Estimating the effects of cigarette taxes on birth outcomes.

Employing provincial data from 1979 to 2004 allows us to exploit the significant (45 percent to 60 percent) reduction in excise taxes in Eastern Canada enacted in February 1994 to estimate the impacts of cigarette taxes on birth outcomes. Empirical estimates suggest that an increase in cigarette taxes is significantly associated with lower infant mortalities. However, we also find some evidence of a counter-intuitive positive correlation between taxes and fetal deaths. Overall, conditional on methodology, we find increased lagged per capita health expenditures and the number of physicians to be significantly associated with improvements in birth outcomes.

[Abortion in the Castilian medical literature of the 16th century]. / El aborto en la literatura médica castellana del siglo XVI.

This article analyzes the causes of abortion according to the medical and surgical literature that circulated in Castilian in the fifteenth and sixteenth centuries. These works not only explain the medical causes of the death of foetuses but also show how female health was discriminated against and how doctors were able to produce an incipient causal theory in accordance with the medical and social problems of their time.

A remarkable case in the history of obstetrical surgery: a laparotomy performed by the Dutch surgeon Abraham Cyprianus in 1694.

In 1700 the Dutch surgeon/medical doctor Abraham Cyprianus (1655/1660-1718) published his Epistola historiam exhibens foetus humani post XXI. menses ex uteri tuba, matre salva ac superstite excisi, a 94-page book in which several remarkable case histories are described and illustrated. The most spectacular case in the book is the accurate and detailed description of the delivery of a dead full-term child (ectopic tubar pregnancy) by a laparotomy he performed in a living woman in December 1694. The woman survived the operation and gave birth to three more children in following years. This remarkable, well-considered, brave and life-saving operation, performed in a time without antisepsis and anesthesia in a domestic situation is seldom mentioned by medical historians describing the history of obstetrics. This particular case is reviewed in this article.

Colored illustrations of obstetrics manipulations and instrumentation techniques of a Turkish surgeon Serafeddin Sabuncuoglu in the 15th century.

Serafeddin Sabuncuoglu (1385-1470) was the author of the first illustrated surgical textbook Cerrahiyyet'ül Haniyye (Imperial Surgery) in the Turkish-Islamic literature. In the obstetric section he gave detailed descriptions of normal and abnormal presentation, surgical manipulation of intrauterine foetal death and retained placenta. He wrote about previously described procedures and the obstetric culture of his time. Some authors have claimed that he only translated Abu Kasim-al Zahrawa (Albucasis)'s Al-Tasrif (Textbook of Surgery) and added the illustrations of the surgical techniques. Even if this is accepted, the illustrations are enough to entitle this work as a milestone. In this paper, we describe the contributions of this pioneer in obstetrics and compare his recommendations with the current practice.

["The devil of Korneuburg"]. / "Der Teufel von Korneuburg".

In 1827 in Korneuburg, a small town near Vienna, an unmarried servant had gone to church during pregnancy, praying in front of the statue of Saint Michael and looking at the devil's figure attached to the statue. In the 6th month of pregnancy, the servant was delivered of a malformed stillbirth. The Pathologist believed in a correlation between her experience in the church and the malformation of the child. This article deals with the oldest specimen with developmental anencephaly, a special form of acrania (protruding eyes, prominent nose and long arms) from the Pathological-Anatomical Museum in Vienna.

A tragic case of complicated labour in early Byzantium (404 A.D.).

OBJECTIVES: Presentation and comment on the problematic delivery of the Byzantine empress Eudoxia's stillborn child. STUDY DESIGN: The original Greek language Byzantine histories, chronicles and hagiographical sources were investigated. Comparisons were then made of the knowledge of obstetrics among contemporary and ancient physicians. RESULTS: The case of Eudoxia's delivery is described in various literary sources with details regarding the fatal clinical picture of the parturient after the embryo's death. The study of early and contemporary medical texts proves that in similar cases conservative treatment was preferred but embryotomy was followed in the event of failure. CONCLUSIONS: Eudoxia's labour represents a characteristic paradigm of the difficulties involved in the confrontation of complicated deliveries in mediaeval times, often resulting in the death of both the mother and embryo. The treatments follow the ancient Hippocratic, Hellenistic and Roman traditions and influence medieval European medicine, thus constituting significant roots of obstetrics.

Un parto distócico en el siglo XIX. El testimonio de un vicario / An dystocique childbirth in the 19th century

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Neonatal mortality and stillbirths in early twentieth century Derbyshire, England.

Neonatal mortality and stillbirths are recognised to be subject to similar influences, but survival after a successful live birth is usually considered in isolation of foetal wastage. Moreover, individual-level data on age-specific influences and causes of death in a historical context are rare. This paper uses an unusual data set to compare the influences on neonatal mortality and stillbirths in early twentieth century Derbyshire, England. Multivariate hazard and logistic analyses are performed to examine the relative roles of various social, environmental, and demographic factors. The influences on and causal structures of neonatal mortality and stillbirths emerge as broadly similar, with previous reproductive history linked to a considerable amount of variation. The clustering of endogenous deaths was much greater than the clustering of exogenous and post-neonatal deaths, probably reflecting the cause-of-death structure and the relatively healthy social and environmental position of early twentieth century Derbyshire.

[Ethics of medical management of inability to give birth. Johannes Stahelin and his plea for embryotomy]. / Zur Ethik ärztlichen Handelns bei Gebärunvermögen. Johannes Stahelin und sein Plädoyer für die Embryotomie.

