Teaching Obstetrics at Home: Medical Schools and Home Delivery Services in the First Half of the Twentieth Century

Bulletin of the History of Medicine

Volumn 72, Issue 2, 1998, Pages 220-245

  Borst, Charlotte G ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; EDUCATION; FEMALE; HISTORY; HOME DELIVERY; HUMAN; MEDICAL EDUCATION; MEDICAL SCHOOL; OBSTETRICS; PREGNANCY; UNITED STATES;

EDUCATION, MEDICAL; FEMALE; HISTORY, 19TH CENTURY; HISTORY, 20TH CENTURY; HOME CHILDBIRTH; HUMANS; OBSTETRICS; PREGNANCY; SCHOOLS, MEDICAL; UNITED STATES;

EID: 0032088843     PISSN: 00075140     EISSN: None     Source Type: Journal    
DOI: 10.1353/bhm.1998.0061     Document Type: Article

References (135)

1. Palmer Findley, "The Teaching of Obstetrics," Am. J. Obstet. Gynecol., November 1928, 16: 611-24, quotation on p. 614.
2. Kenneth M. Ludmerer, "The Rise of the Teaching Hospital in America," J. Hist. Med. Allied Sci., 1983, 38: 389-414, see especially p. 390; Charles E. Rosenberg, The Care of Strangers: The Rise of America's Hospital System (New York: Basic Books, 1987), pp. 203-6.
3. Kenneth M. Ludmerer, "The Rise of the Teaching Hospital in America," J. Hist. Med. Allied Sci., 1983, 38: 389-414, see especially p. 390; Charles E. Rosenberg, The Care of Strangers: The Rise of America's Hospital System (New York: Basic Books, 1987), pp. 203-6.
4. See Abraham Flexner, Medical Education in the United States and Canada, Report to the Carnegie Foundation for the Advancement of Teaching (1910; reprint, Washington, D.C.: Science and Health Publications, 1978), pp. 91-104. See also Rosenberg, Care of Strangers (n. 2), esp. p. 208; Kenneth M. Ludmerer, Learning to Heal: The Development of American Medical Education (New York: Basic Books, 1985), p. 231.
5. See Abraham Flexner, Medical Education in the United States and Canada, Report to the Carnegie Foundation for the Advancement of Teaching (1910; reprint, Washington, D.C.: Science and Health Publications, 1978), pp. 91-104. See also Rosenberg, Care of Strangers (n. 2), esp. p. 208; Kenneth M. Ludmerer, Learning to Heal: The Development of American Medical Education (New York: Basic Books, 1985), p. 231.
6. See Abraham Flexner, Medical Education in the United States and Canada, Report to the Carnegie Foundation for the Advancement of Teaching (1910; reprint, Washington, D.C.: Science and Health Publications, 1978), pp. 91-104. See also Rosenberg, Care of Strangers (n. 2), esp. p. 208; Kenneth M. Ludmerer, Learning to Heal: The Development of American Medical Education (New York: Basic Books, 1985), p. 231.
7. Ludmerer, Learning to Heal (n. 3), p. 226.
8. For an interesting discussion of the present-day implications raised by my work, see Spencer Foreman, "Social Responsibility and the Academic Medical Center: Building Community-Based Systems for the Nation's Health," Academic Med., February 1994, 69: 97-102. (Foreman was the chair of the American Association of Medical Colleges in 1993.)
9. For accounts of this process, see Ludmerer, Learning to Heal (n. 3), pp. 11-12; Rosenberg, Care of Strangers (n. 2), pp. 193-211.
10. For accounts of this process, see Ludmerer, Learning to Heal (n. 3), pp. 11-12; Rosenberg, Care of Strangers (n. 2), pp. 193-211.
11. Ludmerer (Learning to Heal [n. 3], pp. 80-84) notes that the basic sciences were the first medical school subjects to be reformed in terms of pedagogical approaches, while the clinical subjects lagged behind; but by the years just after 1900, even the clinical subjects had improved from the techniques of the mid-nineteenth century. In another place, Ludmerer argues that much of this learning, at least in the early twentieth century, remained passive observation ("Rise of the Teaching Hospital" [n. 2], p. 410).
12. Ludmerer (Learning to Heal [n. 3], pp. 80-84) notes that the basic sciences were the first medical school subjects to be reformed in terms of pedagogical approaches, while the clinical subjects lagged behind; but by the years just after 1900, even the clinical subjects had improved from the techniques of the mid-nineteenth century. In another place, Ludmerer argues that much of this learning, at least in the early twentieth century, remained passive observation ("Rise of the Teaching Hospital" [n. 2], p. 410).
13. The education for obstetrics in this period is explored in Charlotte G. Borst, Catching Babies: The Professionalization of Childbirth, 1870-1920 (Cambridge: Harvard University Press, 1995), pp. 90-116.
14. DeLee's experience is recounted in Leslie B. Arey, Northwestern University Medical School, 1859-1979: A Pioneer in Educational Reform (Evanston, Ill.: Northwestern University Medical School, 1979), p. 87. The school did not have regularly scheduled amphitheater clinics in obstetrics, so that students were forced to find other means to obtain their clinical experience.
15. J. Whitridge Williams, "Medical Education and the Midwife Problem in the United States," JAMA, 1912, 58: 1-7; quotation on p. 1.
16. Frances Kobrin ("The American Midwife Controversy: A Crisis of Professionalization," Bull. Hist. Med., 1966, 40: 350-63) and then Judy Barrett Litoff (American Midwives, 1860 to the Present, Contributions in Medical History, no. 1 [Westport, Conn.: Greenwood Press, 1978], pp. 64-90) identified the "midwife debate" of the late nineteenth and early twentieth centuries with the desire of obstetricians to carve out a professional, scientific arena for their specialty. My own work has shown that obstetricians extended this critique to general practitioners as well: Borst, Catching Babies (n. 8), pp. 131-51. Litoff (American Midwives [n. 11], pp. 65-66) cites Williams's programmatic statement that families needed to be taught that hospitals were the "ideal place" for deliveries, but even he acknowledged that only a small number of childbearing women would be able to avail themselves of these facilities. Judith Walzer Leavitt ("Joseph B. DeLee and the Practice of Preventive Obstetrics," Am. J. Public Health, 1988, 78: 1353-60) argues that DeLee's ideas regarding his low forceps operative technique have to be seen in a public health context.
17. Frances Kobrin ("The American Midwife Controversy: A Crisis of Professionalization," Bull. Hist. Med., 1966, 40: 350-63) and then Judy Barrett Litoff (American Midwives, 1860 to the Present, Contributions in Medical History, no. 1 [Westport, Conn.: Greenwood Press, 1978], pp. 64-90) identified the "midwife debate" of the late nineteenth and early twentieth centuries with the desire of obstetricians to carve out a professional, scientific arena for their specialty. My own work has shown that obstetricians extended this critique to general practitioners as well: Borst, Catching Babies (n. 8), pp. 131-51. Litoff (American Midwives [n. 11], pp. 65-66) cites Williams's programmatic statement that families needed to be taught that hospitals were the "ideal place" for deliveries, but even he acknowledged that only a small number of childbearing women would be able to avail themselves of these facilities. Judith Walzer Leavitt ("Joseph B. DeLee and the Practice of Preventive Obstetrics," Am. J. Public Health, 1988, 78: 1353-60) argues that DeLee's ideas regarding his low forceps operative technique have to be seen in a public health context.
