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HISTORICAL REVIEW
Man-midwifery history: 1730 – 1930
D. C. Shelton
Researcher and author
Introduction
e Royal College of Obstetrics and Gynaecologists was formed
in 1929 and the dedicated medical professionals now involved
with obstetrics share the objective of providing the best patient
care to women at the critical time of bringing new life into the
world. Having achieved a position of respect, the profession can
fully, fairly and openly assess events prior to 1929 and accord the
history of man-midwifery the scrutiny it warrants. (In this paper,
‘ man-midwife ’ is used to describe specialists practising before
1930 and ‘ obstetrician ’ for specialists practising a er 1930).
Various attempts were made to form a separate medical organisa-
tion in the 200 years to 1929, but none were successful, largely due
to opposition from other branches of the medical profession, which
led to a long drawn out ‘ turf war ’ , during which the major losers were
those parturient women and babies who died as innocent victims.
is paper focuses on Smellie and Hunter, in consider-
ing whether their epithet as Founding Fathers is warranted. In
challenging Smellie and Hunter, the paper adds a chronological
framework to previous statistical, iconographic and literary scru-
tiny. e charges against Smellie and Hunter, and the statistical
history of man-midwifery summarised here, have not previously
been aired within O & G journals.
Smellie and Hunter
In seeking legitimacy for the profession, various means were
adopted during the 19th century and early 20th century,
Correspondence: D. C. Shelton, Researcher and author, 114B Remuera Road, Remuera, Auckland, 1050, New Zealand. E-mail: donshelton@actrix.co.nz
including the claim of a history tracing back to the early 18th
century. In so doing, the names of early man-midwives were
invoked, in particular those who had published in the eld. Chief
among these were William Smellie, with his three volume Tre ati se
on Midwifery (McLintock 1876) and his Set of Anatomical Tables
(Smellie 1754), and William Hunter with his Anatomy of the
Human Gravid Uterus (Hunter 1774). In a competitive 19th cen-
tury medical environment, they became promoted as Founding
Fathers, in a sense as ‘ needs must ’ , but without forensic analysis
of their research.
Modern histories of British anatomy lack forensic scrutiny of
the anatomical atlases of Smellie and Hunter. Deaths of healthy
women occurring undelivered were, at this time, exceedingly rare.
Hunter acknowledged this a er 35 years of midwifery experience,
in writing: ‘ the opportunities for dissecting the human pregnant
uterus at leisure, very rarely occur. Indeed, to most anatomists,
if they happen at all, it has been but once or twice in their whole
lives ’ (Hunter 1774). Undelivered deaths were so rare they are
unmentioned in key texts on maternal mortality, infant mortal-
ity and man-midwifery (Donnison 1988; Loudon 1992; Wilson
1995; Woods 2009). Even more surprisingly, given the need
to understand the reasons for undelivered deaths, they are not
mentioned in the 1,370 pages of Smellie ’ s Treatise, nor in the 531
cases discussed there (McLintock 1876). is major disconnect
is unaddressed by Smellie biographers and, by implication, sug-
gests Smellie ’ s Treatise was sanitised before publication, perhaps
by Smollett.
In contrast, since 2010, there has been international debate
over the legitimacy and status of the undelivered subjects pro-
cured and dissected by Smellie and Hunter, and depicted by Jan
van Rymsdyk in the two atlases in 72 plates of forensic quality.
Statistical evidence demonstrates the abundance, Smellie (15) and
Hunter (5), of undelivered, mainly 9th month, subjects procured
and dissected in only 5 years, 1750 – 1754, was procurable in the
quantity depicted only via murder-for-dissection (Shelton 2010).
Suspiciously, that abundance was available to only two of the
man-midwives active in London, and not to those active in Dub-
lin, Edinburgh, Glasgow or York. Inspection of Hunter ’ s plates
suggests heads and limbs of victims were removed to conceal
their identities and transferred to Hunter ’ s anatomy school for
student use. e Journal of the Royal Society of Medicine paper
was followed by a companion paper in the Social History of Medi-
cine , with supporting iconographic and literary evidence (Shelton
2011). A recent letter in the British Medical Journal drew attention
to unethical parallels between:
e skeletal remains of Charles Byrne (the Irish Giant) still •
held in the RCS Museum;
Journal of Obstetrics and Gynaecology, November 2012; 32: 718–723
© 2012 Informa UK, Ltd.
