Excerpt #1 of the 1914 book: Twilight Sleep ~ Simple Discoveries in Painless Childbirth and Dr. J. Whitridge Williams’ influence that defined childbirth as a pathological process .

Excerpt #1  the 1914 book: Twilight Sleep ~ Simple Discoveries in Painless Childbirth. 

It describes Dr. J. Whitridge Williams’ (most famous obstetrician of the 20th century) invention of elective hospitalization of healthy patients as the new economic model for privately owned, for-profit hospitals gave the US.

This is the same economic model for “for-profit” hospitals used in the US to today.

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This physically small, 128-page book was co-written in 1914 by Doctors J. Whitridge Williams and Dr. Henry Smith Williams. Dr. JWW was former Chief of Obstetrics at Johns Hopkins (1904-1910) and Dean of Medicine at the time, and Dr. HS Williams (no relation), who was an MD, attorney and highly respected science writer of the early 20th century.

TS: Simple Discoveries in Painless Childbirth only became publicly available in 2008, after the Stanford’s Lane (medical) Library’s copy was digitized by the Google Library Project into a very early (defective!) PDF that was actually a photo and so you couldn’t use copy & paste function. I wound up typing the entire book into a WORD doc.

Today we would assume the title of the book (i.e. dog-whistle words like “painless childbirth”) meant it was targeted at childbearing women, but that was not the case at all.

Its real (although hidden) agenda was Dr J.W.W’s new and exciting ‘business plan’ for the elective hospitalization of healthy, middle and upper class maternity patients as ‘paying customers.’ The targeted audience of his book were economically secure husbands, elected officials, social trend setters, and most important, wealthy philanthropists of the day, such as Carnegie Foundation and Rockefellers.

The reason behind this was Dr.JWW’s very laudable and noble goal to find a way to finance a national-wide system of general hospitals that were able to serve the needs of all ages and all types of medical or surgical care, like those that had been the norm in Europe for more than two centuries. At that time he graduated from medical school, very little clinical education was available in American hospitals, so Dr. Williams went to Europe to get clinical training in obstetrics and pathology from several famous European hospitals.

He was shocked to discover that each country in Europe had a nationalized system of general hospitals, the largest and most famous being Semelweis’s Allgemeines Krankenhaus (‘Frank’s House’ after its ultra rich benefactor). These huge, well -staffed, well-equipped institutions were open 24hrs a day, 365 days a year and could provide all kinds of medical and surgical services to every age, gender, and stage of life. Nothing came even close to this type of comprehensive hospital care in America.

One historical estimate for the late 1800s and early 1900s was 8,000-plus doctor-owned, one-room hospitals with only 2-10 beds, and near zero 20th century medical technology, unless you counted electricity, running water and a telephone. This also meant no emergency services, the most limited of surgical abilities and if you could pay out of pocket at the time of services, no care at all.

After retuning to America, Dr. JWW was hired by Johns Hopkins, which was not open yet, to set up their gynecological surgery department. He obviously did well, as he became chief of OB, Dean of medical school and wrote Williams Obstetrics, still considered to be the “bible” of obstetrical textbooks.

During that time, John Hopkins sought to mirror all those great hospitals of Europe, not only the grander of their buildings, but their ability to function as full-spectrum general hospital treating all kinds of people and types of medical problems. Nonetheless, Dr. JWW was no fool — he was well aware that one general hospital in one city, no matter how extraordinary, was not enough for a big country like America. The only way to reach a population of farmers, fishermen, tradesmen, housewives, sick kids, and all the people who lived in small towns stretching from ’sea to shining sea’  was to have a general hospital in each and every community with a population of 3,000 or more people.

However, organized medicine would not permit the system that worked so well in Europe — one financed by the national treasury, which is to say, spread across the entire population via taxation —to be used in America. Not for a second would the AMA allow a national financing scheme that included government money (with its “stings attached”) or anything with the slightest whiff of the despised idea of “socialized medicine”. This would interfere with, if not outright kill the entrepreneurial system of medical practice in America.

In the US, ‘doctor’s offices’ were the single most abundant and profitable small business. When doctors got wealthy, they used their wealth to invest in and run their very own for-profit hospital. For the AMA, this was the first of its Ten Commandment — thou shall not mess with the ‘business’ of medicine! 

