Mary Leslie (1863-1927) was a true working-class battler; she is one of my historical heroines. A recent visit to a remarkable medical museum – of which more later – brought her to mind. In 1890 Mary gave birth to a daughter in New Zealand’s first ‘successful’ Caesarean section; that is, one in which both mother and baby survived. I told her story in my history of childbirth, but I think it deserves to be better known. A word of warning though – anybody squeamish might like to stop reading now!
Mary, a servant from rural Aberdeenshire, arrived in Otago in 1884 as an assisted migrant. I am suspicious that she may have been pregnant on arrival. Some unmarried women managed to hide their pregnancy from immigration officers and thus escape from an intolerable situation at home, perhaps banished by their family, rejected by a lover or escaping a bad relationship. Unfortunately no admission records for Dunedin Hospital from this period survive, but at some stage after arriving in Otago Mary gave birth there. Hospital birth, like all hospital care, was reserved for the destitute in nineteenth-century New Zealand. Most women gave birth in their own home, assisted by a midwife or doctor, and many of the women who gave birth in hospital were unmarried servants who had no other place to turn. It was perhaps just as well that Mary did attend the hospital, where expert medical care was available, for all did not go well. She had a very narrow pelvis and the labour was obstructed: she could not give birth naturally. She therefore underwent the most common procedure used in this period when a woman could not deliver her baby: a craniotomy. Essentially, this horrific procedure involved the doctor introducing instruments into the womb and crushing the baby’s head so it could be delivered. The baby inevitably died but the mother’s life was often, though not always, saved.
In 1890 Mary, by now 26 years old and a servant in the Catlins, South Otago, was again pregnant. She came back to Dunedin and was admitted to the Otago Benevolent Institution (this now housed the lying-in ward for destitute women, which had previously been at the hospital). When her labour failed to progress, she was fortunate to come under the care of Dr William Stenhouse. Stenhouse had been for some time uneasy at the use of ‘destructive’ operations, as they were sometimes called, in obstructed labour. The Caesarean section was obviously a better option for the baby, but considered highly dangerous due to its very high mortality for mothers; it was generally only performed as a last resort when the mother was already close to death. Stenhouse resolved that when ‘a favourable case’ came before him, he would recommend a Caesarean rather than a craniotomy. Mary Leslie proved to be that ‘favourable case’: she was a strong and healthy woman who had previously required a very long operation to deliver her baby. She left the choice between craniotomy and Caesarean to Stenhouse. Of course, she lacked any real power in this situation, for she had no support people and was completely dependent on him and the Benevolent Institution for help. Stenhouse, with the assistance of two other doctors and a midwife, went ahead with the Caesarean and Mary and her daughter both survived the procedure. We know a lot about this incident because Stenhouse wrote a detailed article about it for the New Zealand Medical Journal, as part of his campaign to promote the Caesarean section as a viable option. It was a wee while before Caesarean section picked up in popularity, but by the mid-1930s over 100 New Zealand babies were born this way each year. I suspect William Stenhouse would be rather surprised, though, to see how very commonplace it later became, with Caesareans now accounting for around a quarter of New Zealand births.
I don’t know what became of Mary and her baby, named Barbara, immediately after their discharge from the Institution, six weeks after the birth, and neither do her descendants, but three years later she was working as a housekeeper in the Wakatipu district. There she married John Graves, a gardener and rabbiter. After her marriage Mary gave birth to two further daughters; Jane died at eight days but Sarah survived. Sadly for Mary, her troubles were not over, for her husband John died three years later, leaving her with two young daughters to support alone. She continued working in the Wakatipu and Cromwell districts in domestic positions until she died of heart problems in 1927, aged 64. Her family remembered her as a woman who worked hard all her life. Much of Mary’s story remains hidden. The fathers of her first two children are completely absent from the surviving records or her descendants’ knowledge, and neither do we know how she delivered her youngest two babies.
