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    The Dutch Century: Domination of the Spice Trade at Any Cost
    The Dutch Century: Domination of the Spice Trade at Any Cost
    The Dutch Century: Domination of the Spice Trade at Any Cost
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    The Dutch Century: Domination of the Spice Trade at Any Cost

    By Carl Douglass

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    The Dutch Century: Domination of the Spice Trade at Any Cost is the second of three books about the remarkable 17th century, primarily owned by the Netherlands. It reveals--as historical fiction—the adventures, trials, risks, accomplishments, conflicts, atrocities, and crimes, of the Dutch and specifically of the Seagoing Van Brakel family.
    LanguageEnglish
    PublisherPublication Consultants
    Release dateDec 1, 2021
    ISBN9781637470367
    The Dutch Century: Domination of the Spice Trade at Any Cost
    Author

    Carl Douglass

    Carl Douglass has had a long and complex life. The highlights are having married Vera, having four children, 11 grandchildren, and nine great-grandchildren. He has been a Teamster truck driver, a navy general surgeon, a practicing neurosurgeon, and a mental hospital general medical officer. He has written more than forty books of fiction, and ten nonfiction books. He lives in a quiet, smallish city in the Rocky Mountains with his wife and enjoys life there with her.

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      The Dutch Century - Carl Douglass

      CHAPTER ONE

      PREPARATIONS FOR THE VOYAGE TO THE SPICE ISLANDS

      IN THE YEAR OF OUR LORD, MAY, 1647

      The good ship Z-Hendrika Louisa set sail as the tide rose, and the sun peaked out of the sea fog and clouds. The ship was owned by Captain Piet Corneliuszoon Van Brakel and his wife, Anneke and a tithe share controlled by any crew member with three or more years of service on the ship who wished to buy in. That was one major difference between the Z-Hendrika Louis a and almost all other ships engaged in commercial ventures from the Port of Bruges. This was its third voyage and most of the crew had purchased a share and were determined to make the ship’s adventures highly profitable for all aboard.

      The past year had been both sad and rewarding. Sad because Piet and Anneke investigated the whereabouts of her family and determined that the slavers had taken all of them–including Anneke–and the fates of the rest of her large family could not be further determined. There was also sadness because Piet found that his father and mother—Cornelius and Greta–had died in the plague of 1666 along with his sisters Hillegont, Femma, and Vrounwtje—Geertje had died in childhood of a brain fever. His older brother Bart succumbed to the plague. Of his sisters, only Ytje survived the pandemic. It took some investigating to learn that his brothers, Willemt, Metten, and Hendrick, survived the disease as well. Unfortunately for Piet–all three brothers and Ytje–left the Netherlands forever to seek their fortunes in the new world of America. Nothing had been heard of them since. For both Piet and Anneke, the past was gone.

      The future was beginning on a rewarding note: Both Anneke and Piet found themselves the sole possessors of their families’ fortunes. In Anneke’s case, there was truly a fortune, abandoned to the banks when they disappeared. With copies of her parents’ wills in hand, she and Piet had no difficulty having the Amsterdamsche Wisselbank [Bank of Amsterdam] insurance and shares of the Dutch East India Company in which her frugal father had invested early in his youth, turn over the accumulated fortune—enough to keep a family in a life of luxury for life. The investment had increased by 600%. In addition–to take advantage of the security of diversity–her father had established accounts in the Banks of Delft, Middelburg, and Rotterdam. The accounts started with smaller amounts than that in the Amsterdamsche Wisselbank, but it had become sizable owing to a profit of more than 650% compounded over the good years.

      There was a very comfortable sum invested in two merchant ships by her father in the name of his adored daughter, Anneke Blandina van den Voor-Hees. It was sufficient to allow the new partnership of Piet and Anneke to purchase ships outright and to rename them after their mothers—The Hollandische Greta, and the Gunnhilde Scents of Eden. There were now three vessels ready to embark for the Malukus.

      Piet’s family had not done nearly so well, having lost everything in the great tulip disaster of 1636. However–by dint of nearly superhuman effort–Cornelius and Greta had been able to buy a small hotel—the Independent Netherlander Inn–in Rotterdam [Dutch for muddy water] and later, one in Delft—The Royal Delft Hotel. Rotterdam–where they lived–became a major transshipment port for inland Europe, with tens of thousands of Rhine River barges using its facilities. In the 17th century–when the discovery of the sea route to the Indies gave an enormous impetus to Dutch commerce and shipping–Rotterdam had expanded its harbors and accommodations along the Meuse River. By 1645, when Piet and Anneke tracked down his family’s holdings, Rotterdam had become–after Amsterdam–the second most important merchant city of the country. The Van Brakels had prospered along with their new city.

      The Van Brakels’ had allowed themselves one risky venture, as they regarded it. They made a routine investment in one of the six kammers [chambers] of the VOC [Vereenigde Oostindische Compagnie–the Dutch East India Company]. They chose a near perfect time to do so. The VOC was one of the first companies to discover the spice islands; and—having done so, reaped profits so rapidly they could scarcely keep up with the profits, growth, and progress. It was a situation of the tide raises all boats. For the elder Van Brakels, it was like the tulip boom all over again, except this time the spice boom would outlast Cornelius and Greta by more than a hundred years.