ISSN 0144-3615 print/ISSN 1364-6893 online
DOI: 10.3109/01443615.2012.721031
This paper seeks to determine whether the man-midwives
William Smellie and William Hunter deserve continuing
approbation as ‘ Founding Fathers ’ of the obstetrics profession.
Scrutiny of their careers reveals their involvement in murders
for dissection. In addition, the man-midwifery initiative of
delivery in lying-in hospitals resulted in around 1 million more
deaths in Britain and Ireland between 1730 and 1930, than
would have occurred had home-births remained as the norm.
While some may still credit Smellie and Hunter with obstetric
discoveries, their knowledge was obtained by murder-for-
dissection. That indictment, together with the lying-in hospital
legacy, far outweighs their discoveries. The paper invites further
constructive discussion and debate, but concludes the accolade
of Founding Fathers is undeserved. Any continuing endorsement
of Smellie and Hunter e ectively demeans the high ethical
standards and reputation of current obstetric professionals.
Keywords: Anatomist , atlas , Hunter , man-midwifery , murder ,
Smellie
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Man-midwifery history 719
Human remains of pregnant women, still held in Glasgow, •
murdered for dissection and depiction as gravid uterus images
in the anatomical atlases of Smellie and Hunter;
Human remains of concentration camp inmates, still held •
in some European universities, murdered for dissection and
depiction in the anatomical atlas of Eduard Pernkopf (Shelton
2012a).
Roberts, Baskett, Calder and Arulkumaran
In their paper, William Smellie and William Hunter: Two Great
Obstetricians and Anatomists , Roberts et al. (2010) disputed the
two key charges, wherein they stated:
‘ ere were 39 tables in Smellie ’ s atlas but not all of these were
of human subjects. Johnstone quotes Pieter Camper: “ … also
his gures, drawn by Rymsdijk, but not all from real life. e
children ar-e placed in pelves, the children themselves looked
natural but the other parts were copied from other prepara-
tions … ” . us, it appears Smellie stretched his use of cadav-
ers and scrutiny of his atlas suggests that 15 of the plates are
drawn from dead human subjects with the remainder being
diagrammatic line drawings ’ (Roberts et al. 2010).
e Camper reference is of minor relevance, as the charge had
allowed for that. us, Roberts et al. did endorse the rst of the
two key charges; that 15 undelivered subjects are depicted in
Smellie ’ s atlas.
e second charge against Smellie was that undelivered sub-
jects were so rare they were only procurable in the abundance
depicted by murder-for-dissection. In disputing this, Roberts
et al. opined:
‘ His anatomical atlas was published in 1754 a er 15 years of
practice, and he would therefore have had the opportunity
to encounter many maternal deaths. Most of these deaths
were intrapartum or postpartum, however, some were
antepartum ’ .
is view was unsupported by robust or relevant, statistical,
iconographic, literary, or chronological evidence.
In considering the issue, intrapartum or postpartum deaths
are irrelevant, as the subjects in question were antepartum, i.e.
undelivered. Various writers between 1735 and 1754 allude to the
extreme rarity of undelivered subjects (Chapman 1735; Gibson
1737; Paisley 1738; Simson 1738; Exton 1751; Monro 1754).
All writers on Smellie accept the plates date 1750 – 1754, but the
extreme rarity of undelivered subjects rules out forensic quality
images based on artistic impressions. e lack of fetal knowledge
prior to 1750 was discussed by Richard Hale (1749). His paper
observed that the internal physical features of a pregnant human
female, and the fetus in the womb, were the subject of widely con-
icting medical opinions, as examples were unavailable.
