Listening between the Lines: Patient Resistance in the Case Histories of William Smellie

By Marcia Nichols

Eighteenth-century obstetrics pioneer William Smellie’s textbook, A Treatise on the Theory and Practice of Midwifery (1752-1764), recounted his practice of more than 40 years in Scotland and London.[i] The case histories offer a rich treasure trove of information about women from all walks of British life and their interactions with midwifery practitioners, both male and female. Smellie tended to describe his patients as possessing weak bodies unable to deliver a child on their own without his assistance. Smellie even went so far as to blame women who died in labor or miscarried their baby, arguing that they failed to cooperate with him. Although Smellie wrote case histories as cautionary tales, these stories also offer a disruptive counternarrative. Reading against the grain of Smellie’s hegemonizing discourse offers an echo of the voices of women who refused to give up their own authority. By resisting new practices, including physical vaginal examination, these women insisted that medical men defer to their female experience and knowledge. There were women who “wrote back,” destabilizing the dominant medical discourse that marginalized female bodies.

Eighteenth-Century Obstetrics

As has been well-documented, the 18th century saw an obstetrics revolution. Over the course of the century, obstetricians displaced female midwives as the recognized authority over childbirth and pregnancy. Man-midwives claimed authority through a proliferating discourse that proclaimed their scientific mastery over the birth process to be more accurate and safer than the experiential knowledge traditionally attributed to women. In protest against this bid for authority, some London midwives wrote back in midwifery treatises of their own. Some, like Sarah Stone, claimed for themselves the combined power of experiential and anatomical knowledge. Others, like Elizabeth Nihell, declared that women’s “industry, dexterity, ease of execution, patience, constitutional tenderness, and especially natural aptitude” to better suit the needs of women in labor than scientific knowledge, which she characterized as a depraved violation of the natural order. Still others, such as Martha Mears, tried to insert themselves within the masculine discourse as translators of this learning to women patients and readers.[ii] As useful as these works are in recovering the voices of 18th-century women, they offer little insight into patient-centered questions.

What were the feelings of female patients themselves? How many women were like the fictional Elizabeth Shandy (mother of the eponymous hero of Lawrence Sterne’s novel, Tristram Shandy) who insisted on being attended by a female midwife over the objections of her husband?[iii] Historian Adrian Wilson argues that male obstetricians were fashionable among the British upper-classes and their middle-class imitators.[iv] Yet it is also well-known that obstetricians never fully replaced midwives as primary birth attendants.[v] Thus, many women, perhaps from pecuniary considerations or from personal preferences, still relied on traditional female care networks. What were their thoughts? How did they experience care at the hands of either male or female practitioners? While few eighteenth-century patients of either gender left written records, it may be possible to hear their voices if we listen carefully. As feminist scholar Chris Weedon explains

Discourse…offers more than one subject position. While a discourse will offer a preferred form of subjectivity, its very organization will imply other subject positions and the possibility of reversal. Reverse discourse enables the subjected subject of a discourse to speak in her own right. [vi]

For example, in The Woman Beneath the Skin, Barbara Duden engages in such a project with the eight volumes of case histories of a German medicus, Dr. Johannes Storch. She seeks to hear women’s experiences of their bodies through and beneath the masculine discourse in which they are embedded.[vii]

Jakob Rueff, Ein schön lustig Trostbüchle von dem Empfengknussen und Geburten der Menschen, 1554. © National Library of Medicine.

Jakob Rueff, Ein schön lustig Trostbüchle von dem Empfengknussen und Geburten der Menschen, 1554. © National Library of Medicine.

A Peek Inside the Boudoir: Smellie’s Patients

Smellie’s case histories present a panorama of Georgian society through the private spaces of women’s bedrooms. Reading them is a journey from Scottish heaths and farmhouses to London, where one travels from the slums of Gin Alley, with its starving beggar women selling ballads; to Windmill Street, with its young ladies academy; to the fashionable West End where ladies read each other “odd romantic tales” and played cards during their lying-ins (the 18th century term for labor and the subsequent month-long period of confinement).