      The profits and wealth that came from investing in VOC came with a further opportunity: Commerce between the North Sea and the inland Rhine River thirty kilometers inland was profitable but cumbersome owing to the inconveniences of the overland passage. The VOC proposed a canal to link the sea and the river. The offering seemed too great a risk and cost even for the VOC; so, the company spent months in its efforts to secure investors. Comfortable with their savings, the Van Brakels bought three shares. The kammers were responsible for raising the start-up capital for the company, which was eventually to become a huge multinational corporation. The City of Rotterdam–recognizing the Rotterdam port’s importance–contributed 173,000 guilders, an investment that was to pay off in spades over the ensuing centuries.

      There were difficult periods during the construction, but the VOC was a very remarkable company—capable of fulfilling its promises. The Dutch people were futuristic in their visions and as hard-working a people as any who ever lived. As a result, the project was completed on time and underbudget. The final outcome was that the North Sea was linked by a canal–called the New Waterway—to the bustling water highway, the Rhine. Rotterdam lies along both banks of the Nieuwe Maas [New Meuse] River, a northern distributary of the Rhine River.

      Transshipment barges became a virtual necessity, and the Van Brakels’ figured that out well before the canal was finished. The day after the celebration to open the canal, they were the first—and shortly, the foremost–barge company owners in the city. If they had had a printing press to make their own money, they could not have become richer, faster.

      Piet and Anneke rummaged through the now empty Van Brakel house in Rotterdam and found his birth certificate and his father’s will. Piet was the last known survivor and had become the sole heir. In three days of checking papers and investigation of his whereabouts during the previous three and a half years, the bankers and the VOC were satisfied; and Piet became a multi-millionaire. He promptly made legal arrangements to have Anneke become his equal partner and to have a proper will prepared. As their investigations into the financial status of their now dead parents went forward, they were pleased—not only to be rich—but to be financial equals in terms of what each of them was bringing into the future.

      They decided to make Rotterdam their home of record and also to make it their main center of business. So–on their last day in the city, and the last day before setting sail for the Spice Islands–they found a branch bank in the Delfshaven to secure their financial holdings and went to the customs office to register their three vessels as their co-equal property and as proper Dutch registry. They were both attuned to history, and Anneke told Piet that this was the harbor from which the Pilgrims set sale on July, 22, 1620—the year before Piet was born–for the New World and religious tolerance.

      For all the security and peace of mind the riches meant to the young couple, there was something even more rewarding. Anneke gave birth to a beautiful bouncing baby girl—pink, blond, chubby, and beautiful. That day was one of surpassing happiness and a great cloud of love. Piet was now in love with two girls, which made Anneke laugh with joy.

      The delivery was easy as deliveries go. The couple had encountered considerable displeasure on the part of the local physicians and two obstetricians when they announced that they were going to have the baby at home, and he or she was going to be brought into the world by a midwife.

      Witches, the doctors said, don’t know their knees from their elbows. It is not safe, my boy, not safe at all. Mind my words!

      Anneke spoke up for herself, We respect your profession but not for delivering babies. We have seen hospitals and delivery rooms around the world. They are filthy beyond description; the doctors move from one infected woman to another without so much as washing their hands. My mother allowed me to watch two of her deliveries by a mid-wife. There was soap, clean water, hand washing, clean clothes and caring… a lot of that, Sir. We are afraid of your hospitals and your unclean ways. We are safer from the childhood fever at home.

      Young lady, I am a scientist, a fully trained physician. Do you claim to know more than I about medicine?

      No, except on this one subject. Doctor, you and your colleagues would do well to apply your science to the question of why do nurses and midwives who wash their hands have less childhood fever by more than ninety percent than doctors working in hospitals?

      Balderdash. That is an old wives’ tale. And what if you have a difficult birth and need the care of a surgeon in a hospital?

      I would insist that he and everyone else involved wash their hands. My husband, Piet, is strong and determined; and he would see to it that that commonsense dictum is obeyed no matter what you and the other fool doctors think. And more than that, the godfather of my children—a giant named Able Seaman Andries Janszoon–will turn the place upside down if he thinks I am being poorly done by… but thank you for your interest and concern.

      The two doctors who took it upon themselves to consult with Anneke and Piet regarding the delivery of the rich young couple’s baby, held much the same conversation and learned that Anneke was a stubborn and unyielding Dutch girl. After all, she was only eighteen years old.

      The midwife was selected from among the practitioners whom the ladies in their neighborhood in Rotterdam had used. It was easy to forego the suggestions of husbands whose wives who had lost their lives in the expensive and prestigious hospitals. The majority of the multiparous women agreed that a sturdy middle-aged, and highly experienced, Dutch woman by the name of Bertha Elsie Van der Utrecht should attend the beautiful mother to be. She had even had experience in the performance of Caesarian Section for difficult births.

      Anneke was not shy about matters of her health and asked Bertha if having a Caesarian Section was difficult.

      Not when done by me, my girl. The first one was done by a Swiss pig gelder more than a hundred years ago. Mother and child survived and did just fine. If an old farmer with skills can do it, there is no reason to fear the operation being done by me.

      And that was that.

      Anneke’s older and more experienced friends followed her pregnancy looking altogether like mother hens protecting their chicks. Bertha attended Anneke’s stages of pregnancy and was on hand early in the morning of the day of delivery.

