APPENDIX.

MIDWIFERY AS A CAREER FOR EDUCATED WOMEN.

My dear Sisters (or rather, Chers et très-honorés Confrères),

While all that we women think about is to have the same education as men in medicine, must we not feel the women’s medical movement to be rather barren when it might be so fruitful?

But public opinion in England is not free enough for a coward to dare to say what she thinks, unless at the risk of having her head (figuratively) broken.

Is there not a much better thing for women than to be ‘medical men,’ and that is to be medical women?

Has not the cart been put before the horse in this women’s medical movement?

Here is a branch so entirely their own, that we may safely say that no lying-in would be attended but by a woman if a woman were as skilful as a man—a physician accoucheur.

Yet, instead of the ladies turning all their attention to this, and organising a midwifery school of the highest efficiency in both science and practice, they enter men’s classes, and lectures, and examinations, which don’t wish to have them, and say they want the same education as men.

Then, is there not an immense confusion as to whether they are ever to be called in as medical attendants to men?

‘No,’ say those lady doctors who have at all thought out the question. ‘We wish to be educated as if we were going to attend men, but we should think it an insult to be called in to attend men.’

Why not adjourn for a century, or for half a century, the question whether all branches of medical and surgical practice shall be exercised by women, even upon women? It is a question which may safely be left to settle itself.

But here is a matter so pressing, so universal, so universally recognised, viz., the preferable attendance of women upon women in midwifery, that it may really be summed up thus:—Although every woman would prefer a woman to attend upon her in her lying-in, and in diseases peculiar to her and her children, yet the woman does not exist, or hardly exists, to do it. Midwives are so ignorant that it is almost a term of contempt.

The rich woman cannot find fully qualified women, but only men to attend her, and the poor woman only takes unqualified women because she cannot afford to pay well qualified men.

But why should the midwives be ignorant? and why (in the great movement that there is now to make women into medical men) should not this branch, midwifery, which they will find no one to contest against them—not at least in the estimation of the patients—be the first ambition of cultivated women? Is there any rational doubt that, suppose there were a man and a woman, both equally versed in midwifery art and science, the woman would be the one sent for by all lying-in women?

There is a better thing than making women into medical men, and that is making them into medical women.

Surely it is the first object to enable women, by the most thorough training, practical and scientific, to practise that branch of the art of medicine which all are agreed should be theirs, not ‘like men’—for nearly all the best men are agreed how deficient are the practical training and opportunities of medical students, especially in midwifery, which deficiency yet does not prevent them from obtaining diploma, license, all they want, in order to practise—not ‘like men’ then, but like women, like women who wish to be real physician accoucheuses; that is, to attend and to be consulted in all deliveries, abnormal as well as normal, in diseases of women and children, as the best accoucheurs attend and are consulted.

Sensible women say, ‘But the only means to obtain a scientific education is to enter men’s classes.’

Is that the case?

Is the student’s scientific and practical education all that could be wished?

Could there not be given (and is there not given, in some Continental schools?) a far more thorough and complete scientific education, as well as practical, where there are none but women, in a midwifery school, without all this struggle and contest, which raises questions so disagreeable and ridiculous that a woman of delicate feeling shuns the indelicacy of the contest—not the indelicacy of the occupation?

The parody, the qui pro quo, is a curious one.

The indelicacy of a man attending a woman in her lying-in is by necessity overlooked.

The indelicacy of a woman attending with men in medical classes is made much of.

Would it not be far better to get rid of both at once? to have women—trained with women, by women—to attend women—trained in all branches of a scientific and practical midwifery education?

But let no one think that real midwifery education can be less complete and thorough for a woman than it ought to be for a man, if women are really to be physician accoucheuses.

And let no one think that two or three courses of lectures—a month, three months, six months at a lying-in institution, conducting twenty, thirty, or one hundred labours—will make a woman into a (real) midwife.

One hundred labours may be normal, requiring no interference but that which a good midwifery nurse can give. The one hundred and first may be abnormal and may cost the patient her life or health, the attendant her reputation and peace, if her education has been nothing but the few lectures, the few weeks, the few labours.

Let us suppose for a moment that, leaving aside the ordinary talk of giving a woman a ‘man’s medical education,’ good or bad, we imagine what a college might be to give the whole necessary training—medical, scientific and practical—to make real midwives, real physician accoucheuses.

