[Semmelweis - a contemplating human. Scientific historical lessons]. / Semmelweis ­ egy gondolkodó ember. Tudománytörténeti tanulságok.

In this article we examine why Semmelweis's seemingly simple, logical and practical discovery was categorically dismissed by the majority of his contemporaries, and why even many years after his death it was accepted with such reservation. We invoke wherever possible Semmelweis's own words citing from the series of articles appearing in the 'Orvosi Hetilap' [Hungarian Medical Weekly Journal] published in 1858 in Hungary, and also from the German language summary of the Journal published in 1860. We came to the conclusion that although Semmelweis did everything in his power to show the causal relationship between the development of puerperal fever (childbed fever) and some infectious substance on the hands of examining doctors and medical students, this was not convincing enough. The predominant theory at the time held that infection was caused by miasma transmitted in the air and therefore stubbornly precluded any notion of infectious matter physically transmitted on unclean hands. We also concluded that the causal sequence observed by Semmelweis was missing an essential empirical element: visual proof of the infectious agent he correctly postulated as physically transmitted. Visually demonstrating the presence of the infectious agent by means of a microscope would have made his case. This finally did occur but only two years after Semmelweis's death. Had the renowned Hungarian obstetrician realized the significance of taking advantage of the opportunity afforded by Dávid Gruby who was conducting experiments in the same town, a more convincing argument could have been made for his theory. In the 1840s and 1850s, Dávid Gruby was experimenting with various microscopic techniques and their application with success in Vienna before continuing his work in France. Gruby's work, especially that of microscopic observations of tissues, received international acceptance. Therefore, the involvement of Gruby and his work with microscopes to support Semmelweis's observations would most probably have forestalled much of the criticism and rejection his theory was initially awarded (among which perhaps Virchow's rejection proved the most damaging). Had Semmelweis utilized microscopic techniques, he would have been celebrated among the first to discover bacterial pathogens, contributing to the development of the currently predominant germ theory. Failure to utilize the microscope was the root cause leading to the tragedy of Semmelweis's rejection by the medical establishment of the time. Despite the increasing numbers of scientists utilizing the microscope at the University of Pest, offered to corroborate his daims with microscopic observations. Efforts have been made have since been to rehabilitate him as the key figure who not only discovered the method of transmission of infectious disease, but also implemented measures of prevention. Elevating him among the ranks of the ten greatest doctors who ever lived is certainly recognition due, but sadly denied to him in his lifetime. Orv Hetil. 2018; 159(26): 1055-1064.

What happened at Vienna's Allgemeines Krankenhaus after Semmelweis's contract as Assistant in the First Maternity Division was terminated?

Ignác Fülöp Semmelweis is famous for dramatically reducing puerperal mortality while he was an Assistant in Vienna's largest hospital, the Allgemeines Krankenhaus; he did this, mainly, by requiring medical personnel to disinfect their hands by washing in a chlorine solution. But Semmelweis was soon removed from his post as assistant. The conventional view, which is suggested by Semmelweis's own account, is that his contemporaries were skeptical of his results, that he was marginalized and that once he was no longer directly responsible for caring for maternity patients, puerperal mortality returned to its former high levels. In fact, the situation appears to have been quite different. In this paper, we calculate and discuss the number of deaths at the Allgemeines maternity clinic after Semmelweis was removed from his position. As we will see, his successors maintained a relatively low mortality rate roughly consistent with the rate Semmelweis himself achieved. This suggests that the chlorine washings were probably still used conscientiously after he left and that the opposition he encountered had other sources than doubts about the effectiveness of the chlorine washings.

[Historical Review of Cesarean Section at King's Maternity Hospital and Midwifery School Zagreb 1908-1918].

This article presents a historical review of the performance of 23 cesarean sections at the King's Maternity Hospital and Midwifery School in Zagreb during the 1908-1918 period. Following prenatal screening by midwives and doctors in the hospital, deliveries in high risk pregnant women were performed at maternity hospitals, not at home. The most common indication for cesarean section was narrowed pelvis in 65.2% of women, while postpartum febrile condition was the most common complication in the puerperium. Maternal mortality due to sepsis after the procedure was 8.69% and overall perinatal mortality was 36.3% (stillbirths and early neonatal deaths).