Confronted with the inability to give birth to a child, delivery could be achieved by embryotomy--that was only permitted, when the foetus was dead--or by Caesarean section--where the chance to save mother and child as well was merely theoretical until the end of the 19th century. In two statements of the Theological Faculty of the Sorbonne in Paris embryotomy was absolutely rejected (1648), in nearly all cases of impossible delivery the Caesarean section was required (1733). In 1749 Johannes Stähelin starts a daring attempt to justify embryotomy by application of natural law to the situation of critical childbirth. Keywords of the theological statements are confronted with categories of the natural law in a sophisticated way, nevertheless the basis of Christian confession is maintained. This argumentation in order to justify embryotomy as a lawful method to deliver a woman seemed to be more adequate to the medical sphere than claiming the Caesarean section. The ethical debate continued until the problem was solved by mastering Caesarean section.

Swedish maternal mortality in the 19th century by different definitions: previous stillbirths but not multiparity risk factor for maternal death.

BACKGROUND: The high maternal mortality levels in today's developing countries were also found throughout the history of currently affluent countries. The parish information system in Sweden offers unique possibilities for research in historical cohorts. Furthermore, vital events surveillance systems are scarce in today's developing countries. METHODS: This cohort study covers 42,387 mothers who gave birth to 150,932 infants during the 19th century in the Skellefteå and Sundsvall areas. Among these women, 1,237 were dead within one year after delivery. The analysis of the cause of these deaths was done according to the various ICD definitions. Parity five and above was defined as grand multiparity. RESULTS: Maternal mortality ratios, deaths per 100,000 live births were as follows: 256.4 (direct obstetric deaths), 320.7 (direct and indirect obstetric deaths), 489.2 (pregnancy-related deaths), 347.8 (late maternal deaths) and 837.0 (maternal deaths and late maternal deaths). In this study, 59% of all maternal deaths occur within the first 42 days of delivery, two thirds of them having direct and indirect obstetric causes. Of the late maternal deaths, the bulk were infectious or other indirect deaths, mirroring more general female mortality and the pre-existent endemic situation of tuberculosis and other infectious diseases. The combination of previous stillbirth and infant death represented the highest risk ratios, RR 2.77-3.62, while grand multiparity was not associated with increased risk. Urbanized and industrialized areas tended to have higher maternal mortality. CONCLUSIONS: In conclusion, this study shows that the mother's reproductive history was the most important risk factor measured for all definitions of maternal death. Grand multiparity did not increase the risk of maternal death. Maternal mortality ratio varied threefold in the study population, depending on the definition used. The high mortality ratios found in this study, only declining by the end of the century, should be interpreted as a general condition of the society since no significant differences could be perceived regarding social class, while unmarried women were more at risk.

Community-based prevention of perinatal deaths: lessons from nineteenth-century Sweden.

BACKGROUND: Perinatal deaths have been more difficult to prevent than infant deaths in low- income countries due to its close relation to poor maternal outcome. The aim of the study was to perform a comprehensive population-based analysis of perinatal mortality in a high mortality setting and to determine the impact of midwifery-assisted home deliveries. METHOD: The study design was a community-based cohort study. In all, 4876 perinatal deaths were recorded among 116 211 newborns in the districts of Sundsvall and Skellefteâ in northern Sweden during the years 1831-1899. Relative risks, 95% CI, population attributable proportions and prevented fractions were calculated. RESULTS: The overall perinatal mortality rate was 42.0 per 1000 births. A previous stillbirth represented one of the most important risk factors (RR = 3.25, 95% CI : 2.97-3.56), with a population attributable proportion of 7%. Two or more previous stillbirths gave an RR of 8.50 (95% CI : 7.58-9.53) and a population attributable proportion of 4%. There was an increased risk of perinatal mortality for mothers over 35 years old, the primiparous and the unmarried, while grandparous women had a higher perinatal mortality that was accounted for completely by a poor history of previous stillbirths and infant deaths among these women. The children of crofters, farmers and workers had higher perinatal mortality, but area had no significant impact. During the years 1881-1890 and 1891-1899, the prevented fractions of midwifery were 15% and 32%, respectively. CONCLUSION: Poor reproductive history, particularly previously high perinatal mortality, is associated with high perinatal mortality. Midwifery-assisted at home deliveries successfully reduced perinatal mortality.

Molecular sex identification of stillborn and neonate individuals ("Traufkinder") from the burial site Aegerten.

The study reconstructs the sex ratio of 121 stillborn and neonate individuals from the early modern burial site Aegerten, Switzerland. The immature individuals, who were not baptised before death, were buried along the walls of the church. To perform a molecular sex identification, bone samples from the infants were collected from different skeletal elements. Ancient DNA (aDNA) was isolated by a combination of automated phenol/chloroform extraction and precipitation with silica powder. A combination of manuell Chelex extraction and purification kit was also used to perform an extraction. Finally, the aDNA extracts were amplified with a primer system that amplifies a part of the amelogenin gene located on the human sex chromosomes. The morphometrical sex determination of the children suggests a large disproportion of female individuals (about 60%). This finding was compared to PCR-based amplification results. In contrast, the results of the molecular sex identification were a high proportion of male individuals. Looking at these results, it should be noted that the high mortality of male individuals during the last months of pregnancy and during the first month after birth is in accordance with the natural sequence of death also found in recent populations.