Thursday, 24 July 2014

So I Submitted My Thesis For Defense Today...

Well, I sent in the thesis copy to the grad school office and my committee members will get their copies tomorrow.

...and now I feel both really tired and a tiny bit like reminiscing.  Just a very tiny bit while I'm not nervous about the defense (that can wait another month to kick in).

In any case, the PhD was quite a journey and I learned so very much from my instructors, peers, students and all the wonderful people I met in Kingston.

Some lessons I learned.

1) It's worth it to take the time to get to know the people & the place.  This isn't just a quick stop, it's going to be home for a while. 

At first, Kingston was a small town far away from the family and friends I knew and loved best and I realllly did not like it.  

Now, I will forever miss my spot - yes, my spot - at the Grad Club, my favourite barista's latte art, June from my favourite sushi place, Walter who sold me great books, and popping in to see Jackie's newest creations.

Kingston grew on me.

I dare you to not want that sunset.
Surrounding area was good too.
More coffee has been consumed from this mug made by Jackie than probably all other mugs in my house combined

It wasn't all awesome all the time though.  Kingston can be very cold and snowy and seriously lacks snowplows to clear sidewalks.  I have actually seen students snowshoe and cross country ski to class.

Throughout all this, I was busy thinking.  And reading.  And thinking some more.  I even had to buy more bookshelves.

2) Loving what you do really helps.

A PhD is a lot of really hard work. 

Somewhere along the line I had to learn how to read things that looked like this:

Yes, I now have stronger eyeglasses prescriptions.

I stopped being disturbed by words like...fistulae and phrases like rectal prolapse.  At some point I became known as the person who told gruesome stories about medical treatments gone awry (or as intended, in some cases) and even convinced some that studying the early modern period did not mean I was " archeologist."

3) Organize, plan, plot.  Learn how to file.

I didn't for a long time and it was bad.

Papers in a box.
This is much better.

Papers in file folders with labels and everything!
4) Talking about your work is good.

Go to conferences, have coffee with your peers, and talk it through.  It's amazing how much you have yet to learn.  It's also amazing how interesting your work is to others.

By sharing your work, you can clarify your ideas and learn how to tell the story better the next time.  Here, the Museum of Health Care was kind enough to even let me play with their artefacts while I shared the Pepys lithotomy story.

This is me talking. 
5) That if you're going to teach, you should PLEASE invest the effort to do it well or do not do it at all.

Teaching is important.  I want my students to leave the classroom excited about the past, engaged with the material, thinking critically, and having learned new skills.  Teaching well requires a lot of time, a lot of effort, and a lot of thinking.  It requires patience, dedication, tact, creativity, and perhaps above all, sheer determination.

If someone told me 5 years ago that I'd be a good teacher, I probably would have laughed.  But that moment when a struggling student gets it, when you see marked improvement over the course of the semester, when a student asks thoughtful question, or when you get an excited email from a former student accepted to Oxbridge or law school or who got a great job...That moment is pretty awesome.

6a) I am not perfect and my work isn't perfect.  This is not an excuse to shirk the duty to do my best.

Graduate students take themselves and their work very seriously.  Learn humility.  Learn how to let go of that draft.  Learn how to take constructive criticism.

This is really, really hard.

The thesis may take up A LOT of my life, but graduate school/academia/awesome books are only one facet of what makes me a person.

Sure you identify as a scholar, but what else are you?  What makes you happy?  What brings balance to your life?  Some colleagues do yoga, run, read fiction, and play video games.

Turns out, I really like to grow things, feed people, and keep them warm.

And also play board games on things I've crocheted
6b) Life goes on.

Over the course of the PhD thus far, I've made some awesome friends, got adopted by a cat, got married, and moved cities twice.

Companionship helps.

 Just in case I haven't mentioned it already, my cat is the best.

7) Enjoying the process is key.  Attitude is important - even the tediousness of paperwork can be amusing in hindsight. 

Research trips are also the best.  For one, you get to feel like a real scholar, do real history, meet new people, and even touch primary documents without gloves.  Second, you also get to visit places.  They may be places you've been to before, but take the time to explore and enjoy.

