173 But when he turned to the moral objections, some humour was creeping into his discussion. He told them that, if we were to reject pain relief in childbirth as unnatural, then ‘we ought to go naked, ought not to cook, not to wear Hats etc’. In a later lecture he added ‘We are bound as medical men to relieve pain and why not relieve women should they alone now be subjected to the lash’.174 John Coakley Lettsom had considered that labour pain was less severe in southern climates; Simpson similarly believed that black women experienced little or no pain in giving birth, and argued that effective pain relief for the women of Northern Europe would only be reducing their level to that experienced by ‘the uncivilized female of our race’.175 In 1849 the Master of the Dublin Lying-in Hospital, Dr Shekleton, asked John Denham to produce a report on the advantages and disadvantages of this new method of anaesthesia. In reply, Denham stressed the safety of chloroform in childbirth, in natural, preternatural and instrumental deliveries, although he warned that in a minority of cases the drug was ‘positively injurious’.176 Its advantage over opiates was that they stopped contractions whereas, although chloroform could weaken them if given in too high a dose or for too long a period, it did not usually halt the process of labour.177 In particular, chloroform enabled turning to take place, as the practitioner’s hand could be inserted with no resistance; it could also be combined with the forceps.178 If the child was already dead, then chloroform made it easy to remove it, without resorting to dismemberment or evisceration, ‘a most disagreeable operation, exceedingly distressing to the patient, and disgusting to the attendants’.179 Denham’s comments show how unhappy physicians themselves were about the traditional methods of removing a dead child. 173

RCSE notes by William McNeil to the 1863–64 session. The phrasing of Simpson, Answer to the Religious Objections, p. 6 is that if we take the curse literally, it is a sin if man ‘employs the horse and the ox – water and steam power – sowing, reaping, thrashing, and grinding machines, & c’ to do his work. 174 RCSE notes by William McNeil. 175 John Coakley Lettsom, History of the Origin of Medicine: an oration to the Medical Society of London, January 19, 1778 (London, 1778); Simpson, Answer to the Religious Objections, pp. 13–14. Notes from his lectures of 1863–64 argue that labour is easier in black women because black children have smaller heads, making the dominant factor anatomy rather than climate; RCSE ‘Notes of Lectures on Midwifery by Dr J.Y. Simpson’, William McNeil, 1863–64 session, Lecture 2. The belief that women in other societies give birth without pain was a widespread one, found also in the seventeenth century; for example, in Guillemeau, Child-Birth or, the Happy Deliverie of Women, pp. 90–91 where it was described as ‘a rare thing’. 176 John Denham, A Report upon the Use of Chloroform in Fifty-six Cases of Labour Occurring in the Dublin Lying-in Hospital (Dublin, 1849), p. 7. 177 Ibid., pp. 12, 35. 178 Ibid., pp. 17, 26. 179 Ibid., p. 20.

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The passivity of the woman giving birth under chloroform was thus seen as an important advantage, making greater intervention possible. In one of his 1847 accounts of chloroform, Simpson wrote of a patient who had a tumour extracted from below her jaw that ‘her manageableness during the operation was as perfect as if she had been a wax doll or a lay figure’.180 So passive was she that she would not be able to remember what had happened. The lack of any memory of labour after birth with chloroform could be seen as problematic; mothers were reported to have been ‘astonished’ when they were presented with their ‘“own living baby”’. Simpson, reporting the reaction of one such mother, suggested that ‘patients themselves will force the use of [chloroform] upon the profession’.181

180 181

Simpson, ‘A New Anaesthetic Agent’, p. 551. Ibid., p. 551. See also Holbrook, Parturition without Pain, p. 95.

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Conclusion This book has tried to uncover what ‘gynaecology’ meant, from the Hippocratic Gynaikeia or Diseases of Women texts, to the three sixteenth-century editions of the Gynaeciorum libri and the nineteenth-century development of the gynaecologist. It has looked at the changing levels of competition and collaboration among different groups of men involved in childbirth, and between men and women. As Plutarch wrote with respect to the phenomenon of the ‘mole’, ‘No woman can make a child without the part played by a man’. In the sixteenth century, men also claimed the authority to override women’s own sensations as to whether they were carrying a ‘true’ child, or the formless mass of a mole. While such men used the Gynaeciorum libri as a convenient compendium of all that was known about the female body, both within and outside childbirth, my argument has focused on two later figures in medical history, William Smellie and Sir James Young Simpson, both of whom owned and cited the Gynaeciorum libri. Where sixteenth- and seventeenth-century writers focused on treating conditions associated, above all, with menstruation and sterility, eighteenth-century men interested in the diseases of women looked later in the process, to childbirth, as the centre of their practice; however, the field even of ‘men-midwives’ extended well beyond childbirth. The term ‘midwifery’ spanned the diseases of women and of young children, in addition to the process of giving birth: the sphere of the traditional midwife was similarly broad. As the boundaries of ‘midwifery’ expanded and contracted, ‘obstetrics’ was developed as the name for the field as practised, and transformed into a science, by men; ‘gynaecology’, in the sixteenth century an expression of the extent of female difference, took over as the term for what had been called ‘midwifery’. For some writers in the nineteenth century, the word ‘midwifery’, like the women who had practised it, eventually became something to be avoided, as redolent of an ignorant past; instead, ‘obstetrics’ was used, as a gender-neutral term. The past, and its ignorance or otherwise, was very important to men-midwives, and a central theme of this book has been the creation of medical history, in particular by those seeking to legitimate change. Both Smellie and Simpson used the past in this way, Smellie to defend the use of instruments, and Simpson to support the use of drugs in labour. In the fevered climate of the eighteenth-century ‘obstetric revolution’, caused by the novelty of men presenting themselves as the first port of call in normal childbirth, arguments about history were as important as arguments about the merits of different designs of forceps, while assembling