      She was even more brusque and business-like than the neighborhood hens and soon had the master bedroom turned into a delivery room. It was scrubbed with lye soap from top to bottom and side to side twice. New–and newly laundered–sheets and towels were brought into the room, and the kitchen girls fetched large cauldrons of hot water to which Bertha added a large dollop of fragrant and frothy bath soap. She scattered Solomon’s seal on the floor to banish serpents and other venomous creatures from the room. Bertha locked the door to the room and stuffed fennel into the keyhole to protect the room from entry by evil spirits.

      There was some clucking from the hens when Bertha shaved Anneke’s perineum until it was as clean and smooth as a just washed baby’s bottom. She gave the already uncomfortable young mother a laxative and enemas to prevent fecal contamination of the vaginal area.

      Bertha had her own methods for delivery. She instructed Anneke how to squat and hold onto a railing of Bertha’s construction. She supervised a second washing of the delivery area; so, the newborn would enter a pristinely clean new world. She was kind, persuasive, and tutorial, with Anneke and did not allow outside visitors—such as husbands—in the room. She told her patient when to push and how much, and when to rest.

      Anneke was a good birther—wide pelvis, no history of rickets which plagued many girls in the mid-1600s resulting in narrowed pelvises and difficult births. She was brave and trusting of Bertha; and it was not her first time.

      Bertha washed her hands, made certain that everything that touched Anneke or the baby was freshly laundered and sterile. The baby’s head crowned after eight hours of hard labor from which Anneke was nearing exhaustion.

      Work just a little more. Maybe only three or for more pushes, and you will have a good baby to love. What kind do you think it will be, my dear?

      Boy. I produce boys… two of them; maybe, this will be the third.

      "Het zal zijn zoals God mijn meisje wil." [It will be as God wills, my girl.]

      Bertha did a small episiotomy to ease the tearing and sewed the incision carefully afterwards. By then Piet was in the room, and—with a twinkle in her eye—Bertha made two extra stitches to tighten the introitus and whispered to Piet, the husband stitches.

      Bertha then gently extracted the placenta and dropped it into a bucket for the pigs. She doubly tied off the umbilical cord with strong waxed twine, then invited Piet in to do his husbandly duty. She gave him a razor-sharp knife, and Piet neatly severed the birth cord between Bertha’s two encircling ties.

      "Now, this is your baby, my son," she said and smiled at the anxious young man.

      And, God willed Anneke Blandina van den Voor-Hees to have a perfect baby girl, the second female love of her father’s life.

      Bertha ended her work with a brief prayer, "O prijs de Heer, gij zijne engelen, gij die uitblinken in kracht: gij die zijn gebod uitvoeren en zich wenden tot de stem van zijn woorden." [O praise the Lord, ye Angels of His, ye that excel in strength: ye that fulfil His commandment and hearken unto the voice of His words.]

      By then, Andries was in the room towering over his goddaughter and godgranddaughter. He joined in the chorus of Amens.

      With three healthy youngsters, a crew of officers and their wives and six children, and an enthusiastic crew, the three ships of the Van Brakel Maritime Company were ready to set sail for the unknown, but with a certainty that the adventure would be well worth it because of the good omens preceding the departure.

      HISTORY OF CHILDBIRTH; PREHISTORY TO THE TWENTIETH CENTURY

      Being pregnant and delivering a baby is hard; that is not news. It has always been hard, and the difficulty has often not been fully appreciated by men. Some of that is due to superstition, superstitious religion, and to ignorance resulting from secrecy. Having the husband present for the birth of his child is a relatively recent tradition and one of the slowly occurring steps forward. Things have certainly improved; but worldwide, childbirth still causes 600,000 maternal deaths a year.

      With that preamble, let us consider the historical attitudes about procreation, pregnancy, and delivery. It was no great mystery, apparently, that intercourse produced pregnancy. What happened next was a matter of conjecture and superstition which did not detract from the absolute knowledge that each culture’s tradition was true. Ancient Greeks saw the male as the life giver; the female was simply the vesicle to hold the growing fetus. That conclusion was so ingrained that males and females alike held to it for millennia thus fixing the dominance and importance of males in the culture. In front of most homes at the time was an icon—small or large, and apparently size mattered—of a phallus–complete with scrotal sac. Ignorance about female anatomy and physiology was profound. Childbirth in the ancient world was extremely dangerous due partially to a lack of understanding about the female body, leading to societal assumptions about pregnancy and childbirth, as well as the use of potentially dangerous traditional herbs.

      A large portion of the written sources about women’s bodies in Ancient Greece came from the Hippocratic Corpus, seven treatises of which focus specifically on gynecological issues. All written information came from men, and none of the information came from any man who had actually examined or dissected a woman or had attended a delivery. An example from the treatises was that the general explanation for menstruation was that both men and women sucked up nourishment through their glands; but since women did less physical work than men, their excess nourishment had to come out in the form of menses. The quantity of menstrual flow was determined to have to be more than the amount of semen expelled from men in the course of a month, since women had larger breasts, and therefore spongier glands. Diseases in women were a result of their wandering uteruses—a masculine philosophical theory which received considerable attention in the writing of philosophers. According to them, the best ways to keep the wayward uterus in place were intercourse and pregnancy—another way for the better sex to contribute to the life of women. The Greek root for uterus is ‘hyster", hence an upset or delusional woman was hysterical, coming from her excessively wandering uterus.

