Amalie M. Kass

"My brother preaches, I practice"
Walter Channing, M.D., Antebellum Obstetrician

Walter Channing. Photo courtesy of the Colonial Society of Massachusetts.

THERE IS A STORY, probably a true story, that someone came to the door of the house on the corner of School and Tremont streets asking to see Dr. Channing. He was met by a genial man of medium height, with clear gray-blue eyes and dark hair, who replied "Which Dr. Channing? My brother preaches. I practice." ¹

The Dr. Channing who preached was William Ellery Channing, minister at Boston's Federal Street Church from 1803 until his death in 1842, and the most prominent Unitarian of his day. As the country's leading liberal theologian, a social reformer, and an essayist, he enjoyed the respect and admiration of intellectual and religious circles in the United States, England, and France.

The Dr. Channing who practiced was Walter Channing, a prominent physician in antebellum Boston, Harvard Medical School's first professor of midwifery and medical jurisprudence, and the school's first dean. He was appointed assistant physician at the Massachusetts General Hospital when it received its first patients in 1821 and was later promoted to physician. ² He also helped found the New England Journal of Medicine and Surgery and its successor, the Boston Medical and Surgical Journal. Generally acknowledged as New England's leading obstetrician, he assumed a leading role in the establishment of the Boston Lying-in Hospital.

Originally from Newport, Rhode Island, the Channing family became prosperous merchants, sent sons to Princeton, but suffered financial reverses during the Revolutionary War. William Channing, Walter's father, served simultaneously as state attorney general and U.S. attorney for Rhode Island. Lucy Ellery, Walter's mother, traced her heritage to Thomas Dudley and Anne Bradstreet. Her father, William Ellery, whose name reappeared among endless generations of descendants, represented Rhode Island in the Continental Congress and signed the Declaration of Independence. ³

Born in 1786—the sixth of nine children—Walter had the support of a close, socially prominent, well-connected, and ambitious family. Few people in the country enjoyed the renown of William Ellery Channing, but Walter's youngest brother, Edward Tyrrel Channing, attained fame as Boylston Professor of Rhetoric and Oratory at Harvard. A sister, Ann Channing, married the artist Washington Allston, and the Channings counted many first cousins among the Dana and the Gibbs families. William Channing's untimely death—Walter was only seven years old—left the family in "genteel poverty." Lucy was a strict manager and guided the family prudently. Grandfather Ellery took much responsibility for raising the Channing children and more prosperous relatives helped pay for schooling. When William Ellery Channing assumed the pulpit at the Federal Street Church, the family moved to Boston to live with him at the parsonage.

Walter Channing's marriage brought him additional social connections with other prominent Bostonians. His first wife, Barbara, was a granddaughter of Stephen Higginson, one of the city's leading Federalists, and the daughter of Samuel Perkins, youngest of the three Perkins brothers who dominated Boston's merchant class. Walter's son, also named William Ellery Channing, married Ellen Fuller, a sister of Margaret Fuller. Although a continual mystery and a disappointment to his father, this poet-son became a friend to Henry David Thoreau, Ralph Waldo Emerson, and the Transcendentalist circle. One of Walter's daughters married her cousin Thomas Wentworth Higginson, the famed abolitionist, Civil War officer, editor, and literary impresario.

Nothing in the family history provides insight into the reasons for Walter's career choice. ⁴ The decision to enter the field of medicine—one he made while still a youth in Newport—appears to have emerged largely out of his independent spirit. A young man with a contrary sensibility, he embraced the idea of not imitating any of his relations. But his family must have worried over him. He remained at Harvard College for only two years, expelled for participating in the "Rotten Cabbage Rebellion" of 1807, a student protest against the poor quality of college food. Walter recovered from the expulsion by apprenticing to James Jackson, a rising star in Boston's medical community; apprenticeship was then the primary route to a medical career. In a move that reflected his drive and ambition, Channing followed his training with Jackson by enrolling at the University of Pennsylvania, the best American medical school at the time, for two years of academic medical study. He capped that off with a year of additional study divided between Edinburgh and London. He concentrated on obstetrics, well taught in Britain, and gained extensive clinical experience at its maternity hospitals. The medical curriculum at Pennsylvania and at Harvard did not include obstetrics and neither Philadelphia nor Boston offered much opportunity for clinical training. ⁵

