Naissance Macabre: Birth, Death, and Female Anatomy

Brandy Schillace, PhD, the author of today’s guest post, is the research associate and guest curator for the Dittrick Museum of Medical History. She will speak at our October 18th festival, Art, Anatomy, and the Body: Vesalius 500.

The dance of death: Death emerges from the ground and is greeted by a group of allegorical women, symbolizing the vices. Woodcut after Alfred Rethel, 1848. Credit: Wellcome Library, London

The dance of death: Death emerges from the ground and is greeted by a group of allegorical women, symbolizing the vices. Woodcut after Alfred Rethel, 1848. Credit: Wellcome Library, London. Click to enlarge.

The danse macabre, or dance of death, features whirling skeletons and other personifications of death stalking the living. These images appeared regularly in the medieval period, particularly after outbreaks of bubonic plague. One of the salient features was death and life pictured together, frequently in the form of a young and beautiful woman. The juxtaposition symbolized how fleeting life could be, and served as a warning against vice and vanity. While death and the maiden might remind viewers of their own mortality, another set of images became far more instructive to the preservation of life: death and the mother—the anatomy of the pregnant womb.

From Jacob Reuff’s The Expert Midwife. Image courtesy of the Dittrick Museum.

From Jacob Reuff’s The Expert Midwife. Image courtesy of the Dittrick Museum.

The 1500s saw the proliferation of full-figure anatomy. Jacob Reuff’s The Expert Midwife (and other texts like it) displayed women with their torsos peeled back, daintily displaying their inner organs. Plenty of scholarship has focused on the near-wanton and sexualized poses of these and of the “wax Venus” figures, some of whom appear to be in raptures despite being disemboweled. Male figures also appeared in full and sometimes opened—many of Vesalius’ plates in On the Fabric of the Human Body provide these interior views. The male gaze is often directed at the viewer or at the anatomy, while female figures tend to look askance (perhaps with modesty or shame at the revelation of their innards). By the 18th century, however, the whole had been replaced by sectioned and partial anatomies. No longer were the figures walking, dancing, or—in the case of women—curtseying. Instead, only the relevant bits appear in the pages of the atlas, which meant (in pregnant women) only the womb.

Easily the most famous works on pregnant anatomy in the 18th century, William Smellie’s A Sett of Anatomical Tables and William Hunter’s Gravid Uterus provide a portal for viewing key developments in the practice of 18th-century midwifery. In Tables, Smellie set out to demonstrate technique, but, as historian Lucy Inglis explained in a recent talk at the Dittrick Museum, Hunter was more interested in ensuring his fame by making scientific discoveries on the causes of maternal death in childbirth. In fact, the title Gravid Uterus suggests just how primary the womb had become; the women to whom they belonged are depicted headless, limbless, with bloodied cross-sections of stumped legs.

From Hunter’s Gravid Uterus. Image courtesy of the Dittrick Museum.

From Hunter’s Gravid Uterus. Image courtesy of the Dittrick Museum. Click to enlarge.

Neither anatomist provided entire forms—there was no expectation that they should. But Smellie’s models often included sheets of cloth to hide, but also to suggest, extremities. There is some debate about whether Hunter deliberately tried to achieve artistic or visceral impact,1 but unlike the birthing sheet, which hid the woman’s body from the midwife, the atlas rendered the female form more than denuded: It was naked of flesh, severed in places, the internal matter laid open for observation. At the same time, these female anatomies, like silent muses, were invaluable to the practice of midwifery, particularly as it pertained to difficult and dangerous cases. So what was gained—or lost—by these piecemeal renderings?

In February 2013, I worked with Lucy Inglis on a temporary gallery at the Dittrick that showcased both atlases, not for the sake of their authors, but to exhibit the work of the artist. Jan Van Rymsdyk—the artist behind the majority of figures in both atlases—had a “forensic eye.” He attended when Hunter obtained a new corpse and sketched as the dissections took place. Once, he watched a stillborn baby, more suited to the illustration, substituted within a dead woman’s womb. Lucy and I pondered the ramifications of this, the strange artificial quality of these posed cadavers. Enlightenment ideals required strict adherence to evidence, to the “real.” And yet, even here, anatomies were constructed by doctor and artist, a “dance” that renders plain the problems and process of birth at the moment of death.

