Drawing of the stages of development of a human embryo from gestation to just before birth.

Meanings and Materials of Miscarriage: How Babies in Jars Shaped Modern Pregnancy

In 1866, a young man in Crestline, Ohio, visited Dr. J. Stolz to ask the physician for help. Mr. B’s wife was in much pain and distress, and Mr. B feared for her life. Stolz accompanied the young man back to his house where he found the 16-year-old woman thrashing about in bed, screaming in pain. After an examination, Stolz determined that the woman was having a miscarriage and that “labor had proceeded so far its arrest was inevitable.” An hour later the woman delivered a five-month-old fetus. The doctor wrapped the fetus in a flannel and laid it aside on a sofa, turning back to the mother, who was bleeding considerably.

After “giving the usual remedies” to the mother (probably a morphine derivative or ergot to promote uterine contractions to expel the placenta), Stolz turned back to the fetus and was surprised to find it still alive, “gasping for breath, making regular inspiratory movements.” Stolz took the fetus with him when he left the house, and as he reported later in a medical journal: “I carried it to my office, where it was also witnessed by my professional friends, Drs. Booth and Jenners. It gradually succumbed, after surviving its birth one hour and forty minutes. It measured about six inches in length.”1

When I first came upon this case, I sat looking at that closing paragraph for a long time. I tried to picture what had happened: a woman miscarried a living, five-month fetus (a body about the size of a banana with recognizable features and organs), her doctor removed that living fetus from her house, carried it to his office, showed it to his colleagues, then watched it slowly die. The story seemed horrifying, cruel, and unbelievable.

Drawing of a premature baby. (Heather Spears/Wellcome Collection)

In every history course I teach, I start the semester discussing with my students how useless and even dangerous it is to judge historical actors. I tell them it doesn’t help us at all to understand history if we determine people in the past to be “bad,” “racist,” “barbaric,” or “ignorant.” Instead, I push my students to get beyond their initial reactions — Who would think that’s okay? What kind of person does that? — and instead consider what they can learn by asking why. Why did people do the things they did, and why did it make sense in that social context?

When I found the Stolz article early on in my research, it was not merely the first example of a physician describing a case of miscarriage, but also the first describing what became of the material products of that miscarriage. My initial research proposal on nineteenth-century miscarriage did not even mention these products. My plan was to write about why doctors became interested in miscarriage in the second half of the 1800s, how women wrote about their pregnancy losses, and perhaps how American pregnancy changed just before the turn of the twentieth century.

However, as I sifted through hundreds of medical journal articles describing treatments, definitions, and approaches to miscarriage, I soon realized that understanding pregnancy loss also meant understanding how people thought about the material products of miscarriage, whether described as “tissues,” “clots,” “fetus,” or “baby.” Reading Stolz’s cold medical description (“it gradually succumbed”) of what some now might describe as a baby dying, I had a hard time keeping my own judgment in check. But then as I found other physicians describing the cases they attended, and the material products they took away, I was able to move beyond my gut reactions and follow my own advice for my students. Why were doctors interested in these tiny “creatures” (as they often called them)? Why did women and families readily hand them over? What did this sharing of fetuses mean for science and medicine, and ultimately miscarriage in twenty-first-century America?

Numerous physicians removed miscarriage products (embryos, fetuses, placentas) from the homes of miscarrying women in the second half of the nineteenth century. Like Stolz, they frequently shared them with colleagues, sometimes with large audiences at medical society meetings or through the pages of medical journals. Miscarriage products ended up in doctors’ offices, medical school classrooms, and museums all across the country.

Silhouette of a baby fetus. (Juntara/Flickr)

So customary was the practice of securing miscarried embryos and fetuses in American medicine that by the early 1900s when Franklin P. Mall, an eminent embryologist at Johns Hopkins University, decided to build a collection of human embryological specimens, he was able to gather thousands of “creatures” in only a few short years. Over 500 physicians helped Mall, passing along their treasures for what became the largest clearinghouse of embryological knowledge in the nation. Doctors’ common practice of acquiring miscarriage remains enabled the creation of a collection that was used to establish the modern stages of fetal development.

Physicians used miscarriage products to help answer a range of research questions. Some focused on what these tissues could reveal about the process of pregnancy and causes of miscarriage. But a surprising number of them utilized fetuses to explore larger questions about human biology, life, and death. Stolz’s fascination with his specimen came not only in gaining access to the internal workings of pregnancy, but also in the fact that the six-inch, infant-like fetus was still breathing at only five months gestation. Having such an intimate and graphic illustration of the workings of the human body was extremely rare but highly valued in nineteenth-century American medicine.

