Dr. J. Whitridge Williams’ Plan* ~ subdirectory to original book “Twilight Sleep: Simple Discoveries in Painless Childbirth”

by faithgibson on April 22, 2016

^O^ ~ You can ~ skip this intro ~ by dropping straight down to links @ the bottom for all 8 chapters.   

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Background ~ TWILIGHT SLEEP: Simple Discoveries in Painless Childbirth; 1914

This book reflects the perspective, political agenda, and recommendations of Dr. J. Whitridge Williams, MD, a gynecological surgeon, obstetrician, professor of obstetrics at Johns Hopkins University Hosptial, author of the obstetrical textbook “Williams Obstetrics”, and Dean of the John Hopkins University School of Medicine. In writing this book, Dr. J. Whitridge Williams engaged the professional services of Dr. Henry Smith Williams, MD, renowned author of informative scientific articles for the lay public as spokesman for his ideas.

Public access to this important historical book was made possible by the Google Library Project. One of the first archives that Google digitized was Stanford University’s medical library. Before this on-line treasure trove became available, I spent hours every week at Lane Library xeroxing (at 10 cents a page) historical medical textbooks and documents on childbirth practices and the formal disciplines of obstetrics and midwifery. After Google’s digitized version became available, I sat in the comfort of my home and download personal copies of these documents to my laptop and printed out hard copies of especially important material. This was really a thrill.

However, early PDFs (Portable Document Files) were the equivalent of a photograph of each page, which meant the printed text could not be copied and pasted into other word-processing programs. To make this critical information more user-friendly, one of my midwifery students and I typed each chapter into a separate WORD document. Before posting the book’s 8 chapters here, I converted the WORD files to a newer (much better!) version of PDF that permits text to be copied and used in other programs.

Understanding the author’s goals

To best understand and appreciate the author’s perspective and goals, I suggest reading the last four chapters first (ch. 5, 6,  7, & 8), then go back to the beginning and read chapters 1 through 4.

The book itself was a blueprint for dramatically changing the business model of American hospitals and re-writing the economic contract between society and the private institutions that provided fee-for-service medical and surgical care to people with critical medical needs. The book’s target audience was definitely not childbearing women or even the general pubic, but the medical profession itself, wealthy philanthropists and to a lesser degree, middle and upper-class husbands and local officials that controlled the purse strings for local tax revenue.

Dr. JW Williams’ goals for “Twilight Sleep”

In writing “Twilight Sleep”, Dr. Williams had to two main goals. The first and far more important and ambitious was to both explain and disseminate his “think-out-of-the-box” plan for financing of a badly needed nationwide system of ‘general’ hospitals in the US. Unlike Western Europe, America never had any kind of comprehensive, community-based system for providing modern medical care and emergency services to its citizens.

Instead, the American continent was dotted with thousands of 2-to-10 bed, doctor-owned for-profit hospitals. Like old-fashioned one-room schoolhouses, these tiny one-room specialty hospitals were limited to the simplest type of care, with sparse equipment and no modern technology, no emergency facilities and only willing to provide care to paying customers.  These low-volume private businesses did not generate enough revenue to purchase capital-intensive technologies such as x-ray machines and pricey medical equipment or operate an emergency department that treated the general public.

This was in start contrast to hospital care on the European continent where each country had a system of state-supported regional hospitals staffed and equipped to treat the entire spectrum of disease and emergencies in adults and children. As medical science advanced, European hospitals were upgraded with newly invented diagnostic equipment and more effective modern treatments. At least one hospital in each of these population centers was able to provide clinical laboratory services, state-of-the-art x-ray departments,  a pharmacy, and fully-equipped surgical unit with an appropriately trained staff.

In the late 1890s, Dr. JW Williams had been introduced to the European system of general hospitals as a graduate student; he experienced their vastly superior ability to met the medical needs of its citizens.

Appointed Dean of the Johns Hopkins University School of Medicine in 1911, he was acutely aware of just how backward our hodge-podge of ill-equipped one-room hospitals was compared to the European model. While his alma mater — Johns Hopkins University Hospital — was able to provide quality comprehensive care to its Baltimore neighbors, only about 2 dozen institutions in the entire US were able to provide 24-hour emergency treatment, high-quality medical and surgical care to its in-patients, and access to out-patient services.

His dream was to make this same quality of comprehensive and scientifically-advanced hospital care available to all Americans, wherever they lived. The stumbling block to such a coordinated national system in the US was moneywho pays the bills for all this?

Damned as “socialized medicine“, organized medicine in America vehemently rejected the idea of government funding for any aspect of medical care. Any attempt to underwrite such an ambitious nationwide goal without national funding seems like such an impossibility that most people would have just given up. But not Dr. JW Williams. Somehow those thousands of doctor-owned for-profit one-room hospitals had to be upgraded, consolidated as appropriate, and turned into fully-equipped and staffed general hospitals in each population center.

Spurred on by his commitment and confident in his eventual success, Dr. Williams invented a brand new business model for American hospitals that ultimately created the same kind of nationwide system for comprehensive hospital care already enjoyed by the citizens of Europe.

Goal Number two ~ Influencing wealthy philanthropists to underwrite major addition to Johns Hopkins Hospital

Dr. Williams other goals for his book was far less ambitious, but personally very important. As Dean of Johns Hopkins medical school and former chief of obstetrics, he knew how badly the two segregated obstetrical units needed to be remodeled and additional classrooms provided for teaching medicals students during their obstetrical rotation. Here is a very excerpt of his very persuasive pitch to wealthy philanthropists (emphasis added):

“WHAT HALF A MILLION WOULD DO

             Here, then, is a brief outline of a project for the carrying out of investigations in the interests of womankind, and for the better education of the physicians who are to minister to her physical needs. And what, it will naturally be asked, stands in the way of the immediate carrying out of so beneficent a project?

The answer may be given in this brief sentence:  Lack of funds.

The initial endowment left by Johns Hopkins for the foundation of the hospital that bears his name has been kept intact.  But the entire income from it is required to conduct the various departments of the hospital on the existing basis, and it is impossible for the Trustees to apportion money, without an unjustifiable infringement on the capital, for the development of such a woman’s clinic as is absolutely prerequisite to the carrying out of such a project as Dr. Williams outlines.

How much money would be required?

The answer seems almost ridiculous in these days of large financial enterprises.  For we are told, on competent authority, that the paltry sum of $200,000 would suffice to enlarge the present buildings devoted to the obstetrical and gynecological departments at Johns Hopkins Hospital, and that $300,000 more would suffice as an endowment for the maintenance of the additional patients.

Half a million dollars, then, entrusted to the wise stewardship of the Johns Hopkins authorities, would suffice to establish a woman’s clinic, in which matters that vitally concern the twenty million mothers of America would be investigated, as they are being investigated nowhere else in this country.”


TWILIGHT SLEEP: Simple Discoveries in Painless Childbirth ~ 1914

Overview & Backstory:

Chapter 1

Chapter 2

Chapter 3

Chapter 4

Chapter 5

Chapter 6

Chapter 7

Chapter 8