Thursday, 19 March 2015

Mary Wollstonecraft and the Doctors: Part 2

Her magnum opus
The year 1792 brought Mary to prominence among the self-consciously progressive philosophers and philosophesses of the time. She had already boldly weighed in against Edmund Burke’s denunciation of the French Revolution with her Vindication of the Rights of Men (1790), but it was with A Vindication of the Rights of Woman (VRW) that she developed her particular unique contribution to the current debates, and expounded her matured social critique. (1) The topics of medicine and health care are clearly not the main issue in VRW, but loom rather larger than might be expected, from childcare, to life-style advice such as the benefits of exercise, to the reassertion that medicine was a suitable job for women. She rejected the notion of female delicacy debarring them from such a career choice: “Women might certainly study the art of healing, and be physicians as well as nurses. And midwifery, decency seems to allot to them, though I am afraid the word midwife, in our dictionaries, will soon give way to accoucheur [masculine gender]...” (p.337)
As indicated previously, it did not follow that she was hostile to male doctors, indeed she rather prided herself on having been able to communicate with them on equal terms:
“I have conversed, as man with man, with medical men, on anatomical subjects, and discussed the proportions of the human body with artists – yet such modesty did I meet with, that I was never reminded by word or look of my sex, or of the absurd rules which make modesty a whimsical cloak of weakness. And I am persuaded that in the pursuit of knowledge women would never be insulted by sensible men, and rarely by men of any description, if they did not by mock modesty remind them that they were women.”  (p.278, note)
At the same time she set a high value on a sense of privacy (‘personal reserve’), along with cleanliness and neatness in coping with everyday physical functions. Nor did she go to the opposite extreme of idealising traditionally female-dominated folk-healing: “Women should be taught the elements of anatomy and medicine... for the bills of mortality are swelled by the blunders of self-willed old women, who give nostrums of their own without knowing any thing of the human frame.” (p.411) Not that women were the only culprits, and they were often the victims of the assorted ‘quacks’ and charlatans she held to be guilty of preying on the gullibility and folly of many of them, as in the “fashionable deceptions... practised by the whole tribe of magnetisers...” (p.419)
Her own prescription was typically straightforward: “If the functions of life have not been materially injured, regimen, another word for temperance, air, exercise and a few medicines, prescribed by persons who have studied the human body, are the only human means, yet discovered, of recovering that inestimable blessing health, that will bear investigation.” (p.419)
Realising nevertheless that it could not always be so simple, and that even basic common-sense measures were not within everyone’s reach, she showed an awareness of the social causes of ill-health: repression and confinements of female children; the fads and fancies of their mothers; ‘libertines’ and drunkards whose excesses ruined their own and their families’ health; and the grinding poverty and ill-paid labour that was the lot of the lower classes. (Of the prostitutes to whom libertines had recourse she spoke as evoking mingled pity and ‘disgust ‘– not shutting her eyes to their existence as would have been thought proper, but fiercely denying the validity of double standards which always blamed and persecuted the female in any case.
From the cradle...
In the matter of ‘infant management’ – or the care of babies and small children, another recurring theme – she found herself more in tune with advanced medical opinion than with prevailing reliance on traditional practices: “I have often heard women ridiculed... only because they adopted the advice of some medical men, and deviated from the beaten track in their mode of treating their infants... [by adopting] the new-fangled notions of ease and cleanliness... What a number of human sacrifices are made to that moloch prejudice!” (p.418) Even with the best management, she envisaged infancy as a dangerous time, and the risk of one or two neonates or toddlers per family dying as normal, a scenario that sadly fitted her future grand-children. According to Godwin, she was working on a monograph, Letters on the Management of Infants while pregnant with her second child, before she died, and Dr Carlisle, “whom to name is sufficiently to honour”, had promised to look it over. (2) She was strongly in favour of breast-feeding by the mother (rather than a wet-nurse), which had something of a vogue in radical ’circles but was not generally favoured among the upper and middle classes. A beneficial side-effect, supposedly, was the postponement of renewed fertility: “Nature has so wisely ordered things, that did women suckle their children, they would preserve their own health, and there would be such an interval between the birth of each child [and the next], that we should seldom see a houseful of babes.” (p.442)
