Museum of Health Care Blog

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Content warning: This article may contain subject matter that some readers may find upsetting, including discussions medical procedures related to women’s health.

Nothing in the entire realm of medicine was more dramatic than the sudden change in gynaecological therapy which took place in the late decades of the nineteenth century. For more than two thousand years it had remained medical and stationary and in less than half a century it became surgical and spectacular.

–J. V. Ricci [1]

As this quote from James V. Ricci suggests, the landscape of gynaecology changed dramatically during the nineteenth century. Along with experimentation, research, and increasing knowledge came innovation in techniques and technologies until, for better or worse, the Victorian gynaecologist had a veritable arsenal of tools at their disposal. Drawing primarily from the Museum of Health Care’s collection, this blog post examines some of the medical instruments that helped change the face of gynaecology in the nineteenth century, many of which are still in use in some variation today.

This post is by no means a complete overview. Missing from this object history are uterine sounds, trocars and dilators, surgical forceps, scissors and scalpels, and various instruments used for irrigation and douching, to name a few. Additionally, the objects presented here underwent constant modifications by physicians and instrument makers throughout the period creating numerous design variations. Some as small as the placement of an additional screw or a slight adjustment to the length of a handle, others completely revolutionized the function of an object and the treatment of certain medical conditions.

Taken together, these objects offer us a glimpse into a fundamental aspect of women’s health care in the Victorian era while also helping to situate gynaecology within the broader history of medicine in the nineteenth century.

Ether

The discovery of the anaesthetic properties of ether and chloroform in the nineteenth century forever altered the course of medical treatment for all kinds of ailments and injuries, and gynaecological concerns were no different. Without the three necessities of surgery (anaesthesia, antisepsis, and hemostasis) surgical interventions were limited to those procedures that could be done with the most speed and with the best chance of preventing massive blood loss and post-operative infections. This meant that gynaecological surgeries consisted mostly of more superficial procedures like the removal of polyps, the incision of imperforate hymens, and the repair of perineal lacerations.

In the 1840s dentists and physicians began to experiment with and demonstrate the benefits of ether and chloroform during both dental and medical procedures. Soon after, anaesthesia would be applied to the field of surgical gynaecology allowing for more daring, exploratory surgeries like the removal of ovarian cysts, the repair of vesico-vaginal fistulae, hysterectomies, and even caesarian sections to be successfully performed.

But this new ability to alleviate pain had uses beyond surgical procedures, and soon obstetricians began administering anaesthesia to women during childbirth. This, however, proved highly controversial. Many physicians argued that there were more dangers than benefits to this treatment including the possibility of slowing labour or halting its progression altogether. The Church of England also weighed in with ethical objections to the relief of the natural labour pains that were dictated by God as a result of Eve’s original sin. Despite such objections, on the 7^th of April 1853, Queen Victoria summoned her physician John Snow to administer chloroform during the delivery of her eighth child, Prince Leopold. The Queen was certainly pleased with the drug which she referred to as “soothing, quieting and delightful beyond measure,” using it again during the birth of her ninth and final child, Princess Beatrice, and essentially giving the use of anaesthetics during childbirth the royal seal of approval.

Uterine Curette

The uterine curette was likely inspired by various pre-existing medical spoons like those used to remove excess wax from the ears. In the 1840s, famed French gynaecologist Joseph Récamier modified this design by adding a blade-like edge and giving his tool the name “curette” from the French word curer meaning to cleanse. Curettes featuring sharp or serrated edges like this example from the museum’s collection were used to scrape the uterus to remove biological materials such as fungal growths or remaining placenta. The tool, however, would become highly controversial and known for its roughness. Perforation of the uterus and even death were reported as side effects of its misuse.

