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The Historical Horror of Childbirth

Childbirth in much of human history has been a class act. The upper classes were encouraged to reproduce as much as possible, and a woman who was pregnant or recovering from childbirth took time to rest while servants took care of her and the child. The lower classes worked right up to and soon following birth, as they had to work to eat. The upper classes also had the latest medical knowledge at their fingertips, but this wasn't always such a good thing.

Photograph from The Victoria and Albert Museum.

Class distinctions in childbirth during the Renaissance were recorded. In 15th-century Florence, women were married as teenagers and often had five to ten children, depending on whether she survived childbirth. Childbirth was so dangerous that a woman would make out her will as soon as she found out she was pregnant. An age-old method of birth control is extended breastfeeding, which is nature's way of spacing out children. However, the custom among the upper classes was to farm out breastfeeding to wet nurses, which meant that the mother would soon be pregnant again.

It was during the Renaissance that medical doctors began to take part in childbirth, although not without a struggle. Women as whole were sheltered and their bodies hidden under plenty of clothing. It was unseemly for any man to take part in the intimate process of childbirth, and midwives did not want to give up their power or expertise in the area. Midwives had experience on their side; physicians had the authority that comes with the title. Therefore, most of the writings and advice from the period come from prominent physicians, and a lot of their advice was guesswork.  

Three women were pregnant when they boarded the Mayflower on its journey to America. One child, Oceanus Hopkins, was born during the voyage and died during the first winter in Massachusetts. Another, Peregrine White, was born shipboard off Cape Cod and lived to an old age. The third child was stillborn at Plymouth; the mother died in childbirth. Such stories were not at all shocking, as a woman's chances of dying during childbirth were between one and two percent -for each birth. If a woman gave birth to eight or ten children, her chances of eventually dying in childbirth were pretty high. The infant mortality rate was even higher. The chances of a child dying before his fifth birthday were estimated to be around 20 percent, depending on the community (accurate records are scarce). In addition to the fear of death or the fear of the child dying, there was no pain relief during labor, except for whisky in some places. In Puritan communities, pain during childbirth was God's punishment for Eve and all women who came afterward.

Motherhood in early America was even more frightening for slaves. Infant mortality among African and African-American slaves in the 18th century ranged from 28-50 percent, and mortality in children under ten was 40-50 percent, due to maternal malnutrition, overwork, disease, and lack of medical access. Slave owners blamed the mothers for infant deaths, and there is evidence that some babies were deliberately smothered to spare the child a life of slavery, but other factors contributed greatly to the infant death rate.

As Europe became more crowded in the 17th and 18th centuries, communicable diseases caused even more frequent deaths in childbirth. Puerperal fever had been around, but the rise of physician-assisted births increased its rate. It is a bacterial infection that became apparent within days of giving birth. The rise of maternity wards in hospitals meant that many women gave birth within shouting distance of each other. Doctors, in those days before germ theory, went from patient to patient, unknowingly carrying the bacteria on their instruments and their unwashed hands. In the 1790s, Alexander Gordon stressed that the disease was spread from one patient to another. He "bled" his patients at the first sign of puerperal fever, which actually helped in some cases, but no one understood why. In 1842, Thomas Watson recommended that physicians and birth attendants wash their hands and use chlorine between patients. In 1847, Ignaz Semmelweis reduced the rate of fever in his obstetric ward by ordering hand washing, but the idea was still rejected by the medical industry at large. A famous victim of puerperal fever was Mary Wollstonecraft, mother of Frankenstein author Mary Shelley. In 1797 she gave birth to her daughter Mary with the assistance of a midwife. But then a doctor was called to help remove the placenta and he came quickly, with unwashed hands. Wollstonecraft died a painful but typical death over the next week.

Photograph by Billy Hathorn.

Pioneers who settled the American West didn't have it much better than their eastern or European counterparts. Both doctors and midwives were scarce, and the midwives who were able to help in childbirth rarely had more knowledge than the experience of giving birth themselves. Infant mortality remained high, but the isolation of living on wilderness farmland many miles away from settled towns had one advantage: the spread of disease was lessened somewhat.

Childbirth changed dramatically in the 19th century with the introduction of anesthetics. Dentist William Morton developed the use of ether for surgery in 1846. Obstetrician Sir James Young Simpson introduced chloroform as an anesthetic in 1847. Queen Victoria used chloroform during her eighth delivery in 1853. The practice of childbirth anesthesia spread quickly afterward, despite protests from the clergy, who claimed that labor pains are God's will.

In 1914, a method called Twilight Sleep was developed, which involved morphine and scopolamine. The mother slept through delivery, but the drugs also affected the baby, and sometimes the child didn't breathe at all. The morphine also caused some mothers to die in childbirth. 

