The Change of the Status of Joseon Medical Bureaucrats in the 15th and 16th Centuries.

In the 15th century, Joseon dynasty's goal for the stabilization of the ruling system, the ideological freedom of the era, and the necessity of medicine due to the introduction of Jin and Yuan dynasty's medicine led to the increased interest in medicine by the nobility along with tolerant practice. The practice of reading medical books is a good example of this institutional demonstration. However, by the end of the 15th century, a noticeable change had taken place. Within the nobility, there was an ideological rigidity regarding technology other than those of Confucianism, as the nobility became concentrated on the principles of Neo-Confucianism. In addition, as the publication of large-scale editions such as Uibangyuch'wi (the Classified Collection of Medical Prescriptions) came to an end, they have become less inclined to nurture talent at the level of the central government as in the previous period. In addition, as the discrimination against illegitimate children became stronger, technical bureaucrats such as medical officials, which were open to illegitimate children, came to be seen in increasingly disdainful and differentiated manners. From the late Sejong period to the early Seongjong period, the entrance of illegitimate sons into the medical bureaucracy solidified the negligence of medicine by the nobility. After then, the medical bureaucracy came to be monopolized by illegitimate sons. As for illegitimate sons, they were not allowed to enter society through Confucian practices, and as such, the only way for them to enter the government was by continuing to gain experience as technical bureaucrats. Technical posts that became dominated by illegitimate sons became an object of contempt by the nobility, and the cycle reproduced itself with the social perception that legitimate sons of the nobility could not become a medical official. Medical officials from the Yi clan of Yangseong had been legitimate sons and passers of the civil service examination in the 15th century. However, in the 16th century, only illegitimate sons became medical officials. The formation of Jungin (middleclass) in technical posts since the middle of the Joseon period is also related to this phenomenon. The Yi clan of Yangseong that produced medical officials for 130years over four generations since Yi Hyoji, a medical book reading official, is an exemplary case of the change in the social perception in the early Joseon period regarding medical bureaucrats.

Evaluation of an integrated services program to prevent subsequent pregnancy and birth among urban teen mothers.

This article details the evaluation of a clinical services program for teen mothers in the District of Columbia. The program's primary objectives are to prevent unintended subsequent pregnancy and to promote contraceptive utilization. We calculated contraceptive utilization at 6, 12, 18, and 24 months after delivery, as well as occurrence of subsequent pregnancy and birth. Nearly seven in ten (69.5%) teen mothers used contraception at 24 months after delivery, and 57.1% of contraceptive users elected long-acting reversible contraception. In the 24-month follow-up period, 19.3% experienced at least one subsequent pregnancy and 8.0% experienced a subsequent birth. These results suggest that an integrated clinical services model may contribute to sustained contraceptive use and may prove beneficial in preventing subsequent teen pregnancy and birth.

Widowhood, illegitimacy, marital reproduction and female longevity in a rural Spanish population.

Using data from parish and civil registers in a rural community in northwest Spain (Los Nogales), family reconstitution provided 1502 complete reproductive histories, of which 584 corresponded to first marriages of women dying after their 50th birthday. A homogeneous sample consisting of women married in the period 1877-1899 (N=311) provided information concerning their reproductive performance, including ages at first and last maternity and number of children born alive and surviving, which was related to the mother's post-menopausal longevity, also considering premarital fertility and her marital status (widow/married). The results obtained indicate that mothers with a lower proportion of children dying before the first birthday and the age of 15 (mainly males) have a greater post-reproductive longevity. Moreover, women with a more protracted end to their reproductive period and greater fertility live for more years beyond their 50th birthday. These results do not prove a causality between maternal longevity and more successful reproduction; instead, they are indicative of a holistic condition of health. A wide spectrum of favorable biological and environmental factors will have positive consequences for a woman's life trajectory, affecting both her reproductive performance and her own likelihood of surviving.

Paternity testing requested by private parties in Italy: some ethical considerations.

In Italy, judicial and extrajudicial requests for paternity testing have increased in recent years. A retrospective analysis of such private extrajudicial requests received by the legal medicine unit of the Department of Environmental Medicine and Public Health of Padua University was conducted to identify problem areas most helpful in determining whether to accept private parties' requests for paternity testing. Such testing is most delicate when a presumptive father may be seeking to disown paternity and when testing is wanted without the consent of a member of the mother-child-father triangle. Tests that could establish paternity where none has been recognised are less problematic, as the child will not lose out. Legal and ethical-deontological aspects of consent, of the protection of minors and of children's and parents' need for follow-up interviews to deal with the outcome of such testing are carefully considered by the Padua University team when deciding whether to accept a request for testing. It is argued that because such issues are not dealt with by mail-order laboratories, the use of such services is inappropriate.