For most of human experience, midwives, not physicians, delivered babies, assisted by the mother's female relatives and friends. The shift from midwives to male physicians in Western Europe first began in the late seventeenth century. Physicians had a better knowledge of anatomy and physiology and could offer women what they wanted above all else in childbirth: safety. Physicians were also trained in the use of obstetrical instruments, particularly forceps, in the uncommon cases where instruments were necessary. In the colonies during the seventeenth and early eighteenth centuries, midwives attended nearly all births. Physicians began delivering babies during the mid eighteenth century as part of their general practice, especially among the upper-class women who could afford their services. ⁶

Channing's decision to concentrate his studies in obstetrics proved timely. Only two physicians in Boston possessed any specialized training in obstetrics: James Lloyd and John Jeffries. Lloyd died in 1810, just before Channing departed for Britain, and Jeffries, a Tory who had spent the Revolutionary War in Britain, never regained his professional reputation and by that time was seventy years old. ⁷ Thus, when Channing returned to Boston in the summer of 1811 opportunities awaited him. Although he would always depend on general medicine for the bulk of his practice, obstetrics increasingly gained importance and no one in the area could match his training. His decision to devote a year abroad to obstetrical studies made him unique in Boston.

Nevertheless, establishing a medical practice in 1811, in a city where 45 physicians serviced a population of 33,000, proved challenging. ⁸ According to his grandson, the historian Edward Channing, Walter's only patient was faithful Aunt Polly until he hung out a shingle proclaiming, "Just returned from Europe." Thereafter, according to the same legend, his waiting room was never empty. ⁹ While amusing, the story falls short of the truth. Undoubtedly, the advertising drew in some patients, but he continued to rely on the patronage of family and friends. Family support proved especially important during the first eleven years of his obstetrical practice, when, according to his obstetrical casebook, he attended 13 family members or women related to him by marriage out of 156 women who used his services. ¹⁰ He attended his own wife in her four deliveries, a practice no physician would follow today. He also delivered babies at the almshouse, which proved an effective way of impressing local physicians with his skills and encouraging them to consult him in complicated deliveries. ¹¹

Page from "List of Midwifery Cases," in the Walter Channing III Papers, Massachusetts Historical Society.

Obstetrical practice of Channing's time bears little resemblance to the field today. ¹² For many of us it is difficult to imagine not having sophisticated diagnostic tests, fetal monitors, blood transfusions, x-rays, and anesthesia (unknown until 1846) available. Physicians had no antibiotics and did not perform caesarian sections. Except for paupers at the almshouse and poor women at the Lying-in Hospital, all deliveries took place in the home—a practice reemerging today, although under vastly different circumstances. Channing brought his equipment with him: sharp scissors and strong thread, a female catheter, lard or oil, a lancet, and drugs. Over time he added a stethoscope and ether or chloroform to his supply, and he used the lancet less frequently as venesection declined as a medical therapy. ¹³ Often he was meeting the patient for the first time. Unless medical problems arose during the pregnancy, nineteenth-century women did not seek prenatal care from a physician and relied instead on advice from other women.

In the early years of Channing's practice, he reached his patients quickly, usually on foot. But as Boston grew, it might take an hour or more to arrive at a patient's door even with the aid of horse and carriage. On the few occasions when he had two patients simultaneously in labor, he kept a carriage ready to shuttle him from one to the other. He usually slept in a small room close by the front door of his house so that the urgent knocking of a husband or friend of the expectant mother would not disturb his own family during the night. So much of his work involved night-time sojourns that Channing urged the city to improve its lighting and facetiously appealed for the creation of a public "Lamps Department," asking to be appointed chief engineer. ¹⁴

Ideally, when Channing arrived at a patient's home she would be in a room, usually but not always the largest bedroom, set aside for the birth. He believed that healthy conditions included good ventilation and preferred an airy and warm—but not over-heated—room. Special bedding would have been prepared—one mattress on top of another, covered with a piece of oiled silk, untanned skin, or layers of blankets for protection. If possible, the bed's lower end would be raised to elevate the woman's pelvis. ¹⁵ He usually found his patient fully clothed in loose fitting garments and wearing a cap. She might have had a heavy meal shortly before his arrival. He remarked on one woman who "had eaten a hearty breakfast of meat and potatoes, while labor was present," and another who had baked beans and huckleberry pie prior to his arrival. ¹⁶ When it came time for her to be on the bed, attendants placed a doubled sheet between her abdomen and her clothing so that her "private parts" would be covered. Frequently, the patient lay on her left side. ¹⁷

Channing, of course, could not count on ideal conditions. In many instances, especially with Boston Dispensary patients whose attending physicians called Channing for a consultation, he entered the worst kind of a hovel, poorly ventilated, with putrid air, filthy floors, and an equally grimy patient. ¹⁸ He adapted to whatever circumstances he faced and, if necessary, would deliver a woman on a palette or on the floor. He wore no special garments and attended all his patients in street attire. It would be comforting to think that he washed his hands, and perhaps he did, but he left no such indication.

