Mary Wollstonecraft, PPH and eighteenth century maternal care
With all the fuss about the Mary Wollstonecraft statue, it reminded me that one of the topics which was on my mind was the state of maternity care at the end of the eighteenth century. William and Catherine Nicholson seemed to do pretty well with at least 10 kids making it to adulthood. (One infant death is recorded, one of the twelve children still remains a mystery).
Caitlin Moran's response on Twitter to the statue in Newington Green was 'If you want to make a naked statue that represents "every woman", in tribute to Wollstonecraft, make it e.g. a naked statue of Wollstonecraft dying, at 38, in childbirth, as so many women did back then - ending her revolutionary work. THAT would make me think, and cry.'{10 November 2020}
So, I turned to Lisetta Lovett, a retired consultant psychiatrist and medical historian, and asked whether this standard of maternal care was normal for the time? Or was Mary Wollstonecraft just particularly unlucky in her medical advisers?
The information which I had compiled on the birth of Mary's baby with William Godwin was that:
Mary went into labour on Wednesday 30 August, choosing to hire a midwife but no nurse. Godwin described the role of the midwife 'in the instance of a natural labour, to sit by and wait for the operations of nature, which seldom in these affairs demand the operation of art.'
Little Mary was born at 11.20pm and, sometime after 2.00am, Godwin who was keeping out of the way in the parlour, was informed that the placenta had not been removed. A physician was called for and he removed the placenta 'in pieces'. The loss of blood was 'considerable' and Mary's health did not improve over the next few days, despite a second doctor visiting and pronouncing that Mary was 'doing extremely well'.
Godwin wrote that 'On Monday, Dr Fordyce forbad the child having the breast, and we therefore procured puppies to draw off the milk.'
Then on Wednesday, following a recommendation by family friend Dr Carlisle, 'it was now decided that the only chance of supporting her through what she had to suffer, was by supplying her rather freely with wine … I neither knew what was too much, nor what was too little. Having begun, I felt compelled under every disadvantage to go on. This lasted for three hours.'
Dr Fordyce was no beginner - see wikipedia - although we do not know if he was the attending doctor on the first two occasions. Dr Carlisle was a close family friend who went on to become the Surgeon Extraordinary to King George IV in 1820.
Lisetta, whose book Casanova's Guide to Medicine: 18th century Medical Practice is due to be published by Pen and Sword Ltd in April 2021, kindly provided the following insights into the medical profession and the little that we know about Mary Wollstonecraft's death:
The information given here, taken from William Godwin's diary as well as other sources, raises more questions than it answers. However, it looks like Mary suffered from a post-partum haemorrhage, the cause of which seems to have been a retained placenta.
The medical definition of a retained placenta is one that has not been expelled within 30 minutes of delivery. This is still a leading cause of maternal death worldwide, and treatment today is intervention with oxytocin either in the third stage of labour or after delivery and, if this fails, then manual removal under anaesthesia.
By the 19th century, obstetrics had become a medical specialty in its own right, much to the irritation of the midwives. Following the advent of man-midwives, medical doctors moved into the specialty. Neither Dr Fordyce or Dr Carlisle are recorded as having such expertise, but maybe this is not so surprising given that obstetrics as a medical specialty developed a little after their time.
There is a telling quote from a Dr Edgell in On Obstetric Practice, in 1816: "I believe it was an aphorism of the late Dr Clarke, that no woman should die of haemorrhage if an accoucheur is called early...".
Post-partum haemorrhage was a well recognised and potentially lethal complication of child-birth. Accoucheurs applied a variety of treatments to manage it and knew that a quick response could be life-saving. These treatments ranged from a hand in the uterus to stimulate contraction of the uterus and therefore expel the retained placenta (see Davis David in Principles and Practice of Obstetrics 1832-65) to the use of cold water on the stomach, or even injected in the rectum.
The obstetric literature of the early 19th century reveals that there was a lot of medical debate about what measures were most effective, including whether stimulants like brandy or wine should be administered. As the Covid pandemic illustrates, doctors are often in disagreement and so we should not be surprised.
Clearly, Mary would have been better off with an experienced accoucheur, medically trained or not, present throughout the birth ready to respond to any complications. The midwife at least knew that a retained placenta was bad news and informed Godwin who called for a physician. He tried to remove the placenta but probably did not do so completely; a difficult task without the benefit of an anaesthetic and a dreadful ordeal for Mary. For whatever reason, he did not continue to attend her which was a pity.
