The Weaker Vessel: Woman's Lot in Seventeenth-Century England (86 page)

The trouble with the bishops’ licensing was that their interests were all in the supernatural: in the course of ecclesiastical visitations, it was customary to ask after the use of prohibited sorcery rather than the progress of deliveries. Dr Peter Chamberlen, son of Peter the Younger, cried out vigorously against a system whereby any woman ‘with the testimony of two or three gossips’ could pay a fee for her licence, and then hasten into practice. It was a system, he averred, which produced innumerable and ‘uncontrolled female-arbiters of life and death’. In 1654 he attempted in his turn to form a Corporation of Midwives, with himself as governor; towards this end he seems to have held monthly meetings of midwives for the purpose of instruction at his home.
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This innovation aroused angry protests from the midwives at the interruption of their age-old business. Dr Chamberlen, it was asserted, had no greater skill than anyone else save for his ‘iron instruments’. Chamberlen was also accused of bargaining with the rich for larger fees, and neglecting the care of the poor altogether. Among those midwives who petitioned was that Mrs Hester Shaw who may have been the violent midwife of Threadneedle Street criticized by Dr Percival Willughby.
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Hester Shaw, towards the end of her career, got into a dispute with Mr Thomas Clendon, the minister of Allhallows, Barking, over some stolen goods: her houses, and the other houses in her row, having been accidentally destroyed by gunpowder, a great deal of Hester Shaw’s property had, according to her version, ended up in the minister’s possession and stayed there.
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The details of the case revealed incidentally how substantial could be the rewards of a lifetime of midwifery: two bags of silver, worth over £100 each, and quilted rolls of gold were mentioned as missing, as well as a quantity of silver plate. Hester Shaw was also described by the minister himself as of ‘a good education, and volubility of tongue, and natural boldness, and confidence’. In herself therefore she also stood for the midwife as an independent female professional, secure (as she had hitherto always believed) in work which a man was quite unable to perform.

The midwives argued in front of Archbishop Laud and the Bishop of London at Lambeth Palace on 22 October 1634. Their case rested in essence on the importance of experience: ‘it must be continual practise in this kind that will bring experience, and those women that desire to learn must be present at the delivery of many women and see the work and behaviour of such as be skilful midwives who will shew and direct them and resolve their doubts’. On the other hand there was a certain lack of logic in the way the midwives added that they also possessed books in English on anatomy, and ‘most of them being able to read’ (or so they claimed), these books would benefit them more than Dr Chamberlen’s lectures on anatomy.
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After 1662, in the reversion to old ways brought about by the Restoration, the midwives proceeded as they had done formerly,
taking an oath, paying their money, and returning home, in the words of a critical contemporary, ‘as skilful as they went thither’. Parts of the oath still conveyed a chilling impression of contemporary abuses through ignorance: ‘I will not destroy the child born of any woman, nor cut, nor pull off the head thereof, or otherwise dismember or hurt the same, or suffer it to be so hurt or dismembered.’
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The power struggle between the midwives and the doctors was finally resolved by the victory of the latter. Education, as ever in the seventeenth century, was the real key to woman’s weakness. Members of the male sex were always likely by definition to have a far greater knowledge of medicine and anatomy than the average woman, if only for their ability to read Latin (as the midwife Jane Sharp herself admitted).
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As for women doctors, some women did continue to practise medicine on a casual basis – in 1683 one Prudence Ludford of Little Barkhampton was presented at court for unlawful surgery – but the examinations required by the Faculties of Medicine and Surgery in the City of London excluded women.
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By the end of the century it had become customary to call in a ‘Man-Midwife’ for difficult cases. It has been suggested that the vogue for the ‘Man-Midwife’ among the upper classes may have spread from France (like other customs of an intimate nature as the use of the prophylactic sheath), after one of the mistresses of Louis XIV, Louise de la Vallière, had been attended by one. In 1780 the honouring of Sir David Hamilton by King George III, the first knighted obstetrician, indicated the course of the future in the medical profession. Those murmurs of feminine modesty at male examination which had persisted in the seventeenth century – Dr Willughby mentions cases where he was not permitted to gaze on the patient’s face – and had been evinced by the vocal midwives as support for their traditional claims, died away in view of the superior need for truly skilled attention.
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And that, it came to be agreed, could not be supplied by women.

