Medicine, Health and Society (Vanderbilt)

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Men in the Birthroom

Written in Medicine, Health and Society (Vanderbilt), MHS, Sex and Childbirth

by Danielle Kruglak

Seventeenth-century France saw a rise of the prestige of the male midwife, or the chirurgien accoucheur. Two French male midwives who helped the male midwife secure a place in the traditionally female world of childbirth were Jacques Guillemeau and Francois Mauriceau. Their obstetrical treatises open the eye to midwifery practices, beliefs, and conflicts of the time (1).

Guillemeau, who lived from about 1550 to 1613, wrote De l’heureux accouchement des femmes, which was published in French in 1609. His text was broken up into three sections: illnesses and remedies during pregnancy, midwife conduct, and illnesses and remedies after childbirth. Throughout his text, Guillemeau provides references to the methods of the ancients, and he also heavily follows Galenic theory (2).

As a male midwife, Guillemeau was not fond of his female counterpart, and distanced himself from what he considered to be a lesser profession. According to him, female midwives were cunning, not knowledgeable, and would commit errors. They mainly had three jobs: 1) to see if a husband and wife were compatible, 2) to be present at delivery and birth, and 3) to tell if a woman was pregnant (2).

Mauriceau, who lived from 1637 to 1709, wrote two main obstetrical treatises: Des maladies des femmes grosses et accouchees (1668) and Observations sur la grossesse et l’accouchement des femmes (1694). Similar to Guillemeau, Mauriceau followed Galenic theory, including the one-sex model. Much can be attributed to this famous male midwife, such as his tire-tete forceps, which pulled dead children from the womb, and the semi-recumbent or “French” birthing position. Mauriceau also did not approve of female midwives, and he blamed them for causing problems during difficult deliveries (3).

As with many things in life, there were also conflicts within the field of midwifery. One of the largest fights broke out between Mauriceau and Philippe Peu, another well-known male midwife at the time. Through their manuals, treatises, and conflicts, Guillemeau and Mauriceau offer invaluble insight into early-modern French midwifery and culture (1).

Image: Fores, Samuel W. “A Male Midwife,” 1793. Wellcome Library.

(1) McTavish, Lianne. Childbirth and the Display of Authority in Early Modern France. Boston: Ashgate Company, 2005.

(2) Guillemeau, Jacques. Childbirth, or, The Happy Delivery of Women. London, 1612.

(3) Mauriceau, Francois. Des maladies des femmes grosses et accouchees. Paris: Jean Henault, 1668.

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Of Art and Anatomy

Written in Medicine, Health and Society (Vanderbilt), MHS

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by Samantha Breakstone

Leonardo da Vinci wrote, “I counsel you not to cumber yourself with words unless you are speaking to the blind…how in words can you describe this heart without filling a whole book? Yet the more detail you write concerning it, the more you will confuse the mind of the hearer” (Richter). Understanding that many of the earliest writings on human anatomy did not include illustrations, da Vinci brought potent insight into the value of medical illustration. Da Vinci accurately identifies that visual material has the power to both transcend technical terminology and provoke interest that dry textual accounts cannot. Never wavering in its importance, medical illustration has undergone various evolutions throughout its history. However, the two most important influences on this evolution have been the gradual acceptance of human dissection and the advent of the printing press in the 15th century (Tsafrir).

Aristotle of Stagira (384-322 B.C.E.) is recognized by historians as the first to illustrate human anatomy based on legitimate scientific study (Singer). However, Aristotle’s illustrations were inferences on human anatomy based upon the dissection of animals (Tsafrir). Since Greek religion problaimed that the corpse was a sacred entity related to the soul, human dissection was prohibited; as a result, Aristotle’s theories on human anatomy were fatally flawed (Matuk). This is evidence of the crucial role that human dissection plays in the history of medical illustration.

