XYZ ~ *1* Telling the story (w/ link to original sources): How the invention of elective hospitalization of healthy people became economic engine that created & sustains the US system of general hospitals

by faithgibson on February 26, 2018

XYZ ~ *1* Telling the story (w/ link to original sources): How the invention of elective hospitalization of healthy people became economic engine that created & sustains the US system of general hospitals

printed 12-04-2020

December 1, 2020 ~ Opened & saved, read, edited and snips of text c&p to other essays 

Ground Zero: Understanding how America’s current for-profit hospital-based healthcare system stated with a book entitled: “Plan” described in his 1914 book “Twilight Sleep: Simple Methods of Painless Childbirth”

This little book written by Dr. J. Whitridge Williams in 1914, is the equivalent of the “Pentagon Papers” when it comes exposing the hidden agenda and behind-the-scenes deals and corrupt compromises that has produced our unaffordable system.

Dr. J Whitridge Williams’ small (133 pages) but important book introduced his dream of a nationwide system of private and “not-for-profit” general hospitals. This was accompanied by his personal search for a source of seed money and a reliable revenue stream that was necessary to develop and fund such a system of hospitals. He envisioned a fully-equipped hospital in every community with a population over  3,000 and eventually to become, in his own words, as ubiquitous “as schools and libraries”.

Definition of a General Hospital: The services of a modern general hospital are available to the public. It is staffed 24-7 and fully-equipped with relevant supplies, medical equipment, and scientific technology of the era, such as x-ray machines, microscopes, and ‘state-of-the-art’ operating room. This also includes the obligatory and vital support services for any acute-care medical facility — a hospital kitchen and laundry and the all-important central supply department to purchase and stock necessary medical supplies and autoclaves to sterilize equipment and surgical instruments.

General hospitals provide care across the entire spectrum of medical and surgical needs for all age groups and all conditions. They also have emergency services immediately available to anyone who shows up with an acute illness or life-threatening injury. This model had been used in Western Europe for the last two centuries, but when Dr. Williams was writing his book in 1914, the United States had yet to develop a comparable system.

In stark contrast to the hundred or so large state-funded regional hospitals in Europethe United States had (by one estimate) over 8,000 small, for-profit specialty or “boutique’ hospitals privately owned and run by local doctors with medical services that were only available to paying customers.

These tiny 2-to-10 beds hospitals provided very limited services in only one area medical care, such as minor surgery, chronic care for patients with infectious diseases such as tuberculosis, and ‘rest homes’ for patients with severe a mental illness.

As one-room facilities with a small revenue stream and even smaller profit margin, they lacked most of the institutional abilities listed above for general hospitals, especially a budget that allowed them to purchase capital-intensive technologies such as x-ray machine or institutional autoclaves and emergency room care available to the public.

The Pie-in-the-Sky Conundrum Facing Dr. Williams    

Basically, there were only two logical sources of money to fund this important nationwide system of general-purpose hospitals. One was profits from the 8,000 existing private hospitals and the other was public funding provided by the federal government. In theory, these two resources could have negotiated a public-private partnership to the benefits of all.

However, neither of these sources was an option. Here’s why they wouldn’t work and why Dr. Williams had to come up with a creative ‘workaround‘.

Why private hospitals profits were not the answer 

Historically, hospitals were charitable providers of last resort for the desperately ill and injured (also homeless pregnant women and founding babies) who, in almost all cases were NOT able to pay for their care. As a result, hospitals were mainly charity institutions financed by the Catholic Church and run by religious orders of monks and nuns, or financed by the State who employed local staff to run them.

At the time Dr. Williams wrote his book (the early 1900s), there were a couple dozen big charity or state-funded hospitals in large American cities, but the business model for thousands the United States was still the very small doctor-owned businesses that provided services only to paying customers.

This arrangement was obviously convenient and profitable for the town doctor. Instead of spending his day driving all over the county to make house calls, he could concentrate the majority of his sickest patients in one place and employ shifts of nurses to watch them day and night. Of course, this profit-making business model couldn’t and didn’t address the needs of the many ill and injured who were in immediate and desperate need of medical services.

There is a historical truism here that dare NOT be ignored by those who contemplate owning or running a general hospital. Plainly put:

Depending on sick people as paying customers is now and has always been a failed business model.