      The Hippocratic Corpus extensively discusses issues related to pregnancy with special emphasis on conception and miscarriage. If a woman could not get pregnant, it was always the fault of her body, whether from a cervix or uterus that was misshapen, or an excess of phlegm and other fluids. One example from that learned text relates to the treatment of infertility by inserting medication into the cervix immediately before intercourse with a lead probe, and then to lie with crossed legs for at least six days afterwards, avoiding bathing or eating solid foods. Once conception had occurred, however, miscarriage in the ancient world was incredibly common, and once again always the fault of the woman. Miscarriages happened in the third or fourth month of pregnancy if there were unhealthy matters in the uterus, or if the uterus itself was too smooth to prevent everything from slipping out. The text lists several actions by women which induce a miscarriage: lifting something heavy, misbehaves and is beaten, leaps into the air, goes without food, has a fainting spell, is frightened, shouts violently, loses control over herself, eats/drinks something contrary to usual habits. The Corpus states emphatically and by way of instruction that, women need not be surprised at the fact that they have miscarriages although they do not want to, and that it takes special skill and attention to be able to carry a baby to term. Not all women are up to it.

      The Corpus and other medical writings tell of a significant difference between modern women and the ancients. Some–and apparently many–ancient women had menstrual cycles that lasted a full month, and the majority lasted much longer. Those ancient writings state that the healthy amount of blood loss over the course of a period was about a pint [seven to eight times more than modern scientists suggest]. Again, the treatises and their opinions came exclusively from men. It is, therefore, difficult to tell if women actually bled more, or if ancient physicians simply did not have the proper tools for measuring or if they just made estimates based on their dismay at seeing or hearing about the bleeding. The physicians at their writing desks opined that menstrual periods would become less painful only after having achieved pregnancy, which would stretch the womb to allow for enough room to hold such a large amount of menstrual blood.

      Traditionally there was a postpartum ceremony which included a public purification ritual including sacrifice of a dog and burning incense to purify the bodies of mother and child, since childbirth was seen as a polluting act.

      Contraception was a regular feature of ancient Greek life. Soranus of Euphesus–a Greek physician who lived during the Roman period–wrote a four-volume treatise on gynecology in which he speaks at length about the use of herbs as contraceptive and abortive methods. According to his writings, contraceptives were most often administered as pessaries inserted into the vagina since they cause the orifice of the uterus to shut before the time of coitus and do not let the seed pass into its fundus. The use of such herbs was deemed not to be immoral; family planning was an accepted idea since having too many sons would result in dividing the wealth too thinly. Herbs such as silphium from North Africa were also taken orally for contraceptive purposes.

      Pomegranate seeds were commonly used for contraception since they were associated with a pause in fertility because Persephone ate them while in the Underworld. It was after tasting food from the Underworld that she would have to return for a third of every year–during the winter months–while there was a pause in fertility on earth.

      There were many theories used to determine whether a woman was pregnant during antiquity. A popular method involved examining the vessels of her breasts. A second method required a woman to sit on a beer and date mash covered floor using a proportionality equation according to the number of times she vomited. Another method included inserting an onion into a woman’s vagina and determining whether or not it could be smelled from her breath.

      Soranus of Ephesus described three main stages of pregnancy: conception, which regarded keeping the male seed within the womb; pica, which occurred 40 days into pregnancy and included symptoms of nausea and cravings for extraordinary foods. During this phase women were also instructed to exercise and sleep more to build up strength as preparation for the labor process. The final stage of pregnancy was described as the labor and the process of delivery. In preparation for labor, the woman was advised to bathe in wine and sweet-water baths to calm her mind before delivery. Her belly was then rubbed with oils to decrease the appearance of stretch marks, and her genitals were anointed with herbs and injected with softeners such as goose fat.

      Religion played a major role during labor and delivery. Women called upon Artemis, a goddess with the ability to bring new life into the world as well as the ability to take it away. Though the goddess remained a virgin herself, it was said that she witnessed the pain of her mother during the birth of her brother—Apollo–and immediately assumed the position of midwife. If a woman died during childbirth, her clothes were taken to the temple of Artemis to be destroyed since the woman’s death was attributed to her fault or failure. If the birth was successful, the mother would make an offering of thanks by sacrificing some of her clothes to the goddess as well.

      Herbs and other plants were used heavily in the delivery process, a practice linked to religious belief. A drink sprinkled with powdered sow’s dung was given to relieve labor pain, and fumigation with the fat from a hyena was performed to produce immediate delivery. The Hippocratic writers believed that the womb could move out of place and cause health problems, especially during delivery; and the prescribed treatment was to coax the displaced womb back into place using sweet-smelling herbs.

      The role of the midwife was very important during the process of childbirth by the ancients. Soranus described the role of midwives—always females–in great detail. The midwife was to have certain tools to ensure a safe delivery, including: clean olive oil, sea sponges, pieces of wool bandages, to cradle the infant, a pillow, strong smelling herbs in case of fainting, and a birthing stool–a chair from which the seat had been removed.

