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Intro to an 8-chapter series ~ The obstetrical plan to electively hospitalize healthy middle- & upper-class maternity patients as paying customers, and then use this hospital-based revenue stream to help finance a new, nationwide system of general hospitals

Intro to an 8-chapter series ~ The obstetrical plan to electively hospitalize healthy middle- & upper-class maternity patients as paying customers, and then use this hospital-based revenue stream to help finance a new, nationwide system of general hospitals

by faithgibson on April 22, 2016

Overview of a 1914 book ~TWILIGHT SLEEP:
Simple Discoveries in Painless Childbirth

I always urge people to read the original source material whenever possible. This is particularly urgent when it comes to a book like “Twilight Sleep“. You have to hear Dr. J. Whitridge Williams’ own words to really understand the complicated history of obstetrical care for healthy women in the United States.

But the good news is that it’s a very small book by the Doctors Williams and Williams with only eight chapters and 128 pages.

However, the published author of “Twilight Sleep: Simple Discoveries in Painless Childbirth” was Dr. Henry Smith Williams (apparently no relation). Dr H.S. Williams also was a medical doctor as well as an attorney, an autodidact in ancient languages and author of the “History of the Art of Writing“. In the early 20th century, Dr. Henry Smith Williams was considered to be the best and most highly regarded “science writer” of his day (1888 to 1943). When Twilight Sleep came out in 1914, Dr. Henry Smith had already published 119 books, including several 10-volume sets; his most famous (and still most excellent book) being the five volume set known as  “The History of Science” published in 1904.   

It appears that the writing of Twilight Sleep was a joint venture between Doctors Henry Smith and J. Whitridge Williams. Today we would say: “As told by Dr. J. Whitridge Williams to Dr. Henry Smith Williams“.  Dr. Henry Smith had no personal or professional background in the biology of childbirth, the practice of obstetrics or midwifery; none of his hundreds of published works ever had anything to do with childbearing, the obstetrical profession, or use of mind-altering drugs such as scopolamineDr. Henry Smith quoted no other obstetrical sources but Dr. J. Whitridge Williams himself for a brief mention of the German doctor that originally developed the use of the hallucinogenic drug scopolamine as administered to laboring women as an amnesic.  

However, Dr J. Whitridge Williams was arguably the most influential obstetricians of the 20th century. Originally trained as a gynecological surgeon, he was hired early his professional career (1893) by the brand new and not-yet-open Johns Hopkins University Hospital to set up its gynecology surgery department. In the early 1900s, Dr. JWW was appointed Chief of the Johns Hopkins‘ obstetrical department. His most famous textbook — Williams’ Obstetrics — was first published in 1904 and is now in its (?28th?) printing.  At the pinnacle of his career he was appointed Dean of the Johns Hopkins School of Medicine (1911), a post he held until 1923. 

He also was personally and consistently involved in the American Association for the Study and Prevention of Infant Mortality (AASPIM). The group was organized by the AMA in 1904s to search for ways to lower the rate of infant morbidity and mortality associated with pregnancy, childbirth and early infancy in the US. This national group of obstetrically-trained physicians held it first annual meeting at Johns Hopkins University on November 9-11, 1910. Link to Google PDF of AASPIM first national meeting

The “Transaction of the Association for the Study and Prevention of Infant Mortality (TASPIM) were published yearly from 1910 to about 1925. Dr. Williams, as one of the Titans of American obstetrics, always attended these meeting and spoke at length. At this time he was not only America’s most eminent obstetrician, but also Dean of a world-class medical school, so his opinions counted more than most.      

Every annual meeting of the ASPIM included stenographers who made a written record all the formal speeches and back and forth dialog at each of the many different sessions. The TASPIM allow us as modern readers to hear what all these famous doctors thought and their plans for bringing this about.  As a result, we have an extensive and detained historical record that provides insider information about the obstetrical practices and politics of this time period. In particular, we have a written record of the many thoughts, ideas and opinions of Dr. JWW on a wide-range of topics related to the female gender in general (classic chauvinism of the era), as well as his opinions about midwives, childbearing women, and the politics associated with the newly emerging surgical speciality of obstetrics and gynecology. 

During this time period (1900 to 1940s), the newly configured profession of obstetric as a highly-trained surgical speciality was desperately trying to disassociate itself from the female practice of midwifery. This included a public-relations campaign in newspapers, women’s magazine and the radio promoting the idea that country doctors,  midwives and giving birth in one’s own home were all hopelessly old-fashioned ideas to be characterized as “so last century”. In the new century, the “modern” woman deserved to be cared for in a hospital, where her birth would be attended by an obstetrically-trained surgeon who would conduct the “delivery” as a sterile surgical procedure that frequently used forceps in order to extract the baby from its unconscious mother’s body.