Comic by Kate Beaton.

In the 20th century, advances in medicine and germ theory raced ahead of public health and the access of the lower classes to medical care. When Dr. Josephine Baker was appointed as city health inspector for the Hell's Kitchen area in 1901, she found that 1,500 newborn babies died in the district every week. Her crusade to improve prenatal care and child health practices involved inventing formula, opening clinics, launching a school lunch program, training babysitters, and opening milk stations in the city, and it resulted in a huge decrease in infant and child deaths.

Childbirth, though still an ordeal, is much safer today for mothers. Children are much more likely to survive to adulthood. And widely available birth control gives people the option of deciding when and how many children to have. But the hard part comes after childbirth -raising a family, which is more complicated every day. And that's why you should honor your mother this Mother's Day.

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Courtesy New York Academy of Medicine Library
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10 Treasures From the New York Academy of Medicine Library
A urine wheel from Fasciculus Medicinae
A urine wheel from Fasciculus Medicinae
Courtesy New York Academy of Medicine Library

Tucked away on a side street near Central Park, the New York Academy of Medicine Library is one of the most significant historical medical libraries in the world. Open to the public by appointment since the 19th century, its collection includes 550,000 volumes on subjects ranging from ancient brain surgery to women's medical colleges to George Washington's dentures. A few weeks ago, Mental Floss visited to check out some of their most fascinating items connected to the study of anatomy. Whether it was urine wheels or early anatomy pop-up books, we weren't disappointed.

1. FASCICULUS MEDICINAE (1509)

The Fasciculus Medicinae is a compilation of Greek and Arabic texts first printed in Venice in 1491. While it covers a variety of topics including anatomy and gynecology, the book begins with the discipline considered most important for diagnosing all medical issues at the time: uroscopy (the study of urine). The NYAM Library's curator, Anne Garner, showed us the book's urine wheel, which once had the various flasks of urine colored in to help aid physicians in their diagnosis. Each position of the wheel corresponded to one of the four humors, whether it was phlegmatic, choleric, sanguine, or melancholic. The image on the left, Garner explains, "shows the exciting moment where a servant boy brings his flasks to be analyzed by a professor." Other notable images in the book include one historians like to call "Zodiac Man," showing how the parts of the body were governed by the planets, and "Wound Man," who has been struck by every conceivable weapon, and is accompanied by a text showing how to treat each type of injury. Last but not least, the book includes what's believed to be the first printed image of a dissection.

2. ANDREAS VESALIUS, DE HUMANI CORPORIS FABRICA (1543)

Andreas Vesalius's Fabrica
Frontispiece of Andreas Vesalius's Fabrica
Courtesy New York Academy of Medicine Library

Andreas Vesalius, born 1514, was one of the most important anatomists who ever lived. Thanks to him, we moved past an understanding of the human body based primarily on the dissection of animals and toward training that involved the direct dissection of human corpses. The Fabrica was written by Vesalius and published when he was a 28-year-old professor at the University of Padua. Its detailed woodcuts, the most accurate anatomical illustrations up to that point, influenced the depiction of anatomy for centuries to come. "After this book, anatomy divided up into pre-Vesalian and post-Vesalian," Garner says. You can see Vesalius himself in the book's frontispiece (he's the one pointing to the corpse and looking at the viewer). "Vesalius is trying to make a point that he himself is doing the dissection, he believes that to understand the body you have to open it up and look at it," Garner explains.

3. THOMAS GEMINUS, COMPENDIOSA (1559)

Flap anatomy from Thomas Geminus's Compendiosa
Courtesy New York Academy of Medicine Library

There was no copyright in the 16th century, and Vesalius's works were re-used by a variety of people for centuries. The first was in Flemish printer and engraver Thomas Geminus’s Compendiosa, which borrowed from several of Vesalius's works. The first edition was published in London just two years after the Fabrica. Alongside a beautiful dedication page made for Elizabeth I and inlaid with real gemstones, the book also includes an example of a "flap anatomy" or a fugitive leaf, which was printed separately with parts that could be cut out and attached to show the various layers of the human body, all the way down to the intestines. As usual for the time, the female is depicted as pregnant, and she holds a mirror that says "know thyself" in Latin.

4. WILLIAM COWPER, THE ANATOMY OF HUMANE BODIES (1698)

Illustration from William Cowper's The Anatomy of Humane Bodies
Courtesy New York Academy of Medicine Library

After Vesalius, there was little new in anatomy texts until the Dutch anatomist Govard Bidloo published his Anatomia humani corporis in 1685. The work was expensive and not much of a financial success, so Bidloo sold excess plates to the English anatomist William Cowper, who published the plates with an English text without crediting Bidloo (a number of angry exchanges between the two men followed). The copperplate engravings were drawn by Gérard de Lairesse, who Garner notes was "incredibly talented." But while the engravings are beautiful, they're not always anatomically correct, perhaps because the relationship between de Lairesse and Bidloo was fraught (Bidloo was generally a bit difficult). The skeleton shown above is depicted holding an hourglass, by then a classic of death iconography.