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historical precedents went alongside assembling collections of specimens as evidence of being a good practitioner. Smellie explained his decision to begin his midwifery treatise with the history of the field as being to make the material available to ‘those who have not time or opportunity to peruse the books from which it is collected’, and his use of Spach was another aspect of this scholarly convenience. Two decades later, Thomas Young similarly recommended Spach for giving ‘an account of all former authors’. What was important was the accumulation of knowledge in one place. Burton’s accusations of malpractice against Smellie covered both his use of forceps and his construction of history, precisely because the past was a possible source of support for novelties such as the use of instruments. The Gynaeciorum libri can be read as providing evidence of the antiquity of forceps in delivering live babies, and thus for one aspect of manmidwifery. For Smellie, using sources from classical antiquity as well as Arabic texts, the forceps had been used to deliver live babies well before the seventeenth century; for Simpson, denial of Hippocratic involvement in midwifery was matched by a rejection of any Arab use of forceps in live births, and the seventeenth century was when scientific midwifery began. In accusing Smellie of historical malpractice, Burton claimed that he had not used the Spach Gynaeciorum libri accurately; however, as I have shown from Smellie’s library, he appears to have done his research for the historical part of his book not only from Spach, but also from primary sources. The lecture notes of men-midwives gave different versions of the history of their field, written in order to justify men’s involvement. But how far back did this history stretch? In contrast to other eighteenth-century writers on midwifery, who had come to regard Hippocratic midwifery as primitive and valued the father of medicine more as a shrewd observer and guide to morality, William Smellie and his pupils used their own version of Hippocrates. Here, Hippocrates became not only the father of midwifery, but even the first man-midwife, despite not being believed to have performed any deliveries himself. This version was reinforced by the use of a bust of Hippocrates on the certificates awarded to Smellie’s pupils. In keeping with this elevation of Hippocrates, Smellie gendered the ‘jewels’ of the history of medicine as male, and superstition as female, and played down the role of women, for example omitting the name of the legendary ‘first midwife’, Agnodike, and presenting Cleopatra as ‘not at all suited’ to practising as a midwife. In the nineteenth century, the further erasure of women from the history of midwifery went alongside an increasing reluctance on the part of some to use the term ‘midwifery’ for male activity. Simpson, however, was Professor of Midwifery, but his was a midwifery controlled by men. While theory was generally gendered male, and practice female, manmidwifery found the division less straightforward. Writers such as William Douglas insisted on the need for practical experience in the field, and teachers of midwifery emphasized the practical training they gave both through the use of machines and ‘real labours’. While some men-midwives tried to distance themselves from ‘ignorant women’, others believed that such women could be

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educated in the ways of the new midwifery, although not in the use of its technology. In addition, men-midwives used their hermaphrodite identities to emphasize their ‘feminine’ qualities and thus to make themselves appealing to their female clients, rather than being seen as users of technology and bringers of death. But an emphasis on this dual nature also led to them running the risk of being seen as sexually promiscuous; their promotion of women’s fertility was accompanied by fears that they were using their privileged access to the female body in order to satisfy their own desires. By embracing his identity as a hermaphrodite, emphasizing his tender, ‘womanly’ heart, the man-midwife managed to subsume the female into himself, but absorbing only the positive sides of her character. By the nineteenth century, there were those who suggested that no woman could give birth without the part played by a man. Such birth would be considerably easier for both the man and the woman if the latter were to be asleep at the time. Where Smellie had pioneered the ‘machines’ which used a real female pelvis to represent a woman, and from which a doll could be extracted by the manmidwife, Simpson used chloroform to transform the woman herself into a ‘wax doll’ from whom a real foetus could be extracted. In the mid-nineteenth century, the sexes were in general seen as having a greater difference from each other than a century earlier, and the womb was regarded as the organ preventing a straightforward inside/outside relationship between the sexes. This material does not, however, support Laqueur’s model of a shift from a one-sex to a two-sex model of the body in the eighteenth century; the two-sex model, based on the Hippocratic Diseases of Women and stressing difference, had a resurgence in the sixteenth century, while the one-sex model survived to the time of Simpson. For Simpson, the Gynaeciorum libri had some importance in showing the antiquity of his field, but the compendium was only one of the many sources he thought appropriate. However, his wider interest in gender and male/female difference within the context of hermaphroditism could have been illustrated from the examples in the book. His explorations of gender pointed to the womb as the anomalous organ which broke down the one-sex model. Here, if only he had read his sixteenth-century writers more carefully, he could have echoed the final chapter of the Hippocratic Places in Man, ‘the womb is the origin of all diseases in women’. This, however, was not how he used the compendium. Whereas Smellie was accused by Burton of using the Spach edition of the Gynaeciorum libri as a ‘bluffer’s guide’ to the history of the subject, Simpson instead projected himself as a specialist in all matters concerning women by showing the size of his volume. By displaying Spach he was able to cite a historical authority for the crucial claims that female difference required a separate branch of medicine staffed by men, and that one man could perform both the manual art of obstetrics and the learned science of gynaecology.