So the next part of Dr. JWW’s Great Plan was not-so-noble, as it required some entrepreneurial process to (a) provide a steady and dependable revenue stream, while (b) still meeting the stringent criteria of the AMA for no government money. Although squeezed btw a rock and hard place, Dr. JWW was undeterred and in fact, this pressure helped him to ’think outside the box’ and in doing so, to turn the entire economic system of American hospitals upside down.

His new and brilliant idea was to replace the perpetually failing business model of privately-owned hospitals in America which (no joke!) depended on sick people to pay their hospital bills. Since sick people often can’t be employed after a serious illness or injury, and some even die, this turns out to be a really dumb financial plan, unless you’re planning to go bankrupt.

The AMA model of hospitals as great entrepreneurial opportunities did not factor in the obvious — that ever since St Laundy found the 1st Parisian hospital “Hotel Deu” on the banks of the Seine, hospitals have been charity institutions finances by kings-the State and staffed by members of religious orders who worked for free. Sick people have always and will always suck when it come to paying for medical services and costs of hospitalization.

The way you make money from hospitals today is that third parties collect payments from insurance companies and governments, who in turn have collected it from employers and taxpayers and turn around an write the hospital a nice fat check. But that was not the world that Dr. JWW’s was facing in the early 1900s, a world that did not yet have a hospital ’system’ and one that had to create its own version of a third party payor — in this case, electively hospitalized healthy patients who could pay more than cost of their care, this creating a profit.

Dr. JWW’s new economic plan was directly linked to his goal of financing a national-wide system of general hospitals that made it possible to diversify these 2-10 bed speciality facilities and turn them into general hospitals.

Brief Historical Aside:  Changes in the function of hospitals from 19th century palliative and custodial care to 20th century effective therapies: Palliative Care vs. Diagnostic & Therapeutic Services

Before the 20th century, hospitals were mainly medical hotels providing non-therapeutic care that was mainly custodial and/or palliative. By the turn of the century, the emerging ‘modern’ hospital was increasingly equipped to provide effective therapies that could genuinely be described as “cures”.

The stark difference btw these two system was the how each of them defined the concept of ‘medical services’ based on the difference between “care” vs. “services“.

This changed the physical hospital building from a medical hotel that aggregated and housed sick people and was staffed by unskilled caregivers versus the hospital as a building whose purpose was to aggregate and house specialized equipment and trained professions who knew how to use them.

This change stated with Pasteur’s discovery of the microscopic bacteria and his Germ Theory of infectious disease in 1881 and the invention of x-ray machine in 1895. This was followed by break-through discoveries in the biological sciences (blood-typing, etc) that generated a steady stream of ideas for dramatically improving medical care that ultimately created 20th century medicine.

But the practical application of these medical advances almost always required new technologies and specialized equipment. The trifecta of modern medical science lay in its advanced understanding of the human biology, modern technologies and trained professionals. For a hospital to meet the new scientific standard for the practice of medicine, it would need to purchase at least one of every new technological ‘gadgets’ of the day. Obviously this was very capital-intensive undertaking, that included microscopes, sterilizers, central supply autoclaves, x-ray machines, radiology film, oxygen tanks, operating room tables and special electric OR lights.

This was the “brave new world” that Dr. JWW was trying to bring about on a national scale, using his newly invented economic model to finance the expanded these services.  that hospitals provided by bring in electively hospital patients that would be the difference between bleeding red ink and being profitable enough to expand one’s services to include these new and wonderful technologies.

Step #1 of his plan was that small hospitals open new maternity wards and invite the “patronage” of healthy childbearing women from an economic demographic that were able to pay for hospital-based childbirth services.