In the textbook, Smellie characterized the female body as mutable, weak, and fragmented. He described labor as a contest of wills between a woman and her body, and one that women were too weak to win without medical assistance. Smellie’s theory states that birth was initiated by irritation of the “nervous fibres” of the cervix. At the beginning of labor, the woman was an active agent, “sqeez[ing] her Uterus” “to alleviate” the “uneasy sensation” caused by her cervix, which then dilated.[viii] Ultimately, however, she was unable to deliver on her own. She was “unable to continue this effort for any length of time, from the violence of the pain it occasions, and the strength of the muscles being thereby exhausted and impaired.”[ix] Thereafter Smellie took over the birth, placing the laboring woman under his supervision and control. In order to help her, she would need to submit to his direction and will; women who did not risked their own life and that of their infant.

image-3

Plate 15 from Smellie’s Sett of Anatomical Tables (1754) showing childbirth.

Smellie reports only a small number of patients (around 6%) in the case histories who in some way resisted his treatments. Of course, that number is not necessarily reflective of the reality of his interactions with his patients. We have no way of knowing how he chose which cases to include and which to exclude to get a real sense of how many women resisted. It is likely that he shared the cases exhibiting patient resistance for the same reason he shared some cases in which he made (often fatal) mistakes: as warnings to the students he expected to read his book. These young men needed to be aware that not all women would follow their directions, nor allow them to touch their bodies. Or, even with permission from the woman or her family, a woman might not cooperate. She might not hold still—she might even need to be restrained.

Listening Between the Lines: Disobedient Women

Smellie did, however, hold such women culpable for their own deaths and the deaths of their children. For example, one woman, who “had been used to take opiates,” repeatedly refused to let him physically examine her during labor, demanding that he prescribe her opiates for the pain instead. When she did deliver, Smellie was unable to resuscitate her child. He blamed the death of this child on the mother’s “timorous disposition, in consequence of which she refused all assistance at the latter end of labour.”[x] Smellie chose to present her actions as fearful rather than as dismissive of his authority. However, this was a woman who refused to submit to Smellie’s ministrations. She refused to acknowledge that he, as physician, knew what was best for her. She insisted that what we would describe as addiction to opium be indulged even if that meant risking the fetus, challenging societal (then and now) expectations of maternity that expect mothers to place the safety of their children over their own pleasures and needs.. Rather, this woman insisted that, as a paying patient, Smellie defer to her demands.

Smellie presented such resisting women as dangerous. When Smellie was called to a country woman who, like Elizabeth Shandy, came to London to have her first child, she refused to lie in bed as Smellie ordered, but instead attempted to alleviate her labor pains by “hanging on women’s shoulders and the backs of chairs” and “tumbl[ing] about on the floor.” She insisted on activity rather than lying on her left side, a position preferred by obstetricians. In fact, Smellie found her to be “quite unmanageable.” Her subsequent illness during her lying-in came to no surprise to Smellie, who attributed it to her actions. Nevertheless, he carefully doctored her back to health.[xi] This woman seemingly journeyed to London for its superior medical care, but whether of her own accord or from the wishes of her husband, Smellie failed to mention. In any case, her actions suggest she had less faith in the superior wisdom of the physician than her journey implies. In fact, the description of her clinging to other women powerfully conjures an image of her desire to return to the all-female space of the traditional lying-in. Her actions register resistance against the male intrusion of that space.

Women like these, who insisted on their own ways, were, on the one hand, demanding the traditional prerogatives of pregnancy. Long-held beliefs claimed that women who were greatly vexed or denied longings would bear children that were marked by these thwarted passions.[xii] On the other hand, Smellie held these women accountable for the complications of their pregnancies. To cite a final example, he presented a pair of cases in which he attributed difficult pregnancies to each woman’s failure to exercise and to lace tightly enough to hold their uteruses in place. Smellie attended both in their next labors. He found that the first had obeyed his advice and began exercising and lacing. She and her child lived. However, the second “acted in diametrical opposition” to his advice. She and her child died because of her “Indolence.”[xiii] The first woman was willing to alter her behavior, but the second seems to have insisted that she knew what was best. This second woman followed the same routine in her second pregnancy despite Smellie’s advice. In this case, Smellie criticized her inactivity rather than her active resistance.

