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12/03/2013

By rmacfarlane

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Rachael Russell recently completed a PhD at the Centre for the History of Science, Technology and Medicine at the University of Manchester, the title of her thesis being ‘Nausea and Vomiting: A History of Signs, Symptoms and Sickness in Nineteenth-Century Britain’.  Here, Rachael reveals how material from the Wellcome Library assisted her research into normal and acute morning sickness.

Whilst morning sickness is a well-known sign and symptom of pregnancy, few people are aware of the extent to which suffering of nausea and vomiting can persist. The condition attracts a great deal of attention in current medical literature, yet endocrinology and obstetrics specialists accept that the pathophysiology of morning sickness is poorly understood, generally believed to occur as a result of genetic, endocrine, gastrointestinal, environmental and psychosocial factors. Similarly, there is no clear explanation of the cause of acute morning sickness – hyperemesis gravidarum.

The Wellcome Library holds a vast array of gynaecology and obstetrics texts which allowed me, whilst researching the history of nausea and vomiting as signs, symptoms and sickness, to explore the rich and varied nineteenth-century understandings of pregnancy-related illness. The growth of a baby, according to nineteenth-century literature, caused a variety of side-effects: toothache, excessive saliva, expansive appetites, heartburn, and of course, in the early months, nausea and vomiting. The occurrence of these changes provided an opportunity for doctors to investigate and understand pregnancy more generally, and especially how women’s bodies adapted to a new life within. As we recognise them today, acknowledgment and treatment of these conditions would fall into the remit of ‘antenatal care’. Although viewing the observation and treatment of these conditions as nineteenth-century antenatal care would be anachronistic, that is not to say that there was not a deep interest in explaining, and at times combating these ailments.

Vomit3Morning sickness (a name for pregnancy vomiting only adopted by medical practitioners during the 1860s) was understood in-line with wider medical cosmologies. Using the wide selection of texts which are so easily accessible from the Wellcome Library’s open shelves, it is possible to trace a broad shift from humoral to nervous and anatomical explanations, with humoral practises maintaining a stronghold well into the second half of the nineteenth century. For instance, in A Manual of Obstetrics (1858) William-Tyler Smith recommends that patients be ‘puked occasionally with warm water, camomile tea, or a mustard emetic’ (pp 115-6). Emetics were in fact frequently administered due to the recognition that nausea was a much more intolerable symptom that vomiting. In 1873 Robert Barnes was printed in the Lancet as comparing pregnancy vomiting to ‘a safety-valve discharging the superabundant nerve-force, which might otherwise result in convulsion, abortion, or other mischief.’ [1] During the later period, physiological and anatomical explanations, linking the stomach in direct sympathy with the pregnant uterus, came to dominate.

DisordersofPregnancy

What makes the texts such as those found on the shelves at the Wellcome Library so rich, however, is not solely the extent to which they evidence medical practises relating to pregnancy vomiting. It is in their inclusion of what we can broadly term social attitudes to this specific sickness. Although nausea and vomiting were undeniably negative experiences, morning sickness stands out as being responded to with optimism and encouragement. A positive sign, women and their doctors alike agreed that the occurrence of sickness proved the health of both baby and mother. It also served a social as well as medical purpose. Women were said, to the amazement of their doctors, to be able to predict the day on which their baby would be born, based solely on when they first felt nausea. As with the media debating the likelihood that the Duchess of Cambridge was carrying twins, in the nineteenth century we find that the duration and severity of vomiting was used as a tool to predict the sex of the baby, though there does not appear to have been any consensus as to whether boys or girls made their mother’s suffer more. As with the world discovering the news of the Duchess of Cambridge’s pregnancy earlier than the oft-traditional 3-months, morning sickness was a difficult condition to hide from the family and friends of nineteenth-century women. In an era when the confirmation of pregnancy came only with the passing of time, morning sickness was therefore a meaningful sign, the significance of which was passed down through generations of women.