As a hospitalized labor patient,  she would be given two wonderful new drugs that meant she never remember having any labor pains and actually would not even remember being in labor! When the time came to give birth, she’s be “put to sleep” (i.e. given general anesthesia). After the drugs and anesthesia wore off, she’d wake up just as the hospital nurse placed her newly washed and freshly blanketed newborn in her arms many hours later. This was portrayed in these publications and radio broadcast as the very height of “fashion” for childbirth in the early decades of the 20th century.   

Suggest you read chapters 5, 6, 7 & 8 first

I recommend the you read chapters five thru eight first, and then go back to chapters one to four. The reason is that the second half of the book is about the big-picture, which was Dr. William’s ideas for the elective hospitalized of healthy childbearing women as paying customers. He described his reasons as both humanitarian and utilitarian, hoping to assuage the pain and “terror” of childbirth in the more educated and refined class of women, while using the profits generated by hospitalized maternity patients to initially finance a nationwide system of lying-in hospitals. He envisioned at least one lying in hospital in every population center over 3,000, with them eventually becoming as ubiquitous if not quite as numerous as libraries and school houses”.

He passionately hoped that the  dependable economic resource that these lying-in hospitals represented would be used to finance a system of general hospitals able to serve the medical and surgical needs of all Americans, both urban and rural,  by meeting the medical and surgical needs of ages and genders,  men as well as women, infants, children, and older adults

1910 obstetrical textbook photo of normal childbirth conducted as a sterile surgical procedure

The a large and ongoing revenue stream created by obstetricalization of normal childbirth in the United States beginning in 1910 ultimately played a critical part in financing our current system of privately owned general hospitals.

Revenue generated by the hospitalization of healthy maternity patients as paying customers, either by private insurance reimbursements or the federal Medicaid system (which finances 50% of all childbirth services in the US) continues to act as a hospital profit center.

Dependable income from the maternity ward off-sets other departments that often run in the red due to type of time- and resource-intensive care they require — critical cardiac patients, major surgeries, and critically ill or injured patients that required an inordinate amount of time-consuming care over several months.

Obstetrical departments generate an 8-fold greater income than cardiac wards

Sometime in the 1990s a comparative cost analysis of hospital departments was published. It reported that only five cents of hospital profits per dollar came from the cardiac department, while the maternity units provided a revenue stream of 38 cents on the dollar — essentially an 8-fold increase. Busy maternity departments are absolutely critical to maintaining the for-profits corporately owned acute-care hospital system in the US.            

Note the expressionless face of the new mother in the lower right hand corner of this photo

From Dr. J. Whitridge Williams’ perspective,  electively hospitalizing healthy maternity patients was an important step forward in the modern or ‘scientific’ practice of medicine, as it provided the circumstances for Twilight Sleep drugs (morphine and scopolamine) to be routine given to hospitalized women during their labors, the use of general anesthesia for the birth and forceps for delivering the baby. 

Class and Economics in relation to childbirth services in the US — Origin of today’s “for profit” healthcare system

In particular, white middle and upper-class women were generally seen as better educated, more intellectually-astute and psychologically more “sensitive” and “delicate” and assumed to be more easily damaged by the pain and strain for a normal childbirth. As a consequence, Dr. J. W. Williams and his obstetrical colleagues believed this class of women needed a more humane way to be “delivered of child” than the unmedicated “natural” births that were typical for poorer Americans and impoverished immigrant populations who were used to hard physical labor.

Of equal or even greater benefit to society, Dr. Williams and his contemporaries saw the potential economic benefit to electively hospitalizing healthy maternity patients — middle and upper class women as paying customers — which would generate a revenue stream for each of the small privately-owned lying-in hospitals and medium-sized hospitals with lying-in wards.

From an economic perspective, this was in stark contrast to the system in which the mother remained in her own home, cared for by family members during and after the birth, with the doctor or midwife attending the active stage of labor and birth of the baby in the mother’s home. Birth attendants received a professional fee for services rendered, but since the family was in its own home there was no “facilities” fee, charges for room and board, the services of the nursing staff or other hospital-related expenses. 