18. Frances Kobrin ("The American Midwife Controversy: A Crisis of Professionalization," Bull. Hist. Med., 1966, 40: 350-63) and then Judy Barrett Litoff (American Midwives, 1860 to the Present, Contributions in Medical History, no. 1 [Westport, Conn.: Greenwood Press, 1978], pp. 64-90) identified the "midwife debate" of the late nineteenth and early twentieth centuries with the desire of obstetricians to carve out a professional, scientific arena for their specialty. My own work has shown that obstetricians extended this critique to general practitioners as well: Borst, Catching Babies (n. 8), pp. 131-51. Litoff (American Midwives [n. 11], pp. 65-66) cites Williams's programmatic statement that families needed to be taught that hospitals were the "ideal place" for deliveries, but even he acknowledged that only a small number of childbearing women would be able to avail themselves of these facilities. Judith Walzer Leavitt ("Joseph B. DeLee and the Practice of Preventive Obstetrics," Am. J. Public Health, 1988, 78: 1353-60) argues that DeLee's ideas regarding his low forceps operative technique have to be seen in a public health context.
19. Frances Kobrin ("The American Midwife Controversy: A Crisis of Professionalization," Bull. Hist. Med., 1966, 40: 350-63) and then Judy Barrett Litoff (American Midwives, 1860 to the Present, Contributions in Medical History, no. 1 [Westport, Conn.: Greenwood Press, 1978], pp. 64-90) identified the "midwife debate" of the late nineteenth and early twentieth centuries with the desire of obstetricians to carve out a professional, scientific arena for their specialty. My own work has shown that obstetricians extended this critique to general practitioners as well: Borst, Catching Babies (n. 8), pp. 131-51. Litoff (American Midwives [n. 11], pp. 65-66) cites Williams's programmatic statement that families needed to be taught that hospitals were the "ideal place" for deliveries, but even he acknowledged that only a small number of childbearing women would be able to avail themselves of these facilities. Judith Walzer Leavitt ("Joseph B. DeLee and the Practice of Preventive Obstetrics," Am. J. Public Health, 1988, 78: 1353-60) argues that DeLee's ideas regarding his low forceps operative technique have to be seen in a public health context.
20. Frances Kobrin ("The American Midwife Controversy: A Crisis of Professionalization," Bull. Hist. Med., 1966, 40: 350-63) and then Judy Barrett Litoff (American Midwives, 1860 to the Present, Contributions in Medical History, no. 1 [Westport, Conn.: Greenwood Press, 1978], pp. 64-90) identified the "midwife debate" of the late nineteenth and early twentieth centuries with the desire of obstetricians to carve out a professional, scientific arena for their specialty. My own work has shown that obstetricians extended this critique to general practitioners as well: Borst, Catching Babies (n. 8), pp. 131-51. Litoff (American Midwives [n. 11], pp. 65-66) cites Williams's programmatic statement that families needed to be taught that hospitals were the "ideal place" for deliveries, but even he acknowledged that only a small number of childbearing women would be able to avail themselves of these facilities. Judith Walzer Leavitt ("Joseph B. DeLee and the Practice of Preventive Obstetrics," Am. J. Public Health, 1988, 78: 1353-60) argues that DeLee's ideas regarding his low forceps operative technique have to be seen in a public health context.
21. Richard A. Meckel, Save the Babies: American Public Health Reform and the Prevention of Infant Mortality, 1850-1929 (Baltimore: Johns Hopkins University Press, 1990), pp. 220-21. See also Kobrin, "American Midwife Controversy" (n. 11); Litoff, American Midwives (n. 11), pp. 64-90.
22. Richard A. Meckel, Save the Babies: American Public Health Reform and the Prevention of Infant Mortality, 1850-1929 (Baltimore: Johns Hopkins University Press, 1990), pp. 220-21. See also Kobrin, "American Midwife Controversy" (n. 11); Litoff, American Midwives (n. 11), pp. 64-90.
23. Richard A. Meckel, Save the Babies: American Public Health Reform and the Prevention of Infant Mortality, 1850-1929 (Baltimore: Johns Hopkins University Press, 1990), pp. 220-21. See also Kobrin, "American Midwife Controversy" (n. 11); Litoff, American Midwives (n. 11), pp. 64-90.
24. See Kobrin, "American Midwife Controversy" (n. 11).
25. For a good summary of the accomplishments of Sheppard-Towner, see Molly Ladd-Taylor, ed., Raising a Baby the Government Way: Mothers' Letters to the Children's Bureau, 1915-1932 (New Brunswick, N.J.: Rutgers University Press, 1986), pp. 24-32.
26. Judith Walzer Leavitt (Brought to Bed: Childbearing in America, 1750-7950 [New York: Oxford University Press, 1986], pp. 128-41) shows that upper-class women helped to lead the way with their advocacy of "twilight sleep."
27. Michael Davis, Clinics, Hospitals, and Health Centers (New York: Harper, 1927), p. 13; quoted by Rosemary Stevens, In Sickness and In Wealth: American Hospitals in the Twentieth Century (New York: Basic Books, 1989), p. 382 n. 1.
28. Michael Davis, Clinics, Hospitals, and Health Centers (New York: Harper, 1927), p. 13; quoted by Rosemary Stevens, In Sickness and In Wealth: American Hospitals in the Twentieth Century (New York: Basic Books, 1989), p. 382 n. 1.
29. Among Wisconsin's physicians, the mean number of cases attended by graduation rose from 20.64 in the years 1910-19, to 30.68 in the years 1920-30: see Borst, Catching Babies (n. 8), chap. 5, "Educating Physicians," pp. 90-116.
30. Among Wisconsin's physicians, the mean number of cases attended by graduation rose from 20.64 in the years 1910-19, to 30.68 in the years 1920-30: see Borst, Catching Babies (n. 8), chap. 5, "Educating Physicians," pp. 90-116.
31. Findley (quoting Chipman), "Teaching of Obstetrics" (n. 1), p. 613 (emphasis in original).
32. Ibid. Though Findley liked the metaphoric use of this fairy tale, he pointed out that he would not push it to its conclusion, because "we would not depose medicine and surgery from the high positions they have attained, we only ask that obstetrics may share with them, share and share alike" (ibid.).
33. James R. Garber, "Therapy in Obstetrics," Southern Med. J., 1920, 13: 201-5, quotation on p. 201. As noted below, Garber went on to become the first chair of obstetrics at the University of Alabama's College of Medicine when it opened in the 1940s.
34. Henry P. Newman, "The Specialty of Obstetrics: Present Status, Possibilities, and Importance," Am. J. Obstet. Dis. Women and Children, 1919, 80: 466. Obstetricians were "disputing the ground" with more than midwives and general practitioners. In 1911, the American Medical Association formed a section entitled "Obstetrics and Gynecology"; only a year later, however, it was renamed "Obstetrics, Gynecology, and Abdominal Surgery" due to the surgical interests of many of its members, and because these surgeons were fighting with general surgeons over who should operate in the abdomen. The name of the section reverted to "Obstetrics and Gynecology" in 1938. See Rosemary Stevens, American Medicine and the Public Interest (New Haven: Yale University Press, 1971), p. 201 n. 8.