Pregnant women are normally healthy with a natural rst-
line of bodily defence, in the event of stress or illness a ecting
a pregnant mother, being to abort the fetus. If a mother died in
childbirth, doctors and/or midwives intervened to save the baby,
so the mother was no longer undelivered. But the images in the
atlases reveal no evidence of any attempt to save a baby, as with
Hunter ’ s Figure. 4 of Table XXVI depicting a re ection on the
chorion drawn within minutes of the mother ’ s death, and perhaps
commenced while the baby was still alive (Hunter 1774).
e maternal mortality rate (MMR) is largely irrelevant in
analysing the atlases. e critical measure is the far rarer unde-
livered death rate (UDR). So what was the UDR in London?
Mortality tables reveal the average annual births in 1750 – 1754
were 15,558 and child-bed deaths averaged 188; a MMR of
12:1,000 (Anon 1759). Available 18th century statistics are sparse,
but in studies totalling 70,000 deliveries, only two, or possibly
three, are recorded as undelivered, a UDR of 1:23,000 (Shelton
2012b: 153 – 160). us, 99% of child-bed deaths were delivered
and under 1% undelivered; as was endorsed by Bard:
‘ In size and shape, [the pelvis] is so wonderfully adapted to
that of the child ’ s head and shoulders, that notwithstanding
all the variety which occurs in the size of parents and their
o spring, and all the irregularities of shape, from accident
or disease, not one woman in ten thousand dies undelivered ’
(Bard 1819).
By way of a 21st century comparison, in the triennium 2006 – 2008,
261 women in the UK died directly or indirectly related to preg-
nancy, with the MMR being 11.4 per 100,000 maternities. Within
this, there were 28 undelivered deaths over 24 weeks; two direct,
21 indirect, and ve coincidental, and the UDR was around
1:100,000 (CMACE 2011).
A UDR of 1:23,000 when annual London births were 15,558
implies less than one undelivered deat h per year between 1750 and
1754. At a time when around 99% of deliveries were home-births,
there were no hospital transfers, and combined patients seen by
Smellie or Hunter represented only 1 – 2% of London births. e
likelihood of procuring even one of the statistically improbable
undelivered subjects was remote. However, in 1750 – 1754, Smellie
and Hunter procured and dissected 20 mainly 9th month subjects,
and then published plates of all those as undelivered subjects. No
critic of the charges against Smellie and Hunter has been able
to suggest a plausible explanation for the sudden abundance of
undelivered subjects in London.
e probability is that the total number of undelivered subjects
procured for dissection in 1750 – 1754 in London was signi cantly
more than 20, and far more than 32 by 1774, with a need to double
the base to derive total murders when mother and baby are both
counted. Further unpublished drawings by van Rymsdyk are held
by the Pennsylvania Hospital, donated by William Shippen and
it would seem likely a proportion of the total undelivered sub-
jects were not even drawn by van Rymsdyk. In addition, Charles
Nicholas Jenty procured at least three undelivered subjects during
this period, one being drawn by van Rymsdyk and the Hunter
Collection in Glasgow includes 400 obstetric preparations.
e evidence for murder as summarised in this paper, con icts
with the conclusion as reached by Roberts et al.: ‘ It is inconceiv-
able that these men, who were practising obstetricians, o en
working to the point of exhaustion on behalf of their patients,
would knowingly condone their murder ’ .
The aftermath
Although space does not permit discussion here, there is com-
pelling evidence the artist William Hogarth in his 1751 series
of prints, the Four Stages of Cruelty , and Frank Nicholls in his
Petition of the Unborn Babes , also published in 1751, challenged
Smellie and Hunter over the murder of pregnant women (Shelton
2012b: 200 – 230). But little action could be taken in the absence
of rm evidence.
Scrutiny of Smellie ’ s Tables X – XV reveals mothers killed during
progressive stages of labour to allow Smellie to study the turning
of the head during descent. ‘ e light he shed on the mechanism
Nature employed in the passage of the foetus through the pelvis
… was widely recognised in his own time ’ (Johnstone 1952: 136).