However, if this economically-enabled demographic of paying customers could be convinced to patronize hospital maternity wards, hospitals could and would charge a substantial fee for the use of its ‘facilities’. Over the course of several years the revenue stream this generated could used by small ill-equipped speciality hospitals upgrade and remodel themselves into medium-sized general hospitals. Over time, these newly-expanded community hospitals would become part of a nationwide network of general hospitals able to serve the full spectrum of medical and surgical needs of the general public — men, children, infants, the elderly and women before and after childbearing age. These full-equipped general hospitals would be able to serve several surrounding communities, thus meeting the wider needs of the American public without the need to be funded  (thus controlled) by state and federal governments.

From the perspective of the American Medical Association, which represented the economic and political interests of MDs, medical practice in the US was the ultimate entreraperniel opportunity — a chance for each and every doctor to own his own private business as a medical practitioner. This was in stark contrast to the publically supported system used in Western Europe. The AMA was staunchly against any kind of “government interference” that could conceivably interfere in the sacrosanct “doctor-patient relationship“.      

Individual hospitals a “small business” in the early 1900s

I the early 1900s, there were about 8,000 hospital in the US; the majority were small doctor-owned institutions with only 2-to-10 bed and little to no medical equipment. As a for-profit business, they only provided care to people that could pay for their services. Also they were neither staffed nor equipped to provide emergency services to the general public. This was in stark contrast to the Western European countries that for a long as 400 years had large tax-supported regional hospitals that were equipped to provide medical and surgical services to the general public.

After Dr. WIlliams graduated from medical school he went to Europe and spent two (or more) years receiving his clinical training in these big institutions. Obviously, he would have been aware the US didn’t have any nation-wide “system” for providing hospital care to people living in rural, remote or farming areas of the country. He also knew that clinical training had to be regular part of one medical school education and that required hands-on training in a fully equipped and staff general hospital.

However, well over 90% of America hospitals were not big enough to either provide general medical services to the people living in their vicinity and likewise could not be used as planes to provide clinical training to medical students. Dr. Williams “Plan” for the elective hospitalization of healthy maternity patients provided a dependable revenue stream that would allow many of small lying-in hospital to eventually become general hospitals. Eventually this would create a network of hospital all across the country that would be a able to provide comprehensive medical services to patients of all ages, all genders and regardless of the type of care they required.

While Dr. Williams motive were by themselves admirable, the reality of electively hospitalizing a large proportion of childbearing women in a pre-antibiotic era (prior to 1945) unnecessarily exposed these new mothers and babies to potentially-fatal hospital-acquired infections — puerperal sepsis more commonly known as “childbed fever. This type of septicemia or (blood poisoning” was the most frequent cause of maternal mortality in the US. Unfortunately, ad the number of hospitalized maternity patients rose, it was accompanied by a steep rise in the  maternal mortality rate in this country.  

Before the plan for the mass hospitalization of healthy women was implemented (1916) the US had approximately 16,000 annual maternal deaths out of an annual birth rate of 2 million mothers or a ration of one matern death for every 125 live births. As the proportion of women who gave birth in a hospital rose, 25,000 maternal deaths were recorded in 1925, maternal deaths increased to one out of every 80 births.      

The links below lead directly to each of the 8 chapters of  the Doctors Williams’ book. A link to the next chapter is at the bottom of each chapter.

Read these chapters after finishing chapter 5-to- 8

Chapter 1

Chapter 2

Chapter 3

Chapter 4

Recommend reading these chapters first

Chapter 5

Chapter 6

Chapter 7

Chapter 8


 

INTRO of Dr. Williams’ landmark book:

‘Truth’, with a capital “T”, is rarely obvious. To get to the bottom of things, we usually have to ask a lot of questions and look careful beneath the surface to determine if what is said about something actually matches the facts.

This is particularly the case for 20th century obstetrics in America, which developed a medicalized system that uncritically accepted an unscientific model of care — general anesthesia and invasive obstetrics — as the norm for all childbearing women. This included the 70-to-85% of pregnant women who were in perfect health and had normal term pregnancies.

The result was to normalize of a highly interventive and invasive model of obstetrics that has been used on the overwhelming majority of childbearing women in the US for more than a 100 years.

This dysfunctional system is directly responsible for the sky-rocketing Cesarean section rate in the US, creating a situation that unnecessarily introduces so many otherwise preventable risks, complications, and increased maternal mortality rate in today’s hospitals. 

The most Profound Change in Normal Childbirth Practices
in the History of the human species

It’s impossible to understand the true nature of our uniquely “American” system of maternity care without first knowing its unique American history. Very early in the 20th century, the obstetrical profession in the United States redefined the millions of healthy childbearing women in America by turning them into patients of a hospital-based surgical speciality. Then influential obstetricians redefined normal childbirth, by insisting that childbirth “was now, in intelligent circles, a surgical procedure”.

