Why remove the illustrations from a nineteenth century midwifery manual? Rebecca Whiteley, Shreeve Fellow in the History of Medicine at the John Rylands Research Institute, University of Manchester, explores a material history of absence.

This article is part of a two-week takeover (1-14 June) of The Polyphony by Thinking Through Things, an ECR-led collaborative project designed to stimulate interdisciplinary dialogue around the holdings of Wellcome Collection. Thinking Through Things is supported by the Northern Network for Medical Humanities Research and is funded by a Wellcome Trust Discretionary Award. Following a training day co-hosted by Thinking Through Things and Wellcome Collection in February 2020, delegates were invited to write a short text exploring one or more objects held by Wellcome Collection. 

When working with archival and library sources, historians negotiate presences and absences: what the source tells you, and what it doesn’t. In most cases, establishing the absences, what the source isn’t saying, is work to be consciously undertaken. But in some cases, the absences are blindingly, enjoyably obvious. One such absence that I came across recently in the Wellcome Library is a copy of Reid’s 1836 Manual of Practical Midwifery.

This book contains brief accounts of the various difficulties that might be encountered during childbirth, accompanied by wood-engraved illustrations. The Wellcome copy has undergone some unusual interventions. Not only have the title page and frontispiece lithograph been removed, but some of the illustrations were at some point neatly pasted over with squares of white paper. These were later removed, in some instances so as to leave almost no trace, and in others leaving large parts of the paper behind, or tearing away much of the print beneath. This was likely done some time in the nineteenth century, and certainly before the book was acquired by the Wellcome Library in 1936.

But why? Why intentionally erase the visual material from a pocket midwifery guide? There’s no knowing for sure, but I have a few ideas.

Firstly, it is possible that they were covered because the craftmanship simply wasn’t very good. One reviewer of the work, for instance, called them ‘miserably executed, and often inaccurate’.[1] Some conscientious user may, therefore, have been at pains to protect others from these potentially misleading images. Secondly, it is possible that the images were judged too risqué, showing as they did both female reproductive anatomy and the practitioner’s hand touching the patient’s body. Indeed, in this period there was widespread anxiety about cheap and accessible medical books serving unlearned readers as sex manuals or soft pornography (Fissell 2015; Haynes 2003). A user may, therefore, have covered the images in an attempt to make the book safe from such misuse.

Finally, and this is my top theory, the covering of the images and removal of the frontmatter may have been part of an act of conscious anonymisation. This work was produced to fill a particular gap in the market: the want among students and junior practitioners of a book that ‘while it should include all the information that might be necessary in the moment of doubt and difficulty, could still, from its size, be portable, and easily referred to, at the precise time when assistance is so anxiously required, and delay might be so perilous.’ (Reid 1836, iii-iv). This is a book that could be hidden in a pocket, and discreetly referred to while the practitioner was attending a labour.

However, reviewers of the work, regardless of what they thought of the content, universally deplored this use of the book. The Lancet (1836) declared that ‘the practitioner who required to be thus fortified in the lying-in chamber, should have a better memory, to save him from the danger and discredit of an appeal to its pages in that place.’[2] According to the reviewers, referring to a book while attending a case was bad for the practitioner’s reputation, it reduced their authority and sowed doubt as to their skills. It also, one reviewer claimed, could give false confidence to a junior practitioner who ‘may be tempted to rely upon himself and his horn-book’ rather than calling for a second opinion.[3]

Imagine, therefore, a junior practitioner, who has attended a course of lectures on midwifery, and perhaps a couple of cases with his teacher, and now sets himself up as an ‘accoucheur’. Such was often the way with struggling medical men in the early nineteenth century. Midwifery cases, while generally looked down upon by the medical establishment, were plentiful, and often gave junior practitioners much needed income as well as an introduction to families who might then call them to treat other ailments (Digby 1994, 254–57). This young practitioner feels the need of his pocket guide against any unforeseen emergency, but is reluctant to be caught relying on such a text. By removing the title page and obliterating the illustrations, he gives himself a better chance at surreptitiously consulting it, perhaps in the lying-in chamber but more likely in another room of the house, without being found out by someone passing by. The interventions in this copy of Reid’s manual are an act of anonymisation, an erasure not of the informational content, but of the identity of the work.

