MIDWIFERY EDUCATION

1
MIDWIFERY EDUCATION

• in 18th century London
• Anna Bosanquet
• (supervisors Hilary Marland and Claudia Stein)

2
BACKGROUND

• Century of great social, economic, political
  changes, affecting
• daily lives of women, including their experience
  of childbirth
• working lives of midwives and doctors, including
  their training, knowledge and practice

3
PROFESSIONAL RIVALRIES

• Old tradition
• a female midwife

New species a man-midwife
4
TRADITIONAL HISTORYnegative view of a female
midwife

• Very little is known of the early history of the
  English Mid-wif... It is certain, however, that
  she was a woman of inferior education.
• Superstitious, elderly, drunk and dirty women
• Ignorant of anatomy, and obviously unreliable in
  emergencies, they contributed considerably to the
  maternal and neo-natal death-rates yet they
  flourished for lack of alternative facilities.

• J. Aveling ENGLISH MIDWIVES THEIR HISTORY AND
  PROSPECTS. 1872, reprinted 1967

5
THE ENGLISH MIDWIFE?
6
Challenges to triumphalist medical history since
1980s

• Donnison
• Marland
• Versluysen
• Evendeen
• Croxson
• Cody
• Wilson
• Harley
• Grundy
• Tew
• Schofield

7
MIDWIFE TRAINING BEFORE THE 18TH CENTURY

• Traditional apprenticeship
• Long period of training majority 5-10 years
  (3-30!)
• High literacy levels
• Testimonials and witnesses
• England different to the Continent and Scotland
• No structured / national training
• Various failed proposals
• Always political humanitarian efforts but also
  vested interests and hidden agendas

8
RESEARCH QUESTIONS

• What types of midwifery courses and training were
  available for men and women in 18th century
  London?
• What was their content, structure, and what
  teaching methods were used?
• Who were the midwifery pupils and what was their
  experience?
• What were the consequences of new training
  methods for the professional standing of a female
  midwife?

9
SOURCES 1

• Midwifery textbooks, manuals and course syllabi
  published by man-midwives and female midwives

10
SOURCES 2

• Hospital archives, including minutes of Board
  meetings and published reports

11
SOURCES 3

• Hand-written lecture notes taken by midwifery
  pupils
• Personal letters describing training