This was the single most profound change in normal childbirth practices in the history of the human species.

Changing normal normal labor and birth into a hospital-based obstetrical procedure began with the elective hospitalization of healthy women who, as newly-admitted labor patients, were routinely injected with powerful mind-altering drugs. This included morphine (or other narcotics) and scopolamine, which is the Twilight Sleep drug that produces amnesic and hallucinations. Hospitalized labor patients were sometimes given additional drugs to induce or speed up labor.

When it was time for the baby to be born, these women were rendered unconscious under general anesthesia, then an elective “low forceps delivery” was ‘performed’ as the obstetrical profession considered the use of forceps to be a ‘normal’ part of normal childbirth. Soon after, the obstetrical profession declared this highly interventive model and its invasive methods to be their new and improved standard of care. During this period, the maternal mortality rate in the US was twice as high as England and three times higher than in Sweden.   

Based on the historic birth rate in the US during the 20th century (2-4 million annually), well over 200 million childbearing women received a risky, painful, frequently humiliating, and unproductively expensive form of care that did not include any ‘informed’ consent, while it did include a dramatic increase in preventable morbidity and mortality of new mothers and their unborn and newborn babies.  

Here at the beginning of the 21st century, our obstetrically-centric interventive system still has a 93% medicalization rate, which means that 93 of 100 laboring women who give birth in a hospital undergo seven or more medical or surgical interventions or invasive procedures including drugs to speed up labor, episiotomies and operative deliveries. In addition to the already mentioned dozen (or more) routine obstetrical interventions and a sky-rocketing Cesarean section rate, the newest 21st century addition to the obstetrical notion that “you can’t have too many interventions”, the obstetrical profession is now recommending that the labors of all healthy pregnant women be routinely induced @ 39 weeks (the week BEFORE their baby is due!).   

This is part-1 of an eight-part series that covers the historical aspects of this topic to the modern-day consequences of Dr. Williams’ quite obviously successful plan. I and many others activists describe this as

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 Hospital, 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  science writer Dr. Henry Smith Williams, MD, renowned author of informative articles for the lay public, as spokesman for his ideas.

Public access to this important historical book was made possible in 2008 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 obstetrical textbooks, documents on childbirth practices and the formal disciplines of obstetrics and midwifery.

After Google’s digitized PDFs 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, like having a box of 64 crayons become 64 million colors!

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 (Jennifer Haystack, LM) and I typed each chapter into a separate WORD document. Before posting the book’s 8 chapters, 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 really 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, local officials that controlled the purse strings of local tax revenue, and better-off middle- and upper-class husbands that could afford to electively hospitalize their healthy wives for normal childbirth and the standard 14 days of “lying-in” services for both mother and newborn baby.

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 across the wide expanse of our country.

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 other pricey medical equipment or to operate an emergency departments able to meet the medical and surgical needs of  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 1880s, Dr. JW Williams was incidentally introduced to the European system of general hospitals as a graduate student. During two year of his clinical training in obstetrics in the best hospitals of Europe, he personally witnessed and experienced Europe’s vastly superior hospital system that successfully met the healthcare needs of its citizens.

Appointed Dean of the Johns Hopkins University School of Medicine in 1911, Dr. JWW 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, there were only about 2 dozen institutions in the entire US (all in metropolitan population centers) that could 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 or for paying a doctor’s professional fee. 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. Williams. He was convinced that the thousands of doctor-owned for-profit one-room hospitals in the US could be upgraded or merged with other smaller hospitals into one medium-sized institution. Over time, these small hospitals could eventually turned into fully-equipped and staffed general hospitals in each population center — a system to at least rival, if not actually exceed, those in western Europe.

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.

But unlike the publicly financed hospital in European countries, those in the US would eschew all forms of government funding, choosing instead to initially finance this new general hospital system by using Dr. JWW’s new economic “invention”  — the elective hospitalization of healthy middle- and upper-class maternity patients as “paying customers” and immediate propagation of new lying-in hospitals and new lying-in wards in small and medium-sized hospitals.

Dr. JWW’s Pearl of Great Price: a nation-wide system of full-equipped, well-staffed, acute-care general hospitals

In the simplest terms, Dr. JWW’s “plan” was the social, economic and political ‘capture‘ of normal childbirth services for healthy women as a profit-generating revenue stream for American hospitals. Middle- and upper-class maternity patients, as profitable paying customers, would make up for the hospital’s loss when it bled red ink from the uncollectible debts of critically ill or injured patients who inconveniently died without paying their hospital bills.

