Miscarriage in Nineteenth Century America

Shannon Withycombe’s Lost: Miscarriage in Nineteenth-Century America puts miscarriage at the center of the study of nineteenth-century science, medicine, and women’s experience with their reproductive bodies. You may be surprised by the range of responses to pregnancy loss, motherhood, and reproduction in the 19th century.

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Elizabeth: Hey Dig listeners. This series we are talking about bodies. Not exactly a topic we shy away from here on the podcast, but this series we’re going all in. The history of the body is a hot topic in the field of academic history and all our our own research touches on aspects of studying the body in one way or another.

Sarah: Today we’re going to look at miscarriage in the 19th century. Elizabeth and I explored early pregnancy in two previous episodes, Family Limitation in Early America and Birth Control and Abortion Before Roe v Wade. In those, we focused a lot on understandings of women’s reproduction in the seventeenth, eighteenth, and nineteenth centuries. We encourage you to listen to those episodes to gain a deeper understanding of women’s conceptions of their pregnant bodies and what pregnancy and personhood meant to women in prior centuries. Today however, we’re going to focus closely on miscarriage in the nineteenth-century.

Elizabeth: I recently read a book by historian Shannon Withycombe entitled Lost: Miscarriage in Nineteenth-Century America that puts miscarriage at the center of the study of nineteenth-century science, medicine, and women’s experience with their reproductive bodies. To be perfectly honest, Withycombe’s findings were not what I expected to find when I began reading.

The cover of Lost, by Shannon Withycombe | Rutgers University Press

Sarah: We tend to think of miscarriage today as something extremely difficult and sad. In fact, there’s a kind of cultural taboo around even talking about miscarriage. So many people who experience miscarriage can feel quite isolated and alone- left to feel they are experiencing and dealing with their miscarriage by themselves, which is far from reality as estimates put modern miscarriage rates at between 15-30 percent of all pregnancies. Some of our modern silence around miscarriage perhaps manifests because we as a society don’t know how to talk about miscarriage, or empathize with people who have experienced it. So miscarriage lives in this hushed, sad silence. But one thing Withycombe highlights in her book is how common miscarriage is and how in the 19th century miscarriage wasn’t always a hushed and silent event, or even a particularly sad event in all circumstances. It also shows how our modern-day feelings about miscarriage are culturally constructed and can change as society changes. This is in no way said to diminish pain and heartbreak felt by those who experience miscarriage, just to point out that our modern-day sensibilities do not necessarily reflect the same feelings and experiences of those living in the nineteenth-century.

I’m Elizabeth

And I’m Sarah

And we’re your historians for this episode of Dig.

Elizabeth: Framing miscarriage in the nineteenth-century gives us a really interesting way of looking at the massive changes that happened in America in the nineteenth-century. The Industrial Revolution and what some historians call the Market Revolution spurred massive movements and migrations of people all over the continent. This resulted in people moving away from their families and extended kin networks. Additionally, a massive uptick in reading took place as newspapers, instruction books, and novels gained vast amounts of readership. These two phenomenon drastically changed how reproduction, pregnancy, and miscarriage were experienced in the nineteenth-century as opposed to centuries past.

Sarah: We’ll look at migration and movement first. Prior to the nineteenth century, America was primarily an agrarian nation. Although trends that pushed people out of this lifestyle and into more urban areas began earlier, it was during the nineteenth-century that this movement really had a dramatic effect on how people lived and worked. As labor in the household changed, so too did social networks. Prior to the nineteenth-century, women’s reproductive capabilities were largely within the purview of women. Networks of women consisting of mothers, daughters, cousins, aunts, neighbors, and trusted midwives took care of the bodily needs of women in childbirth and miscarriage.