12
SOURCES 4

• 17th-18th century Burney Collection newspapers

13
SOURCES 5
Year accepted Last Name First Name Husband's Name Age Husband's Occupation Cross References Address/Town Region/County Widow spinster
1753 Fiddes Elizabeth George 36            
1753 Fletcher                  
1754 Hall Margaret John 28            
1754 Nettlefold Mary John 30            
1754 Russell Anna Maria   26            
1754 Preest Mary Richard 38 Apothecary   Kingston-upon Thomes (late of) Surrey x  
1754 Butler Jane Pierce 30 Surgeon and Apothecary Appointed Matron of the British Lying-in Hospital Chancery Lane, London London    
1755 Emerton Sarah John 36 Mariner   Hamlet of Ratcliff in the Parish of Stepney Stepney    
1755 Evans Ursula Charles 36 Farmer   Wellington in the County of Hereford Hereford    
1756 Brightwell Agnes John 27 Superviser of the Excise   Basingstoke in the County of Hants Hants x  
1756 Boadger Catherine William     Former patient        
1757 Gyfford Elizabeth Edward 27 Apothecary   Barking Essex x  
1758 Blackstock Mary Edward sister of Matron, Mrs. Oakes
1758 Case Mary William 44 Surgeon Lynn Norfolk
1758 Prick Abigail John 40 Bricklayer Queenborough Kent
1758 Tuffin Mary Charles 25 Cornet in the Regiment of Horse called the Oxford Blues
1759 Vacry Maria Margaretta Nicholas John 40 Surgeon Albemarle Row, London London x
1760 Wright Susanna John 30 Yeoman Feniton Devon x
1760 Webb Mary William 29 Carpenter St. Dunstan in the West, London London
1760 Fearnall Martha William 34 Tallow Chandler Oakingham Berks
1760 Randall Anna Maria Edward 30 Yeoman Chawton Southampton
1760 Maynard Mary William 30 Hair Merchant Gloucester Gloucester x
1760 Haynes Mary 25 x
1761 Turner Jane James 32 Silver-Smith late of St. Martin's Lane but now of Jamaica Jamaica
1761 Powell Mary Henry c 42 Coach Keeper Old Bethlehem, London London
1761 Middleton Sarah Thos. 43 Cabinet Maker Gosport Hampshire
1761 Ring Mary James 25 Mason Basinstoke Southampton
1762 Coates Anne William Apothecary Theal Berks
1762 Higgs Mary William Tallow Chandler St. Mary le Bone London
1762 Boxall Ann John 35 Carpenter Plestow Sussex
1762 Williamson Esther John 41 Mariner York x
1762 Cartwright Ann Jeremiah 31 Mason of the Hay County Brecknock
1763 Allen Elizabeth William 41 Joyner   Egham Surrey    
1763 Ross Elizabeth William 30 Merchant   Aberdeen Scotland    
1763 Garlick Ann William 28 Maltster   Stelmet Court, in the Strand, London London    
1763 Yewd Ann Thos.   Secretary to this Charity Wife of the Secretary of the British Lying-in Hospital London London    
1763 Powell Elizabeth William 40 Officer of excise   of the Hay County Brecknock x  
1763 Bevan Ann Richard 29   Neith County Glamorgan, South Wales    
1764 Seyliard Mary Thomas 32 Attorney Serves as deputy matron through March 1766 Peckham x  
1764 Jones Elizabeth William 44 Wheelwright   Old Brentford    
1764 Guerrier Sarah William 34 Tidesman   Dockhead Southwark    
1765 Racketta Sarah Alexander 30 Surgeon   Chester    
1765 Featherstone Mary Frances upwards of 30 Mariner   Whitby York x  
1765 Langcake Ann John about 35 Taylor   Windmill Street, London London    
1765 Goff Mary John about 28 Surgeon From the late 1760s onwards, Mr. and Mrs. Goff advertised in the London press their lying-in hospital. Pall Mall, London London    

• Secondary analysis of original data provided by
  other scholars and re-analysis of published data
• Lisa Cody private communication
• Susan Lawrence 1996

14
Newspapers items relating to midwifery
  YEARS Midwife or midwives or midwifery Midwifery and lectures Midwifery and course Midwifery and pupils Midwifery and students
1700-1709 99 - - - -
1710-1719 144 0 0 0 1
1720-1729 771 1 15 8 2
1730-1739 1092 8 19 13 25
1740-1749 834 5 7 1 19
1750-1759 1152 152 80 102 21
1760-1769 2541 56 29 36 9
1770-1779 2715 50 15 47 25
1780-1789 2944 181 170 167 53
1790-1799 2377 362 365 69 51
1800-1809 436 178 211 101 70
1810-1819 401 165 203 164 80
15
Classified ads . World (1787) (London, England),
Friday, March 12, 1790 Issue 996

• Dr. Osborn and Mr Clarkes last Winter courses in
  Midwifery and the Diseases of Women and Children
  will begin as follows
• The MORNING COURSE at No. 10, Queen Street,
  Golden-square, on Tuesday next, March 16, at half
  past Ten oClock.
• The EVENING COURSE, at No. 12, Chancery-lane,
  Fleet street , (for the concenience of Gentlemen
  living near the City, or who cannot attend in the
  morning) on the folllowing Monday, March 22, at
  half past Five.
• Proposals may be had, and farther particulars
  known, by applying to Dr Osborn, Hanover-square
  Mr.Clarke, Queen-street, Golden-square, or at the
  Lecture-room, in Chancery-lane.