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Stolberg, Michael (2003). ‘A Woman Down to her Bones: The Anatomy of Sexual Difference in the Sixteenth and Early Seventeenth Centuries’, Isis, 94: 274–99. Tait, Haldane P. and Wallace, Archibald T. (1952). ‘Dr William Smellie and his Library at Lanark, Scotland’, Bulletin of the History of Medicine, 26: 403–21. Tatlock, Lynne (1992). ‘Speculum feminarum: Gendered Perspectives on Obstetrics and Gynecology in Early Modern Germany’, Signs, 17: 725–60. Temkin, Owsei (1956). Soranus’ Gynecology, Baltimore, MD: Johns Hopkins University Press (reprinted 1991). [Thicknesse, Philip] (1764). Man-midwifery Analysed: and the Tendency of that Practice Detected and Exposed, London: R. Davis. Trapp, Helga (1967). Die hippokratische Schrift De natura muliebri: Ausgabe und textkritischer Kommentar, PhD thesis, Universität Hamburg. Trotter, David (2001). ‘Les Manuscrits Latins de la Chirurgia d’Albucasis et la lexicographie du Latin médiéval’, Archivum Latinitatis Medii Aevi, 59: 181– 202. ——— (2005). Albucasis: Traitier de Cyrurgie. Édition de la traduction en ancient français de la Chirurgie d’Abū’l Qāsim Halaf Ibn ‘Abbās al-Zahrāwī du manuscrit BNF, français 1318, Tübingen: Max Niemeyer. Ullman, Berthold L. and Stadter, Philip A. (1972). The Public Library of Renaissance Florence. Niccolò Niccoli, Cosimo de’ Medici and the Library of San Marco, Padua: Editrice Antenore. van der Eijk, Philip J. (2000–2001). Diocles of Carystus: A Collection of the Fragments with Translation and Commentary. Volume One: Text and Translation; Volume 2: Commentary, Studies in Ancient Medicine, vols 22 and 23, Leiden and Boston: Brill. Viets, Henry R. (1958). ‘Another Smellie’s Certificate’, Medical History, 2: 155–6. von Staden, Heinrich (1989). Herophilus. The Art of Medicine in Early Alexandria, Cambridge: Cambridge University Press. ——— (1991). ‘Apud nos foediora verba: Celsus’ Reluctant Construction of the Female Body’ in G. Sabbah (ed.), Le Latin médical: la constitution d’un langage scientifique, Saint-Étienne: Publications de l’Université de SaintÉtienne, pp. 271–96. Watts, Giles (1755). Reflections on Slow and Painful Labours, and Other Subjects in Midwifery. Together with observations on several disorders incident to pregnant women. Interspersed with remarks on Dr. Burton’s letter to Dr. Smellie, in which the merits of the cause between these two authors are, in some measure, considered, London: G. Keith. West, Charles (1850). A Brief Sketch of the More Important Fluctuation in Opinion … with Reference to the Performance of Turning, and the Application of the Forceps, London: Wilson and Ogilvy (first published in the London Medical Gazette). Wildberg, Christian Friedrich Ludwig (1819). Bibliotheca medicinae publicae, in qua scripta ad medicinam et forensem et politicam facientia ab illarum scientiarum initiis ad nostra usque tempora digesta sunt, Berlin: C.G. Flittner.

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Willughby, Percival (1972). Observations in Midwifery, Wakefield: C.R. Publishers (reprint of 1863 edition, Warwick, H.T. Cooke). Wilson, Adrian (1995). The Making of Man-midwifery. Childbirth in England, 1660–1770, Cambridge, MA: Harvard University Press. ——— (1997). ‘A Memorial of Eleanor Willughby, a Seventeenth-century Midwife’, in Lynette Hunter and Sarah Hutton (eds), Women, Science and Medicine 1500–1700: Mothers and Sisters of the Royal Society, Stroud: Sutton Publishing, pp. 138–77. Wolf, Caspar (1566). Moschionis medici Graeci de morbis muliebribus liber unus: cum Conradi Gesneri viri clarissimi scholiis et emendationibus, nunc primum editus opera ac studio Caspari Wolphii Tigurini medici, Basle: Thomas Guarinus. Worth-Stylianou, Valérie (2007). Les Traités d'obstétrique en langue française au seuil de la modernité, Geneva: Librairie Droz.

Index abortion 59 advertising 81, 132, 134, 159 Aetius of Amida 16, 34, 50, 87, 100, 116, 147, 152–3, 169, 187 Agnodike 91–2, 117, 192 Akakia, Martin 3, 5, 40, 48, 64, 125, 129, 152, 156 Albosius, Joannes 118–9, 120 Albucasis 2, 4, 143–50, 153, 163, 176–7 Alexander of Tralles 87, 152 Alexandria 15, 42 anaesthesia 18, 157, 172, 185, 186, 188; see also chloroform; ether anatomy 26, 72, 80, 84, 93, 169, 188 annotation 59, 60, 64, 100, 126, 142 and material text 48 as authorship 49 of medical books 7, 17, 44, 48–52, 57, 59, 84, 156 Apollo 41, 185 apoplexy 38 apothecary; see also surgeon-apothecary in childbirth, 71 definition 20 eighteenth-century 71, 80, 93, 148 Hippocratic physician as, 20 relationship to midwife, 21, 69, 111, 114, 167 on Smellie’s courses, 80 apothecary-surgeon 71 Arabic medicine 17, 33, 142, 144, 170 disparagement of 2 Archibald, Paul 100, 146 Aristotle 169 on female seed 54 on menstrual blood 56 on midwives 127, 129 on moles 62