35. Henry P. Newman, "The Specialty of Obstetrics: Present Status, Possibilities, and Importance," Am. J. Obstet. Dis. Women and Children, 1919, 80: 466. Obstetricians were "disputing the ground" with more than midwives and general practitioners. In 1911, the American Medical Association formed a section entitled "Obstetrics and Gynecology"; only a year later, however, it was renamed "Obstetrics, Gynecology, and Abdominal Surgery" due to the surgical interests of many of its members, and because these surgeons were fighting with general surgeons over who should operate in the abdomen. The name of the section reverted to "Obstetrics and Gynecology" in 1938. See Rosemary Stevens, American Medicine and the Public Interest (New Haven: Yale University Press, 1971), p. 201 n. 8.
36. Newman, "Specialty of Obstetrics" (n. 21), p. 466.
37. Leavitt, Brought to Bed (n. 15), pp. 38, 39. See alsojudith Walzer Leavitt, "'A Worrying Profession': The Domestic Environment of Medical Practice in Mid-Nineteenth-Century America," Bull. Hist. Med., 1995, 69: 1-29.
38. Leavitt, Brought to Bed (n. 15), pp. 38, 39. See alsojudith Walzer Leavitt, "'A Worrying Profession': The Domestic Environment of Medical Practice in Mid-Nineteenth-Century America," Bull. Hist. Med., 1995, 69: 1-29.
39. The relation of science, gender, and space is a very interesting one. I explore this issue in Charlotte G. Borst, "Gender, Space, and Science in the Twentieth-Century Academic Medical Center" (paper given at the Annual Meeting of the History of Education Society, Philadelphia, Pa., October 1997).
40. W. E. B. Davis, "Obstetrics and Gynecology," JAMA, 21 July 1900, 35: 131-34, quotation on p. 131.
41. Edward P. Davis, "Obstetric Surgery a Modern Science," JAMA, 14 October 1916, 67: 1123-26.
42. Comment by J. Whitridge Williams on Joseph B. DeLee, "The Prophylactic Forceps Operation," Am. J. Obstet. Gynecol., October 1920, 1: 77.
43. By 1930, 30% of all women in the United States had hospital births. However, this figure varied by region of the country, by social class, and by race. Even by 1940, while 76% of urban women had births at the hospital, only 32.3% of rural women did so. The figures were even lower for nonwhite women: 51.4% of nonwhite women in 1940 had hospital births, but only 8.6% of rural nonwhite women. (Figures taken from U.S. Bureau of the Census, Vital Statistics of the United States, 1950 [Washington, D.C.: U.S. Government Printing Office, vol. 1, table 6.32, p. 96.)
44. As late as the 1940s, less than 15% of births in South Carolina were hospital deliveries, and only 50% of all births were physician-attended. Physicians in this state cited the low remuneration for obstetric work. One small-town physician who averaged more than 100 deliveries per year, for example, reported that he collected less than $600 from his obstetric practice: see Robert E. Seibels, "Obstetric Problems in the Rural South," Southern Med. J., 1943, 36: 41-45, see especially pp. 43-44. The problems of the general practitioner were well documented in the medical literature. In the last decades of the nineteenth century and the early decades of the twentieth century, JAMA featured many articles that addressed the problems faced by general practitioners: see, for example, Onslow Gordon, "The Narrowing Field of the General Practitioner," September 1896, 27: 710; S. S. Towler, "Why General Practitioners Send Cases to the Hospital," March 1894, 22: 298-99; B. C. Keister, "Some Things That Should Not Be Forgotten by the General Practitioner," January 1894, 22: 120-21; Thomas Shastid, "A Country Doctor," February 1897, 28: 400-2. By the earlv 1920s, these concerns about general practitioners leaving rural areas had risen to genuine alarm, and many state medical journals published articles analyzing the problem.
45. As late as the 1940s, less than 15% of births in South Carolina were hospital deliveries, and only 50% of all births were physician-attended. Physicians in this state cited the low remuneration for obstetric work. One small-town physician who averaged more than 100 deliveries per year, for example, reported that he collected less than $600 from his obstetric practice: see Robert E. Seibels, "Obstetric Problems in the Rural South," Southern Med. J., 1943, 36: 41-45, see especially pp. 43-44. The problems of the general practitioner were well documented in the medical literature. In the last decades of the nineteenth century and the early decades of the twentieth century, JAMA featured many articles that addressed the problems faced by general practitioners: see, for example, Onslow Gordon, "The Narrowing Field of the General Practitioner," September 1896, 27: 710; S. S. Towler, "Why General Practitioners Send Cases to the Hospital," March 1894, 22: 298-99; B. C. Keister, "Some Things That Should Not Be Forgotten by the General Practitioner," January 1894, 22: 120-21; Thomas Shastid, "A Country Doctor," February 1897, 28: 400-2. By the earlv 1920s, these concerns about general practitioners leaving rural areas had risen to genuine alarm, and many state medical journals published articles analyzing the problem.
46. As late as the 1940s, less than 15% of births in South Carolina were hospital deliveries, and only 50% of all births were physician-attended. Physicians in this state cited the low remuneration for obstetric work. One small-town physician who averaged more than 100 deliveries per year, for example, reported that he collected less than $600 from his obstetric practice: see Robert E. Seibels, "Obstetric Problems in the Rural South," Southern Med. J., 1943, 36: 41-45, see especially pp. 43-44. The problems of the general practitioner were well documented in the medical literature. In the last decades of the nineteenth century and the early decades of the twentieth century, JAMA featured many articles that addressed the problems faced by general practitioners: see, for example, Onslow Gordon, "The Narrowing Field of the General Practitioner," September 1896, 27: 710; S. S. Towler, "Why General Practitioners Send Cases to the Hospital," March 1894, 22: 298-99; B. C. Keister, "Some Things That Should Not Be Forgotten by the General Practitioner," January 1894, 22: 120-21; Thomas Shastid, "A Country Doctor," February 1897, 28: 400-2. By the earlv 1920s, these concerns about general practitioners leaving rural areas had risen to genuine alarm, and many state medical journals published articles analyzing the problem.
47. As late as the 1940s, less than 15% of births in South Carolina were hospital deliveries, and only 50% of all births were physician-attended. Physicians in this state cited the low remuneration for obstetric work. One small-town physician who averaged more than 100 deliveries per year, for example, reported that he collected less than $600 from his obstetric practice: see Robert E. Seibels, "Obstetric Problems in the Rural South," Southern Med. J., 1943, 36: 41-45, see especially pp. 43-44. The problems of the general practitioner were well documented in the medical literature. In the last decades of the nineteenth century and the early decades of the twentieth century, JAMA featured many articles that addressed the problems faced by general practitioners: see, for example, Onslow Gordon, "The Narrowing Field of the General Practitioner," September 1896, 27: 710; S. S. Towler, "Why General Practitioners Send Cases to the Hospital," March 1894, 22: 298-99; B. C. Keister, "Some Things That Should Not Be Forgotten by the General Practitioner," January 1894, 22: 120-21; Thomas Shastid, "A Country Doctor," February 1897, 28: 400-2. By the earlv 1920s, these concerns about general practitioners leaving rural areas had risen to genuine alarm, and many state medical journals published articles analyzing the problem.