The male practitioner’s behaviour in the lying-in chamber in this period was already one of negotiated presence and absence. Vocal critics condemned male attendance on labouring women, calling it indecent, and suggesting it opened the way to the seduction and abuse of women.[4] Regardless, male medical practice in midwifery expanded, in domestic spaces among the middle and upper classes, and in hospitals for the poor. But practitioners recognised the potential problems of their presence. Reid, for instance, advised his young readers not to enter the lying-in room suddenly, in case the shock of their presence stopped the labour pains. They were to be conciliatory with their patients, waiting until fear overtook modesty and women agreed readily to proposed examinations or interventions. And when all was going well, during the first stage of labour and recovery, the practitioner was to mostly wait in another room.[5] Thus, even doctors who argued strenuously for the needfulness of medical attendance and intervention knew that their very presence could also retard labour, unsettle or frighten women, and slow recovery. They were present, but as little as possible.

The copy of Reid’s manual at Wellcome expresses medicine’s new presence in midwifery, but also its anxiety over and mitigations of that presence. In this copy, we find a set of material traces for a kind of book-use that normally leaves no traces at all: discretion, secrecy, and a minimising of medical presence and medical knowledge in the lying-in chamber.

This book, I think, led a life of curated absence when it was used as a midwifery manual, and in another way, it still does so today as a historic resource. During the Thinking Through Things workshop at Wellcome Collection in February, I had some excellent conversations with other delegates about how we negotiate presence, absence and access in libraries and archives. Almost all special collections cannot be browsed, but must instead be called up using catalogues which are themselves full of absences. Catalogue metadata is a highly selective language, shaped by the needs of institutions and particular kinds of scholarship. The problem for me, as a scholar who works mainly with book illustrations, is that my material has almost no presence in the catalogue. Catalogues are not always accurate about whether illustrations are present, and almost never give detailed descriptions of subject matter, medium or artist. Equally rare are descriptions of interventions: in the catalogue entry for Wellcome copy of Reid’s manual, it is noted that the title page is missing, but not the frontispiece image, and nothing is said about the paper covers on the illustrations. The intervention can only to be discovered when the work is actually consulted. I called up this work as part of a project I often undertake, to browse widely and with hopefulness for unusual illustrations and interesting interventions, and here I was fortuitous. Having led a life of secrecy as a discreet pocket manual, Reid’s manual keeps its secrets in the archive, offering the material history of absence only to those looking for the unseen.

The Wellcome copy of Reid’s manual has been digitised and can be consulted in full here, but in another instance of absence, the digitisation does not always show clearly where paper has been removed from the illustrations.

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Dr Rebecca Whiteley is the Shreeve Fellow in the History of Medicine at the John Rylands Research Institute, University of Manchester. Her research works in the intersections between visual culture, history of medicine, social history and material culture. She is currently working on aspects of midwifery and women’s medicine in nineteenth-century Britain. Twitter: @BeccaKWhiteley

References:

Anon. 1835. ‘The Obstetrician’s Vademecum [and] Manual of Practical Midwifery’, The London Medical and Surgical Journal 8, no. 202 (1835): 624.

Anon. 1836. ‘Art. VII. – Manual of Practical Midwifery’, The British and Foreign Medical Review, April 1836; 513.

Anon. 1836. ‘Manual of Practical Midwifery’, The Lancet 2, 2 July 1836; 480.

Digby, Anne. 1994. Making a Medical Living: Doctors and Patients in the English Market for Medicine, 1720-1911. Cambridge: Cambridge University Press.

Fissell, Mary E. 2015. ‘When the Birds and the Bees Were Not Enough: Aristotle’s Masterpiece’, Public Domain Review, http://publicdomainreview.org/2015/08/19/when-the-birds-and-the-bees-were-not-enough-aristotles-masterpiece/

Haynes, April. 2003. ‘The Trials of Frederick Hollick: Obscenity, Sex Education, and Medical Democracy in the Antebellum United States’, Journal of the History of Sexuality 12, no. 4: 543–74.

Reid, James. 1836. Manual of Practical Midwifery: Containing a Description of Natural and Difficult Labours, with Their Management. Intended Chiefly as a Book of Reference for Students and Junior Practitioners. London: John Churchill.

Notes:

[1] Anon., ‘The Obstetrician’s Vademecum [and] Manual of Practical Midwifery’, The London Medical and Surgical Journal 8, no. 202 (1835): 624.

[2] Anon., ‘Manual of Practical Midwifery’, The Lancet 2 (2 July 1836): 480.

[3] Anon., ‘Art. VII. – Manual of Practical Midwifery’, The British and Foreign Medical Review, April 1836, 513.

[4] [John Stevens], An Important Address to Wives & Mothers, on the Dangers and Immorality of Man-Midwifery (London: The Author, 1830); Anon., An Address to the Public on the Propriety of Midwives, Instead of Surgeons, Practising Midwifery, 2nd ed. (Manchester: The Author, 1826).

[5] See, for example, Reid, Manual of Practical Midwifery, 25–26, 33, 36, 155.