on pregnancy 162 on women 55, 56, 181 Aristotle’s Complete and Experienced Midwife 137 Aristotle’s Masterpiece 60, 74, 127 Arnott, James 165–6, 168, 171 Artemis 40–41 Aspasia 116 Athena 156 Athens 91 Augenius, Horatius 118 autopsy 180 Aveling, James Hobson 164, 165 Avicenna 34, 55, 141–3, 146 and instruments 131, 142–4, 151–3 on one-sex model 181 role of midwife 150 Baillie, John 87, 93 Baptista da Monte, Giovanni 4 barbers 43, 130 Barker, John 88 Barnes, Robert 165, 182 Bauhin, Caspar 2, 3, 5, 48, 49; see also Gynaeciorum libri, 1586–88 edition beard 180 bearded ladies Arsano, Maria 180 Lefort, Marie Madeline 181 Nonzia, Maria 180 Berchelt, Simon 49 Berlin 12, 19, 45, 53, 102, 146 Bernard of Gordon 34 Bible 159, 183, 184, 186–7; see also Christianity bibliographies 6, 45, 49 birth, multiple, 159; see also twins

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bladder stones 171 blood circulation 128, 133 role in female body 30, 35, 52 and umbilical cord 127 use in magic 50 blood-letting 20, 39, 58, 183 Bonacciuoli, Luigi 3, 4, 17, 18–19, 36, 48, 51–2, 64, 129, 176 book collectors 1, 6–7, 17, 87, 155, 159, 160–1 Frankfurt Book fair 6 and medical authority 8 publishing 6 booksellers 43, 161 Borgia, Lucrezia 5, 36 Bottoni, Albertino 3, 5, 55 Bouland, Ludovic 1, 16 Bourgeois, Louise 119 Bracken, Henry 71, 74, 89, 98–9, 127, 138 brain 53 breasts 24, 62, 180 Burnet, Thomas 103, 104, 107, 124, 173 Burton, John accused of plagiarism 68 challenge to Smellie, 8, 67–72, 104, 105, 107–8, 114–16, 118–31, 148, 151–4, 192–3 as collector 70 on fillet 138 on forceps 138–43, 149, 151, 170 on Hippocratic medicine 88 on midwifery 71, 165 publications 67, 69, 95, 149, 182 training 108, 122 Byron, Lord 159 Caesar 100 Caesarean section 3, 105, 119, 140 Calvi, Marco Fabio 18–19, 29, 56, 124, 131 Cambridge 43–4, 108, 133 case histories 24, 48, 74, 79, 84, 95, 112, 135, 140, 172 Castro, Roderico à 29–30

catalogues 99, 116, 130, 134, 143, 159, 160, 179 of Arabic manuscripts in Bodleian library, 147 Manchester Medical Society 161 Obstetrical Society of London 164 Royal Medical and Chirurgical Society of London 160 of Simpson’s library 155 of Simpson’s specimens 70 of Smellie’s library 100–102 Catharine d’Amboise 35 Catherine de’ Medici 36–8, 41, 60 caudle 58 Cellier, Elizabeth 109 Celsus 49, 94, 99, 169, 173 on embryotomy 93, 151–3 prose style 94 as surgeon 169 use by Albucasis 144 use by Charles Clay 162 use by Colin Mackenzie 99 use by William Smellie 96, 100, 101, 102, 152 use on medical certificates 93 certificates, of medical training 20, 83, 93, 95, 97, 99, 103 Chamberlen family 143 Channing, John 147–50 Chapman, Edmund 58, 66–7, 71, 74, 75, 76, 110, 135, 137, 138, 167 Chartier, René 87, 104, 125, 131 chastity 41, 54 Chatry, Colombe 118 childbirth, 17, 18, 20, 22–4, 26, 36, 41, 58, 60, 65, 91, 95, 109, 165–7, 172, 177, 191 as a disease 22 death in 38, 110 difficult 22, 24, 64, 78, 108, 114, 115, 134, 142, 143, 150 imagery of 17 in Soranos 14 painless 18, 27, 183–8 publications on 3, 94 child-rearing, 41 children, sickly 50; see also languid child

Index chloroform 7–8, 155, 157, 163, 183–9, 193 objections to 186 Chrestien, Guillaume 34–42 Christianity 45, 74, 159, 175; see also Bible Circe 185 citation, role in sixteenth-century medicine 48 Clay, Charles 92, 146, 149, 162–4, 168 Cleopatra 11, 15, 116–7, 192 Clifton, Francis 89, 95, 98, 102–3, 104, 111 climate 88, 188 clitoris 178, 179–80, 181, 182 Cody, Lisa Forman 19, 23, 24, 27, 77, 182 collections 69; see also book collectors; libraries College of Physicians, London 20 Colombo, Realdo 180 colour, and healing 58 Columella 56 conception 14, 15, 32, 35, 36, 52, 56, 57, 63, 64, 90, 96, 166 contraception 50, 65 contractions, see labour pains Corde, Maurice de la 3, 5, 11, 19, 30, 31, 33–4, 41, 60, 61, 107–8, 119–21 craniotomy 22, 73, 143 Crombie, Charles 169, 171 Crompton, Samuel 161 Crosse, John Green 45, 46, 51, 161 crotchet 21, 83, 137, 138, 139, 141, 150, 151, 153 Cullen, Baillie 102 Cunningham, Andrew 88 Dean-Jones, Lesley 24 defloration 31–2, 33, 177 Demand, Nancy 23 Denham, John 188 Denman, Thomas 23, 93–5, 111, 127, 129, 135, 138, 141, 166 desire 54, 179 Deucalion 118 Diane de Poitiers 35–41, 58 dictionaries, medical 125