My favourite part of The National Archives, Kew
Splurge once in a while.  Asceticism and moderation can be downright boring.

Yes.  That is, in fact, way too many euros worth of dessert for two people.  Luckily for us, it was lunch.

8) A PhD teaches you a lot about yourself and what you value.

Take a moment out of your busy schedule and meditate (either literally or figuratively) about it.

Have some jumbled thoughts.  I'm a, sleepy, @medhistorian.


Tuesday, 15 July 2014

Midwifery II: The Battle for Authority

You may want to check out Midwifery I before continuing...

How did the authors present themselves and their practice?  And second, how did they present practitioners of the opposite gender? 

Male authors

The male authors of the English treatises typically stressed their knowledge of anatomy as well as their practical experience to make their texts seem more authoritative.   

John Maubray’s 1724 text was entitled The female physician and addressed to “all learned and judicious professors of physick, as well as ingenuous and experienced practisers of midwifery.”[1]  Maubray, unlike many other authors of the time, did not expound upon the successes of his practice.  Rather, he stated confidently that his work would stand up well on its own.[2]  Like many other male writers, he praised the work of male midwives for their knowledge of anatomy and greater presence of mind.”[3] 

William Smellie’s 1762 text began with a long exposition of his achievements.  Arrogantly, he stated that he had “given upwards of two hundred and eighty courses of Midwifery, for the instruction of more than nine hundred pupils, exclusive of female students: and in that series of courses, one thousand one hundred and fifty poor women have been delivered in presence of those who attended me.”[4]  With such vast experience in the field it is no surprise that his texts were some of the most widely read and respected.  John Clarke, in contrast, simply had the fact that he was a physician and teacher of midwifery printed on the title page of his work.

When attacks were made on practitioners of the opposite sex, no criticism of their specific practice was made.   Rather, instead of case studies, the male writers used the power of language and invoked greater knowledge.  This is particularly interesting as these male practitioners were in the best position to print stories glorifying their actions while attacking those of “ignorant” midwives. 

John Maubray provided the most subtle criticism of all the writers.  Instead of making negative comments about female midwives he stated that all practitioners – whether male or female – should be knowledgeable of anatomy.[5]  Though seemingly innocuous, many practicing female midwives had little or no official training.  Indeed, anatomical knowledge belonged to male scientists, physicians, surgeons and the like and to only a very few females. 

William Smellie also used this tactic in his Treatise on the theory and practice of midwifery.[6]  Moreover, he anticipated that a female midwife’s patient may have need to be rescued by a male practitioner.  He urged the midwives to “avoid all reflections upon men-practitioners” and to not hesitate to call upon them when at a loss.[7]  While they expected that the female midwife be competent in anatomy, the male midwife – or accoucheur – needed to be competent in anatomy, surgery and physick.[8] 

Likewise, the author of the The ladies physical directory (1739) The text, whose author was identified only as “Physician,” endeavoured to provide a female audience with the tools necessary to know when they should contact a physician.  This was necessary, he stated, because:
“those who chiefly undertake the cure of the secret indispositions of the female sex…are notoriously ignorant of them; I mean midwives, nurses and…other good women.”[9] 
The anonymous author of The ladies dispensatory (1640) was just as negative in his opinion of female midwives, calling them “bad Councellors.”[10]  John Grigg also wrote negative comments, however, he limited his attacks to lower class female practitioners who possessed little education and thus provided poor or harmful advice to their patients.[11] 

Female writers

The female treatise and advice literature authors wrote in a surprisingly similar manner to their male counterparts.  Indeed, they used much the same language, tactics and arguments in favour of their practice. 

Margaret Stephen noted that she taught anatomy to her midwifery students and had numerous patients.[12]  Sarah Stone wrote that she practiced midwifery in Taunton and was very experienced in delivering difficult births.[13]  Interestingly she was also the lone author examined who used cases to stress that her work was authoritative. 

Indeed, Stone’s entire work consisted of upwards of forty case studies or observations of difficult births.  In most cases – though not all – Stone noted that the delivery was made successfully and both mother and child survived.  Both the male and female authors of the midwifery treatises sought to present their texts – and by extension their genders – as authoritative. 

