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Bartholomew Mosse was born in 1712, the sixth child of the Reverend Thomas Mosse, who had come to Ireland as a chaplain to King William III. After the Battle of the Boyne, he was appointed Rector of Mayborough. Bartholomew was educated by a tutor at home until he was 17 when he became apprenticed for five years to Mr John Stone, a barber-surgeon in Dublin. After receiving his qualification in 1733 from the surgeon-general in Ireland, he is thought to have practised as an assistant surgeon in Dublin for the next five years.
In 1734 he married Elizabeth Mann with whom he had a son in 1737, but both mother and child died shortly after the birth. At the age of 26 Mosse was appointed surgeon in charge of a draft of troops dispatched to Minorca during the War of the Spanish Succession. With a view to improving his surgical and midwifery skills, he subsequently travelled in England, France, and Holland, before returning to Dublin (fig 1).1 2
Bartholomew Mosse, 1712–59.
In 1742, at the age of 30, Mosse became a licentiate in midwifery of the King and Queen’s College of Physicians, and from then on determined to devote himself to midwifery. At that time most mothers were delivered by traditional midwives and maternal and infant mortality were very high; midwifery was considered to be fit only for handywomen and surgeons. Mosse was appalled by conditions for the poor: “...the misery of the poor women of the city of Dublin, at the time of their lying-in, would scarcely be conceived by any who had not been an eye witness of their wretched circumstances; that their lodgings were generally in cold garrets, open to every wind, or in damp cellars, subject to floods from excessive rains; destitute of attendance, medicines, and often of proper food, by which hundreds perished with their little infants.”
On 15 March 1745, Mosse opened a small hospital of 10 beds in George’s Lane, Dublin, with the help of a group of friends and supporters. Named the Hospital for Poor Lying-in Women, it was the first maternity hospital in the British Isles. By the end of the year the hospital had 28 beds and 208 women had been delivered, with the loss of only one mother, while 190 infants had been discharged. Mosse’s principal focus from then onwards was to raise money for the running costs and to provide improved facilities. He was a genius at fundraising, organising concerts, lotteries, and other charitable events. Besides raising more than £20 000, he gave freely of his own money. Following the purchase of a 4 acre site north of the river, he opened fashionable pleasure gardens and a coffee house. In 1750 he commissioned Richard Casells to build a new maternity hospital on the site. The foundation stone was laid in 1751. It was designed to have small wards, probably with a view to controlling the spread of puerperal infection.
In 1752 Mosse petitioned for a Royal Charter, outlining the benefits that would result. It was granted by George II in 1756. By raising the status of the project from a charity to a national institution, government financial support was ensured and indeed was provided to the tune of £12000. On 8 December 1757, the original lying-in hospital was closed and the new 150 bedded hospital opened by the Duke of Bedford, the first president of the hospital, with Mosse as its first Master. During the first year there were 454 deliveries with eight maternal deaths. The institution was renamed the Rotunda Hospital in 1767 following the completion of a large round entertainment room, the Rotundo, another of Mosse’s schemes.
Mosse was a deeply religious man with a strong social conscience. Besides wanting to help the lying-in women of Ireland and improve midwifery, he also wanted to establish a school for the training of midwives and doctors. In both aims he succeeded. In its first 100 years, the hospital admitted 183 000 women for delivery and in the second century another 552 000. Many thousands of doctors and midwives from all parts of the world have also been trained at the hospital.
Mosse married for the second time in 1743. His wife, Jane Whittingham, was the daughter of the Archdeacon of Dublin and a first cousin. They had two children.
In 1759 Mosse fell ill and died two weeks later at the age of 47. He was buried in Donnybrook Cemetery. His wife died five years later in 1764.
Fielding Ould succeeded Mosse as Master in 1759.1-3 Born in 1710, he was the son of an army captain in the Royal Welsh Fusiliers and a Miss Shaw of Galway. After studying for two years, under the guidance of Grégoire in Paris, he returned to Dublin in 1737 and the following year became a Licentiate of the King and Queen’s College of Physicians. In 1742 he published a Treatise of Midwifery4which was dedicated to the President, Censors, and Fellows of the College. This, the first British text of any importance on obstetrics, broke new ground in several ways, in particular in respect of the understanding of labour as a mechanical process. He favoured the left lateral delivery position and advocated the introduction of the thumb into the rectum to pull back the coccyx and facilitate the delivery of the head. With breech delivery, he brought down the arms and delivered the head with a finger of one hand in the child’s mouth and the fingers of the other hand hooked over the shoulders. In the case of twins he recommended that the second baby be delivered immediately after the first. He condemned routine manual removal of the placenta and advocated its spontaneous expulsion by the mother with very gentle cord traction. Ould was able to perform version. He applied forceps with the woman in a kneeling position. Forceps should not be used though, he said, when the fetus was dead; rather, the baby’s head should be opened using his tenebra occulta, an instrument with a guarded cutting edge. Occasionally, he advocated the use of an episiotomy when the perineum was very rigid, but caesarean section he regarded as barbarous and fatal to the mother. Ould’s description of fetal circulation is splendid, though he makes the error, not uncommon at the time, of believing that it communicated with that of the mother.
On the fetal circulation4
“This (umbilical) vein enters into the abdomen of the foetus at the navel and goes directly into the liver, where it discharges itself into the sinus of the Vena Portae; whence by a particular canal (Canalis Venosus), it is carried in part to the Vena Cava, which carries it to the heart...thence to the right auricle, from that the greatest part of it conveyed immediately into the left auricle by an opening in the partition that divides them, called the Foramen Ovale from its figure; were if not for this contrivance there could be no circulation, for being destitute of respiration, the blood could not pass through the lungs as in the adult; but that the right ventricle should not be absolutely without action, some part of the blood escaping the foramen ovale goes into it, whence it is thrown into the pulmonary artery, which still meeting with opposition in the lungs, in great measure passes directly into the aorta, by a canal for that purpose called Canalis Arteriosus, and thence through the whole body of the foetus...from the iliacs arise the umbilical arteries, which are two in number, which go along the sides of the bladder contiguous to it, and contiguous to each other, from thence to the navel, whence they go spirally round the umbilical vein, till they enter the placenta, where they are divided into very small branches to join the uterine veins.”
In 1753 Ould received a bachelor of arts degree from Trinity College (fig 2). However, his request to be examined by the College of Physicians for a medical degree in 1756 was rejected on the grounds that the practice of midwifery was derogatory to the dignity of the profession of medicine. Ould persisted and in 1761 Trinity University awarded him an MB in spite of the continued opposition of the College of Physicians, whose fellows felt that they had been treated with great disrespect, and for more than 20 years refused to examine Trinity undergraduates. Only in 1785 did they relent and confer a medical degree on Ould.
Sir Fielding Ould, 1710–89.
By the time Ould was appointed master and a governor of the hospital in 1759, he had built up an extensive private practice among the upper classes and is said to have attended the Countess of Mornington at the births of the Marquis of Wellesley and of Arthur, the future Duke of Wellington. In 1760 he received a Knighthood from the Lord-Lieutenant of Ireland, the Duke of Bedford. During his seven year Mastership, 1759–66, 3800 women were delivered in the hospital with 49 (1.28%) deaths. Ould died of apoplexy on 29 November 1789, and was buried in St Anne’s Church, Dublin.