The ill, injured, elderly and infants are a demographic category that, with the rarest of exceptions, is NOT able to pay for expensive and often lengthy medical care. That is why the history of hospitals starts out with charity institutions run by the Church or State, and a few very posh private hospitals owned by wealthy doctors and financed by the fees of their even wealthier patients and patrons.

This idea is not rocket science — orphans don’t financially support orphanages, school children do not pay the salaries of their teachers, jail inmates don’t hire their prison guards and soldiers don’t fund the military. Even public libraries are financed by someone other than the kids who check out books.

Unfortunately, there just aren’t enough really wealthy sick people to support general hospitals as profit-making business ventures. Period.

Dr. Williams was no fool; he knew only too well that the money he needed would not be found in the pockets hospital patients.

Public Funding or (yikes!) “Socialized Medicine

This was a total non-starter for American doctors. Organized medicine was dead-set against ANY type of ‘national’ system of hospitals or the provision of medical services the mirrored the model of public funding used in Western Europe.

{{ leave out?? }} The entry for the AMA’s timeline of it’s most important achievements for 1933 (the lowest point of the Great Depression) is a statement that it would be unethical for doctors who are members of the AMA to be paid less than the fee paid by a private donor, medical insurance company or a government agency to the doctor’s employer (community clinic) for that service or treatment. In other words, any profit relative to a physician’s service was to remain 100% with the physician.

Organized medicine has always interpreted the idea of America as the “land of the free” to mean “land of free enterprise”. After all, our European ancestors didn’t risk their lives for nothing, suffered months of hardship as they crossed the Atlantic ocean in a crowded, storm-tossed and often leaky wooden boat while being actively pursued by pirates.

America was suppose to be as big as everyone’s biggest dream; as a class, doctors were dreaming big about making their mark in a country defined by an unlimited entrepreneurial spirit and the freest form of free enterprise.

All this was in sharp contrast to what AMA members saw as their not-to-bright European counterparts. In their opinion, the ‘professional’ status of a doctor was always demeaned by becoming mere an employee of someone else, especially a state-run hospital system.

As if that was not bad enough, doctors working in nationalized systems had to deal with the politics of a State bureaucracy. Far too often, the King would appoint his wife’s brother’s once-removed nephew as a hospital’s chief of staff.  That he wasn’t a doctor and didn’t know jack-shit about the job of running a hospital was irrelevant.

As a physician-employee, the politics of big bureaucracies meant that who you knew mattered far more than most what you knew, or how good or hard working you were. Instead of being lauded for their innovative ideas, these doctors were dismissed out-of-hand or even criticized and demoted. At the same time, their lackluster, gold-bricking, brown-nosed counterparts were sky-rocketing up the bureaucratic latter, with fat raises and guaranteed job security!

One example of how crazy this could get is the story surrounding the invention of the stethoscope in 1816 by a Parisian doctor (Rene Theophile Hyacinthe Laënnec). Many doctors were excited by this new cutting-edge ‘technology’ and eager to use it themselves. But the head of the medical staff at the big general hospital in Vienna didn’t understand how it worked and thought it looked silly and unprofessional, so he forbid his staff doctors to use it for several years.

In sharp contrast to these European customs, the practice of medicine in the US meant privately-owned clinics and hospitals, in which doctors saw themselves as patriotic entrepreneurs. As self-employed professionals, doctors were their own “boss”, beholding to none, which is to say they were not hamstrung by the policies and protocol associated with institutional systems and free from the political limitation that inevitably accompany bureaucracies!

To the thinking of the AMA, everything about a nationalized hospital system and big bureaucracies was an anathema and totally un-American.

The primary role of the AMA — the reason doctors paid membership sues — was to make sure the “State” (i.e., government financing and associated politics) did not interfere in any way with the practice of allopathic medicine in the United States of America.

The central issue was the entrepreneurial aspect of medical practice as the most frequent and most profitable ‘small business’ was for-profit medical offices, clinics, and  hospitals. and and to their way of thinking, a ‘natural’ circumstances in which doctors were the ‘natural’ choice to own and run hospitals. That model depended on doctor-owned hospitals as a profit-making small business, or in the sacred ‘doctor-patient relationship‘ by reducing doctors to a subservient role as mere employees of a government-run bureaucracy.