5. 17TH-CENTURY IVORY MANIKINS

17th Century Ivory Manikin
Courtesy New York Academy of Medicine Library

These exquisite figures are a bit of a mystery: It was originally thought that they were used in doctors’ offices to educate pregnant women about what was happening to their bodies, but because of their lack of detail, scholars now think they were more likely expensive collector's items displayed in cabinets of curiosity by wealthy male physicians. The arms of the manikins (the term for anatomical figures like this) lift up, allowing the viewer to take apart their removable hearts, intestines, and stomachs; the female figure also has a little baby inside her uterus. There are only about 100 of these left in the world, mostly made in Germany, and NYAM has seven.

6. BERNHARD SIEGFRIED ALBINUS, TABULAE SCELETI (1747)

Illustration from Bernhard Siegfried Albinus's Tabulae Sceleti
Courtesy New York Academy of Medicine Library

One of the best-known anatomists of the 18th century, the Dutch anatomist Bernhard Siegfried Albinus went to medical school at age 12 and had a tenured position at the University of Leiden by the time he was 24. The Tabulae Sceleti was his signature work. The artist who worked on the text, Jan Wandelaar, had studied with Gérard de Lairesse, the artist who worked with Bidloo. Wandelaar and Albinus developed what Garner says was a bizarre method of suspending cadavers from the ceiling in the winter and comparing them to a (very cold and naked) living person lying on the floor in the same pose. Albinus also continued the dreamy, baroque funerary landscape of his predecessors, and his anatomy is "very, very accurate," according to Garner.

The atlas also features an appearance by Clara, a celebrity rhinoceros, who was posed with one of the skeletons. "When Albinus is asked why [he included a rhinoceros], he says, 'Oh, Clara is just another natural wonder of the world, she's this amazing creation,' but really we think Clara is there to sell more atlases because she was so popular," Garner says.

7. FERDINAND HEBRA, ATLAS DER HAUTKRANKHEITEN (1856–1876)

Circus performer Georg Constantin as depicted in Ferdinand Hebra's dermatological atlas
Courtesy New York Academy of Medicine Library

By the mid-19th century, dermatology had started to emerge as its own discipline, and the Vienna-based Ferdinand Hebra was a leading light in the field. He began publishing this dermatological atlas in 1856 (it appeared in 10 installments), featuring chromolithographs that showed different stages of skin diseases and other dermatological irregularities.

"While some of the images are very disturbing, they also tend to adhere to Victorian portrait conventions, with very ornate hair, and [subjects] looking off in the distance," Garner says. But one of the most famous images from the book has nothing to do with disease—it's a depiction of Georg Constantin, a well-known Albanian circus performer in his day, who was covered in 388 tattoos of animals, flowers, and other symbols. He travelled throughout Europe and North America, and was known as "Prince Constantine" during a spell with Barnum's Circus. (The image is also available from NYAM as a coloring sheet.)

8. KOICHI SHIBATA, OBSTETRICAL POCKET PHANTOM (1895)

19th century Obstetrical Pocket Phantom
Courtesy New York Academy of Medicine Library

Obstetrical phantoms, often made of cloth, wood, or leather, were used to teach medical students about childbirth. This "pocket phantom" was originally published in Germany, and Garner explains that because it was made out of paper, it was much cheaper for medical students. The accompanying text, translated in Philadelphia, tells how to arrange the phantom and describes the potential difficulties of various positions.

9. ROBERT L. DICKINSON AND ABRAM BELSKIE, BIRTH ATLAS (1940)

Image from Robert Dickinson's Birth Atlas
Courtesy New York Academy of Medicine Library

Robert Dickinson was a Brooklyn gynecologist, early birth control advocate, and active member of NYAM. His Birth Atlas is illustrated with incredibly lifelike terracotta models created by New Jersey sculptor Abram Belskie. The models were exhibited at the 1939 New York World's Fair, where they became incredibly popular, drawing around 700,000 people according to Garner. His depictions "are very beautiful and serene, and a totally different way of showing fetal development than anything that had come before," Garner notes.

10. RALPH H. SEGAL, THE BODYSCOPE (1948)

The Bodyscope
Courtesy New York Academy of Medicine Library

This midcentury cardboard anatomy guide contains male and female figures as well as rotating wheels, called volvelles, that can be turned to display details on different parts of the body as well as accompanying explanatory text. The Bodyscope is also decorated with images of notable medical men—and "wise" sayings about God's influence on the body.