Significantly, this curette from the museum’s collection features a wooden handle. In the nineteenth century the design of surgical instruments could be as much about beauty as it was about practicality. Instruments like this curette often featured handles made from wood or even ivory which could be carved with various designs ranging from the simple crosshatching in this example (designed to aid the surgeon’s grip of the tool), to company logos and personal insignia, to the downright ornate featuring patterns such as florals and scrollwork.

In the late 1860s Joseph Lister began experimenting with and publishing on sterilization and antiseptic surgery. Despite the ground-breaking nature of his work, it proved highly controversial in the medical community and the Victorians would struggle to understand and accept germ theory and the need for sterilization. Gradually, as the concept of asepsis caught on, surgical tools such as this curette would leave behind their ornate handles made of porous materials which harboured bacteria in favour of alternatives made entirely of metal which could be properly cleaned between uses.

Medical Reference Book

While we may not initially think of books when we think of innovative technologies, the Victorians experienced an unprecedented explosion of print culture in their lifetime. Thanks to the mechanization of the printing press books were easier and cheaper to make than ever before. This, coupled with rising literacy rates and increased distribution via the new and rapidly expanding steam engine railway network, meant that books of all genres could be printed, distributed, and consumed by the mass public. The same logic applied to medical reference texts. As medicine underwent a process of professionalization, standardization, and increased regulation in the nineteenth century, medical reference textbooks, like this example from the museum’s collection, became an important educational tool for students and physicians alike.

This text is the fifth edition of A Practical Treatise on the Diseases of Women written by the American gynaecologist Theodore Gaillard Thomas and published in 1880. [2] In this image the text is open to a section titled “Means of Diagnosis”. After thoroughly outlining the necessary questions a physician must pose in order to collect a full patient history, Thomas moves on to describe the “management of [a] patient during physical examination”. Here, Thomas discusses the potential objections a physician may face when asking a female patient to undergo a vaginal examination:

“It may be said that many ladies will strongly object to the exposure incident to getting upon a table. This is not so; a little persuasion will overcome such objections at once, and the increased exposure is in reality imaginary, for the table is to all intents a bed, and a sheet for covering the person gives all desirable protection”. [3]

In this passage, Thomas has tried to simplify what was, in fact, a very complicated issue for the Victorians— what degree of exposure was both appropriate and medically necessary for a female patient in the presence of her male physician? Within the context of gynaecological and obstetrical care, this debate raged on throughout the nineteenth century. Strict social mores regarding proper female behaviour and respectability applied even during medical exams and procedures. Here, Thomas reminds his reader that a patient should remain clothed with a sheet “spread over her so as to conceal the person”, a practice which remains today. [4]  

Vaginal Speculum

While the speculum itself is an ancient tool with archeological examples being excavated from the likes of Pompeii, its popularity and use seems to have waned throughout history. That is, until it was reintroduced and redesigned by Joseph Récamier in the early nineteenth century. The introduction of the vaginal speculum allowed the gynaecologist unprecedented visual access to the cervix and fundus of the uterus, and as such, it was primarily a diagnostic tool. Employing the speculum allowed the gynaecologist to detect changes to the surface of the cervix such as its colour which may indicate pregnancy, and the presence of abnormalities such as chancres, ulcers, or discharge which could be signs of venereal disease

The speculum became one of the most highly debated medical instruments of the century. Amongst the medical community, there were those who believed the speculum, like other medical technologies being introduced in the nineteenth century, privileged the sense of sight over taxis or touch which had dominated medical practice for centuries. Just as we saw with the discussion regarding the need to cover patients during gynaecological exams, the speculum prompted the same fears regarding female propriety and modesty as the tool forced the gynaecologist into extremely close visual proximity with the sexual organs of his patients.

But unlike many of the other controversial medical tools of the Victorian era, the debate over the use of the speculum did not remain exclusive to the medical community. In a future blog post we will take a closer look at some of the objections and arguments made against the speculum by Victorian feminist activists.

Special thanks to Ian M. Fraser and Janine M. Schweitzer for their generous support of the 2023 Margaret Angus Research Fellowship.