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J R Coll Physicians Edinb 2016; 46: 65–67
http://dx.doi.org/10.4997/JRCPE.2016.113
© 2016 Royal College of Physicians of Edinburgh
Smellie & Hunter:Atlases of the gravid uterus. Part 1
Opinions, advice and admonitions about
But neither of these men would have
human reproduction and its vicissitudes
been regarded as a man-midwife. The
are to be found scattered through the
male midwives of 18th century England
medical writings of all ages. The attitude
were not necessarily medically qualified
of the medical profession to these was
(though some were) and were usually
far from consistent. There was
distinguished by practising only
sometimes acceptance that such expert
obstetrics – though some had previously
opinion was important and that it was
practised as surgeons. Is it too simplistic
valuable – and there was the rub. Its
to suggest that the rise of the manvalue to those who needed the advice
midwife in the 18th century was simply
was not disputed – but it was also
because they were perceived to be –
valuable as a source of income to
probably because they were, in fact –
medical professionals; too valuable,
more successful in delivering a live child
some felt, for it just to be given away by
from a still-living woman, when labour
indiscriminate publication. It was not
was complicated?
difficult to find reasons to maintain
professional secrecy about the
Though there had never been a shortage
mysteries of reproduction; to the
of so-called wisdom about reproduction,
spectre of the danger to the public ex libris RCPE
pregnancy and childbirth, this ‘wisdom’
posed by exposing them to information
divided between a mass of more-or-less
they were not able to understand or A set of anatomical tables...
nonsensical belief, superstition and myth
use correctly – a well-worn argument by William Smellie, M.D.,
and a great deal of hard-earned practical
for protection of the populace by (Second edition). London,
experience gained by observation of,
maintaining secrecy – could be added 1761.
and participation in, childbirth. But,
appeals to decency and stern warnings
valuable and useful as this practical
that it would be outraged by making
experience was, it lacked much
such matters public. One might say, for example, ‘What underpinning of accurate knowledge of the anatomy of
responsible man would wish his wife, daughters or the genital organs of pregnant women. Without this
servants to be encouraged to contemplate, discuss and – knowledge it was difficult for the accoucheur to make
oh horror – to act upon such matters without his rational analyses of the causes of difficulty in labour and
knowledge and approval?’ These sentiments are common to choose the interventions most likely to be helpful. The
in, for example, the medical writings of the 16th century organised medically-based training of accoucheurs, mostly
and have continued to be expressed in one form or men but a few women, depended on a new acquisition
another until the present. They were certainly still in the and application of this knowledge of structure and
background in 18th century England.
function during the 18th century.
Despite the constant difficulty of finding sufficient female
cadavers for dissection, the anatomy of the non-pregnant
uterus and its relations to bladder, bowel and pelvis was
more-or-less understood after the anatomical revolutions
of the 16th century; but that of the gravid uterus and the
all-important relations of the unborn child and its placenta
to the uterus and to the bony structures of the pelvis and
spine were still very imperfectly known in the early 18th
century. The reasons for this are not hard to seek; very
few cadavers of pregnant women at or near term were
available for dissection. Sources of bodies for anatomy in
the 18th century were few; the bodies of executed felons
could be used – if the anatomists’ representatives could
prevent relatives seizing them after the hanging, and, in
occasional cases, the judge ordered dissection as part of
the sentence. Not until the 1752 murder act did the
sentence on convicted murderers routinely include
dissection after hanging. But these sources would not
have provided bodies of pregnant women near term.
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history
But in the world outside medicine matters were rather
different. With – or very much more often without – the
benefit of the learned and their opinions, women became
pregnant as they had always done. If the pregnancy
survived to term – and sometimes even if it did not –
almost all women would need and expect assistance with
their delivery and it seems that historians are agreed that
this assistance had been provided by other women since
time immemorial. But, by the early years of the 18th
century, though most deliveries were still overseen by
women midwives, official or otherwise, trained or not,
male accoucheurs (men-midwives), were beginning to
make a substantial appearance. Intervention by men in
childbirth was, in fact, far from new. Medical practitioners
had probably always assisted in delivery, particularly when
there were difficulties. For example, in the 16th century,
Ambroise Paré had, famously, re-discovered the technique
of podalic version and his pupil, Jacques Guillemeau, had
become famous as an ‘obstetrician’ as well as a surgeon.
history
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Women could claim pregnancy – ‘plead their belly’ – to
avoid or delay execution. And, of course, fewer women
than men were convicted of murder in any case. But,
occasionally, the bodies of pregnant women did come into
the hands of anatomists.
In 1754 and 1774, there appeared the first accurate
anatomical atlases of the human gravid uterus, the earlier
by William Smellie and the later by William Hunter; as we
shall see, they are very different.