221 diet 12, 35, 54, 96, 181 Dionis, Pierre 138, 151 Dioscorides 186 divorce 60 dolls 18, 133, 134, 135, 189, 193 Douglas, William 64, 70, 81, 83, 89–90, 110–14, 134–5, 136, 140, 159, 192 Dreger, Alice Domurat 165, 179–80 dropsy 77 drugs 18, 20, 44, 54, 58, 76, 83, 88, 108, 182, 184–5, 191; see also ether, chloroform in labour 111 opiates 114 use by midwives 21 du Coudray 133 Dublin 134, 175, 186, 188 Dubois, Jacques 3–5, 22, 31, 34–41, 50, 52, 53, 54–5, 56, 57, 58–9, 108, 121 Duval, Jacques 177 Edinburgh 7, 8, 25, 64, 68, 70, 80, 82, 85, 101, 102, 103, 149, 155, 156, 158, 163, 165, 166–7, 171, 174, 183, 185 education classical 8, 72, 113, 174 medical 7, 42, 66, 73 midwifery 79, 82, 158, 163, 165, 168, 192 Egypt 69, 85 Elisabeth de Valois 38 embryotomy 93, 142, 149–53, 188 emmenagogues 58–9 erection, in defining functioning penis 177 ether 185 ethics, medical 94 Eve, curse of 184, 186, 187 Evenden, Doreen 20–21, 71, 73 exercise 12, 54 experience, role in medicine 8, 14, 25, 37, 40, 77, 84, 94, 99, 109, 129, 185 Exton, Brudenell 22, 71, 75, 135, 136, 137, 138, 151, 183

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Falcutius, Nicolaus 57 Faraday, Michael 174 Fausto-Sterling, Anne 179 female seed, see semen, female Fernel, Jean 36, 38, 40 Fife, Ornelle 71–2 fillet 137–8, 141, 142–3, 170 Fletcher, Anthony 6 Florence 40, 42, 43 fluor albus 103, 105, 115, 121–6, 169 Foës, Anuce 122, 131 foetus development of 62 extraction from womb, see embryotomy foetal position 75, 76, 79, 135, 137 models of 18 nutrition of 96 folk medicine 173 forceps 66–7, 70, 78, 83, 108, 109–10, 114, 137, 144, 146, 170–71, 188, 191; see also instruments and 1597 Gynaeciorum libri, 139, 142, 147–9 claims for antiquity of 131, 141, 142–4, 151–3, 170 difficulty of using 138–41 Foster, Thomas 60 fractures 130 Freind, John 45, 68, 86–9, 96–8, 102, 107, 148, 152 fumigation 58, 150 Galen 13–14, 18, 19, 34, 49, 53–6, 61, 88, 90, 96, 100, 102, 125, 169, 173, 181, 187 Gardner, Augustus 168 garlic 129 gender, as continuum 14 General Lying-in Hospital 99 generation 3, 34–5, 61–2, 66, 121, 179 organs of 12–13, 23, 90, 165, 179 Gerard of Cremona 144 Gesner, Conrad 1, 3, 16, 83 Gilbert, Ruth 14, 177, 178 Glaister, John 72, 100, 120 Glasgow 67, 73, 102, 108 Glover, John 49

Goldast, Melchior 15 gonorrhoea 126; see also venereal disease gossips 77 Göttingen 12, 115 Goulston, Theodore 52, 59 Graaf, Regnier de 180 Green, Monica 5, 6, 19, 25, 31, 59, 91, 150 Guerrini, Anita 132, 133 Guillemeau, Jacques 15–16, 22, 92, 107, 127, 131 Guy’s Hospital 67, 80–1, 170 Gynaeciorum libri 1–7, 104, 144, 160 1566 edition 1, 5, 11, 17, 34, 44, 49, 57, 156 1586–88 edition 2, 11, 44, 45, 46, 47, 49, 51, 59, 60, 161, 163 1597 edition 6, 7, 8, 11, 17, 30, 52, 60, 68, 83, 102, 104, 107, 118, 123, 124–5, 129, 130, 139, 145, 146, 147, 149, 152, 153–4, 155– 6, 159, 163, 184, 187, 192, 193 gynaecologist, role of 22 gynaecology 164 as a specialism 19, 157, 164 Hippocratic 18, 33, 34 historical origins 8, 9, 11, 164 gynaikeia 2, 53, 166 hair 177 hand of man-midwife 41, 136–7, 138, 150–51, 152, 153, 157, 188 of midwife 22, 142, 150, 170 Hannibal 109 Hanson, Ann Ellis 15, 24 Harvey, William 93 Harvie, John 95, 97, 112, 134 heart 38, 53, 63, 117, 183, 193 Henri II 36, 37, 40, 41, 60, 119 Heracles 16 herbs 51, 58, 59, 186 hermaphrodites 27, 158, 176–83, 193 as all female 178 as all male 178 explanations of 177 manufacture of 178