Despite differing qualifications, both male and female authors presented their practices in similar manners.  The first argument against man-midwifery was similar to that used by the male practitioners against women.  That is, the training and education received by male midwives. 

Nihell, for example, stated that many men were practicing only after a short period of training.  Indeed, many men-midwives were “made out of broken barbers, tailors, or even pork-butchers.”[14]  Martha Mears, like John Maubray, provided the most subtle criticisms of other practitioners.  She took a slightly different view than Nihell and instead criticized the flashy trappings of male midwives.  These men, she stated, “come dressed out in a rich wardrobe of words, to dazzle their [the audience’s] attention.”[15] 

Mrs. Wright, the midwife, also expounded upon the strengths and weaknesses of man-midwifery.  While men held a reputation for being more educated than women, they used potentially harmful instruments and worked quickly rather than waiting patiently for nature to take its course.[16]  Sarah Brown did not criticize men-midwives.  Rather, she referred to the “midwife” using both male and female pronouns interchangeably.[17]

These were subtle criticisms and the female midwives were frequently far more militant.  They criticized the practice of men-midwives on two main grounds: the use of instruments and the female modesty. 

Elizabeth Nihell’s 1760 treatise was one of the first, aimed at the general public, to examine systematically the faults of men-midwives and defend it as a female profession.  Rather than elevating the female midwife as an experienced professional, Nihell’s text lambasted man-midwifery as harmful to both mother and child. 

These men, she stated, have “added new and worse errors of their own to those bequeathed to us by the antients.”[18]  In particular, she attacked the use of instruments as:
 “surgeons in form of men-midwives, have been the death of more children with their speculum metricis, their crotchet, their extractors or forceps, their tire-tétes, &c. than they have preserved.”[19]   
Using the language of battle, she described these men-midwives as the “forerunners of murder,” cutting and slashing their way into the womb with iron and steel.[20] 

Smellie-type forceps
Sarah Stone also attacked male childbirth assistants’ use of instruments.  She did not expound significantly and her criticism was limited to a short, yet descriptive statement: “infants have been born alive, with their brains working out of their Heads: occasion’d by the too common use of instruments which I never found but very little use to be made of, in all my practice.”[21] 

Though the use of instruments has been long considered the defining difference between male and female practitioners at this time, more recent scholarship has shown it to be only one of several distinctions.  Indeed, Stephen admitted to using the forceps on occasion and even taught it to her pupils.[22]

The use of instruments was not the only battle fought in this war for dominance in the field.  Sarah Stone
Chamberlen forceps
lambasted her female peers for having to call men-midwives for help, summing up her observation of the common phenomenon, she stated:
“I cannot comprehend, why women are not capable of compleating this business when begun, without calling in of men to their assistance, who are often sent for, when the work is near finish’d; and then the midwife, who has taken all the pains, is accounted of little value, and the young men command all the praise.”[23] 
Like the male writers, she called for midwives to become more acquainted with anatomy and “the difficult part of [this]…business.”[24]  Unlike the male practitioners, however, this evidently stemmed from the fear “that the modesty of our sex will be in great danger of being lost.”[25] 

Margaret Stephen also worried about the mother’s modesty, reminding her readers that females had, as recorded in the Bible and throughout history, been the attendants of birth.[26]  Indeed, she believed that women, and not men, were mandated by God to aid in childbirth.[27]  In keeping with Erickson’s comments on female modesty, if one could not safely publish information about sexual matters, how could physical contact between a male physician and a female patient be considered appropriate? 

The most interesting finding was that the female midwives had adopted the language and style used by their male counterparts.  Indeed, in some instances, they used the same arguments! 

The debate between male and female midwives was quite active in the eighteenth century.  Men-midwives did not simply run roughshod over their female counterparts.  Indeed, women writers were frequently just as caustic in defending their practices and criticizing those they saw as encroaching on their traditional field.  

Let me know what you think here or on Twitter – I’m @medhistorian.