      During the labor process, the mother was placed on her back on a hard, low bed with support under her hips. Her thighs were parted with her feet drawn up. Gentle massage was implemented to ease labor pains as cloths soaked in warm olive oil were laid over her stomach and genital area. Against the woman’s sides were placed hot compresses in the form of warm oil-filled bladders.

      During the actual delivery, the mother would be moved to the birthing stool, where she was seated or would squat on two large bricks with a midwife in front of her and female aides standing at her sides. In a normal headfirst delivery, the cervical opening was stretched slightly, and the rest of the body was pulled out. Soranus instructed the midwife to wrap her hands in pieces of cloth or thin papyrus so that the slippery newborn did not slide out of her grasp. Once the woman gave birth, she was on her own about how to care for the newborn. Medical books of the period–as well as the doctors–were of little help to the new mother; and nurses had not yet become part of the medical process.

      In ancient Greece and Rome, birth was usually an all-female event which affirmed the parturient’s status as mother of the patriarchal family, especially when she produced a male child. Women in labor prayed to Aesclepius and Artemis for support. Midwives came from a range of socioeconomic backgrounds, and they enjoyed varying amounts of prestige according to their training. In Greece, there is record of some nondoctor males as well as the female healers who were trained in empirically based knowledge. A midwife untrained in Hippocratic medicine relied on a variety of folk nostrums as well as on charms and amulets.

      Throughout most of the ancient world over millennia, when a baby’s abnormal birth position slowed its delivery, the birth attendant turned the infant in utero or shook the bed to attempt to reposition the fetus externally. A dead baby who failed to be delivered would be dismembered in the womb with sharp instruments and removed with a squeezer. A retained placenta was delivered by means of counterweights, which pulled it out by force. Pain relievers and sedatives were employed only for excessive maternal suffering due to birth complications; pain associated with normal labor was seen as productive and as a part of the birthing process.

      In primitive tribes studied by anthropologists in the twentieth century, the woman in labor was usually attended to by her mother or other female relative. Prehistoric figures and ancient Egyptian drawings show women giving birth in the sitting or squatting position. Birthing stools and midwives are also mentioned in the Old Testament. Their ideas and practices from classical antiquity endured in Western medicine for centuries and many themes are still seen in modern women’s health.

      Medical schools attached to temples in ancient Egypt were numerous, including well-known medical schools for women at Heliopolis and Sais, where women are also believed to have been the professors. Antiquarian texts mention the use of slaves or members of a doctor’s family as assistants, but nurses as such were unknown. The closest similarity to that of a nurse during antiquity was a midwife. Midwifery flourished in ancient civilizations, including Egypt, Byzantium, Mesopotamia, and the Mediterranean empires of Greece and Rome. The writings of Hippocrates in the fifth century BCE include a description of normal birth. Instrumental delivery was restricted to stillborn babies and involved the use of hooks, destructive instruments, or compressive forceps. Such instruments were described in Sanskrit texts as well and were known in Arabia, Mesopotamia, and Tibet. Instrumental intervention in obstructed labor carried a high cost in terms of maternal mortality.

      There certainly were dark ages for obstetrics. Soranus’s writings formed the basis of the Moschion, a Latin manuscript in the sixth century CE; but little more was added to obstetric knowledge until the invention of printing 900 years later. The first obstetric pamphlets were printed in Latin or in German but not until the latter part of the 15th century; and they made little impact on the general milieu of ignorance and superstition. In 1513, however, a German obstetric textbook appeared which became a bestseller. Der Schwangern Frauen und Hebamen Rosengarten was translated into Dutch in 1516 and reprinted many times in Dutch and German over subsequent decades. It was also translated into several other languages, including French and English. It was the only published work of Eucharius Rosslin–an apothecary from Freiburg–who took up medicine in 1498. Rosslin probably never actually practiced obstetrics but instead simply restated the obstetric teaching of the ancients, including Soranus. In 1668, an accoucheur [male midwife] named Mauriceau published a celebrated text, Traite des Maladies des Femmes Grosses, which was translated into several languages and went through many editions. Mauriceau pioneered primary suturing of the perineum after delivery, cleansing… with red wine then applying three or four stitches, he wrote. He introduced the practice of delivering women in bed rather than on a stool, something taken for granted in the last three and a half centuries. Nevertheless, he remained steadfastly opposed to Caesarean Section, on the understandable grounds that it was almost invariably fatal to the mother.

      Caesarian Sections were done relatively infrequently since such deliveries all too often resulted in the death of the mother and child. It is commonly believed that word Caesarian derives from the ancient Roman ruler Julius Caesar, because it was believed that Caesar was delivered via this procedure or that it came from the practice of Caesar’s legionnaires cutting the unborn child from the womb of a living woman as a means of spreading terror. That is untrue. The practice of C-section surgery is considerably older than Julius Caesar, and C-sections–as performed by the Romans–were done to rescue the baby from a dying or already dead mother, in which they were performed post-mortem. The Greek god Aesclepius was fabled to have been extracted from his mother’s womb through this procedure. The first successful Caesarean Section in the Britain was performed by an Irish midwife, Mary Donally, only as late as 1738. The ancients considered that if one touched or handled the corpse, one became polluted; so, the task was given to women. That attitude carried on into the Medieval and Renaissance periods often leaving women to attempt to extract a living baby from a dead mother.