But, as foreshadowed by Elizabeth Nihell, ‘ you will nd the merit
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720 D. C. Shelton
of [Smellie ’ s] whole works shrink to little or nothing, under the
appraisement of common sense ’ (Nihell 1760: 147).
In publishing his atlas, Smellie gave credit to Colin Mackenzie
for Table X: ‘ With respect to the position of twins it is o en di er-
ent in di erent cases; but was thus in a late dissection of a gravid
uterus by Mr Mackenzie ’ (Smellie 1754). However, when the atlas
appeared there was a realisation the images represented murder vic-
tims which could potentially be tabled as evidence in a prosecution
against Smellie. A successful prosecution would have led to Smellie ’ s
execution and, by implication, the execution of his assistant Colin
Mackenzie, logically followed by William Hunter and John Hunter.
us in 1755, despite giving earlier credit for the twins, Smellie
dismissed Mackenzie, supposedly for dissecting the twins with-
out permission. But clearly this was instead to distance Smellie
himself from the images, and position Mackenzie as a potential
scapegoat, if needed. Adams wrote of the incident:
‘ Mr Hunter ’ s note appended to this passage. “ Dr. MacKenzie
being then an assistant to the late Dr. Smellie, the procuring
and dissecting this woman without Dr. Smellie ’ s knowledge,
was the cause of a separation between them, for the lead-
ing steps to such a discovery could not be kept a secret. e
winter following, Dr. MacKenzie began to teach midwifery
in the Borough of Southwark ” . is paper was not published
till a er Dr. Hunter ’ s death ’ (Adams 1818: 122).
e e ort to conceal ’ the leading steps ’ being necessary a er a
realisation that scrutiny of those steps could infer the murder of
the subject containing twins.
Further events in the tight chronology surrounding the pub-
lication imply a fear of public disorder if the murders became
widely known. It appears man-midwifery was encouraged to
secretly censure Smellie and Hunter; with the authorities agree-
ing not to progress a prosecution in return for Smellie and Hunter
ceasing gravid uterus experiments. In 1756, George Macaulay was
among those who convened as a conference of London surgeons
and physicians to discuss Smellie ’ s atlas, but met under the guise
of a discussion over the contracted pelvis; this at a time in the
18th century when rickets rarely a ected pregnancies.
“ ... ‘ to consider ’ , as Munk puts it, ‘ the moral rectitude of, and
advantages which might be expected from the induction of
premature labour in certain cases of contracted pelvis; when
the plan received their general approval, and it was decided
to adopt it for the future. e rst case in which it was con-
sidered necessary was undertaken by Dr Macaulay in 1756 ’ . ”
(Glaister 1894: 291).
As a result Smellie, William Hunter, John Hunter, Jenty, John Bur-
ton and Mackenzie all ceased gravid uterus research by 1756. Van
Rymsdyk le London for Holland, before re-emerging in Bristol
as an impecunious artist. Both Jenty and John Hunter joined
the army and le the country. A er 1756, Smellie and Hunter
adopted a stance of non-intervention, as poachers now rmly
turned gamekeepers.
e Hunters prevailed with this stance under fear of renewed
exposure by Hogarth until 1764, the year of Hogarth ’ s death when
they resumed gravid research. Some 12 more undelivered sub-
jects were procured, dissected and drawn by van Rymsdyk, with
William Hunter ’ s total of 17 undelivered subjects depicted in his
atlas when it was published in 1774. As a deceased fetus decays
very quickly, the pregnancies of the mothers of early term, as
depicted in the atlas, were only discoverable on opening subjects
murdered-for-dissection at the Hunters ’ anatomy schools. e
description of the atlas remained unpublished on Hunter ’ s 1783
death, being revised by Baillie, seemingly in a sanitised form, and
appeared only a er John Hunter ’ s death in 1793, implying a reluc-
tance for it to be published.