Soon enough she had the opportunity to put her ideas on motherhood to the test, with a baby daughter of her own. (3) In spite of difficult, stressful circumstances, and being already in her mid-thirties, she seems to have managed well. Realistic but upbeat, she described her experience of childbirth in a letter to Ruth Barlow six days later: “Nothing could be more natural or easy than my labour – still it is not smooth work.” (4) “This struggle of nature,” she added, “is rendered more cruel by the ignorance and affectation of women.” Pleased with her quick recovery, she went for a walk no more than eight days afterwards, contrary to the custom of the time. She was pleased too with the flourishing “little animal” she had produced. She practised what she had preached with regard to breast-feeding and close maternal care generally, albeit with the indispensable help of a maid. Fanny Imlay, the child in question, was at age three and a half, in her step-father’s view, “a singular example of vigorous constitution and florid health.” (2)
In the midst of Revolution
This first experience of becoming a parent took place in revolutionary France where Mary continued to associate by preference with a fairly close-knit group of mostly politically-motivated people. Some like her had come from abroad to observe at first-hand and report on what was happening, others adhered to similar groups and networks of French writers and thinkers. Most of her affinity group were in sympathy with the ‘Girondin’ faction, rather than the more authoritarian and anti-feminist hard left.  One new acquaintance was Fran├žois Lanthenas, a Paris physician and member of the National Convention. He was a foremost exponent of what has been called the ‘Rousseauist fantasy’ that “the regeneration of society would restore mankind’s primitive good health and make medicine itself unnecessary.” (5) Although involved with the Rolands’ entourage, unlike them he survived the Terror, reputedly by disassociating himself in time from his dangerous connections. Evidently he did not totally renounce old friendships, since he sponsored the application for French citizenship of Mary’s brother James, in 1796. (6)
Not surprisingly perhaps, all things considered, in spite of her initially positive reaction Mary went through a phase of uncertainty and low spirits, exacerbated by her dismay at the course of public events, after her daughter Fanny was born. Worries about her health resurfaced, and the baby fell ill too, with what was diagnosed as smallpox (happily she got over it, a result for which her mother felt she, as nurse, could take some credit). Her letters to Gilbert Imlay, Fanny’s father, who was more or less in the process of leaving her to fend for herself as a single parent and expatriate, convey something of her negative feelings and worries. In February 1795: “Physicians talk much of the danger attending any complaint in the lungs, after a woman has suckled for some months. They lay a stress also on the necessity of keeping the mind tranquil. – ” She tried to overcome her symptoms by will-power, asserting at one point that her mind could make her body do anything it wished, a theory popular with rationalists.
Norway, Sweden, Denmark
Tranquility, though, was not to be the prevailing mode of the relationship. Within a few months its breakdown had led to Mary’s first suicide attempt, back in London, by means of a laudanum overdose; perhaps ‘para-suicide’ would be more accurate, since she notified Imlay of her intention in time to be rescued. Godwin thought it was “perhaps owing to [Imlay’s] activity and representations that her life was saved” on this occasion. By way of therapeutic distraction she found a new type of purpose-directed activity in the form of a journey to Scandinavia, accompanied by her child and maid, on Imlay’s business. While waiting to sail from Hull, she called on a physician to whom she had been given, or as she put it had had forced on her, a letter of introduction, and was pleased to find him “an intelligent and rather interesting man” who with his wife and “young brood” showed her great hospitality.
Travel eased her mind, if only temporarily, to the extent of supplying the material and impulse for the production of a successful book, her Letters Written during a short Residence in Sweden, Norway and Denmark (1796).  This dealt with and dwelt on her own psychological state as well as the countries she visited. Her capacity for observation and tendency to introspection were both in evidence, in a combination that appealed to many readers.  The consolations of landscape and interesting novelty of meeting different people did not always carry the day, but she tried:
“I need scarcely inform you, after telling you of my walks, that my constitution has been renovated here; and that l have recovered my activity, even whilst attaining a little embonpoint. My imprudence last winter, and some untoward accidents just at the time I was weaning my child, had reduced me to a state of weakness which I have never before experienced. A slow fever preyed on me every night, during my residence in Sweden, and after I arrived at Tonberg.” (7)
In London on her return she had to confront once more the reality of her moribund relationship with Imlay. A second attempt at suicide, this time by drowning, in 1796, was more determined than the first and more nearly succeeded. She was, however, retrieved from the River Thames and revived; an unnamed physician was sent for and attended her at the Duke’s Head public house. The Royal Humane Society, with which her old acquaintance Dr Lettsom was closely involved, had shown the practicality and propagated the technique of reviving the apparently drowned. (8) Mary found the experience of near-drowning extremely painful, and resolved to try another method if she should feel suicidal in the future. There were in fact no more such attempts, although she went on alluding occasionally to the possibility, for a while.