Elizabeth: Female friends and relatives came to provide comfort, knowledge, and practical help when a woman went into labor or to assist after a miscarriage. For most seventeenth and eighteenth-century women, their lives were spent in a prolonged period of childbearing, nursing, and caring for children. The average age of marriage was around twenty-two and a woman’s last child would be born around the age of forty. This meant that a mother could be giving birth to her youngest child around the time that her first-born was giving birth to her grand-daughter! Family size decreased as the centuries wore on, but families were still large and child raising and domestic tasks were still extremely burdensome. So when a woman went to child bed, or suffered a miscarriage, women friends, kinfolk, and midwives stepped in not only to assist in delivery and recovery but perhaps more importantly, assisted in the care of the rest of the household. This women-centered labor was extremely important for carrying on the day-to-day activities of the household while also acting as a way to share knowledge about women’s reproduction. I mean, if you think about it, these women saw and participated in a lot of pregnancies and miscarriages throughout their lifetime. It was something they experienced in their own bodies and saw with their own eyes. Male physicians were rarely called in for these kinds of life events, and usually only for cases of emergency. Reproduction primarily rested within the purview of women.

Sarah: In the late eighteenth and early nineteenth-century this began to change and for a number of reasons. Midwives, once considered an important element of any community, slowly began to be replaced by male physicians. The dominant narrative surrounding the rise of male physicians argues that male doctors began to assert their authority over women’s reproduction through the professionalization of medical knowledge and the desire to profit from that expertise, all while demonizing midwives’ lack of scientific expertise. That is definitely part of of the larger story but not all of it. There were other factors that created this change too.

Elizabeth: The massive changes happening in American industry and the economy also had a part to play. Throughout the early nineteenth-century, more and more families began to work within the market economy. Mostly men, but women too, began working outside of the home in factories for wages. Additionally, many households began to bring industrial work into the home to be assembled by family members. A good book that chronicles this shift is Paul Johnson’s Sam Patch, The Famous Jumper. At its core, it’s a book about a famous waterfall jumper (it’s kind of a bonkers story) but it also chronicles how many families weathered this change, from agrarian self-sufficiency to entry into the market economy. As families navigated these economic changes, many moved away from the social networks they had traditionally been a part of. This meant that women no longer had these vast networks of women friends and relatives to aid and assist in reproduction like their grandmothers had in years past. Meanwhile more, mostly male, physicians began to study at European and American medical schools and were anxious to ply their trade. Physicians began to form social and professional organizations and leadership.

Sarah: This coincided with a kind of information revolution that took place. Throughout the first half of the nineteenth-century, literacy rates among American-born white people skyrocketed – up to 90% in 1850! The market revolution facilitated these rising reading levels because reading material became more readily available. The steam printing press and shortened shipping times aided by transportation innovations like the Erie Canal, made it easier for people to get their hands on books, magazines, and health and wellness guides. Medical manuals for both medical practitioners and laypeople flourished and more and more people began to gain their health and wellness knowledge not from their wise grandmother, but from the latest health guides. These kinds of books were in no way new, but in the 1840s publishers focused on books and pamphlets particularly aimed at women and women’s health. For example, there was the popular encyclopedic Gunn’s Domestic Medicine, or my favorite, Edward Dixon’s Woman and Her Diseases, from the Cradle to the Grave, just to name a few.

Elizabeth: These domestic health manuals helped physicians convince female readers of the importance of medical intervention in the case of miscarriage. Previously, most women went through miscarriage as they had done with childbirth- among trusted female friends, family, and midwives. In the case of miscarriage, they perhaps even experienced it alone or with their spouse and close family members, bleeding and cramping until it was done. Rarely was a doctor brought in as miscarriage was considered a normal part of many women’s reproductive lives. Only when there were complications such as convulsions, excessive or extensive bleeding, or severe fever was medical assistance sought out.

