Supplementary Appendix 123a.2 – Caroline Schelling

Catharine Margaretha Klocken
Midwife in Göttingen
Defense against Several Accusations
made by
Herr Professor Osiander
1793 [*]

Incident Account

|3| Since having been granted the office of midwife by local officials here, I may justifiably boast of having brought more than two thousand children into the world with the greatest of success, and every woman in childbed who has engaged my assistance, be she of high or low status, can attest that I have always gone about my work with the utmost care and precaution. Several hundred children who were entangled by their umbilical cords two or often even three times round came into the world successfully thanks to my help, moreover, without needing either a birthing stool or lever and forceps.

Hence it could not but be doubly surprising to me to read in an announcement of academic lectures by Herr Osiander, [1] in which one |4| should hardly have expected such a thing, the account of the birthing history of a certain lady in which my own assistance, performed with a complete awareness of my duties and according to my experienced assessment, is portrayed in invidious colors and my good name publicly vilified.

My sense of honor demands nothing less than that I defend myself publicly against the accoucheur’s published accusations against me and to do so precisely in the public forum, the public itself being the most competent judge in this matter. Before addressing specific points, however, I must first and foremost counter the account related by the accoucheur with my own version of this birthing story, one bearing more the stamp of veracity and capable of corroboration by truthful witnesses. Here is that story.

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About five weeks before the delivery of the lady mentioned in that treatise, her mother sent word asking that I come see her. I did so. She immediately told me that, since her daughter’s delivery was so close, she and the other members of the family, though initially desiring to engage the services of the accoucheur, Herr Professor Osiander, now |5| wished for me to take care of her daughter’s delivery alone, and asked that I see her daughter the next day. I did so, encountering her there with her husband. Both expressed their joy at my arrival and not only repeated the same wish her mother had the day before, but also added that they would very much like for me to visit them often if possible. Hence I did indeed repeat my visits several times until the lady’s delivery. I was summoned to the lady on the Wednesday before Easter, the 27th of March of this year [1793], at about 9:00 a.m., and not, as the accoucheur incorrectly states, at 7:00 that morning. When I arrived, she complained of having been unable to sleep comfortably the previous night because of stomach pains and bloating. I responded by asking why she had not had me summoned, and then administered a clyster to her.

Because the lady wished to have yet another, believing she would then feel even better, I administered a second and discerned a marked improvement. She then walked about a bit in the room. At about 10:00 she began complaining about pressure in her lower abdomen, and at my examination I |6| noted that the child was descending ever lower. I suggested the lady might want to try the much-praised, altered Stein birthing-stool beforehand, to see how comfortable it might be simply sitting in it, since it was not yet time to engage the stool seriously. The lady’s husband was of my same opinion and thus helped me open up the stool.

When the stool had been adjusted sufficiently for a simple test, the lady sat down in it, and when I asked her how she liked it, she, now encouraged, responded, “Quite well.” While I was still discussing these things with her, her husband escorted the accoucheur into the room. I was not sitting in front of the lady, as the accoucheur alleges, but rather was standing before her; moreover, after my previous preliminary examination, I could quite justifiably respond to his question of how things stood with the child with respect to delivery by saying, “Everything is fine.” Since the accoucheur’s question here could not but suggest that he had perhaps been summoned, I suggested he confirm through his own examination what I had just |7| told him. After the lady had gotten out of the stool, in which she had hitherto been sitting upright, the accoucheur now adjusted it as he thought best; such could have been accomplished at leisure, since the customary signs of imminent birth that otherwise might have made doing so more urgent had not yet commenced. So the lady had to sit down once more in the stool, now adjusted in the accoucheur’s fashion, and he proceeded to examine her. The parturient reacted with extreme discomfiture and anxiety, even screaming out loud, and asked the accoucheur to withdraw his hand a bit. Instead of doing so, however, he tried to comfort her by assuring her that if he were not to withdraw his hand, she would deliver within a couple of hours. And now he left his hand in her birthing parts without interruption from 11:00 a.m. till 12:30 p.m. While sitting in this position, he asked whether I might have a small children’s syringe at home. I answered affirmatively and thereupon had it fetched as he wished. He then syringed oil into the mouth of the womb, remarking concerning the latter that the opening would accommodate an opening two-fingers wide but not four.