Wrongs of Woman
Again she set about writing it all out of her system, and doing much more besides, in a second novel, The Wrongs of Woman (a.k.a. Maria).  Although it was to remain unfinished, she wrote enough to provide many useful insights into various aspects of the society of the time, and especially on how the laws made by men dominated and damaged the lives of women in different social strata. (9)
The setting of the opening scenes is a lunatic asylum in which the (sane) heroine, Maria, is incarcerated by an ill-intentioned husband, with a cover story to keep her there: “No person, excepting the physician appointed by the family, was to be permitted to see the lady... The malady was [alleged to be] hereditary, and the fits not occurring but at very long and irregular intervals, she must be carefully watched; for the length of these lucid periods only rendered her more mischievous, when any vexation or caprice brought on the paroxysm of phrensy.” Thus however sane she appeared, it was to be taken as only a temporary remission, and the longer it went on the worse it would be when it ended.
In his journal Godwin recorded a visit he and Mary made to ‘Bedlam’ (Bethlehem Hospital, for those considered mentally ill, or ‘mad’) in February 1797, with Joseph Johnson. It was quite a fashionable pastime to walk round looking at the lunatics, but in their case morbid curiosity was no doubt less of a motive than research for their respective writings and analyses of the contemporary world in all its aspects. Certainly Mary seems to have come away with deep and lasting impressions that influenced her novel. She was aware of different categories of inmate: “Melancholy and imbecility marked the features of the wretches allowed to be at large; for the frantic, those who in a strong imagination had lost a sense of woe, were confined.” One of the minor characters is a “fair maniac” similar to those found in other 18th century fictions, for example, Fanny Burney’s Camilla and Mackenzie’s Man of Feeling. But perhaps her most significant and original creation in the book is the asylum attendant, Jemima. The story of this woman’s life, presented as a narration in her own voice, is an indictment of the established class structure and economic inequality, including the (lack of) medical care for the poor. When after a number of adverse events she is forced by an accident at work to seek medical help, her experience as a moneyless patient in a money-driven set-up is recounted at some length, in damning detail:
Hospitals, it should seem (for they are comfortless abodes for the sick) were expressly endowed for the reception of the friendless; yet I...  wanted the recommendation of the rich and respectable, and was several weeks languishing for admittance; fees were demanded on entering; and, what was still more unreasonable, security for burying me, that expence [sic] not coming into the letter of the charity. A guinea was the stipulated sum – I could as soon have raised a million; and I was afraid to apply to the parish for an order, lest they should have passed me [under the Poor Law regulations] I knew not whither. The poor widow at whose house I lodged, compassionating my state, got me into the hospital; and the family where I received the hurt [injury], sent me five shillings, three and sixpence I gave at my admittance – I knew not for what.
My leg grew quickly better ; but I was dismissed before my cure was completed, because I could not afford to have my linen washed to appear decently, as the virago of a nurse said, when the gentlemen (the surgeons) came.  I cannot give you an adequate idea of the wretchedness of an hospital; every thing is left to the care of people intent on gain. The attendants seem to have lost all feeling of compassion in the bustling discharge of their offices; death is so familiar to them, that they are not anxious to ward it off. Every thing appeared to be conducted for the accommodation of the medical men and their pupils, who came to make experiments on the poor, for the benefit of the rich. One of the physicians, I must not forget to mention, gave me half-a-crown, and ordered me some wine, when I was at the lowest ebb.  I thought of making my case known to the lady-like matron; but her forbidding countenance prevented me. She condescended to look on the patients, and make general enquiries, two or three times a week; but the nurses knew the hour when the visit of ceremony would commence, and every thing was as it should be.  – pp.117-8.
Mary had not been a hospital patient herself, nor had she experienced hardships comparable with those of Jemima, although she may have heard first-hand from women who had. For one, there was a young sister of Fanny Blood’s who had fallen into extremely distressed circumstances and whom Mary tried to rehabilitate. Then there were her doctor friends with hospital appointments, who may have talked about their work environment. It is worth noting that a ‘good’ doctor is on hand to give help when Jemima most needs it.
The story allows Jemima to have found a kind of asylum in the asylum, but she has no illusions about it as an institution: “The overseer... purchased this dwelling, as a private receptacle for madness. He had been a keeper at a house of the same description ... [He] offered to instruct me how to treat the disturbed minds he meant to intrust to my care. The offer of forty pounds a year, and to quit a workhouse, was not to be despised, though the condition of shutting my eyes and hardening my heart was annexed to it... Four years have I been attendant on many wretches, and the witness of many enormities.” In spite of everything she retains enough humanity to respond to the heroine’s plight and help her escape. Maria’s troubles are not over but she too has at least met with much-needed kindness from a stranger.
