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Dr Smellie’s Prescriptions for Pregnant Women

Published online by Cambridge University Press:  17 May 2012

Robert Woods
Robert Woods
Affiliation:
Robert Woods, MA, DPhil, LittD, FBA, is John Rankin Professor of Geography at the University of Liverpool, Liverpool L69 7ZT, UK; e-mail: [email protected]
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Information
Medical History , Volume 52 , Issue 2 , April 2008 , pp. 257 - 276
Copyright
Copyright © The Author(s) 2008. Published by Cambridge University Press

References

1 R W Johnstone, William Smellie: the master of British midwifery, Edinburgh, E & S Livingstone, 1952, and L Lewis Wall, ‘William Smellie (1697–1763), the father of scientific obstetrics’, Medical Heritage, 1986, 2: 158–67; Adrian Wilson, The making of man-midwifery: childbirth in England, 1660–1770, Cambridge, MA, Harvard University Press, 1995, especially pp. 123–33, ‘A new synthesis: William Smellie’; Pam Lieske, ‘William Smellie’s use of obstetrical machines and the poor’, Studies in Eighteenth-Century Culture, 2000, 29: 65–86, discuss Smellie’s methods; see Lisa Forman Cody, Birthing the nation: sex, science and the conception of eighteenth-century Britons, Oxford University Press, 2005, especially pp. 152–97, ‘Breeding Scottish obstetrics in Dr Smellie’s London’, on the uses to which Smellie’s work can be put in cultural history. See Irvine Loudon, Medical care and the general practitioner, 1750–1850, Oxford, Clarendon Press, 1986, for a discussion of the work of the general practitioner in eighteenth-century England, including that of the apothecary and the surgeon-apothecary, as well as diagnosis, prescribing and pharmacy; also Joan Lane, ‘A provincial surgeon and his obstetric practice: Thomas W. Jones of Henley-in-Arden, 1764–1846’, Med. Hist., 1987, 31: 333–48, for a finely worked, detailed example of how one provincial general practitioner combined obstetric work with other cases.

2 Alfred H McClintock (ed.), Smellie’s treatise on the theory and practice of midwifery, edited in three volumes with an introduction and annotations by Alfred H McClintock, London, New Sydenham Society, 1876, 1877, 1878.

3 The following are some of the most useful reference works: Jonathan Pereira, Selections from physicians’ prescriptions, 1st ed., London, John Churchill, 1824, 12th ed. 1854; Henry Beasley (ed.), The book of prescriptions: containing 2900 prescriptions, collected from the practice of the most eminent physicians and surgeons, lst ed., London, John Churchill, 1854; William Watson Will, Prescription reading, London, Metropolitan College of Pharmacy, 1898; Joseph Ince, The Latin grammar of pharmacy, 8th ed., London, Baillière, Tindall & Cox, 1903.

4 These conventions have been applied to Smellie’s prescriptions reported and discussed here. Every effort has also been made to standardize the abbreviations used so that cases can be compared, and to check McClintock’s edition against the first editions of volumes II and III. Several manuscripts in the Wellcome Library, London, illustrate prescribing practice in the eighteenth century. For example, Wellcome MS. 7525 has six handwritten prescriptions on pieces of paper of various sizes, but all follow the conventions of grammar and layout although they look like rough shopping lists. Wellcome MSL/MSS. 16 and MS. 1730, also dating from the eighteenth century, are books of prescriptions neatly copied out, possibly from other sources.

5 The dispensatory of the Royal College of Physicians in Edinburgh, trans. Peter Shaw, MD, London, printed for William and John Innys, 1727 (ED); The dispensatory of the Royal College of Physicians in London, trans. John Quincy, MD, London, printed by W Bowyer, for R Knaplock, B Took, D Midwinter, R Smith, W and J Innys, and J Osborn, 1721 (LD); Dr Radcliffe’s practical dispensatory. Containing a complete body of prescriptions, fitted for all diseases internal and external, digested under proper heads, ed. Edward Strother, MD, 5th ed., London, printed for C Rivington, 1730 (RD); and Dr William Lewis, The new dispensatory, 3rd ed., London, printed for J Nourse, 1770 (ND). These dispensatories, or pharmacopoeias, are remarkable compendia of learning and practical instruction. Originally published in Latin, translated editions became widely available during the early eighteenth century. The Practical dispensatory of the famous royal physician Dr John Radcliffe (1650–1714) is especially interesting because, unlike the other dispensatories, it contains prescriptions in Latin and English forms, together with observations on the treatment of specific complaints or diseases.

6 Penelope Hunting, A history of the Society of Apothecaries, London, Society of Apothecaries, 1998, pp. 153–72, discusses the distinction and the establishment of a laboratory and retail shop for the manufacture and sale of chemical medicines in the late seventeenth century. Hunting (p. 171) says there were about 700 apothecaries’ and chemists’ shops in London and its suburbs in the 1740s.