[The early years of anatomy and obstetrics at the Göttingen University, 1734-1760]. / Az anatómia és a szülészet kezdeti évei a göttingeni egyetemen, 1734-1760.

In the Age of Enlightenment medical education was based on new fundamentals. According to experts at that time, a medical faculty had to have five branches: anatomy, botany, chemistry, practical and theoretical medicine. Perhaps Göttingen was the most successful university foundation at that time, because a generous financial support was provided, outstanding professors were invited and an education without censorship was warranted. The spirit of Enlightenment affected both the structure and the standards of education of the facultas medicinae. The word-wide reputation of this faculty was earned by Albrecht von Haller. Haller conceived both the still highly regarded botanical garden and the anatomical theatre, which was the first of its kind in the German speaking area. Furthermore, he founded one of the first clinical obstetrics departments in the world. Students gained theoretical knowledge, were trained practically and had the opportunity to make scientific observations and medical experiments. This paper describes the founding era of the medical faculty of University of Göttingen from a historical-cultural view of point, based on contemporary documents from Germany and Hungary.

[Introduction of the psychoprophylactic method and its influence on the prenatal care program for institutional parturition in Japan: the practice in the Central Hospital of Maternity of the Japanese Red Cross Society and Oomori Red Cross Hospital, 1953-1964].

The psychoprophylactic method is one of the methods for providing 'painless childbirth without drugs' and was invented by applying I. Pavlov's theory of higher nervous activity. In 1951, it was adopted as a national policy in the Union of Soviet Socialist Republics. This method was then introduced in the People's Republic of China in 1952. In 1953, it was brought to Japan by Masatomo SUGAI, an obstetrician, and was introduced into the Central Hospital of Maternity of the Japanese Red Cross Society with the support of the director, Naotarou KUJI. The practice of this method by the research team, which consisted of the obstetricians and midwives of the Central Hospital of Maternity of the Japanese Red Cross Society and Oomori Red Cross Hospital, resulted in the initiation and characterization of the prenatal care program to encourage the autonomy of the pregnant women for normal parturition in the institutions of Japan.

Charting the history of midwifery education.

Despite the recent popularity of exploring the history of midwifery practice, there has been minimal attention paid to the history of midwifery education. The purpose of this paper is to display a visual map and timeline of midwifery education from the eighteenth century, when formal midwifery programmes were introduced, to the present day. The paper will be inclusive of the history of midwifery teaching through the use of the High Coombe College archives (Lorentzon et al 2008). Prior to the eighteenth century, processes for learning midwifery were informal and unregulated. Traditional apprenticeships were gradually replaced by formal, regulated educational midwifery programmes, which were assessed. Midwifery teacher training finally became established in the twentieth century.

Man-midwifery history: 1730-1930.

This paper seeks to determine whether the man-midwives William Smellie and William Hunter deserve continuing approbation as 'Founding Fathers' of the obstetrics profession. Scrutiny of their careers reveals their involvement in murders for dissection. In addition, the man-midwifery initiative of delivery in lying-in hospitals resulted in around 1 million more deaths in Britain and Ireland between 1730 and 1930, than would have occurred had home-births remained as the norm. While some may still credit Smellie and Hunter with obstetric discoveries, their knowledge was obtained by murder-for-dissection. That indictment, together with the lying-in hospital legacy, far outweighs their discoveries. The paper invites further constructive discussion and debate, but concludes the accolade of Founding Fathers is undeserved. Any continuing endorsement of Smellie and Hunter effectively demeans the high ethical standards and reputation of current obstetric professionals.

Finance and faith at the Catholic Maternity Institute, Santa Fe, New Mexico, 1944-1969.