16
MEDICAL EDUCATION IN 18th CENTURY LONDON

• No university, no centralised training
• Private medical courses
• Advertising in newspapers
• Increasing opportunities for pupils to gain
  practical experience in hospitals
• 1700-1820 at least 234 men lecturing on various
  medical subjects (Lawrence 1996)
• 1 in 5 taught midwifery
• 33 midwifery teachers between 1700-1800

17
MALE MIDWIFERY TEACHERSin 18th century London
18
MALE MIDWIFERY TEACHERSin 18th century London

• 33 teachers
• Never more than 6
• Most specialised
• 14 linked to hospitals
• Others Homebirths
• From 1 to over 30 years
• From 9 to 24 lectures
• Similar content (but two camps!)
• Very different teaching styles
• Using machines for demonstrations
• Different costs 3-10-20 guineas
• Smellie 900 men, 1150
• mothers in 10 years
• Many publications

19
MAN MIDWIVES PUBLICATIONS

• John Maubray 1730
• Richard Manningham 1744
• William Smellie 1752
• Brundell Exton 1766
• John Leake 1767
• William Hunter 1774
• Thomas Denman 1782
• Colin MacKenzie 1789
• William Lowder 1789
• William Osborn 1792
• John Haighton 1799

20
RULES AND REGULATIONS

• Clear rules about costs and privileges
• Attending women at home or hospital
• Strong etiquette
• all conversation tending to excite
  apprehension in the patient be avoided, such as
  descriptions of bad labours, anatomical
  dissections, the state of their experience in
  obstetrical subjects, c. (Haighton 1799)

21
(No Transcript)
22
MALE STUDENT EXPERIENCEletters of Thomas Bishopp
of Leister
25 /5/1793 Mr Cruikshank lectures have finished.
He has now entered with Dr Clarke - the
surgeon to study midwifery, as well as Dr
Pearsons lectures on physic, chemistry and
materia medica from eight till half past ten in
Leicester Square. There are no other lecturers
on midwifery so nearer and anyway, Thomas 'should
not be so well satisfied with any other'.
17/9/94 'I am sorry to say that I have failed
in every attempt I have made to get any private
patients in midwifery
23
COMPLETION OF TRAININGletters of Thomas Bishopp
  Anatomy Dr Baillie and Mr Cruikshank 4
courses Mr Cline 1 course - dissected 14
subjects , 2 for Dr Bailleys lectures Physiology
Dr Heighton 2 courses Surgery Mr Hunters
lectures by Home, 1 course The practice of St
Thomas , Guys, St Bartholomews and St
George's hospitals successively for 4and a half
years Midwifery Dr Clarke and Dr Osborne 6
courses Chemistry Dr Babington 2 courses Botany
Dr Smith 1 course Physic Dr Fordyce lectures 1
course Dr Crichton lectures 1 course Fordyces
and the practice of the other physicians at St
Thomas hospital 2 years. During attendance at
the above hospitals took down about 1500 medical
and surgical cases. Natural philosophy Mr walker
1 course Rev Mr Roberts 1 course Took out a
diploma at Surgeons Hall in 1795
7/11/1794 'I shall be sufficiently acquainted
with practical dissection and anatomy to
undertake all the common operations in surgery
with good confidence in my qualification and I am
not at all doubtful but that I understand the
theory and practical department of midwifery as
well as the majority of those who settle in the
country.
24
FEMALE MIDWIVES

• Jane Sharp 1671, 17245
• Knew Greek and Latin
• Sarah Stone 1737
• Three generations, trained in dissections
• Elizabeth Nihell 1760
• Two years training in Hotel Dieu in Paris
• Margaret Stephen 1795
• Trained by man midwife, pupil of Smellie
• Martha Mears 1797
• Spent some years under the most eminent
• professors of midwifery

25
EDUCATING FEMALE MIDWIVES in 18th c LONDON

• Some of the male teachers offered courses to
  women
• Different costs and conditions
• Women expressing dissatisfaction about unfair
  treatment of female pupils
• When successful proud to be trained by men
• Evidence of only one private midwifery school run
  by a woman to train female midwives Margaret
  Stephen

