Tuesday, 16 August 2016

"The Great Arcana of the Deity": Menstruation and Menstrual Disorders in Eighteenth-Century British Medical Thought

In late May 1762, concern for the health of his adolescent daughter prompted James Hamilton to write to Dr. Robert Whytt. Noting that “my daughter, Jeannie, your patient menstruated [for] . . . five days as Usual and [my wife] . . . thinks she had a sufficient Quantity,” Hamilton begged Whytt to recommend a regimen that would ensure that Jeannie’s menses continued to follow a healthy pattern. 1 In the months that followed this letter, Hamilton—and Jeannie—meticulously followed Whytt’s advice, recording, predicting, and treating Jeannie for any and all menstrual irregularities. As an educated layperson and a concerned father, Hamilton was well aware that the “morbid flux” that began at puberty could “excite a thousand Disorders in [a woman’s] frame.” 2 Additionally, he recognized [End Page 38] that a normal menses was no guarantee of future health. While few fathers and practitioners shared his zeal in recording and assessing their daughters’ and/or patients’ menstrual cycles, most eighteenth-century Britons firmly believed that menstruation determined and defined the weaknesses of the female body. This conviction that menstruation served as a barometer for a woman’s health led a growing number of medical theorists and practitioners to debate both the causes and the implications of menstruation and menstrual disorders during the course of the eighteenth century. For the historian, these debates illustrate the emergence not only of different ideas regarding sexual difference, but also of new reasons for accepting some classical medical theories.
While medical practitioners had always speculated on the causes and meanings of the menses, the eighteenth century—a time when male practitioners began to enter the field of midwifery in large numbers—witnessed a growing interest in and concern with menstruation. For men-midwives, the care and treatment of women suffering from either the catamenia (the menses) or one of its attendant disorders provided an unparalleled opportunity to extend their practice beyond the field of obstetrics and thus to better their status. Originating in the 1720s, a widespread campaign had resulted in the development of rigorous and comprehensive midwifery courses designed to make the man-midwife the equal of the physician. Some of these courses, most notably those taught by Thomas Young, Alexander Hamilton, and James Hamilton, were a part of the medical curriculum offered at Britain’s most innovative medical school, the University of Edinburgh; 3 along with others, such as those offered in London by John Clarke, Thomas Denman, John Haighton, John Harvie, William Hunter, John Leake, William Lowder, Colin Mackenzie, John Maubray, William Osborn, William Saunders, and William Smellie, these courses drew increasing numbers of aspiring practitioners as the century progressed. 4 The subsequent blurring of the[End Page 39] professions makes it impossible to categorize these men as either men-midwives or physicians. 5This blurring also meant that midwifery instructors and practitioners borrowed heavily from, and were influenced by, many of the leading medical theorists of the day. New practical definitions of the menses were, in other words, influenced by elite physicians and elite medical theories. But the interaction between these two groups was by no means a one-way street: elite practitioners, such as John Freind of the Royal College of Physicians, wrote extensively on gynecological and obstetrical problems. For such practitioners, however, gynecological problems often remained an abstract or theoretical issue, as they did not maintain an extensive midwifery practice.
In seeking to understand and redefine the menses, elite physicians and men-midwives did not ignore or unequivocally reject ancient theories regarding menstruation; instead, ancient beliefs were often used as the building blocks for eighteenth-century theories. Thus, while a shift in understanding of the menses and sexual difference did occur, the new theories cannot be said to represent a radical break with the past. The modest nature of the transformation stemmed, in part, from the complexity of the ancient and medieval medical legacy. “Medieval views on the status of the uterus and the opinions of medieval physiognomers about male and female traits suggest,” as Joan Cadden has pointed out, “evidence of [multiple] models.” 6