It was not the case that only midwives could be ignorant and incompetent. Some man-midwives were equally injurious when delivering children, despite being trained under doctors and man-midwives who taught classes and used obstetrical machines or phantoms.
Advertising for the services of Mr. Ames, a surgeon, apothecary, and man-midwife (Source: Wellcome Library, London)
Mistaking the Placenta for a Tumor
Mr. David Evans, a surgeon and man-midwife, described a case in which he was called to attend a young woman in labor of her first child. The woman was attended by “an irregular practitioner” — a man who had recently begun his practice of midwifery, having been instructed in the profession by an old neighborhood midwife. The irregular practitioner had detected what felt like a soft tumor and concluded it was the placenta sticking to the child’s head. He thought it necessary to cut down through the tumor to allow the head to pass through the birth canal. In the process he had “absolutely scalped the child as far as he could reach with his fingers.” Mr. Evans had only to wait patiently to deliver the child. Both mother and child did well, although a portion of the child’s scalp sloughed off due to the injury.1
Removing Limbs to Enhance the Birth
1773 etching titled “Doctor Forceps,” showing a blind, senile man-midwife (Source: U.S. National Library of Medicine)
Mr. Evans reported a case in which a friend was sent for by a woman who had been in labor for several days. The person who attended her, a Mr. ______ [no name given], observed that it was an arm presentation, meaning that rather than having the top of the head appear first during the delivery (as is the usual presentation), an arm appeared. Not knowing what to do with it, he cut it off! On discovering that this action did not much help the labor process, he sent for a surgeon who turned the child and delivered the woman with ease.1 It appears Mr. ______ was so deficient in understanding as to be nearly as blind and senile as Doctor Forceps, shown at right.
In a similar case, a young man attended the delivery of a neighborhood woman. The face presented in this instance. Not knowing what to do, the young man sent for another young man (a friend presumably) to assist him. Together they turned the child, which action brought down a foot. Now being presented with a novel situation and not knowing the standard practice, they decided to amputate it. The result was they cut off the joint at the knee!1 Recognizing their ignorance, they sent for an elderly practitioner, but by the time he arrived, the child had been delivered by the effort of nature.
Destroying through Brute Force
Drawing of a child being delivered successfully using Dr. William Smellie’s forceps (Source: Wikimedia Commons)
Dr. Harrison wrote of a situation where a Mr. ______ was called to attend a birth in which the feet presented. In trying to resolve this problem he pulled on the child’s legs with such force that the child’s head was torn from its body and remained in the uterus. Having now destroyed the child he tried to extract the head using instruments, which he employed with “equal ignorance and brutality.” The mother died from her lacerations. This awful case occurred despite the fact that Mr. ______ had served the usual apprenticeship in London before moving to the country.2
Accused of Murdering a Patient
In a write-up of Old Bailey sessions for 1829, the case Rex v. Williamson, O.B. 1807 is described.3 A 75-year-old man had the habit of acting as a man-midwife among “the lower classes of people,” even though he had not been trained as an accoucheur. He was indicted for the murder of Ann Delacroix and also charged with manslaughter by the coroner’s inquisition. Evidence presented by the nurse who attended Mrs. D indicated that Williamson had delivered her child on Friday, but that on the Sunday following he was recalled to the patient’s bedside where he diagnosed a prolapsed uterus. (A prolapsed uterus occurs when the pelvic floor muscles are so weakened that the uterus slides down into the vagina.) Williamson mistook the prolapsed uterus for the remaining portion of the placenta, which he had not removed at the time of delivery. When he attempted to rectify the situation, he used such force that he lacerated the uterus and tore the mesenteric artery, which caused the patient to bleed to death. Several medical witnesses testified that Williamson’s lack of knowledge about anatomy had caused the woman’s death.
Williamson said he acted according to his best judgment. His defense was supported by the testimony of six female witnesses, all of whom said they had been delivered by the prisoner at different times; they mentioned his kindness and skill.
In his summation, Lord Ellenborough stated that no evidence had been entered to support convicting the prisoner of the crime of murder, although a case of manslaughter might be appropriate. To prove manslaughter, however, the prisoner must be shown to be guilty of criminal misconduct. “It would seem,” said Lord Ellenborough, “that, having placed himself in a dangerous situation, he became shocked and confounded . . . if you find the prisoner guilty of manslaughter, it will tend to encompass a most important and anxious profession with such dangers as would deter reflecting men from entering into it.” The jury must have been impressed with the good Lord’s argument, for they returned a verdict of Not Guilty.
A Miracle Any Child Survived
Families in the “lower classes of people” often could not afford the trained accoucheurs who had a better chance of delivering a whole, healthy infant. It makes me wonder whether hundreds of Regency children grew up scarred, maimed, or missing limbs as a result of botched deliveries.
Drawing of a child lying in the transverse position, with an arm presenting (Source: Wikipedia Commons)
Of course, being a member of the aristocracy did not guarantee protection against an awful outcome. Princess Charlotte of Wales was attended by the accoucheur Sir Richard Croft. Sir Richard was trained by Dr. John Hunter, a famous surgeon and anatomist, and also by Dr. Thomas Denman. He served as Physician to King George III. Following medical doctrine of the time, Sir Richard kept Princess Charlotte on a strict diet and bled her frequently. Her labor lasted some 50 hours, being made difficult by the child’s position: it was lying transverse in the womb. (In a transverse presentation the arm or shoulder enters the birth canal first.) Such presentations are uncommon and generally require a cesarean section, which was not feasible in 1817. Likewise, forceps were not used in this case. Princess Charlotte eventually delivered a large stillborn boy. A few hours later she died, presumably from internal bleeding. Sir Richard was so distraught over her death that he killed himself a few weeks later. A sad outcome all around.
Sources:
1Evans, David. A series of cases of bad practice in midwifery and surgery. In: Transactions of the Associated Apothecaries and Surgeon-Apothecaries of England and Wales, Vol. I (London, 1823), pp. 202-204 (PDF pp. 393-395).
2Harrison, Edward. Remarks on the Ineffective State of the Practice of Physic in Great Britain (London, 1806), pp. 13-14 (PDF pp. 18-19).
3Carrington, FA, and Payne, J. Rex v. John Williamson, O.B. 1807, cor. Lord Ellenborough. In: Reports of Cases Argued and Ruled at Nisi Prius in the Courts of King’s Bench & Common Pleas, and on The Circuit, Vol. III (London, 1829), pp. 635-636 (PDF pp. 652-653).