There must be first, of course, the lying-in institution, the deliveries conducted by fully qualified head midwives, of whom enough perhaps exist already for this purpose, who will give practical instruction to the pupil midwives at the bedside.

There must be a staff of professors, to give scientific instruction in midwifery, but also in anatomy, physiology, and the like; in pathology and pathological branches; above all, in sanitary science and practice.

Dissections and post-mortem examinations will have to be practised. It need not be said that these must be at a quite different time and place in the ‘course of education’ from the training about the lying-in patients.

Probably all these professors, or nearly all, must at first be men.

Probably in time all these professors, or nearly all, will come to be women.

The course of education, before the end of which no pupil can receive the certificate of a fully qualified midwife, must certainly not be less than two years.

Is this merely an ideal? Is it an Utopia? Have we never seen it in practice? Could it not be put in practice in practical England?

Seen it in practice we have—save and except the sanitary practice, which is wofully deficient—on the continent of Europe.

And lady professors there have been in midwifery on the Continent quite equal to the most distinguished physician accoucheurs in this or in any other country; who took their place among these, among the Sir James Simpsons and the Sir Charles Lococks, as of them, and not outside of them, in all midwifery matters, scientific as well as practical.

The names of Madame Boivin and Madame Lachapelle, of Paris, are known to all Europe. And there are many other names of lady professors in midwifery and of midwives, not known in England at all, who take their uncontested places on the continent in practice, in consultation, in teaching, as a Sir James Simpson here. They teach in midwives’ colleges, and imperial and royal ladies are sometimes, and often wish to be always, attended by them.

Note.—A society has already existed for several years, the object of which, according to its programme, is ‘to provide educated women with proper facilities for learning the theory and practice of midwifery, and the accessory branches of medical science.’

The programme states most justly that, for want of these, for want of ‘proper means of study,’ of ‘any public examination,’ ‘any person may undertake the duties of a midwife.’

Let us look what the ‘proper means of study’ are which it provides.

They are—1. Attendance upon lectures during two winter sessions. 2. Attendance ‘during the intervening summer’ upon clinical practice at ‘a’ lying-in hospital or maternity charity, with personal attendance upon at least twenty-five deliveries!

[It is easy to make a rough calculation how many cases of abnormal parturition occur to how many normal. Is it likely that among ‘twenty-five deliveries’ there will be abnormal cases enough to practise the pupil-judgment, the pupil-hand?]

These ladies have not even the advantages which the idlest student can hardly help availing himself of—and his minimum is ‘three years.’ Yet this is the course proposed to enable a woman to ‘practise midwifery,’ even in the sense in which we understand a man to ‘practise midwifery,’—to enable a woman to become a physician accoucheuse (for these ladies are expressly styled ‘accoucheuses’) in the sense in which we understand a man to be a physician accoucheur.

The paper states, doubtless with truth, that these ladies ‘are the best taught accoucheuses hitherto accessible to the English public.’ May we not hope that, in future years, the society will be enabled to give ‘accoucheuses’ still better taught ‘to the English public’?

LONDON: PRINTED BY

SPOTTISWOODE AND CO., NEW-STREET SQUARE

AND PARLIAMENT STREET

[1]. Exclusive of the case of a poor woman who was delivered in a cab, and died in the hospital of post partum hæmorrhage.

[2]. ‘So was confined in No. 4 ward.’

[3]. Patient died 48 hours after delivery.

[4]. Patient died on her way to the hospital: not included in the calculated rates.

[5]. One case had gastric fever on admission, and in two cases puerperal peritonitis came on after instrumental delivery.

[6]. In 1868, 69, 70, there were in Liverpool workhouse, 1,416 deliveries, including 20 premature, and 6 deaths from all causes, of which 3 at least were non-puerperal. The total death-rate was only 4·2 per 1,000. There were 13 London workhouses in which, in 5 years, 2,459 deliveries, but no deaths in childbed, took place.

[7]. Exclusive of a fatal case delivered in a cab.

[8]. One delivery took place in a cab, and the woman died in hospital.

[9]. Husson, ‘Étude sur les Hôpitaux,’ p. 254.

[10]. Tables XI., XII., XIII., abstracted from the ‘Statistique médicale des Hôpitaux de Paris.’

