A Midwife with a Beard

A male nursery school teacher doesn't surprise anybody nowadays, but a lady who's asphalting the road still tangles. Mockery is often a first reaction: Queer, softy, battle-axe: a stream of abuse for men and woman who step outside their gender-scope.

Gender is the social-cultural construction of the biological notion of sex. As long as men and women fulfill their social role within the social-cultural scope everything is fine. But if they enter each others fields this has implications for the social status of the people involved. This problem isn't new: in early modern Europe some professions gave rise to confusion about gender which challenged the status of the professional group.

Gender and status

In the compilation The task of healing. Medicine, religion and gender in England and the Netherlands 1450-1800, one of the themes is the confusion as to gender when a man undertook -female- tasks as consultation and examination of a sick person.

The physicians made sure that the association with the feminine stayed somewhat limited. They avoided the taint of craft or manual labour and didn't touch the body. That's why urinoscopy was so important in England: the physician didn't need to touch the body. The urine was often brought to them by servants.

During a consultation in the intimacy of the bedroom, the physician stood mostly at the foot of the bed. Entering this room and the mystical atmosphere behind closed doors made the doctor associated with secret pregnancies, sexual problems and venereal diseases: like women he knew secrets learned at the bedside. That's the reason why physicians never were alone with their patients. The contact between patient and practitioner was often through intermediaries, for instance a family member.

The - potential - patient expected the doctor to be quiet, gentle and self-effacing. His therapy had to be expectant and aimed at non-intervention. These are the same feminine qualities that they expected from a good midwife. That's why the physician sometimes was called sardonically 'midwife with a beard' or 'a bull with a ring'.

Early modern society entertained ambivalent feelings towards these men. There was a great need for knowledge and care, but at the same time the status of he practitioner was low. In the seventeenth century the London College of Physicians got onto the offensive of the low status and negative image of her members with a programme of professionalisation.

What about the man-midwife who made his entry in the eighteenth century? Margaret Pelling, deputy director of the Wellcome Unit for the History of Medicine in Oxford, uses the term 'gender transition' in her article about the role of men in healthcare in England. It's my opinion that in Holland, the function of the man-midwife didn't lead, as in England, to gender problems because (in the Dutch Republic) the occupational group of midwives was the most professionalised.

The image of the barber-surgeons

For the barber-surgeon direct contact with the body was inevitable. Although their social status was lower than that of physicians, they had a much more virile image.

The barber-surgeon used his instruments, he was decisive and his help was frequently called for victims of wars, duels and street fights. Also men with a venereal disease appealed to him: "... the barber surgeon can be seen as having a certain privileged access to male genitalia, in a way that looks like the polar opposite in gender terms of the legal responsibilities of the midwife in respect of the female body. Surgeons could just attest to male integrity. Seen in this light, the surgeon had authority over the weapons of Venus as well as over the field of Mars." And of course early modern male committed his genitals only to a real man!

Already in the seventeenth century the ambiguities of gender had two sides. Women who by exercising their duty behaved too masculine, met with resistance. Charles Dickens created Sairy Gamp, the fat, old midwife and nurse with hoarse voice and red nose. For over fifty years she was the negative metaphor for the midwife in England. The metaphor was used by medical practitioners who appropriated the work area of the midwife, but also by men and women who denounced unfeminine behaviour: Sairy Gamp was independent and able to support herself. In Holland there was no equivalent for 'Mrs. Gamp', although there are descriptions of midwives with the same negative clichs.

At the end of the nineteenth century Arie van Geyl, gynecologist and would-be medical historian gave a sketch of the midwife in the eighteenth century: "The eighteenth century was the flowering time of the old, bent, stiff and hunch-backed 'wives', about whom almost all writers on midwifery from those and later days have poured their furious wrath; women, mostly widows, who out of poverty and because they were not in state to do anything else and trifling with decency and esteem, promoted themselves to midwife; who came to attend deliveries, which they not seldom made a mess of through [giving] bad advice or injudicious interventions."

In the seventeenth and eighteenth century there was, beside the negative, a strong positive image of the midwife as a hardworking, competent woman.

Control of health-care

Local magistracy in the Dutch Republic were of of importance in ***controlling*** health-care. The Dutch historian Frank Huisman explains the interference of the authorities from a social-political point of view. He thinks that the control of 'health care' was a by-product of a policy that was primarily directed towards maintaining social order. In 1556 the city council of Groningen, a middle-sized city in the North of the Dutch Republic, appointed a town surgeon who was obliged to inform the authorities about all treated persons who got wounded during a fight. Then the authorities could easily trace all those concerned and punish them.

The town surgeon was a civil servant but the other surgeons were united in guilds. In exchange for the privileges the guild got, the surgeons had to take care for the sick, the poor and the orphans without being paid for. Some years later they received an annual salary. Beside the town surgeon local authorities also appointed town midwives. They had to stand by women during delivery and received like, the town surgeon, an annual salary. This gave them a solid social position. Before they were eligible for the very desired position they had to comply with strict terms: they had to be middle-aged, married or widowed, they had to have children of their own, and had to be living in the city where they were working.