So Dr. Williams, the hero of our story, knew he had to look elsewhere if he ever wanted to see a nationwide system of general hospitals become a reality in the US.

What to do? Stay tuned for a really big surprise . . . .

The Invention of “Elective Hospitalization” for healthy paying customers  

Dr. JWW knew that depending on hospitalized sick people for a profitable revenue stream had long ago been demonstrated to be a failed strategy. So he boldly turned his attention in a novel direction and invented the idea of “elective” hospitalization of healthy paying customers.

In the far future, the categories of ‘electively-hospitalized healthy patient’ would expand to include cosmetic surgery patients, those undergoing bariatric (weight-loss) surgery and those hospitalized for diagnostic work-ups. But in 1914, the only demographic of healthy people that were obvious to Dr. Williams — who was himself an obstetrician, chief of Obstetrics at Johns Hopkins Universtiy Hospital, appointed Dean of the University’s School of Medicine in 1910, was healthy childbearing women.

Once electively hospitalized, their normal classification of “pregnant woman” change from the ordinary everyday term to a new medicalized category of “maternity patients“. This is accompanied by the financial burdens and entanglements that went with that new designation, as well as the many iatrogenic and nosocomial risks associated with medical care and the hospital bio-hazardous environment.

Nonetheless, electively hospitalizing healthy maternity patients was the perfect (if Machiavellian) economic plan for generating seed money AND a continuing source of steady revenue to develop and implement Dr. Williams’ dream. As a result, most people live within reasonable driving distance of a comprehensive, state-of-art general hospital as a full-service provider able to meet all the community’s medical needs.

Lying-in Wards & the new demographic of electively hospitalized patients 

Adding ‘Lying-in’ wards to basic hospital services for the ill and injured was to become the core of a new business model that would catapult small hospitals with marginal profits into privately owned or not-for-profit general hospitals, remodeled and retrofitted with state-of-the-art equipment and one or more modern operating room.

As a business model able to meet the capital-intensive requirement of 20th-century American hospitals, Dr. Williams’s elective hospitalization of maternity patients as a financial strategy was a stroke of pure genius. Dr. Williams assured everyone one that their new maternity beds would soon be filled to capacity.

Unlike illness, which tends to be seasonal, and accidental injury and major medical problems, both of which are unpredictable in timing as well as frequency, childbirth is wonderfully predictable, with an annual occurrence evenly spread around the  365-days of every year.

In 1914, the US birth rate was 2 million annually, so this category of service was expected to add at least a million ‘elective’ hospitalizations every year (its now 4 million annually). According to Dr. Williams, the average population of a county in 1914 was 20,000 inhabitants. With an annual birth rate of 35 per 1,000 that would provide 700 births a year. He concluded that was:

ample material for the patronage of a small hospital, located … at the county seat, if even a large minority of the women of the community can be induced to patronize it.”

If even only half of these mothers-to-be could be convinced to have babies in the hospital (and their husbands talked into paying for it), it would generate a new admission almost every day or 350 a year.

The math was simple: when the new mother’s 14-day postpartum stay was added to the 14-day stay of her baby in the hospital nursery, it produced an annual census of 9,800 patient days. Maternity patients paid only a few dollars a day for their hospital room, but combined with small additional fees for use of the L&D facilities, special equipment, other supplies and newborn nursery charges, each new lying-in ward would generate tens of thousands of dollars in additional revenue annually. This steady revenue stream would handsomely underwrite the expanded services of a community hospital and the purchase microscopes, operating tables and x-ray equipment.

Dr. William’s plan replaced the idea of “build it and they will come” with a new paradigm: “if you can get them to come, you’ll have enough money to build it”.

Dr. Williams’ Dream-Solution to the funding problem

The plan was simple: every small and medium hospital in the US should add a ‘lying-in’ ward (or ‘re-purpose’ an unused or unprofitable part of the building). At that time, the vast majority of hospitals in the US were proprietary facilities with less than 25 beds owned and run by physicians and only able to provide very limited services. Dr. Williams’ plan would allow them to extend their basic services to include physician-attended childbirth services and a 14-day postpartum stay for the mother and 14 days of nursery care for her healthy newborn.

