- Function of the pelvis: Janette Allotey
- From ritual to regulation?: Anne Cameron
- Puerperal fever controversies: Christine Hallett
- Modernising midwifery: Aya Homei
- ‘A price must be paid for motherhood’: Tania McIntosh
- Obstetric ultrasound technology in Scotland: Debbie Nicholson
- Edinburgh Royal Maternity Hospital: Alison Nuttall
- Scottish midwives 1916-1983: Lindsay Reid
Function of the pelvis: Janette Allotey
Function of the pelvis: discourses on the function of the pelvis from ancient times until the present day
PhD thesis, University of Sheffield, July 2007
This historical research traces evolving beliefs about the function of the pelvis in childbirth from ancient times until the present day. The female pelvis was considered facilitative of birth in ancient times, acquiring an increasingly negative image adjacent to developments in the study of anatomy and medicine.
The ancient doctrine of humours highlighted constitutional differences between the sexes, which sixteenth-century anatomists refined down to the level of the pelvis. The idea that the female pelvis was perfect for childbearing was exalted as a natural reason for women’s domestic and childrearing roles in society. Paradoxically, men midwives (now obstetricians) contended pelvic pathology often meant that women failed miserably in this role.
The pelvis was also harnessed by men midwives to demonstrate traditional midwives’ ignorance of reproductive anatomy. The midwife authors discussed in this thesis were aware of this, and the need for all midwives to have a contemporary knowledge of the bony pelvis and female reproductive anatomy, in order to converse with doctors and maintain public confidence.
Whilst forceps could overcome mild degrees of obstructed labour caused by a narrow pelvis, surgical techniques were employed to explore ways of widening or bypassing it, such as symphysiotomy or caesarean section.
The foray into pelvic mensuration which began in the eighteenth century, continued unabated until the late twentieth century. Seemingly objective medical studies were also cultural markers which aimed to justify social differences between sex, race, and class.
As maternal mortality declined in the late twentieth century, and the safety and versatility of the caesarean operation increased alongside developments in fetal medicine, concerns about the size and shape of the pelvis became of less consequence.
Despite tremendous medical endeavour, the old adage, the fetal head is the best pelvimeter, continues to underpin practice to this day.
From ritual to regulation? Anne Cameron
From ritual to regulation? The development of midwifery in Glasgow and the west of Scotland, c.1740-1840
PhD thesis, University of Glasgow, September 2003
Contact: Dr Anne Cameron
Centre for the History of Medicine, University of Glasgow
This thesis explores the development of midwifery in Glasgow and the West of Scotland between c.1740 and 1840. It draws upon a wide range of published and archival sources, including personal diaries and correspondence, local newspapers and trade directories, lecture notes and casebooks, and the minutes of numerous institutions. The first three chapters are concerned with the practices, characteristics and regulations of midwives, who, prior to this period, were neither certified nor examined, and acquired their skills through experience. An integral part of their role in the birthing chamber was to ensure that certain rituals, believed to mitigate the risks and agony of labour and to protect mother and child against supernatural agencies, were observed, and chapter one is devoted to an exploration of these rituals. In 1740 the Faculty of Physicians and Surgeons of Glasgow (FPSG) imposed a system of compulsory examination and licensing for midwives throughout Lanarkshire, Renfrewshire, Ayrshire and Dunbartonshire, and chapters two and three analyse the impact of this scheme and the personal and professional characteristics of the women thus licensed.
The remaining three chapters consider the development and significance of formal lectures in midwifery for both female and male practitioners, which were advertised in the Glasgow press from the 1750s. Around that time, surgeons, who had previously only been summoned to obstetric emergencies, were increasingly engaged to attend normal deliveries, creating a new demand for obstetrical instruction. Midwifery lectures were introduced at Glasgow University in the late 1760s, and by 1817 every medical and surgical graduate of the University, and every male licentiate of the FPSG, was obliged to have studied midwifery.