Not all midwives were employed by local authorities; some had their own practice, but they also were obliged to work within the rules of the authorities. For example, they were obliged to call for the help of another midwife in case of a difficult delivery and they were not allowed to use instruments. The magistracy was especially concerned about omission: the midwife didn't come when she was asked for help or she left a patient for another who paid more money.

Because midwives were also obliged to ask unmarried women for the name of the father of their baby and had to inform local authorities about infanticide and child-abuse, they had some authority within the community.

A midwife was a self-employed woman, an unusual and threatening phenomenon in early modern society. Because her social status, based upon her knowledge and skill, she didn't meet contemporary gender stereotyping. The negative image is a reaction to this.

In their contribution to the compilation, Pelling and Marland emphasize the relation between gender and medicine. Van Lieberg, De Waardt en Wear explain the meaning of Calvinism for the process of professionalizing health-care and reducing the role of the clergy. Beside the articles of the authors I mentioned, the compilation offers far more exciting cultural-historical views on medicine and its practitioners.

Marland, H. and Pelling, M. (eds.), The task of healing. Medicine, religion and gender in England and the Netherlands 1450-1800. ƒ 84,50 (317 p.), ISBN 90-5235-096-5. Pantaleon reeks nr. 24, paperback

The ‘task of healing’ was a religious, social, and even political imperative in the early modern period, but one open to very different private and public interpretations. Medicine itself was extremely diverse and involved a wide range of religious, administrative, and educational institutions.

Its practitioners included university-educated physicians, surgeons, apothecaries, and midwives, whose respective roles and status shifted considerably over the period under scrutiny. A variety of unlicensed and lay healers also claimed legitimacy or practised without it.

This volume explores aspects of the healing task as it was interpreted and structured between 1450 and 1800 in the predominantly Protestant cultures of England and the Netherlands. As towns assumed responsibility for problems of poverty and ill-health, the services of medical practitioners were called upon more systematically, especially in the Netherlands. Competing religious groups sought to define and control the healing role, a process which could end in secularisation. Religious moralists grappled with the balance between body and soul. Individual men and women sought strenuously to achieve their own aims within a complicated structure of different authorities. The forms of authority concerned were almost exclusively male, which is well illustrated by the case of midwives. However male medical practitioners, always vulnerable to the gender connotations of the medical role, faced particular difficulties in contexts where misogynistic attitudes devalued women's nature and women’s work. Spheres of work, balances of power, gender connotations, and notions of the proper competence of different medical groups all changed during this period, in ways reflecting the differences in social structure in the two countries. Medicine was an integral part of major intellectual developments, such as natural history, in which both countries were especially distinguished.

The gap between medical practitioners and laymen and women widened, as medical learning, always broadly based, slowly became concentrated in the universities – but this was accompanied, especially in the Netherlands, by the modification of text-based learning by forms of ‘practice’. Some dimensions of medical practice were explored in art as a form of social commentary, particularly by the Dutch and Flemish genre painters of the seventeenth century. The volume draws upon this important pictorial evidence, in addition to a wide range of archival and literary sources.

Notes on the editors: Hilary Marland was until recently Research Officer at the Institute for Medical History, Erasmus University Rotterdam, and also the holder of a Wellcome Research Fellowship. In 1996 she has taken up a Wellcome Trust Research Lectureship in the History of Medicine at the University of Warwick. Her current research interests include the history of childbirth in the seventeenth century with special reference to iconography, Dutch midwifery practice, and puerperal insanity in nineteenth-century Britain.

Margaret Pelling is Deputy Director of the Wellcome Unit for the History of Medicine in the University of Oxford. Her main research interests are in health, medical practice, and social conditions in early modern London.

Contents: Hilary Marland and Margaret Pelling, Introduction; Fred Bergman, Hoping against hope? A marital dispute about the medical treatment of leprosy in the fifteenth-century Hanseatic town of Kampen; Peter Murray Jones, Book ownership and the lay culture of medicine in Tudor Cambridge; Frank Huisman, Civic roles and academic definitions: the changing relationship between surgeons and urban government in Groningen, 1550-1800; Margaret Pelling, Compromised by gender: the role of the male medical practitioner in early modern England; Mart va Lieburg, Religion and medical practice in the Netherlands in the seventeenth century: an introduction; Andrew Wear, Religious beliefs and medicine in early modern England; Hans de Waardt, Chasing demons and curing mortals: the medical practice of clerics in the Netherlands;Willem Frijhoff, Medical education and early modern Dutch medical practitioners: towards a critical approach; Margaret Pelling, The body's extremities: feet, gender, and the iconography of healing inseventeenth-century sources; Harold J. Cook, Natural history and seventeenth-century Dutch and English medicine; Hilary Marland, ‘Stately and dignified, kindly and God-fearing’: midwives, age and status in the Netherlands in the eighteenth century; Index

A publication of Erasmus Editors, Rotterdam

The doctor as Christ (1752). Attributed to Jan Jozef Horemans de Jongere. Collection Museum Boerhave Leiden (Holland).

Doctor's visit. Jan Steen. John G. Johnson Collection, Philadelphia Museum of Art.