|8| During the second syringing, which took place at 12:30, he burst the water. The lady noticed this and said to him, “But now the water will probably run out too soon; I have heard that if it is let out too early, the delivery will drag on.” To which the accoucheur responded: “I merely let out a little water so that the child will descend farther; I am holding the rest back.” The lady responded: “You broke the water with the syringe, I am certain I felt it.” He remained sitting before the lady for about another half hour. She was in an extremely pitiable condition, asking him to let her stand up at least a bit because her neck and chest were hurting because of the stool’s low setting, this position making it impossible for her to breathe. Even the others present in the room could not but be pained by the lady’s complaints, and renewed her plea. But the accoucheur countered that were he to allow that, “the delivery would take place an hour later,” and that, after all, she was “sitting on the stool as comfortably as on her sofa.”

Notwithstanding the parturient’s constant shifting of position had quite disarranged the pillows in the stool, |9| making it thus impossible for the lady to remain comfortably seated, it was only after repeated pleas that he permitted her to stand up. She sat down on the sofa. After she had had a bit of a respite, the accoucheur asked the lady to sit down in the aforementioned stool again. She did so, and he again seated himself before her. Her husband, however, now also became quite anxious and fearful. In the meantime, the lady’s mother had me summoned to her room and inquired about the parturient’s condition. She remarked that it was very unpleasant for her that the accoucheur was there, saying that they had not summoned him at all and that her sole wish had been for me to assist her daughter alone. Here I genuinely learned for the first time that the accoucheur had merely come by accident, whereas I earlier could only believe he had been genuinely summoned. I returned to the lady’s room. My own account must leave a blank space concerning what the lady’s husband and the accoucheur had discussed during my absence. Toward 6:00 the accoucheur left to take care of domestic errands. I do not recall, however, the lady’s husband saying anything about forceps after the accoucheur’s departure. |10| Perhaps that took place during my absence. After his departure, I seated myself before the lady and examined her. I found the opening to the womb larger, and the labor pains now came more frequently and urgently, from which I concluded that her delivery was now quite imminent. I also expressed this suspicion to the lady, who then quite desired to have the delivery take place before the accoucheur returned. She begged me not to leave her, including should the accoucheur return, since my own examinations did not cause her as much pain as did his. The labor pains returned a bit more slowly. The accoucheur returned toward 7:00 and inquired how things stood. I answered that the delivery could not be far off, since the child had already descended quite far. I asked whether he himself wanted to do an examination. He did so and confirmed my assessment. He then remarked that this whole business was probably becoming too distasteful to me and suggested that he take my place. I, however, asked that he let me remain sitting simply because the lady herself had previously urgently entreated me to do so. |11| Approximately a quarter hour later, since some labor pains were coming quite slowly and without effect, the accoucheur wanted me to stand up that he might try to aid the birth by use of the lever. He now seated himself before the parturient, who, however, asked him quite anxiously in the presence of the others in the room to proceed just as carefully as I, since otherwise she could not endure it. He engaged the lever futilely. Finally, after considerable coaxing by her sister-in-law and husband, the child was indeed brought into this world by the use of forceps, notwithstanding the lady had beforehand feared she would not be able to endure it and had also demonstrated her opposition to this instrument several times. After an hour had passed, the afterbirth had still not come loose. The lady greatly yearned to be freed from it that she might also be relieved of her arduous situation and be taken to bed. Hence at her request I examined her twice very gingerly with my finger, following carefully after the umbilical cord; but both times I found that the placenta was still firmly affixed. I related these findings to the accoucheur with the request that one wait a bit longer. He agreed, remarking also that it was a good idea. |12| A quarter hour had perhaps elapsed when he sat down and found the afterbirth freed. He took it out, whereupon the servant woman, without my knowledge, as is customary, disposed of it. After this, I lingered yet until 10:30 p.m.