Upper-class and middle-class women enjoyed abundant assistance at the time of childbirth—family members and friends from near and far assisted in the labor and subsequent confinement. The well-to-do hired nurses especially for the event and the weeks of convalescence. For lower-class women, there might be no assistance except a neighbor who came for the delivery and might provide help with household chores for a few days afterward. Among elite and common folk, husbands occasionally remained with their wives during labor and delivery. ¹⁹ The presence of additional women during childbirth had its roots in customs associated with female midwifery, but physicians too needed their assistance. Channing preferred to exclude "excitable" women, although as a guest in his patient's home he could not easily influence the choice of attendants.

After hurrying to the home of an expectant mother, Channing sometimes found himself waiting for a patient not yet ready to see him. After responding to a 7:00 a.m. call to a woman in her fifth labor, he was advised to return when the labor was more advanced. He called again about 11:00 a.m.—no change. At 7:00 p.m., he finally saw the patient. She was sitting up, complaining of only slight pain, and still unwilling to submit to an examination. ²⁰ In other cases, he would make an examination and decide how far along the labor had progressed. If delivery appeared imminent he stayed; if not, he went home and waited to be summoned again. Occasionally everyone misjudged the progress of a labor, and birth occurred before Channing reached the bedside. Nonetheless, he tied the cord, ascertained the child's good health, removed the placenta if it had not been naturally expelled, and attended to the general comfort of the mother. If serious complications arose during delivery or post partum, he remained as long as needed—in one case he remained for four days and nights.

Women's letters and diaries revealed their fear of pregnancy and labor. ²¹ They knew that the months of pregnancy would be uncomfortable at best and full of possible dangers and that labor could result in damage to a woman's health or even death. Many women had a friend, a mother, or a sister who had died in childbirth or had known the sorrow of a stillbirth or the death of a newborn. The dangers and suffering that women endured in childbirth affected other family members as well. One husband wrote: "[childbirth] is an hour of harrowing anxiety. . . . There is surely no pain like it in the world. . . . It is the rending asunder of all but soul & body. . . . What a load from the heart of a husband . . . [when] the precious life of a wife is spared." ²²

Channing assumed that the fears and anxiety of the patient or others in the birthing room might affect the course of labor and could produce unwanted complications. The conduct, attitude, and words of the physician could also affect a woman's emotional state. Thus, he sought to allay the patient's fears and gain her trust. He entered the patient's room as if on a friendly visit and exchanged the usual compliments of the day. If she wanted to reveal her fears, he tried to soothe her. Throughout the delivery he remained calm, thereby imparting a sense of control and composure to the patient and her family, and avoided relating bad news for as long as possible. As Boston's immigrant population grew, Channing adapted and used a few words in the patient's language to gain her confidence. Obstetrical practice required patience and tact as well as medical knowledge and skill.

Channing also had to observe the strictest decorum. It is an irony of nineteenth-century obstetrics that male physicians became prominent at the very time society increasingly valued female modesty and delicacy. For this reason, during the early stages of labor, Channing did not remain longer than necessary in the birthing chamber. If the woman did not wish to discuss her pregnancy and the progress of her labor, he consulted the female attendants. He could unobtrusively observe superficial signs: the condition of the woman's skin, tongue, eyes, and pulse, and her general demeanor. He transmitted any questions or orders related to bodily functions indirectly through the female attendants. When the time arrived for a physical examination, he asked one of the attendant women to inform the patient. Again, decorum required that he avert his eyes from the woman's body for as long as possible, taking advantage of the sheet that draped the woman's abdomen. After the examination (called "touching"), sensitivity to the delicate feelings of his patient required that he wipe his hand on a towel well hidden from view.

Fortunately, most deliveries occurred without complications and Channing easily performed the few indispensable tasks: ascertaining the position of the fetal head and the presence of possible obstructions, preventing peritoneal tearing, and receiving the baby. He then checked for deformities, tied the cord, and waited for expulsion of the placenta. Complications, however, presented a vastly different story. Like many of his colleagues, Channing believed that the progress of civilization had rendered contemporary women less fit for childbearing than their foremothers had been. As he put it, "the progress of civilization has tended to interfere with original design, making delivery at most a painful, frequently a formidable, and sometimes a dangerous process." ²³ Channing identified three categories of complicated labors: those lasting more than twenty-four hours (some went on for sixty hours or more); those in which the baby presented buttocks, feet, shoulder, or arm first; and cases involving convulsions, hemorrhaging, or other disasters. Though only about 4 percent of all births—then and now—fall into these three categories and represented uncommon occurrences for most physicians, Channing attended a far higher percentage of complicated births. Because of his greater experience, his prestige, and his position as a medical professor, other physicians frequently called on him for assistance when facing hazardous births.