In Dream Anatomy, historian Michael Sappol suggests that mastery over the dead body was akin to mastery over oneself, and even a kind of mastery over death.2 He notes, too, the attempts of early anatomy texts to shock the reader, and even the pleasure of shock; the sense that anatomists and anatomy artists wielded an erotic power in undressing the body.2 The detachment necessary to the task (and feared by a public concerned that dissection rendered doctors inhuman) cannot be universally applied to all, however. Van Rymsdyk suffered something akin to a breakdown from the hours spent hovering over dead women and their children with his palette of chalks—and Smellie turned his anatomical information into instruction for saving the lives of women and children. Even so, in the naissance macabre, artist and author reduce female anatomy to constituent parts: woman becomes womb, objectified as teaching tool…a mute muse, but a muse none the less.

References

1. McCulloch, N.A., D. Russell, S.W. McDonald. “William Hunter’s casts of the gravid uterus at the University of Glasgow.” Clinical Anatomy 14, no. 3 (2001): 210-217.

2. Sappol, M. (2006). Dream Anatomy. Washington, D.C.: Government Printing Office, 34.

The Art of Midwifery Improv’d

During the fall 2013 semester, Hunter College students in Professor Daniel Margocsy’s undergraduate seminar, Health and Society in Early Modern Europe, 15001800, visited NYAM several times to talk about rare anatomical books. Each student then studied one text in depth, learned about its bibliographical and historiographical context, and wrote a blog post about that item. We are pleased to feature two of the blog posts from the class, one this week and one next, both on books from our collections relating to midwifery.

By Sarah Hatoum

The Discovery

Title page to The Art of Midwifery, Improv'd.

Title page to The Art of Midwifery, Improv’d. Click to enlarge.

In the eighteenth century, the field of obstetrics enjoyed an influx of novel scientific observations about birth and innovations aiding the process of birth. Dutch physician Hendrik van Deventer, author of The Art of Midwifery Improv’dwas the first to give a thorough description of the pelvis and was the first to suggest that the shape and size of the pelvic bone could cause difficulty in birth (e.g. if the pelvis were too narrow, usually due to rickets—the softening and deformation of bones caused by malnutrition—a child could not be born).1 Van Deventer asserted that determining the shape and size of a pregnant woman’s pelvis and being familiar with the relationship of the fetus and pelvic bones were essential for a midwife to carry out a safe delivery. 2

In the preface of Van Deventer’s instructive, detailed, and “beautifully calf-bound octavo volume” The Art of Midwifery Improv’d,3 translated from Dutch and Latin into English in 1716, an “Eminent Physician” briefly praises the works of contemporary French physicians such as the skilled man-midwife Francois Mariceau but ultimately remarks that Van Deventer’s The Art of Midwifery Improv’d is “more perfect, more easy, better founded, and extend[s] to more Cases” than other physicians’ works.4

While this was a lofty claim, it was true that prior to Van Deventer there had been little attention paid to the structure of the pelvis. Dr. H. L. Houtzager suggests two reasons for this lack of attention prior to the eighteenth century. Since there was an accepted belief that fetuses were born “by their own strenuous efforts,” there was no reason to blame the bony structure of the pelvis for the death of a fetus. The second reason was that people did not often challenge the Hippocratic paradigm (named after the ancient Greek father of medicine, Hippocrates) that suggested that pelvic bones completely separated during birth. Van Deventer determined that the pelvis was essentially “rigid and had only one mobile part—the coccyx.” Again, following the Hippocratic idea, there would also be no cause to suggest that the pelvis could cause a malformed or fatal birth.5

The Journey

Van Deventer was born in the Netherlands in 1651, during a Dutch golden age. In his early adulthood, Van Deventer moved to Germany and joined an orthodox Protestant sect, the Labadists. Van Deventer was in good company, for two notable women, religious writer Anna Maria van Schurman and the natural-philosophical artist Maria Sibylla Merian, had also belonged to the sect.7 Van Deventer became a mentee to the parish’s medical assistant and eventually became the community’s private physician, surgeon, and man-midwife (he later wrote, five years before his death in 1724, “I have already been delivering babies for roughly forty years…”).8 Van Deventer’s time as the head physician of the Labadist community allowed him to gain hands-on experience in certain fields of medicine, most particularly, orthopedics. The Labadists maintained an ascetic diet often resulting in a vitamin D deficiency that led to bone deformation. Van Deventer thus became proficient in the field of orthopedics, invented instruments to correct bone deformities in adults as well as infants,9 and even treated the King of Denmark, Christian V, for rickets.10

In 1694, the central college of doctors in The Hague denied Van Deventer membership because he did not have the proper background (i.e. he had not studied classical Latin). As a result, he moved to Voorburg (where philosopher Baruch Spinoza lived in the 1660s and worked on his magnum opus Ethics), which was not under the Hague’s jurisdiction, allowing Van Deventer free reign; it is here that he began to educate midwives. Several years later, as a middle-aged man, Van Deventer was finally allowed to officially practice as a physician in The Hague.11

