Thanks to Elizabeth Bennet, the heroine of Pride and Prejudice, the character of Anne de Bourgh is forever fixed as “sickly and cross”1—which begs a question: Why is she so disagreeable? In my Regency novel, Rosings Park, Anne has two reasons to be cross as crabs. First, she has returned home from a trip to Tunbridge Wells, where she submitted to leeching for treating a rheumatic attack. Having 15 leeches placed on the stomach and allowed to engorge themselves might make anybody sickly and cross, fair enough. (Read my blog post “There’s a Leech for That!” for treatments related to rheumatic “affections” and other conditions.) But Anne has another reason for being crabby: her dearest friend, Tilly Sparke, is pregnant with her first child and a tedious labor is unfolding.

Tilly’s Worrisome Labor

Tilly’s labor begins with a few pains and dribbling waters, which is not what anybody expected or can explain. Over the course of two or three days, her labor progresses slowly, and the young midwife feels a bit out of her element. Recognizing a need for help, a plea is sent to a London doctor—a man-midwife—who determines that the opening to Tilly’s womb is swollen. Dr. Granville applies a bread-loaf poultice to Tilly’s private parts to reduce the swelling. He also prescribes Tincture Thebaic to relieve pain and help his patient sleep and asks the midwife to prepare an emollient clyster because Tilly is quite constipated. Is there a basis for these treatments?

Dr. William Smellie: Famous Man-Midwife

Dr. William Smellie image

Engraved portrait of Dr. William Smellie, famous man-midwife of the 18th century (from Wikipedia, image licensed under Creative Commons 4.0/deed.en)

The short answer: Yes! Tilly’s labor is based in part on a case study described by Dr. William Smellie (1697-1763), the leading accoucheur or man-midwife of his day. The Scottish obstetrician began his career as a surgeon and apothecary, setting up practice in his home town of Lanark, Scotland. Later he gained admittance to the Faculty of Physicians and Surgeons of Glasgow, where he taught midwifery. After moving to London, he continued to teach and received his medical degree from the University of Glasgow in 1745. Several of his books on midwifery became standard texts of his time.

Choosing among Dr. Smellie’s Many Interesting Cases

In preparing to write about Tilly’s birthing, I read much of Dr. Smellie’s 1752 treatise on midwifery2 and volume II of his 1764 book of cases and observations on midwifery.3 I also browsed Alfred McClintock’s editions of Smellie’s treatise published in the 1870s. I had my choice of interesting cases. There was the account of a fetus taken out of a woman’s abdomen, after lying there close to 16 years, during which time the woman gave birth to four children, all born alive! Strange, but true. Virtually every case was interesting. After reading dozens of case reports and footnotes, I chose case No. 226: Primipara; Tedious Labour from Mismanagement; Forceps.4

For reasons that aren’t clear to me now, I changed the case study so that forceps were not required during the delivery. Moreover, the young midwife managing Tilly’s birthing in Rosings Park was merely inexperienced and not neglectful, unlike the midwife in Dr. Smellie’s case. Still, case # 226 is the basis for the early stage of Tilly’s labor.

Drawing of Dr. Smellie's forceps

Drawing of Dr. Smellie’s forceps (from A Sett [sic] of Anatomical Tables, 1754, Table 35)

Dr. Smellie’s Treatment in Case No. 226

In case No. 226, Dr. Smellie is called to treat a woman who has been in labor for three days. When he arrives at the woman’s house, he finds a talkative midwife who is ignorant of her profession. She has tired her patient with walking and conducted so many vaginal examinations that the os uteri externum (the vaginal opening of the uterus or mouth of the womb) has become swollen.4 The following treatments were prescribed:

  • An anodyne mixture consisting of Aq. Fontan. mixed with Tinct. Thebaic and sweetened with sugar — Anodyne mixtures are medicines that relieve pain. Tincture Thebaic specifically referred to opium in alcohol (also known as laudanum); 30 drops were generally recommended for the relief of pain. Even though the available pharmacopoeia might use different labels — “tincture Thebaic,” “tincture of opium,”5 or “tinctura opii6,7 — laudanum was routinely prescribed for women during childbirth.
  • Emollient clyster — Because Tilly was costive (that is, constipated), she was given an emollient clyster, which is a softening enema. The Oxford English Dictionary online defines a clyster as a “medicine injected into the rectum, to empty or cleanse the bowels, to afford nutrition, etc.”8 An emollient clyster consisted of linseed tea and new milk, each six ounces, mixed together.5
  • Loaf-bread poultice with hog’s lard — Dr. Smellie used this poultice to reduce swelling. It consisted of loaf-bread and milk mixed with hog’s lard. Thinking about how this was done puzzles me. I can imagine the hog’s lard poultice being packed gently into the vagina, but picturing the poultice being removed is a little harder. Presumably a douche was used to rinse the vagina. I haven’t found a discussion of douches in the medical texts I’ve read, but maybe I didn’t use the right keyword.

Would Dr. Smellie’s Treatments Have Been Used in Jane Austen’s Time?

The above treatments were used in a case study reported in the mid-18th century. Would these treatments have been in use 50 years later, during Jane Austen’s time? I believe they would have been. Although progress had been made in understanding female anatomy, menstruation, and conception, treatments for maladies and unusual occurrences during pregnancy had not advanced greatly, with the possible exception of the use of forceps. Laudanum and emollient clysters were still being used in the early 19th century.5,7 Man-midwives might no longer use a hog’s lard poultice to reduce swelling—I can find no evidence for or against its use in Austen’s time—but poultices or cataplasms (as they were known) were popular in Austen’s day.7

Future research is needed to settle the issue of the hog’s lard poultice. Do let me know if you find evidence of its use in Austen’s day.

1Austen, Jane. Pride and Prejudice. London: Penguin Classics, 1996, p. 156.
2Smellie, W. A Treatise on the Theory and Practice of Midwifery. (London, 1752).
3Smellie, William. A Collection of Cases and Observations in Midwifery, Vol. II, 3rd ed. (London: 1764).
4McClintock, Alfred H. Smellie’s Treatise on the Theory and Practice of Midwifery, Vol. 2. (London, 1877), pp. 54-55 (PDF pp. 71-72) and 298-299 (PDF pp. 315-316).
5Buchan, William. Domestic Medicine (London,1798), p. 697 (PDF p. 736) and (Boston, 1811), p. 464.
6Denman, Thomas. An Introduction to the Practice of Midwifery. (Brattleborough, 1807), p. 403 (PDF p. 442).
7Powell, Richard. The Pharmacopoeia of The Royal College of Physicians of London. (London, 1809), pp. 252 and 345 (PDF pp. 309 and 403).
8Oxford English Dictionary (OED) online (personal subscription). Accessed June 11, 2012.

NOTE: The drawing of Dr. Smellie’s forceps can be found at