[11]. This drain was shown on the Plan from which Plate I. is taken.

[12]. Premature births: Seven months, 8; deaths, 5; six months, 6; deaths, 6; five months, 1; death, 1.

[13]. 1 puerperal convulsions, 1 bowel disease.

[14]. 1 after instrumental labour, 1 metritis.

[15]. 1 heart disease, 1 dropsy.

[16]. The approximate number of deliveries, 6396, given elsewhere, is rather under the mark than over, as will be seen by this Table, and is taken in order to be on the safe side. For, up to the three last years, the numbers are rather estimated than reckoned from the records. The total annual average deliveries calculated from different monthly records, i. e. 10 years of months = 500 in round numbers—1858–1867.

The three years 1868–9–70, for which only there are accurate records, speak for themselves; and they show that the death-rate is marvellously low: not higher than in the healthy districts of England.

[17]. An attempt has been made in certain cases to account for the high death-rates of lying-in hospitals from the large proportion of unmarried women admitted. This opinion is directly contradicted by the experience of Liverpool workhouse, where out of 1,401 deliveries of women, 936 of whom, or two-thirds, were unmarried, there were only 6 deaths = 4·2 per 1,000 death-rate.

[18]. In Lambeth and St. Pancras the wards are generally full.

[19]. These arrangements are commonly the same in civil lying-in institutions.

[20]. I call a midwife a woman who has received such a training, scientific and practical, as that she can undertake all cases of parturition, normal and abnormal, subject only to consultations, like any other accoucheur. Such a training could not be given in less than two years.

I call a midwifery nurse a woman who has received such a training as will enable her to undertake all normal cases of parturition, and to know when the case is of that abnormal character that she must call in an accoucheur.

No training of six months could enable a woman to be more than a midwifery nurse.

[21]. In some London workhouses it is yet larger.

[22]. The only difficulty is as to protecting the patient (a lying-in woman) during the transit in cold or wet weather; but perhaps some cover might be contrived for the bed or litter on which she is carried, which would be light, easily removable, and which could be exposed to the free action of the open air when not in use.

[23]. For a great part of the foregoing details of management I am indebted to the valuable experience of her, who, as then Superior of the nursing at King’s College Hospital, conducted our Training School for Midwifery Nurses there, so kindly, so wisely, and so well, that its necessary breaking up was the more to be deplored by all.

MEDICAL and SURGICAL WORKS.

NOTES on HOSPITALS. By Florence Nightingale. Third Edition, enlarged, and for the most part re-written. Post 4to. with 13 Plans, 18s.

The DIAGNOSIS and TREATMENT of DISEASES of WOMEN, including the DIAGNOSIS of PREGNANCY. By Graily Hewitt, M.D., Professor of Midwifery and Diseases of Women, University College, and Obstetric Physician to the Hospital, President of the Obstetrical Society of London. Second Edition, revised, and for the most part re-written; with 116 Illustrations engraved on Wood. 8vo. 24s.

The DUBLIN PRACTICE of MIDWIFERY. By Henry Maunsell, M.D., formerly Professor of Midwifery in the Royal College of Surgeons in Ireland. New Edition, enlarged and revised. Edited by T. M. Madden, M.R.I.A., &c., Senior Assistant-Physician to the Dublin Lying-in Hospital. Fcp. 8vo. 5s.

HINTS to MOTHERS for the MANAGEMENT of their HEALTH during PREGNANCY and in the LYING-IN ROOM: With Hints on Nursing, &c. By Thomas Bull, M.D. New Edition, revised and enlarged. Fcp. 5s.

The MATERNAL MANAGEMENT of CHILDREN in HEALTH and DISEASE. By the same Author. New Edition, revised and enlarged. Fcp. 5s.

On the SURGICAL TREATMENT of CHILDREN’S DISEASES. By T. Holmes, Surgeon and Lecturer on Surgery, St. George’s Hospital, and Surgeon-in-Chief to the Metropolitan Police. Second Edition, thoroughly revised; with Additional Chapters on Orthopædic Surgery and Paracentesis Thoracis. With 9 Chromolithographic Plates and 112 Woodcut Illustrations from Original Drawings. 8vo. 21s.

On some DISORDERS of the NERVOUS SYSTEM in CHILDHOOD. Being the Lumleian Lectures delivered before the Royal College of Physicians in March 1871. By Charles West, M.D. Crown 8vo. 5s.