      In the patriarchal societies of Ancient Greece, the husband had the power to decide if the newborn child was to be declared legitimate or not, based on what he determined to be the child’s worth. The baby—more commonly, a female–was declared illegitimate if born frail or deformed. The man’s options [father or husband] were to sell or to give away the unwanted child as a slave, or more commonly to be left out to die of exposure—similar to Asian and Middle Eastern practices which survive even to the present day in some regions. In his writings, Aristotle stated emphatically that it was an absolute requirement that no deformed child be reared. Killing a new-born–or rather letting it die–was not the same thing morally or legally as killing a genuine member of the family. There was no obligation for the man to pay attention to any bond that occurred between mother and child.

      Jews in ancient Rome successfully practiced C-sections on living mothers who were not in danger of dying. Evidence of these procedures is found in several collections of ancient Roman rabbis, the most famous of which is called the Mishnah. Egyptians did not perform C-sections, either post-mortem or on living mothers. Nowhere in the ancient world was C-section performed with any great frequency owing to lack of skill and education by practitioners and the public, the fairly common occurrence of serious complications, because of Christian religious beliefs held by doctors, and a host of other superstitions. Midwives were of importance but did not record their practices in writing. It is, therefore, possible that C-section was more common than believed owing to the sparsity of comment in doctors’ literature.

      During the medieval and Renaissance periods—the time when Anneke was having children–childbirth was a home-centered social event involving the collaboration of the birthing mother, her female relatives, and a midwife—a predominately female activity. Midwives administered narcotics or supposedly pain-relieving herbs and wine in spite of the biblical injunction that in sorrow thou shalt bring forth children [Holy Bible, Book of Genesis 3:16]. That would change dramatically again during the Victorian period. Catholic mothers also sought solace in praying to St. Margaret, the patron saint of pregnant women, while Protestant women prayed directly to their Lord without the intercession of saints.

      To hasten delivery, a midwife massaged the mother’s belly and genitalia with oil. Bloodletting at an ankle vein was often administered. During labor, the pregnant woman was urged to move constantly about the lying-in room, trying to find a comfortable position from which to give birth. Birth stools were common, especially in Germany. For abnormal deliveries, the skilled midwife had several options: she could burst the amniotic sac to induce labor; she could tie cloth to an impacted fetus and pull; or she could reposition the infant internally or externally using manipulation or abdominal massage. In instances of breech presentations, stillbirths, twins, or other problems caused by the mother’s pelvic deformities, a surgeon was called in as a last resort. Sometimes he would have to dismember and extract the fetus with crochet hooks and knives to save the life of the mother. This was a bone of contention from the Catholics who strongly preferred that the mother be sacrificed in favor of the infant in such cases.

      For well over 1,000 years, obstetricians had managed obstructed labor by converting the presentation to a footling breech and delivering the baby by traction. Delivery of the aftercoming head, was facilitated by pressure on the mother’s abdomen. Crude as this ancient method may seem, it is good to remember that in the very long era before Caesarean Section, the main risk of obstructed labor was death of the mother and usually the child. The obstetrician would only be summoned once the midwife realized that problems were developing; and often by that stage, the baby was already dead. Note that the stethoscope was not invented until the 19th century, so the fetal condition could not be monitored.

      From the late thirteenth to the late eighteenth century, a midwife’s social background, occupational status, and skill level, varied significantly within and among countries. Her workload, pay, range of tasks, and acceptance, also varied. Midwives ranged from ignorant and unskilled to skilled and respectable. In some instances—usually propagated by doctors–midwives were characterized as witches. Mothers usually ignored such imaging. Midwives were rarely accused of witchcraft in courts. Ecclesiastical and municipal authorities entrusted midwives with a variety of medical and legal responsibilities including having the midwife be called upon to testify as an expert witness in cases of contested pregnancy, infanticide, virginity, and rape; to mediate domestic squabbles; and to attest to religious conformity, illegitimate birth, or infanticide.

      Religious concerns motivated the first official regulation of midwives in 1277 at the Trier Synod. Midwives were enjoined to learn how to perform an emergency baptism when there was no time to call in a priest. Beginning in the sixteenth century, municipal authorities regulated midwives under the aegis of the emerging male medical hierarchy. A midwife’s morals, religiosity, and sometimes her skills, were evaluated. In England and the United States, however, midwives received only sporadic regulation. The Hippocratic Corpus writers stated regularly that men were more rational than women, and that women’s physiology made them susceptible to problems that would cause symptoms of irrationality. This untested hypothesis continued into the Medieval period resulting in men dominating the profession of physicians, an occupation requiring rational research, and for which they believed women were not suited.

      Nonetheless, women did become physicians and were formally and legally recognized as such. The Law Code of Justinian presumed women doctors to be primarily obstetricians. The first medical text known to be written by a woman was by Metrodora. The earliest copy dates from between the 2nd century and the 4th century CE.

