From Man-Midwife to Female Master : 350 years of Obstetricians and Gynaecologists in Ireland

Royal College of Physicians of Ireland

 An exploration of the development of the profession, from its origins in the 1600s, to the foundation of the Institute of Obstetricians and Gynaecologists in 1968, examining key achievements to the present day.

Foundations
In the second half of the seventeenth century, childbirth in Ireland was in a state of transition. In a predominantly agrarian society, almost all births took place in the home with the local midwife, or "wise woman", in attendance. However, this period also saw the rise of a professional male interest in obstetrics. This was based on a new scientific interest in sexuality and reproduction, and the development of obstetrical instruments, which were almost exclusively used by men. The period saw the beginning of a struggle between men and women for control of the profession, and the start of the professionalisation of the speciality.

The publication of 'The Birth of Mankinde' was a significant moment in the field of midwifery. Written by Eucharius Rösslin in 1513, it was originally published in German and was translated into English in 1545. It opened up and formalised the secretive world of midwifery and provided information on fertility, pregnancy, birth and infant care, as well as up-to-date anatomical description.

In Cork in 1670 James Wolveridge published one of the first English texts on midwifery, 'Speculum Matricis Hybernicum: Or, the Irish Midwives’ Handmaid'.

Wolveridge structures the work as a dialogue between a doctor, Philadelphos, and a midwife, Eutrapelia.

The manual was re-issued in 1671 with the altered title of 'Speculum Matricis.'

The year after Wolveridge's text, an English Midwife Jane Sharp published 'The Compleat Midwive’s Companion'. She drew on her 40 years of experience, as well as extensive reading, to produce a guide for women. Sharp criticises man-midwives as expensive and unnecessary, dedicating her text to her ‘sisters’ the ‘celebrated midwives of Great Britain and Ireland’.

The 1692 Royal Charter of this College granted the power to license midwives, in order to reduce the "greate abuses frequently committed by unskilled midwives practizeing who doe not understand their Duty or Office".

The first licence was granted to Mrs Cormack on 3 February 1697. Only four applications were received in the next forty years, two from men and two from women.

In 1742, Bartholomew Mosse received the College’s Licence in Midwifery, having studied in continental Europe. Horrified by the conditions of Dublin’s poor, Mosse established a Lying-in hospital for poor women. It opened on 15 March 1745 on George’s Lane; the first hospital of its kind in the British Isles. In 1757 it moved to its current location as the Rotunda Hospital.

Mosse raised funds for his hospital in a variety of ways, from lotteries to concerts, plays and charitable bequests. The hospital’s new location included a pleasure garden, with a charge for admittance to raise funds. It was not until 1785 that an annual government provision was made for the hospital, based on a tax on private sedan chairs in Dublin city.

Fielding Ould succeeded Mosse at the Rotunda. Ould was granted the College’s Licentiate in Midwifery in 1738 and described as "singularly well qualified". In 1743 he dedicated his 'Treatise on Midwifery' to the College. However, in 1756 Ould attacked the College, who had refused him a Licentiate in Medicine, as they believed it not ‘consistent with the dignity of their body’ for a man to hold both Licentiates.

Ould’s 'A Treatise on Midwifery' was a ground-breaking book, bringing scientific investigation to childbirth. Ould drew on his education in Paris, making several original observations, including the mechanism of labour.

Ould also included a design for an instrument, called a 'Terebra Occulta', to be used in the event of a death in the womb.

'Consistent with the dignity of their body'
In March 1735, the Dublin Evening Post recorded that ‘The Right Honourable Lady Mountjoy was safely delivered last Friday by Doctor Van Lewen, President of the College of Physicians.’ Van Lewen was the first obstetrician to hold the office of President. Although his election might seem to herald the wider acceptance of man-midwives, he was an anomaly as the only man-midwife in Dublin. Van Lewen died in January 1736 and a month later the College passed a resolution ‘that no man for the future shall have a license to practice Midwifery & Physick together’. The College’s decision was based on a view of midwifery as an inferior, unscientific part of medicine, not befitting the dignity of a Physician.

In the 1750s, obstetric teaching was developing in England, but a proposal to introduce teaching at the Rotunda was opposed. Trinity College thought it was their preserve, and the governors feared ‘the patients ... were to be subjected to all sorts of indignities in order to afford instruction to a parcel of Brats of Boys’. It would be 1774 before the first lectures were delivered by Dr David MacBride.