An illustration showing a half-man, half-woman midwife

A Man-Midwife, Samuel William Fores, 1795 | The Wellcome Collection

Sarah: As regular doctors – regular being the term that professional doctors used to distinguish themselves from untrained healers or quacks as they called them- gained more knowledge and access to women’s reproduction, they also increased their focus on the medicalization of miscarriage and their clinical expertise. Organizations such as The American Medical Association, formed in 1847, continually pushed for the professionalization and regulation of medicine. Essentially, they worked to keep the practice of medicine out of the hands of lay healers, like midwives. Additionally, pain relieving chloroform and ether were both used for women in childbirth for the first time in 1847. This allowed women to be relieved of some of the pain in childbirth while further increasing medical dominance in obstetrics and gynecology. And to be clear, middle and upper-class woman began seeking out professional medical care. It was fashionable and the “new” thing to have a medically trained doctor, who administered pain relievers and sedatives, and who might even use metal forceps (something that midwives on a whole did not use because of their potential complications) to help speed along a delivery. So as more male physicians were admitted to assist with birth and miscarriage, their knowledge and expertise increased. As the century progressed, it became more normal to have a male physician attend women during childbirth and miscarriage.

Elizabeth: One of the best parts of Withycombe’s book Lost, is her study on how women during the nineteenth century actually felt and experienced miscarriage. She combed through women’s diaries and family papers to find evidence of their miscarriages and what they had to say about them. It’s important to point out that the written historical sources we have, so say papers found in archives, are usually saved because someone deemed them important enough to keep. This typically means that these types of written sources normally represent the voices of white men and occasionally white women. So it’s important to remember that these weren’t the experiences of all American women. However, the writings she explored regarding women’s miscarriage give us more information on the matter than previously thought possible.

Sketches of a woman's torso as it grows through the stages of pregnancy

The stages of pregnancy | Wellcome Images

Sarah: The personal writings of women who miscarried in the nineteenth century ran the gamut from relief, to sadness, to even joy at the outcome of their miscarriage. Emily McCorkle Fitzgerald was the wife of an army surgeon who was stationed in Sitka, Alaska in the late 1840s. In a letter home to her mother, Fitzgerald wrote about the hardships of raising children in an unfamiliar and harsh environment. She wrote, “I have not been feeling well for a month. I know I look badly and I know Doctor has been a little concerned, for he has put me on cod liver oil, and iron and quinine, and all those lovely things. I did not think I would tell you until I saw you, but I will now. I had a miscarriage about five or six weeks ago, but I lost a great deal of blood and all my strength… I have not gotten over it yet.” However, Fitzgerald went on to write, “I am thankful now that I did have it [the miscarriage], as another Sitka baby would have been my fate.” Her relief is evident in her letter. Fitzgerald’s letters to her mother were filled with the domestic responsibilities of raising young children. She was obviously not in a hurry to add another one. Remember, this was a time when women did not have much control over their fertility and the spacing and timing of their children.

Elizabeth: In 1875, Annie Youmans Van Ness wrote about her miscarriage in her diary. Her and her husband’s financial situation was not good and in January she suspected she was pregnant. She wrote that it made her feel “very cross and irritable.” Two weeks later she wrote , “I am happy again, a week ago last night I was taken sick at the supper table, I went to my room and retired early, to make a long story short I will say, that the next day Ma told me she had seen her first grand child.” She went on to write, “I just happened to think that any body might imagine from reading this that I had a baby, but I haven’t! It was only what they call a miss–. It wasn’t any larger than a jointed doll.”^{^[1]} Clearly Van Ness was also relieved by her miscarriage, even talking about it kind of flippantly.