7 For example, there are collections by Beasley, op. cit., note 3 above, with many revisions and additions from 1854, and collections by pharmacists: I M Slocombe, ‘A Bradford-on-Avon pharmacy: prescription books, 1863–1918’, Pharmaceutical Historian, 1996, 26 (2): 17–19; Stuart Anderson and Christine Homan, ‘Prescription books as historical sources’, Pharmaceutical Historian, 1999, 29 (4): 51–4. Most of this material dates from the nineteenth century, but there is also a very small number of eighteenth-century examples: A collection of receipts in physic, being the entire practice of a late eminent physician [Dr Bloxam]; containing a complete body of prescriptions answering to every disease, London, printed for Lokyer Davis, 1752, and A new collection of medical prescriptions … by a member of the London College of Physicians [Dr Richard Pearson], London, printed for R Baldwin, Jun., 1791. Both of these books are in English and avoid the usual prescription conventions. Wellcome MS. 4118 is the notebook of a Warwickshire physician written between 1755 and 1758 comprising 270 hand-written pages of prescriptions, usually with the patient’s name included. While it follows the prescription writing conventions, it is not a book of case notes and, in consequence, lacks the value of Smellie’s collection. It is unusual for prescriptions to be included in the large number of midwifery textbooks published in the eighteenth century. However, A treatise of midwifery, comprehending the management of female complaints, and the treatment of children in early infancy, London, printed for J Murray, 1781, by Alexander Hamilton, professor of midwifery at the University of Edinburgh, does contain a concluding section entitled ‘Qualifications of midwives with prescriptions for women and children’ (pp. 422–64), but there are no case notes.

8 David Wootton, Bad medicine: doctors doing harm since Hippocrates, Oxford University Press, 2006, takes the medical profession to task for its inability, especially during the eighteenth century, to develop and apply scientific principles to therapy. “Before 1865 all medicine was bad medicine, that is to say, it did more harm than good” (p. 26). However, Wootton does allow that the obstetrical forceps were successful (pp. 273–4).

9 An alternative strategy would involve a systematic content analysis of the prescriptions, relating the ingredients used back to the circumstances.

10 The cases are referred to by McClintock’s numbers in bold, as well as by Smellie’s original collection and part numbers, and the McClintock volume and page numbers. His notes are also reported where useful. Brief notes outline the circumstances of the case, while extracts from Smellie’s own account are shown indented following a bullet point. References to pages in the dispensatories are preceded by the abbreviations ED, LD, RD and ND (e.g. ED 18).

11 Foetal mortality is discussed in Robert Woods, Children remembered: responses to untimely death in the past, Liverpool University Press, 2006, pp. 49–55, and Robert Woods, ‘Mortality in eighteenth-century London: a new look at the Bills’, Local Population Studies, 2006, 77: 12–23. While it is not possible to tell what proportion of pregnancies ended in miscarriage in the eighteenth century, it is likely that the risk of a stillbirth once a foetus had reached a gestational age of 28 weeks from conception and before full-term at 40 weeks was from 4 to 6 per cent. Miscarriages and stillbirths would have been far more common in Smellie’s practice, however.

12 McClintock notes (II 86): “The confectio Fracastorii here ordered is only another name for the electuarium e scordio (or diascordium), an astringent, antispasmodic compound, of which the most important ingredient was opium. The first name was applied to it from its having been introduced by Hieronymus Fra(s)catorius”. The dispensatories also give details of composition (ED 100; LD 99; ND 588). Scordium is the water-germander, “a small, somewhat hairy plant” of no great medicinal esteem (ND 223).

13 The Edinburgh dispensatory has the following recipe (ED 111): “Syrup of White Poppies, or Diacodium. Take of the heads of the white Poppy, in a middle degree of maturity, and moderately dried, fourteen ounces; boiling Spring-water, a gallon: let them infuse for a night; then boil to the consumption of one half of the liquor; strongly press out the remainder, and add there to three pounds of white Sugar; and boil them up to syrup.”

14 Friedrich Hoffmann (1660–1742) physician and professor at the University of Halle, Germany. Hoffmann is also cited in case 88.

15 Mithridate, or the confection of Damocrates, contained some 45 ingredients, including ginger, saffron, myrrh and 5 drachms of opium.

16 McClintock notes (II 6): “The pilulae Matthei ordered here and in many other places were sometimes called Starkey’s pills, and pilulae pacificae in the old Edinburgh Dispensatory. The most important ingredient contained in them was opium, in the proportion of one grain to every eight or ten grains of the mass. The other ingredients were, according to the formula given in the old Edinburgh Dispensatory, Russian castor [from beaver], English saffron, soap of tartar, and balsam of capivi.” The Edinburgh dispensatory has the following recipe (ED 162): “Anodyne Pills, commonly called Matthew’s Pills. Take of Virginia Snake-root, Castor, Saffron, and Opium, each an ounce; Soap of Tartar, three ounces; Balsam Capivi, a sufficient quantity: mix them together, artificially, so as to make a mass for Pills.”