In 1944, the Medical Mission Sisters opened the Catholic Maternity Institute in Santa Fe, New Mexico, primarily to serve patients of Spanish American descent. The Maternity Institute offered nurse-midwifery care and functioned as a school to train nurse-midwifery students. Originally planned as a home birth service, the Catholic Maternity Institute soon evolved into a service in which patients chose whether to deliver in their own homes or in a small freestanding building called La Casita. In fact, despite their idealism about home birth and strong feelings that home birth was best, the sisters experienced significant ambivalence concerning La Casita. Births there met many of the institute's pragmatic needs for a larger number of student experiences, quick and safe transfers to a nearby hospital, and more efficient use of the midwives' time. Importantly, as the sisters realized that many of their patients preferred to deliver at La Casita, they came to see that this option permitted these impoverished patients an opportunity to exercise some choice. However, the choice of many patients to deliver at La Casita--which was significantly more expensive for the Maternity Institute than home birth--eventually led to the demise of the Maternity Institute.

[Women, the press, and hygiene: the medicalization of birth in Bahia (1910-1927)]. / Mulheres, imprensa e higiene: a medicalização do parto na Bahia (1910-1927).

The article discusses the role played by the lay press in disseminating the hygienist agenda in the city of Salvador, Bahia, in the early twentieth century, when journalists were writing about medicalized birth and the new standards of attention to the female body and to newborns. The Climério de Oliveira Maternity Hospital enjoyed the unrestricted support of the press, which went out of its way to portray the facility as ideal for hospital births.

For the good of the nation: scientific discourses endorsing the medicalization of childbirth in Peru, 1900-1940. / Por el bien de la nación: discursos científicos en favor de la medicalización del parto en el Perú, 1900-1940.

Over the course of the twentieth century, a series of changes occurred in the understanding of childbirth, which went from being a natural reproductive phenomenon belonging to the female, domestic sphere to a professional medical matter handled in an institutional setting. Through procedures like the use of anesthesia, Cesarean sections, ultrasound and other techno-scientific interventions, rapid and significant improvements and changes took place in the health and life of society and of women. The medicalization of childbirth in the early twentieth century was part of a broader process of constructing the state and institutionalizing the patriarchy that was common throughout the region.

A lo largo del siglo XX se sucedió una serie de cambios en la forma de concebir el parto que pasó de ser un fenómeno reproductivo natural propio del ámbito doméstico y femenino a un asunto médico y profesional del ámbito institucional. A través de procedimientos como el uso de anestesia, la cesárea, el ultrasonido y otras intervenciones técnico-científicas se han generado rápidas e importantes mejoras y cambios para la salud y vida de la sociedad y las mujeres. La medicalización del parto a comienzos del siglo XX fue parte de un proceso más amplio de construcción del Estado e institucionalización del patriarcado común en la región.

The role of the Doran Building in puerperal fever in Canada.

The Doran Building at the Kingston General Hospital, opened in 1894, represents an early Canadian initiative to apply the principles of sanitation, antisepsis, and asepsis to prevent puerperal fever ina freestanding lying-in hospital. This initiative was a response to maternal mortality during the 17th and 18th centuries, when approximately half of maternal deaths were due to puerperal fever. During the 250 years leading up to 1890, an understanding of the clinical nature of puerperal fever, its cause, mode of spread, and means of prevention had gradually developed. Despite this progress, puerperal fever remained a major cause of maternal mortality in the latter part of the 19th century. The Doran Building is a compact example of a pavilion hospital,built as a freestanding facility for women and children, with its own staff. Kenneth Fenwick, who was Professor of Obstetrics and Gynaecology at Queen's University and a vigorous advocate of sanitation, antisepsis, and asepsis, established the principles of patient care in the Doran Building during the period 1894 to 1928.His goal was the prevention of maternal mortality due to puerperal fever. During this period, there was a modest increase in the number of deliveries each year to a total of 3111 by 1928. There were 26 direct and indirect maternal deaths, representing a maternal mortality rate of 8.25 per 1000 live births. Puerperal fever accounted for the deaths of three women: one who had delivered in hospital and two who had delivered in the community and had been admitted following delivery. The application of the principles of isolation, sanitation, antisepsis, and asepsis limited the mortality in hospital due to puerperal fever in a manner consistent with the best hospitals elsewhere at that time.

[Ethical dilemma in the Women's Hospital of Basle. Diaconesses took a stand on abortions]. / Ethischer konflikt im Basler Frauenspital. Diakonissen nahmen Stellung zu Schwangerschaftsabbrüchen.