In these difficult obstetrical cases, Channing delayed intervening in the belief that in most instances nature would rectify the situation. He offered encouragement to the woman and to her friends and family, but if the expectant mother became excessively fatigued, or when fever, headache, weak pulse, or extreme paleness developed, he quickly intervened. For long labors, he might give opium—or even bleed the patient—which usually relaxed her and relieved pain. When contractions seemed ineffective, he gave ergot to stimulate the labor. ²⁴ He might try to facilitate labor by artificially puncturing the amniotic sac, usually with his fingernail. In the rare cases where there still was not enough natural force he used forceps. Forceps could damage both mother and child and required great skill as well as considerable strength on his part.

When the fetus did not present head first, he tried internal version and delivery by the feet. If this was not successful, he resorted to instruments as he also did in cases when the head was completely impacted. He used instruments too in any case involving danger to the mother's life, or if he deemed it important to end the labor as quickly as possible. The mother's safety remained Channing's primary concern, even at the expense of the child's survival. He felt this responsibility keenly, and often called in another physician for an opinion on what he called "operative obstetrics." An instrumented delivery could cause complications or damage the mother, even if it spared her life. Channing always advised the patient, either directly or through the attending women, before applying instruments. In some cases the mother or her family refused permission, preferring to risk her life rather than submit to an operation that might be very painful and very gory. Hydrocephalic babies had their skulls crushed and other fetuses had to be dismembered. Without caesarian section, these cases offered no alternative to avoid maternal death. Successful caesarian operations in the nineteenth century occurred rarely and Channing never performed one. Not only would it have been excruciatingly painful without anesthesia, but the operation risked a fatal infection.

Physicians and patients alike feared infection, always a possibility in natural births as well as in instrumented deliveries. All too often, a woman who had given birth to a healthy baby and anticipated the joys of motherhood suddenly developed a severe chill, followed by high fever, pain in the lower abdomen, and increased discharge. A localized infection offered excellent chances for recovery, but if it spread, especially into the blood stream, death was almost a certainty. Puerperal fever, also called childbed fever, remained the leading cause of maternal mortality well into the twentieth century.

Without any knowledge of microbes as infectious agents, puerperal fever greatly puzzled physicians, especially as it failed to fit their understanding of a contagious disease, as in the case of smallpox. These patients did not come in contact with each other, and they did not transfer the disease to nonpuerperal women or to men. Unlike the large maternity hospitals of European cities, where puerperal fever continuously threatened the lives of new mothers, in the United States it struck unexpectedly in individual women's homes, whether they lived in cities, small towns, or remote rural areas. ²⁵

Channing and his colleagues frequently discussed puerperal fever at meetings of the Boston Society for Medical Improvement, a group of leading physicians who convened bi-weekly to communicate interesting or unusual medical events. At a meeting in 1842, Channing reported thirteen recent cases of puerperal fever, all fatal. Other physicians also saw an increase in puerperal fever. They even knew of physicians who died from wounds received while performing postmortems on puerperal fever victims. ²⁶ Oliver Wendell Holmes, one of the younger members of the profession, undertook an extensive review of the literature on puerperal fever. He studied the work of British writers who had described (although they did not analyze) the disease over the past seventy years and the reports of physicians in Boston and other parts of the United States. Holmes found the cumulative evidence overwhelming. Repeated incidence of the disease in a single physician's practice and the horrendous epidemics in European lying-in hospitals, where the same attendants examined row after row of women and delivered their babies, pointed conclusively to the contagious nature of the disease and to the physician as the agent who transmitted the contagion. Holmes published his findings, with his warning that physicians must take every precaution to avoid spreading the infection, in a paper that has become one of the classics of medical literature. ²⁷

Channing had always taught his students about the dangers of puerperal fever, but he remained unconvinced of the contagious nature of the disease. His own experience showed that a physician could encounter one isolated case in a string of perfectly healthy deliveries. He continued to consult in puerperal fever cases and his own patients did not necessarily get the disease. Gradually, however, he accepted Holmes' argument and became increasingly cautious, as well as defensive, avoiding puerperal fever consultations and refraining from entering the sick room if possible. ²⁸ Fears "of conveying that certain something" that proved disastrous to childbearing women did not end until 1879, when Pasteur showed that the streptococcus bacterium caused puerperal fever. ²⁹