      During the sixteenth and seventeenth centuries, the systematic study of human anatomy, recovery of ancient medical knowledge, and a renewed interest among male medical practitioners in human reproduction, encouraged the growth of obstetrics and obstetrical innovation. The advent of printing technology facilitated the spread of knowledge. The French surgeon Ambroise Paré [1510–1590] reintroduced podalic version in 1550 [an obstetric procedure wherein the fetus is turned within the uterus so that one or both feet present through the cervix during childbirth]. It is used most often in cases where the fetus lies transversely or in another abnormal position in the uterus. Other talented surgeons, and a few midwives, published obstetrical texts that included protocols for normal and abnormal labor and deliveries. During that period, the French paved the way for the English surgeons and surgeon-apothecaries of the next century to become birth attendants for the aristocracy.

      In 1610, Peter Chamberlen developed the obstetric forceps to be used in live births which remained as a Chamberlen family secret for most of the following century. Peter’s son, Hugh, offered the secret of the forceps to the French government in 1670 but seems to have only fully divulged it to a Dutchman, Roger Roonhuysen, in 1693. The secret and the forceps monopoly remained with the Roonhuysen family in Amsterdam for another 60 years.

      The efforts to conquer the extremely vexing issues of maternal death and infant mortality consumed the careers of several notable physicians beginning in the nineteenth century, and those efforts are worthy of being told in amplified stories.

      Maternal death in antiquity was high owing to several factors, chief among which were: the nearly complete lack of sanitation and hygienic awareness, no understanding of micro-organisms, and almost no effective drugs among the traditional apothecary. In the context of childbirth, however, maternal and infant mortality were exponentially higher compared to modern standards. This resulted from the toll childbirth took on women, and the increased risk of infection following labor. Maternal mortality figures are at best estimates and comparisons until the 18th century in some countries. Scientific studies estimate that maternal mortality rates between 1400 and 1800 to have stayed fairly stable at one to three percent. Most of the women died in protracted labor caused by a narrow or deformed pelvis, fetal malpresentation, postpartum hemorrhage, and puerperal—childbed—fever; and most of them died very soon after delivery. In eighteenth-century rural England, maternal mortality averaged 25 per 1000 births.

      Despite modest advances, at the start of the 19th century childbirth was still dangerous to women and it remained so, despite several more advances, until well into the 20th century. Among the poor, rickets caused pelvic deformities and very difficult deliveries, especially in rural areas, inner cities, among minority populations, and women of the lower economic stratum. Maternal death—however–affected all social classes. In England and Wales, one in every two-hundred pregnancies ended in the death of the mother. In maternity hospitals, however, the death rate was often much higher than that. Lying-in hospitals had been founded in cities such as London and Dublin in the middle of the 18th century, with trained midwives and accoucheurs to attend the poor. For centuries, they were subject to frequent epidemics of puerperal fever, during which the maternal death rate might reach between two and eight per 100 deliveries—around 10 times the rate outside hospitals. This was the nasty little secret of the modern era.

      Infant mortality is a different matter because in antiquity there was infanticide and death by exposure for which there is a great dearth of records or even mention in texts. Medical based mortality—which does not include intentional homicide—is hamstrung by lack of records and must rely on comparative studies with current societies which are similar in the level of poverty, filth, ignorance, superstition, and reluctance to seek medical care. In modern industrialized societies, infant mortality is consistently less than ten per one thousand births. Risks during the medieval and early modern era increased with every new pregnancy, and most families tended to be large. The comparable societies to the antiquarian and Medieval ones displayed rates of fifty to two hundred or more deaths per thousand and a life expectancy average of twenty-five years. This equates to a rate of 300 per thousand in Roman times.

      To emphasize the problems faced by women and the medical personnel who championed their causes, we will consider the story of Dr. Ignaz Philipp Semmelweis. He happened on the scene during a time of rather poor communication about medical issues, especially among doctors. Another doctor–James Young Simpson–recognized the importance of hand washing in obstetrics shortly before Dr. Semmelweis, but did not make his announcement in a timely fashion. Dr. Simpson, however, performed the first delivery under general anesthetic in January, 1847; and Semmelweis made his announcement shortly thereafter—two of the most important obstetrical developments of all time–victory over pain and puerperal sepsis–both in the same year. Both men faced fierce opposition for their discoveries.

      In the interest of space, the story of Semmelweis will be presented here, and Simpson’s accomplishment mentioned more briefly afterwards.

      At the annual meeting of the Académie de Médécine held in Paris in 1879, the most prestigious men of medicine in the nation listened to learned professors expound on the best and the latest in the science of medicine. They had the privilege of hearing from the men who occupied the pinnacles of power and honor in their profession. One such eminent professor addressed the problem of childbed fever and declared himself and the profession to be stumped as to the cause of the dreadful phenomenon befalling hapless French women. As an aside, he scoffed at the relatively newly hatched idea that the disease was spread by the hands of the doctors.

      One of the most prestigious of all French professors of science–indeed of the world–stood up in the audience and interrupted the learned professor’s oration. He shouted, The thing that kills women… is you doctors that carry deadly microbes from sick women to healthy ones. [quote from René Vallery-Rabot, The Life of Pasteur, Forgotten Books, Classic Reprint Series]. The man calling from the audience—nearly a lone voice crying in the wilderness—was Louis Pasteur, the renowned French chemist and biologist, professor and dean of the science faculty at the University of Lille. This was 1879, a full thirty years since Hungarian Ignaz Philipp Ignaz, Englishman, James and American, Oliver Wendell Holmes, Sr., had proved the efficacy of simple hand washing to prevent the scourge of childbed fever. In the interim, thousands of women and their babies had died at the hands of their obstinate doctors, while midwives lost less than one percent of theirs. Primeval medical notions based on no science remained the accepted standard of practice during the ensuing three decades after those men proved that hand washing saved women from puerperal sepsis.