But even better, this new and dependable revenue stream would easily pay for upgrading, remodeling and expanding the hospital’s facility, this allowing them to put in a clinical laboratory, a state-of-the-art operating room with ceramic-tiled walls, a bigger hospital kitchen, more administrative offices, and in future years, a hospital gift shop that was also profitable for the hospital.

As the hospital’s favorite cash cow, profits generated by its maternity ward would underwrite the purchase of capital-intensive equipment such as x-ray machines, autoclaves, microscopes and big operating room lights. Just as Dr. JWW predicted, this would allow thousands of the small, doctor-owned 2-to-10 bed hospitals and minor surgeries to eventually upgrade to the status of an acute-care general hospital.

Over the next 30 years, Dr. J. Whitridge Williams and other influential obstetricians successfully eliminated the physiologically-based care of normal childbirth in healthy women as it had traditionally been provided by midwives and family practice physicians. This low-cost, high-personalized care was replaced with a hospital-based model that substituted narcotics, amnesic drugs and general anesthesia for the social support of the laboring woman’s family.

The reassuring and non-interventive presence of her midwife or doctor, who patiently awaited the spontaneous birth of her baby, was replaced by an ever-lengthening list of interventions and invasive procedures and normalization of the unscientific notion that childbirth was “now a surgical procedure” that required the routine use of general anesthesia and forceps and often accompanied by babies suffering from profound respiratory depression that were never able to breath. This was the result of narcotics given to its mothers.

Goal Number 1: Mainlining Dr. J. W. Williams’ Ideas      

As the subtitle Dr. JWW’s 1914 book suggests, it’s not a stretch of the imagination to say that his “Simple Discoveries in Painless Childbirth” helped to “mainstream” the idea that healthy childbearing women belonged in acute-care hospitals and medically-speaking, they biologically required massive amounts of mind-altering drugs during a normal labor, and that normal childbirth in the 20th century “was now, in intelligent circles, a surgical procedure” “performed” by physician-surgeons on women rendered unconscious by general anesthesia.

The medical-surgical model of normal childbirth began by injecting newly admitted labor patient with Twilight Sleep drugs. The effect of scopolamine is equivalent to a chemical lobotomy that temporarily erases the brain’s normal “executive functions” as well as all social inhibitions.

In this new 20th century version of childbirth as a medical-surgical procedures, it was inaccurate to say that a woman “gave birth”, when in fact the baby was now delivered by her doctor!

The proper role of the mother-to-be as a “surgical” patient, was to lay perfectly still under the influence of powerful narcotics during the pre-op or “waiting” period (normal labor) before the doctor was called. After the physician-surgeon arrived, her only role was to lie unconscious on the operating room-delivery room table under general anesthesia while the doctor performed the surgical procedure of “vaginal delivery”, using whatever manipulations or surgical instruments he required or preferred to use to extract the baby from the mother’s inert body.

However, promotion of Twilight Sleep, general anesthesia and birth as a surgical procedure was NOT Dr. JWW’s primary goal, but a key part of a lengthy process with many moving parts that he believed would achieve his much bigger and all important goal of a nationwide system of acute-case general hospitals.

As described earlier in detail, the elective hospitalization of healthy middle and upper-class maternity patients in lying-in wards was the magical “open sesame” to achieving his dream of a nationwide system of general hospitals that in his own words would be “as ubiquitous, if not as numerous, as libraries and schoolhouses” in every population center with 3,000 or more inhabitants and his vision prevailed.

Unfortunately, many of today’s inhabitants of those small town are uninsured and can no longer afford to be hospitalized!

The second half of Dr. J W Williams’ book — chapters 5 thru 8 —  gives voice to his dream, identifies his motives and describes the truly innovative new business plan for American hospitals that he invented, promoted, ultimately brought to fruition, and under which we currently organize our hospitals as social and economic entities in a free market culture. It is really worth reading if you can get past its occasionally-antiquated vocabulary.

Original Building ~ Johns Hopkins University Hospital, late 1800s

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 in JH University Hospital needed to be remodeled and additional classrooms added to provide clinical training for 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.”


An older Intro that does not link to the 8-part series  ~ Overview & Backstory ~


Link here to part 2 of this eight-part series ~

The Dream, the Motives, and the Plan  by Dr. J. Whitridge Williams