I’m devoting August 2023 to posting and organizing the mass of material I have on the life and influence of Dr. J. Whitridge Williams on obstetrics in America and his (unfortunately) successful efforts to officially define obstetrics as a surgical specialty, childbearing women was “surgical patients” and childbirth as a surgical procedure “performed” by the doctor on an anesthetized woman.
However, these posts are not necessarily consecutive — that is, just another piece of the puzzle that is not necessarily in chronological order. Also some posts are redundant, as there are only minor differences from the previous versions.
My goal is to collate all this material into a single volume. So if many of these posts seem redundant, you are right! Various versions were written at different times, came from different sources and represent different perspectives.
So read what interests you, and skip those that don’t.
faith gibson, LM
August 02, 2023
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The problem:
In the late 1800s and early 1900s, the US was still a third-world country when it came to its hospital system. The problem was that we simply had no “system” compared to Western Europe countries. For more than two centuries, the population of Europe had access to a system of regional “general hospitals” in every large population center. Compared to the sophisticated hospital services easily available in Europe, we were a third-world country.
What we badly needed but didn’t have was a nationwide system of fully-staffed and equipped general hospitals able to provide comprehensive care to all ages and provide the full spectrum of care. This included 24-7 emergency and diagnostic services, as well as medical, surgical, obstetrical, and pediatric inpatient care.
While the US had many more hospitals (the best estimate is 8,000), 99.9% of US hospitals were private, very small (2-to-10 bed) doctor-owned, for-profit facilities that still reflected the 19th-century practice of medicine.
For the 8,000 or so one-room private hospitals of the late 19th and early 20th century, equipment primarily consisted of electric lights and a telephone. For the most part, their clientele was restricted to middle and upper-class families who could pay upfront. Hospital care was provided by a small staff that prepared and served meals and provided bedside “nursing” care when necessary while washing bed linens and cleaning floors the rest of the time. The services of these tiny hospitals often narrowly focused on some specialty areas such as minor surgery, setting bones, or as a place to sequester a relative who was having a ’nervous breakdown’.
What they didn’t have were microscopes, x-ray machines, and well-lighted operating rooms. What they couldn’t provide were basic services such as clinical labs, and operating and emergency room care. For those services, patients had to be transported to a general hospital, which could be more than a hundred miles away in another state. For those lucky enough to live within driving distance, there were a couple of dozen or so large, well-endowed charity or teaching hospitals in large metropolitan areas of the country. This included New England and big cities on the lower East Coast, Chicago, New Orleans, Denver, Seattle, San Francisco, and the Los Angeles area.
General Hospitals — often not available solutions
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Related topic of hospital-economics
Depending on patient-based revenue stream –
Seasonable nature of illness and unpredictable nature of disease and serious accidents, both in frequency and timing, the totally unpredictable and erratic aspect of serious injuries, the ‘feast and famine’ issue of trying to match the number of beds and round-the-clock duties of the staff with the number of patients, last but not least the high level of patients who had a serious need for lengthy hospital care but was unable to pay his bill.
Inventing the idea of elective hospitalization paying customers as a new business model
Applying the principle of elective hospitalization as an economic tool in the world of the early 1900s
The solution was a new business plan for hospitals that would add 2 million childbearing women as healthy maternity patients who were to be electively hospitalized each year. This demographic was seen as dependable patrons and paying customers
Implementation of the plan called for building lying in hospitals or adding a lying-in ward to existing hospitals.
A-The goal was a nation-wide system of well-equipped general hospital in every county seat and every town of more than a 3,000 population.
B- The plan was for hospitals to create a dependable revenue stream in order purchase new and capital-intensive scientific equipment – microscopes, sterilizers, autoclaves, clinical laboratory supplies, x-ray machines, well-equipped surgery department with new ceramic-tiled, brightly lighted operating rooms, specialized operating tables, surgical instruments, a central-supply department to purchase, sterilize and distribute this chain of supplies and equipment.
The goal was to use income generated by the elective hospitalization of their healthy childbearing population as a dependable revenue stream to finance national system of general hospitals “as ubiquitous if not as numerous as schools and libraries”.
The strategy was to convince the majority of the childbearing population in each of these communities to have their babies in the hospital
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Dr JWW’s plan included a “scheme” (his word) to sell the public on the notion that the labor pains associated with normal childbirth in healthy were actually pathological. However, this idea did NOT apply to poor working women or ethnic minorities — only white women of the middle and upper class.
According to his account, the ‘lower’ class of women – poor working women, immigrants, and ethnic minorities were still biologically normal – that is, they still benefited by the successful evolutionary process that had been relatitively successful for hundreds of thousands of years, and allowed the the female of the human species to labor without undue pain or hardship.