When Alexander the Great finally sanctioned human dissection in Hellenic Alexandria, Hippocrates’s theories of humors drove medicine and were believe to have a more holistic scope that didn’t necessitate physical proof (Calkins). Dissection was therefore driven by spiritual and aesthetic motivations rather than scientific, as the Greeks saw the body as nature’s masterpiece, each part held to define perfection in form and purpose (Matuk).

This treatment of the human body as an objective form of interest was reawakened by the same humanistic ideas that gave birth to the Renaissance (Roberts). Artists of the 15th century became increasingly interested in the human form for artistic purposes; meanwhile, the emerging spirit of critical inquiry also inspired scientific revolution in the field of human anatomy as anatomists hungered to dissect cadavers in order to investigate the structures of the human body (Sappol). Both art and science held claims on the human form, and neither could completely understand it without assistance from the other. Leonardo da Vinci (1452-1519) was the first artist to consider anatomy for reasons beyond its artistic applications (Tsafrir). He studied structure and function in depth through observation and careful dissection–completing approximately 30 within his lifetime (Smith). Da Vinci was unique in that he could dissect and illustrate from his own observations. Human dissections in the name of art were more respected in the public than those in the name of science; thus, most anatomists after da Vinci looked to accomplished artists to illustrate their dissections (Roberts). As a result, the boundary between art and science during the early modern era was permeable; medical illustrations emerged as a unique balance of accuracy, beauty, and entertainment such as those in Vesailius’s De Humani Corporis Fabrica (1543) (Sappol).

Matuk, Camillia. “Seeing the Body: The Divergence of Ancient Chinese and Western Medical Illustration.” Journal of Biomedical Communications (32:1) 2006.

Richter, Ian. The Notebooks of Leonardo da Vinci. Oxford: OUP, 1952.

Roberts, K. B., and J. D. W. Tomlinson. The Fabric of the Body: European Medical Traditions of Anatomical Illustration. Oxford: Clarendon, 1992.

Sappol, Michael. Dream Anatomy. NIH publication.

Smith, Sean. “From Ars to Scientia: The Revolution of Anatomical Illustration.” Clinical Anatomy (19) 2006.

Tsafrir, Jenni, and Avi Ohry. “Medical Illustrations: From Caves to Cyberspace.” Health and Information Libraries Journal (18:2) 2001.

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The Trial of Jacqueline Felicie: A Female Physician

Written in Crime, Medicine, Health and Society (Vanderbilt), MHS

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by Jade Morales

The trial of Jacqueline Felicie, though not considered a monument in the history of medicine, is historically significant enough that many textbooks include an in-depth analysis of her 1322 Parisian trial. Jacqueline Felicie, referred to as Jacoba Felicie in the Charlutarium Universitarias Parisiensis, was accused by the Medical Faculty of Paris of practicing as a physician without a license. Felicie’s trial is intriguing because it provides an insider view into the Parisian medical marketplace, into how women’s roles were perceived within that marketplace, and into the university’s power to effect medical culture (Barrett 10).

The trial itself was documented in the Charter of the University of Paris, and it includes arguments for and against Felicie. Felicie’s accusers claim that she visited several patients, examined them, and claimed to cure them, despite being warned against practicing without a license. Along with the Medical Faculty, the Archbishop also expressed concerns that practicing without a license could result in the mortal sin of murder, which was punishable by excommunication. For this reason, her accusers claimed that preventing her from practicing was in the interest of her soul. Felicie’s defense brought forth 6 witnesses that all attested to her experience and skill in curing them, even after many received unsuccessful treatment from well-known licensed physicians. So the natural question is: what were the motivations of the Medical Faculty of the University of Paris? Was the health of Parisians their main concern, or was this trail an attempt to slowly reduce the competition to university-trained physicians? (Green 15).