48. As late as the 1940s, less than 15% of births in South Carolina were hospital deliveries, and only 50% of all births were physician-attended. Physicians in this state cited the low remuneration for obstetric work. One small-town physician who averaged more than 100 deliveries per year, for example, reported that he collected less than $600 from his obstetric practice: see Robert E. Seibels, "Obstetric Problems in the Rural South," Southern Med. J., 1943, 36: 41-45, see especially pp. 43-44. The problems of the general practitioner were well documented in the medical literature. In the last decades of the nineteenth century and the early decades of the twentieth century, JAMA featured many articles that addressed the problems faced by general practitioners: see, for example, Onslow Gordon, "The Narrowing Field of the General Practitioner," September 1896, 27: 710; S. S. Towler, "Why General Practitioners Send Cases to the Hospital," March 1894, 22: 298-99; B. C. Keister, "Some Things That Should Not Be Forgotten by the General Practitioner," January 1894, 22: 120-21; Thomas Shastid, "A Country Doctor," February 1897, 28: 400-2. By the earlv 1920s, these concerns about general practitioners leaving rural areas had risen to genuine alarm, and many state medical journals published articles analyzing the problem.
49. The maternal mortality rate in the United States in 1929, for example, was 7.0 per 1,000 living births - several times higher than in western Europe, where it was 2.8 (cited by Fred L. Adair, "Some Points from the Reports of Committees on Obstetric Education of Physicians of the White House Conference on Child Health and Protection," J. Assoc. Amer. Med. Coll., 1932, 7: 197).
50. Virginia G. Drachman, "The Loomis Trial: Social Mores and Obstetrics in the Mid-Nineteenth Century," in Women and Health in America: Historical Readings, ed. Judith Walzer Leavitt (Madison: University of Wisconsin Press, 1984), p. 166.
51. Nancy Schrom Dye, "Modern Obstetrics and Working-Class Women: The New York Midwifery Dispensary, 1890-1920," J. Soc. Hist., 1987, 20: 549-64.
52. Horace W. Davenport, Fifty Years of Medicine at the University of Michigan, 1891-1941 (Ann Arbor: University of Michigan Medical School, 1986), pp. 387-88.
53. Ibid., p. 388.
54. R. H. Riley, "The Public Health Aspect of the Teaching of Obstetrics," JAMA, 25 April 1936, 106: 1438-40, see especially p. 1438.
55. This issue is discussed at length in Borst, Catching Babies (n. 8), pp. 117-30. See also M. G. Peterman, "A Pediatric Program for the Family Doctor," J. Kansas Med. Soc., 1939, 40: 240.
56. This issue is discussed at length in Borst, Catching Babies (n. 8), pp. 117-30. See also M. G. Peterman, "A Pediatric Program for the Family Doctor," J. Kansas Med. Soc., 1939, 40: 240.
57. Here, I think, Kenneth Ludmerer overstates his case when he asserts that medical schools in the twentieth century were becoming "more and more alike" (Ludmerer, Learning to Heal [n. 3], p. 218). While it is true that state medical schools did promote some research, it is clear that real divisions remained between the research- and the practitioner-oriented schools. See, for example, the statements of E. D. Plass from the State University of Iowa School of Medicine in "Postgraduate Teaching in Obstetrics through Extramural Courses," J. Assoc. Amer. Med. Coll., 1932, 7: 203; also, the programmatic statement by Roy R. Kracke, the first dean of the University of Alabama's Medical College, in Roy R. Kracke and J. W. MacQueen, "Developments in the Medical College of Alabama," Southern Med. J., 1946, 39: 8-12, see especially p. 8. One of the franker discussions of the inherent tensions involved in these two models can be found in Esther Everett Lape, "Medical Education as Discussed in 'American Medicine,'" J. Assoc. Amer. Med. Coll., 1937, 12: 357-75.
58. Here, I think, Kenneth Ludmerer overstates his case when he asserts that medical schools in the twentieth century were becoming "more and more alike" (Ludmerer, Learning to Heal [n. 3], p. 218). While it is true that state medical schools did promote some research, it is clear that real divisions remained between the research- and the practitioner- oriented schools. See, for example, the statements of E. D. Plass from the State University of Iowa School of Medicine in "Postgraduate Teaching in Obstetrics through Extramural Courses," J. Assoc. Amer. Med. Coll., 1932, 7: 203; also, the programmatic statement by Roy R. Kracke, the first dean of the University of Alabama's Medical College, in Roy R. Kracke and J. W. MacQueen, "Developments in the Medical College of Alabama," Southern Med. J., 1946, 39: 8-12, see especially p. 8. One of the franker discussions of the inherent tensions involved in these two models can be found in Esther Everett Lape, "Medical Education as Discussed in 'American Medicine,'" J. Assoc. Amer. Med. Coll., 1937, 12: 357-75.
59. Here, I think, Kenneth Ludmerer overstates his case when he asserts that medical schools in the twentieth century were becoming "more and more alike" (Ludmerer, Learning to Heal [n. 3], p. 218). While it is true that state medical schools did promote some research, it is clear that real divisions remained between the research- and the practitioner- oriented schools. See, for example, the statements of E. D. Plass from the State University of Iowa School of Medicine in "Postgraduate Teaching in Obstetrics through Extramural Courses," J. Assoc. Amer. Med. Coll., 1932, 7: 203; also, the programmatic statement by Roy R. Kracke, the first dean of the University of Alabama's Medical College, in Roy R. Kracke and J. W. MacQueen, "Developments in the Medical College of Alabama," Southern Med. J., 1946, 39: 8-12, see especially p. 8. One of the franker discussions of the inherent tensions involved in these two models can be found in Esther Everett Lape, "Medical Education as Discussed in 'American Medicine,'" J. Assoc. Amer. Med. Coll., 1937, 12: 357-75.
60. Here, I think, Kenneth Ludmerer overstates his case when he asserts that medical schools in the twentieth century were becoming "more and more alike" (Ludmerer, Learning to Heal [n. 3], p. 218). While it is true that state medical schools did promote some research, it is clear that real divisions remained between the research- and the practitioner- oriented schools. See, for example, the statements of E. D. Plass from the State University of Iowa School of Medicine in "Postgraduate Teaching in Obstetrics through Extramural Courses," J. Assoc. Amer. Med. Coll., 1932, 7: 203; also, the programmatic statement by Roy R. Kracke, the first dean of the University of Alabama's Medical College, in Roy R. Kracke and J. W. MacQueen, "Developments in the Medical College of Alabama," Southern Med. J., 1946, 39: 8-12, see especially p. 8. One of the franker discussions of the inherent tensions involved in these two models can be found in Esther Everett Lape, "Medical Education as Discussed in 'American Medicine,'" J. Assoc. Amer. Med. Coll., 1937, 12: 357-75.