Sarah: Mary Cheney described her miscarriage in 1879 as a relief as well, but also expressed sadness at the experience. The Cheney’s had nine children by that time. In a letter to her husband, regarding her miscarriage she wrote, “O Bliss, O Rapture unforseen! … the imaginary Number 10, whom I had already begun to love, is not a real entity as yet, and will not be for a long time to come.” She went on, clearly saddened by the event but also relieved. She wrote, “I don’t know that we are called on to mourn the loss of a child, but you will perhaps wonder at me that I found it at first so hard to part with my trial [so her trial being pregnancy and miscarriage], for trial it has been but one in which much sweetness has been delivered.”^{^[2]}

Elizabeth: It’s actually a bit of a surprise to read these kind of accounts about miscarriage because motherhood was such an important and critical element to popular conceptions of womanhood in the nineteenth century. And yet, birth control and family planning were almost impossible for many women. Women who wanted to control their fertility, to keep their children paced in years, to not be pregnant every year for the rest of their lives, had little control short of just staying as far away from their husbands as possible. So in that respect, these reactions to miscarriage make more sense.

Sarah: Throughout most of the nineteenth century, women and doctors viewed miscarriage as a kind of correction- as nature’s way of fixing a non-viable pregnancy, or even just a delayed menses. After roughly the 1840s however, doctors began to view miscarriage as something over which they had expertise and as a type of medical malady that could be fixed, or studied. Women on the other hand, had varying views of doctor’s expertise when it came to their miscarriages as doctors had little to no actual ways to help their patients during miscarriage or stop the process. Withycombe found in many women’s diaries and personal papers that women were disappointed in the medical help they received during a miscarriage. In 1856 Gertrude Thomas had a miscarriage. She wrote, “early the next morning I found that I was in such a situation as to frighten me with fears of sickness. Coming up home we called by for Dr. Eve. Nothing that he did (in fact he did nothing) proved efficacious, and on Monday I had an abortion – at two months.” Now note, her use of the term abortion, which prior to the twentieth century, and even into the twentieth century, was an interchangeable term with miscarriage. Women wrote about having an abortion in ways that made it clear the event was neither intended nor induced and doctors described abortions as mostly accidental. By Gertrude Thomas’ own words, it was evident that she had a miscarriage, had called the doctor for assistance, and was disappointed when he “did nothing.”^{^[3]}

Elizabeth: Medical instructors, so doctors teaching doctors, and medical textbooks instructed doctors in the 1840s and 1850s to generally let nature take its course when a woman was miscarrying. For the first two-thirds of the century physicians described miscarriage as something occurring naturally and warned of the possible dangers of interference in the event. In 1856, physician G.S. Palmer was called to treat a woman who was experiencing “a strange pain in the vagina” and had been experiencing pain and discharge for four weeks prior. When Palmer examined the woman he found a five-month fetus in her birth canal, which he removed easily. However, his attempts to help her expel the placenta, by giving her ergot, which helped uterine contractions, did not produce the desired result and instead produced a “frightful hemorrhage.” Instead of forcing things along, Palmer wrote that he stemmed the hemorrhage blood flow with a tampon and let nature take its course. Four days later she expelled part of the placenta. He was called back to her home four months later to find the woman “flooding copiously” until she finally delivered the rest of the placenta. Palmer wrote about the event in the Boston Medical and Surgical Journal as a successful treatment, closing his article with the words, “thus did nature hermetically seal up, and perfectly protect from decomposition, in a high temperature for four months, a foreign substance, which it could not throw off at the proper time, and when the system returned to a proper state and condition, she relieved herself by the same.”^{^[4]} So Palmer is basically saying, the body is a mechanism of nature, it did its natural thing, and when it was done, all was well. Withycombe’s research through all of these medical journals and textbooks, found that was the basic understanding among American physicians. This began to change during the 1870s however.

Sarah: This shift in the latter part of the nineteenth-century again coincided with another mass migratory and economic transformation in America. Massive immigration into the country, as well as the migration of native-born young people to urban centers along the East coast further disrupted old social networks. For new immigrant women, their families and the reproductive networks they would have utilized in their home countries were simply not available in their new cities. Young women were often separated from women knowledgeable about reproduction. Additionally, cramped urban housing meant that there often simply wasn’t room for a laboring or miscarrying woman to be taken care of in the home. Thus the rise of the maternity or lying-in hospital in America was born. These charity hospitals were founded to help poor and unmarried women with medical care. In exchange for the free or low cost medical care women received, their experiences were used as training for new doctors, nurses, and medical students.