‘As much in repute, as formerly he was the reverse’
On 1 November 1779, Francis Hopkins received a Licentiate in Medicine from the College. Hopkins, then Assistant Master at the Rotunda, already held a Licentiate in Midwifery, and was the first man to be allowed to hold both. This marked the start of an improved relationship between the College and Obstetricians. In 1785, at the age of 75, Sir Fielding Ould finally received his Licentiate in Medicine from the College, over 40 years after he first applied. In the following decades, a number of obstetricians were elected President of the College, including Francis Hopkins. By the mid-19th century, obstetrical teaching and practice in Dublin had gained international recognition.

Francis Hopkins was elected President of the College five times between 1785 and 1816, and devoted much time to the College. His later terms of office coincided with his seven years as Master of the Rotunda. He also served the College as Dun’s Librarian, in the year before his death in 1819, and donated a number of early medical books to the College's collection.

In 1827 Trinity College established the first Chair of Midwifery in Ireland, with William Fetherston Montgomery as the first professor. Ten years later he published a work on the signs and symptoms of pregnancy, which would be translated many times.

It includes detailed illustrations showing changes to the glands in the areola, eponymously known as 'Montgomery’s Tubercles'.

For centuries, puerperal fever was a serious risk in childbirth. In maternity hospitals, death rates could reach 100% during epidemics. Robert Collins correctly believed puerperal sepsis was a contagious disease, implementing the cleaning of wards, ventilation control and hand washing, with his work being greatly admired by Ignaz Semmelweis, pioneer of antiseptic procedures. In Collins' last 3 years as Master of the Rotunda there were no puerperal sepsis deaths.

Evory Kennedy succeeded Collins as Master of the Rotunda and College President. He continued Collins’ work, and also helped to introduce the stethoscope to obstetrics. In 1838 Kennedy gave the inaugural address to the new Dublin Obstetrical Society, concluding that ‘the accoucheur is as much in repute, as formerly he was the reverse’.

Fleetwood Churchill was a leading figure in obstetrics in Dublin. A prolific author, he wrote a number of textbooks based on his own observations which were translated into many languages, including Chinese.

Like other leading obstetricians, Churchill produced his own versions of designs for obstetrical tools, which were marketed under his name.

Of the half-dozen maternity hospitals founded in Dublin in early 19th century, the only one to survive for more than a couple of decades was the Coombe.

In 1826, Mrs Margaret Boyle left £100 to establish maternity services in the Coombe area. In 1829, a hospital, founded a few years earlier by Dr John Kirby, was purchased and became the Coombe Lying-in Hospital.

Outside Dublin, the first Lying‐in hospital opened in Belfast in 1794, followed, 4 years later by Cork, and in 1812 one opened in Limerick. In Galway, maternity provision primarily came from nursing homes and the workhouse, but by 1942 the Central Hospital provided midwifery care.

Training for female midwives was slow to develop. In 1856, Fleetwood Churchill lamented ‘the merest rudimentary knowledge’ of many midwives. He published a manual in which he ‘endeavoured to teach as much as a midwife need know’. The lack of trained midwives was a concern to the Masters of the maternity hospital, who instituted programmes of reform and education.

‘Carry them beyond the merest rudimentary knowledge’
During the 19th century, maternity facilities and nursing homes opened across the county. The dispensary system, introduced in 1862, provided for a doctor and midwife in each district, although many midwives were untrained.  County hospitals, established in the 1920s, provided for abnormal maternity care. In the cities, regional hospitals developed specialist midwifery departments. Although the provision of trained practitioners and hospital beds increased across the 19th century, for the vast majority of the population, births still took place in the home, with the doctor called only in difficult cases. 

For nearly twenty years the College engaged in the debate on midwives' registration. During this period, several obstetricians served as President, including Lombe Atthill and Andrew Horne who took leading roles in the debate. The College supported the idea of registration, as long as Irish qualifications were recognised. The Midwives (Ireland) Bill was eventually passed in 1918.

Medical Registration was introduced by the Medical Act of 1858, but obstetrical training was not included until the 1888 Amendment Act. Training was limited to a short rotation in a Maternity Hospital, including a stint 'on the district', carrying out deliveries in the home. Despite obstetrics being central to their practice, rural GPs could qualify having attended at only a dozen uncomplicated births.

A literary interlude
During the twentieth century, a number of obstetricians and gynaecologists made cameo appearances in works by Ireland’s leading literary figures. Part of Joyce’s 'Ulysses' takes place in the National Maternity Hospital, named in the work as 'the House of Horne' after the first Joint Master of the hospital, Sir Andrew Horne. The gynaecologist Bethel Solomons is referenced in 'Finnegan’s Wake' ("in my bethel of Solyman’s I accouched my rotundaties") and in the work of Signe Toksvig. Later in the century, Seamus Heaney celebrated the role of the rural GP in bringing new life into the world in his poem ‘Out of the Doctor’s Bag’. 

Andrew Horne became the first Joint Master of the National Maternity Hospital in 1894, and College President in 1908.