It is not clear if Mary continued to bleed or not but, given the second doctor's optimism, it sounds as if the bleeding appeared to have stopped.By the time Dr Fordyce is called, it is four days post-partum! He may have suggested the puppies in order to stimulate the uterus to contract and thereby encourage the expulsion of any remaining placenta as suckling induces the body to produce oxytocin. But why not allow the baby to suckle Mary?
Perhaps, she already had a wet nurse, and the doctor wanted to avoid disruption to the baby's feeding. That being said, the cult of breast-feeding your own baby had become popular in the 18th century especially in France where Rousseau's re-evaluation of maternity was influential. Mary had spent several turbulent years living in France and was no doubt aware of this.
Mary obviously was deteriorating, in part because she continued to lose blood (perhaps internally so it was not obvious) leading to severe anaemia. She may have also developed septicaemia although there is no mention of her having a fever. Ironically, one cause of this could have been manual placental removal. At this time there was little, if no notion, of the importance of keeping one's hands clean to prevent dissemination of germs.
When Carlisle finally sees her, I think he knows she is going to die and this is why he suggests wine as a 'tonic', not as a treatment but rather as an anaesthetic to make her last hours a little more bearable.
Godwin must have bitterly regretted his early laissez faire comment about childbirth. It is a great pity that he had not employed from the outset an experienced accoucheur, although even so Mary might have died. At this time, childbirth was one of the most dangerous challenges a woman might be obliged to address.
You can follow Lisetta Lovett on her blog Casanova's Medicine.
Today, according to the WHO, about 14 million women around the world suffer from postpartum haemorrhage every year. This severe bleeding after birth is the largest direct cause of maternal deaths. And of course, in addition to the suffering and loss of women's lives, when women die inchildbirth, their babies also face a much greater risk of dying early. Shockingly, 99% of the deaths from PPH occur in low- and middle-income countries, compared with only 1% in high-income countries.
Tags | Death | Friends | Science
Mary Wollstonecraft sculpture and the feminists' new clothes
I guess I feel that I have a very small right to claim a connection to Mary Wollstonecraft, as my 5 x great grandmother Catherine Nicholson was one of the two close friends (along with Eliza Fenwick) who stayed with and comforted Mary Wollstonecraft in her dying days.
Catherine wrote to William Godwin after his wife's death to say:
Myself and Mrs Fenwick were the only two female friends that were with Mrs Godwin during her last illness. Mrs Fenwick attended her from the beginning of her confinement with scarcely any interruption. I was with her for the four last days of her life …
She was all kindness and attention & cheerfully complied with everything that was recommended to her by her friends. In many instances she employed her mind with more sagacity upon the subject of her illness than any of the persons about her …
I noticed the fundraising appeal for the statue in 2019 – but it was not clear how much they were trying to raise; how much was still needed; and how it would be spent. There was no information about the finances on the website, only the vague statement "A capital sum for the memorial and a revenue source for the Society will ensure that Wollstonecraft's legacy and learning will continue." I was simply seeking to clarify the financial position, but my polite enquiry elicited a rather frosty response, suggesting that I should find another memorial to support.
I'm a fan of figurative sculptures and am lucky enough to live near to the National Memorial Arboretum. As you walk round, you cannot fail to be moved by the way that the sculptures make a historic figure lifeisize (or larger) making more real the boy who represents all those shot at dawn, thechild evacuees, or the ladies Women's Land Army and Timber Corps. I'd never heard of lumber jills before, but seeing the memorial prompted me to find out more.
So, OK I'll admit that I'm not very radical in my taste for sculptures, And Mary Wollstonecraft was a radical, so she needs a radical sculpture – right?
Mary Wollstonecraft was strong and adventurous, working as a journalist she headed off to Paris to cover the revolutionary troubles for the publisher Joseph Johnson. But, I'm afraid I cannot see strength and courage in this sculpture.
She was a thinker, an author, and an educator. How is this portrayed in the sculpture? And how is it meant to inspire young women toexpand their minds?
The Mary on the Green website states that "Her presence in a physical form will be an inspiration to local young people in Islington, Haringey and Hackney" … and The Wollstonecraft Society's objectives are "to promote the recognition of Mary Wollstonecraft's contribution to equality, diversity and human rights."
In Original Stories from Real Life: With Conversations, Calculated to Regulate the Affections, and Form the Mind to Truth and Goodness (1788), Wollstonecarft wrote of a woman who lost her good looks to the small pox and ".. as she improved her mind, she discovered that virtue, internal beauty,was valuable on its own account, and not like that of the person, which resembles a toy, that pleases the observer, but does not render the possessor happy."
I'm struggling to see how any child who sees this toy-like sculpture will come away with the message that cultivating the mind is more valuable than looks.