Since healthy maternity patients were not ill or injured, it cost the hospital very little, as new mothers need little more than medical hotel services — clean sheet, meals, a supply of clean diapers for their babies. Hospital charges for maternity patients had a really high profit margin (one contemporary source reported a 39% profit margin for maternity patients vs. only 5% for cardiac patients). One

This new and dependable profitable revenue stream generated by providing lying-in services (2 week stay postpartum stay for mom and 2 wks of nursery care for the baby) to middle and upper class families would in turn finance the necessary hospital up-grades and renovations to turn itself into general hospital able to provide all the new technological accruements that began with intervention of the x-ray machine in 1895, followed by an ever-increasing stream of capital-intensive medical technologies such as x-ray machines, clinical lab equipment, microscopes, industrial autoclaves, new ceramic-tiled operating rooms equipped with OR tables and a really good electrical lighting system

After the small boutique hospital opened a new “lying-in” ward, and then used the new revenue stream make itself over as a general hospital, with the new cornucopia 20th century medical technologies —  the maternity department would become the ‘cash cow’ that covered the losses incurred by patients who needed expensive care but were unable to pay or (worse luck) died without an estate.  became a newly profitable ,

And voila! The American Way of Birth was the flying carpet that changed our 19th century system of hospitals as providers of hospitality services to the 21st century, many-headed leviathan that is our corporate hospital system. It’s not really a healthcare system (i.e. doesn’t care about keeping healthy people healthy) but “medical services delivery system”. This is not far removed from the assembly lines of 20th century factories.

Like a MacDonald’s Resturant, a different health care ‘professional’ is assigned to do each different step of a complicated and choreographed process of patient care and/or patient treatment.  For the average hospital patient, this means dozens of different people who do not have any kind of one-on-one relationship with them and who the patient often never sees again.  This costly and complicated system is difficult to use and frankly depressing at a personal level.

My hope (and prayer) is the AI can automat the automatic aspects of caring for and treating patients and that will make real people available to provide real “care” (as in to care about as well as to care for) patients who in many instance may not even be in the ‘old-fashioned’ 20th century hospital, but now at home while being monitored by AI gadgets that auto-dial the doctor or 911, depending on the problem.

I’ve read futurist reports of hospitals ‘downsizing’ and diversifying so each major institution would have a dozen of small satellite hospitals with only 20 beds. When this happens, normal childbirth will be the only ‘pathology’ left that requires the super big guns of a big hospital, while those heart transplant patients sleep comfy in their own bed at home every night.

Is that too cynical for words or what!

Actually, I’m am more sarcastic and less cynical that I sound. And like Dr. JWW, I too have a plan, only my plan is to unglue the system that he started, one that Listerized, and anesthetized, and pathogized normal birth into a surgical procedures in 1910 and then in 1970s, it epiduraled and electronically-monitored and delivered “normal childbirth” to surgeons via Cesarean incision.

Instead of trying to turn back the clock (which never works) I have an actual plan for changing our relationship with improperly technologized style of childbirth and letting that 70+% of healthy moms — those who want to — spend the night before and night after their birth in their very own bed. As for those hours in between, I expect them to be spend walking about, hanging out in the shower or a deep water tub and sooner or later, pushing their baby out under their own power and justifiably taking a great deal of personal credit for a hard job well done.

Drs. Williams and Williams, circa 1914, USA

This synopsis of good doctor’s story is provided by his own words and organized by topic.

It was aimed at convincing middle and upper class husbands to electively, prophylactically hospitalize his sensitive, intelligent, and delicate flower of a wife, to prevent her from going insane from the pain and strain of giving birth. Thus she could fulfill: “the sacred function of maternity”, while modern obstetrics would save her from “hours of agony” by medicating her with morphine and scopolamine, and anesthetizing her for the ‘delivery’.

The mother became the least important person in the process and the only person who was not permitted to be consciously present at her baby’s birth.

 “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;

p.12 …how has it come about that this most natural and essential function should have come to be associated with so much seemingly useless suffering.

…the wonderful effort that has been made by a band of wise physicians in Germany to give solace to the expectant mother, and to relieve the culminating hours of childbirth of their traditional terrors.

Even in this second decade of the 20^th 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.

 “…. 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 ancestor 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 (Caucasian & European) 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.

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.

“In Johns Hopkins Hospital,” said Dr Williams, “no patient is conscious when she is delivered of a child. She is oblivious, under the influence of chloroform or ether.

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

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.