However, the more affluent women from Northern European populations had been damaged over the last few centuries by the “hot-house effect” of our highly evolved civilization. The easier (or cushy) life of ‘modern’ women resulted in an evolutionary weakness in the biology of childbirth. This produced a population of ‘better-off’ women who were too ‘delicate’ to withstand what would otherwise be considered the “normal” biology of childbirth.
As a result of the negative effects of advanced civilizations on the evolutionary process, middle and upper-class white women risked severe psychological damage as a result of having unmedicated labors and births. To prevent affluent white women from going crazy during CB (and winding up in a mental institution for the rest of their life), these women had to be attended by doctors who could order narcotic pain killers for labor and administer general anesthesia for the birth.
Husbands were officially informed by medical experts that their wives should be electively hospitalized for normal childbirth in one of the new ‘lying-in’ wards or maternity hospitals in order to avoid debilitating mental health problems that could otherwise ruin their lives.
However, it had already been established that normal ‘lying-in’ services were very inexpensive to provide and families generally seemed happy to pay an amount that allowed the hospital to make a significant profit on electively hospitalized maternity patients, as it cost far less to provide this simple care of the new mother and baby than the hospital received in compensation.
If systemized across the country, this would provide a dependable revenue stream to purchase the capital-intensive equipment required for a ‘modern’ (i.e. technologically-equipped) general hospital which required clinical laboratory services, an x-ray department, and a well-appointed surgery department, as well as a specialized staff to run these new technologies.
revenue from these new lying-in facilities was to function as a spring-board to underwrite a nationwide system of fully-equipped general hospitals that would in turn be able to provide the full services – diagnostic as well as medical and surgical – to the general population. One of the obvious selling points was to emphasis how income produced by ‘lying-in’ services for childbearing women this would also benefit all the men, children, travelers and the elderly in the entire community.
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Dictated material below
Quick list of massive projects policy activities
first off is hiring a lawyer to sue the bastards to insist that the on the vitriolic aiming midwife
on thought-out plot
second is changing the getting a billing code physiologically manage billing codes everything you should not in order is
teaching physiological management another schools in clinical settings in which midwives including direct entry midwives are part of the program on the
third thing is standard criteria standard research criteria that am applies retrospectively to interrupt the concept of him of what authoritative or definitive definitions of midwifery that we’re arrived at by cookbooks by the obis him and second off to apply to all future studies
the issue of the money issue and money angle which is the Gov. Brown Medi-Cal’s scope of scope of practice partnership AMA all of those kind of other issues him
last but not least there is Ricki Lake and the concept of call the midwife some version American version called midwife it tells both historical and contemporary story diversity hysterical and the contemporary story and format of this is additional information relative to litigation.
When I say into the bastards I’m talking about the fact that doctors don’t know anything about midwives or spontaneous birth and am relative safety all of these things but nonetheless, they insist on speaking authoritatively as if they do
and that needs to stock they need to fix that problem you need to know what you’re talking about or they need you cannot shut I don’t care which him and
in general I believe that the medical community has a due diligence obligation to actually teach and learn the principles of physiological management, including the technical skills and practices
they can choose not to use it when people come to an obstetrician they’re hiring the surgical specialist so that would mean that they were hiring and they were hiring a they were contracting for a phonetically/surgically manage childbirth
I supposed to physiologically manage .
However that does not negate the obligation of the medical profession in general the obstetrical profession and particular of actually understanding physiological management has a science-based method model of care, not a criminal act by crazy women who are making were trying to kill the babies and midwives who are you killing babies. And note
============== text copied from earlier works on same topic ==========
comes from file – DrJWW_#rdLevel_Edit_Jun5-2011
DRAFT: The economic model of hospitals in the US and the secret to making this work
How the Great Divide in biological science – pre-germ vs. post-germ theory of disease — shaped our 20th century hospital-based healthcare system in 1910.
At the end of the 19th century, most European countries had nationalized hospital systems. However the US chose a business model that depended on hospitalized patients to be responsible for paying the cost of their hospital care. Since the acutely ill and seriously injured are generally don’t have the economic resources to pay for the sophisticated diagnostic and therapeutic services of the ‘modern’ hospital, it was necessary for hospitals to look to other markets for their services that would dependably stablize
orphan–>capital improvements in the way of expensive technology such and or expanded facilities.
Expanding the market for hospital services from its classic but economically restrictive demographic of the seriously ill and injured to those who were healthy and for whom hospitalization was ‘elective’ provide hospitals with a dependable way to meet pay their overhead – staff salaries and running expenses. Equally important, it meant they could afford capital-intensive expenditures, such as x-ray machines, microscopes and autoclaves, and also be able to remodel or expand their facility as science and technology evolved.