Non-university trained traditional healers, like Felicie, were the predominant practitioners of early 14th century Paris. Many women who were skilled through apprenticeship or practice acted as healers for lay people. Because women weren’t admitted to the University, they were unable to obtain the licenses that the Medical Faculty mandated. Thus, academically trained physicians were all male, and women were at a disadvantage when the university began to regulate medical practice. Parisian medicine requiring university-training and licenses occurred at the expense of female traditional healers (Minkowski 4-5).

Felicie, though considered very wise and skilled by her patients, was found guilty. Her sentencing included excommunication and a fine of 60 Parisian pounds. It is not known with certainty whether Felicie continued to practice in secret or whether she moved away. What historians do know is that traditional healers continued to cure when academically-trained physicians could not. The population of Paris was bigger than the licensed physicians could accommodate, so the likelihood of Felicie staying in business was high. Her trial is not only an example of the attempt to regulate the Parisian medical marketplace; it also allows us to question the motivations of academic institutions.

Image: “Medicin examinant les dents d’un patient.” Manuscrits occidentaux (1350). (Bibliotheque Paris)

Sources:

Barrett-Graves, Debra, Jo E. Carney, and Gwynne Kennedy. Extraordinary Women of the Medieval and Renaissance World. Greenwood Press, 2000.

Green, Monica H. “Women’s Medical Practice and Health Care in Medieval Europe.” Journal of Women in Culture and Society (14) 1988-89.

Minkowski, William. “Physicians’ Motives in Banning Medieval Traditional Healers.” Journal of Women and Health (1:2) April 1994.

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Realism in Dissection

Written in Medicine, Health and Society (Vanderbilt), MHS

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by Mary Coleman (Vanderbilt University)

During the scientific revolution and particularly the 17th century, anatomical dissections and representations took on a new element of “realism.” Dutch anatomist Govard Bidloo’s 1689 anatomical manual, Anatomia Humani Corporis, and the controversy surrounding its illustrations highlight the manner in which such realism was a product of the times.

The manual’s hauntingly precise illustrations, drawn by Dutch artist Gerard de Lairesse, were central to the success of the work and proved so in later allegations of plagiarism. When William Cowper published an anatomical manual in 1698 using the same plates drawn by de Lairesse, he gave no credit to the artist or the anatomist. Although Cowper wrote an entirely original English text to accompany the plates, his status as a plagiarist remains. Author and historian William Cobb considers the importance of illustrations in 17th century medical publishing: “Precise anatomical descriptions were a key part of the scientific revolution’s attempt to provide a material account of the universe” (163).

Why were such illustrations so imperative to the livelihood of 17th century anatomists? The invention and development of the microscope in the Netherlands during the early 17th century brought medical and public attention to the uncharted realm of minute structures. With the enhanced observational power of the microscope, realism and even hyperrealism became vital to the success of anatomical illustration. During the Dutch Golden Age of the 17th century, the Netherlands really was the center of scientific and artistic innovation, producing such celebrated artists as realist painter Jan Vermeer and Rembrandt, certainly a master draftsman. During this “golden” era, distinguished artists and scientists mingled in the universities and public spheres.

Medical education during the century increasingly included observation of dissection in “anatomical theatres.” Professors performed dissections while dictating anatomical lessons to students, and public dissections were put on display for a fee. As interested parties became well versed in the drama of dissection and anatomical macro-structure, anatomists were pressed to deliver cutting-edge observations with precision.

Govard Bidloo’s text and the controversy surrounding its publication demonstrate the beginnings of an emphasis on exacting observation that continues today in medical experimentation.

Image: Gerard de Lairesse, “Structure of Head” (1685).

Bidloo, Govard. Anatomia Humani Corporis, 1685.

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Gerard van Swieten

Written in Medicine, Health and Society (Vanderbilt), MHS

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by Julie Ann Fenstermaker

In 1740, when Maria Theresa inherited the Habsburg Empire, Austria was about 200 years behind its European neighbors in the medical realm. Maria Theresa acted fast and recruited knowledgeable people to her court. Gerard van Swieten was one of the most important people she brought to Vienna, Austria.