Peter Camper
Peter Camper was a Dutch man-midwife who made three visits
to London and studied with Smellie. In 1749, Smellie observed to
Camper: ‘ we can come to no certain decision about the position
of the embryo or fetus in the uterus ’ (Camper 1939: 31). By 1752,
Camper was a respected professor in Holland, with ample oppor-
tunity to undertake man-midwifery experiments. But why did
Camper make a puzzling, and major in the 18th century, channel-
crossing to conduct experiments with forceps on undelivered
subjects? ere had to be a reason to make the journey and, criti-
cally, Camper had to know before setting out that Smellie would
have undelivered subjects available.
Statistics show the incidence of undelivered subjects across the
whole of London in 1752 was about one per year. But Smellie pro-
vided three subjects within days of Camper ’ s arrival. He arrived
in London on Friday 14 July and between 18 July and 27 July, he
and Smellie experimented with forceps on three corpses, at least
two of which were undelivered, before sawing one of the victims
in half to see inside (Camper 1939: 123 – 131). Progressive images
of one of those forceps deliveries appear as Smellie ’ s Tables XII
and XVI – XIX.
Pregnant subjects could only be guaranteed by resorting to
murder-to-order, and planning weeks in advance to allow for
travelling time. e evidence demonstrates Camper knew he
needed to experiment with Smellie, as pregnant victims for mur-
der and dissection were readily available in London, whereas they
were unavailable in Holland. No other plausible explanation ts
the chronology.
Familiar with the source of Smellie ’ s subjects, Camper seems
responsible for his own series of murders-to-order of pregnant
women as: ‘ [Camper ’ s] interest in fetus development led him to col-
lect throughout his life a series of white and black embryos, from
the time of rst conception until the term of pregnancy, for his per-
sonal museum ’ (Meijer 1999). It should be realised that pregnant
black mothers were very rare in 18th century Holland. Undelivered
subjects were as rare as in England, hence it was only via aborted
fetuses that it could be marginally easier to collect ‘ black and white ’
sets of fetuses, than for Smellie and Hunter to procure ‘ white ’ sets.
e thought process associated with Camper obtaining black
fetuses, from black pregnant mothers, for his ‘ black ’ set leads
to sinister conclusions and it must be doubted if Camper ’ s sets
comprised naturally aborted fetuses. With few Africans in 18th
century Holland, it seems Camper, as a wealthy man, arranged
for the captains of Dutch slave ships on the triangular route,
Holland – Africa – South America, to sell him any pregnant moth-
ers among the slave cargo, and return them to Holland for study
and dissection. In the same way as he had live orangutans shipped
to Holland from Asia for study and dissection.
Lying-in funds and lying-in hospitals
From 1660 magistrates were ruthless in pushing pregnant paupers
outside their borders.
‘ Many Overseers of the Poor, however, did their best to
whisk over the parish boundaries any ‘ great-bellied ’ women
who had no right of ‘ settlement ’ there (sometimes even
when her labour had begun) in order to avoid the possibility
that her pauper child, which by birth there would gain that
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Man-midwifery history 721
right, might remain a long term charge on the rate-payers ’
(Donnison 1988: 38).
In considering man-midwifery initiatives, the lying-in hospitals
for married women warrant discussion. Although hospital gov-
ernors were motivated by charitable intent, the man-midwifery
impetus behind them was not as altruistic. Time was money and
by having parturient women come to a central point for delivery,
a man-midwife could attend more patients and undermine the
customer base of midwives.
Smellie practised as a country practitioner, then in 1738 went to
Paris to attend lectures on midwifery, before returning to London to
teach midwifery. As one of his initiatives, he facilitated his teaching
by setting up a lying-in fund for poor patients on the condition they
allow his students to observe them during late pregnancy and birth.
Smellie arranged private lodging houses for undelivered patients
and in 1742 he advertised: ‘ He has houses where poor women with
child are delivered, at which deliveries those who are his pupils may,
on reasonable terms, be present ’ (Seligman 1980). Such lying-in
houses, represented a ready supply of vulnerable pregnant women
for murder and dissection with little fear of detection. If a friend
enquired, they were told the mother had died in childbirth. With the
corpse immediately dissected, this defence could not be disproved.