61. The rate in the United States even in 1937 was 48.88 per 10,000 births (calculated from Bureau of the Census, Vital Statistics of the United States, 1937, 2 vols. [Washington, D.C.: U.S. Government Printing Office, 1939], vol. 1, table XI, p. 26; table 1, p. 85).
62. Seibels provided a thoughtful discussion of this problem for South Carolina in the mid-1940s: Seibels, "Obstetric Problems" (n. 29), pp. 41-44.
63. Rosenberg (Care of Strangers [n. 2]) and Stevens (In Sickness [n. 16]) provide lengthy explanations of the idea of volunteerism in the nineteenth and twentieth centuries. Paul Starr (The Social Transformation of American Medicine [New York: Basic Books, 1982], pp. 266-89, 337-38) finds that from the 1930s through the 1950s, many physicians countered pending federal legislation for health-care financing by arguing that the traditional means by which physicians had provided charity work were best.
64. Rosenberg (Care of Strangers [n. 2]) and Stevens (In Sickness [n. 16]) provide lengthy explanations of the idea of volunteerism in the nineteenth and twentieth centuries. Paul Starr (The Social Transformation of American Medicine [New York: Basic Books, 1982], pp. 266-89, 337-38) finds that from the 1930s through the 1950s, many physicians countered pending federal legislation for health-care financing by arguing that the traditional means by which physicians had provided charity work were best.
65. Rosenberg (Care of Strangers [n. 2]) and Stevens (In Sickness [n. 16]) provide lengthy explanations of the idea of volunteerism in the nineteenth and twentieth centuries. Paul Starr (The Social Transformation of American Medicine [New York: Basic Books, 1982], pp. 266-89, 337-38) finds that from the 1930s through the 1950s, many physicians countered pending federal legislation for health-care financing by arguing that the traditional means by which physicians had provided charity work were best.
66. Edward C. Hughes, "Use of the Home Delivery Service in Syracuse in the Teaching of Obstetrics," J. Assoc. Amer. Med. Coll., 1939, 14: 151.
67. Ibid., p. 153.
68. Ibid., p. 154.
69. Paul F. Clark, The University of Wisconsin Medical School: A Chronicle, 1848-1948 (Madison: Wisconsin Medical Alumni Association and the University of Wisconsin Press, 1967).
70. John A. Buesseler, Larry H. Hogan, and Loraine E. Schulz, "Those Were the Days," Wisconsin Med. Alum. Mag., The Quarterly, 1993, 33 (1): 8. My thanks to Judith Walzer Leavitt for bringing this service and this article to my attention.
71. Leavitt, "Joseph B. DeLee" (n. 11), p. 1355; Margot Edwards and Mary Waldorf, Reclaiming Birth: History and Heroines of American Childbirth Reform (Trumansburg, N.Y.: Crossing Press, 1984), p. 6.
72. Leavitt, "Joseph B. DeLee" (n. 11), p. 1355; Margot Edwards and Mary Waldorf, Reclaiming Birth: History and Heroines of American Childbirth Reform (Trumansburg, N.Y.: Crossing Press, 1984), p. 6.
73. Paul De Kruif's four articles "Why Should Mothers Die?" written for The Ladies' Home Journal in 1936 underscored this accessibility; see esp. April 1936, p. 109.
74. Buesseler, Hogan, and Schulz, "Those Were the Days" (n. 45), pp. 8-13.
75. Frederick C. Irving, "Maternal Mortality at the Boston Lying-in Hospital in 1933, 1934 and 1935," N. Engl. J. Med., 28 October 1937, 217: 693-95. See also James Locke Neller's reminiscences of his student experiences: "The Deliverer," Harvard Med. Alum. Bull., Summer 1995, pp. 28-33.
76. Frederick C. Irving, "Maternal Mortality at the Boston Lying-in Hospital in 1933, 1934 and 1935," N. Engl. J. Med., 28 October 1937, 217: 693-95. See also James Locke Neller's reminiscences of his student experiences: "The Deliverer," Harvard Med. Alum. Bull., Summer 1995, pp. 28-33.
77. The report by the AAMC is detailed in "Teaching of Obstetrics," J. Assoc. Amer. Med. Coll., 1940, 15: 207-8.
78. Norman F. Miller, "The Perpetuation of Error in Obstetrics and Gynecology," JAMA, 13 September 1941, 117: 905-7, quotation on p. 906.
79. Ibid., p. 906.
80. Ibid., p. 907.
81. Rosenberg explores this relationship in Care of Strangers (n. 2), pp. 147-50.
82. Miller, "Perpetuation of Error" (n. 51), p. 905. The attacks on a research paradigm were echoed by Frederick H. Falls, chair of the Department of Obstetrics and Gynecology at the University of Illinois College of Medicine, in a report to the AAMC in 1943: "This [clinical] ability cannot be gained by any amount of reading or work in a chemical or physiological laboratory" (Frederick H. Falls, "Teaching of Obstetrics to Undergraduate Medical Students," J. Assoc. Amer. Med. Coll., 1943, 18: 212-13).
83. Miller, "Perpetuation of Error" (n. 51), p. 905. The attacks on a research paradigm were echoed by Frederick H. Falls, chair of the Department of Obstetrics and Gynecology at the University of Illinois College of Medicine, in a report to the AAMC in 1943: "This [clinical] ability cannot be gained by any amount of reading or work in a chemical or physiological laboratory" (Frederick H. Falls, "Teaching of Obstetrics to Undergraduate Medical Students," J. Assoc. Amer. Med. Coll., 1943, 18: 212-13).
84. Southern physicians wrote moving accounts of the problems with access to maternity care in their areas. Many of them stressed the need to put aside prejudices toward home deliveries. See, for example, Robert E. Seibels, a South Carolina physician, who argued that "the solution of difficulties in delivery care will not be through additional institutional beds, but through improved conditions for home delivery" ("Obstetric Problems" [n. 29], p. 43). Harry Jenkins, a Knoxville, Tennessee, physician, made a similar argument in "Influence of War on Obstetrics," Southern Med. J., 1943, 36: 422-25, see especially p. 424.
85. Southern physicians wrote moving accounts of the problems with access to maternity care in their areas. Many of them stressed the need to put aside prejudices toward home deliveries. See, for example, Robert E. Seibels, a South Carolina physician, who argued that "the solution of difficulties in delivery care will not be through additional institutional beds, but through improved conditions for home delivery" ("Obstetric Problems" [n. 29], p. 43). Harry Jenkins, a Knoxville, Tennessee, physician, made a similar argument in "Influence of War on Obstetrics," Southern Med. J., 1943, 36: 422-25, see especially p. 424.