When puerperal fever struck, Channing treated it like any non-obstetrical infection, using the full panoply of nineteenth-century medical treatments: bleeding, emetics, cathartics, diuretics, and blisters. These therapies severely weakened the patient and often hastened her demise, but Channing acted in accordance with the prevailing medical theory that required these so-called "heroic measures" to purge the body of fevers and inflammation. Sometimes the patient recovered, making physicians like Channing look effective. In the later years of his practice, such drastic therapies went out of style as physicians increasingly accepted the concept of self-limited diseases and the idea that nature often heals without assistance. ³⁰ But, until the development of antibiotics began in the mid 1930s, neither heroic medicine nor unassisted nature could end the deadly threat of puerperal fever.

Channing's advocacy of anesthesia in childbirth represented his most important contribution to the practice of obstetrics. Ether, first demonstrated in a surgical procedure at the Massachusetts General Hospital in October 1846, rapidly gained acceptance in surgery and dentistry. A Scottish physician, James Young Simpson, first used ether in obstetrics when he attended a woman with a severely deformed pelvis for whom the pain of labor and the danger of an impacted baby warranted the experiment. In the United States, a woman in Cambridge, Massachusetts, not a physician, proved the safety of anesthesia in childbirth.

Fanny Appleton Longfellow, wife of poet Henry Wadsworth Longfellow, knew of Simpson's experimental procedure and also knew that no Boston physician had yet dared use ether while delivering a child. So in April 1847, when Fanny's labor began (her third pregnancy), she summoned Nathan Cooley Keep, a dentist who had experience with anesthesia, to her Brattle Street home to administer ether; a midwife then delivered a healthy daughter. Fanny, understandably satisfied, called ether "the greatest blessing of this age." The experiment so pleased her husband that the next day Henry had the stump of a tooth removed under anesthesia by the same Dr. Keep. ³¹

Though Fanny Longfellow had been delivered without mishap and British reports encouraged the use of anesthesia, concerns remained about its use in childbirth. No one understood how anesthesia worked and many feared that it might induce puerperal convulsions, affect other organs, and threaten the health of the mother. Others wondered if it would halt uterine contractions or make them less effective. Would it be unsafe for the baby? For how long and in what dosage could it be administered without danger? Some physicians still believed in the physiologic necessity for pain—an argument that made all other questions moot.

Cultural assumptions about the pain of childbirth also hampered use of anesthesia in obstetrics, especially the Christian belief that such pain represented God's punishment for Eve's sin in the Garden of Eden: "I will greatly multiply thy pain and thy travail, in pain thou shalt bring forth children" (Genesis 3:16). Some believed that middle-class women had become "weak" from their soft, less demanding lives, and had developed greater sensitivity to pain than lower-class women and women in more primitive societies. Finally, others maintained that, psychologically, the pain a mother suffered in childbirth helped establish strong bonds with the baby. ³² Not surprising, men expressed most of these views.

Channing had long regretted his inability to offer women a magic potion that would reduce their agony and lessen fear. Opium and bleeding, especially if blood loss induced unconsciousness, could reduce pain. But these options struck Channing as inadequate. He had read the reports from Britain and France, as well as an account by Nathan Cooley Keep in the Boston Medical and Surgical Journal, and wanted to test the effectiveness of anesthesia himself. ³³ The opportunity came in May 1847, when he gave ether in the case of a woman more than forty-two hours in labor whose survival required the use of forceps and other instruments. The child had been dead for many hours. This case represented the first use of anesthesia in operative obstetrics in the United States. The results pleased both Channing and the mother. The ether took effect almost immediately, without difficulties, and without interrupting the contractions. When he stopped giving ether, the patient quickly regained consciousness. Remembering nothing, she expressed a level of relief he had never seen at the conclusion of such a long and difficult labor. ³⁴ Thereafter, Channing used ether in any complicated birth when he believed it would benefit the patient. In time, patients asked for it and Boston physicians regularly used anesthesia, ether or chloroform, although some remained skeptical about the wisdom or the propriety of the therapy.

To promote use of anesthesia, Channing published A Treatise on Etherization in Childbirth (1848), his most important book. He had sent a questionnaire to colleagues in Boston and vicinity, asking for details of their experiences with anesthesia. Forty-five physicians responded, enabling him to summarize and analyze 581 cases and allowing him to assert the complete safety of anesthesia with confidence. Channing's research uncovered no cases of maternal or child death as a result of its use. He devoted a substantial part of the book to refuting all the prevailing criticism of anesthesia—he even included testimony from a professor at Harvard Divinity School in order to dispel the notion that God intended Eve and her descendants to suffer for original sin.

