This article has been peer-reviewed under the direction of Professors Mary Elizabeth Leighton and Lisa Surridge (University of Victoria). It forms part of the Great Expectations Pregnancy Project, funded by the Social Sciences and Humanities Research Council of Canada.
Pregnancy, labour, and suckling, therefore, should be looked upon as one process; conception being the commencement, weaning the close, and labour the connecting link. Thus, a woman may consider herself a mother, not only from the birth of her child, but even from the moment of conception. From that important epoch her duties commence – duties amongst the most sacred and dignified which humanity is called upon to perform. [Bull 3–4]
The nineteenth century was the golden age of mass printing and reading, including that of guidebook literature. Guidebooks provided advice on how to behave and conduct oneself in society, create a happy marriage with a suitable life companion, understand religious texts, and raise children. Amongst examples of this flourishing genre, health manuals and guidebooks were their own very successful branch; medical manuals intended for lay readers were highly popular and were written and printed in large numbers by medically qualified writers and publishers. In the female life cycle, certain life periods were thought to need special guidance, such as the early years of married life, motherhood, and the change of life, as menopause was called in nineteenth-century medical parlance. This article concentrates solely on nineteenth-century popular medical advice books on pregnancy and childbirth written by the medical profession. These guidebooks were intended for use by lay women, either recently married or living through the first years of their family life, allegedly with little knowledge or practical experience of pregnancy and childbirth.
To Educate, Entertain, and Enlighten
Popularisation has always been a historically significant part of medical enterprise; in the nineteenth century, popular guidebooks already had a long history (see Urban). The primary function of popular health manuals focused on pregnancy, childbirth, and family life was to guide women through the critical years of motherhood, furnishing them with medically correct information in simple, non-professional language. In the lives of most nineteenth-century married women, pregnancy and labour occurred regularly, even though the birth rate started to decline around the 1870s (see McLaren). Thus, women were expected to be keen to know more about the matter so close to their personal lives and general expectations.
In the nineteenth century, a woman was viewed as a potential mother if she did not have a disability or a serious illness such as tuberculosis or traces of mental illnesses (see Levine-Clark). As potential mothers, women were expected to observe their bodies, notice special changes in their bodily functions, and take care of their general state of health. However, the lines between expected self-care, overly independent home doctoring, and self-medication were never particularly clear.
Indeed, it is crucial to understand that nineteenth-century popular health manuals were never intended to be comprehensive collections of advice. They offered an idealized view of reproductive life rather than describing what doctors did in practice. Nor did popular guidebooks represent the latest medical knowledge or innovations that existed and were available to the medical profession itself. However, new ideas—such as the introductions of anaesthesia and antiseptic, often called "surgical cleanliness" in nineteenth-century texts—made their way into such writings, and many writers discussed experiences gained in practical work. For example, doctors witnessed cases in which women had not recognized the signs and symptoms of pregnancy and went into labour quite unexpectedly. Some writers also acknowledged that their literary work had benefitted from co-operation with their patients; there are mentions that the patients of medical authors had proofread the manuals and then given their suggestions for improvements (Niiranen 145–46, 157–58).
The general purpose of such manuals was to encourage women readers to exercise self-control, moderation, and constant vigilance, but in cases of emergency, readers were strongly advised to call for a doctor. Writers such as Doctor Henry Thomas Scott stressed that, in the hands of ignorant persons, medical books were "misapplied, mischievous, and even dangerous" (Scott 1–3). Health manuals synthesized the medical knowledge of nineteenth-century doctors, medical traditions, and literary conventions. Most of these manuals shared a basic structure; first, the advice on pregnancy, then the moment of birth, and lastly, family life and child-rearing. Guidebooks consisted also of entertaining stories, poems, religious texts, and moral aphorisms. Moral lessons were often highlighted. The idea was to educate, entertain, and enlighten readers.
Generally, popular guidebooks consisted of medically correct information in an easily understandable form, while they also promoted the work and competence of the medical profession (Niiranen 160–62). Popular health manuals were also literary manifestations of the professional competence, authority, and general respectability of their writers. During the nineteenth century, medical qualifications, supervision, and education were being re-defined, standardized, and specified, and academically trained doctors were gradually forming a unified profession, united by common traditions, shared symbols, collective identity and solidarity, and internal integrity (Niiranen 115–23). In their writings, doctors represented themselves as the only legitimized authors of reproductive knowledge and medical treatments. The irregulars, as the healers providing alternative medical care have been called, were declared dangerous and incompetent (see Loudon).
Manuals represented the ideal, typically male doctor as a competent and compassionate professional, who was able to take care of his patients with tact, decorum, and understanding, inspiring them with the confidence so indispensable to every doctor-patient relationship. The doctor was described as the "best friend for the time being" of the woman when she was pregnant and giving birth; the doctor took "an active interest in her welfare and advise[d] her as to her health during the trying time of pregnancy" (Allbutt 9, 19). Thus, medical manuals can be seen as the collective business cards of the medical profession, promoting their work and knowledge in the written word. Their main competitors, female midwives, were often depicted in a less positive light. A persistent stereotype of a midwife was an unhygienic and incompetent non-professional who allegedly jeopardized her patient's health with non-scientific methods and impatience (Stables 217–219). This negative point of view was probably motivated by the fact that the medical profession and midwives were competing for the same patients and fees.