An engraving showing a man and woman peering at a tiny fetus in a jar on a mantelpiece.

“A bourgeois wife shows her husband the preserved fetus of her cousin” SGC Garvani | Wellcome Images

Elizabeth: As poor and working-class women began to enter the maternity hospitals, the power dynamic between miscarrying woman and medical professional began to shift. Middle and upper-class women who invited a doctor into their home held some power over what they would and would not allow a doctor to do. Women within a charity hospital however, did not have that kind of authority. Doctors could study women’s miscarrying bodies, and the tissues they expelled, more readily than they could in a “respectable” women’s home environment. The knowledge doctors gained from working on the poor they could then be used as a means to establish themselves professionally, either by using that knowledge with their private, paying clients, or through publications in prestigious medical journals. Additionally, the more physicians were called on in times of miscarriage, the more familiar with the event they became. By the 1880s, physicians began to describe miscarriage as an abnormality or pathology that only their medical skills could adequately deal with.

Sarah: Instructors advised physicians to clear out the uterus as quickly and efficiently as possible, using their fingers, metal instruments, or if necessary, their whole hand. Withycombe found a change in the language used in these texts later in the century. No longer was a miscarriage happening to a female patient, but to a uterus. Physician J.S. Baer wrote in 1897 that “an empty uterus was a safe uterus, and the organ is only safe when it is empty.”^{^[5]} Additionally, Withycombe found surgical instrument catalogs rarely sold curettes in the mid-nineteenth century but by 1899, they were extremely popular and marketed as useful tools for extracting miscarriage tissues.

Elizabeth: According to reports in medical journals, physicians attended an increasing amount of miscarriage cases between the years 1870 and 1900. Additionally, domestic health texts increasingly encouraged women to seek out professional medical care when they experienced a miscarriage as opposed to taking care of it on their own. Doctors began seeing the value of attending miscarriage, particularly because of the amount of miscarriages they were seeing when poor and immigrant women came to them through maternity hospitals, Additionally, women themselves began to see a value in seeking out professional medical help during a miscarriage. These coinciding threads culminated into a construction of miscarriage as an abnormal medical phenomenon that was an event that brought a healthy pregnancy to an unhealthy end. The close reading of medical texts, domestic health books, and the diaries and personal papers of women illuminates how popular conceptions of miscarriage changed over the nineteenth century into an understanding of miscarriage as a medical anomaly.

Sarah: The increased medicalization of miscarriage had another impact on scientific study and understandings of human development. As more physicians attended miscarriage, they were able to probe and study the actual products of miscarriage, the fetal tissues and placenta that came out of women’s bodies. Collections of fetal tissue began to line the walls of private doctors and university labs. There is little evidence from women’s writings as to what they did with the matter that came out of their bodies after a miscarriage. Most likely, many women had little issue with the materials of their miscarriage going home with their attending physician.

Elizabeth: Archaeological evidence from the nineteenth century and before shows that much of the material from miscarriages wound up in privies and other disposal sites. However, some women chose to bury the results of their miscarried pregnancy. Caroline Healey Dall described the miscarriage of her five month-old fetus in 1847 writing, “it is impossible not to love it, though it should prove an abortion.” The fetus had “no thumb on the right hand – but instead five fingers- the fifth growing out of the first. The smaller intestines were formed on the outside and the scrotum was deficient.” Her husband “buried his little one, with his own trembling hands.”^{^[6]} It is interesting to point out that Dall also had a miscarriage the year before when she was three months along. She did not mention in her diary what she and her husband did with the outcome of that miscarriage. One could assume that they were disposed of because perhaps, they did not bare as much resemblance to a fully formed human. However, that is only an assumption. Women and families who miscarried at home had the power to decide what they would do with the products of a miscarriage.