Because Channing did not keep a consecutive record of his obstetrical cases, we do not know how many deliveries he performed over a typical year or over the course of his career. Nor do we know the mortality rates among Channing's patients. Since he served as a consulting physician in many difficult cases, the mortality rate of his practice must have been higher than the average. No maternal death proved more traumatic or personally wrenching than that of his second wife, Eliza Wainwright Channing, who died in childbirth March 22, 1834. Eliza had been in labor for more than three days when Channing reluctantly decided to use instruments. He removed the child himself and expected his wife to quickly recover. Instead, she went into convulsions, probably as a result of internal hemorrhaging, and died soon after. ³⁵

Channing's case notes, his lectures, and his publications give evidence that he saved many women's lives by moving swiftly to deliver a child before the mother went into severe convulsions or bled to death. We know that very few of his patients suffered permanent damage from fistulas or tearing and that he attended many women over the course of his career. He saved many children's lives, slipping a twisted umbilical cord over a baby's head to prevent asphyxiation or reviving stillborns with artificial respiration. He customarily visited the new mother and her child for several days after delivery to insure the good health of both and returned as often as needed, sometimes for a month or more.

Channing continued to work into his eighties. Among his papers lies a note expressing what he found so appealing in the practice of medicine. "It is in itself highly interesting. It addresses the whole mind and asks mysterious questions. What is life? What is this perpetual motion and how is it sustained?" ³⁶ Perhaps, after all, from different perspectives both the Dr. Channing who preached and the Dr. Channing who practiced asked the same questions.

AMALIE M. KASS, a lecturer in history of medicine at the Harvard Medical School and co-author of Perfecting the World: The Life and Times of Dr. Thomas Hodgkin, 1798–1866 (1988), is writing a biography of Walter Channing.

NOTES

An early version of this article was presented at a meeting of the Massachusetts Historical Society, May 14, 1998.

I am grateful to J. Worth Estes, Elin Wolfe, Anne Hecht, and Susan Korrick for their helpful comments on that version and to the librarians at the M.H.S. and the Rare Books and Special Collections Section of the Countway Library for their assistance in the research.

^1. Howard A. Kelly and Walter L. Burrage, American Medical Biographies (Baltimore, 1920), 205–206; Edward Channing, "Recollections of a Hitherto Truthful Man," typescript, courtesy of W. P. Fuller, Jr., p. 6. See also Frederick C. Irving, Safe Deliverance (Boston, 1942), 102–103; Walter Channing to William Ellery Channing, July, [n.y.], Walter Channing III Papers, Misc. Box, Massachusetts Historical Society (hereafter M.H.S.).

^2. In its early years, the hospital staff size and the number of patients remained small. A physician, assistant physician, surgeon, and assistant surgeon comprised the staff. N. I. Bowditch, History of the Massachusetts General Hospital (Boston, 1851); Leonard K. Eaton, New England Hospitals, 1790–1833 (Ann Arbor, 1957).

^3. William Henry Channing, The Life of William Ellery Channing, D.D. (Boston, 1880), 1–10; Edward Channing, "Recollections," 1–4; Edward Tyrrel Channing, Notes Concerning the Channing Family, Written 10 August 1836 (Boston, 1895). For William Ellery see also William M. Fowler, Jr., William Ellery: A Rhode Island Politico and Lord of the Admiralty (Metuchen, N.J., 1973).

^4. A grandson, also named Walter Channing, did become a physician and was well known in Boston circles as a pioneer in psychiatry.

^5. Midwifery (as obstetrics was called in the eighteenth and early nineteenth centuries) was taught intermittently at the medical schools in New York, beginning with John V. B. Tennent and Samuel Bard. New York Hospital also maintained a maternity ward. Channing likely did not consider studying in New York because the city's facilities could not match those in Britain. In Boston, childbirth at public facilities occurred only in the almshouse. Philadelphia had a small lying-in ward at the Pennsylvania Hospital. Harold Speert, Obstetrics and Gynecology in America, A History (Chicago, 1980), 73–75, 90–99.

^6. Adrian Wilson, The Making of Man-Midwifery: Childbirth in England, 1660–1770 (Cambridge, Mass., 1995); Judith Walzer Leavitt, Brought to Bed: Childbearing in America, 1750–1950 (New York, 1986), 36–49; Josiah Bartlett, "A Dissertation on the Progress of Medical Science in the Commonwealth of Massachusetts," in Medical Communications and Dissertations (Boston, 1813), 2:243.