17 Case 481 is too long to reproduce in full here. Mr Ayer also followed different conventions in writing out his prescriptions.

18 Woods, ‘Mortality in London’, op. cit., note 11 above, Table 3, summarizes what is known about maternal mortality in London and England.

19 McClintock notes (II 226) that acute diarrhoea and cholera, but especially dysentery, are apt to bring on labour pains. “Opium is here our sheet-anchor, and may be employed by the mouth or by the rectum, endermically or hypodermically. Under pressing circumstances I would not hesitate to use all these four methods in the same case.”

20 McClintock notes (II 171–2): “The Aqua Alexiteria simplex was distilled from green mint, the tops of sea wormwood, and green angelica leaves. It possessed little use beyond being a pleasant aromatic vehicle for more active medicines.” The Edinburgh dispensatory has the following recipe (ED 61): “Alexiterial Water. Take of the fresh leaves of Carduus benedictus [blessed thistle], Baulm and Scordium, each three ounces; those of common Wormwood and Mint, each two ounces; those of Rue and Angelica, each one ounce; add two gallons of spring water, and distil according to the rules of art.”

21 Dr Radcliffe’s dispensatory has the following recipe (RD 438): “Paregorick Draught. Take black cherry-water, one Ounce and half; Compound Peony Water, one Drachm and half; Extract of Theban Opium, one Grain and a half; Sugar, what suffices; mix, and make a Draught, to be taken at Bed-time.”

22 For example, the Edinburgh dispensatory has the following (ED 87): “Tinctura Opij or Liquid Laudanum. Take of crude Opium, an ounce; and Spanish white wine, ten ounces: with a gentle heat, in Balneo Mariae extract a Tincture, and let it afterwards be filtered.” While the London dispensatory has a more elaborate version (LD 21): “Sydenham’s Liquid Laudanum. Take of opium two Ounces; of saffron one ounce; of Cinnamon and Cloves, each one Drachm; of Canary [wine], sixteen Ounces: Digest these together in a Bath Heat for three Days; and when the Faeces are settled, pour it off for use.”

23 McClintock notes (III 259) that although patients often said opiates disagreed with them, he ignored this and made sure opium, laudanum, morphia did not appear on the prescription. “For pure sleeplessness not the consequence of pain, chloral or bromide of potassium is generally the best hypnotic, and far superior, I should think, to Smellie’s dose of castor and carbonate of ammonia.”

24 Smellie was also careful to ensure that the wet nurse should not feed the baby at her breast, but use a feeding boat. Such an object is shown in George Morland’s, A visit to the child at nurse, c.1788 (Fitzwilliam Museum, Cambridge). See Woods, Children remembered, op. cit., note 11 above, illustration L.

25 Wellcome MS. 1730, op. cit., note 4 above, p. 29, has the following use of rhubarb: “For the Gripes, Wind, and Bowel Complaints in Infants. Take of the best rhubarb, six grains; magnesia, two scruples; cinnamon water, two ounces: mix, and give a tea-spoonful to the child occasionally. If the child is troubled with purging, substitute prepared chalk for the magnesia. Or give the child a teaspoonful of castor-oil.” Hamilton’s Treatise of midwifery (1781), op. cit., note 7 above, also makes ready use of rhubarb for children (p. 462) and favours chicken broth for nourishment (p. 448).

26 Also cases 15, 16 and 17: Menorrhagia, dating from a miscarriage some months previously; plus 11 and 12: Amenorrhoea tardira, all taken from Dr John Freind (1675–1728), Emmenologia, translated from the Latin by Dr Thomas Dale, London, printed for T Cox, 1729.

27 It is possible that there were some female apothecaries (they would certainly have had female assistants in their shops), and apothecaries could write prescriptions, but women-midwives could not. Hamilton’s Treatise of midwifery (1781), op. cit., note 7 above, p. 425, outlines the qualifications required of a midwife: “She should know the composition and method of preparing those prescriptions which she may, from time to time, have occasion to advise; and should also be well qualified for instructing the nurse in the manner of preparing variety of foods and drinks adapted to particular circumstances.” There was, therefore, a sharp line between food and drug preparation.

28 It is impossible to evaluate how effective Smellie was as an obstetrician in the manner demanded by Wootton’s Bad medicine, op. cit., note 8 above. We cannot calculate his success rate, or those of other London midwives at the time with which he may be compared. However, apart from the blood-letting, it would also be unfair to say that his was “bad medicine”, poor therapy, and indifferent practice. These points are developed at greater length in Robert Woods, ‘Lying-in and laying-out: fetal health and the contribution of midwifery’, Bull. Hist. Med., 2007, 81(4): 730–59.