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Defense

Now that I have provided this simple, truthful account of the incident, permit me now to illuminate a bit more closely, and point by point, the birthing history as related by the accoucheur himself in his treatise; since I myself was a direct witness to what happened, I also believe I can provide a more accurate assessment. Moreover, I consider myself all the more obliged to do so insofar as I have found not a few details portrayed quite incorrectly. I will focus especially on those passages in which the accoucheur has taken the liberty to level bitter accusations against me, and try to defend myself against these accusations by referring to principles deriving from the simple rules and truths of the arts of midwifery. |13| I will always begin with the accoucheur’s own words.

Page 14. “The midwife finally asked whether I myself might want to do an examination.”

I asked this question assuming the accoucheur had been explicitly summoned and thus considered it a matter of courtesy to let him take part in the examination.

“Since even the most cautious examination seemed to cause her pain, I administered a syringe of olive oil.”

When I examined her, everything proceeded quietly and calmly, with no sounds or groans being heard. But as soon as the accoucheur sat down and inserted his fingers into her vagina, the lady began to whimper and groan. She beseeched and implored him tearfully to cease the examination, that it was hurting her too much and she could not endure it; others present in the room were startled and frightened by this sudden change in the lady.

|14| Was this examination then indeed carried out cautiously? It seems his fingers penetrated so far up into the birthing parts, which were not particularly moist, that he could feel the water sack, for he explicitly stated that “it was tensed during the labor pains.”

That is, it was not merely his fingers alone that the accoucheur placed into the vagina, but part of his hand as well, since the head, still being positioned too high, would have prevented his fingers from reaching the water sack. And given the rather dry condition of the internal birthing parts, this penetration could not but be extremely painful and irritating. In any event, I thought this hand maneuver as well as the frequent examinations in the larger sense to be of no real use. Moreover, as I recounted above, the accoucheur left his hand in this position inside the birthing parts for an extremely long time, thereby increasing both irritation and sensitivity. I cannot understand the point of this. Perhaps to prevent the uterine orifice from closing up again? That would be a novel idea indeed! Or in order to widen it artificially before nature herself considered it the appropriate time to do so? Such a hand maneuver was in this particular case utterly contrary to purpose.

|15| And what need was there for the oil? To make the parts slippery? In my opinion, this was of no use, since as soon as the water has broken, these parts are sufficiently moistened in any case. Not to mention that the entire area becomes quite unclean because of the oil.

“Toward 12:00 noon, I found the uterine orifice completely open and the placenta ready to burst; and when I syringed in oil again because the birthing organs were dry, the placenta burst and the water deliberately drained slowly out with my hand held forward.”

I have already recounted in my narrative above, along with the accompanying discussion, that the accoucheur, burst the placenta by inserting the syringe up quite far. I similarly noted that the uterine orifice was open not four-, but rather only two-fingers wide, so it is incorrect for him to state that the “uterine orifice was completely open.” Let those with more knowledge of such things determine what one is to understand by “deliberately draining slowly out” and by the alleged |16| “holding back” of the water. After this bursting, the accoucheur kept his hand in the aforementioned position for yet another half hour, though I cannot understand why.

Page 15. “After two hours had passed amid strong but brief labor pains, and the head had not descended any farther, etc., at about 3:00 I said something to the effect ‘I believe the head is wrapped round by the umbilical cord, which invariably delays birth.'”