It is of some interest to mention a claim made a few years
ago by Shelton1 that gave rise to a considerable amount of
comment in the public press – most of it much more
sensational than informed – that Smellie and Hunter
solved the difficulty of obtaining subjects for dissection by
indulging in serial murder of pregnant women. Shelton’s
claims were completely unsupported, far less substantiated,
by evidence. Anyone interested in the controversy will
find details and references in Professor Helen King’s
perceptive article on medical history and the internet.2
Her commentary on the influence of modern media of
mass communication on the dissemination of
misinformation, and of ill-informed opinion disguised as
evidence, is a great deal more valuable than the claims that
triggered the media’s interest in Smellie and Hunter.
William Smellie and William Hunter, very different in
temperament and, in the end, in their standing in London
society, were closely linked at some stages of their
careers. Smellie was born in Lanark in 1697,3 probably
received some medical education in Glasgow and was in
general medical practice in Lanark by about 1720; he
seems to have developed a particular interest in obstetrics.
Between then and his departure for London in late 1738
or early 1739 he became acquainted with a man who was
to become one of the 18th century’s most famous
physicians, Dr William Cullen, then practising in Hamilton.
By the time he left for London, Smellie had gained a great
deal of experience in obstetric practice and was
prosperous enough to have bought several properties. He
had also been keeping records of his obstetric cases – a
habit which he continued. In London, it seems he was
dissatisfied with the standard of obstetric practice he
found and he soon went to Paris – at the time considered
a particularly advanced centre of the obstetric art. There
he saw the work and teaching of Grégoire, one of the
leading accoucheurs, including his use of an obstetric
‘phantom’ to teach the manipulations of practical
obstetrics.3 Smellie was not favourably impressed and
soon returned to London where he developed his own
obstetric ‘machine’ for teaching.
On his return from Paris, Smellie settled in Pall Mall,
practising at first as an apothecary as well as an
accoucheur and, by 1741, he was also teaching midwifery.
In July 1741, on the recommendation of Cullen, William
Hunter, another, younger, Scot, moved to London with the
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intention of improving his medical practice; the plan was
that he should return to join Cullen, with whom he had
already worked, in Cullen’s practice. Hunter stayed with
Smellie for a short time, very possibly on the
recommendation of their mutual friend Cullen – to
whose practice it turned out that he never returned.Thus
began a long acquaintance and professional relationship
between the two men who would become the most
famous and influential obstetricians (man-midwives) of
the 18th century. Smellie’s influence on obstetric practice
and teaching was probably much greater than Hunter’s; on
the other hand, Hunter’s teaching of anatomy, particularly
the anatomy of the female reproductive system, was very
influential indeed. Hunter was later assisted in this by his
younger brother John, whose range of interests was much
wider and who, in the end, would become the more
famous of the brothers.
By 1741 Smellie had begun the courses on practical
midwifery which would make him famous. In conjunction
with these he developed his own apparatus for what
would now be called simulation. The advantage for pupils
– and their patients – of being able to learn how to
discern the presentation of the foetus and the progress of
labour on a piece of apparatus in which errors would not
lead to disaster was obvious and was very soon appreciated
by the pupils who flocked to Smellie. Having been
distinctly unimpressed by the Parisian phantom he
developed his own rather different ‘machine’. One
principal difference was that, in Paris, the practice was to
put a dead full-term foetus in a ‘phantom’ – which was
simply a female bony pelvis enclosed in basketwork – to
teach the manipulations. Smellie developed a better
system. He had a number of stuffed leather dolls made for
use in his more sophisticated machine which allowed
better manipulation of the size of the uterus and vulva to
simulate the conditions of various presentations and
complications of labour. A pamphlet of 1750 (quoted in
ref. 3 p. 27) had no doubt about the superiority of
instruction on Smellie’s machine:
When a Person has Judgement enough to work well
on these Machines (of Smellie), he would soon be a
good Accoucheur; whereas, one might work to
Eternity on Gregoirs Basket, and never know anything
of the matter
Machines based on Smellie’s design became widely
used throughout the UK but, sadly, not a single example
of a machine seems to have survived, nor is there an
illustration of one. An article by Lieske4 in 2011
provides the best account available and contains
references to, and quotations from, such contemporary
descriptions as there are. Lieske points out that
historians of medicine and science have often failed to
appreciate the difference between such simulators and
mere anatomical models. Of some cultural historians
she says, rather mildly:
J R Coll Physicians Edinb 2016; 46: 65–67
© 2016 RCPE
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With well-intentioned but misplaced feminist
sensibilities, they view obstetrical machines as a
combination of misogynistic popular entertainment
and bad science. These scholars ride the coat-tails of
eighteenth-century, anti-male midwifery critics, such
as William Douglas, Elizabeth Nihell, and Philip
Thicknesse, and denigrate male midwifery through
the childbirth practices of William Smellie, the
seminal figure in eighteenth-century obstetrics.