Lying-in and laying-out: fetal health and the contribution of midwifery.

This article considers the quality of midwifery skills and practice principally in eighteenth-, nineteenth-, and early twentieth-century England. It discusses the merits of assessing effectiveness via differentials and changes in late-fetal rather than maternal mortality. Evidence from the lying-in hospitals, both in-patients and out-patients, in terms of stillbirths and the deaths of mothers and children is set against what is known from demographic studies of the background levels of early-age and maternal mortality. The conclusions emphasize the value of taking a "fetal health" perspective, rather than viewing midwifery simply in terms of maternal well-being. They also note the apparent superiority of London's position compared with the provinces and the steady improvement during the eighteenth century, and lack of progress during the nineteenth; and they reconfirm the particular dangers to mothers delivered as hospital in-patients. Finally, the considerable methodological problems faced by such studies are emphasized.

[Medical-social aspects pregnancy, labor and puerperium in patients the solitary mother home in Karwowo near Szczecin]. / Medyczno-spoleczne aspekty przebiegu ciazy, porodu i pologu u pacjentek--pensjonariuszek domu samotnej matki w Karwowie kolo Szczecina.

PURPOSE: Solitary maternity is a significant problem of modern times requiring socio-economic and psychological, as well as perinatological studies. The twentieth anniversary of the Maternity Home managed by the Benedictine Samaritan Sisters motivated the present study. MATERIAL AND METHODS: Hospital discharge summaries of 429 women (group DSM) who lived at the Maternity Home between 26 July 1983 and 26 February 2002 were analyzed. This documentation was supplemented with hospital data on 177 women who gave birth at two Szczecin hospitals and on 13 who left the Home before delivery. RESULTS: Residents of the Home came from all regions of Poland and from urban and rural societies. They were between 14 and 43 years of age (mean 22.6 +/- 5.7). 87.4% of them were single and 63.7% were primipara. 50.4% of them failed to complete primary education while 3.4% had university-level education. 6% were mentally and/or psychologically handicapped and 42.7% had no profession. The major causes of admission into the Home were: desire to hide the pregnancy, family conflicts, homelessness, difficult material situation, mental or physical disability, violence or alcoholism in the family. The control group comprised 400 women (group K) who gave birth at the Department of Obstetrics and Perinatology, Pomeranian Medical University in Szczecin. 51.5% of them were primipara. The mean age in this group was 27.4 +/- 5.4 (17-44). 71.3% were married. The Majority had secondary (41.9%) or university (32.5%) education. Most of them worked as artisans, teachers or economists. Neurological or psychiatric diseases dominated in group DSM but otherwise no severe disease at all could be disclosed. Satisfactory prenatal care was provided to 33.1% of DSM patients and to 78% of group K. No prenatal care was provided to 9.5% of DSM patients and to 1.7% of group K. EPH gestosis was more often observed in DSM patients and imminent abortion, premature birth, PROM, urinary tract infection, and anaemia were more frequent in controls. More DSM patients had no treatment during pregnancy than controls. The use of tocolytics was significantly more frequent in DSM patients. Antibiotics and drugs accelerating maturation of the respiratory system were applied with similar frequency in both groups. Frequency of immature and mature births was similar in both groups. 84.2% of DSM patients and 68.8% of controls had natural delivery. Cesarian section was twice more frequent in group K. Immediate indications dominated in both groups (74.1% in DSM; 57.4% in K). No medication was used during delivery in 30% of patients. DSM patients more often required strong analgesics. Antibiotics and agents increasing uterine tension more often were used in K patients. Deliveries in both groups were usually without complications. Female genital tract injury was more frequent in DSM patients (20.9% in DSM; 14.8% in K). Delivery duration was similar in both groups, but the second part of delivery was longer in K primipara. Mean neonatal weight in the 1000-2500 g range was similar in both groups but was significantly higher in controls for 2501-4000 g neonates. The difference for newborns weighing more than 4000 g was not significant. There were no neonates weighing less than 1000 g. The clinical condition of newborns measured with the Apgar scale was worse in the DSM group after the 1st min, as well as after the 3rd and 5th min and the difference in each case was significant. Puerperium was usually uncomplicated. However, urinary tract infection was more frequent in DSM patients and anaemia was more frequent in controls. The duration of hospitalisation was similar in both groups (mean = 6 days). 120 of 177 DSM mothers left hospital together with their children, as compared to 99.3% in the control group. 87 children of mothers from the Maternity Home were offered for adoption. CONCLUSION: By studying unwed maternity it was observed that a holistic approach is the only way to disclose all the problems which are often unusually complex and concealed but which determine the normal development of an individual in the society. Analysis of the factors involved may help in attaining goals that serve the good of the society.