I must consider this statement a bit more closely. Because the head had advanced very little during these two hours, the accoucheur immediately came upon the notion that the entangled umbilical cord was causing the delay; that is, this wrapping round had made the umbilical cord too short and is was continually pulling the child back. But was that necessarily the only possible cause? It does not seem so to me. On the contrary, I believe that nature |17| was not yet ready for full birth, since the uterine orifice had not yet sufficiently opened. The premature bursting of the placenta had disrupted the entire birthing process, the labor pains, which previously had been sufficiently strong, diminished, and it would be some time before nature could continue on with the birth. On page 18 one can also see quite clearly that the head had sufficiently descended once nature was seriously intent on completing the birth. Nor could the head have descended farther in the accoucheur’s absence if the entanglement of the umbilical cord and its resulting shortening had genuinely kept the head from descending. But even if such really had been the case, the accoucheur could not complete the birth with forceps until this entanglement of the umbilical cord had been resolved and it was once again sufficiently long, since otherwise either the placenta would have been torn away from the womb or even drawn inward. And yet neither of these unfortunate circumstances occurred during this birth. Nor did I notice that the accoucheur engaged a hand maneuver in order to lengthen |18| or sever the umbilical cord, which, after all, would have to have been done in this particular case if precisely these difficulties were to be avoided. Nor does he himself mention any such hand maneuver in his own narrative, proof enough that the umbilical cord was in fact not too short. If, however, amid such entanglement the umbilical cord is nonetheless sufficiently long (as was indeed the case here), then the entanglement will not significantly delay birth. I myself have had the opportunity to observe hundreds of such and even more severe entanglements than the one mentioned here. Every single one of those births concluded successfully simply through the help of nature herself. From this one may justifiably conclude that in this case as well, since no particularly serious hindrance was present, birth would have taken place quite naturally had the lady not been prematurely strained and the water not been broken prematurely, thereby, as I mentioned, disrupting the entire birthing process. I am convinced at the very least that the entanglement in this case would not in the slightest have prevented the birth from being completed naturally, just as little as would have the allegedly incorrect position of the head as described on page 19, in the treatment of which the lever, too, was futilely engaged. For |19| on page 18, after the accoucheur had returned, I was already maintaining that the head had descended so far that it might well see the light of day after but a few more labor pains, nor did I feel anything akin to an incorrect position of that head. The only thing required was patience, and nature would have brought the birth to a successful completion. Since I was in fact not persuaded of the accoucheur’s statements, I said quite justifiably that everything was fine and that one need merely continue to await the onset of the good labor pains.

Page 16: “The time in the birthing stool was becoming quite tedious for the parturient.”

As I mentioned in my narrative above, it was not so much that the time became tedious for her than that the constant horizontal position became unbearable. From the very outset, she was forced to lie too flat, and yet without any reason being evident. For her body position was not at all as inclined as one might believe; it merely appeared such because the lady was of such diminutive stature. By contrast, given her excessively horizontal position she was quite unable to exert her own strength sufficiently to engage the labor pains properly.

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Page 19: “I maintained there could be no doubt about an entanglement.”

The following page in his book states that this genuinely was the case; I, however, doubt for the aforementioned reasons that it could have presented any serious hindrance, also because the head had indeed descended farther as a result of the successful labor pains. I leave to those learned in midwifery to determine whether such raised the necessity of employing the aforementioned instruments. I at least thought them to have been quite superfluous in this particular case, for as long as nature voluntarily engages her own powers, is actively involved, and as long as the proper descent of the child justifies her efforts, just as long, I believe, should one leave things to nature alone, particularly since in this case the position of the head was so good. Artificial help is necessary only when the forces of nature are exhausted or cannot alone remove some other hindrance thwarting the birth. But every accoucheur has experienced situations, and finds them quite normal, when the child’s head withdraws a bit each time a labor pain recedes.

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Page 20. “My persuasion was that the perineum remained untorn.”

I beg the accoucheur’s pardon in this case for candidly contradicting this statement and openly pointing out, commensurate with the truth of the situation, that after the birth was completed the perineum was indeed torn. I felt this clearly when afterward I had to administer several clysters. The servant woman noticed the same thing.

page 21: “The midwife finally sat down of her own initiative and pulled on the umbilical cord.”