Index Herophilos 14–15, 91 Hippocrates authority of 19, 30, 67, 89, 9, 94, 99, 125 challenges to 90–91, 92–3, 128, 169– 70 as Father of Medicine 19, 30, 34, 89, 92, 128 as Father of Midwifery 92, 95, 96, 102–3 as first man-midwife 18–19, 99, 117, 162, 169 as gynaecologist 6, 9, 11–12, 14, 19, 29–30, 32–3, 51, 56, 61, 121–2 as Newtonian, 86 and political conservatism 86–7 Hippocratic bench 130 Hippocratic corpus 12; see also Hippocratic texts Hippocratic physician 20, 23 Hippocratic texts Airs, Waters, Places 98, 95, 102 Aphorisms 7–8, 18, 34, 53, 135, 162 Diseases of Women 3, 11–12, 13–14, 16, 18, 19, 23, 26, 29, 30, 31, 33, 34, 37, 38, 41, 51, 53, 56, 61, 62, 96, 103, 107, 120, 121, 122, 125, 129, 146, 151, 176, 191, 193 On the Diseases of Young Girls 11, 41 Epidemics 12, 18, 24, 51, 53, 88, 102, 103 On the Excision of the Foetus 20, 151 On Generation/On the Nature of the Child 52, 176 Nature of Woman 29, 32, 103, 123, 126 Places in Man 11, 13, 193 Prognostics 95, 102 Prorrhetic 53 On Superfetation 90, 126, 128, 129 translations 31, 34, 99, 103, 122–3, 125, 131; see also Calvi Holbrook, Martin 181 homeopathy 161 Homer 100, 173, 174, 185 Horace 175

223 hospitals 1, 8, 74, 80, 81, 93; see also under individual hospitals maternity 158 Hull, John 161 Hunter, William 67, 73, 93, 112, 128, 134, 137, 149 Hunterian School of Medicine 169 hydropsy 62 Hyginus 91 hymen 58 imperforate 105 hypospadias 36 hysterectomy 162 illustrations, anatomical 2 incunabula 48 instruments, see fillet; forceps; crotchet; machines surreptitious use of 139, 141 Jones, Peter Murray 3, 42–3, 57, 160 Jordanova, Ludmilla 183 Juvenal 175, 179 Kay, Richard 77, 80–83 Kelly, Howard 7 Kingston, Francis 82 labia 105, 153, 178 labour cause of 132 difficult 22, 25, 71, 76, 78, 83, 111– 14, 126, 131, 137, 141, 150 final stages 65, 74, 184 hastening 78 natural 22, 23, 24, 65, 66, 78–9, 165–6, 167, 186 pains 78, 114, 135, 183–5, 187, 188 ‘real’ labours 77, 79, 81–2, 95, 134, 192 spurious pains 78, 135, 183 understanding of normal labour 66, 140, 151, 169–70 lactation 15, 33 Lanark 7, 66, 72, 84, 86, 100, 101, 102, 103, 117, 130, 146, 147 languages, classical 108 languid child 126

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Laqueur, Thomas 13–14, 23, 26, 27, 176, 181, 193 Latin as medical language 3, 39, 80, 117 translations from Greek 8, 96, 123, 125, 130–31 Leake, John 76, 80–81, 90, 94, 96, 143, 151, 167 le Bon, Jean 3, 5, 32, 50 Le Clerc, Daniel 45, 68, 86–8, 96, 102, 103–4, 107, 116–17, 130, 152, 169 lecture notes 23, 69, 81–4, 91, 95, 96, 129, 157, 165, 166, 167–8, 172, 174, 179, 192 leisure 54, 87 lethargy 38, 111–12, 114, 115 Lettsom, John Coakley 184, 188 libraries 3, 6–7, 16, 130; see also book collecting; individual medical societies British Library 64 Cambridge University Library 44 Edinburgh University Library 50 Glasgow University Library 67 Herzog August Bibliothek 50 John Rylands Library 44–7, 59, 63– 4, 120, 161, 163 Laurentian 42 medieval 42 Merton College, Oxford 52 personal 44, 48, 50, 57, 72, 86, 100, 115–18, 130, 152–3, 155, 162, 174 Queen’s College, Oxford 59, 64 Royal College of Physicians of Edinburgh 155–6 Washington 161 Lindsay Institute 7, 84, 100–103, 146 lithopaedion of Sens 2, 117–19 liver 51, 53, 54–5, 127 Lloyd, James 95 Lock’s Hospital 179 Longfellow, Henry Wadsworth 159 Lorkyn, Thomas 44, 49, 50, 57 Lotichius, Johann Peter 9 Loudon, Irvine 8, 65, 72, 167 Lucian 100

Lucina 114, 185 Lucretius 100 Macbeth, Norman 8, 10, 111, 155 machines to imitate childbirth 18, 93, 99, 117, 132–5, 157 as term for instruments 1301, 137, 143 Mackenzie, Colin 99, 134, 143 Mackie, William J. 186 Maclean, Ian 2, 6, 7, 57 magic 50, 85 Manchester, see libraries, John Rylands Library Manchester Medical Society, 161–3 man-midwife bespoke 70–71, 75–6, 78–9 explanations for rise of 72 as hermaphrodite 113 origin of term 66 as sexual predator 66 visual images 141, 158, 180 Manningham, Sir Richard 80, 132, 136, 138, 161 Manuli, Paola 11 manuscripts 16–17, 45, 48, 61, 69, 101, 123–4, 144, 147–8, 154, 155 Margaret of Navarre 36 marriage 38, 57, 73, 179 of bearded ladies 180 Martial 175, 176, 179 Mary Stuart 35 masculinity 5, 180 materia medica 34 Mauriceau, François 84–5, 96, 138, 154 May, Mary 66 McGrath, Roberta 8, 27, 164 McTavish, Lianne 136–7 Mead, Richard 87 medical societies 160; see also under individual societies medicine eighteenth-century 8 empiricist 14, 24 forensic 45 heroic 105 history of 18, 88, 94, 169