Soon a er William Hunter established his anatomy school in
1746, he was active as a founder of the [British] Lying-in Hospital
in Brownlow Street in November 1749, being one of two man-
midwives on call. When established it was the only hospital in
England solely employed for lying-in women, but only for those
who were married. e hospital rules of note included:
‘ e Committee decreed that women should be received in
the last month of their pregnancy on a letter of recommen-
dation from a subscriber and on producing an a davit of
their marriage ... In 1751 a patient, Ann Poole was summar-
ily dismissed from hospital because she was unmarried and
had falsely sworn on a davit that she had been married in
the Fleet [prison] and had been subsequently deserted. Her
defence that ‘ necessity obliged her to crave the aid of charity ’
was of no avail. … Regarding maternal deaths and stillbirths
it was said that ‘ if patients or their children die in hospital
the Steward must notify the relations or friends if known.
If they did not care to have them buried then the Steward
was instructed to cause them to be buried in the cheapest
manner he could ’ (Vartan 1972).
e burial instruction ‘ in the cheapest manner ’ was a euphe-
mism for transfer to Hunter ’ s anatomy school. e hospital rules
show the bleak situation for unmarried pregnant women bere
of support, who turned in desperation to Smellie ’ s free service.
One can speculate a reason for hospitals refusing unwed women,
was to ensure Smellie, Hunter and other man-midwives retained
a steady stream of indigent pregnant women thereby forced to
become teaching subjects.
Although the British had only been founded in November
1749, bed capacity was soon an issue. ‘ In 1751 Mr Hunter sug-
gested that one double and three single beds should be added to
the complement and it is not without interest that the Steward was
asked to nd lodgings nearby where undelivered women could
wait to make room for those in labour ’ (Vartan 1972). On 11 July
1751, the British ‘ resolved also that 4 houses behind the hospital
should be immediately taken and furnished for the reception of
lying-in women ’ (Anon 1751). Unmarried women accepted into
these, or private lodging houses, on a mistaken belief of charitable
intentions towards them as cases for student instruction, were
potential undelivered subjects for Smellie and Hunter.
Anatomy schools
Hunter was founder of the rst school to guarantee each student
a body to dissect. Smellie demonstrated on female bodies as well
as on machines during his lectures. omas Denman was another
man-midwife who had forensic quality images of an undelivered
subject drawn by van Rymsdyk, likely resulting from murder-to-
order and implying murder was widespread, with no reason for
anatomists to limit it to pregnant females. e schools of Wil-
liam, and his brother John Hunter, therea er set an example for
anatomists. It has been estimated that some 200,000 bodies were
procured for dissection, over 80% by resurrection or murder-
for-dissection, across Britain and Ireland in 1745 – 1832 (Shelton
2012b: 85 – 86). e proportion murdered-to-order will never
be known, but 10% or 20,000 seems a modest estimate as, over
100 years, 20,000 equates to only 4 per week across all Britain and
Ireland. John Hunter admitted dissecting thousands of bodies and
many of those were likely murdered. A er the 1832 Anatomy Act,
it became legal to dissect unclaimed bodies, reducing the need
for murder.
‘ In their own wretched dwellings ’
Man-midwifery became fashionable as Britain became wealthy.
But a major risk for parturient women entering lying-in hospitals
between 1730 and 1930 was that of infection leading to death.