86. Stevens, In Sickness (n. 16), pp. 209-11.
87. H. J. Stander, "Undergraduate and Graduate Instruction in Obstetrics and Gynecology," Am. J. Obstet. Gynecol., 1946, 51: 771-79, quotation on p. 772. A survey done at the end of the war found that 79% of 71 medical schools taught obstetrics by requiring their medical students to live in the teaching hospital for from one to eleven weeks, with an average of five weeks. Moreover, by 1945, 51 of 71 medical schools reported combined departments of obstetrics and gynecology (pp. 771-79). He decried the obstetrical "isolationists" as lacking a "broad vision" (p. 772). Pamela S. Summey and Marsha Hurst state that obstetrics in the 1950s "resolved its chronic identity crisis by defining itself as a specialty that encompasses 'all of the medical factors which have a bearing on the reproductive process'" - a definition, they argue, that avoided basing claims to specialization based on technology or anatomy (Pamela S. Summey and Marsha Hurst, "Ob/Gyn on the Rise: The Evolution of Professional Ideology in the Twentieth Century - Part II," Women and Health, 1986, 11: 111). William Ray Arney (Power and the Profession of Obstetrics [Chicago: University of Chicago Press, 1982], p. 8) argues, on the other hand, that obstetrics underwent a profound transformation after the war, invoking a new systems metaphor for the body that gave the physician a rationale for constant monitoring and surveillance. None of these authors, however, tackles the question of how "science" operated to legitimate this specialty.
88. H. J. Stander, "Undergraduate and Graduate Instruction in Obstetrics and Gynecology," Am. J. Obstet. Gynecol., 1946, 51: 771-79, quotation on p. 772. A survey done at the end of the war found that 79% of 71 medical schools taught obstetrics by requiring their medical students to live in the teaching hospital for from one to eleven weeks, with an average of five weeks. Moreover, by 1945, 51 of 71 medical schools reported combined departments of obstetrics and gynecology (pp. 771-79). He decried the obstetrical "isolationists" as lacking a "broad vision" (p. 772). Pamela S. Summey and Marsha Hurst state that obstetrics in the 1950s "resolved its chronic identity crisis by defining itself as a specialty that encompasses 'all of the medical factors which have a bearing on the reproductive process'" - a definition, they argue, that avoided basing claims to specialization based on technology or anatomy (Pamela S. Summey and Marsha Hurst, "Ob/Gyn on the Rise: The Evolution of Professional Ideology in the Twentieth Century - Part II," Women and Health, 1986, 11: 111). William Ray Arney (Power and the Profession of Obstetrics [Chicago: University of Chicago Press, 1982], p. 8) argues, on the other hand, that obstetrics underwent a profound transformation after the war, invoking a new systems metaphor for the body that gave the physician a rationale for constant monitoring and surveillance. None of these authors, however, tackles the question of how "science" operated to legitimate this specialty.
89. H. J. Stander, "Undergraduate and Graduate Instruction in Obstetrics and Gynecology," Am. J. Obstet. Gynecol., 1946, 51: 771-79, quotation on p. 772. A survey done at the end of the war found that 79% of 71 medical schools taught obstetrics by requiring their medical students to live in the teaching hospital for from one to eleven weeks, with an average of five weeks. Moreover, by 1945, 51 of 71 medical schools reported combined departments of obstetrics and gynecology (pp. 771-79). He decried the obstetrical "isolationists" as lacking a "broad vision" (p. 772). Pamela S. Summey and Marsha Hurst state that obstetrics in the 1950s "resolved its chronic identity crisis by defining itself as a specialty that encompasses 'all of the medical factors which have a bearing on the reproductive process'" - a definition, they argue, that avoided basing claims to specialization based on technology or anatomy (Pamela S. Summey and Marsha Hurst, "Ob/Gyn on the Rise: The Evolution of Professional Ideology in the Twentieth Century - Part II," Women and Health, 1986, 11: 111). William Ray Arney (Power and the Profession of Obstetrics [Chicago: University of Chicago Press, 1982], p. 8) argues, on the other hand, that obstetrics underwent a profound transformation after the war, invoking a new systems metaphor for the body that gave the physician a rationale for constant monitoring and surveillance. None of these authors, however, tackles the question of how "science" operated to legitimate this specialty.
90. Paul Titus, "The American Board of Obstetrics and Gynecology: A 15-Year Review," Am. J. Obstet. Gynecol., 1947, 53: 704-8; and R. E. Campbell, "Presidential Address: The American College of Obstetricians and Gynecologists Fifth Anniversary Meeting, 1956," Obstet. Gynecol., 1958, 11: 474-79 - both cited in Summey and Hurst, "Ob/Gyn on the Rise" (n. 58), p. 109.
91. Paul Titus, "The American Board of Obstetrics and Gynecology: A 15-Year Review," Am. J. Obstet. Gynecol., 1947, 53: 704-8; and R. E. Campbell, "Presidential Address: The American College of Obstetricians and Gynecologists Fifth Anniversary Meeting, 1956," Obstet. Gynecol., 1958, 11: 474-79 - both cited in Summey and Hurst, "Ob/Gyn on the Rise" (n. 58), p. 109.
92. Paul Titus, "The American Board of Obstetrics and Gynecology: A 15-Year Review," Am. J. Obstet. Gynecol., 1947, 53: 704-8; and R. E. Campbell, "Presidential Address: The American College of Obstetricians and Gynecologists Fifth Anniversary Meeting, 1956," Obstet. Gynecol., 1958, 11: 474-79 - both cited in Summey and Hurst, "Ob/Gyn on the Rise" (n. 58), p. 109.
93. Though nationwide, by 1960, 85% of nonwhite women had hospital births, many nonwhite women in the South continued to deliver at home with midwives: the figures were at least 30% in Alabama, Arkansas, Mississippi. North Carolina, and South Carolina. (Figures from Bureau of the Census, Vital Statistics of the United States, 1960, 3 vols. [Washington, D.C.: U.S. Department of Health, Education, and Welfare, 1963], 1: 12).
94. By 1950, 88% of all births took place in hospitals; white women had an even higher rate, 92.8%, while the nonwhite women's rate was 57.9%. (Figures from Vital Statistics of the United States, 1950 [n. 28], table 6.32, p. 96.) Syracuse ended its program around 1942-43. For an account of the last years of the Chicago Maternity Center, see Edwards and Waldorf, Reclaiming Birth (n. 46), pp. 9-10. See Stevens, In Sickness (n. 16), pp. 227-83, for a discussion of the postwar change in hospitals.
95. By 1950, 88% of all births took place in hospitals; white women had an even higher rate, 92.8%, while the nonwhite women's rate was 57.9%. (Figures from Vital Statistics of the United States, 1950 [n. 28], table 6.32, p. 96.) Syracuse ended its program around 1942-43. For an account of the last years of the Chicago Maternity Center, see Edwards and Waldorf, Reclaiming Birth (n. 46), pp. 9-10. See Stevens, In Sickness (n. 16), pp. 227-83, for a discussion of the postwar change in hospitals.
96. By 1950, 88% of all births took place in hospitals; white women had an even higher rate, 92.8%, while the nonwhite women's rate was 57.9%. (Figures from Vital Statistics of the United States, 1950 [n. 28], table 6.32, p. 96.) Syracuse ended its program around 1942-43. For an account of the last years of the Chicago Maternity Center, see Edwards and Waldorf, Reclaiming Birth (n. 46), pp. 9-10. See Stevens, In Sickness (n. 16), pp. 227-83, for a discussion of the postwar change in hospitals.