Here, too, I must contradict. It has never been my method to loosen the afterbirth by pulling. I know only too well what horrendous consequences doing so can have. And yet a little earlier in his book, on the same page, the accoucheur says: “I tried to see whether it might perhaps come loose as a result of gentle pulling.” That is, he himself acknowledges having made the mistake he now wishes to attribute to me. To do so, however, he had to plant this small untruth beforehand to prove that I caused the hemorrhage. |22| This is why he immediately continues there:

“She suddenly stood up again and said that the afterbirth was now free. Blood now profusely poured out etc.”

Here I come to the primary passage in which the accoucheur accuses me of having caused a hemorrhage and having split the placenta along with the umbilical cord. Let me first address what it means to “split” in this instance. As I pointed out in my narrative, I twice felt with my finger to determine whether the afterbirth had already been loosened; but because I found it still affixed, I did nothing in order to loosen it. This I can swear to by oath. Hence it is untrue when the accoucheur says “she suddenly stood up again and said that the afterbirth was now free.” Since it was still affixed, how is one to imagine that I tore it in two with my finger examination and also split the umbilical cord? With what sort of hand maneuver could I possibly have achieved this? Hence I cannot |23| comprehend how these parts can be artificially separated when still positioned in the womb cavity. I should sooner suspect that, quite to the contrary, this splitting is a natural condition and a mere play of nature of the sort I have had the opportunity to observe on several occasions, just as it is similarly well known that the placenta sometimes divides into several pieces that are not quite so firmly attached to each other. When it separates into two pieces, those two pieces are sometimes equal, though most often one is smaller and indeed is often merely an appendage. The present case seems to have been one in which the two parts were almost equal in size, and it is probable that one part of the umbilical cord sank into the one piece, the other part into the other. This natural separation conjured the notion for him that the split was violently caused. The entire accusation would be thus refuted, and the accoucheur must thus indict nature on this charge. Yet even in a larger sense, he has described this phenomenon so incompletely that one cannot really gain any clear understanding of this separation, though it was certainly incumbent upon him to express himself quite clearly indeed were he choosing this particular phenomenon for |24| accusing me of having made a mistake. He does indeed also adduce the fact that I allegedly had the afterbirth taken away too hastily, trying to show that I was allegedly aware of having made a mistake and merely wanted to avoid any further investigation by having the afterbirth swiftly taken away. Unfortunately, he gives an incorrect account on page 22. It seems that in his haste, the accoucheur mistook me for the servant woman; for when he demanded to see the afterbirth, the umbilical cord being unusually long, and I asked the servant woman where she had deposited it (since I myself had not seen it at all), I received the answer that she had already — as is quite customary — thrown it away, whereupon I myself expressed my dissatisfaction.

Furthermore, the accoucheur found half the placenta had shifted into the vagina, the other half remaining yet affixed. That is, he is maintaining that I loosened half of it and pulled it out, suggesting thereby that I made the mistake of leaving the other half affixed and causing him the arduous trouble of having to loosen it. But I must beg the accoucheur’s pardon |25| for contradicting him anew. My own teacher instructed me either to loosen the placenta entirely or, should such not proceed as planned, to cease from this task entirely. Hence I would have followed this same useful rule in this case, and were this the appropriate place, I could relate to the accoucheur specific examples in which I did indeed precisely follow this rule. In my own account above, however, I related that when I stood up I announced to him that the afterbirth was still affixed. After a quarter hour (for he did not immediately sit down himself, letting this time pass instead: an important circumstance that he himself did not relate!), he found it loose. Now, is it not probable — and I myself would maintain: certain — that the contraction of the womb caused half of the placenta to loosen voluntarily and drop down into the vagina? This completely refutes the reproach leveled at me on page 21.