Index household 38, 41, 43, 111 Methodist 24, 61 Medico-Chirurgical Society of Edinburgh 171, 185 memory 174 loss of 18, 189 menarche 33, 41, 105, 166 menopause 40, 54, 58, 166 age at 175 menstrual blood physicians’ attitudes to 56 qualities of 56 menstrual suppression 29, 35, 51–4, 57, 59, 103–4, 105 causes, in Galen 54 remedies for 58 menstruation 3, 6, 11–12, 24, 27, 34–5, 37, 39, 41, 52–61, 64, 94, 165, 166, 180, 191 benefits of 52 and conception 57 duration of 175 nature of menstrual blood 52 in pregnancy 40 role in female body 53 terminology of 53 Mercado, Luis de 3, 5, 30, 31–2, 48, 51, 123, 129 Mercuriale, Girolamo 3, 4, 48, 50, 51, 55–7, 59, 64, 125, 143, 187 mesmerism 175 Middlesex Hospital 93, 113 ‘midwife’s powder’ 21 midwifery definitions of 25, 157 history of 67–8, 70, 84–5, 90–93, 100, 102, 109, 169, 172, 192 training, see education, midwifery mind 26, 62, 174 miscarriage 60, 70 Moehsen, Johan Karl Wilhelm 45, 47, 51 mole, see uterine mole monsters 70, 177 Monte, Giovanni Baptista da 53, 55, 61 Moscucci, Ornella 8 Motte, Guillaume Mauquest de la 84, 117, 136 mugwort 51, 172

225 Muscio 2, 3, 4, 16 mustard 129 Naegele, Franz Karl 169, 171, 184 Nankivell, James 95 Nature 13, 52–3, 56, 140 navy 93, 113 nerves 53 Niccoli, Niccolò 42, 43 Nihell, Elizabeth 69, 75, 78, 90, 91, 92– 3, 94, 109, 111, 117, 134, 136–7, 141, 158, 167 note-taking, see lecture notes nursing 37, 76, 79, 168 observation 8, 24, 27, 88–9, 92, 94, 98, 102, 128, 174, 192 Obstetrical Society of London 160, 163– 4 ‘obstetric revolution’ 65, 191 obstetrics 23, 44, 95, 104, 105, 136, 155, 162, 164–6, 168, 182, 191, 193 obstetricy 168 Oldham, Henry 164, 182 onions 129 opiates 111, 114, 183, 185, 186, 188 orgasm 185 Oribasius 62, 87, 153 Osborn, William 78, 82, 93, 94, 111, 129, 139, 141, 166, 184 ovariotomy 162 ovary 180, 181 Ovid 100, 118, 175, 176 ovulation 35 Padua 53 pain relief, see childbirth, painless; labour; opiates Pandora 12 Paracelsus 87 Paré, Ambroise 2, 3, 5, 60, 73, 83, 177– 8, 180 Paris 119, 133, 168, 179, 181 Parsons, James 178 ‘passing the hand’ 128 patients 17, 25, 76, 78, 79, 94, 108, 110– 11, 122, 130, 138, 159, 186, 189 control over 58, 189

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descriptions of pain 122, 138, 184 emotions of 61, 83, 139, 170–71, 183, 188 questioning 24 uncooperative 112 patriarchy 6 Paul of Aegina 87, 103, 143, 152, 153, 176–7 pelvis 69, 75, 79, 84, 131, 132–3, 139, 141, 166, 171, 193 penis 26, 36, 177, 178, 180, 181 pennyroyal 51 period pains 55, 183 Persius 100 pessaries 58, 104 Peterson, Jeanne 8 Petrucci, Armando 42, 49 Peucer, Caspar 17 pharmacopoeias 78 Philumenos 152, 153 physicians 9, 12, 15, 29–30, 39, 41, 56– 7, 73, 76, 80, 97–8, 121, 126 ancient Greek 173 assistants 153 and books 44–5, 87, 161 and childbirth 22–3, 32, 188 French 38 and gynaecology 36, 59 and midwifery 23, 167 obstetric 152 ‘women’s’ 15, 19, 20 pica 50 Pindar 100 placenta 119, 128, 150, 151 Plato 13 Platter, Felix 2, 3, 4, 26 Pliny 56, 100, 173, 176, 186 Plutarch 32, 62, 105, 116, 191 Portal, Paul 171–2, 180 portraits, medical 8, 10, 155–7 pregnancy 2, 15, 21, 32, 33, 40, 45, 50, 54, 59, 60, 61, 62, 63, 68, 69, 75, 104, 109, 110, 118, 133, 136, 156, 165, 177; see also labour extrauterine 45 false 63 Procopius 32

