In a Tortoiseshell
In this excerpt, I set up the scholarly conversation about physicians’ adoption of obstetric anesthesia in the late 19th century. I aim to highlight different historical camps and to reveal a question overlooked by historians. I am curious not only about how obstetric anesthesia came to be accepted by doctors, but also about how and why obstetric anesthesia was framed as a racially-specific intervention. In this manner, I aim to demonstrate my motive for closer analysis of primary sources, specifically Dr. James Young Simpson’s writings about obstetric anesthesia.
Excerpt
In 1847, Scottish obstetrician Dr. James Young Simpson began advocating among his colleagues for the use of chloroform to treat parturient pain.1 At first, the overwhelmingly white and male American and European physician class was divided over whether to adopt this novel intervention.2 Scholars have noted that the normative debate among physicians about the use of obstetric anesthesia hinged on defining whether parturient pain was pathological or physiological.3 Historians have offered various theories about how obstetric anesthesia became widely accepted by the medical community in the late nineteenth century. According to historian Judith Walzer Leavitt, some physicians believed that labor pain was natural, and they worried about the side effects of anesthesia on the mother’s health.4 Walzer Leavitt argued that the pro-anesthesia faction prevailed largely due to parturient women’s grassroots advocacy for pain relief during labor.5 Historian Jacqueline Wolfe endorsed Walzer Leavitt’s stance with an important caveat: altruism was not physicians’ only motivation for giving women the anesthetics they desired. Rather, physicians from America and Great Britain shared their nations’ worries about the declining birth rate among white women.6 According to Wolfe, nineteenth-century physicians set aside their concerns about the safety and efficacy of obstetric anesthesia in favor of addressing this social problem; by making birth less painful for white women, they could persuade these women to have more children.7 However, Wolfe did not detail exactly how physicians managed to label obstetric anesthesia as an intervention suitable for white women only, leaving this an open question in the scholarship. Examining the writings of Dr. James Simpson, the first obstetrician to promote chloroform as obstetric anesthesia, reveals that he justified its use by relying on medical myths that Black women were primitive and insensitive to pain in order to label parturient pain as a disease unique to white, civilized women. Employing this racialized logic allowed physicians to respond to concerns about white population decline while reinforcing their professional authority and upholding social norms regarding gender and race.While Walzer Leavitt and Wolfe highlighted the legitimate dispute about the safety of obstetric anesthesia alongside social pressures which spurred physicians’ acceptance of this intervention, they overlooked the implications of the obstetric anesthesia debate for the professional status of physician-obstetricians themselves. At the turn of the 19th century in Europe and America, male obstetricians were still struggling to usurp female midwives as the dominant professional authority on childbirth.8 If obstetricians established labor pain as a prevalent disease that could only be treated using anesthetics—inaccessible to midwives—then these physicians could better contest the inclusion of midwives in the birthing process due to their lack of specialized knowledge about pathology and their dearth of necessary medical supplies. However, pathologizing labor pain also risked undermining male physicians’ professional authority as it potentially posed a radical challenge to nineteenth-century gender roles in Europe and America. In her analysis of 19th century folklore about labor pain, Miriam Rich specified that the pains of childbirth helped justify mothers’ assignments as stewards of domesticity; labor pain was thought to render mothers too fragile to function outside the home.9 Thus, many physicians and common people reasoned that the experience of labor pain naturally predisposed women to serve as ideal family caretakers.10 Accepting parturient pain as a ubiquitous disease of childbirth could have weakened this convenient justification for women’s relegation to the domestic sphere. Because the physician class was nearly exclusively male, they benefited from the myth that women’s reproductive capabilities made them naturally suited for work inside the home and, implicitly, unsuitable to compete in the medical marketplace as a physician. Thus, male physicians were tasked with negotiating a professional tradeoff: rejecting labor pain as a disease could provide midwives an opening to regain control over the birthing chamber, but accepting this pathological classification risked destabilizing patriarchal values. Simpson cleverly resolved this dilemma by framing labor pain as a disease of civilization to which white women were uniquely susceptible. Under this definition, although the effects of labor pain were harmful to a white woman’s health, the existence of this pain signaled their pre-existing refinement, fragility, and sensitivity as byproducts of civilization, qualities that made a mother well-suited for the delicate work of nurturing children. By framing labor pain as a race-specific disease and consequence of civilization, physicians justified the intervention of obstetric anesthesia for their target audience of white, upper-class women while maintaining the overall cultural association between labor pain and domesticity alongside whiteness and advanced civilization.