Doctors went to extremes to obtain products of miscarriages, sometimes deceiving their patients, pocketing embryos, and bringing even destroyed tissues to medical meetings. Anything and everything that came out of a woman’s vagina was important for understanding the science of human anatomy. At a time when university-educated, European-influenced medical practitioners were becoming increasingly convinced of the utility of learning anatomy and physiology, but were hampered by a culture that was horrified at the idea of medical researchers using human cadavers, miscarried fetuses allowed doctors the opportunity to investigate how humans become alive and how they die, as well as research how organs and systems work in conjunction and fail at the end.

As a result, in late-nineteenth-century America, the miscarried fetus became a scientific specimen. But doctors were not alone in this construction. While physicians wrote hundreds of articles reporting on countless cases of miscarriage, and discussed these specimens at local and national meetings, they did not find these “creatures” in a pond or under a microscope. In order for doctors to obtain these newly-valued objects, women and their families needed to include physicians in their miscarriage experiences, and then hand over the tissues that resulted.

We cannot forget the power that women, their families, and their birth attendants (female relatives, midwives, neighbors) held over the initial step of turning a fetus into a specimen. As bemoaned by one physician after delivering a set of twins he estimated to be between four and five months gestation: “I made an earnest effort to secure the children…to preserve as specimens, but failed, the parents objecting to it.”2 Doctors, in most cases, could not remove the fetus, be it alive or dead, from a family’s home unless that family deemed the fetus to be of little personal value.

As I have discussed elsewhere and develop at length in my new book, the restrictive nature of nineteenth-century reproductive politics actually may have helped physicians gain access to these new specimens. At a time when many American couples were interested in limiting their family’s size, birth control and abortion were criminalized, leaving most with unreliable, costly, or nonexistent fertility control. In such circumstances, some women actually found comfort in having a miscarriage, and considered the products more akin to a specimen than a child. For most of the cases reported in medical journals, late-nineteenth and early-twentieth-century families did not view miscarriage products as “children” or “babies,” but rather something of which to dispose.

Remarkably, it was seeing the products of miscarriage not as infants, but still as clear representations of humans, that enabled the embryological research that helped construct the modern pregnancy that revolves around the developing infant. Anatomical and physiological developments that personalize the fetus, such as when the heart starts to beat — a milestone favored by anti-choice groups and obstetricians alike as “proof” of the child — entered twentieth-century pregnancy advice and obstetrical practice only after families and doctors categorized miscarriage products as specimens rather than people.

Now, as contemporary reproductive rhetoric relies on the embryological “facts” presented in medical texts, ultrasound images, and public health propaganda, it conveniently erases its own cultural history of how this supposedly “objective” knowledge came to be in the first place. Our ability to know when fetal heartbeats start, or when hair grows, or when a fetus can feel pain depends directly on women and their doctors first agreeing on the quasi-human status of miscarried fetuses.

In 1849, Dr. Charles Munde assisted his own wife through a miscarriage at five months, ending his report: “After twenty-two hours from the beginning of the accident, the foetus, a boy (whom I preserve in alcohol) went off.”3 This scenario, a doctor delivering what many would consider today his own son, yet putting the fetus in a jar of alcohol for preservation, seems foreign and strange. But these historical accounts remind us that miscarriage, like all health and bodily conditions, is socially constructed. Munde lived in a society in which doctors readily gathered up fetal specimens from miscarriage cases and studied them, preserved them, shared them, and learned from them. Munde also lived in a society in which families struggled to limit the number of children they had, at times welcomed miscarriage, and faced no reprobation for allowing a physician to leave their home with a (sometimes living) five-month old fetus.

While that is not the society we live in today, it is dangerous to think that miscarriage is now somehow imbued with certain natural and inalienable meanings as a death, a tragedy, and something gone wrong. Millions of women still face struggles with obtaining safe, reliable, and affordable means to control their fertility, and certainly some of them welcome miscarriage as a result. Forcing families to categorize miscarriage as the death of a child, as numerous states have attempted to legislate in the past decade, only harms families and women.

Even for those who do think of their miscarriages as a tragedy, unnecessary laws governing fetal remains cause undue burdens on families in terms of cost and physical and mental harm. As many nineteenth-century women and physicians understood, and as Stephie Grob Plante recently affirmed, grieving a miscarriage does not necessarily involve losing a person. It can, of course. But it can also embody a wide range of meanings: losing an opportunity, an idea, a fear, or a source of anxiety. In order to truly support families, we must not impose a universal meaning or moral judgment on an event that means different things to different people in different circumstances.

Notes

  1. J. Stolz, “Respiration and Signs of Life in a Five Months Foetus,” Medical and Surgical Reporter 15, no. 16 (1866): 344-345. Return to text.
  2. T. R. Rubush, “Superfoetation,” Transactions of the Indiana State Medical Society 43 (1892): 181-187. Return to text.
  3. Charles Munde, “Water in Miscarriage,” Water-Cure Journal 9, no. 6 (1850): 190-191. Return to text.

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