I see Mary as a heroine because she was willing to put her own life at risk and undergo a dangerous and somewhat experimental operation in order that her unborn baby’s life would not be sacrificed. When we consider the difficulties that a destitute unmarried woman could expect in bringing up a child during this era her decision seems even braver. Ironically, the survival of both Mary and her baby resulted from her dire social situation. Had she not been forced to turn to the Benevolent Institution for charity her baby, and perhaps Mary also, would have died. Though institutional childbirth carried its own dangers, for institutions were prone to outbreaks of puerperal fever, such places could also offer skilled care to birthing women. The annual reports of medical officers of the Otago Benevolent Institution sang the praises of Lucy Mee, who was the wife of the institution’s manager and ran the lying-in ward, serving as midwife. Expert medical care was also at hand. This was a much higher level of care than might be received by a poor woman who could not afford to employ a doctor or midwife, and depended on a friendly neighbour for assistance at a birth.
While in Christchurch recently I visited the Cotter Medical History Museum, where I saw some of the medical equipment available in Mary’s time. This collection started with artefacts and archives collected by Christchurch surgeon Pat Cotter, with material added by many other donors since. It is managed as a trust, with a group of enthusiastic volunteers (mostly retired healthcare workers). It has display cases around various Christchurch sites – I saw some at the medical school building – with the main collection store at Hillmorton Hospital. Bramwell Cook, a retired gastroenterologist who is an expert on the collection’s historical instruments, kindly assembled and described for me some of the childbirth-related items. These really brought home to me the horrors faced by nineteenth-century women who encountered problems giving birth. The most benign items are the obstetrics forceps, with design slowly improving through the years. Less benign – and now, thankfully, obsolete – is Frommer’s dilator, dating from around the early twentieth century. This was used to dilate the cervix in cases where an urgent delivery was required; if a woman had eclampsia, for instance. Once the cervix was sufficiently dilated the doctor used forceps to deliver the baby as quickly as possible. The major problem with dilators was the high risk of laceration. As Caesarean section became safer, it took over from ‘accouchement forcé’ (as it was politely known) for emergency deliveries.
Perhaps the saddest instruments in this collection, though, are those designed for craniotomy, sometimes known as embryotomy or perforation. This is the operation Mary Leslie underwent at Dunedin Hospital in the 1880s. It could be a tricky process, with Mary spending 9 hours under chloroform for her procedure. As Bramwell Cook writes in his fascinating book on the items held by the Cotter Medical History Trust: ‘Destructive instruments were kept by every accoucheur for the 1 in 400 deliveries that they were required to save the life of the mother.’ They included perforators for piercing the baby’s cranium and crochets for taking a hold inside the cranium ‘to seize and extract’ it. If a crochet couldn’t do the job, a cranioclast or cephalotribe might be used to further crush the skull. The horrific decapitating hook was, thankfully, ‘very rarely required’; it might be used to cut up a dead unborn child lying crossways in the womb and unable to be turned.
No wonder William Stenhouse and others were keen to promote the use of Caesarean section for emergency and obstructed deliveries! My thanks to Bramwell Cook and the other friendly volunteers of the Cotter Medical History Trust for their help. I am also grateful to Annie Wrigley, Mary Leslie’s great granddaughter, who got in touch with me after my book was published and kindly shared the photograph (which we managed to sneak into the e-book version!).
H. Bramwell Cook, Silent treasures tell their stories: Cotter Medical History Trust collection, 2nd ed. (Christchurch: Cotter Medical History Trust, 2012).
William M. Stenhouse, ‘Successful Case of Cesarean Section’, New Zealand Medical Journal, 3 (1890), 225-30. [This article describes Mary Leslie as ‘ML’ – I identified her through the Otago Benevolent Institution Inmates Book at Archives New Zealand Dunedin Regional Office.]
Biographical details of Mary Graves (nee Leslie) from birth, death and marriage registrations, Otago Southland Assisted Passengers list, Otago Benevolent Institution Inmates Book, family information, obituary (Cromwell Argus, 25 July 1927).