On the other hand, (having once accompanied a group of 11-year olds on a school trip to Paris) it is not hard to imagine the giggling and sexist comments that might emerge among some and the embarrassment that might be felt by others.
I don't envy the teacher who has to create a lesson plan around this educational trip!
Tags | 18thC Publishing | Arts | Friends
Lady Luck is smiling on us ... Outdoor walks and talks proceed under Tier 2 London Lockdown
London is now in Tier 2 lockdown, which means that households in areas under high alert (Tier 2) can only mix with others outdoors, in groups of six or fewer.
It seems that Lady Luck has smiled on St George's Garden's once again, and as our event is an 'outdoor talk' with plenty of space for social distancing, then it still has the green light to proceed.
Ticketholders must wear a mask, stay in their bubble, avoid mingling and keep their distance from the performers.
Click here for the latest update from the Bloomsbury Festival Director.
Tags | Bloomsbury Festival 2020
A long shot … will our Bloomsbury Festival live event survive the 'Covid-19 circuit-break'?
A short history of the ups and downs of organising a live event for the Bloomsbury Festival during the coronavirus
On 17 March 2020, just a few days before our world turned upside down due to the coronavirus, I received an email from Diana at the Friends of St George's Gardens (where Nicholson is buried):
"This is just a long shot. But how would you like to do a walk round St George's Gardens and talk about William Nicholson in late October, as part of the Bloomsbury Festival? We did this in 2018 for Zachary Macaulay with two actors in costume – Zachary and his wife. … "
A few days later on 23 March, the nationwide lockdown was announced by the government. The prospect of 12 weeks at home provided the perfect opportunity to write up a script, and with everything looking so bleak, this was something exciting to look forward to.
At that time, although all summer events were being cancelled, we all thought that life would be back to normal after a few months and October was far enough ahead to be safe. How incredibly naïve!
By the end of April, we'd all embraced the powers of Zoom and a meeting with the Bloomsbury Festival team, led by Rosemary Richards, explained that they were going ahead with various contingency plans, and we should plan an online version as a backup.
I was also interested to see that UCL were participating in the festival – for I knew they had a history of science faculty. As I had started writing the script and reached the scientific bits, I was wondering how we could get the discovery of electrolysis across in an interesting and engaging way – as this was distinctlynot my area of expertise.
Having seen that the festival team had been involved with the science festival GravityFest, I asked if they might have any useful contacts at UCL. Fortunately on they wrote to say "UCell are happy to help/collaborate with you in giving a talk at the Bloomsbury festival" and Alice, Harry and Keenan agreed to comealong and recreate the water-splitting experiment from May 1800 and then demonstrate how electrolysis plays a role in clean energy production with their hydrogen fuel cell.
In May Diana emailed to mention "another committee member, Ian Brown, who is a theatre director and will have good ideas about how to make the most of a story." Looking him up online to find he had run the highly regarded West Yorkshire Playhouse in Leeds for a decade, I didn't know whetherto be delighted or petrified. The sum total of my dramatic experiences to date comprised playing Mary in a nativity play at infant school and a mime on a student trip to Santander a few decades ago – neither role having had any script – what had I let myself in for?
Thankfully, Ian turned out to be delightful and thoroughly put me at ease. He suggested the performance should take the form of an interview with Nicholson's ghost (great idea!) and was also very pragmatic about the format of the online version when my multi-media ambitions ran away with themselves. Ian also took on the role of finding an actor, when it turned out that my friend was in a high-risk group and was shielding could be confined indefinitely (as it seemed at the time).
Details of the event had to be finalised for the programme by the end of May, and so it was agreed to perform live on the first Saturday 17th and the online event was scheduled for Tuesday 20th October. The title of the talk was agreed as "In conversation with Mr Nicholson" referring to the conversazione evenings which were hosted by Georgians.
The running order started with me interviewing the ghost of Nicholson about his life up to the point of the experiment in 1800 – then we would introduce the UCell team and Nicholson would take up the baton and ask them about their experiments and the future usefulness of his work. I was thrilled that we would be able to show how relevant his work had been to the future of clean energy, and in a way that would be much more visually interesting for an audience.
However, this was not without a few challenges of its own, as the UCell team had to get approval from the university for their participation and use of the fuel cell stack (a very valuable piece of kit, the size of a large supermarket trolley). And while we could record the interview on zoom at any time for use in the online version, the only chance to video the experiments would be on the 17th October (Covid-19 permitting).
We all pressed on in good faith, and I booked the last week of May off work to get the script finalised and over to Ian.