In the early 1900s, the average married woman had 6 children, so repeat business was a given for a large (and healthy) segment of the population who were happy to pay a modest (but still very profitable) fee for this ‘elective’ service. Most notable of all – Dr. Williams’ his plan economically revolutionizes the business end of hospitals without involving the federal government (the dreaded idea of ‘socialized’ medicine) or any other centralized bureaucracy that might limit the many entrepreneurial opportunities available to the medical profession.

It is no surprise that Dr. Williams’ plan to electively hospitalize healthy maternity patients was eagerly embraced by the medical profession and organized medicine. While they greatly appreciated his plan’s ability to generate additional revenue, they also saw hospitalized maternity patients as an invaluable asset in two other important areas.

Fortuitous Side-effects of Dr. Williman’s Invention of ‘Elective Hospitalization of Healthy Patients

First was the expanded opportunity for clinical training of medical students. The medical profession had quite a list of reasons for objecting to midwife-attended births, but very high on this list was the food fight over ‘teaching cases’, or as described by obstetricians “obstetrical ‘material‘”.

Every time a midwife attended a normal birth, the obstetrical profession claimed they had ‘wasted’ a perfectly good opportunity for a medical student to expand his clinical knowledge and sharpen his skills. In the opinion of the medical profession, the training of future doctors was ever so much more important than the “dubious” contribution of midwives.

“It is generally recognized that obstetrical training in this country is woefully deficient. There has been a dearth of great obstetrical teachers with proper ideals and motives, but the deficiency in obstetrical institutions and in obstetrical material for teaching purposes has been even greater. It is today absolutely impossible to provide {teaching} material.” [1912-B, p. 226

When we recall that abroad the midwives are required to deliver in a hospital at least 20 cases under the most careful supervision and instruction before being allowed to practice, it is evident that the training of medical students in obstetrics in this country is a farce and a disgrace.

It is then perfectly plain that the midwife cases, in large part at least, are necessary for the proper training of medical students. If for no other reason, this one alone is sufficient to justify the elimination of a large number of midwives, since the standard of obstetrical teaching and practice can never be raised without giving better training to physicians.” [1912-B, p.226] {emphasis added}”

In addition to the steady revenue created by electively hospitalizing maternity patients, there was a second bonus — an expanded market for the services of graduate physicians. Since only medical doctors were allowed to practice in hospitals (practice privileges extended by MDs to MDs), this instantly eliminated the economic competition of midwives.

While increased income was the primary goal, the dramatically improved job opportunities and working condition for doctors were greatly appreciated. Physicians who normally attended births in the homes of their patients were quick to grasp the time and labor-saving elements of Dr. Williams’ plan to cluster their labor patients together in one place – the convenient local hospital.

For doctors, this was a huge improvement in working condition compared to the typical experience of a general practitioner who routinely provided care in the cramped, inconvenient, poorly lit and often unheated home of a farm family having its 10th child on a cold and stormy mid-winter night. Even if everything went perfectly and quickly, it was still an uncomfortable and inconvenient experience for the doctor.

If any kind of medical or surgical intervention was required, having instant access to a well-equipped hospital and well-trained staff was obviously a vast improvement. Hospitals conveniently provided a clean, spacious, warm and well-lit facility, plenty of nurses and other staff, access to special equipment, and (thankfully!) a central supply department that did all the cleaning and sterilizing of instruments.

Last but not least the hospital maternity ward provided an on-going opportunity for social and professional interaction between the community’s physicians, thus creating a camaraderie that helped elevate the status of the medical profession in its own eyes.

None of these physical, technological or social advantages could have been duplicated in the old, time-consuming system of house calls that dispersed doctors to the far reaches of their geographical district, isolating them from the daily contact of their peers and technologically-centric improvements of ‘modern’ medical science.

Standard Hospital Birth In America ~ 1910 to 1960 ~Physician-attended childbirth in an American hospital during the early decades of the 20th was starkly different from the historical experience of midwives and MD birth-attendants during all preceding centuries.  In fact, it was the most profound change in normal childbirth practices in the history of the human species. As a result, healthy childbearing women became the patients of a surgical specialty and normal childbirth was turned into a surgical procedure to be ‘performed’ by a medical doctor.