e risk of death from infection was far less for home-births, in
stark contrast to rising MMR at hospitals. As in a telling comment
of 1852, comparing the Glasgow Lying-in Hospital with home-
births: ‘ Permit me to remark in conclusion that the maternal mor-
tality of the cases delivered within the hospital amounts to 1 in 77,
whereas the maternal mortality of those delivered in their own
wretched dwellings is 1 in 325 only ’ (Pagan 1854). Irvine Loudon
commented upon midwifery standards:
‘ To return to the question of the e ectiveness, or if you like,
the safety of the trained midwife. We have already seen
favourable evidence in this chapter in the case of Swedish
midwives in the mid-nineteenth century. And in previous
chapters there was the further evidence such as the Ken-
tucky Frontier Nursing Service, the Queen ’ s Institute nurse-
midwives in Britain, and the out-patient lying-in charities
which depended largely on the midwives trained by those
institutions. In fact, throughout the years I have spent on this
study, I have found – and it was not a nding I expected –
that wherever a city, a county, a region, or a nation had
developed a system of maternal care which was rmly based
on a body of trained, licensed, regulated, and respected mid-
wives (especially when the midwives worked in close and
cordial co-operation with doctors and lying-in hospitals)
the standard of maternal care was at its highest and maternal
mortality was at its lowest. I cannot think of an exception to
that rule ’ (Loudon 1992: 426 – 427).
Figure 1 compares MMR for hospital births attended by man-
midwives with home-births attended by GPs and midwives. It
summarises 30 separate studies and over 3,500,000 deliveries
(where nil means no data available), mainly in Britain, but also
USA and Western Europe. e weighted average for MMR at hos-
pitals at 156:10,000 was around six times worse than the MMR
of 27:10,000 for home-births (Shelton 2012b: 273 – 276). e IMR
(Infant Mortality Rate) in related studies were 82:1,000 for hospi-
tals and 30:1,000 for home-births.
Hospital gures could include emergencies, but without
ambulances, hospital transfers were minor. e poor outcome for
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722 D. C. Shelton
hospitals was attributable particularly to puerperal fever, itself an
impact of the trend away from home-births, but also to ‘ obstetric
meddling ’ . Meddling is di cult to quantify, but Sir Anthony Car-
lisle observed that children delivered by midwives in almost all
instances possessed well-shaped heads, while expressing concern
that gentleman attendants to ‘ Mr Obstetric ’ , were moulding new-
born babies heads to achieve crainiological heads to best t with
the teachings of phrenology.
A review of maternal deaths for Britain and Ireland between
1850 and 1930 suggests the average MMR for all maternal deaths
was around 47:10,000 (Loudon 1992: 542 – 550). e results are
convertible into absolute gures by applying them to the total
population. Although annual births increased over time, it is
estimated that births in London between 1730 and 1930 averaged
about 100,000 per year, i.e. 20,000,000 births in 200 years. Over
the same period, London represented around one-tenth of the
total population, which equates to a total of around 200,000,000
births for all Britain and Ireland between 1730 and 1930. Scholars
may wish to re ne these gures, but they represent a preliminary
benchmark.
A revealing calculation is then to discover how many maternal
deaths in Britain and Ireland between 1730 and 1930 could have
been avoided if trained midwives had retained prime responsibil-
ity for all deliveries up until 1930, with surgeons only called to dif-
cult deliveries. Applying the home-birth average MMR of 27 to
total deliveries of 200 million, suggests 540,000 maternal deaths
if trained midwives had retained prime responsibility. In con-
trast, applying the estimated average MMR of 47, derives 940,000
maternal deaths. is suggests around 400,000 (940,000 – 540,000)
maternal deaths resulted from the man-midwifery initiated trend
to hospital births. True, a proportion was due to puerperal fever
outbreaks in hospital, but infection would not have spread had
home-births remained as the norm. In 1833, Robert Lee, a noted
London man-midwife suggested all lying-in hospitals be closed
due to the high MMR.
To judge the full impact of the trend, the impact of IMR
also needs assessment. It is estimated 5% or 10,000,000, of the
200,000,000 births between 1730 and 1930, were hospital births.
Applying a net IMR of 52 (82 – 30) to this gure derives 520,000
extra neonatal deaths across Britain and Ireland. When added to
the e ect of the MMR, it suggests nearly 1,000,000 (400,000 mater-
nal plus 520,000 neonatal) deaths between 1730 and 1930 resulted
from the man-midwifery initiative encouraging hospital births.