[1] John Maubray, The female physician, containing all the diseases incident to that sex, in virgins, wives, and widows; together with their causes and symptoms, ... London (1724), iii.
[2] Ibid., iv.
[3] Ibid., 169.
[4] Smellie, v.
[5] Maubray, 171.
[6] Smellie, 442.
[7] Ibid., 442-443.
[8] Ibid., 440.
[9] Physician, Preface unpaginated.
[10] Anonymous, The ladies dispensatory, 258.
[11] Grigg, 85.
[12] Stephen, 4 and 7.
[13] Stone, xiii.
[14] Ibid., 71.
[15] Mears, 2.
[16] Mrs. Wright, 17-21.
[17] Brown, 5.
[18] Nihell, A treatise on the art of midwifery, London (1760), v.
[19] Ibid., 54.
[20] Nihell, 57.
[21] Stone, viii.
[22] Stephen, 4.
[23] Stone, ix-x.
[24] Ibid., x.
[25] Ibid.
[26] Stephen, 9.
[27] Ibid., 10.

Tuesday, 8 July 2014

Midwifery I: Constructing the 18th Century Midwifery Treatise

Pregnancy and childbirth were, potentially, terrifying prospects in eighteenth century England.  First came several months of nausea and physical distress, followed by decreased mobility and, eventually, the painful experience of childbirth.  After this painful ordeal women were typically confined to the lying in chamber for one month. 

Pregnancy and childbirth were taxing on both body and mind – the threat of miscarriage, death in childbirth or even death during the lying in period loomed large. 

It is thus not surprising that such an experience warranted both advice literature aimed at pregnant women and a plethora of treatises aimed at midwives and other such practitioners.  Doubtless though, the works published during the eighteenth century were more liable to confuse, rather than comfort, expectant mothers as they tended to offer conflicting advice. 

It is important to note that the texts were, largely, products of the midwifery professionalization debate and that this was reflected in the structure of texts and language used in them.  This post will be first part of two posts on eighteenth-century midwifery treatises.  The second post will address the battle for professional legitimacy by male and female midwives.  


As Lianne McTavish has stated, “treatises enjoyed a diverse audience consisting of male medical practitioners, female midwives, pregnant women, lay people, and even readers in search of a sex manual.”[1]    

Authors delineated who they thought to be their audience. Sarah Stone’s midwifery treatise, for example, stated on the title page that it was aimed at “all female practitioners.”[2]  Smellie’s A treatise on the theory and practice of midwifery was meant to “whet the genius of young practitioners, and be as hints to introduce more valuable discoveries in the art.”[3] 

In the case of the advice literature, the intention and audience were typically stated together such as John Leake’s attempt to “afford women an adequate idea of their own disorders.”[4]  In contrast to these, Elizabeth Nihell addressed her text to both the pregnant woman and her husband as decision makers.[5] 

Several treatises, however, stated that they were aimed at both pregnant women and practitioners.  Henry Bracken, for instance, hoped that his treatise would profit “men by the choice of skillful men or women midwife, and women by learning how to behave themselves, with respect to conception and during pregnancy” while stating that it was “not below the perusal of any one.”[6]  In addition Margaret Stephen’s work was aimed at both midwives and pregnant women while ignoring male practitioners completely.[7] 


Related to the discussion of target audience is the issue of language use.  Perhaps inevitably, many of the writers who professed to write for female audiences stated that they would write as modestly and simply as possible. 

Henry Bracken stated that chose an “easy and intelligible style,” while mentioning that he would have much preferred to write – as he would normally – to his peers, the men-midwives.[8] 

The anonymous male author of The ladies physical directory wrote that: 
to make this treatise as truly useful to the fair sex as I thought was absolutely necessary, I have been forced, tho’ with some reluctance to write in a very plain manner of all secret illnesses.[9]   

Indeed, throughout the work, the author wrote without the medical jargon or subtleties liable to confuse a less educated or familiar reader.  Another anonymous text aimed at women used unadorned and frank language in discussing female anatomy and the disorders liable to women.[10] 

The tone and language of these statements seem patronizing towards female readers. What is interesting, however, is the fact that female authors also made such comments.  Mrs. Wright, the midwife, stated that “few read large elaborate works, and many would be glad to receive instruction advantageous to themselves and their families from a small pamphlet.”[11] 