^7. Lloyd, also unsympathetic to the Patriot cause, made fewer controversial political statements and remained in Boston throughout the war. Accordingly, his practice did not suffer. James Thacher, American Medical Biography (Boston, 1828), 359–376; Howard A. Kelly and Walter L. Burrage, eds., Dictionary of American Medical Biography (New York, 1928), 1:658–659, 2:751; William Wellington, "Biographical Sketches of Deceased Members of the Obstetrical Society of Boston, with an Outline of the Earlier Obstetrical History of Boston and Vicinity," Boston Medical and Surgical Journal 105 (1881):494–496.

^8.The Boston Directory (Boston, 1810); Oscar Handlin, Boston's Immigrants (Cambridge, Mass., 1959), table 2, p. 239.

^9. Edward Channing, "Recollections," 5.

^10. Walter Channing, "List of Midwifery Cases," Walter Channing III Papers, Misc. Box, M.H.S. See also Amalie M. Kass, "The Obstetrical Casebook of Walter Channing, 1811–1822," Bulletin of the History of Medicine 67 (1993):494–523. The casebook lists 195 separate obstetrical events in 11 years, further evidence of the need for a general medical practice.

^11. Walter Channing, "List of Midwifery Cases," cases 1–18. Harvard medical professors treated almshouse patients gratis in exchange for the opportunity to bring selected students with them. Although Channing was not yet part of the medical faculty, it is likely that because of his friendship with Jackson and the other professors he gained access to obstetrical patients. Since many physicians disliked obstetrics, Channing may have substituted for them.

^12. The description of Channing's obstetrical practice that follows is based on case notes and lecture notes, Walter Channing II Papers, M.H.S., and his descriptions of cases published in The New England Journal of Medicine and Surgery and The Boston Medical Journal. In addition, lecture notes taken by some of his students proved a valuable source, especially those of Robert Treat Paine, 1820–1821, David H. Storer, 1823–1824, John G. Metcalf, 1825–1826, Edward Jarvis, 1827–1828, and J. M. Warren, 1831, all at the Countway Library of Medicine, Harvard Medical School.

^13. For nineteenth-century medical therapeutics, see John Harley Warner, The Therapeutic Perspective, Medical Practice, Knowledge, and Identity in America, 1820–1885 (Cambridge, Mass., 1986); Charles E. Rosenberg, "The Therapeutic Revolution: Medicine, Meaning, and Social Change in Nineteenth-Century America," in The Therapeutic Revolution, Essays in the Social History of American Medicine, ed. Morris J. Vogel and Charles E. Rosenberg (Philadelphia, 1979), 3–26.

^14. Fragment from the New England Galaxy, n.d., Miscellaneous notes, Walter Channing II Papers, M.H.S.

^15. Jarvis, Lecture XXIV, p. 88, Countway Library of Medicine, Harvard Medical School. In retrospect, this seems strange for it would force the woman to push uphill in the final stage of labor. A possible explanation is that, because of the beds' softness, physicians wanted to make certain that a woman's pelvis would be well supported.

^16. Walter Channing, Treatise on Etherization in Childbirth (Boston, 1848), 190, 321. Even before the use of anesthesia, physicians preferred that their patients refrain from "stimulating food" and anything else that "shall have a tendency to excite the system." All physical organs were believed to affect one another and this was especially thought true of the stomach. William P. Dewees, A Compendious System of Midwifery (Philadelphia, 1824), 192.

^17. Channing was less rigid on this point than many of his colleagues. His case notes describe women who preferred to deliver on their backs or on hands and knees.

^18. Founded in 1796, the Boston Dispensary provided medical care to the poor in their own homes. The city was divided into districts, each with its own dispensary physician appointed by the Board of Managers. Recent graduates of Harvard Medical School vied for these posts as a way of earning a small income and becoming better known within the medical community. Although never a dispensary physician, Channing frequently consulted in difficult obstetrical cases. Robert W. Greenleaf, An Historical Report of the Boston Dispensary for One Hundred and One Years, 1796–1897 (Brookline, Mass., 1898); Boston Dispensary Papers, Countway Library of Medicine, Harvard Medical School; "The Boston Dispensary, 1796–1962," New England Journal of Medicine 266 (1962):29–31.

^19. See Shawn Johansen, "Before the Waiting Room: Northern Middle-Class Men, Pregnancy and Birth in Antebellum America," Gender and History 7 (July 1995):183–200.