Training in the early 20th century
Man-midwifery training was inadequate in early 20th century
England, with Loudon quoting Haultain in 1911: ‘ e parade
of the puerperal wards, so far as true clinical instruction is
concerned, is a farce, and might be as thoroughly conducted at
Madame Tussaud ’ s ’ , and Loudon himself observing: ‘ In general
the teaching of midwifery in England in the nineteenth century
was grossly inadequate. Many fresh young general practitioners
embarked on their career with a degree of ignorance about normal
and abnormal labours that hardly bears thinking about ’ (Loudon
1992: 192). Loudon also notes on p. 230:
‘ Sir Eardley Holland remembered that at his medical school
in 1901, “ getting your Midder done and out of the way ” , as
the Dean put it, consisted of one month on the “ Extren. Dis-
trict ” , unsupervised and with no in-patient midwifery teach-
ing whatsoever. ... Sir Dugald Baird, recalling his student
days in the 1920s, said that clinical instruction consisted of
watching their teachers perform Caesarean deliveries from
a distance in an amphitheatre, and conducting domiciliary
deliveries “ on the district ” , unsupervised, with no practi-
cal instruction, and without being allowed to give drugs to
relieve pain or stop bleeding ’ .
Loudon follows that with a further telling observation: ‘ If I was
asked to pick out one factor above all others as responsible for
the high maternal mortality in the rst thirty- ve years of this
century, it would be the standard of obstetric education in the
medical schools ’ . Since 1935, things have improved and in the 21st
century, MMR and IMR as between midwives and obstetricians
are comparable.
Concluding remarks
Johnstone described the main reasons for the rise of man-
midwifery as: rst, man-midwifery knowledge; second fashion;
and, ‘ A third and much more speci c in uence resulted from the
disclosure of the secret of the midwifery forceps. An instrument
of that sort clearly called for more knowledge and skill in its use
than could be expected of a midwife ’ (Johnstone 1952: 30).
But as outlined in this paper, those and similar comments
about the worth of man-midwifery do not stand up to forensic
scrutiny. Combining the legacy of extra maternal and neonatal
Figure 1. Comparison of MMR for hospital and home-births by decade.
J Obstet Gynaecol Downloaded from informahealthcare.com by Don Shelton on 10/18/12
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Man-midwifery history 723
deaths, together with subjects murdered for dissection, derives
around 1 million human deaths connected to man-midwifery
initiatives of the 18th century. In simple terms, those deaths arose
from dismantling the pre-1730 structure of maternal home-care
provided by trained midwives.
e two most culpable in these initiatives were Smellie and
Hunter, with a catalyst for their actions being Church inaction
in licensing midwives and disinterest in policing resurrection-
ists. It is clear from this study that the work of Smellie and the
Hunters warrants reassessment. Despite the medical discoveries
made, their murder of vulnerable pregnant women should disbar
Smellie and Hunter from any accolade as Founding Fathers. Such
censure would then avoid their unethical practices tainting the
positive achievements of the obstetrics profession in the 80 years
since 1929.
Author Details
Don Shelton was born in Epsom, Surrey, England, has lived in NZ
since 1952 and was educated at Victoria University, Wellington.
Prior to retirement his employment was as Chief Financial O cer
in large corporates in the investment, banking, and retail sectors.
Since 2006, he has researched and written extensively on art
history for his website at: www.portrait-miniature.blogspot.com
which displays an internationally important collection of minia-
ture portraits.
He has also authored the rst full biography of the surgeon Sir
Anthony Carlisle FRS, PRCS (1768 – 1840) and from 1808 – 1824
Professor of Anatomy at the Royal Academy. e e-book biog-
raphy is entitled e Real Mr Frankenstein and demonstrates
compelling evidence to show Carlisle was the model for Mary
Shelley ’ s Victor Frankenstein.
Acknowledgements
e author is grateful to the medical professionals and art histo-
rians in UK, USA, Germany and NZ who have kindly answered
questions and made helpful suggestions, but in particular to
Lynda Williams and Professor Ron Jones. Any remaining errors
are my own.
Declaration of interest: e author report no con icts of interest.
e author alone is responsible for the content and writing of the
paper.
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