Take, as a single illustration, the matter of displacement of the uterus. I have quoted Dr. Williams to the effect that no one knows just why such displacements occur, or in what cases they are likely to occur.  What we do know is that in a certain large proportion of cases, such a displacement does occur in the course of the few weeks succeeding delivery.  And Dr. Williams is authority for the statement that the displacement may ordinarily be remedied effectually and permanently by the simple expedient of using a supporting pessary for a few weeks, if the condition is diagnosed at once and the remedial agency employed.

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 skilful service in carrying her through the ordeal that the performance of this physiological function imposes upon her.

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

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.

In time every mother in the community should come to patronize such a hospital; for it will come to be known that the home is no place for a woman during the ordeal of childbirth.

These comforts, it must be borne in mind, include the use of pain-annulling drugs.  In this country, it is customary to anaesthetize the patient with chloroform, though some competent practitioners prefer ether.  We have already seen that the merits of the morphine-scopolamin[e] treatment, inducing the Twilight Sleep, are to be fully tested at the Johns Hopkins Hospital…

Sub-heading in original — “OBJECTION FROM WOMEN” — Of course there will be difficulties in the way of carrying out such a scheme, with its implied sojourn in a hospital for the great majority of women during their accouchement.

The chief objections will come from the women themselves. Indeed, this is about the only opposition that need be considered. Woman is the ruler in America, and what she wishes is never denied her. So it remains only to gain the assent of women to put the project for the wide extension of a lying-in service ….

… the farm wife must be educated before she could be made to see the desirability of this arrangement.  The first thought of the average wife is that she cannot possibly be spared from home, and that the idea of going to the hospital is not even to be considered.  But as soon as the advantages offered by the hospital – painless childbirth, safety to the offspring, and rapid and permanent recovery – come to be generally known the feasibility of the project will quickly be demonstrated.

What a boon it will be, then, to the six million farm wives of America, when facilities have been provided, and customs have been established, making it certain that she may have the comforts of a lying-in hospital, with adequate medical attendance, to solace her in what would otherwise be the dangerous ordeal of motherhood.

p. 81 “The laity should also be taught that a well-conducted hospital is the ideal place for delivery, especially in the case of those with limited incomes.

“Moreover, they should learn that the average compensation for obstetric cases is usually quite inadequate; and should realize, … that doctors who are obliged to live on what they earn from their practice cannot reasonably be expected to give much better service than they are paid for.

“I think I may safely state that obstetric fees are generally much too low as those for many gynecologic and surgical operations are absurdly high. I am loath to mention so sordid a matter and I do so at the risk of being misunderstood, but in know … that many well-to-do patients object to paying as much for the conduct of a complicated labor case as for the simplest operation which involves no responsibility.

In a population of twenty thousand people, there will occur, on the average, about seven hundred births in a year.  So the obstetrical needs of such a community as this are by no means insignificant when considered in the aggregate.  There is ample material for the patronage of a small hospital, located, let us say, at the county seat, if even a large minority of the women of the community can be induced to patronize it.

….small lying-in hospital, with its average of one or two births per day, will be provided of course with a resident physician and with a staff of nurses competent to give the first doses of the drug [of scopalomine].  So the treatment may be carried out as it is at Freiburg, and a considerable proportion of patients will secure the hoped-for boon of the “Twilight Sleep.”

Recall that the average annual birthrate is about thirty-five to every thousand inhabitants; that is to say, about one in every six families, and that sooner or later there are children in every normal household.  We are dealing, then, with a project that concerns not here and there an exceptional family, but one that concerns each and every family.  No project could more justifiably call for the expenditure of public money, – money raised, if need be, by the issuing of bonds or by the levying of a special tax.

In many places small public or semi-public hospitals already exist.  These can be enlarged at relatively small cost, or their existing wards, – which in many cases are now for the most part vacant, – may be utilized as lying-in quarters.

Once the hospital is in operation, it will in many regions be altogether self-supporting, – for, of course, all but the poorest classes will wish to pay for the services received.  And even where the funds received are inadequate to meet the necessary outlay, there will be no part of the public service for which the average citizen will more willingly submit to taxation than for this institution which so manifestly adds to the comfort and well-being of the mothers and wives and daughters of the community.

But even without resort to public funds, there should be no difficulty whatever in any community in securing subscriptions for the erection and maintenance of the lying-in hospital, so soon as the need of it and its manifold beneficences are clearly understood.