Nonetheless, the medical profession enthusiastically embraced this drastic change in how childbirth services were provided to healthy childbearing women without too much concern for how this affected these women and their families. Hospitals, as the central location for all the childbirth services provided by doctors, made as dramatic a change in the working lives of doctors as it did in the experience of the childbearing families.

Before Dr. Williams’ plan for elective hospitalization was implemented, the family would call the doctor in the middle of the night and tell him “It’s time” (my wife’s in labor and she says its time for you to come”. The doctors had to get out of bed and drive to the often cramped and untidy quarters of a rural farmhouse on a dark and stormy night to provide his professional services.

After hospitalization became the norm in America, a doctor instructed his patients to go to the hospital when she was in labor. After being admitted to the Labor and Delivery ward, the doctor would be notified by phone and give instructions to the nurse to call him when the birth was imminent; then he went back to sleep.

This is another example of what I characterized earlier as “the most profound change in normal childbirth practices in the history of the human species“. In this case, the change is the doctor’s professional relationship with labor. Before Dr. Williams’ plan, part of the doctor’s role was to be present and attentive during the mother’s active labor as well as the birth of the baby.

But after physician-attended childbirth was moved out of the family’s residence to the hospital, doctors no longer had to do what was called “labor-sitting” — to sit in the room with a laboring patient. Nurses would call the doctor if a problem arose, but otherwise, he was not expected to provide hands-on care or be directly involved in the management of a patient’s normal labor.

Labor ~ the waiting period before the doctor is called

Instead, labor-related care became a function of the hospital’s nursing staff. This saved physicians from the tedium of a long labor. This perspective was aptly described in an obstetrical textbook of the era, which referred to labor as ‘the waiting period before the doctor was called’.

When the doctor was finally needed at the hospital, he was greeted by a clean, warm, well-lighted and well-staffed facility staffed by professionally-trained nurses eager and willing to do his bidding.

Between 1910 and as late as the 1980s, nursing care during this ‘waiting period’ started with regular injections of Twilight Sleep drugs (a mixture of the strong narcotic morphine and scopolamine, a hallucinogenic and amnesic drug), which were repeated every 2-3 hours around the clock. While the mother continued to labor in a semi-conscious state under the influence of these drugs, her doctor slept soundly at home or hospital’s OB call-room.

The next and biggest departure from traditional childbirth practice – normal birth as a surgical procedure performed on an anesthetized and unconscious mother

The doctor was not awakened or notified to come to the hospital until the heavily-medicated mother was completely dilated, actively pushing her baby into the birth canal and was already in the OR-style delivery room. This required the nurses to transfer each of these semi-conscious mothers from their bed to a stretcher and then wheeled into the delivery room and moved over to the delivery table.

Then her limp legs were strapped into obstetrical stirrups, her hands locked into leather wrist restraints (lest she rouses enough to touch something and contaminates a sterile instrument) and her entire body buried under sterile drapes.  The nurse-anesthetist was called to give the mother general anesthesia.

After the mother was unconscious, the doctor came on the scene, already capped, masked, gowned and gloved. Over the next 30 to 45-minutes, the surgical procedure of forceps-assisted vaginal birth would be ‘performed’. This would include an episiotomy and low forceps delivery. This typically included instructions to the nurse to provide aggressive fundal pressure pushing down on the mother uterus from above as the doctor pulled on the handles of the forceps with each push from below.

After the baby was born, an L&D nurse would stimulate it to breathe as the OB doctor donned extra long sterile gloves so he could reach up into the mother’s uterus and manually disengaged the placenta from the interior wall of the uterus and bring it out. Then he would suture the episiotomy, to conclude the infamous “husband stitch”.

As an L&D nurse myself, this was explained to me by one obstetrician that i worked with as a response to a random complaint voiced by some long-dead husband. After his wife gave birth, he went back to the obstetricians and complained that having sex with her was “like walking into a warm room”. Henceforth, the obstetrical culture responded by doing episiotomies (using surgical scissors to make an inch-long incision in the mother’s perineum) and sewing the little woman up real tight so she could please her man.