Cover, title page, and introduction to Allbutt. Courtesy of the Cushing-Whitney Medical Library.
The majority of the authors of such manuals were indeed medical men. In the nineteenth century, female medical practitioners were a small and often underrated minority in a male-dominated branch. In their writings, male dominance was taken for granted; male doctors could claim that they had both a deep understanding of the laws of nature and the ability to employ scientific surgical methods, should complications occur during pregnancy or childbirth. It is important to be aware that, in the nineteenth century, men published more than women did about the female life circle, thus shaping cultural expectations and stereotypes.
Left: Title page of Chavasse. Courtesy of the Wellcome Collection. Right: Excerpt from Bull's Table of Contents. Courtesy of Jisc and the Wellcome Collection.
Some authors had long and successful careers in medical publishing. One of them was Pye Henry Chavasse (1810–79), a medical man from Birmingham who published several popular guidebooks on family life, motherhood, and childbirth (see Chavasse 1889 & Chavasse 1878). Another well-read manual in the nineteenth century was Hints to Mothers by Thomas Bull, which was published for the first time in 1837. Bull's and Chavasse's guidebooks were reprinted several times during the century, and they were often recommended in the medical periodicals where doctors enquired about informative manuals on behalf of their female patients (Niiranen 160–161).
"Prevention is Better than Cure": The Idea of Prevention in Popular Medical Manuals
Nineteenth-century health manuals for pregnant and parturient women followed long medical traditions of self-care and prevention. In popular medical literature, the slogan was "Prevention is better than cure" (see Chavasse 1889, 175). Women were both encouraged and expected to take care of their own health. Prevention was especially important where female reproductive health was concerned. As Doctor Jane H. Walker wrote in her 1893 guidebook, every woman was "a physical creature with mortal needs, subject to natural laws" (2). Women were viewed as the future mothers of the nation, and thus responsible for the future of the whole empire, nation, and race. Walker wrote in her manual, describing the role of a mother, that "the strength of her body, the attributes of her mind, her moral and spiritual individuality, are brought to a focus here, and the whole of the future of her country and of the world depends upon this work of hers" (1). Healthy mothers meant healthy children. This idea strengthened, especially during the second half of the nineteenth century, especially due to the rise of eugenic ideas both in medicine and in larger society.
The long tradition of six non-naturals, categories forming the basis of health, dating from antiquity, was still apparent in the advice given in nineteenth-century medical manuals. One's health was to be kept in balance with air, exercise, sleeping and waking, food and drink, excretion, and emotions. This meant that potential mothers were advised to pay extra attention to their sleeping habits, exercise, and diet. They were also encouraged to enjoy fresh air, preferably with the help of good ventilation in the house and an hour's walk every day. Good mental health, meaning a calm composed mind without any negative emotions, was especially important during the pregnancy months. Fear was commonly seen as a harmful emotion, causing pain, distress, and complications in labour. This was indeed one reason why female peer support was generally considered unsuitable in medical literature; according to the authors, women tended to tell horror stories to each other and exaggerate their sufferings and pain, thus only increasing apprehensions and prejudices toward childbirth. However, one married female friend was considered a suitable companion during childbirth; her role was to encourage the parturient woman and keep her calm with her own personal experience (see Chavasse 1889, 221–22).
In most examples, the advice presented in guidebook literature was detailed; manuals included, for example, special recipes for food and drink, bathing and exercise hints, and tips on how to medicate oneself, if needed. Certain material requirements were recommended to prepare women for pregnancy, childbirth, and lying-in, meaning the postnatal period immediately following childbirth (see also Childbirth by Hilary Marland). For example, manuals gave practical hints on the arrangements of the birthing room and bed, including the mattress and bedsheets. Pregnancy clothing was also discussed, though many times only on the ideal level. The ideal dress was described by Doctor Robert Hills in his 1841 manual: "light, loose, easy, and warm" (Hills 7). Much of the advice given concentrated on discouraging the practice of tightlacing, meaning the use of a corset to noticeably reduce the appearance of the waist, which was thought to be the cause of many complications in pregnancy and childbirth.
The supposed reward for following the rules given was a healthy child and a mother who survived the critical period without any physical or mental injuries. Women were also promised that labour would be "least painful, shortest, and safest" (Bull 3) if they followed guidelines. Miscarriage was represented in such texts as a potential threat, jeopardizing both family life and a woman's health and future (see also Miscarriage by Shannon Withycombe). The causes were many: "over exertion", dancing, running, jumping, falls, living too luxuriously, great pain, and strong emotions (Stables 208–11). Consequently, much of the advice concentrated on the prevention of miscarriage and premature labour.