Many a man who will give for almost no other object, will make liberal donations when he is convinced that the project is one that will immeasurably decrease the dangers and practically annul the pains of the women of the community in the condition which he has hitherto contemplated with the utmost apprehension as a menace, present or prospective, to the loved ones of his household.

            Incidentally, it should be noted that the male population of the community will also benefit directly from the introduction of such lying-in hospitals, because it will be possible to establish in connection with these hospitals, wards or departments of general surgery, for the treatment of various diseases, in many places where it would be impossible to maintain such a hospital service independently, because of insufficient patronage.  The patronage of a lying-in hospital is an assured element, assuming good proportions even in districts relatively sparsely settled.

The need of such a service would long ago have been evident, had it not been for the current conviction that the bearing of children is a physiological function not to be considered seriously; and a function, moreover, that is scarcely to be referred to in general conversation.

Now that the time has arrived when a matter of such vital import can be frankly discussed in public, we may expect to see aroused a growing interest in the betterment of the condition of woman through amelioration of the evils incident to the performance of her supreme function.

Whatever your position in the community, you can at least call the attention of your friends and neighbors to this vitally important matter.  And it may well be expected that the response will be quick and keen; that knowledge of the movement will spread from house to house; and that the public interest aroused will lead to active steps for the establishment in your midst of an institution where the woman in childbirth may be given the solace of the “Twilight Sleep,” with all the attendant blessings that the word in its wildest implications is here meant to connote.

            Is it not worth your while to have a share in this beneficent movement?

Secondary source – As indigent women were brought into the system as teaching cases it was discovered that they were willing to pay a small sum for their 2 week stay ($1.28) and that even that small amount represented a profit to the hospital. Maternity patients were beginning to be viewed as not only as valuable “clinical material” for medical education but also as a source of profit to the hospital.

“the tendency to retard respiration on the part of the child may sometimes be beneficial, preventing the infant from inhaling too early, thus minimizing the danger of strangulation from inhalation of fluids. It appears that statistics of the Frauenklinik show that the percentage of infant mortality is low.

“As against an infant mortality of 16 percent [editor’s note: in today’s terms, that is 160 baby deaths per 1,000 births] for the state of Baden [Germany] in the same year a report on 421 ‘Twilight Sleep’ babies showed a death-rate of 11.6 percent [NNMR of 116 per 1,000]

“For this strikingly low mortality of the children during and after birth under semi-narcosis, explanation was sought of Professor Ludwig Aschoff, the great German authority on morbid anatomy. He offered the theoretic explanation that slight narcotization of the respiratory organs during birth by extremely minute quantities of scopolamine[e] is advantageous to the child, as it tends to prevent permanent obstruction of the air-passage of children by premature respiration during birth.”

“The peculiar ills to which women are subject by virtue of their sex are so familiar that we are apt to overlook their number and importance. Dr. Williams called attention to them in a recent address before the American Association for the Study and Prevention of Infant Mortality and he emphasized others in a private conversation

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.”

~ ” ….. the ideal obstetrician is not a man-midwife, but a broad scientific man, with a surgical training, who is prepared to cope with most serious clinical responsibilities, and at the same time is interested in extending our field of knowledge. No longer would we hear physicians say that they cannot understand how an intelligent man can take up obstetrics, which they regard as about as serious an occupation as a terrier dog sitting before a rathole waiting for the rat to escape.“      1911-B American Association for the Study and Prevention of Infant Mortality; Williams.MD – “The Midwife Problem and Medical Education in the US”

Even were local lying-in hospitals to be established everywhere, however, there would still remain much to be done before the needs of women in connection with the great function of child-bearing have been adequately met.

“At present, gynecology and obstetrics are too sharply divided and are conducted upon too practical a basis to give ideal results.  The progressive gynecologist considers that obstetrics should include only the conduct of normal labor, or at most of such cases as can be terminated without radical operative interference, while all other conditions should be treated by him – in other words, that the obstetrician should be the man-midwife.

            “The advanced obstetrician, on the other hand, holds that everything connected with the reproductive processes of women is part of his field, and if this contention were sustained, very little would be left for the gynecologist.

            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.

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.