About the records

Administrative Information

The original volumes are held by the Royal Women's Hospital Victoria Archives. The digital images of the pages of registers presented here have been reduced in size (and quality) to enable reasonable delivery across both dial-up and broadband Internet connections.

• The records have been allocated to 1 series. The codes used to uniquely identify each series range from RWHS405 to RWHS405.
  
  
• Through the processing of the records, 3 provenance entities were identified. The codes used to uniquely identify each provenance entity, i.e. records creator or custodian, range from MID to RWHP002.
  
  
• The inventory covers 1 items, and may include records of continuing value, records sentenced for destruction and records that have been destroyed. The codes used to uniquely identify each inventory item range from A19910501 to A19910501. The total collection occupies 5 linear cm of shelf space (or its equivalent).
  
  
• The documentation of the records at inventory level started on 27 June 2006. The latest additions were made on 27 June 2006. The latest modifications were made on 13 November 2006. This collection profile was updated on 28 November 2006.
  
  

Scope and Content

The two Midwifery Books covering 1856 to 1887 are in the form of ‘Simpson midwifery books’, named after the great Scottish obstetrician, James Young Simpson, of the Edinburgh Lying-In Hospital. They record a range of personal and medical details that the doctors needed so that they could analyse and evaluate their practice.

The book recorded the patient’s name, age, marital condition and parity - or number of previous deliveries - date of admission and discharge. It then recorded details of the labour and delivery: the time in labour (which generally meant the time in second stage or heavy labour), the presentation (head, breech, transverse) and whether the baby was born alive or was stillborn. If the baby was alive, its sex, weight and length were noted, as were any interventions such as the use of forceps, or any manipulation by the accoucheur of its presentation. Complications such as prolonged (‘tedious’) labour, haemorrhage, pre-eclampsia or obstructed labour would be noted, along with occasional social comments such as ‘a notorious thief’ or ‘brought in by police’. In the early years, maternal deaths were described in detail in the midwifery book, but later they were recorded in a separate casebook, which has since been lost. Some maternal deaths were concealed when women who had a post-partum infection were transferred to the Infirmary wing and were recorded as gynaecological deaths.

The statistical analysis of medical cases was one of the essential building blocks of the new clinical medicine that had emerged from the Paris charity hospitals after the French Revolution. Doctors needed to know how to manage problems, and how safe their interventions - like using chloroform or forceps - might be. Measurement of the ‘average’ and the ‘abnormal’ was essential to understanding natural processes like childbirth. They needed to count how many mothers had difficult labours and how many babies were stillborn, but they were not as interested in how many babies died after birth, because their greatest concern was with the survival of the mothers. We now know that death in childbirth, although greatly feared, was rarely frequent enough in the past to affect numbers in the general population. However, doctors knew their reputations depended on having a good record in obstetrics and dreaded losing a mother. In nineteenth century Australia, most babies were delivered by midwives who had served some sort of apprenticeship or by women who were self-taught. Only the well-off could afford to engage a private doctor in preparation for a confinement. Doctors generally attended emergency cases when the midwife found she could not manage complications. In the new Lying-In Hospital, midwives still conducted normal deliveries, but the doctors were called in when the labour was obstructed or the patient was becoming ill. The hospital therefore provided expert medical care for the very poor, and women who had experienced serious complications in previous deliveries began seeking admission in hope of better care in their next birth. Emergency cases in labour were also rushed to the hospital, usually by horse-drawn cab.

The new Lying-In Hospital needed to establish a good record, and for the next forty years, until the introduction of antiseptic midwifery in 1887, it was fearful of being stigmatised as a dangerous place to have a baby. During outbreaks of puerperal fever in Victoria in 1874-6 and again between 1882-7, the hospital was periodically closed and women were delivered in the premises of approved midwives in Carlton and North Melbourne. There was public outcry, critics condemned it as having walls ‘impregnated with evil miasmas’ and the state of its cesspit - full of decomposing placentae - was a scandal. However, once antiseptic midwifery was adopted, which required careful cleansing of both the patient and her accoucheurs, deaths from infection contracted in the hospital, fell away dramatically. In the 1920s it was discovered that the most lethal germs were carried, often asymptomatically, in the nose and throat of nurses, doctors and patients, so that facemasks became routine until antibiotics and better general health in the community made puerperal infection relatively rare.

The nineteenth century midwifery books are reticent about mothers’ pain. Many of these patients endured long and very painful labours, and when labour failed, the doctors had to resort to the terrible destructive operations: the craniotomy and embryotomy, where the foetal head was crushed or decapitated, or limbs amputated so that the remains of the foetus could be extracted. Chloroform, available in Melbourne since the early 1850s mercifully obliterated consciousness for instrumental interventions, but the doctors were reluctant to use it for ordinary labour as they observed that anaesthesia weakened the contractions.

The first caesarean was not performed in the hospital until 1886, and since doctors did not know now to prevent internal wound infections, it was believed safer to remove the uterus as well as the baby and close the external wound with a pedicle, left outside the body where it would gradually wither away. The first caesarean was performed on a seventeen-year-old unmarried girl who suffered from achondroplasia. The baby was born alive and the mother made a complete recovery.

Among the most detailed records is a sequence of just over a hundred deliveries recorded by Dr John Dunbar Hooper in the winter of 1886 when, as the resident midwifery surgeon, he was trying to discover patterns in the high infection rates. Just 11 per cent of these mothers were discharged ‘perfectly well’ and his scientific paper delivered to the Victorian Medical Society the following year helped win the argument to introduce antiseptic procedures in the labour ward.

Family History Research

Around half the patients were single, and it seems that some were anxious to conceal their ‘shame’, so they gave false names or pretended to be married. Most of these girls married later and often kept this first baby’s existence secret.

Mortality among the babies born in the hospital was scandalously high: in 1886 for instance, 60 per cent of the babies born in the hospital died before the age of twelve months, compared to 18.5 per cent of those born in neighbouring Carlton and just 7 per cent of those born in middle-class Kew. Nearly three quarters of the illegitimate and a third of the legitimate infants perished.

Although the hospital clerk generally registered the births in batches, in the early years it was the parents’ responsibility, so that birth certificates do not exist for all children. Infant deaths, we suspect, were sometimes concealed and registration of deaths did not become reliable until the 1880s. Some children were adopted out through the Industrial Schools and sometimes their changes of identity can be traced through those records at the Public Record Office. In a project funded by the Australian Research Council, just 53 per cent of the babies born in the hospital between 1857 and 1900 have been traced to a death certificate, most of them in infancy.

There are some spelling errors in patient’s names, especially when the mother was illiterate.

Finally, many patients had common names and they simply disappear into the great armies of Smiths, Williams, Ryans and Campbells. Birth certificates were usually more carefully compiled than these midwifery records, often entered by candlelight in the middle of a noisy and busy ward, but keen researchers may still find missing babies from their ancestors’ reproductive history. [Janet McCalman, 2006]