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Diary of a Surgeon-Accoucheur, 1765-1766

The diary of “Surgeon Accoucheur” Isaac Williamson of Whitehaven, Cumberland, was created during his formative years as a medical student in Edinburgh and Dublin in 1766 and 1767, respectively. The diary comprises 95 manuscript pages and is written in the printed journal, The Gentleman's and Trademan's Complete Annual Accompt-Book

Williamson's diary offers a rare insight to the everyday life of a young man who spent his time between medical classes, clinical lectures and assisting women in labour, as well as socialising with a wide circle of friends. What makes the diary particularly valuable is its focus on man-midwifery. Williamson’s studies coincided with a dramatic period in the history of obstetrics, when midwifery was ‘medicalised’ and men-midwives (accoucheurs) replaced women as birth attendants. You will also see that Williamson kept a very careful daily account of his expenses, and this detail provides a fascinating record of how students managed their finances. 

Available biographical detail on Williamson is scant, and there are very few clues on his subsequent career, although he did return to his hometown of Whitehaven to practice after a possible spell in the Isle of Man. A particularly interesting detail is that he is recorded as delivering the HMS Bounty mutineer Peter Heywood. At Heywood’s trial in 1792,”Isaac Williamson, Surgeon and Man-midwife” was called upon to certify that “Peter Heywood was born at the Nunnery in the Isle of Man…on the 5th of June 1772”.

He died in 1829 and his will records him as “surgeon”. Williamson did not use the diary to record his innermost thoughts although we do get glimpses of his love life. There is a love poem to a Nancy Richardson of Whitehaven with her name penned in secret code, a carefully written “amo NR” and references to letters sent and received, including one from Nancy “w[i]th some hair”. Historical records reveal that an Isaac Williamson married Ann Richardson at Holy Trinity in Whitehaven in 1768. Isaac and Ann went on to have a large family, including a son and grandson both named Isaac.

Edinburgh and RCSEd Midwifery Connections

Edinburgh was the first city in Britain to deliver formal obstetrical training, and our members and fellows had strong connections with midwifery education in its nascent period. In 1726, in light of the “many fatal consequences have happened to women in child-birth” and following a recommendation by the Incorporation of Surgeons, Edinburgh Town Council created the world’s first Chair of Midwifery. Joseph Gibson was subsequently appointed Professor of Midwifery to the City, although he likely only trained female midwives. The Town Council at this time also passed an Act stipulating that the only persons permitted to practice midwifery in the city to licensed surgeons or licensed by a surgeon or doctor (from either the Incorporation of Surgeons or Royal College of Physicians) upon presentation of a certificate to magistrates. Gibson had joined the Incorporation as a member in 1722, although he had been practicing in Leith for some time before his appointment.

Notably, our first female licentiate Ann Ker trained in midwifery, and in 1751 petitioned for ‘license to practise Midwifery in any Town or Shire…[and was found] in every respect Extremely well Qualified to discharge the Office of a Midwife.“

Other influential midwifery figures associated with our College in the eighteenth century include James Hamilton, who was Deacon (that is, President) from 1700 to 1702, and incidentally our first College Librarian. A man “much emploied in midwifery”, he attended the fatal confinement of Lady Clerk of Pennycuik, one of the earliest known references to obstetrics in Scottish medicine. With Archibald Pitcairne, Hamilton presided over the first two public anatomical dissections at the Incorporation. Another influential figure was Alexander Hamilton and it was under his Deaconship that the Incorporation was granted a Royal Charter from George III 1778. Hamilton was instrumental in the establishment of the Edinburgh Lying-in Hospital in 1791, which he co-founded with his son James Hamilton who succeeded his father as Professor of Midwifery and became RCSEd Fellow in 1788. Initially, the Lying-in Hospital had been envisioned by Thomas Young, who is central to Isaac Williamson's experience.

An Edinburgh Student of Surgery and Medicine

Despite not graduating, attendance at Edinburgh provided Williamson with an education far exceeding others and he was taught by some of the most eminent teachers of the time. His accounts show him to have been a serious student.  There are deposits of money to borrow books from the library and numerous book purchases. He records attending anatomy and surgery lectures by the distinguished Alexander Monro secundus, observes numerous dissections and sees the elderly Alexander Monro primus assisting clinical patients: “saw a woman at Mr Monros Class with a very large aneurism of the Aorta”.  

Williamson was also able to take advantage of Edinburgh’s somewhat unique position (outside London) for offering infirmary-based teaching to supplement lectures and practical instruction. Clinical instruction had a huge impact on redefining medical education and was established in the wards from 1748. The theatre in the Infirmary had a dual function as lecture hall, and Williamson subsequently witnessed numerous surgical operations; legs amputated, stones and tumours removed, an aneurism of the aorta, a worm 20 yards long and victims of consumption and hanging. He also notes, “saw a woman open[e]d in the infirmary who had been 4 months gone with child & miscarried yest[er]d[a]y”.

Midwifery Training with Thomas Young

In 1756, Thomas Young became the first University Professor of Midwifery in the United Kingdom, and the same year he became Deacon to the Incorporation of Surgeons. Isaac Williamson was fortunate to attend Young’s pioneering classes, taking two consecutive courses and he records the subjects covered. 

Young’s great contribution in Scotland was the lying-in ward he established in the attic story of the Royal Infirmary in 1756 and at his own expense fitted-out this teaching facility to accommodate eight women. Under his tutelage, midwifery pupils gained from the stipulation that no pregnant patients be admitted unless they “will submit to be delivered by the students”. Williamson embraced this experience and attended numerous births, whatever the hour: “I was called up betwixt 3 hr this morning to a Delivery…was over about 6”.

Williamson makes a curious reference to a particularly innovative teaching practice of the period, “had a touching lecture [with] 10 women”, and the financial detail against this was one shilling, “for Touching the Women”. Touching lectures involved a group of pregnant women gathered in a standing-position, with students examining each one. 

A Student in Dublin

From January 1767 Williamson continued his training in Dublin where he immersed himself in anatomical dissection. He records attendance at lectures by notable surgeon-anatomist George Cleghorn and others by David McBride, a well-known obstetrician. In Edinburgh Williamson appears to have only observed dissection, but in Dublin he was able to undertake his own dissections. He noted for example, ‘dissected in the forenoon, finish’d the trunk’, and his accounts show purchases of a seton needle, dissecting knives, a pair of forceps, and injection tubes. An interesting entry however does point to a shortage in cadaveric material: “Mr Cleghorn could not proceed for want of a Subject but showed us Albinus & Eustach Tables”.

Social activities 

Williamson took full of advantage of residency in two major cosmopolitan cities. In Edinburgh he visits the castle and “saw the room where James 1st was born”, and on arriving in Dublin pays for “seeing ye wild beast”. He attends numerous tea parties, dines on oysters, attends balls at the Assembly Room, sees plays at the theatre, learns fiddle, goes to the races, dabbles at cards and goes bowling and skating. 

The physical manuscript itself is sadly in need of conservation treatment, and we are making it available for adoption through our 'Adopt a Book' scheme to any interested parties. Please email library@rcsed.ac.uk for more details.

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