In the 1940s there occurred an ethical conflict in the Women's Hospital of Basle. It arose in the context of a shortage of nurses, the introduction of the Swiss national criminal law, the change of the hospital director, the increase of abortion and the nursing ideal of obedience and serving. The conflict showed the social change towards measures of birth control such as abortion and sterilisation. Different political opinions and strong convictions clashed. The paper is focusing on denominationally affiliated nurses, the deaconesses of Riehen, who were standing between the religious conviction to protect unborn life and the professional principle of unconditional nursing. Finally they decided to leave the hospital.

[Origins of institutional Pediatrics: Maternity and Childhood Hospital of Mexico City in the nineteenth century]. / Orígenes de la pediatría institucional: el Hospital de Maternidad e Infancia de la Ciudad de México en el siglo XIX.

In June of 1866, the empress Carlota founded the Maternity House in the Department of Secret Births at the Hospice of the Poor. Upon the reinstatement of a republican government, Dr. Ramon Pacheco was appointed director of the Maternity House. Shortly after, in February of 1868, Dr. Luis Fernandez Gallardo established a pavilion for sick children in the Hospital of San Andres. After realizing this pavilion didn't have the adequate conditions to operate properly, and in the need of a children's hospital in Mexico City, Dr. Pacheco merged both institutions in April 2, 1869 -with the help of Ms. Luciana Arrazola- and founded the Maternity and Childhood Hospital, the first institution for the care of ill children in the independent Mexico. Ever since it was founded, Dr. Eduardo Liceaga was in charge of the children's health. Later, with the help of the presidents Juarez, Lerdo de Tejada and Díaz, he was able to consolidate the hospital in academic and health services aspects. This noble institution closed its doors on February 5, 1905, upon its incorporation to the General Hospital of Mexico, after 36 years of working for the welfare of Mexican children.

La leche por bandera en Granada. Evolución de las nodrizas desde la plaza de las pasiegas hasta el banco de leche del hospital materno infantil de Granada / Milk by flag in Granada. Evolution of the wet nurses from Pasiegas square to the Maternal Human Milk Bank of the Maternity Hospital in Granada

Cuando pensamos en nodriza, las dos palabras que se vienen a la cabeza son leche materna y altruismo. Dos vocablos que han estado ligados a ellas y que hoy, en el siglo XXI, aún continúan. Las primeras nodrizas hicieron de esto una forma de trabajo, no estaba remunerado y para la clase alta era una forma de librarse del cuidado y crianza de sus hijos. Para las nodrizas supuso la incorporación al mundo laboral [Fragmento de texto] (AU)

Premature Infant Care in the Early 20th Century.

The complex early history of infant incubators provides insight into challenges faced by medical professionals as they promoted care for premature infants in the early 20th century. Despite their absence from the narrative to date, nurses played vital roles in the development of neonatal care. Working in many different settings, from incubator-baby shows to the first hospital unit designed specifically for premature infants, nurses administered quality care and promoted advanced treatment for these newborns.

[Childbirth without pain. Politics in France during the cold war. ]. / [L'Accouchement sans douleur. Un enjeu politique en france pendant la guerre froide.]

Dr. Lamaze introduced Natural Childbirth (ASD) in France in 1951. While this event is significant to the history of obstetrics and women's experience, we would like to concentrate upon another aspect here: how it is situated within the political debates of the period. In the midst of the Cold War, Lamaze was a sympathizer, although not a member of the Communist Party (PCF). He ran a maternity clinic for the CGT, a union affiliated with the PCE During a trip to Russia in 1951, he discovered a new method to relieve pain in labour through a psychological technique inspired by Pavlov. Upon his return, when he dedicated his energies towards the popularization of ASD, he looked for support from the PCF and to draw upon their propaganda network; this subsequently aroused suspicion and hostility. A few years later, ASD received the blessing of women's groups won over by its improvements to birthing. At the moment of Lamaze's triumph, he fell victim to a resurgence of Stalinism. With his team, he denounced the Soviet invasion of Hungary and lost the financial support of the unions which owned the clinic. Exhausted and profoundly disappointed, he died in March 1957.

Doris Gordon: foundation of a legacy.

Doris Gordon Memorial Oration delivered to RANZCOG Annual Meeting, Wellington, 2 October, 2015.