Lieske’s article leaves one in no doubt of the success,
popularity and, above all, importance of this early venture
into teaching of practical procedures by simulation.
Smellie was the first to understand the mechanics of
labour in detail and to devise rational and humane
instructions for the use of instruments when – and only
when – they were essential. In the 18th century, pelvic
malformations were much more common than now,
severe haemorrhage (‘flooding’) was a life-threatening
complication and, in spite of the dark mutterings of critics
of the man-midwives, caesarean section in a living patient
really was not an option.There is no evidence that Smellie
ever attempted delivery of a living woman by caesarean
section, though he did carry out a few post-mortem
caesareans attempting to save the children of mothers
who had died in labour.
Smellie’s methods saved countless lives and his teaching
became justly famous. By the 1750s he felt that he had
accumulated sufficient material to begin to publish his
experience and, over the course of the next few years, he
published his three treatises and, to illustrate them, his
Anatomical Tables. First published in 17545 these were
reissued in a second edition in 1761,6 and of this edition
the Sibbald Library has a copy.
The whole of the Drawings are faithfully engraved by
Mr. Grignion, delicacy and elegance however has not
been so much consulted as to have them done in a
J R Coll Physicians Edinb 2016; 46: 65–67
© 2016 RCPE
Smellie’s intention, then, was to produce a series of images
that would illustrate the processes of, and procedures to
be applied during, childbirth and not to provide a detailed
anatomy of the uterus. It is not surprising, then, that many
of the illustrations are semi-diagrammatic and some are
line diagrams.As we shall see in the next part of this paper,
Hunter’s approach was very different.
The images in the first and second editions of the Tables
were printed from large engraved copper plates and it
seems that not many copies were sold. Then, having been
lost for years, the plates reappeared and were acquired by
Hamilton, Professor of Midwifery in Edinburgh, who had a
new edition printed from them (1787) with the addition
of a new plate of instruments engraved by Daniel Lizars.
We have a copy of these plates, but without the
accompanying text, bound with another work. Subsequent
editions of the Tables used smaller re-engraved copies
generally considerably inferior in their workmanship to
the very fine quality of the original plates.
Space does not allow inclusion of any of the plates here
but four images from Smellie’s Tables will be found on the
inside cover of this issue of the Journal and a gallery of
images from both Smellie’s and Hunter’s atlases will be
available on the Journal website alongside the online
version of this paper.
IML Donaldson
Honorary Librarian, RCPE
(email [email protected])
References
1 Shelton DC. The Emperor’s new clothes. J R Soc Med 2010; 103:
46–50. http://dx.doi.org/10.1258/jrsm.2009.090295
2 King H. Second opinion. History without historians? Medical
history and the internet. Soc Hist Med 2012; 25: 212–21. http://
dx.doi.org/10.1093/shm/hkr054
3 Glaister J. Dr. William Smellie and his contemporaries. Glasgow:
James Maclehose and Sons; 1894.
4 Lieske P. ‘Made in Imitation of Real Women and Children’:
Obstetrical Machines in Eighteenth-Century Britain. In: Mangham
A Depledge G, editors. The Female Body in Medicine and Literature.
Liverpool: Liverpool University Press; 2011. p.69–88.
5 Smellie W. A sett [sic] of anatomical tables, with explanations, and
an abridgment, of the practice of midwifery, with a view to
illustrate a Treatise on that subject, and Collection of cases.
London: printed in the year MDCCLIV [1754]. 1754.
6 Smellie W. A set of anatomical tables, with explanations, and an
abridgment, of the practice of midwifery, with a view to illustrate
a Treatise on that subject, and Collection of cases. The second
edition, corrected. London: printed in the year MDCCLXI [1761].
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history
The Tables were published by subscription and Smellie
employed a very competent artist (Jan van Rymsdyk who,
by 1750, was already working for William Hunter as well
as for Smellie) to make many of the drawings. A wellestablished engraver, Grignion, made the copper plates for
their printing. In his preface, Smellie said:6
I shall only beg leave to observe here by way of
Preface, that the greatest part of the figures were
taken from Subjects prepared on purpose, to shew
every thing that might conduce to the improvement
of the young Practitioner, avoiding however the
extreme Minutiae, and what else seemed foreign to
the present design; the situation of parts, and their
respective dimensions being more particularly
attended to, than a minute anatomical investigation
of their structure.
strong and distinct manner, with this view chiefly, that
from the cheapness of the work it may be rendered
of more general use.