Sarah: As physicians attended more miscarriages however, they began to collect the expelled matter and tiny beings for scientific study. Many histories center the emergence of the field of embryology in Europe but Withycombe argues that American physicians and anatomists were also integral to the growth of the field. More importantly, understanding women’s attitudes about miscarriage was critical to the emergence of this new field of study. The importance of obtaining miscarried materials increased as throughout the nineteenth century, reference to the products of a miscarriage changed from descriptors such as “fruits,” “bubbly lots,” “moles,” and other indiscernible objects that were expelled from the vagina were replaced by a sense of scientific excitement as to the marvels of human development available from the body of a miscarrying woman. For physicians interested in adding to the study of fetal and human development- and increasing their own professional expertise- attending a miscarrying woman was the easiest way to obtain fetal tissues.

Elizabeth: A Dr. Hendrix displayed a what he termed “an interesting specimen” to the St. Louis Medical Society in 1884; a seven-month old fetus complete within the placenta. He explained that he had been called to the bedside of a woman in miscarriage but because he arrived late, he had not been able to rupture the membranes to speed the delivery along. On account of his tardiness, he was able to procure the delivered fetus, which was still inside the placenta. He did not say anything about negotiating with the woman to allow him to keep the fetus, but since this seemed to be a private delivery in a home, it can be assumed that she agreed to let him take it. That wasn’t always the case however, as a Dr. T.R. Rubush described his inability to take a pair of five month developed twin specimens from a home in 1892, as the “parents object[ed] to it.” This shows us that women who had miscarriages in their own homes with a hired physician had more say in the matter of deciding what was a fetus, a child, a clot, or something else.

Sarah: This wasn’t the case for Ohio physician James Irvine however, who upon delivering a full term healthy baby to a Mrs. S, discovered that she also delivered a premature fetus. Irvine wrote that “this [the preterm fetus] I concealed under the bed-clothes, informing my patient and the bystanders that it was merely the passage of a few clots of blood.” He “directed the all-inquisitive nurse to go down stairs and make the mother a cup of tea, and during her absence ascertained that the mass first expelled was a foetus of from four to five months, in a high state of preservation.”^{^[7]} Another physician reported a similar event and told his audience, “It must be remembered that the mother does not know of the second fetus,” giving some indication that the physician was deceiving her so as to collect the fetus for study. Another physician recounted a case where attended a miscarriage that consisted of one fetus he and two placentas and “regretted exceedingly, since the occurrence of this circumstance, that I had not pocketed the curious productions for preservation in alcohol.” ^{^[8]}

Elizabeth: These examples of “specimen collection” makes me think back to an episode I did not the rise of the natural history museum and how scientific knowledge was built on these huge collections of specimens. Additionally, scholars have done a lot of work on exploring how many Western museums and universities collected the bones and cultural materials of indigenous and non-western peoples and the exploitation and chicanery behind many of that collecting. So in terms of this episode and miscarriage, it’s interesting to think about the ways that a lot of scientific knowledge we kind of take for granted, was produced. These examples of fetal and tissue collection that Withycombe has uncovered really make us think about the point of transfer, from woman’s body to lab, of these products of miscarriage and how often it was women’s conceptions of what the products of their miscarriage actually were that allowed these “specimens” to make it into networks of scientific research.

Sarah: That’s it for today. Thank you to Shannon Withycombe for sending us your brand-spanking new book, Lost: Miscarriage in Nineteenth-Century America. Listeners, if you’d like a little more information on reproduction throughout history, check out our show notes for sources used in this episode and suggestions for further reading.

Elizabeth: Also, we ask that if you enjoy our episodes, please leave us a review in your podcast app. We’re not joking when we say that reviews help us grow this podcast. The more reviews our podcast has, the more the podcast apps share our podcast with potential listeners. So please. Leave us a five star review.

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Elizabeth: Thank you for listening!

Bye!

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