Despite these developments, midwifery in the West of Scotland was not completely transformed by 1840. The licensing scheme for midwives was difficult to enforce and easily eschewed by those who assisted at childbirth only occasionally, therefore only a minority of midwives were licensed. As formal instruction became more sophisticated and comprehensive, professed midwives gradually rejected the FPSG’s scheme in favour of accreditation through lecture courses, and the licensing regulations were abandoned altogether in the 1830s. Unlike licensing, however, neither lecture courses nor the practical training available to women at the Glasgow Lying-in Hospital from 1834 were compulsory. Thus the practice of midwives in the West of Scotland was once again formally unregulated. Furthermore, while both lectures and licensing were intended to rectify the ‘ignorance’ of midwives, including their adherence to superstitious practices, the fact that formal training remained optional and many midwives avoided licensing allowed these customs to survive into the mid-nineteenth century and beyond.
Puerperal fever controversies: Christine Hallett
The puerperal fever controversies: a study of ‘Enlightenment science’ in British medicine, 1760-1850
Ph.D. thesis, University of Manchester, 2002
Contact: Prof Christine Hallett
School of Nursing, Midwifery and Social Work, University of Manchester
Puerperal fever was an important disease in the late eighteenth and early nineteenth centuries, causing numerous deaths and sometimes occurring in an epidemic form. Physicians, surgeons and men-midwives recognised that they did not understand its nature. During the period 1760 to 1850 repeated attempts were made to determine it aetiology and natural history and to propose a successful treatment. These endeavours took place alongside the emergence of ‘man-midwifery’ as a discipline which developed into ‘obstetric medicine’, and can be seen as part of a process of knowledge construction. This process is studied through an examination of all of those medical treatises which were published in Britain between 1760 and 1850 and which deal with the subject of puerperal fever.
In debating the nature of puerperal fever, physicians and man-midwives drew upon a complex array of medical and scientific theories. Prominent among these were the humoural and Hippocratic approaches which had long been current in the medical thinking and the more recent ones drawn from the ideas about inflammation and putrefaction. Writers also made use of an amalgam of newer scientific ideas and perspectives such as vitalism, Brunonianism and certain eighteenth-century chemical theories. The Enlightenment emphasis on the ordering of knowledge found its way into their complex nosologies of puerperal fever and they also debated the extent to which the disease might be contagious. The methods they adopted were part of a self-conscious drive to mark out their approaches as rigorous. They presented their empirical data – particularly their dissections – in great detail and can be seen to have drawn upon experimental and numerical methods.
This thesis examines the process of knowledge construction as it relates to one disease – puerperal fever – during the period from 1760 to 1850. It does so through the lens of Thomas S. Kuhn’s ‘paradigm theory’.¹ The complex web of knowledge created by the men midwives of the late eighteenth and early nineteenth centuries is seen as a ‘pre-consensus phase’ in the history of this disease. The work of the eighteenth- and early –nineteenth-century physicians can be seen as a series of attempts to reach consensus by a group of individuals who were beginning to see themselves as part of a community of shared knowledge. Ideas about puerperal fever never attained the level of consensus necessary to mark them out as a ‘paradigm’. Rather, this period was characterised by both co-operation and disputatious controversy. Among the later works on puerperal fever were those such as the 1839 treatise of Robert Ferguson which can be interpreted as attempts at paradigm formulation.² Nevertheless, no final, clear consensus was reached and the period from 1760 to 1850 can be seen as a ‘pre-paradigm’ phase in the history of puerperal fever.
¹ Kuhn, Thomas S. The Structure of Scientific Revolutions (Chicago, 1996 edition) passim
² Ferguson, R. 1839. Essays on the most important diseases of women. London. passim
Modernising midwifery: Aya Homei
Modernising midwifery: the history of a female medical profession in Japan, 1868-1933
Ph.D. thesis, University of Manchester, ??