Towards the end
In their author’s life the recent melancholy was now mitigated by a new relationship, with fellow writer and political thinker William Godwin. Like her he had produced substantial, original works both of fiction (Caleb Williams, or, Things As They Are, 1794) and non fiction (An Enquiry Concerning Political Justice, 1793); he had also spoken for the defendants in the Treason Trials. 
Together, they maintained their contacts with other radicals and literary personages, in spite of government repression of dissent and the growing climate of reaction. Mary’s circle of acquaintance was broadened to include women writers Mrs. Barbauld and Amelia Alderson, both daughters of dissenting medical men, John Aiken and James Alderson respectively. Fanny Imlay, Mary’s daughter, was of course still with her, growing satisfactorily but coming in for her share of childhood ailments. In September Mary wrote to another new friend, Mary Hays, “A fever, which has tormented my darling for some days past, gave me no little uneasiness. I am now reassured by the sight of the Chicken-pox, and know that she will soon be well again.”
Not all their acquaintances stayed close to William and Mary when they married, since the fact that Mary had not been married to the father of her first child was now inescapable, and the ensuing scandal was too much for some. Doctors Fordyce and Carlisle, however, were among those who were not put off; Mary mentioned a visit to the former in February 1797, and from the latter in June – in each case social rather than professional, apparently, although she was by that time pregnant again. It was also primarily as friends rather than physicians that the same two made their first visits after the birth of a daughter on 30th August.
Mary had taken a positive attitude to her second pregnancy, and initially at least, expressed confidence at the prospect of her imminent confinement. She had been through it once, in more daunting circumstances, and survived. This buoyancy, regardless of what was she had seen of death in ‘childbed’, was not in itself rash or irrational; distressing as its incidence was, research has shown maternal mortality to have been not quite as prevalent in Mary’s world as may be supposed. (10) Of course it was a home birth; an experienced midwife, Mrs. Blenkinsop of Westminster Lying-in Hospital, had been booked to attend.
Unfortunately Mary’s optimism turned out to be misplaced. There were complications (retention of the placenta) and a doctor had to be called in after all. Dr Louis Poignand, physician and man-midwife, was also from Westminster Hospital. Prominent in his field, he had published in 1778 a translation of a French work on a substitute for the caesarean operation. (11) At first his intervention seemed to have succeeded. After she had got past the pain – the worst, she said, that she had ever experienced – Mary’s condition appeared greatly improved. When Dr Fordyce visited her he “saw no particular cause of alarm; and quoted Mary’s case as a corroboration of a favourite idea of his, of the propriety of employing women in the capacity of mid-wives. Mary ‘had had a woman, and was doing extremely well’”. Dr Carlisle’s first visit likewise passed without any sign of foreboding, but shortly afterwards things took a turn for the worse; the most likely retrospective diagnosis is that the attempt to deal with the problem of the afterbirth had introduced an infection (puerperal sepsis). A few days later, Poignand withdrew from the case, saying he would make no more visits, ostensibly because the household had “thought proper to call in Dr. Fordyce”, but possibly, it has been suggested, because his greater experience convinced him there was no hope.
Mary’s last few days, until her death on 10th September 1797, were meticulously recorded in Godwin’s journal, from which he compiled the Memoirs he began only a fortnight later. Nursed by Mrs. Blenkinsop and a friend, Eliza Fenwick (another writer, commended by Carlisle as “the best nurse he ever saw“), the patient received every attention that devotion could suggest and current knowledge provide. (11a) Godwin, who had attended lectures on medicine the previous year, did his best to ensure that her care was state-of-the-art, using his many contacts. He recorded that he had called on John Walcot, Gilbert Thompson and George Tuthill during this time, in addition to the four medical men who actually attended Mary. The fourth was Dr John Clarke, who had been brought in by Fordyce because he was not himself a specialist in obstetrics, in case an operation was considered advisable; no doubt mercifully, it was not. Clarke was the author of Practical Essays on the Management of Pregnancy and Labour and of Epidemic Diseases of Lying-in Women. (12) He continued in attendance despite a possible clash between his outlook and that of the other doctors and the household. He had a name for opposing female midwives, but on examining some of his strictures on ignorance and superstition they appear not so very different from things Mary herself had written. Any difference of opinion did not lead to a lack of respect on his side: he described her to Godwin, in a note of thanks for a copy of Memoirs and Posthumous Works, as a valuable member of society and a worthy woman. (13)
 Modern-minded as they were, those around her were ready to resort to anything that might help to ease her situation. When the pain became too severe, she was plied with “as much wine as the stomach could bear” and any other beneficial “cordials” available. A week after the birth Carlisle was fetched from dinner on the far side of town, and stayed on in the house for the remaining four days that Mary lingered. “It was impossible,” Godwin wrote, “to exceed his kindness and affectionate attention – ever upon the watch, observing every symptom.” He was frank about the prognosis and “observed that her continuance was almost miraculous – remarking that perhaps one in a million in her state might possibly recover.” The most that could be done was to try to relieve her suffering. She cooperated with their efforts to the limits of her considerable physical and mentality strength, but will-power, the mind-over-matter theory she and Carlisle both favoured, could not prevail against the overwhelming odds or postpone the inevitable end for long.