After the birth, the baby was taken away to the nursery and the unconscious mother to a post-anesthesia recovery room.  Over the next couple of hours the combined effects of the narcotics, scopolamine, and anesthetic gases, (ether or chloroform or cyclopropane) would gradually wear off. A side-effect of general anesthesia is retching and vomit as the mother begins to wake up.

As she became more aware but still under the lingering amnesic effect of the scopolamine, and the mother would ask “what did I have?” The nurses would say you had “a girl” or “a boy”. However, these new mothers still could not remember anything for long and would ask again and again and again: “What did I have” and we nurse would tell them over and over again.

You see, the only person that did NOT get to attend the birth of her baby was the mother herself.

The Dark Side of the Moon — Improvising a fantastic story to match Dr. JWW’s fantastic economic invention of elective hospitalization of maternity patients

Amazing as it seems, the current American hospital-centric for-profit healthcare system started with Dr. J. Whitridge Williams’ dream of a nationwide system of general hospitals funded by the elective (i.e. medically-unnecessary) hospitalization of healthy maternity patients as paying customers.

This created a profitable business model specifically developed to generate seed money and create a steady stream of revenue to remodel and upgrade existing hospitals and to build and equip new general hospitals in every mid-sized city and town, from shore to shining sea!

But after we build it, how do you get them to come?  

All that was left was to convince “the little woman” to be hospitalized for normal childbirth and to get her husband to agree to pay for these comparably expensive services (when contrasted with midwifery care in their home).

Dr. William’s plan for hospitalizing healthy childbearing women included a PR campaign to ‘educate’ the general populous about the extraordinary advantages of routine hospitalization and persuade them that hospital childbirth was the wonderful new modern way; it was the classic “be there, or be square!” argument.

This was a big departure from the typical public opinion about hospitals which, reasonably enough, which saw hospitals as places very sick people go to die. Up to this point, the few women who did go to the hospital for normal childbirth were either very poor or suffering from life-threatening complication. The words ‘healthy woman’, ‘normal childbirth’, ‘economically-secure family’ almost never wound up in the same sentence as ‘gave birth in hospital lying-in ward’.

But Dr. JWW’s efforts persuade the public in 1914 that hospital childbirth was the new modern way to have a baby was based on a very dark and menacing story invented by him for this specific purpose. Unfortunately, it was one that also went against common sense, direct experience, and all the scientific data.

In essence, he claimed that healthy white childbearing women from the middle and upper classes were suffering because not enough medical and surgical interventions were being used during their normal births. Specifically, Dr. WIlliams claimed that these economically secure white mothers-to-be were getting not enough narcotics and hallucinogenic drugs during labor and not enough chloroform and ether during the birth, not enough episiotomies, not enough forceps deliveries, not enough manual removals of their placentas and not enough stitches after giving birth vaginally.

The Florida High school students who survived the Valentine’s Day Massacre of 2018 would have responded to Dr. Williams’ explanation by saying: “We call that ‘BS'”.

The backstory concocted by Dr. Williams was his claim that the pain of normal childbirth in healthy middle and upper class (white) woman had, in very recent times, become acutely pathological in nature. Citing the newly embraced Darwinian theories of evolution, he attributed this newly-discovered pain pathology in healthy (and wealthy) women as being caused by the negative effects of civilization and to be a phenomenon that only affected the particular demographic of childbearing women whose husbands could afford to pay for hospital-based childbirth services.

He was specifically referring to white, economically-secure, educated, intellectually stimulated, well-mannered, socially astute and emotionally “delicate”. Unfortunate for us modern readers, Dr. Willimans’ little book never technically defines the characteristic he called ‘delicate’, but my best guess is women who faint at the sight of blood, or become unduly emotionally when looking at pictures of starving children or wounded soldiers.

Irrespective of exactly who and how women become ‘delicate’, Dr. Williamns purports to have insider information as an obstetrician and to be able to speak authoritatively from his own professional experience that “modern” women who are not:

  • immigrants
  • ethnic minorities
  • poor women working

but stay-at-home married women with husbands who are employed full time or independently wealthy — those healthy, well-off white women, if not given the ‘blessings of forgetfulness” via Twilight Sleep drug and general anesthesia would literally be driven crazy by the normal pain of labor and spontaneous birth.