Contact: Dr Aya Homei
Centre for the History of Science, Technology and Medicine, University of Manchester
This dissertation deals with the process that transformed midwives in Japan between the 1850s and the 1920s, from traditional /kyu-sanba/ into ‘modern’, scientific, /shin-sanba/. The thesis aims to explain why and how this change occurred, map the forms and patterns of the shift, and determine the social forces and the arguments that drove the change. The process, the author argues, was one of ‘modernisation’ and of professionalisation. It was driven by state policies as well as by professional interests, by midwives as well as by medical officers and obstetricians. Commercial considerations and issues of gender identity, too, played central parts. In 1927, with the launch of the independent, all female Japan Midwives Association, the professionalisation of midwives can be seen as in many ways completed. The dissertation ends with the year 1931, when the demands of the war economy led to the implementation of a new set of policies affecting midwives.
Drawing on a wide range of sources, the thesis argues that the changes which led to the establishment of what is characterised as a ‘modern’, female, medical profession of midwifery were an expression of a specifically Japanese modernity and were triggered by a course of events that started in 1868, the year in which the Meiji era began, and the new government began to ‘modernise’ Japan. It was part of the attempt of the government to ‘nationalise’ the Japanese people. As part of its ‘modernisation’ scheme, the government officially announced that Japanese medicine would be modelled on Western medicine.
Government officials began to regulate midwifery, defining it as a medical profession exclusively for women. Western-trained obstetrician-gynaecologists began to train the first generations of shin-sanba, and the author compares the knowledge on birth and midwifery that they promoted with older notions and practices. Practice, however, was not identical with textbook knowledge, and the thesis follows midwives into the field, in order to understand how the competition with traditional midwives, the interactions with doctors and government officials, and the business relationship with their clients shaped the new midwives.
The dissertation compares the professional reality of midwives with that of other working women in early twentieth-century Japan and argues that midwives were especially suited to embody both the nationalist ideal of /ryôsai kenbo/, “good wife, good mother” and the new ideal of a professional woman. The author aims to contribute to the fields of women’s history, the social history of medicine, and the history of modern Japan. If you wish your email address. This last item is I realise not acceptable to all. If you do not wish your email to be shown and enquires come in regarding your work/potential students, I could simply forward the query to you for you to deal with personally.
‘A Price Must Be Paid For Motherhood’: Tania McIntosh
‘A Price Must Be Paid For Motherhood’: the experiences of maternity in Sheffield, 1879-1939
Ph.D. thesis, 1997, University of Sheffield
This study considers the reproductive experiences of women in Sheffield between 1870 and 1939, encompassing the development of concepts of maternal and infant welfare, and debates over birth control and abortion. It focuses on the impact of state and voluntary enterprise, on the development of health professions and hospitals, and on the position of mothers.
The study shows that high infant mortality was caused primarily by poor sanitation. Unlike other areas, Sheffield had low rates of both maternal employment and bottle feeding, suggesting that these were not significant factors. The decline in infant mortality was due to a combination of factors; the removal of privy middens and slum areas, and the development of welfare clinics and health visiting services.
High maternal mortality was prevalent mainly in areas of skilled working class employment; not middle class areas as in other cities. There was no inverse correlation between infant and maternal mortality in Sheffield. Maternal mortality was caused by high rates of sepsis following illegal abortion. The reduction in mortality was due to a cyclical decline in the virulence of the causative bacteria, and the application of sulphonamide drugs to control it. The development of antenatal and birth control clinics had little impact. Despite early action to train midwives in Sheffield, midwifery remained a largely part time, low status occupation throughout the period. The hospitalisation of normal childbirth occurred early in Sheffield, and demand for beds outstripped supply, demonstrating that women were able to shape the development of services.
Local authority and voluntary groups generally co-operated in the delivery of services, which were developed along pragmatic lines with little reference to eugenics or national deterioration. The growth of welfare schemes was circumscribed by the available resources. Central government provided enabling legislation, but schemes were planned and implemented at the local level.
Obstetric ultrasound technology in Scotland: Debbie Nicholson
Diffusion of obstetric ultrasound technology in Scotland from the early 1960s through to the end of the 1980s
PhD thesis, ??, ??