      Prior to the twentieth century, hospitals were places of abject horror. The typical woman who entered a lying-in hospital was young and healthy; and a great many of them died needlessly in agony from infections coming from their wombs. The previously vigorous young woman would–in all probability–not die if she delivered her infant at home with the assistance of completely untrained family members. Many indigent women–knowing of the ghastly reputation of the hospitals–faked carriage accidents; so, they could deliver their babies on the filthy streets of the cities in order to be able to take advantage of the social welfare programs available only to indigents who had their babies delivered by nurses in the lying-in hospitals. The lying-in hospitals were such a disaster that, in retrospect, it would have been better if they had never been established before the introduction of antisepsis in the 1880s. [Irvine Loudon, an English medical historian, The Lying-in Hospital, Oxford University Press, 1993].

      For a decade leading up to 1879, a small clinic in the French provincial countryside recorded the deaths of so many of its female patients to infection—sixteen out of sixteen in one month alone—that the founder and continuing lead physician of the clinic publicly declared that whoever solved the problem of the death of so many mothers deserved to be honored with a gold statue. His clinic came to be known as the House of Crime. That clinic’s experience was hardly unique. The prevailing science of the time—a science almost wholly lacking in evidence-based medicine—was founded on the widely held theory of spontaneous generation, an ill-defined and unsuccessful concept hallowed by long tradition. Other, less widely accepted theories of etiology, included the belief that chemical damage from exposures to bad air—miasma—was the source of puerperal sepsis, and uncleanliness of the bowel–which at least–had some approximation of plausible causation. As a result of that concept, extensive purging was the preferred treatment. Not an iota of success in stemming the tide of death in maternity rooms came from any of the primitive traditional beliefs and practices, but they nonetheless prevailed with a near religious fervor that a dissenter could attack only at peril to his professional career. This constituted a refusal to accept the real and carefully documented science of medicine despite all evidence of its validity.

      Semmelweis took notice of the fact that–in his hospital–the nurses’s obstetrical ward had a very minor incidence of childbed fever as opposed to the doctor’s—men’s—ward’s ghastly statistics. The difference came from the scholarly practice of the men to do autopsies on the women who died the previous day, dipping their hands in the pus, and then attending to deliveries of their patients of the day without ever washing their hands. The routine of attending to the autopsy followed by going to the delivery room became an obligatory criterion of employment for physicians. Dirty coats stiff and glazed with blood were seen as a sign of a surgeon’s knowledge and experience, and the smell was referred to as good old surgical stink. Hands coated with blood and laudable pus served as evidence of their advanced experience and scientific bent.

      Semmelweis changed all of that in his clinic by requiring that everyone wash his or her hands with chlorinated lime solutions every time they had an encounter with a woman’s genitalia. That simple innovation resulted in a drop in childbed fever deaths to the laudatory level already attained by the nurses and midwives. His findings–remarkably well documented–were published as Semmelweis, Ignaz, Etiology, Concept and Prophylaxis of Childbed Fever, 1847. He ran into a wall of resistance and was roundly belittled for the absurdity of his simple concept which ran contrary to the scholarship of the men over millennia. He did not live long enough to see his idea come to fruition; and in fact, he died in an insane asylum in 1848 after being beaten nearly to death by guards, from a cut on his hand resulting from the beating which produced septicemia. He and his concept were so despised that almost no one attended his funeral or burial.

      However, finally–by the end of the century–Holmes, Semmelweis, Lister, and Pasteur, among others, were acknowledged not only to have been right but to have saved the lives of countless women in the developed world. In order to change the prevailing primeval nonscientific traditional beliefs, it would be necessary for people to accept that lethal infection was caused by something invisible, eventually to have to accept that creatures so small that millions of them could dance on the head of a pin. Such a concept was nonexistent during the lifetime of Ignaz Semmelweis, and it would take practical and long-suffering science to affect a change. Unfortunately, Semmelweis would never live to see his vindication.

      European and American physicians, clergy, most innocent women, and their husbands, believed fervently and accepted with resignation that the dreaded childbed fever was God’s punishment for the sinful act of procreation and childbirth—a fulfillment of the biblical command: (Holy Bible Genesis 3:16) To the woman He said, ‘I will greatly multiply your pain in childbirth, in pain you shall bring forth children; yet your desire shall be for your husband, And he shall rule over you. The same traditional-religious-pseudoscientific level of reasoning that condemned women to death by infection resulted in a pitched battle against using anesthesia during delivery for suffering women. This constituted a refusal to accept the real and carefully documented science of medicine despite all evidence of its validity.

      The first transfusion of human blood in obstetrics [Dr. James Blundell] was performed in 1818 for massive postpartum hemorrhage.

      The first anesthetic for childbirth [by James Young Simpson] and the first recognition of the importance of hand hygiene in obstetrics [by Ignaz Phillip Semmelweis] coincidentally occurred within 5 months of one another in 1847. More than 150 years later, one would have thought that these milestone events would have been fully integrated into practice. However, individuals resist transformational change—a fundamental

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