26
Margaret Stephen MIDWIFERY TEACHER

• I teach my own pupils the anatomy of the pelvis
  and of the foetal skull, on preparations which I
  keep by me, with everything else relative to
  practice in nature, at labours also turning, and
  the use of the forceps, and other obstetric
  instruments, on a machine which I believe few
  teachers can equal and I make them write
  whatever of my lectures may prove useful to them
  in their future practice, for which they are as
  well qualified as men. (p 4)
• I intend to continue my lectures as usual to
  women entering upon the practice of midwifery,
  until the men who teach that profession render
  them unnecessary, by giving their female pupils
  as extensive instructions as they give the males
  (p 6)

27
Lying-in hospitals in 18th century London
28
Female pupils 1739 First Lying in
Facility Manninghams private rooms
1739-1744 ?Marylebone Road
Female pupils 1758
Female pupils 1753
Exton, Denman, Khron, Heineken
W.Hunter, Sandys, Layard, Kelly
Female pupils 1758
Heineken, Ball, Grundy
Female pupils ?1809
Female pupils 1769
MacDonough, Walsh
New Westminster Lying-in Hospital
1765 Westminster Bridge Road
Leake, Brickenden, Harris
29
MIDWIFERY PUPILS AT THE BRITISH LYING IN
HOSPITAL

• Admitted from 1753
• No more than 4-6 pupils at one time
• 3-6 months training
• Resident in the hospital
• High cost at 35 guineas
• Taught by Gentlemen of the Faculty
• Delivering under the matrons and man-midwives
  supervision
• Certificate on completion

30
MIDWIFERY PUPILS AT THE BRITISH LYING IN
HOSPITAL1753-1819
  1753- 1763 1764- 1773 1774- 1783 1784- 1793 1794- 1803 1804- 1813 1814- 1819 Total  
Number of new pupils 38 38 25 19 30 28 7 185  
Range of admissions per year 1-6 2-6 0-6 0-8 2-5 2-5 1-2 0-8
31
MIDWIFERY PUPILS AT THE BRITISH LYING IN HOSPITAL

• Mean age 37, most in their 30s, range 20-60
• 2/3 married, 1/3 widows, few spinsters from 1780s
• 1/3 from London, 1/3 close to London, 1/3 far
  away North, Ireland, Scotland, Jamaica
• Economically stable social backgrounds

32
British Hospital MIDWIFERY PUPILS 1753-1819
HUSBANDS OCCUPATION
TOTAL 110 wives of medical men 42
artisans/ craftsmen 29 tradesmen /skilled
workers 7 Gentlemen/professionals
33
Jane Wright

• Wife of a wine merchant
• In London for 6 years
• Has practised much among poor gratis on the
  continent and at home
• Enrols as pupil at the British LI Hospital in
  1797, aged 32
• Publishes pamphlet 1798
• Later serves as Matron at the Westminster
  Lying-in Hospital

34
Jane Wright 1798
Jane had taken much satisfaction, for years, to
acquire knowledge in female diseases under able
instructors both at home and abroad. Intends
to practise midwifery, being entitled to it by
my liberal certificates, from the physicians and
surgeons of the British Lying in hospital in
Brownlow Street.   She feels sincerest
obligations to them for their 'goodness and able
instructions', as well as to the 'intelligent
matrons of that useful charity' to whom she also
offers her honest acknowledgements. (p 34)
35
THE LYING IN CHARITY FOR DELIVERING WOMEN AT
THEIR OWN HABITATIONS

• 1757
• What was its role in training male and female
  midwives?
• Further research is required

36
CONSEQUENCES?

• Enormous impact
• Overly progressive
• Intrinsically regressive
• Increasing control of training by men
• Removal from community to hierarchical
  institutions embedding values of obedience and
  conformity
• Sub-servant role less attractive to well-off
  women
• FROM PRIDE TO HUMILTY

37
18th century
38
Before the 18th century
39
Before the 18th century
40
(No Transcript)
41
(No Transcript)
42
End of 18th century
43
End of 18th century
44
Post-18th century
45
Post-18th century
46
Post-18th century