Van Swieten was educated at the Leiden University; he studied under Herman Boerhaave and became a well-respected physician. He actually compiled his notes from Boerhaave’s lectures into a 15 volume set. In Austria, van Swieten was appointed as the Chief Physician, which meant he not only cared for the royal family, but he also managed the entire medical staff as well. He was also named the Director of the Imperial Library. As President of the Censorship Committee, van Swieten had access to all the new books being published. He documented the list of books that the committee read in Supplementum Librorum Prohibitorum. This record of 3,120 works, 595 of which were banned, provides insight to historians on the social and political sentiments of the time.

Van Swieten’s legacy is in his reform movement. In 1749, he proposed a plan to completely reorganize the faculty of medicine. Maria Theresa agreed to this plan and provided funding to establish the Vienna School of Medicine. Van Swieten added professorships of botany, chemistry, and surgery to the university and personally taught a two year lecture series on the functioning of the human body and the pathology of diseases. He also reformed pharmacy inspections to make the apothecaries more accountable.

In his book Diseases Incident to Armies, van Swieten describes a cure for syphilis. The concoction of mercury sublimate was called Liquor Swietenii. It was not invented by van Swieten, but he was the one who administered it on a large scale; therefore it was credited to him for over 100 years.

Van Swieten’s efforts of reform made a powerful impact in Austria. The Vienna School of Medicine became a highly respected institution of learning, and he was able to recruit impressive physicians and scientists to Vienna. Van Swieten was commemorated on the Euro in 2007 and can also be found on the Maria Theresa statue near the Hofburg in Vienna.

Image: Gerard van Swieten

Sources:

Brechka, Frank T. Gerard van Swieten and his World, 1700-1772. The Hague: M. Nijhoff, 1970.

Kidd, Mark, and Irvin M. Modlin. “Van Swieten and the Renaissance of the Vienna Medical School.” World Journal of Surgery (25:4) 2001: 444-50.

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Men and Women in Midwifery

Written in Medicine, Health and Society (Vanderbilt), MHS, Sex and Childbirth

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by Allison Nelson (Vanderbilt University)

In the early modern period, midwifery began to change from a female art into a male occupation. The shift was not a smooth one. Indeed, it began in 1522, when Dr. Wertt of Hamburg dressed up as a woman in order to observe midwives and learn about childbirth. When he was discovered as a man, Wertt was burned alive. Later in the mid-sixteenth century, however, the renowned surgeon Pare laid a more solid foundation for men’s work in the birthing room; he did this by aiding in delivery by pulling babies out of the womb by their feet during difficult births.

A contributing factor in this shift of gender roles was Louis XIV’s use of male midwives to deliver his illegitimate children. As men delivered his mistresses babies, male midwives gained popularity. A rapid population boom in Europe further encouraged these social changes; as the population grew and universities increased their study of reproduction and anatomy, childbirth became a medicalized and, thus, masculinized domain. Case studies, rather than oral tradition, became the preferred method for educating individuals about childbirth (1).

There existed three recognized distinctions between male and female midwives. First, the men held a monopoly over medical tools, which women were disallowed from owning. Second, the male midwives were more formally educated in universities; there they dissected bodies, read case-studies, and learned about classical theories. Women, on the other hand, were taught through experience; they apprenticed and learned through women’s household manuals. Third, male and female midwives viewed patients differently. While women’s manuals emphasize individual relationships and take a maternal tone, men’s manuals stressed quantitative practices and medical causality (2).

Even as male midwives gained popularity, their acceptance was not unanimous. Some people believed that men did not belong in the birthing room; since men could never experience childbirth, some believed it was beyond the realm of male expertise. Such critics often cited the Bible, claiming the absence of men at recorded births. Other critics viewed male midwives as interlopers into other men’s domestic territory. In a space where the husband or father was absent, the male midwife’s presence stood out as inappropriate; it raised questions about the male midwives’ potentially inappropriate behavior toward vulnerable female bodies. Thus issues of female modesty and male property emerged, and opponents called upon husbands to bar male midwives from their homes (3).

