48. Irvine Loudon, The Tragedy of Childbed Fever (Oxford University Press, 2000).
49. David Rush, ‘Nutrition and maternal mortality in the developing world’, American Journal of Clinical Nutrition Vol. 72, No. 1, July 2000. pp. 212-240.
50. Dr. Craigen. BGMA 1915. p. 2. 51. RSG. AR 1907-08. p.40.
52. A. M. Davies, ‘Geographical epidemiology of the toxemias of pregnancy’. Journal of Medical Science 1971 Vol 7. cited in Rush, ‘Nutrition’.
Training the Servant Class; Colonial Midwifery in British Guiana 1890-1914
The successful workings of the colonial infrastructure (administration, transport, sanitation, police) required the recruitment of many non-European subjects. This unavoidable undertaking sometimes caused tension within ruling circles. A reliance upon non-Europeans in the administrative structures of society emphasised the dependency o f the state upon social classes whose values were often different, and whose loyalty was uncertain. A measure of deep underlying levels of anxiety present in governing circles over the bulk of the population can be seen in the care taken to maintain and fund the semi-militarised colony police force.
However, for the most part, transmitting the imperatives of authority required little more than the elaboration of bureaucratic mechanisms through layers of collaborators, combined with a determination to avoid alienating any large mass o f the population. As in many other parts of the world, supervision in the form of a chain of command, and a measure of accountability, was sufficient to achieve most bureaucratic g o a l s .I n the case of medicine, as already stated, European domination was expressed through the institution of the hospital and the colony’s medical service. Outside of these institutional spheres doctors experienced far more difficulty inculcating colonial subjects with the premises of medical or ‘public health’ thinking. In the urban or rural environment the structures of support for Western medicine were relatively weak. In these places the disciplines and orderings of the colonial hospital or estate hospital were not replicable. This was particularly so with regard to childbirth and midwifery.
In country districts, in villages along river banks, and in the towns and settlements, midwives worked independently of the medical profession, and in locations where it was impossible for them to be supervised. Gaining a foothold in the practices of these women, changing the way they worked, and making them the bearers of Western biomedical thought, became a key aim of the colony’s medical establishment in the early twentieth century. The colonial strategy for increasing its medical authority in these urban and rural areas involved four important interrelated elements. Namely; the training of nurses already employed at the Public Hospital in midwifery; certification;
54. In 1900 the government secretly re-equipped them with the latest armaments. This included importing 1500 point 303 rifles, three maxim guns and nearly a million rounds of ammunition. The cost of this expenditure was hidden from the public and press in a ‘loan account’. 4 January 1900. C.O. 111/517. 55. Peter Burroughs, ‘Imperial Institutions and the Government of Empire’, Porter, (ed.), Oxford History pp.
registration of existing midwives with the Medical Board; and finally, attempts to raise the standard of midwifery for those already practising in the colony.
In Britain in the late-nineteenth century midwifery training for women was not obligatory but was increasingly recognised as desirable within the medical profession. By 1895, and perhaps earlier, this idea had been taken up in Guiana. In the first place, potential midwives were selected from small numbers of ‘respectable women’ between the ages of twenty-one and forty taken from amongst the ranks of the hospital’s nursing probationers.^’ They then underwent six months of training and attended a series of lectures in midwifery, pharmacy, general nursing, and the care of infants. After this training midwives took an examination set by the Medical Board. Success at this stage was rewarded by certification which allowed nurse-midwives to attend women in cases o f ‘simple or natural l a b o u r . A sign that doctors were keen that midwives should remain medically and administratively subordinate to the professionally trained medical practitioner, especially those in possession of a Licentiate in Midwifery was that midwifery certificates were initially stamped with the following in red lettering: ‘This Certificate Does Not Entitle The Holder To Practice M id w if e r y .T h is legally distinguished the midwife’s work from the midwifery practised by the colony’s medical profession, most of whom did not in fact possess any special midwifery qualifications, although those trained in Edinburgh or Glasgow would have attended a midwifery course.^® Before the turn of the century most women trained in the hospital continued to work there, although a small proportion went out into the towns or attempted to find work in the villages. By 1914 a total of 138 nurse-midwives had trained and qualified in this way.^’
In 1897 the government and medical service also decided to begin a colony- wide system of certification for women already practising as midwives. This simple measure of competency was achievable through an oral examination in front of a
56. Lara V. Marks Model Mothers Jewish Mothers and Maternity Provision in East London 1870-1939 (Clarendon Press 1994), p. 98.
57. RSG. AR 1895-96. p. 8. 58. Ibid.
59. RSG. AR 1895-96. p. 8.
60. Alison Nuttall, ‘A preliminary survey of midwifery training in Edinburgh, 1844 to 1870’, International History of Nursing Journal Vol. 4. No. 2. 1988/1999. p. 5. Johanna Geyer-Kordesch and Fiona MacDonald, Physicians and Surgeons in Glasgow: The History of the Royal College of Physicians in Glasgow. 1599-
Training the Servant Class: Colonial Midwifery in British Guiana 1890-1914
Medical Practitioner or a Justice of the Peace or Poor Law G u a rd ian .In other words, it was probably not an exacting test. However, further efforts to control the activities of midwives began in 1900 when compulsory registration was introduced. This not only allowed for the fixing of fees, but also provided for fines and the cancellation of certificates should midwives be shown as ‘incompetent, addicted to intemperance, or negligent in her midwifery duties, or guilty of any misconduct in connection th erew ith .R e g istra tio n began slowly, although by 1905 the Argosy newspaper was able to print the names of 521 officially accredited midwives. It is important to note that the names of these women indicate that all o f the colony’s different races were represented. Despite this apparent success strong suspicions remained amongst the colony’s doctors that unregistered midwives without certificates continued to ply their trade.^^ This is very likely. In England too, where supervisory systems were much more developed, unlicensed midwives were known to continue their work in ‘blissful ignorance’ for many years after the implementation of the 1902 Midwives Act.^^
The new century also saw an attempt to extend the benefits of a formal training to ‘native’ midwives. This too bore parallels with some European countries where, as Hilary Marland explains: ‘The midwife was to be lifted out of society, reformed and transformed, and put back amongst people of her own class, ready to work as a childbirth missionary’.®^ In 1903 the Georgetown hospital adopted a policy o f offering a limited number of places to ‘intelligent women’ outside the ranks of nursing probationers.®’ In addition to the core midwifery curriculum these women were instructed in the feeding of infants, indicating that midwifery was already seen in a wider context than help with birth. This initiative was helped by the arrival of Miss 1. M. Cowie (formerly of the Western Infirmary in Glasgow) as Superintendent of Nurses in the colony. Under her guidance the nursing and midwifery regimes in the hospital began
61. RSG. AR 1915. p. 16. 62. RSG. AR 1897-98. p. 6-7.
63. Medical Ordinance No. 9. Of 1886, Amendment Ordinance No. 32 of 1900. 64. Argosv 1 March 1905. Argosy 25 February 1910. Minett, WIMC p. 56.
65. Enid Fox, ‘Midwifery in England and Wales before 1936: handywomen and doctors’. International History of Nursing Journal Vol. 1. No. 2 1995. pp. 17-18.
66. Hilary Marland, ‘The Midwife as Health Missionary. The Reform of Dutch childbirth practices in the early twentieth century’, in Hilary Marland & Aime Marie Rafferty (eds). Midwives. Society and Childbirth (Routledge 1997), p. 153. See also regarding Sheffield, England, Tania McIntosh, ‘Profession, Skill or Domestic Duty?’, Social History of Medicine Vol. 11. No. 3 1998. p.418.