In some cases, this can become relatively permanent, requiring the “little woman” to be committed to a mental institution, thus leaving dad to care for the other 3 or 4 kids and a new infant.  In his book, which is subtitled: “Simple Discoveries in Painless Childbirth“, Dr. Williams’  describes the pain of normal childbirth for this demographic as:

 “…. the most intense pain that can be devised!  The pain of childbirth is the most intense, perhaps, to which a human be can be subjected.

Dr. Williams conducted himself as it was his God-given duty to save these delicate darlings from this fate worse than death; the only way to carry that out was to convince philanthropists and husbands that what American women (of means) needed was for more hospitals to be built so more women could be hospitalized for normal childbirth while heavily medicated and rendered unconscious by general anesthesia.

This brings us back to his “Plan” for financing a national system of general hospitals and his need that dads and other men be convinced that their wives no long have midwife or country doctor-attended home birth but instead they voluntarily admit themselves to a local hospital with a ‘”Lying-in” ward thru a set of swinging doors that say in big black print: “No Admittance ~ Hospital Personnel Only“.

Once they become a labor patient in an L&D ward, they will be isolated from family and friends for the duration, given massive doses of narcotics and amnesic and hallucinogenic drugs, labor on their backs with their wrists and often both ankles tied to the four corners of the bed so they can’t fall out and break a tooth or an arm, will be taken to a sterile operating room and but on an OR-type delivery “table”,

There she will be rendered unconscious by general anesthesia, and the typical litany of surgical interventions will be performed — episiotomy, forceps, manual removal of their placenta, significant suturing of the perineal incision, the ‘husband’ stitch, etc. After the birth, the new mother will be sent off in one direction to recover from the profound state of unconsciousness, while her newborn — still a sight unseen by its new mother — is sent to the NB nursery, to be appreciated by the dad and gathered family members. However, it will be hours before the mother gets to see her own baby.

In this bizarre system, the mother herself does get to be present at her own birth,  The hospital staff and all her relative will know ‘what she had’ (boy or girl” for many hours before she is conscious and her normal mental facilities have returned so she can even remember whether her own child is a girl or a boy.

This is what turned  Dr. JWW’s dream into a modern nightmare for healthy childbearing women in the 20th and 21st century. 

In 2018, the decisions and the system as organized in 1914 are still basically driving our hospital-based obstetrical system provides care to healthy childbearing women.  This fundamental structure — the idea that MORE interventions (like more guns) are always better — the answer to any idea of safety or ‘appropriate standard of obstetrical care’ issue. However, how that looks like and how it is experienced by childbearing women is different but in many ways it is a distinction without a difference.

We still have a system organized around the elective hospitalization of healthy childbearing women. Since no one seem to notice that this was on its face illogical the new idea for electively interventions in normal childbirth in healthy women is our ever-increasing sky-Cesarean section rate. Many obstetrical leader insist this is safer and better but the scientific literature does NOT unsupported notion that elective C-sections the safer, better standard of card.

When it became obvious that increased CS tracked with increased maternal morbidity and mortality, the obstetrical focus turn to the idea of universal induction. That has come to fruition with the ARRIVE study that American obstetrician are assuring us makes automatic induction at 39 weeks the new standard of care.

What i mean is that healthy mothers are still routinely admitted to the hosptial but instead of Twilight Sleep narcotics during labor and general anesthesia for the birth, “modern’ mother are given an epidural that numbs then from the waist down during the entire labor.


Below is the short version of the nightmare-half of Dr. William’s plan in his own words, with the short quotes organized by category.

Pain associated with biologically normal childbirth as described by the Doctors Williams ~

“Nature provides that when a woman bears a child she shall suffer the most intense pain that can be devised!  The pain of childbirth is the most intense, perhaps, to which a human be can be subjected.

…the sacred function of maternity … causes her months of illness and hours of agony;

Even in this second decade of the 20th century, … women bring forth children in sorrow, quite after the ancient fashion, unsolaced by even single whiff of the beneficent anesthetic vapors, through the use of which the agonies of tortured humanity may be stepped in the waters of forgetfulness.

Pain as pathology of modern civilization among the more cultured  women of society ~

“…. the cultured woman of to-day has a nervous system that makes her far more susceptible to pain and to resultant shock than was her more lethargical ancestors of remote generations.