Social differentials in the decline of infant mortality in Sweden in the twentieth century: the impact of politics and policy.

This article describes some of the policies behind the decline of infant mortality in Sweden during the 20th century, from very high levels and large social differentials at the turn of the 19th century to one of the lowest levels in the world by 1950. Political commitment to reducing infant mortality and disparities between groups, a more equitable distribution of economic resources, and a successful combination of universal social and health policies most benefiting the least advantaged families and their children contributed to this favorable development.

[The gate the Kaiser opened for women. Rotenhausgasse (1), Vienna-Alservorstadt]. / Das Tor, das der Kaiser den Frauen auftat. Rotenhausgasse (1), Wien-Alservorstadt.

This paper refers to one of the entrances to the former 'delivery house' of the old Vienna General Hospital, namely the door in Rotenhausgasse. It was used for 70 years, from 1784 to 1854. According to the wishes of Emperor Joseph II, unmarried women could be supported by specialists, anonymously and thus escaping shame. Connected with it was the protection of the newborn against exposure and infanticide.

Clinical Evaluation of Unmarried Maternal Neonates Admitted to NICU

PURPOSE: This study was done to see whether neonates born to unmarried mothers have higher rates of prematurity, low birth weight, perinatal morbidity and mortality than normal married group. METHODS: 88 neonates of unmarried mothers who were admitted in our NICU during the 5-year period from January 1987 through December 1991 were evaluated, and as the control group served 276 neonates of married mothers in 12 randomly selected weeks extended over the year during the same period. In statistical analyses, all data were analyzed by x2 test, Student t-test, and regression equation. RESULTS: 1) Unmarried mothers were 19.9+/-2.5(SD) year-old, with the majority(64.8%) falling into to age group between 16 and 20 years, whereas the control group was significantly older with 28.8+/-3.9 years. 2) Sex ratio was 1.38 : 1, with male prepondering, mean gestational age 35.5+/-3.7 weeks and mean birth weight 2,240+/-640g, in the unmarried group, differing significantly from the control group with 38.5+/-37 weeks and 2,910+/-750g. 3) Incidences of prematurity and low birth weight (LBW) were 70.5% and 75.0%, and total mortality was 28.4%. These values were significantly higher than in the control group, with 22.5%, 32.2%, 7.2%, respectively, and prematurity and LBW rate were also significantly higher in both groups of the same maternal age. Birth weight of unmarried group was significantly lower than control group in the same gestational age. Gestational age, birth weight, mortality rate were not significantly correlated to maternal age in both unmarried and control groups. 4) For the neonates of unmarried mothers, the majority was delivered either by midwife or in local obstetric clinics, and most of them(57.9%) were delivered by induction. 5) Neonatal diseases were jaundice, respiratory distress syndrome(RDS) and infection in the decreasing order, and incidence of RDS was significantly higher than in control group. But the death rate of RDS only tended to be higher in the unmarried-group. CONCLUSIONS: The neonates born to unmarried mothers have significantly higher rates of prematurity, LBW and mortality, and lower birth weight than the control group in the same gestational age. For neonatal diseases, incidence of RDS was significantly higher, and its mortality was significantly higher in the unmarried-group. Awareness on the seriousness of the problems leading to preventive measures against juvenile and unmarried child births, along with improved managements of babies born to unmarried mothers are urgently advocated.

Neonatal outcome in planned v unplanned out-of-hospital births in Kentucky.

We conducted a survey of 1,064 out-of-hospital Kentucky births during 1981 to 1983 in order to classify each by planning status (planned or unplanned to occur out of hospital) and attendant. Among the 809 births for which we obtained information, 575 (71.1%) were planned. We examined birth outcome by low birth weight (LBW) and neonatal mortality (NM). Compared with planned births, unplanned births were associated with increased risk of LBW (odds ratio = 6.6; 95% confidence limits [CL], 3.9 to 11.2, adjusted for maternal age). Furthermore, after adjusting for maternal age and parity, LBW births occurred at less than expected frequency among planned births (observed to expected [O:E] ratio = 0.48; 95% CL, 0.29 to 0.73), but at greater than expected frequency among unplanned births (O:E ratio = 2.9; 95% CL, 2.2 to 3.8). A similar, but nonsignificant, trend was seen for NM and NM was much greater in the unplanned group (72.7 per 1,000 live births) than in the planned group (3.5 per 1,000).