Ironically enough there was far more substance to the
midwives’ claims to represent the correct – because it was divinely-ordained and thus natural – approach to labour than many people, including the doctors, realized at the time. Recent research has come to criticize the ‘meddling’ male doctors who with their forceps intervened with the natural process of childbirth.
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It is of course impossible (as was pointed out on p.92), to estimate with any certainty the figures for mortality in childbirth at this period; even the hazy figures available give no clue as to the relative responsibility of midwife, doctor, let alone that other important figure present at every childbed, ‘Dame Nature’ herself.

Obstetrics in any modern sense was in its infancy where doctors as well as midwives were concerned. This was an age when the Caesarean delivery was popularly – if not quite correctly – believed to result in the inevitable death of the mother. The key work
De Generatione Animalium
by Dr William Harvey, described as ‘the father of English midwifery’,
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was published in Latin in 1651 and, with a thirty-nine-page section ‘Of the Birth’ translated into English in 1653 (it had a strong influence, for example, on Dr Percival Willughby). But even Harvey was capable of harbouring such misconceptions as attributing to the foetus an active role in breaking out of the womb, in addition to the mother’s contractions, on the analogy of the chicken breaking out of the egg.

While some of the notions cherished by the midwife Jane Sharp have a ludicrous sound to modern ears, others are sensible enough. On the one hand she believed the liver rather than the heart to be the fountain of the blood, that boys were begotten from the right ‘stone’ (testicle) and girls from the left, and that after conception boys lived in the right of the womb and girls on the left. On the other hand Jane Sharp believed in sustaining the strength of women during labour and in keeping them warm afterwards, both sound principles. She was much against hurrying on labour, warned against the difficulty of a breech presentation, and she was aware of the threat of haemorrhage with the need to remove the ‘after-burden’ (placenta). Her chosen covering for a recently delivered woman – the newly flayed skin of a
sheep and a hare-skin on her belly – may sound bizarre, but William Sermon, a doctor, enunciated the same principle in 1671 in
The Ladies Companion
(though Dr Sermon preferred the skin of an ox).
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As for Dr Sermon, he too had his capricious notions: for example, he believed one flat breast to be a sign that one twin would be miscarried. Like many doctors and scientifically-minded people in the seventeenth century, he attached much importance to obtaining that popular talisman of the time, an eagle-stone, to aid an easy delivery. Lord Conway, husband of Anne Viscountess Conway and a Fellow of the Royal Society, took enormous trouble to find exactly the right size and shape of one before her delivery in December 1658; fabled to be found in the birds’ nests, an eagle-stone was in fact merely an accidental configuration of an ordinary hollow pebble.
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In such a primitive state of medicine, the midwives were not so far out in their emphasis on the importance of womanly experience. An accomplished sensible midwife like Jane Sharp would not really do much less well than a doctor like William Sermon, because in so many cases both of them were effectively helpless. Dr Sermon himself recognized this when he suggested that the ‘discreet Midwife’ should encourage her patient to call on the Almighty for help: ‘and let them call to mind what God hath said with his own mouth; for it would be almost a miracle to see a woman delivered without pain’.