Maternity care for the general population, which is to say, a healthy demographic, was the perfect choice. This as a source of staple patronage allowed hospitals in the US to be run a business model, which was a necessity since the organized medicine in America was opposed to any form of a national healthcare system.
Jan29-new:
[NOTE to self-draft: In 18th and 19th century America, medical students from affluent families were customarily sent abroad to study for a period of time. Medical education in England and the European continent had been part of a university system since the first university-based medical school was established in Italy at t ——–in 1300.
During this same era (1300-1900) the number of large charity hospitals in Europe greatly increased. Medical schools recognized the opportunity this presented for clinical training and used this endless supply of indigent patients as teaching case. They got free care in return for being ‘clinical material’ for the instruction and practice (in the sense one ‘practices’ the paino!) of undergraduates. The university’s supply of bright and eager students, in combination with unlimited access to teaching ‘material’, provided the perfect circumstances for scientific inquiry.
Jan29-new:
The hotbed of medical education on the Continent included (list of Dr. Williams’ most famous of these was the medical school of the University of Vienna, which was an educational Mecca for elite students of medicine, both and those who in the 19th century was the program Vienna’s Allgemeine Krankenhaus, the largest hospital in Europe and largest lying ward in the world.
For instance, its 19th century teaching staff and medical students when the new fields of pathological anatomy, histology (microscopic study of cells), where providing new methods for conducting scientific experiments to test out medical theories. These were important advances in the body of knowledge we now call modern bio-medicine.
From the standpoint of health/medical care needs of each country’s population, the European model met the needs of its citizens in two vitally important realms. The first was a highly developed ability to provide care to medically indigent ill or injured individual who could not to pay for the necessary care. The second was the clinical training of doctors and associated opportunities to advance medical science by using the ‘scientific method’ of study and research.
Jan29-new: Such opportunities for advanced clinical education and scientific discovery were not generally available in the US until much later in 20th century. As a result, an elite cadre of American medical students and newly graduated doctors went ‘abroad’ each year to received advanced or ‘clinical’ (hand-on) medical training in European hospitals.
This not only exposed them to superior educational circumstances, but also to the often rigid bureaucracies of a medical system ultimately run by the state government. In the last half of the 19th century, most of European countries were still ruled by monarchies and all their state bureaucracies were run by minions of the Crown.
Kings often appointed untalented family members or political insiders to key posts, including as administrators of these state hospitals. The result was many layers of power politics, lots of ‘palace’ intrigue, and an old-boys network of ‘its not what you know, but who you know’. This stifled the medical careers of all but the chosen few.
Jan29-new: While American med students liked the heady intellectual climate and rich opportunities to sharpen their clinical skills, they were not impressed by these encrusted old-world ways, in particular the fact that doctors in these systems were salaried employees of the state. As an employee, a bright, hard-working, innovative physician with superior clinical skills or leading-edge ideas was paid no more than a plodding, unimaginative, lazy or incompetent one.
Jan29-new: By the last decades of the 19th century, medical practice in the US had already enjoyed more that a century of entrepreneurial zeal. From an economic standpoint, each physician was the independent owner of a small business, with total freedom to set the terms of their practice. What was not to like about that?
Jan29-new: The second aspect was meeting the needs of its citizens as taxpayers by providing a system that was effective and efficient — able to meet humanitarian goals of health care while at the same time containing costs.
This system logically draws revenue from those who are healthy and (unless independently wealthy) employed, and then in turn makes those funds, in the payment of necessary services, when the person is ill, injured, disabled or elderly and thus unable to work and pay for care.
A key aspect of that was the fact that its doctors were salaried, which eliminated the whole ‘fee-for-service’ element – what now days is called “billable units” and its perverse incentive to do more because more procedures paid more better.
A significant number of American physicians who rose to positions of influence in organized medicine in the last 1800s and early 1900s saw this as very ‘un-American’. They appreciated the benefits of a large, well-run, well-staffed, technologically-equipped and stocked hospital and coordinated clinic system but wanted nothing to do with anything that impinged on their freedom to control the terms of their practice.
To them, a state-run system, with its hierarchical system of supervisors and bureaucratic might and in fact often did between the doctor and the patient (second-guessing his clinical decisions).
But equally egregious was not being in control their compensation and having the entrapenuial opportunities that were a standard part of the practice of medicine in the US. Salaried employees were not rewarded for working harder. Being smarter or better or more innovative was not reward with a higher income. In fact, being on the leading edge or pioneering new innovations would likely stir up professional jealousies and maybe even get them censured, demoted or fired in many bureaucracies.
National healthcare systems – pejoratively referred to as socialized medicine — was a disaster to be avoided at all costs.
END NOTE]