What especially vexes and hurts me, however, is that I must read the accusation that, through my incautious actions, I caused a hemorrhage that allegedly contributed to |26| the lady’s death. And yet I have already quite sufficiently recounted above that when I left my place, the afterbirth was still affixed. How, then, am I to have caused the hemorrhage? Even after the accoucheur had taken away the afterbirth, the hemorrhage was no stronger than usual, something evident from the following circumstance. After the delivery, one of the bandages advised by the accoucheur was to be applied. But during fitting, the first proved to be too narrow, the second too broad, so that we finally had to make do with a hand towel, binding it round. But the fitting took a bit of time, during which the lady had to stand. But had a strong hemorrhage been present, she would not have been able to remain long in that standing position, since the hemorrhaging would have exhausted her strength and doubtless caused fainting. Even after the parturient had been put to bed, I variously inspected the flow of blood and found it commensurate with what was customary according to nature, which is why I responded to the accoucheur’s query by saying that this blood flow was “natural.” What this clearly shows is that no hemorrhaging at all had been caused, and that this accusation is thus untrue and completely |27| false. Or does the accoucheur consider a normal discharge of blood after delivery to be an unnatural hemorrhage according to medical understanding? Nonetheless, he advised cold wraps. I proposed to him that this was not at all a case of unnatural hemorrhaging and that such was thus quite unnecessary. He responded that one must try to forestall any hemorrhaging: yet additional proof that the accoucheur did not speak the truth, since here he himself obviously acknowledges the absence of any hemorrhaging. And now, at his command, those things were done that he describes on pages 22 and 23. Whether this idea is commensurate with medical principles I will leave for specialists to determine, who might also examine and assess the treatment of this childbed.

From this account one can now see that:

(1) The lady was delivered artificially even though there was no urgent need to do so; the umbilical entanglement posed no real hindrance, nor was there any need for either lever or forceps.
(2) It was the accoucheur who tore the perineum.
|28| (3) The cold wraps were applied even though there was no urgent need to do so, since there was no hemorrhaging.
(4) The tearing of the placenta was merely a harmless separation caused by nature.

I have tried to defend myself against the accoucheur’s accusations. May the Göttingen public determine with what success. Both I and my opponent have chosen it as our judge. May it now examine which of us may claim favorable judgment. I am prepared to attest in person before the proper authorities all the sworn facts I have presented in this publication commensurate with my sworn oath of office to the extent they are based on the principles of my profession, and to corroborate the facts that took place before witnesses through the latters’ sworn testimony.

Notes

[*] Catharine Margaretha Klocken, Vertheidigung gegen einige Beschuldigungen des Herrn Professors Osiander (N.p. [Göttingen] 1793). This was Madam Klocken’s response to Osiander’s precipitate self-defense (see below) after Lotte Michaelis’s death on 2 April 1793.

After this present response was published, there immediately appeared Ludwig Orth, Sendschreiben an Herrn Doctor und Prosector Hempel über die vor kurzem erschienene Vertheidigung der göttingischen Hebamme Catharine Margaretha Klocken ([Göttingen] 1793), a defense of Orth’s teacher Osiander full of invectives and addressed to the physician Adolph Friedrich Hempel, who Orth thought had composed Klocken’s piece.

A cursory response quickly came from Hempel himself, namely, Antwort auf das Sendschreiben des Herrn Doktors Ludwig Orth (n.p. [Göttingen?] 1793), in which he explained that while he had indeed authored some of the medically related passages, an unnamed legal consultant whom Madam Klocken had consulted had composed the majority after asking him, Hempel, for assistance in parts of which he, the consultant, had neither experience nor understanding. Back.

[1] Friedrich Benjamin Osiander, Fried. Benj. Osiander’s Anzeige seiner Vorlesungen im Sommerhalbenjahr 1793. Das Neueste aus meiner göttingischen Praxis (Göttingen 1793); complete text see supplementary appendix 123a.1 (with illustrations of the birthing stool mentioned in this present account). Back.