In another passage however, Dr Sermon did draw attention to a remarkable instance of childbirth without pain which he himself had witnessed by chance in 1644. The doctor was lurking in the hedgerows, hoping to shoot a hare, when he saw a woman on her way back from market ‘delivered of a lusty Child in a Wood by herself’. Presently she encased the infant in some oak leaves and wrapped it in her apron. She then marched ‘stoutly’ for half a mile to what happened to be the doctor’s uncle’s house. Within two hours the woman felt well enough, having secured some proper linen for the child, to proceed on her way ‘not in the least discouraged’. Dr Sermon knew of other examples in history of women delivered without pain. He also fondly believed that
the contemporary women in America sprang out of a bed and ministered to their own husbands immediately after giving birth out of gratitude ‘because they [the American husbands] take some pains to beget them with Child’. If only English women were equally unselfish, reflected Dr Sermon, their husbands would give up kissing their ‘handsome Nurses’ and generally misbehaving themselves with the neighbours in a similar situation.
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But such ‘natural’ childbeds were rare indeed in the conditions of seventeenth-century England. The real point about obstetrics and midwifery during this period (and for nearly 200 years to follow, until the invention of disinfectant by Joseph Lister in 1867 caused maternal mortality to decline sharply) was that the nature of bacterial infection itself was not understood. Here both doctors and midwives were alike in their ignorance.

Dr William Harvey called for cleanliness to prevent the onset of fever. Handbooks advocated common-sensical measures of hygiene for midwives. Jane Sharp called for pared nails, and Dr William Sermon for comely and neat midwives, hands small, fingers long not thick, ‘nails pared, very close’. As for Jane Sharp’s recipe for a herbal bath at the onset of labour, to include hollyhocks, bettony, mugwort, marjoram, mint, camomile, linseed and parsley boiled up together, that must at least have involved cleansing the patient; if her recommendation that the woman’s ‘privities’ should be anointed with a compound of oil of sweet almonds, lilies, violets, duck’s grease, hen’s grease and wax, with butter, ground quince kernels and gum optional is less instantly appealing to modern sensibilities.
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But none of the endless herbal remedies recommended in handbooks and household books alike for the inexorable female ordeal of childbirth had any real relevance to the problem of sepsis.

It was from septicaemia that the suffering patients died in their hundreds and thousands. This septicaemia was sometimes brought about by the unhygienic conditions of the home (although some immunity must have been established to those); more often it was brought about by that concomitant of most labours, ‘the examining hand’.
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Here both doctor and midwife
were equally guilty. The doctor blithely and unknowingly brought with him infection from other cases which might include scarlet fever; the midwife from a daily round which might include the cow-byre and the farmyard generally as well as the lying-in of a neighbour.

It was a hideous truth that progress in this field could lead to greater not lesser mortality, as the examining hand of the doctor grew more skilful, and the importance of internal examination was increasingly stressed. The establishment of the first lying-in hospitals led to the first epidemics of puerperal fever, the first one accurately recorded being in the middle of the seventeenth century.
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It was in this sense that the least skilful midwives, lacking the knowledge to do much more than concentrate on their herbal remedies in the patient’s own home, might actually do less harm, by not spreading infection, than the most practised of the doctors.

The ideal midwife (from the point of view of a masculine-dominated society, and no doubt from the point of view of most patients as well) might be ‘modest and grave’, but there was something about the intimate power of the position, the fact that most midwives acted throughout their careers as ‘uncontrolled female arbiters’ in the indignant phrase of Dr Peter Chamberlen, which could lead to the development of an altogether bolder type of woman. Mrs Elizabeth Cellier was that outspoken midwife who in 1687 announced that over 6,000 women had died in childbed within the last twenty years, more than 13,000 children had been abortive, and another 5,000 had died in the first month of their life; about two thirds of these had ‘in all probability perished, for want of the due skill and care, in those women who practise the art of midwifery’.
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Her career previous to the initiation of her campaign for better training in midwifery had been equally bold, if not quite so judicious. For the details of her early life, we have to choose between the tales of her enemies – that she was born Elizabeth
Marshall, the daughter of a brazier or tinker living near Canterbury – and her own account in one of her self-justificatory pamphlets.
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According to the latter, she was brought up by parents who were fervent Royalists – Protestants, but accused of papistry and idolatry on account of their Royalist sympathies. These perverse accusations led the young Elizabeth to inquire into the truths of the Catholic religion, as a result of which she herself became converted to it.