Moreover, Wright included a glossary at the end of her work, explaining the meaning of terms she deemed “somewhat technical.”  Perhaps insultingly though, her list included such words as: adult, feminine, substitute and technical.[12] 

Sensitivity and Titillation 

Robert Erickson, in his work on British midwifery texts, noted that there was frequent debate among early modern authors about the propriety of frank discussions of sex and the sexual organs.  These writers, he stated, were “faced with the very real threat of prosecution for indecency and immodesty…[and] almost all of them undergo, in their ritualistic ‘Prefaces to the Reader’, a variety of apologetic contortions for the propriety of their language.”[13] 

Erickson’s observation was quite accurate and a number of texts comment on the possible modesty of their readers. 
Smellie - Plate 8 of fetus in utero

In addition to this practice, William Smellie, for example decided to publish entirely separate works with case information and illustrations.  Rather than simply worrying about a female reader’s modesty, he feared that illustrations would “embarrass the student in the progress of his readings.”[14]  The texts devoted to tables and illustrations were replete with images that would not only embarrass the reader, but were likely to offend the modesty of many.  

Predictably, such illustrations were quite rare in the sample of texts examined. 

Indeed, only two other treatises included such titillating illustration.  The first, was misleadingly entitled Aristotle’s Master-piece.  The text – aimed at practitioners and pregnant women – was a conglomeration of writings from a variety of authors, indeed, later editions bore the name of famed astrological physician William Salmon.  The illustrations included in this text were titillating in a different manner.  Rather than anatomical figures, the text boasted sketches of ‘monstrous births’ and ‘hairy women.’ 

Two plates from Aristotle's Masterpiece
Surprisingly, however, the second text was penned by female midwife Jane Sharp.  The  illustrations must have been inserted in accordance with her wishes as they appear in earlier editions of the text that were published during her lifetime.  The figure in question was allocated a page of its own and buried within the text.  It depicted a naked woman, breasts exposed, with a partially dissected womb that revealed a fetus; the woman’s genitalia were covered by a flower.  

As Sharp’s text was meant to be read by a female audience, the full-page sketch of a partially dissected, and naked, woman would have been likely to offend on several grounds.

From Jane Sharp'sThe Compleat Midwife's Companion
So ends part one of my mini-series on midwifery.  Let me know what you think here or on Twitter – I’m @medhistorian.

[1] Lianne McTavish, “Blame and vindication in the early modern birthing room,” Medical History 50,4 (2006), 449-450.
[2] Sarah Stone, A complete practice of midwifery. Consisting of upwards of forty cases or observations in that valuable art, selected from many others, in the ... London, 1737.
[3] William Smellie, A treatise on the theory and practice of midwifery. London (1762), ii.
[4] John Leake, Medical instructions towards the prevention, and cure of chronic or slow diseases peculiar to women: especially, those proceeding from ... London (1777), 10.
[5] Elizabeth Nihell, A treatise on the art of midwifery, setting forth various abuses therein, especially as to the practice with instruments, London (1760), i.
[6] Henry Bracken, The midwife's companion, or, a treatise of midwifery: wherein the whole art is explained. Together with an account of the means to be used for ... London (1737), Preface unpaginated.
[7] Margaret Stephen, Domestic midwife; or, the best means of preventing danger in child-birth, London (1795), 3.
[8] Bracken, Preface unpaginated.
[9] Physician. The ladies physical directory: or, a treatise of all the weaknesses, indispositions, and diseases peculiar to the female sex, from eleven years ... London (1739), Preface unpaginated.
[10] Anonymous, The ladies dispensatory or, every woman her own physician. Treating of the nature, causes, and various symptoms, of all the diseases, ... London, 1740.
[11] Mrs. Wright, i.
[12] Ibid., 36.
[13] Robert Erickson, “‘The books of generation’: some observations on the style of the British midwife books, 1671-1764,” Sexuality in eighteenth-century Britain Paul-Gabriel Boucé ed., Manchester : Manchester University Press (1982), 74.
[14] Smellie, iii.