Footnotes
- Jacqueline Wolfe, Deliver Me From Pain (Baltimore: Johns Hopkins University Press, 2009), 24. ↩︎
- Wolfe, Deliver Me From Pain, 27. ↩︎
- Wolfe, Deliver Me From Pain, 28; Miriam Rich, “The Curse of Civilised Woman: Race, Gender and the Pain of Childbirth in Nineteenth-Century American Medicine,” Gender & History 28, no. 1 (2016): 68. https://doi-org.ezproxy.princeton.edu/10.1111/1468-0424.12177. ↩︎
- Judith Wazler Leavitt, Brought to Bed: Childbearing in America, 1750-1950 (New York: Oxford University Press, 1986), 117. ↩︎
- Wazler Leavitt, Brought to Bed, 118. ↩︎
- Wolfe, Deliver Me From Pain, 17. ↩︎
- Wolfe, Deliver Me From Pain, 17-18. ↩︎
- Wazler Leavitt, Brought to Bed, 38; Rich, “The Curse of the Civilized Woman,” 60. ↩︎
- Rich, “The Curse of the Civilized Woman,” 58. ↩︎
- Rich, “The Curse of the Civilized Woman,” 58. ↩︎
Bibliography
Rich, Miriam. “The Curse of Civilised Woman: Race, Gender and the Pain of Childbirth in Nineteenth-Century American Medicine.” Gender & History 28, no. 1 (2016): 57-76. https://doi-org.ezproxy.princeton.edu/10.1111/1468-0424.12177.
Walzer Leavitt, Judith. Brought to Bed: Childbearing in America, 1750-1950. New York: Oxford University Press, 1986.
Wolfe, Jacqueline. Deliver Me From Pain. Baltimore: Johns Hopkins University Press, 2009.
Author Commentary / Sonia Cherian
I wrote this essay as my final paper for HIS 390: Formations of Knowledge: Historical Approaches to Science, Technology, and Medicine. I enjoyed learning about the philosophy of science as a tool to analyze values and epistemic virtues embedded in different practices of science. This class showed me that even though science is seen as an “objective” endeavor, scientific practice and findings can be shaped by a host of social and cultural factors which impact definitions of health and sickness. This notion that disease categories are historically and culturally contingent was central to my exploration of the development of obstetric anesthesia. When I began researching the history of obstetric anesthesia, I expected to uncover a story of empowerment: how could offering women the option to reduce childbirth pain be anything but a triumph for obstetricians and their patients? However, assessing the scholarly conversation and analyzing physicians’ primary source writings about obstetric anesthesia led me to a different conclusion. I realized that physicians relied on, and even reinforced, racist notions about which women experience pain in order to label obstetric anesthesia as a racially-specific intervention. Through my historical analysis, I discovered that this racialized definition may have appealed to the white, male 19th-century physician class as they sought to elevate their professional status while upholding gender norms. During my writing process, I first combed secondary sources about the development of obstetric anesthesia: this helped me identify my key primary sources, writings by James Young Simpson. However, only during my own close reading of the source did I uncover his racialized descriptions of parturient pain that had gone unmentioned in the secondary sources. I spent lots of time going back and forth between the secondary and primary sources to make sure that I had truly identified a “gap” in the scholarship, and to equip myself with historical context to better evaluate Simpson’s motives. Writing my introduction with the goal of laying out my motive helped me solidify my scholarly conversation and thesis.
Editor Commentary / Katja Kochvar
Sonia and I are both students in the sciences, most familiar with concise and precise scientific writing. While the course Sonia wrote this essay for may have “science” in the name, the focus was placed squarely on historical analysis. Historical analysis is necessarily a process of imagination. It forces us to reconcile the facts, statistics, and accounts from primary sources with perspectives, ideas and interpretations from secondary sources. In analyzing history, we must not only decipher what happened, but question who tells the story of what happened and what their motivations might be.
Sonia embraces this challenge by evaluating historical analyses from multiple secondary sources. She first lays out a historian’s interpretation of why parturient anesthesia was widely adopted by the medical community, namely that “grassroots advocacy for pain relief during labor” was the main driver. She juxtaposes this claim with an account from another historian, who instead proposes that “the declining birth rate among white women” was a broader concern and motivation for adopting anesthetics. Based on this interpretation, Sonia cleverly identifies a gap in the literature: how did concerns about white birth rates justify an intervention many physicians deemed unsafe and risky?
In answering this question, Sonia inserts herself in the past, fully immersing herself in the mind of a key physician, Dr. James Simpson, and the broader context of the era. This task requires immense creativity—it is no easy task to imagine the inner workings of a white male physician’s brain in the 1800s! Yet Sonia does not shy away from succinctly detailing the anxieties physicians felt about their precarious role as authorities on childbirth and defenders of patriarchal values. Her deep understanding of these concerns, paired with careful analysis of the primary source writings of Dr. James Simpson, allowed Sonia to follow the logic of physicians’ ultimate decision to adopt parturient anesthesia. What she finds is a story rooted in racist and sexist notions about who experiences pain and what treatment they are entitled to in a white supremacist society.
It is worth noting that the prompt for this paper was entirely open-ended; Sonia had the power, and burden, of choosing a topic of her own. While this task can be daunting for many students, Sonia allowed her own interests in medicine and careful reading of secondary sources to guide her to an unsolved scholarly puzzle. This essay can hopefully encourage other students facing big, broad prompts to follow your feelings—of curiosity, interest, indignation—to an interesting thesis. It is this process of finding your unique voice that often leads to the most creative writing solutions.