LECTURES on the DISEASES of INFANCY and CHILDHOOD. By Charles West, M.D., Physician to the Hospital for Sick Children. Fifth Edition, revised and enlarged. 8vo. 16s.

HOW to NURSE SICK CHILDREN; Containing Directions which may be found of service to all who have the charge of the Young. By Charles West, M.D., &c., Physician to the Hospital for Sick Children. Third Edition. Fcp. 8vo. 1s. 6d.

A SYSTEM of SURGERY, THEORETICAL and PRACTICAL, in Treatises by Various Authors. Edited by T. Holmes, M.A. &c. Surgeon and Lecturer on Surgery at St. George’s Hospital, and Surgeon-in-Chief to the Metropolitan Police. Second Edition, thoroughly revised, with numerous Illustrations. 5 vols. 8vo. £5 5s.

LECTURES on the PRINCIPLES and PRACTICE of PHYSIC. By Sir Thomas Watson, Bart. M.D., Physician-in-Ordinary to the Queen. New Edition, thoroughly revised. 2 vols. 8vo. price 36s.

LECTURES on SURGICAL PATHOLOGY. By Sir James Paget, Bart, F.R.S. Third Edition, revised and re-edited by the Author and Professor W. Turner, M.B. 8vo. with 131 Woodcuts, 21s.

On CHRONIC BRONCHITIS, especially as connected with Gout, Emphysema, and Diseases of the Heart, By E. Headlam Greenhow, M.D. F.R.C.P. &c. 8vo. 7s. 6d.

The CLIMATE of the SOUTH of FRANCE as SUITED to INVALIDS; with Notices of Mediterranean and other Winter Stations. By C. T. Williams, M.A. M.D, Oxon. Physician to the Hospital for Consumption at Brompton. Second Edition. Crown 8vo. 6s.

CLINICAL LECTURES on DISEASES of the LIVER, JAUNDICE, and ABDOMINAL DROPSY. By C. Murchison, M.D. Physician and Lecturer on the Practice of Medicine, Middlesex Hospital. Post 8vo. with 25 Woodcuts, 10s. 6d.

ANATOMY, DESCRIPTIVE and SURGICAL. By Henry Gray, F.R.S. With about 410 Woodcuts from Dissections. Fifth Edition, by T. Holmes, M.A. Cantab. With a New Introduction by the Editor. Royal 8vo. 28s.

CLINICAL NOTES on DISEASES of the LARYNX, investigated and treated with the assistance of the Laryngoscope. By W. Marcet, M.D. F.R.S. Crown 8vo. with 5 Lithographs, 6s.

PHYSIOLOGICAL ANATOMY and PHYSIOLOGY of MAN. By the late R. B. Todd, M.D. F.R.S. and W. Bowman, F.R.S. of King’s College. With numerous Illustrations. Vol. II. 8vo. 25s.

Vol. I. New Edition by Dr. Lionel S. Beale, F.R.S. in course of publication, with numerous Illustrations. Parts I. and II. price 7s. 6d. each.

The HOUSE I LIVE IN; or, Popular Illustrations of the Structure and Functions of the Human Body. Edited by T. G. Girtin. New Edition, with 25 Woodcuts. 16mo. price 2s. 6d.

OUTLINES of PHYSIOLOGY, Human and Comparative. By John Marshall, F.R.C.S. Professor of Surgery in University College, London, and Surgeon to the University College Hospital. 2 vols. crown 8vo. with 122 Woodcuts, 32s.

COPLAND’S DICTIONARY of PRACTICAL MEDICINE, abridged from the larger work, and throughout brought down to the present state of Medical Science. 8vo. 36s.

A MANUAL of MATERIA MEDICA and THERAPEUTICS, abridged from Dr. Pereira’s Elements by F. J. Farre, M.D. assisted by R. Bentley, M.R.C.S. and by R. Warington, F.R.S. 1 vol. 8vo. with 90 Woodcuts, 21s.

THOMSON’S CONSPECTUS of the BRITISH PHARMACOPŒIA. Twenty-fifth Edition, corrected by E. Lloyd Birkett, M.D. 18mo. 6s.

London: LONGMANS and CO. Paternoster Row.

TRANSCRIBER’S NOTES