While gender issues caused debate, so too did suspicion about scientific instruments and their over-use in the birthing room. Frequently, male midwives used tools even in “normal” births that might not necessitate them — and the tools posed additional risks. Not only did the tools threaten additional infections, but their misuse could harm the baby or its mother. Renowned female midwife Sarah Stone, for example, claimed that in her career she had only seen four cases that could have been safer through the use of tools (4).

Image: Fores, Samuel William. “A Man-Mid-Wife.” From Man-Midwifery Dissected. London, 1793. (Wellcome Library, London)

(1) Schnorrenberg. “Is Childbirth Any Place for a Woman? The Decline of Midwifery in Eighteenth-Century England.” Studies in Eighteenth Century Culture (10) 1981: 393.

(2)Fife, Ernelle. “Gender and Professionalism in Eighteenth-Century Culture.” Women’s Writing (11:2) 2004: 185-200.

(3)Blunt, John. “Man-Midwifery Dissected: or, The Obstetric Family Instructor.” 1793.

(4) Stone, Sarah. “A Complete Practice of Midwifery.” 1737.

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Syphilis in Early Modern Europe

Written in Medicine, Health and Society (Vanderbilt), MHS, Sex and Childbirth

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by Jamie Whittenberg

Syphilis, a highly infectious sexually transmitted disease, sparked fear among the early Europeans. And for good reason.

Syphilis has three stages, the last being deadly and untreatable if advanced enough. First recognized as an outbreak in 1494 in Naples among the French mercenary troops, it quickly spread to all parts of Europe. Faced with such a contagious and disfiguring disease, the early Europeans quickly blamed one another or attributed it to external forces such as interspecies sex, the planets, or witchcraft (1).

Often, the men were most often depicted as victims of syphilis. The course of the disease: a woman, the carrier of death. The case of Bellina Loredana exemplifies this attitude. She was accused of inflicting the disease on a prostitute through witchcraft, until she was (partly) exonerated due to the prostitute’s obviously promiscuous behavior. Still, the idea that women spread the disease by seducing men was prevalent (2).

As the disease spread, early modern Europeans began to turn to more naturalistic causes for syphilis. This evolved into two theories: Pre-Columbian and Post-Columbian. The former operated on the belief that syphilis was always present in Europe, possibly misdiagnosed as leprosy. Although the surge may have been noticed after contact with the New World, this theory states that it is just a coincidence. The Post-Columbian theory suggests that syphilis was a disease brought over from the Indians and that no European country was to blame, no matter how much they bickered among each other (1).

No consensus was reached on who was correct in this matter. Many seemed to offer contradictory views on the subject, such as John Smith. He at once called syphilis the “French pockes” as well as the “Indian disease” within one sentence. Both theories are present in his statement. Even looking retrospectively, bio-archaeologists have found it impossible to determine which theory is correct. They studied for syphilitic lesions on the bones in pre-contact Europe and America (1). Although they did find evidence of syphilis in early America, it does not have the characteristic dental pathology that is typical with syphilis. Therefore, it is still undetermined to this day whether syphilis came over from the New World, or if syphilis exploded into a potent form during the siege in Naples in 1494 (1).

Image: Gilman, Sander L. “AIDS and Syphilis: The Iconography of Disease.” October (1987): (43) 87-107.

(1) Qualitiere, Louis F. & William Slights. “Contagion and Blame in Early Modern England: The Case of the French Pox.” Literature and Medicine (2003): (22) 1, 1-24.

(2) McGough, Laura J. “Demons, Nature, or God? Witchcraft Accusations and the French Disease in Early Modern Venice.” Bulletin of the History of Medicine (2006): (80) 2, 219-246.

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