When women wanted relief from their sickness, rather than consult a medical professional they predominantly turned to advice literature. Numerous health manuals written by doctors offered rules on simple ‘care’, such as diet, exercise and life-style. In addition to strong coffee or plain foods before rising, numerous concoctions were recommended: bicarbonate of potash, to be taken with water, and lemon juice as an effervescing draught, for instance. Women’s advice and domestic homeopathy texts also recommended the use of ipecacuanha and nux vomica in the home. It is also likely that women turned to popular patent remedies for their cure. In the 1830s and 1840s various versions of ‘Harvey’s Restorative Cordial’ were advertised for ‘the morning sickness of females,’ as well as ‘[a]ll those debilitated by luxurious living, late hours, vexation, intense study, or confinement to business, [who] will find this Cordial their best friend.’ [2]  In the late nineteenth century the Illustrated London News carried adverts for ‘Dunn’s Pure Fruit Saline’, which was sold solely for the relief of morning sickness.[3] Many patent remedies, however, were also aimed at calming the nerves, rebalancing the constitution or providing something easily digestible by the stomach.

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Prof William Featherstone Montgomery (Image: National Library of Medicine)

Yet the fine line between health and illness, a mild complaint or a threatening condition, on which morning sickness could so easily tread, did not go unnoticed. The views expounded by William Fetherston Montgomery in An Exposition of the Signs and Symptoms of Pregnancy (1856) are representative of the approach taken within specialist texts to the subject of normal and acute morning sickness: ‘it is not to be forgotten’, Montgomery wrote, ‘that occasionally the natural sympathetic affections may become excessive, and be very injurious, or even destructive of life’. Predominantly, acute pregnancy vomiting was characterised by emaciation of the sufferer. It was generally considered to be an excessive sympathy, but one so excessive that it justified the practice of nineteenth-century abortion. Induction of labour was, however, only used in the most obstinate cases, whereby the mother became so emaciated it threatened her own life.

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The potential threat of this condition to women’s health encouraged it to be brought closer in line with the increasingly standardised, anatomical explanations of illness. As the sufferer could reasonably be hospitalised, it’s reporting in the publications of hospitals such as St Bartholomew’s and Saint Thomas’, provided invaluable data to both contemporary commentators and historians. The appearance in hospitals of such cases allowed for the sharing and comparison of studies relating to the condition, and encouraged the publication of a small number of specialists monographs, such as Graily Hewitt’s On Severe Vomiting during Pregnancy and Charles Clay’s On the Severe and Obstinate Forms of Vomiting during the Latter Months of Pregnancy. Hewitt, for example, upon examination of 116 cases, found that the majority were characterised by an anteverted, retroverted, flexed or anteflexed uterus. He advocated, therefore, treatments involving mechanical reduction of the malposition of the uterus, application of pessaries, or artificial abortion, all to be supplemented by rest and occasional caustics. The assumption of technical-medical language and the establishment of clear boundaries of normal and abnormal responses distinguished this condition as resting within the medical sphere. Furthermore and as a result, the natural, or normal, nausea and vomiting of pregnancy increasingly stood in stark contrast to severe pregnancy vomiting, even more so as medical understandings of the latter condition solidified as the century progressed. Indeed, the recognition of obstinate vomiting confirmed that normal morning sickness was not a cause for concern.

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Today, the outlook for acute pregnancy vomiting sufferers is undoubtedly far improved from that faced by women of the nineteenth century. Browsing responses within the media to the news of the Duchess of Cambridge’s sickness, however, demonstrates that this illness persists in perplexing practitioners. The experience of this condition – ultimately an amplification of the often-despised regular morning sickness – is perhaps only mildly bettered by more recent medical advances. Historical responses to morning sickness remind us that common illnesses, taken for granted as being temporary and mild, were and are meaningful. They simultaneously illuminate medical views and opinions on the extent to which illness is considered ‘tolerable’, and demonstrate that a large proportion of ill-health remains outside of the medical sphere.

Author: Rachael Russell



[1] Barnes R., ‘Lumleian Lectures: On the Convulsive Diseases of Women’, Lancet (19th April 1873), p. 551.

[2] ‘Harvey’s Restorative Cordial – Advertisements & Notices’, Jackson’s Oxford Journal (7th May 1836) and ‘Harvey’s Restorative Cordial – Advertisements & Notices’, Manchester Times and Gazette (13th May 1837).

[3] ‘Multiple Classified Advertising Items’, Illustrated London News (22nd August 1891), p. 262.

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