Contact: Dr Debbie Nicholson
School of Health, Nursing and Midwifery, University of the West of Scotland
This thesis examines the diffusion of obstetric ultrasound technology in Scotland, from the early 1960s through to the end of the 1980s. Although the origins of obstetric ultrasound can be traced to 1955, and the pioneering work undertaken by Professor Ian Donald and his colleagues in Glasgow on the gynaecological applications of ultrasound, it was not until the early 1960s that the pathologies associated with pregnancy were directly investigated. Over the next thirty years, the technology underwent a number of significant transformations – in technical design, application and use, and organisation. The main focus of this thesis is on the uptake and implementation of obstetric ultrasound in new locations across Scotland, and on the dynamics of change associated with its use in clinical practice.
Using a case-study approach which centres on four individual Scottish hospitals, this thesis traces the complexity and heterogeneity evident in the diffusion of this technology. The definition of ‘technology’ employed in this thesis is three-dimensional – comprising of technical, cognitive and interactive/performative dimensions. Here it is argued that all three of these dimensions compose a technology, and that all three are open to adaptation and change, thus essentially changing the nature of the technology itself. This is highlighted through a comparative account, focussing on site-specific differences in the development, organisation and use of the technology.
The evidence presented here has been drawn from a variety of historical sources. The recollections of a number of actors involved in the introduction, use and development of obstetric ultrasound in Scotland, as well as of women who experienced ultrasound during their pregnancies, have been collected using semi-structured interviews. To this oral history has been added information from a variety of archival sources held at the British Medical Ultrasound Society’s Historical Collection (housed at The Queen Mother’s Hospital, Glasgow). These include specialist professional journals, correspondence relating to ultrasound, manufacturers’ literature, draft versions of key published papers, transcripts of interviews with prominent actors in the field and material donated by ultrasound workers across Scotland. Furthermore, the Collection also boasts a wide array of visual information (including pictures of various types of ultrasound equipment and images generated from them) and artifacts (ultrasound machines dating from the 1950s through to the 1980s). These, less conventional, historical sources are also employed in this thesis.
In this comparative study of the diffusion of ultrasound, three related arguments are presented. Firstly, it is argued that innovation and diffusion are not mutually exclusive terms or periodising concepts, but are interwoven processes and forms of activity. The diffusion of obstetric ultrasound did not signal the ‘end’ of innovation, but merely the point at which new actors in new locations undertook it. Innovation is a crucial component in adapting a technology to new circumstances, users or contexts and thus it is argued that innovation and diffusion are inter-related, mutually dependent forms of interested human action.
Secondly, obstetric ultrasound is characterised in this thesis as an emergent phenomenon, shaped by both technical and social factors. When the development of this technology is examined in a variety of historical and spatial contexts, it is evident that the form it takes is determined by the interplay of social factors (professional relationships and interests, actors interpretations of technology, etc.) and more technical or material factors (the way a machine responds to new demands or itself requires certain types of human or social response). Thus a complete account of the diffusion of obstetric ultrasound necessitates an approach that considers both social and material influences on technological change.
Finally, this thesis explores the significance of site-specific local arrangements for the shaping of obstetric ultrasound. Interactions with technology take place within specific historical and locational settings. The specific character of each setting can affect the nature of inter-professional relationships, the organisation and administration of the technology, the characteristics of the patient population, and so on. Thus, the diffusion of obstetric ultrasound and the form that it takes in each new location are partly shaped by the way in which the technology interacts with new environments.
The Edinburgh Royal Maternity Hospital: Alison Nuttall
The Edinburgh Royal Maternity Hospital and the medicalisation of childbirth in Edinburgh, 1844-1914: a casebook-centred perspective
PhD thesis, University of Edinburgh, 2003
Full text available via Edinburgh Research Archive
Contact: Dr Alison Nuttall
School of History, Classics and Archaeology, University of Edinburgh
This thesis examines the development of the Edinburgh Royal Maternity Hospital in the context of medical care in Edinburgh during the period 1844-1914. It is based primarily on casebooks of the hospital and, in particular, on in-depth micro-studies of all of the hospital’s Indoor and Outdoor cases in four discrete years, at approximately 20-year intervals. The central argument of the thesis is that over the period 1844-1914, professionals and patients at the hospital came to understand birth as a medical rather than a social event, and that this had repercussions for both groups as well as the institution itself.