Portrait of William Smellie. © Wellcome Images, Wellcome Library, London.

Portrait of William Smellie. © Wellcome Images, Wellcome Library, London.

Smellie did not demand passivity from his patients, but obedience. In fact, the women whom Smellie admired most were the ones who “endured…with great fortitude” and “courage.”[xiv] These were women who calmly submitted to his ministrations, no matter how painful and tedious. The women in the case histories discussed here failed to obey—either through their unwanted activity or extreme passivity. In their acts of resistance, one can tease out a counter-narrative that allows for a different subject position than the one Smellie would have readers inhabit. The dominant discourse is Smellie’s disapproving one; however, within it are whispers of these women’s experiences—their desires as the subjected subject. Indeed, these women insisted on maintaining their own subject positions—insisted that their desires be held paramount during the birthing process. They refused to submit to either the ideals of maternity or to masculine authority. Such women threaten to destabilize the authoritative discourse in which they are embedded. Yet—their stories persist and raise questions. What histories did Smellie leave out? Did all women who resisted really suffer such severe physical consequences? What might their lost stories be able to tell us?

 

Marcia D. Nichols is Assistant Professor in the Center for Learning Innovation at the University of Minnesota Rochester where she teaches literature and medical humanities and engages in learning research. Her current book project analyzes the constructions of gender, sexuality and masculine identity in midwifery manuals and other medical texts in the long eighteenth century.  

 

[i]All citations refer to William Smellie, A Treatise on the Theory and Practice of Midwifery Vol. I (London, 1752). (Birmingham: Classics of Medicine Library, 1990); Smellie, A Collection of Cases and Observations on Midwifery, Vol. II (London 1758); and Smellie, A collection of preternatural cases and observations in midwifery, Vol. III. (London, 1764). Hereafter Vol. I, Vol. II, or Vol. III respectively. A version of this paper was presented at the SAHMS conference, March 3, 2012.

[ii] Sarah Stone, A Complete Practice of Midwifery (London 1737); Elizabeth Nihell, A Treatise on the Art of Midwifery (1760). Eighteenth Century British Midwifery, Vol. 6. Ed. Pam Lieske (London: Pickering & Chatto, 2008); Martha Mears, The Pupil of Nature (London, 1797). Nihell, 17-18.

[iii] Lawrence Sterne, Tristram Shandy. Ed. Howard Anderson. (New York: Norton, 1980).

[iv] Adrian Wilson, The Making of Man-Midwifery (Cambridge, MA: Harvard UP, 1995).

[v] Ornella Moscucci, The Science of Woman (Cambridge: Cambridge UP, 1990); Judith Walzer Leavitt, Brought to Bed (Oxford: Oxford UP 1986).

[vi] Chris Weedon, Feminist Practice, Poststructuralist Theory (New York: Basil Blackwell, 1987), 109.

[vii] Barbara Duden, The Woman Beneath the Skin. Trans. Thomas Dunlap. (Cambridge, MA: Harvard UP, 1991).

[viii] Vol. I, 118-19, italics in original.

[ix] Ibid, 119.

[x] Vol. II, 229-31.

[xi] Vol. III, 394-95.

[xii] The dangers of the maternal imagination is a theme in most early modern works on midwifery. For two recent scholarly discussions on the topic see David M. Turner “Birth Anomaly and Childhood Disability” In The Secrets of Generation: Reproduction in the Long Eighteenth Century. Eds. Raymond Stephanson and Darren N. Wagner. (Toronto: Toronto UP, 2015), 217-37 and Lisa Foreman Cody, Birthing the Nation: Sex, Science, and the Conception of Eighteenth-Century Britons (Oxford: Oxford UP, 2005), esp. 120-50.

[xiii] Vol. II, 121-23.

[xiv] Vol. III, 197.

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