On 18 June, the festival team emailed to say "As you know, we are working with the current, and ever-changing, government advice regarding Covid-19 and social distancing, and of course the safety of our performers and festival goers is our absolute priority. With this in mind, we have come to the decision to cap the number of participants for your talk to 20 participants for the time being. As you can imagine, this is to protect the safety of the people attending, and yourself. If nearer the time restrictions are relaxed, we will release more tickets." Having scoped out the layout in the gardens the FoSGG team were later able to increase this to a maximum of 30.
At the beginning of July, Ian helped me to shape the script – adding more depth to the character of Nicholson and his family, explaining all the other characters, adding some gossip and eliminating non-sequiturs!
We still didn't have an actor for Mr Nicholson. Hugh Jackman was of course isolating in Australia, so I spent an evening looking through actor directory websites – mercilessly judging men solely on their appearances.
Meanwhile, lockdown had not ended, and we were all still working at home. It was necessary to decide on whether to charge participants an entry fee, and in the end it was decided that it was "a bit more than a talk, with a scientific demo and a speaker in costume" so fees were set at £8 for the live event and £5 for the online event. The Bloomsbury Festival typically do a 50/50 split with paid ticketed events, and they have a "box office intern" and volunteer present to deal with last minute onsite tickets and to take payments. Soon, the contract was signed and Diana was looking into whether we should or could use microphones.
On 21 July, Ian emailed to say he had found a potential Mr Nicholson "I got an email from a local actor this morning - he's a barrister as well as an actor. Going to meet him." A week later Julian Date had joined the team – a family barrister by day, I was amazed that he would have the head space to learn so many lines as well as running court cases up to the performance, but apparently these use different parts of the brain.
August and September saw us all rehearsing on Zoom and fine tuning the script. It was quite enchanting to see Jules bringing Mr Nicholson to life after the character had been rattling around in my brain for so long.
The UCell team could show us some of their science online – with a mini hydrogen-powered car – but we will not get the full picture until the big day. They normally participate in many live events, (and should have been in Florida for one of our rehearsals), but we were the only live event that was still on their calendar for this year.
Finding a costume for Julian turned out to be another challenge as all the theatres were closed, and consequently so were all the costumiers. Eventually a service in Bristol was identified which provides costumes to the BBC and could send it by post, so Julian had to provide his vital statistics.
September ended, and despite a variety of lockdown measures and a recent new restriction of group sizes to a maximum of six people, the event was still not cancelled. It was outdoors and thanks to Sue Heiser of FoSGG and her work on the risk assessment, it will be possible to keep everyone at an appropriate distance.
Tickets were selling and by October the live event quickly sold out its 30 tickets. But we still hadn't nailed down the details of the online event, and while we thought we would be able to record all the interview on Zoom and the experiments on video, we were not sure how this would all come together and then be broadcast. Fortunately, Rosemary Richards called in Hannah a digital producer and Mirabel who is also at UCL and doing science outreach. There was a debate about the comparative merits of YouTube and Zoom, but the latter has the added advantage of participation and so we can have a Q&A at the end.
This put us on track and reassured us that someone who knew what they were doing would be pressing all the Zoom buttons on the day. I'll be providing a live introduction before the interview and linking to the video, then managing the Q&A with someone from the UCL team who will handle the scientific questions.
On 7th October, we were still waiting to hear from UCell team whether they had approval from UCL to participate, and thankfully this came through and they can bring the hydrogen fuel cell stack. The costume has arrived in London, and everything is planned for next Saturday, the 17th October.
With coronavirus cases rising by the day again, and with les than a week to go, we are waiting with bated breath to hear whether there will be a "circuit-breaker" lockdown over half term or a local lockdown affecting London, and whether the live event will still go ahead.
It's a long shot, but we re keeping our fingers crossed that the show will go on
#32,
Tags | Bloomsbury Festival 2020 | Clean energy | Societies
17 and 20 October - In Conversation with William Nicholson and the UCL Ucell clean energy team at the 2020 Bloomsbury Festival
It is very exciting to announce that William Nicholson (1753-1815) will be making an appearance at the 2020 Bloomsbury Festival alongside the UCL hydrogen fuel cell demonstrator!
Saturday 17 October 2020,
2.30 – 3.30 pm – Live event in St George's Gardens, London, WC1N 6BN at thewest end.
Tickets £8 (£6 concs) – Clickhere for details.
2.30 – 3.30pm – Online event, via the Bloomsbury Festival at Home
Tickets £5 – Clickhere for details.
Tags | Bloomsbury Festival 2020 | Clean energy | Electrolysis | Science | Societies