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

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 • 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

15. Classified ads . World (1787) (London, England), Friday, March 12, 1790; Issue 996 • Dr. Osborn and Mr Clarke’s 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 o’Clock. • 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)

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 Pearson’s lectures on physic, chemistry and materiamedica 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. 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 Hunter’s lectures by Home, 1 course The practice of St Thomas’ , Guy’s, St Bartholomew’s 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 Fordyce’s 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 COMPLETION OF TRAININGletters of Thomas Bishopp 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, 1724&5 • 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’ • Jane Wright 1798 • Pupil at the British Lying in Hospital

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: Manningham’s 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 matron’s and man-midwives’ supervision • Certificate on completion

30. MIDWIFERY PUPILS AT THE BRITISH LYING IN HOSPITAL1753-1819

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: HUSBAND’S OCCUPATION TOTAL 1:10 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

42. End of 18th century

43. End of 18th century

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46. Post-18th century