A History Of Contraception

A History Of Contraception: From Antiquity To The Present Day

Angus McLaren - Blackwell, 1990 - 278pp. - £25

History Of Childbirth, Fertility, Pregnancy And Birth In Early Modern Europe 

Jacques Gelis, translated by Rosemary Morris - Polity Press, 1991 - 326pp. - £39.50

'Shattered Nerves' - Doctors, Patients And Depression In Victorian England

Janet Oppenheim - Oxford University Press, 1991 - 388pp. - $27.95

The history of medicine used to be a peripheral subject confined largely to doctors who had antiquarian interests or who wished to celebrate their own interests – along with the march of medical progress. The subject was of little interest to historians. But the history of medicine is now a major branch of history, central to the study and understanding of any society and attracting gifted historians. Michel Foucault initiated a new historical industry in the study of power relationships and this has been particularly fruitful in the history of medicine. Recently historians have been looking at those subjects that were once no part of medicine but which became 'medicalised' and so part of the medical profession's struggles for power, both internal and external. New light on these problems can also blind. Many of those working in the field have no medical background and this can cause problems. All these books show how historians and doctors need each other.

Each of these books makes important contributions to the new tradition. All present their subjects from modern angles with extensive references (though these are sometimes difficult and tedious to follow because of the failure to put page numbers in the lists of notes or to indicate the whereabouts of the full reference). All the books will be useful to those who read, write, teach or research in these fields, and for many they will be invaluable.

Contraception (like abortion) is one of those subjects over which the medical profession struggled to gain control in order to do little or nothing about it. Angus McLaren's History of Coatraception is much more than just a history of the subject. Written by a professor of history, it avoids the approach that concentrates on progress and new discoveries and enters the field of the history and significance of fertility control. McLaren discusses population changes and attitudes to marriage and divorce; babies normal and abnormal, their care and sometimes their killing; fertility and infertility, including such practices as concubinage, the sharing of fertile wives and, recently, surrogacy; impotence and masturbation, abortion and miscarriage; drugs in pregnancy; and property rights in relation to fertility.

Discussion of (quite sophisticated) attitudes to contraception in Ancient Greece and Rome is followed by assessment of the question of birth control in the early Christian period, during which the initial preaching of equality between the sexes gradually gave way to the development of a male- dominated, hierarchical institution fiercely opposed to birth control and, it seems, to women in general. McLaren questions the common view that the 'Dark Ages' are of no interest to the historian of birth control. He points out that this period saw the change from 'the old Roman-style family' to the 'new symmetrical household', now without slaves and cherishing large numbers of children for their work potential. Meanwhile, throughout the Middle Ages, the Church increased its attempts to control sexuality and prevent the use of contraception.

Then came the gradual shift of the Church's objections to contraception from theological to medical arguments and gradually doctors became the 'experts' in all things sexual and procreative. By the nineteenth century fecundity was competing with gentility and, amid insufficient resources for both, gentility won. But well into the twentieth century powerful doctors continued to insist (on no evidence other than their own strong feelings) that control of conception was dangerous and harmful and led to serious diseases. Politicians were equally condemnatory. 'The woman who flinches from childbirth', declared Theodore Roosevelt, 'stands on a par with the soldier who drops his rifle and runs in battle', But this was going against the tide and family size was already diminishing. It seems that birth control campaigns are successful only when births are already declining.

Jacques Geli's History of Childbirth was published in France in 1984 and is researched largely from French sources. It is more anthropology than history, with much fascinating information and many anecdotes, some of them sad or gruesome. There is a particularly interesting account of pain in childbirth and its symbolic meaning in motherhood along with, until comparatively recently, lack of consideration for possible suffering of the infant.

Among the many other topics discussed are attitudes to pregnancy and to babies, positions for delivery and how these are socially determined, and the anthropology of monstrosities, 'imperfect beings' or 'nature's jokes'. There are also stories of a woman who gave birth to a bitch because her husband treated her like one, of women who ate their placentas and even their new- born babies, of babies emerging spontaneously several days after the death of their mothers – including twins in a grave later exhumed. We can read here of the dangers of redheads (believed to be the product of menstrual blood) and of the custom of preserving the umbilical cord with its Iigature, to give to the child at the age of three or four to see if it could untie it, a sort of intelligence test. The book discusses the interesting shift in vocabulary as doctors gradually wrested control of childbirth from midwives. For example, s'accoucher, to deliver oneself, gave way to etre accouchee, to be delivered, and there is a graphic description, with examples and quotations, of the lack of effort to resuscitate newborn babies up to the mid-seventeenth century. Was this a disguised form of infanticide?

This is a visual subject but unfortunately the book contains few illustrations. It also contains some mistakes which obscure some of the meaning of the text. It is not always clear whether these come from the translation or the original text. The presence of albumen in the urine of a pregnant woman is abnormal (p.48), so this does not explain the 'uromancy' described on p.48. The word 'probe' is used instead of 'catheter'. The malformations described as 'perforated anus or uretha' (p.174) are fanciful (these structures are normally perforated!); it looks as though what is meant is something like 'imperforate anus and atresia of the urethra'. Although it discusses the subject of 'face presentation', a comparatively rare condition, there is no entry for 'breech', the commonest malpresentation. This is described as 'feet first birth', which few readers would look for. These things annoy because it is such a good book.

Oppenheim's book is just as good despite her confusing equation of 'incapacitating depression' with 'nervous breakdown'. Nervous breakdown is a popular term for an inability to carry on normal life for psychological reasons, and there are many types. Although depression may be the commonest, I found myself constantly thinking of others (e.g. anxiety, schizophrenia, phobia, etc.). Nevertheless, here is a wealth of information and stimulating surprises for modern enthusiasts for the Victorian period. As the author says, it is impossible to read all the sources in this rich field, but her reading is impressively wide and covers psychiatric and medical texts as well as periodicals, diaries and letters, contemporary fiction and much else. Probably wisely, she makes no attempt to assess why the Victorians, both men and women, were so de- pressed, or even whether they were really more depressed than those before and after them. The fact is that many of them were depressed and exploring this gives a fascinating and unusual path into the Victorian world.

It is strange that the book contains no entry for 'religion', since this was important in depression. There is also little about anxiety, which plays such an important part in psychiatric disturbances. Neurosis is discussed briefly (p.8) but is not listed in the index, whereas anorexia nervosa, believed until the late twentieth century to be a rare disease, gets nineteen entries! Oppenheim is interesting on the subject of depressed Victorian gentlemen who consulted gynaecologists for relief but is curiously silent about the many thousands of depressed and hysterical women who came into the hands of the same gynaecologists and had their ovaries (and sometimes their clitorises) removed as a result.