Words of Wisdom

Van Deventer applied his orthopedic knowledge to obstetrics and was the first to focus on physical structure of the pelvis and its importance in The Art of Midwifery Improv’d. The question of why Van Deventer decided to write this book as well as why he became interested in obstetrics could be because of his religious fervor. In The Art of Midwifery Improv’d, there is an emphasis on a safe, natural (i.e. without the use of forceps) deliveries because of his belief that a child is made in the image and likeness of God. Furthermore, the work concludes with an Amen. His handbook acts as a prayer for the preservation of the lives of God’s creations. Perhaps Van Deventer’s challenge of the widely accepted Hippocratic paradigm was a testament to Van Deventer’s religious conviction, and he saw himself as a martyr in the name of perfecting the art of the birth of a child made in God’s image.

Plate 4, with figures showing shows the relation of a certain position of the fetus to the pelvis. Click to enlarge.

Plate 4, with figures showing shows the relation of a certain position of the fetus to the pelvis. Click to enlarge.

Van Deventer held midwives in high esteem and was unlike some of his contemporaries who preferred “man-midwives” to female midwives. Man-midwives, from the seventeenth century onward, were fighting to gain supremacy over female midwives and believed that female midwives were “ignorant meddlers whose arrogance prevented them from calling for male assistance” and that they “lacked a theoretical comprehension of childbirth.” 12 Van Deventer was probably a supporter of female midwives because his wife was a midwife, practiced with him and may have contributed to innovative medical discoveries.13

Figure 5, Number 1 shows a placenta for a single infant. Number 2 shows a placenta for twins.

Figure 5, number 1 (bottom) shows a placenta for a single infant. Number 2 (top) shows a placenta for twins. Click to enlarge.

Many man-midwives such as Mauriceu were “confined within the horizon of traditional obstetric surgery” which Wilson ascribes to a focus on handling a dead child rather than a live one.14 Van Deventer instead focused on providing a safe delivery. He gave detailed advice that would allow midwives to perform a safe and efficient birth. First and foremost, he wrote, midwives should have knowledge of female anatomy. Thenceforth, Van Deventer wrote, midwives should know:

  • How to handle patient and child
  • How to deal with afterbirth (the placenta discharged after birth)
  • How to respond to infants positioned awkwardly in the womb during birth
  • General birth preparation
  • How to offer emotional support post-birth to mother and child15

Unlike many of his predecessors, Van Deventer’s work featured accurate illustrations of the pelvis, seen in Figure 1 below:

Figure 1: The pelvis.

Figure 1: The pelvis. Click to enlarge.

The Art of Midwifery Improv’d brought forth important ideas that had not been studied prior to its publication— particularly the importance of the pelvic bone in birth. Hendrik van Deventer laid the groundwork for a focus on orthopedics within the field of obstetrics. Safer deliveries of children and a better understanding of the process of birth came through his advice to midwives.

References

1. John Byers, “The Evolution of Obstetric Medicine,” The British Medical Journal 1, no. 2685, 15 June 1912, 1347.

2. H. L. Houtzager,“The Commemoration of the Birthday of H. Van Deventer,” Vesalius 7, 2001, 17.

3. Byers, 1347.

4. Hendrik van Deventer, The Art of Midwifery Improv’d, (London, 1716): 4.

5. Adrian Wilson, The Making of Man-midwifery: Childbirth in England, 1660-1770, (Cambridge, Massachusetts: Harvard University Press, 1995), 56 and Houtzager, 16-17.

6. L. J. Benedek-Jaszmann, “The Silversmith Who Became the Co-Founder of Modern Obstetrics,” 1980, 243.

7. Wilson, 80.

8. Qtd. in Peter M. Dunn, “Hendrik van Deventer (1651-1724) and the Pelvic Birth Canal,” Perinatal Lessons from the Past, 1998.

9. Byers, 1347.

10. Jaszmann, 243.

11. R. M. F. van der Weiden and W. J. Hoogsteder, “A New Light upon Hendrik van Deventer (1651-1724): Identification and Recovery of a Portrait,” Journal of the Royal Society of Medicine 90, October 1997.

12. Lianne McTavish. Childbirth and the Display of Authority in Early Modern France, (International Ltd., 2005).

13. Wilson, 80.

14. Wilson, 56.

15. Van Deventer, 14.