^20. Obstetrical Cases, Apr. 17, 1829, Walter Channing II Papers, M.H.S.

^21. Sylvia D. Hoffert, Private Matters: American Attitudes toward Childbearing and Infant Nurture in the Urban North, 1800–1860 (New York, 1989); Sally D. McMillen, Motherhood in the Old South: Pregnancy, Childbirth, and Infant Rearing (Baton Rouge, La., 1990); Leavitt, Brought to Bed.

^22. Robert F. Lucid, ed., The Journal of Richard Henry Dana, Jr. (Cambridge, Mass., 1968), 1:68–69.

^23. Miscellaneous lecture notes, Walter Channing II Papers, M.H.S.

^24. Ergot, Secale cornutum, a fungus found on rye plants, was an oxytocic used to hasten labor and in some instances to facilitate expulsion of the placenta. Its indiscriminate use could prove dangerous.

^25. Irvine Loudon, ed., Childbed Fever, a Documentary History (New York, 1995); Irving, Safe Deliverance, 140–184; Speert, Obstetrics and Gynecology in America, 131–135.

^26. Boston Society for Medical Improvement, Records, Vol. 4, June 27, Oct. 10, Nov. 23, 1842, Jan. 9, 1843, Countway Library of Medicine, Harvard Medical School.

^27. Oliver Wendell Holmes, "On the Contagiousness of Puerperal Fever," New England Quarterly Journal of Medicine 1 (1842–1843):503–530. Holmes later republished his paper, with a few addenda, in Puerperal Fever as a Private Pestilence (Boston, 1855).

^28. Boston Society for Medical Improvement, Records, Vol. 4, Mar. 11, 1844; Vol. 6, Mar. 14, May 14, 1849, May 12, 1851, Countway Library of Medicine, Harvard Medical School; "Boston Medical Association," Boston Medical and Surgical Journal 40(1849):183–184; Walter Channing, "Puerperal Peritonitis," Boston Medical and Surgical Journal 40(1849):274–276.

^29. In 1847, Ignaz Semmelweis demonstrated the contagious nature of puerperal fever by insisting that the medical students serving the obstetrical wards of Vienna's Allgemeines Krankenhaus wash their hands in a chlorine solution before attending the patients. As a result of this precaution, puerperal fever rates declined substantially. Nonetheless, like Holmes, Semmelweis had no real understanding of the causative agent of the disease. Ignaz Semmelweis, The Etiology, Concept, and Prophylaxis of Childbed Fever, trans. and ed. K. Codell Carter (Madison, 1983).

^30. Note 13 above.

^31. Edward Wagenknecht, Mrs. Longfellow: Selected Letters and Journals of Fanny Appleton Longfellow (1817–1861) (New York, 1956); Edward Wagenknecht, Longfellow: A Full-Length Portrait (New York, 1955); Andrew Hilen, ed., The Letters of Henry Wadsworth Longfellow (Cambridge, Mass., 1972), 3:134–135. Quotation is Fanny Longfellow to Anne Longfellow Pierce, n.d., in Wagenknecht, Mrs. Longfellow, 129–130.

^32. For discussion of objections to the use of anesthesia, see Roselyne Rey, The History of Pain, trans. Louise Elliott Wallace, J. A. Cadden, and S. W. Cadden (Cambridge, Mass., 1995); Martin Pernick, A Calculus of Suffering, Pain, Professionalism, and Anesthesia in Nineteenth-Century America (New York, 1985); Irving, Safe Deliverance, 85–103. For a recent overview of pain in childbirth, see Donald Caton, What a Blessing She Had Chloroform (New Haven, 1999).

^33. "The Letheon Administered to a Case of Labor," Boston Medical and Surgical Journal 36(1847):226. William T. G. Morton first administered ether, which he called "letheon," at the Massachusetts General Hospital, and hoped to keep his formula a secret. Oliver Wendell Holmes is credited with suggesting the term "anesthesia."

^34. Walter Channing, "A Case of Inhalation of Ether in Instrumental Labor," Boston Medical and Surgical Journal 36(1847):313–318.

^35. Elizabeth P. Peabody to Mary T. Peabody, Mar. 22–24, 1834, Berg Collection, New York Public Library. I am grateful to Megan Marshall for informing me of the existence of this letter.

^36. Miscellaneous notes, Walter Channing II Papers, M.H.S.

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"My brother preaches, I practice"Walter Channing, M.D., Antebellum Obstetrician

AMALIE M. KASS

"My brother preaches, I practice"
Walter Channing, M.D., Antebellum Obstetrician