[Private charity - public health service. Comparison between British and German birthing centers of the 18th century]. / Private Wohltätigkeit--öffentliches Gesundheitswesen. Zum Vergleich zwischen britischen und deutschen Entbindungsanstalten des 18. Jahrhunderts.

In the eighteenth century, lying-in hospitals were founded in many European towns and cities. The way in which these institutions were financed differed greatly across Europe. In the UK, most of them were "charities" and relied on donations from wealthy benefactors, whereas on the continent they were usually funded by "public" money, be it from the state or local communities. The paper focuses on British charities and German hospitals, and explores the corollaries of the mode of financing. In the eighteenth century, a market emerged in Britain where numerous charities with different aims competed for donations from the well-to-do. For attracting benefactors, a charity had to convince potential donors that its clientele and purpose were particularly deserving, and that it used the money donated in a cost-efficient way. In Germany, it was mainly bureaucrats and governments who had to be persuaded, but public opinion did matter as well. In British lying-in charities, the main donors acted as governors, and benefactors could recommend persons for being admitted. In publicly funded German hospitals, the medical directors had much more power. In the competitive market, in which British charities acted, out-patient dispensaries (policlinics) became increasingly important, since they could argue that they were more cost-efficient and had lower mortality. In Germany, however, hospitals remained the dominant type of assistance in this field, in spite of the criticism they received. The different sources of finance appear to have been one of the reasons for this divergence. Teaching was the main purpose of most German lying-in hospitals. They either trained medical students or midwife apprentices or both. Since the patients served as teaching objects, all women were welcomed, and in fact most patients were single mothers. By contrast, most of the British institutions admitted only married women, because donors did not wish to encourage immorality. The charities staged the relation between donors and patients as a personal patron-client bond.

[The Charity (La Caridad) Hospital in Coruna. Foundlings and secret deliveries]. / Hospital de la caridad de A Coruña. Expósitos y sala de partos secretos.

The ideas of the Age of Enlightenment brought about an important advance in the attitudes regarding education and the importance that children have in society. This made it possible to start opening dispensaries, to paying more attention to child care, to contemplating special measures in the care for foundlings and for those mothers who were not able to give birth to their children inside a family structure. This article analyzes the cases of foundlings in La Coruña during the 18th and 19th centuries bearing in mind the care provided by the Charity Hospital in La Coruña and in the Maternity Center in Lugo. A summary of this article was presented as a open communication at the 16th National Congress of Nursing for Neonatal and Pediatrics Intensive Care.

[Learning at the bedside of pregnant patients. On the typology of the birthing center in Germany (1728-1840)]. / Lernen am Bett der Schwangeren. Zur Typologie des Entbindungshauses in Deutschland (1728-1840).

The process of institutionalization of obstetrics in the German universities is investigated on the basis of contemporary accounts and archival documents. The inauguration of the "school for midwives" by Johann Jakob Fried at Strasbourg (1728) was followed after 1750 by the foundation of numerous other obstetric departments and lying-in hospitals, in which midwives and medical students could attend a regular and systematic bedside-teaching for the first time. As to the architectural types, four basic structures have to be distinguished: Whereas in big cities the teaching centres were integrated in pre-existing hospitals (type A), the setting up of lying-in hospitals in regional universities took place in decaying old buildings (type B). The organizing of an obstetric ward in the former "clinicum" together with the medical and surgical department (type C) was rather seldom. Before 1850 the construction of expensive new buildings for lying-in hospitals (type D) was only realized at few places. In conclusion the emphasis is put on the political intentions and tendencies of the enlightenment philosophy which influenced considerably the creation and the development of the first teaching centres for obstetrics.