Examining the history of obstetrics and puerperal anatomy: Smellie & Hunter’s works on anatomy.

By Nate Cougill

William Smellie (1697-1763) was a Scottish physician practicing in obstetrics during the mid-18th century. Among the advances Smellie made in obstetrics were his uses of forceps for complicated deliveries, advances techniques for the management of breach presentations; however the anatomical illustrations he commissioned stand out as his most enduring contribution to medicine. The illustrations contained in his book A Sett of Anatomical Tables (1749), depict pregnant females dissected, laying bare the mysteries of gravid female anatomy for the study of obstetricians, midwives, and curious Enlightenment thinkers alike.

William Hunter (1718-1783) was a student of Smellie’s and the elder brother to John Hunter, an accomplished physician and anatomist in his own right. He published his work on the subject of obstetrics, Anatomia uteri umani gravidi [The anatomy of the human gravid uterus] (1774), which contained many of the same illustrations used in Smellie’s work. He freely acknowledges this fact in his preface. Hunter’s text for the illustrations was published posthumously, and later expanded and edited by Matthew Baillie, Hunter’s nephew, 20 years later. This was not terribly uncommon at the time; the cost of creating such illustrations was enormous at this time, and the body of the text was the primary focus for each work.
There were depictions of pregnant females in anatomy texts for centuries prior, though the accuracy of these were lacking. The earliest known example of an accurate gravid uterus was by the famous Leonardo da Vinci for his treatise on anatomy which was never published. The illustrations were on display during Smellie & Hunter’s era, and the gentlemen took a special interest in the works—helping to revive interest in the works of Leonardo for subsequent generations. The reclining position of the female torso with fetus in situ is a blatant nod to a similar illustration drawn by the Renaissance man.

Smellie joined forces with Dutch artist Jan van Rymsdyk and Petrus Camper to produce 34 illustrations. It is thought that Smellie may have produced two unattributed illustrations himself depicting the use of forceps. These were then engraved onto copper plates by Charles Grignion and sent for printing. The original 61 red chalk drawings have survived and remain in the special collections department of the University of Glasgow where they were deposited by his estate. There are a few photos of these drawings available on the web. High-resolution scans of an original printing are available through the National Library of Medicine’s amazing online exhibit. There are several other libraries with their own scans as well.

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There has been some recent controversy surrounding Smellie and his colleagues William and John Hunter’s methods of obtaining cadavers. The volume of specimens illustrated would have been a challenge to obtain. In his 2010 article “The Emperor’s New Clothes” published in the Journal of the Royal Society of Medicine (JRSM), researcher Don Shelton made a convincing case that the young pregnant females in A Sett may have been “burked,” murdered for hire, in a manner similar to that popularized decades later by Burke & Hare from which the term is derived. He examines the improbability of the young women having died of natural causes. He contends that Smellie obtained the specimens in a very brief period of time, in similar stages of pregnancy, in a limited geographic area, without benefit of modern refrigeration or embalming. Shelton contends that it would have been nearly impossible for the victims to have died without a third party forcing nature’s hand. Of the 34 plates in the volume, 10 are depicting the same woman. That leaves 24 cadavers; of these, not all are full-term. The illustrations are arranged starting at full-term and working backwards. There are three women in the book that are near full-term. Others are in earlier stages. If the anatomists had connections with gravediggers

There’s certainly motive, means, and opportunity. Considered in the context of 18th century Scotland where the study of medicine was rapidly growing, new medical schools were opening and competing for a stagnant number of legal cadavers. Ambitious young physicians were eager to overtake the practice of midwifery which had been a female-dominated practice for millennia. Smellie needed a way to create a treatise of obstetrics that would leave no question as to his and the medical community’s importance in the field. This was also at a time when there were a large number of immigrants in urban centers, hoping for a better life after many poor harvests left rural populations devastated. There would be nobody to raise questions as to these young women’s whereabouts. Smellie could even be called a man of considerable means. He had a very successful practice lived very comfortably for the time.
One must consider Smellie and Hunter as products of their time period in many different respects. For one, obtaining cadavers was largely a clandestine activity at this time. Grave robbing was a common occurrence during this period as cadavers for study were in high demand and fetched a substantial price. For instance, to apply for a license to practice surgery from the Royal College of Surgeons, each would-be surgeon had to attend two full courses in anatomy. In 1793, there were 200 medical students in London and this rapidly increased five-fold to 1000 by 1823. The cadavers of criminals were commonly given to anatomists for study, though even in late 18th century London, that only amounted to around 100 corpses per year, and most were male. There was still a large gap in empirical knowledge of female anatomy; even today executing a pregnant female is nearly unheard of. Add to this the number of women and children dying in childbirth and shortly after. Obstetrics was still transitioning from witchcraft and conjecture to a hard science. Puerperal fever was still an issue that would not be addressed until the 19th century by Semmelweis. Without the blueprints drafted by Rymsdyk, the cervix was a black hole and physicians were fumbling in the dark. It’s essentially a perfect storm for such a crime to have occurred.
Much of what we know today about human anatomy we owe to the Scottish Enlightenment. The study of medicine flourished during this era, and with many works that exemplify a golden age of medical illustration. The Universities at Glasgow and Edinburgh were at the forefront of the sciences. Lecturers performed profitable public dissections for curious onlookers, in part leading to a growing shortage of cadavers. Supply was limited and demand was high, and It was in this context that anatomists were faced with a dilemma: should they honor the edict of primum non nocere (first, do no harm), or resort to utilitarianism? Would it be moral to murder a few pregnant women in order to save innumerably more by furthering the science of obstetrics? Utilitarianism was a hotly-contested philosophy during this time, being actively debated by Scottish thinkers such as David Hume. In fact, William Cullen, William Hunter’s mentor, was Hume’s physician!
Whether it be the misgivings of two opportunists or the conflated ambitions of two revolutionary physicians, the moral relativism introduced by debasing the inherent value of human life leads to outrage in the medical community whether it be at the time of the murders in the case of the Burke and Hare incident, or 250 years after the fact in the case of Smellie & Hunter. Dr. Robert Knox for instance, the second-hand recipient of the Burke & Hare cadavers, was ruined by his involvement in the incident despite previously being a well-regarded physician and never actually dealing with the men directly. When we seek the help of doctor, we’re not after moral relativism. For all the grey-areas and moral mine fields that they must cross, the utmost goal must be prolonging quality life and relieving human suffering.
Rather than pass judgment so far removed from the initial insult, let us instead appreciate the illustrations for what they are: extraordinary representation of gravid anatomy beautifully, ahem, executed for the advancement of science. It is still not so uncommon for advancement of the sciences to ride precariously on the coattails of unbridled ego, and it is grossly apparent that the sciences have always and will always progress in this manner.

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