… women of primitive and barbaric tribes appear to suffer comparatively little in labor, coupled with the fact that it is civilized women of the most highly developed nervous or intellectual type who suffer most.

Such a woman not unnaturally shrinks from the dangers and pains incident to child-bearing; yet such cultured women are precisely the individuals who should propagate the species and thus promote the interests of the race.

This seems to suggest that the excessive pains of childbirth are not a strictly a ‘natural’ concomitant of motherhood, but rather that they are an extraneous and in a sense an abnormal product of civilization.

Is there not fair warrant for the assumption that the pains which civilized women—and in particular the most delicately organized women –suffer in childbirth may be classed in this category?

Abnormal pain as an evolutionary threat to the (white, Europen) race ~

“Considered from an evolutionary standpoint, the pains of labor appear not only uncalled for, but positively menacing to the race.

…… any trait or habit may be directly detrimental to the individual and to the race and they may be preserved, generation after generation, through the fostering influence of the hot-house conditions of civilized existence.

Evolutionary pain in white women as a Darwinian segue to a perverse form of eugenics

Everyone knows that the law of natural selection through survival of the fittest, which as Darwin taught us … does not fully apply to human beings living under the artificial conditions of civilization. These artificial conditions often determine that the less fit, rather than the most fit, individuals shall have progeny and that undesirable rather than the desirable qualities shall be perpetuated.”

The problem of making child-bearing a less hazardous ordeal and a far less painful one for these nervous and sensitive women is a problem that concerns not merely the women themselves, but the coming generations.  Let the robust, phlegmatic, nerveless woman continue to have her children without seeking the solace of narcotics or the special attendance of expert obstetricians if she prefers.  But let her not stand in the way of securing such solace and safety for her more sensitive sisters.

… every patient who goes to the hospital may have full assurance that she will pass through what would otherwise be a dreaded ordeal in a state of blissful unconsciousness.

The truth is that in assuming an upright posture and in developing an enormous brain, the human race has so modified the conditions incident to child-bearing as to put upon the mother a burden that may well enough be termed abnormal in comparison with the function of motherhood as it applies to other races of animate beings. Moreover, … the displacement of the uterus after parturition is a condition of unknown cause, notwithstanding its frequency and the severe character of the suffering that it ultimately entails.

That word ‘physiological’ has all along stood as a barrier in the way of progress. “

The Mysterious Misplaced Uteri ~ rationale for electively hospitalizing healthy women for normal childbirth

Editor’s NOTE: As part of Dr. Williams’ pitch for lying-in hospitals, he perpetuates the mythical ‘displaced uterus’ story. He claimed that midwives and GP could not diagnose or treat, but a displaced uterus supposed to affect one out of every three or four women who gave birth and if left untreated (without a pessary), would be required the “most serious kind of surgery” (hysterectomy?).

“Thousands of women go through life without enjoying a really well day, because of such a uterine displacement, undiagnosed or uncorrected. Yet it goes without saying that the woman who is attended by a midwife or by an unskilled practitioner is usually never so much as examined to determine whether the uterus has or has not maintained its natural position after childbirth.

If the service of the lying-in hospital had no other merit than the single one of assuring to each other mother the normal involution, and retention of normal placement of her uterus, its service in the interests of the health and welfare of women would still be enormous.

What an incalculable boon and blessing it would be, then, if conditions could be so altered that every woman brought to childbed might be insured efficient and skillful service in carrying her through the ordeal that the performance of this physiological function imposes upon her.

And this can be accomplished in no other way than has been suggested, except by the extension of a lying-in service far beyond the bounds of anything that has hitherto been attempted.

To meet their needs, it would be necessary to have a small lying-in hospital located in every town of three or four thousand inhabitants. At first thought, this seems an ideal impossible of realization.  But if we consider the matter with attention, without for a moment overlooking the practicalities, we shall see, I think, that such a project by no means presents insuperable difficulties.

Dr. JWW get the last words:

“Have you ever considered,” he said, “the economical significance of the fact that three out of every five women are more or less incapacitated for several days each month, and that one of them is quite unable to attend to her duties?

Granting that the two sexes are possessed of equal intelligence, it means that women cannot expect to compete successfully with men. For until they are able to work under pressure for 30 days each month, they cannot expect the same compensation as the men who do so.”