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23 Funny Historical Letters to Santa
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At the end of the 19th century, illustrator Thomas Nast popularized our current version of Santa Claus: a fat, jolly man with a white beard and a red suit who lives at the North Pole. Nast’s cartoons in publications like Harper’s Weekly also helped spread the idea of sending St. Nick mail. By the late 1870s, American children had begun mailing their Christmas wish lists to Santa, but the Post Office considered these letters undeliverable. Around this time, newspapers began prompting children to send wish lists to them, which would then be published so that Santa (and parents) could read the letters all in one place. We’ve collected 23 funny historical letters from children to Santa Claus, as printed in newspapers across the U.S.

1. CONRAD FROM NEBRASKA (1896)

The Courier, Dec. 19, 1896

Conrad tries to mask his violent tendencies by interspersing the weapons between non-threatening gifts, but he shows his hand with that threat at the end.

2. CLIFFORD FROM NEBRASKA (1896)

The Courier, Dec. 19, 1896

Clifford sounds ... intense.

3. MARIE FROM NEBRASKA (1896)

The Courier, Dec. 19, 1896

“As I can not have it I will not ask for it" ... but I will mention it, just in case.

4. LYNWOOD FROM VIRGINIA (1903)

“I smashed everything you sent me last year." I won’t tell you what I want this year, but you better not mess up.

5. PAUL FROM VIRGINIA (1903)

This 4-year-old is very concerned about his infant brother’s lack of teeth. Since the local doctor has proved useless to rectify the situation, Paul hopes Santa might be able to lend a hand. He is magical, after all.

6. HARRY FROM MONTANA (1903)

Fergus County Argus, Dec. 16, 1903

Who knew keeping your feet dry was such an important part of staying off the Naughty list?

7. RAYMOND FROM WEST VIRGINIA (1907)

Clarence doesn’t sound very nice.

8. PERCY FROM WEST VIRGINIA (1907)

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Poor Opal and Mildred. They’re just girls. Do girls even have preferences?

9. VIRGINIA FROM MISSOURI (1907)

Virginia understands that sometimes Santa needs to delegate.

10. ROBERT FROM TENNESSEE (1913)

The Commercial, Dec. 19, 1913

Old people get lonely.

11. WILLIE FROM FLORIDA (1915)

Sure, an axe sounds like an age-appropriate gift for a five-year-old.

12. ELEANOR FROM FLORIDA (1915)

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“Bring both if possible.”

13. UNSIGNED LETTER FROM FLORIDA (1913)

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This transplant from Maine would really like a basketball, but he doesn’t quite believe that a Santa Claus can exist in Florida, where there isn’t even any snow.

14. WALTER FROM FLORIDA (1915)

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The Daytona Daily News, Dec. 17, 1915

Good choice not to act a pig, Walter.

15. MERLA FROM FLORIDA (1915)

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The Pensacola Journal, Dec. 24, 1915

Merla will not be ignored!

16. ROY FROM FLORIDA (1915)

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The Pensacola Journal, Dec. 24, 1915

A doll dressed in a cowboy suit could not be called Raymond. A lack of sailor suit is a dealbreaker.

17. MAXWELL FROM FLORIDA

The Pensacola Journal, Dec. 24, 1915

Ways to improve your chances of getting a pony from Santa, according to Maxwell Hudson: 1. Admit right off it’s expensive. 2. Say you will use it to take your sisters to school. 3. Promise to be grateful for anything Santa brings, so as not to seem greedy. 4. Make yourself seem extra kindhearted (and thus deserving of a pony) by showing concern for your fatherless neighbors. Did it work? We will never know.

18. MOXIE FROM TENNESSEE (1916)

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Perhaps a kid known for being mean shouldn’t be given a firearm.

19. DICK FROM SOUTH CAROLINA (1916)

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The County Record, Dec. 21, 1916

No, Santa certainly wouldn’t want to get “fastened in” the chimney.

20. JOHN FROM NEW MEXICO (1918)

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World War I devastated Western Europe, decimating a generation of young men—and apparently killing the French Santa Claus.

21. MARY FROM NEW MEXICO (1922)

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The Carlsbad Current, Dec. 15, 1922

Come on, Mary, Santa’s not a mind reader.

22. JEWEL FROM NEW MEXICO (1922)

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The Carlsbad Current, Dec. 15, 1922

No apology for the door-slamming incident. That might have helped your cause, Jewel.

23. R.B. FROM NEW MEXICO (1922)

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The Carlsbad Current, Dec. 15, 1922

R.B. is very thoughtful to provide such specific instructions; otherwise, Santa might get confused.

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