One particularly important theme in the books was how to recognize the usual and less common signs and symptoms of pregnancy (see also "Early Pregnancy Tests" by Isabel Davis). It was emphasized that not every woman experienced every symptom, and, in the case of the same woman, her different pregnancies might not be the same. However, the main four signs were mentioned: 1) missed monthly periods ("the stoppage of the monthly flow"), 2) morning sickness, 3) bodily changes, especially in the breasts and abdomen, and 4) the quickening, the first movements of the foetus felt by the pregnant woman around the fourth or fifth month. In addition to these main categories, there was a group of minor signs and symptoms generally thought to be common, such as heartburn, palpitation, constipation, flatulence and diarrhoea, irritable bladder and incontinence, varicose veins, cramps and swellings, and mood changes (Niiranen 166–75). In the absence of pregnancy tests, the quickening was still considered an important indicator of gestation in popular health manuals (see Allbutt 8). The quickening was a very personal haptic sign that could be noticed solely by the pregnant woman herself, like "a bird fluttering within the woman," traditionally seen as a mark when the foetus became a living thing (Duden 80–81). Nineteenth-century doctors claimed that this was not the case: in their view, the foetus was a living thing from the moment of conception and, analogously, the woman was already a mother from the beginning of her pregnancy (Stables 163).
The majority of nineteenth-century health manuals were clearly written for middle-class readers. In the manuals, certain living standards and material requirements were assumed, such as carriages, large townhouses near park areas, and separate gendered spaces occupied by different family members. However, not everyone could afford these kinds of luxuries. Middle-class women had the necessary wealth and a similar kind of socio-economic background as their medical attendants; consequently, they were most likely to pay for the services of a doctor and acquire popular literature written by the medical profession. By contrast, many working-class women suffered from lives of general hardship, including repeated pregnancies, poverty, and poor diets. Many Victorian working-class houses were small and overcrowded, with bad ventilation and non-existent sewage systems. They could very probably not follow the advice to get fresh air and avoid stress and exercise. They were also less likely to meet any member of the medical profession in person. The reality is that not all women could or would follow the advice given in medical manuals; disinterest, poverty, illiteracy, and, possibly, reluctance to continue a pregnancy may have led some women to resist such advice.
In summary, nineteenth-century manuals depicted an idealized version of pregnancy and childbirth. They suggested that every woman was able to enjoy safe pregnancy and labour, in addition to quick convalescence after delivery, with the help of their own natural bodies, medically correct information, and the legitimized medical profession. Another prize was "a healthy, bright, and happy child" (Stables 206). The written word was the best way to educate young middle-class mothers. If following the medically correct instructions and "the rules of Nature," so the manuals advised, healthy women had no reason to be alarmed. As Chavasse wrote, "Labour is, as a rule, perfectly safe and natural; and confidence and cheerfulness are two of the grand remedies to bring it to a happy conclusion" (1889, 224).
Allbutt, Henry Arthur. The Wife's Handbook: How a Woman Should Order Herself during Pregnancy, in the Lying-In Room, and after Delivery, with Hints on the Management of the Baby [etc.]. London: R. Forder, 1888.
Bull, Thomas. Hints to Mothers for the Management of Health during the Period of Pregnancy and in the Lying-In Room; With an Exposure of Popular Errors in Connection with Those Subjects and Hints upon Nursing. Sixteenth Edition. London: Longmans, Green, and co., 1865.
Chavasse, Pye Henry. Advice to a Mother: On the Management of her Children, and on the Treatment on the Moment of Some of Their Role Pressing Illnesses and Accidents. Thirteenth Edition. London: J. & A. Churchill, 1878.
______. Advice to a Wife: On the Management of Her Own Health and on the Treatment of Some of the Complaints Incidental to Pregnancy, Labour, and Suckling with an Introductory Chapter Especially Addressed to a Young Wife. Thirteenth Edition. London: J. & A. Churchill, 1889.
Duden, Barbara. The Woman beneath the Skin: A Doctor's Patients in Eighteenth-Century Germany. Translated by Thomas Dunlop. Cambridge & London: Harvard University Press, 1991.
Hills, Robert. The Wife and Mother's Guide: Or, a Few Plain Rules for Pregnant Women. London: Wilson & Ogilvy, 1841.
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Loudon, Irvine. Medical Care and the General Practitioner, 1750–1850. Oxford: Clarendon Press, 1999.
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Scott, Henry Thomas. Counsel to a Young Wife: On the Rule of Conduct Requisite during Pregnancy and Lying-In, With Hints on the Management and Nursing of Children, and the Treatment of the Diseases to Which Mother and Child Are Liable. London, Liverpool & Dublin: James Cornish & Sons, 1870 [publishing date uncertain].
Stables, Gordon. The Wife's Guide to Health and Happiness' London: Jarrold & Sons, 1894.
Urban, Marsha. Seventeenth-Century Mother's Advice Books. New York & Basingstoke: Palgrave Macmillan, 2006.
Walker, Jane H. A Handbook for Mothers: Being Simple Hints to Women on the Management of Their Health during Pregnancy and Confinement; Together with Plain Directions as to the Care of Infants. London & New York: Longmans, Green, and co., 1893.
Created 13 August 2022