Chapter 1 places the thesis in the context of other secondary work on the development of maternity hospitals and care, and examines the use of casebooks as primary sources. Chapter 2 considers the hospital and its staff in relation to the city and the Edinburgh medical community in particular. Chapter 3 examines the patients who attended. It argues that, in the nineteenth century, their perception of the hospital was as a place of social shelter. However, by 1912 a greater number attended for otherwise unaffordable medical care at birth. Chapter 4 examines the medical treatment given to patients. It argues that there was increasing acceptance of medicalisation by patients in the period studied, and increasing confidence in giving such treatment by the professionals involved. Chapter 5 discusses the staff and male and female trainees at the hospital. It suggests that, prior to the introduction of national requirements, the provision of training was driven by commercial concerns, and therefore varied throughout the period studied, particularly in the amount of practical experience offered. The relationship between the different grades of staff and the treatment they offered, described in the chapter, suggests increasing stratification in the roles of doctors and nurses at delivery and during the puerperium. The increase in nursing care following the birth indicates the creation of a professional role that among the poor had previously been undertaken by family members. The role played by increasing anxiety over infection following the introduction of strict antiseptic measures is discussed.
The thesis concludes that in Edinburgh the medicalisation of childbirth among the poor was well-advanced by 1912, and suggests that this was a result of increasing patient acceptance combined with the increasing professionalisation of care.
Scottish midwives 1916-1983: Lindsay Reid
Scottish midwives, 1916-1983 : the Central Midwives Board for Scotland and practising midwives
Ph.D. thesis, University of Glasgow, 2002
The purpose of this thesis is to explore how differing circumstances came together to help or hinder the autonomous practice of midwives in Scotland between 1916 and 1983 when the Central Midwives Board (CMB) oversaw their training and practice. The thesis includes an examination of the records of the CMB for Scotland from 1916 to 1983 and, through oral testimonies, the work of practising midwives during the same period.
The thesis is divided into two parts. Part I, comprising five chapters, explores the work of the CMB from 1916 to1983. This includes: an examination of the issues surrounding the 1902 Midwives Act which did not apply to Scotland, and the campaign for, and opposition to, a similar Act for Scotland, passed in 1915; the constitution and early activities of the CMB which the 1915 Midwives (Scotland) Act established to oversee the enrolment, training and practice of midwives; a discussion of the national concern over the Maternal Mortality Rate in the 1920s and 1930s, subsequent Government reports and legislation and the CMB’s responses to these issues; an examination of the CMB’s work during the time of World War II, the shortage of midwives, and the changes the National Health Service administration made to midwifery in Scotland. Finally, Part I examines the last decades of the CMB’s existence, including its response to changes in midwifery management, education, practice and statute.
Part II, comprising three chapters, focusses on the practice of midwives in Scotland during the period through the aspects of antenatal, intranatal and postnatal care. Each chapter uses evidence from oral testimonies of midwives working within the framework established by relevant Acts and the CMB. Part II illuminates the contrast between the work of the CMB and the world of hands-on midwifery practice.
The 1915 Midwives (Scotland) Act officially recognised midwives as a group, gave them a legal identity, and status as autonomous practitioners. However, its provisions affected this autonomy. During the period under examination, midwives’ ability to be autonomous practitioners fluctuated within the frameworks which regulated their education and practice.
Within the period of the CMB’s existence the education of midwives improved. Nevertheless, the CMB, a product of the implementation of the 1915 Midwives (Scotland) Act and the essential body for the oversight of midwifery in Scotland, perpetuated the hierarchical customs of the day. Thus, throughout most of its existence, the CMB’s influence prevented midwives from achieving parity with those with whom they worked: it kept midwives firmly in a role subordinate to GPs and obstetricians. In addition, through its Rules and strict supervision it delayed the development of autonomous midwifery practice.
However, improved education of midwives gradually brought an increase in confidence. In an endeavour to evaluate the level of midwifery autonomy lost, gained or maintained, the thesis reveals the developing confidence of the midwife of the 1980s but suggests that to capitalise on this, midwives require the goodwill and confidence of themselves, other professionals and women with whom they work.