progress 69, 88–9 Public Schools Commission 174 purges 24, 54, 90 Pyrrha 118 quickening 63 Quincy, John 79, 125–6 Ranchin, Francois 33 rape 66, 158, 162 Raynalde, Thomas 172 reasoning 27, 33, 94 Reformation 5 Rhazes 34, 45, 59, 181 Rigby, Edward 171 Roche, Nicholas de la 3, 4, 17, 35, 64 Rotunda Hospital 134 Rousset, François 3, 5, 44, 45, 48, 105, 118–19 Royal College of Obstetricians and Gynaecologists 22, 23, 95, 97, 134, 140 Royal Medical and Chirurgical Society of London 160, 163 Royal Society of Medicine 163 Rubens, Peter Paul 95 Ruf, Jakob 2, 3, 4, 48, 64, 105, 156, 176, 178 St Mary’s Hospital for Women and Children 162 Salutati, Coluccio 42 Savage-Smith, Emilie 147, 148, 149 Savonarola, Girolamo 34 scent therapy 90 Schiebinger, Londa 26, 54, 182 scrotum 178 secrets, of women 37, 91 semen 14, 36, 54, 56, 61, 66, 177, 178 female 38, 54, 177, 178 sex difference, 1, 6, 9, 14, 23, 27, 34, 41, 51, 157 sex similarity 13, 32 sexual positions 36 Shakespeare, William 159 Macbeth 111 Sharp, Jane 20, 21, 25, 78, 117, 127, 172

Index Simpson, Sir James Young, 7–9, 10, 18, 25, 27, 70, 74, 80, 93, 101, 114, 141, 155–89, 191, 192, 193 lectures 157, 179 library 155 skeleton 26 skin, human 1, 16 Smellie, William, 7, 8, 13, 18, 20, 22, 27, 65–105, 107–54, 155, 157, 159, 162, 165, 169, 170, 171, 173, 182, 186, 191, 192, 193 experiments with forceps 139, 140 female pupils 74 lecture syllabus 69, 129 library 100–102, 117, 125, 130, 142, 146, 147–8, 154 publications 84–5, 115, 117, 131 pupils 27, 56, 77–8, 81–2, 99, 113, 115, 117, 128, 134, 143, 171 relationships with midwives 74, 75 syllabus 76, 80, 95, 133 will 101 Smith, William Tyler 168, 181, 184, 185 Smollett, Tobias 13, 112–13, 115, 130 Soranos of Ephesus 3, 14–16, 19, 24, 53, 61–3, 153, 166 Spach, Israel 2, 6, 11, 17, 52, 54, 59, 60– 63, 64; see also Gynaeciorum libri, 1597 edition speculum 144–6, 171 statistics 175 sterility 33, 36, 40, 59, 60, 65, 173 as fault of woman 60 Sterne, Laurence 67–8, 120, 149 stillbirth 112, 114 Stolberg, Michael 9, 26 suction tractor 171 suffocation of the womb, see womb, suffocation of superstition 85, 192 surgeon-apothecary, 69, 72, 80, 161 surgery 20, 22, 44, 66, 72–3, 80, 81, 85, 93, 95, 102, 111, 113, 131, 150, 158, 159, 161, 162, 165, 167, 169, 186 ‘sweeping the womb’ 150 sympathy 27, 182 as medical principle 53

227 symphysis pubis 170 division of 141 syphilis 173; see also venereal disease testicles 52, 178, 180, 181 textual communities 43 Theodoric of Bologna 186 Thicknesse, Philip 23, 136, 140, 157, 158 Thucydides 159 touch 75, 135–6; see also hand Trincavelli, Vittore 3, 4, 55 Trotula texts 4, 31–2, 40, 54, 59 turning, in utero 73, 76, 77, 82, 92, 136, 137–8, 139, 141, 149–50, 188 twins 173 ulcer 61 umbilical cord 115, 126, 129 cutting 127 unicorn horn 38, 42 urine, of ass 122 uterine mole 30, 45, 52, 59, 61, 64, 90, 156 uterus, see womb vagina 32, 49, 104, 135, 147, 165, 172, 178, 181, 182 Van der Gucht, Gerard 95 van Deventer, Hendrik 73 van Helmont, Jan Baptista 181 van Rymsdyck, Jan 132 venereal disease 66 ventouse 171 Vesalius, Andreas 2, 34 Virgil 100 Virgin Mary 57 virginity 1, 6, 20, 31, 33, 57, 58, 65, 121 Vitruvius 32 Waldung, Wolfgang 50–52 Watts, Giles 68–9, 70–71, 89, 99, 109, 112, 127, 128–9 waxworks 132 wet-nurses 36 white flux, see fluor albus Wildberg, Christian Friedrich Ludwig 45, 46, 51

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Willughby, Percival 76 Wilson, Adrian 20–21, 65, 67, 70, 72, 77–8, 137 Windsor, John and Thomas 44, 51, 161 Wolf, Hans Kaspar 1, 3, 4, 11, 16, 17, 50; see also Gynaeciorum libri, 1566 edition womb 11, 13, 15, 16–26, 29–30, 32, 35, 36, 38, 52, 53–4, 61, 63, 166 coldness of 118 damage to 22 functions of 53 inflammation of 33, 50–51, 59, 61 material of 15 mouth of 59, 78, 150 movement of 13, 29, 90, 103, 105 and one-sex model 27, 34, 179, 181–2

origin of disease in women 193 positive images of 55 prolapse of 32, 33, 180 as a sewer 55, 56–7 suffocation of 38, 64 women as colder than men 13, 55, 56 as having looser flesh 42 as hotter than men 55 ‘natural incapacity’ of 168 softer flesh 12 as wetter than men 12, 51 Young, Thomas 25, 68–9, 80, 82–3, 90– 91, 115, 121, 135, 139, 141, 164, 165, 167–8, 178, 179, 180, 192 Zurich 17