Extract from 'Ulysses' by James Joyce

He was knighted in 1913, wearing this hat, sword and shoe buckles . Horne is also reputed to have thrown James Joyce, then a medical student, out of Holles Street for making an offensive remark about the hospital's patients. As a result, Horne is said not to have read 'Ulysses' due to his dislike of Joyce.

Extract from 'Ulysses' by James Joyce

Oliver St John Gogarty’s 'Tumbling in the Hay' gives an insight into the often rambunctious life of medical students in the National Maternity Hospital. Gogarty was acquainted with Joyce, and appears in 'Ulysses' as Malachi Mulligan.

Other identifiable medical men in Joyce's works are the gynaecologist Richard Dancer Purefoy, and medical students Thomas J. Madden and Vincent Cosgrave.

Bethel Solomons was born in 1885 to a prominent Dublin Jewish family. Specialising in gynaecology, he was elected Master of the Rotunda in 1926. In 1946 he was nominated for the Presidency of the College of Physicians of Ireland

Extract from 'One Doctor in His Time' by Bethel Solomons

Bethel Solomons became President of the College of Physicians on 18 October 1946. As he recalled in his autobiography he had played rugby for Ireland before the demands of his medical career forced him to retire.

Extract from 'One Doctor in His Time' by Bethel Solomons

Solomons is believed to have been the inspiration for Dr Michael McMurrough in Signe Toksvig’s 'Eve’s Doctor'. The book describes a handsome gynaecologist who ‘walked ... the street enveloped in quick warm darting glances and brought secretive smiles that made every husband want to remonstrate with his spouse about her behaviour’. Toksvig and Solomons are believed to have had an affair.

Extract from 'Eve's Doctor' by Signe Toksvig

Heaney’s poem 'Out of the Doctor’s Bag' celebrates the role of the rural GP in childbirth. It focuses on Dr Joseph Kerlin, a GP based in Magherafelt, Co. Derry, who delivered Heaney and his siblings. Heaney creates an evocative image of Kerlin arriving for each delivery in his ‘fur‐lined coat’, surrounded by the tools of his trade, ‘a whiff of disinfectant … highlights on the forceps’.

Extract from 'Out of the Doctor's Bag' by Seamus Heaney
The Institute of Obstetricians and Gynaecologists
Although only fifty years old, the Institute has its origins in the Dublin Obstetrical Society, which was founded 180 years ago. The Society aimed to provide a forum for the exchange of information and research in the speciality. In 1882, it became the Section of Obstetrics in the Royal Academy of Medicine in Ireland, which was still going strong in 1968. The focus of the Section of Obstetrics was on the exchange of research and in the 1960s, Irish Obstetricians and Gynaecologists felt they needed a body to represent their opinions as a profession. This led to the founding of the Institute of Obstetricians and Gynaecologists in 1968. Today, the Institute is the national professional and training body for Obstetrics and Gynaecology in Ireland, and works to ensure the highest standards in women’s health.

With only 52 obstetricians and gynaecologists in Ireland in the 1960s, it was felt impractical to found an Irish College. The group looked instead to found a Faculty within one of the existing Colleges. It was decided that RCPI was most suitable, given ‘the medical nature of much of the work’. The first meeting, attended by 31 doctors, was held on 11 October 1968.

Over the past 50 years the Institute has developed as the professional body for Obstetricians and Gynaecologists, and sets standards in education though the MRCPI in Obstetrics and Gynaecology and the Diploma in Obstetrics and Women’s Health. Today, there are 228 Members and Associate Members of the Institute, and 157 doctors on the Institute’s training programmes.

The profession has, to some extent, come full circle. 350 years ago, a female dominated profession was taken over by the rise of the Man-Midwife. Today, 75% of the trainees on the Obstetrics and Gynaecology programme are women. In 2018, for the first time, two of the three Dublin Maternity Hospitals had Female Masters, the same year as the Institute appointed its first female Chair.

Credits: Story

Curation: Dr Michael O’Dowd, Claire Ó Nualláin, Harriet Wheelock

Images: Bobby Studios

Audio: Peter Flood, Gary Killeen, Joe McGurk and Alexandra St John

This exhibition was a joint project of the RCPI Heritage Centre and the Institute of Obstetricians & Gynaecologists, to mark the 50th anniversary of the founding of the Institute.

We would like to thank all those who helped in the creation of the exhibition, especially Dr Peter Boylan, Dr Conor Carr, Edel Hynes, Dr John Murphy, Dr Cliona Murphy, Dr Maeve Eogan and Dr Sorca O'Brien

Credits: All media
The story featured may in some cases have been created by an independent third party and may not always represent the views of the institutions, listed below, who have supplied the content.
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