97. Kracke and MacQueen, "Developments" (n. 37), pp. 8-12.
98. Jefferson County (Ala.) Coordinating Council of Social Forces, directed by Valerie A. Earle, The Jefferson County Survey of Health, Welfare, and Recreation Needs and Services (Birmingham: University of Alabama Press, 1955; located in the Birmingham Public Library, Government Documents Room), pp. 100-102 (henceforth Jefferson County Survey).
99. Committee on Medical Education and Hospitals and the American Association of Medical Colleges, "Survey of the Medical College of Alabama, Department of Obstetrics," (henceforth "Survey of the Medical College"), 15-20 February 1953, p. 104, manuscript copy in University of Alabama at Birmingham Archives, Birmingham, Ala. The Medical School had moved to Birmingham in large part to gain access to the large number of patients available in an indigent-care hospital and a voluntary hospital run by the county. The hospitals were combined into one teaching hospital, with nine hundred beds. However, though half the beds were designated as free beds, their number was limited by the reimbursement schedule from the county; charity beds were then divided up between those for blacks and those for poor whites, and the number for blacks was always significantly lower. See Jonas N. Muller and Milton Terris, "Jefferson County Survey: Medical Care for the Indigent," Draft Memorandum of Recommendations, manuscript copy located in Dean Durrett Administrative Files, folder 2:24, UAB Archives. A 1953 outside evaluation of the medical school led by T. Duckett Jones and other academic physicians reported that there were 4,371 births per year in the fiscal year 1952-53 ("Duckett Jones Report," Appendix 9, p. 2, typescript in Dean Durrett Files, UAB Archives).
100. Committee on Medical Education and Hospitals and the American Association of Medical Colleges, "Survey of the Medical College of Alabama, Department of Obstetrics," (henceforth "Survey of the Medical College"), 15-20 February 1953, p. 104, manuscript copy in University of Alabama at Birmingham Archives, Birmingham, Ala. The Medical School had moved to Birmingham in large part to gain access to the large number of patients available in an indigent-care hospital and a voluntary hospital run by the county. The hospitals were combined into one teaching hospital, with nine hundred beds. However, though half the beds were designated as free beds, their number was limited by the reimbursement schedule from the county; charity beds were then divided up between those for blacks and those for poor whites, and the number for blacks was always significantly lower. See Jonas N. Muller and Milton Terris, "Jefferson County Survey: Medical Care for the Indigent," Draft Memorandum of Recommendations, manuscript copy located in Dean Durrett Administrative Files, folder 2:24, UAB Archives. A 1953 outside evaluation of the medical school led by T. Duckett Jones and other academic physicians reported that there were 4,371 births per year in the fiscal year 1952-53 ("Duckett Jones Report," Appendix 9, p. 2, typescript in Dean Durrett Files, UAB Archives).
101. Committee on Medical Education and Hospitals and the American Association of Medical Colleges, "Survey of the Medical College of Alabama, Department of Obstetrics," (henceforth "Survey of the Medical College"), 15-20 February 1953, p. 104, manuscript copy in University of Alabama at Birmingham Archives, Birmingham, Ala. The Medical School had moved to Birmingham in large part to gain access to the large number of patients available in an indigent-care hospital and a voluntary hospital run by the county. The hospitals were combined into one teaching hospital, with nine hundred beds. However, though half the beds were designated as free beds, their number was limited by the reimbursement schedule from the county; charity beds were then divided up between those for blacks and those for poor whites, and the number for blacks was always significantly lower. See Jonas N. Muller and Milton Terris, "Jefferson County Survey: Medical Care for the Indigent," Draft Memorandum of Recommendations, manuscript copy located in Dean Durrett Administrative Files, folder 2:24, UAB Archives. A 1953 outside evaluation of the medical school led by T. Duckett Jones and other academic physicians reported that there were 4,371 births per year in the fiscal year 1952-53 ("Duckett Jones Report," Appendix 9, p. 2, typescript in Dean Durrett Files, UAB Archives).
102. Odin W. Anderson, National Family Survey of Medical Costs and Voluntary Health Insurance (New York: Health Information Foundation, 1954), cited in Jefferson County Survey (n. 63), p. 97.
103. Odin W. Anderson, National Family Survey of Medical Costs and Voluntary Health Insurance (New York: Health Information Foundation, 1954), cited in Jefferson County Survey (n. 63), p. 97.
104. Jefferson County Survey (n. 63), pp. 97-98.
105. In 1960, Alabama's overall maternal mortality rates were among the highest in the nation. The nonwhite rate (142.4 per 100,000 live births) was the highest; infant mortality rates were also dismal, but they were not the worst in the country. See Vital Statistics of the United States, 1960 (n. 60), vol. 2, table 1-AA, pp. 1-17; table 3-F, p. 39.
106. After a very unfavorable report on Alabama's Medical College by the Association of American Medical Colleges in 1953, the dean of the Medical College commissioned his own survey, led by T. Duckett Jones and a number of other academic physicians from outside Alabama. The ensuing report was a very thorough analysis of the school's short-comings. Among other things, it noted the costs involved in hospital care: actual costs ran about $16 per day, of which county funding covered $11. See "Duckett Jones Report" (n. 64), pp. 4-5.
107. The number of hospital beds was noted in the Jefferson County Survey, p. 99 n. 19. Jefferson County and the state continued throughout the next few decades to argue over the costs of indigent care at the University Hospital. In 1953, the argument spilled out into the public arena, when the Medical School's accreditation was threatened. See Dean Durrett Files, UAB Archives, esp. "County Wants Patient Teaching Costs Defined," Birmingham News clipping, 26 July 1953.
108. The number of hospital beds was noted in the Jefferson County Survey, p. 99 n. 19. Jefferson County and the state continued throughout the next few decades to argue over the costs of indigent care at the University Hospital. In 1953, the argument spilled out into the public arena, when the Medical School's accreditation was threatened. See Dean Durrett Files, UAB Archives, esp. "County Wants Patient Teaching Costs Defined," Birmingham News clipping, 26 July 1953.
109. The Jefferson County Survey found that indigent medical care for both blacks and whites was severely limited, but that sick and poor black patients sometimes lacked access to any medical care. Several hospitals in the area provided prenatal and delivery care for poor white women; poor black women could turn only to the Slossfield Clinic, which closed in 1948, and then to Holy Family Hospital, which opened in 1942 under the auspices of the Sisters of Charity of Nazareth. Interestingly, by 1948, though fewer than 50% of black women statewide were attended by a physician, 97% of the births to black women in Birmingham were physician-attended, mostly by the black physicians in the city. These were almost always home births, however; black physicians were not welcome at the university hospital. For a good account, see Mary Rhinelander McCarl, "Doctor Tom Boulware and the Slossfield Center: Training Black Physicians in Obstetrics in a Segregated Society, Birmingham, 1941-1948," manuscript, in my possession.
110. "Survey of the Medical College" (n. 64), p. 100.
111. Jefferson County Survey, p. 97.
112. Transcript of oral history interview with Dr. Thomas Boulware, June 1983, Thomas Boulware Papers, UAB Archives. Boulware noted that the Bessemer Clinic, like all others, was strictly segregated, with separate buildings for white and black patients. He reported that he always staffed the "Negro" clinic.