Did she die of a surfeit of doctors? In the view of at least one biographer, medical men did not just fail to save her, they were responsible for the tragedy, insofar as her chances would, it is argued, have been better if Godwin had not been so quick to involve them. (14) Even if the fatal infection was iatrogenic, though, it must be open to doubt whether, given that the expectation of a straightforward delivery and trouble-free recovery had not been fulfilled, leaving nature to take its course would have brought a happier end result. It would be almost another half century before the classic description of transmission of infection by (hospital) doctors to women in childbirth was published. (15)
Recording aspects of health provision and medical practice in the context of her times was hardly a major part of Mary Wollstonecraft’s life work, but it stands as a not insignificant, if so far largely unregarded, feature of her legacy.
E. A. Willis
Originally written c.1995; published online only (so far).
It was the basis of a seminar paper for London Socialist Historians at the Institute of Historical Reaearch c.1996
Notes to Part 2:
1. Mary Wollstonecraft, A Vindication of the Rights of Woman. Facsimile edition. Gregg International Publishers, 1970. Page references in the text are for this edition.
2. William Godwin, Memoirs of the Author of A Vindication of the Rights of Woman [1798]. Facsimile edition, bound with VRW, Gregg International Publishers, 1970, as at Note 1.
3. Biographical information here mainly from Claire Tomalin, The Life and Death of Mary Wollstonecraft. Weidenfeld & Nicolson, 1976.
4. Ralph, ed., Collected Letters of Mary Wollstonecraft. Ithaca/London, Cornell U P, 1978. Superseded by Janet Todd, ed. (Allen Lane 2003). Quotations from MW’s letters in the text are from the Wardle edition.
5. Matthew Ramsay, Professional and Popular Medicine in France, 1770-1830. Cambridge U P, 1988; p.72.
6. Tomalin, p.135.
7. Mary Wollstonecraft, Letters Written during a short Residence in Sweden, Norway and Denmark (1796). Fontwell, Sussex, Centaur Press, 1970. Excerpt in Dale Spender, Janet Todd, eds., Anthology of British Women Writers. London, Pandora, 1989, p.317.
8. Joseph Johnson published at least one of the Royal Humane Society’s prize essays: Edmund Goodwin, The connexion of life with respiration... London, printed by T. Spilsbury for J. Johnson, 1788.
9. Mary Wollstonecraft, Mary, and The Wrongs of Woman, ed. and intro. G. Kelly, OUP 1961.
10. pp 16-17 in Irvine Loudon, ‘Deaths in childbed from the eighteenth century to 1935’, Medical History 1986, vol. 30: 1-41.
11. Poignand is in Munk’s Roll: William Munk, The Roll of the Royal College of Physicians of London, vol.2, (1978), pp. 390-1.
11a. An unreliable edition (maddeningly rife with grotesque mistranscriptions), of Eliza Fenwick’s novel ‘Secresy’ [sic, not a mistranscription] was published by Pandora in 1989.
12. Clarke is in Munk’s Roll vol.2, pp. 369-71; and Sir George Clark, A History of the Royal College of Physicians of London, vol.2, OUP, 1966, pp. 588-9.
13. Kenneth N Cameron, ed., Shelley and his Circle, vol. 1. Oxford U P 1961. Notes on pp. 186, 195, 201.
14. William St. Clair, The Godwins and the Shelleys. Faber & Faber, 1989, pp. 177-8.
15. Oliver Wendell Holmes, The contagiousness of puerperal fever, 1843 (“classic paper”).

London street art portrait of MW

Now available: Both parts combined (with fewer illustrations)
                           as 16-page article (Word); also as pdf 

1 comment:

  1. Footnote to the above: According to Mark Steel's Lecture on Mary Shelley, Dr. Anthony Carlisle continued his friendship with the Godwin family and may have been one source of inspiration for 'Frankenstein', having watched an experiment involving electricity and dead bodies.