Abortion in the nineteenth century Maori: a historical and ethnopsychiatric review.

The recorded evidence for the practice of induced abortion in the nineteenth century Maori is evaluated. Aborticide as opposed to feticide in late pregnancy an infanticide was very rare. Aborticide was not practised for fear of retributive Makutu.

PIP: The anthropological writings on the 19th-century pre-European Maori of New Zealand are reviewed. It seems that various observers misunderstood local folk customs and arrived at wrong conclusions regarding certain childbirth-related practices. Evaluation of the literature shows that induced abortion was not practiced among these people for fear of retributive Makutu. They did, however, attempt feticide by premature induction of labor in late pregnancy. Infanticide was also common. In support of these conclusions, it is noted that missionaries felt the need of speaking out against infanticide; they did not mention aborticide. The folk ritual of taiki, performed during pregnancy, was done not to induce abortion but to destroy the spiritual and punitive powers of the fetus so that infanticide could later be performed safely. the natives seem to have learned about inducing abortion through the use of herbal preparations only after observing white men doing so. The issue of illegitimacy as a reason for abortion is not an issue. Illegitimate children had differnet names but there was no stigma attached to being an unwed mother or an illegitimate child. Aristocratic virgins (puhi) who conceived by a slave could not have hoped to redeem themselves by merely aborting the fetus.

[Contribution to the study of pregnancy, abortion and childbirth among the coastal Mataco Indians]. / Contribucion al estudio del proceso de gestacion, aborto y alumbramiento entre los Mataco costaneros.

PIP: The native concepts of conception, pregnancy, abortion, and childbirth of the Mataco Indians of the Pilcomayo River in Argentina are described. The Mataco view the man as playing the more active role in conception through contribution of seminal fluid, while the woman's uterus is more of a passive receptacle for accumulation of sperm. The embryo develops in a bag which the woman expels shortly after delivery. The number of children is believed to correspond to the number of bags a woman has. The possibility of reproduction for the Mataco is believed to result from actions of Tokjuaj, the central character in an extensive narrative cycle, in the earliest times. Tokjuaj showed the primitive human beings how to have coitus, supplied men with semen, and removed teeth around the vagina that prevented sexual contact. Sterility is always viewed as a feminine shortcoming, although not hopeless since the therapy of a shaman may cure it. The Mataco attribute sterility to the lack of the container in which the embryo develops with successive deposits of seminal fluid. Sterility is just 1 of the diseases believed to result from malevolent intentions of the supernatural. The shaman cures it by interceding with the spirit who caused it, and the woman responds with a payment. The shaman sucks and blows on the affected part to remove the illness and construct a new bag to hold the embryo. Pregnancy can result within a month. The parents must copulate frequently during the first part of pregnancy so that the embryo can develop. The embryo has a soul from the time it arrives in the mother's body. It is able to move because it has a soul. The Mataco appear to have a mythical rather than a physiological vision of pregnancy, although they recognize that the suspension of menstruation can signal pregnancy. Fathers are obliged to observe various prescriptions, primarily regarding dietary taboos, to avoid harming the future child. Sexual relations are discontinued in the later part of the Pregnancy to avoid conceiving another child, twins being subject to infanticide. Abortion is common among the Mataco, particularly among single women and those abandoned by their husbands. Mechanical means are used to induce abortion in the last months of pregnancy. Births are assisted by 1 or more midwives. The list of prescriptions for fathers multiplies at the time of delivery. Any accident during delivery is understood to result from violation of 1 or more of the norms surrounding pregnancy and delivery. For the Mataco, the possibility of conceiving a child, the desire to seek an abortion, or a successful delivery do not depend on the individual's will but on a combination of human intentions and those of the ruling spirits.^ieng

Anaemia of pregnancy: the changing postwar pattern.

A popluation survey covering over a quarter of a century has shown clearly the improvement in haemoglobin levels in women attending antenatal clinics at the Glasgow Royal Maternity Hospital. Various influences have helped to bring this about, foremost among these being routine early prophylaxis with combined iron and folate supplements. Indeed, a time-space relationship between changes in prophylactic therapy, rates of improvement, and the incidence of megaloblastic anaemia can be shown. The women at risk are still essentially the same except for a new group of young, unmarried girls, who must be watched. In our view the withdrawal of routine prophylactic therapy in pregnancy would be retrograde step.