113. Telephone interview with Dr. Edward Waldrop, retired professor of obstetrics, UAB, August 1994. Dr. Waldrop was a medical student at Alabama in the late 1940s.
114. "Survey of the Medical College" (n. 64), p. 104.
115. See Jefferson County Survey, pp. 101-2.
116. "Survey of the Medical College" (n. 64), pp. 102-3. The AAMC report especially criticized the policy of sending out teams of medical students unaccompanied by a resident or professor. Though this practice had been criticized by Williams in the 1930s, it was the policy of the Chicago Maternity Center, where it did not come under fire as bad obstetrics. As at the Chicago Maternity Center, the Alabama medical students could call a resident at the hospital for backup. For details on the Maternity Center, see esp. De Kruif, "Why Should Mothers Die?" (n. 47); for the Alabama program critique, see "Survey of the Medical College" (n. 64), p. 107.
117. "Survey of the Medical College" (n. 64), pp. 102-3. The AAMC report especially criticized the policy of sending out teams of medical students unaccompanied by a resident or professor. Though this practice had been criticized by Williams in the 1930s, it was the policy of the Chicago Maternity Center, where it did not come under fire as bad obstetrics. As at the Chicago Maternity Center, the Alabama medical students could call a resident at the hospital for backup. For details on the Maternity Center, see esp. De Kruif, "Why Should Mothers Die?" (n. 47); for the Alabama program critique, see "Survey of the Medical College" (n. 64), p. 107.
118. "Survey of the Medical College" (n. 64), pp. 102-3. The AAMC report especially criticized the policy of sending out teams of medical students unaccompanied by a resident or professor. Though this practice had been criticized by Williams in the 1930s, it was the policy of the Chicago Maternity Center, where it did not come under fire as bad obstetrics. As at the Chicago Maternity Center, the Alabama medical students could call a resident at the hospital for backup. For details on the Maternity Center, see esp. De Kruif, "Why Should Mothers Die?" (n. 47); for the Alabama program critique, see "Survey of the Medical College" (n. 64), p. 107.
119. It appears that Dr. Garber's political capital in the community ruled out eliminating the program outright. Instead, he resorted to administrative roadblocks, placing so many restrictions on medical students' hours of participation that running the program became virtually impossible. See "Letter from James R. Garber to James J. Durrett," and "Quote from the Report of the Curriculum Committee," in Dean's Administrative Files, 1951-55, folder 3:41, Obstetrics and Gynecology Department, 1953, UAB Archives.
120. John E. Deitrick and Robert C. Berson, Medical Schools in the United States at Mid-Century (New York: McGraw-Hill, 1953), p. 253.
121. Ibid., p. 257. The Chicago program at the Maxwell Street Clinic was still operating in the early 1950s, according to a 1952 graduate of Northwestern University Medical School. It is also noteworthy that he reports that he was not supervised directly, but that a resident was available by phone (telephone interview with Dr. Gayle Stephens, retired family practioner in Birmingham, 5 December 1994).
122. Walter T. Dannreuther, "The American Board of Obstetrics and Gynecology: Its Organization, Function and Objectives," JAMA, 1931, 96: 797-98; cited in Stevens, American Medicine (n. 21), p. 202.
123. Walter T. Dannreuther, "The American Board of Obstetrics and Gynecology: Its Organization, Function and Objectives," JAMA, 1931, 96: 797-98; cited in Stevens, American Medicine (n. 21), p. 202.
124. The Board assumed the power to determine hospital privileges in 1936; see American Board of Obstetrics and Gynecology, Yearbook, 6th ed., 1936, quoted by Stevens, ibid., p. 203.
125. Summey and Hurst ("Ob/Gyn on the Rise" [n. 58], p. 138) trace this surgical stance to those obstetricians who promoted an "activist" stance that would unite obstetrics with gynecology.
126. William F. Mengert, History of the American College of Obstetricians and Gynecologists, 1950-1970 (Chicago: American College of Obstetricians and Gynecologists, 1971), p. 26.
127. National Institutes of Health and the U.S. Public Health Service, Cesarean Childbirth (Washington, D.C.: U.S. Department of Health and Human Services, 1981), p. 80.
128. Jefferson County (Alabama) Health Department, Annual Report, 1957-58 (Government Documents Room, Birmingham Public Library), p. 18.
129. "Baby Born in Hospital Yard Like Animal - Cites Need for Indigent Patient Funds," Birmingham News, 14 December 1958, clipping in University Hospital Public Relations Scrapbook, UAB Archives. discuss this case, and the gender and racial aspects of indigent care, further in "Gender, Race and Indigent Medical Care in Birmingham, Alabama, 1950- 1964," submitted for publication.
130. "Baby Born in Hospital Yard Like Animal - Cites Need for Indigent Patient Funds," Birmingham News, 14 December 1958, clipping in University Hospital Public Relations Scrapbook, UAB Archives. discuss this case, and the gender and racial aspects of indigent care, further in "Gender, Race and Indigent Medical Care in Birmingham, Alabama, 1950-1964," submitted for publication.
131. This was true in Birmingham as elsewhere. In 1972, the county finally opened a charity hospital, funded by county, state, and federal funds. The university was now out of the indigent-care business; indeed, on the same day the hospital opened, the university closed its indigent-care dispensary. See University of Alabama Hospital Beacon, August 1972, 16 (2): 2, in UAB Archives.
132. Cesarean Childbirth (n. 82), p. 80.
133. Figures cited by Wayne Flynt, Poor but Proud: Alabama's Poor Whites (Tuscaloosa: University of Alabama Press, 1989), pp. 360-61. For a good review of the feminist critique on late-twentieth-century obstetrics, see Summey and Hurst, "Ob/Gyn on the Rise" (n. 58). Obstetricians in the 1970s and 1980s rued the decline in their authority. For a good analysis of the obstetricians' point of view, see William T. Mixson, "The Golden Years: Presidental Address," Am. J. Obstet. Gynecol., 15 September 1985, 153: 119-23.
134. Figures cited by Wayne Flynt, Poor but Proud: Alabama's Poor Whites (Tuscaloosa: University of Alabama Press, 1989), pp. 360-61. For a good review of the feminist critique on late-twentieth-century obstetrics, see Summey and Hurst, "Ob/Gyn on the Rise" (n. 58). Obstetricians in the 1970s and 1980s rued the decline in their authority. For a good analysis of the obstetricians' point of view, see William T. Mixson, "The Golden Years: Presidental Address," Am. J. Obstet. Gynecol., 15 September 1985, 153: 119-23.
135. Figures cited by Wayne Flynt, Poor but Proud: Alabama's Poor Whites (Tuscaloosa: University of Alabama Press, 1989), pp. 360-61. For a good review of the feminist critique on late-twentieth-century obstetrics, see Summey and Hurst, "Ob/Gyn on the Rise" (n. 58). Obstetricians in the 1970s and 1980s rued the decline in their authority. For a good analysis of the obstetricians' point of view, see William T. Mixson, "The Golden Years: Presidental Address," Am. J. Obstet. Gynecol., 15 September 1985, 153: 119-23.