DrJWW ~ 817 words Twilight Sleep book by men for men, synoptic introduction of DrWilliams’s Economic Plan

by faithgibson on May 1, 2023

Draft of “A brief example of how deep and unimaginable these problems were”

I found a partial answer to these questions in a book published in 1914 titled Twilight Sleep: Simple Discoveries in Painless Childbirth“. Based on the title, you’d think it was written for women as a primer on “How to have a painless childbirth“. Actually it was written by men for men, with the hope of influencing Uber-wealthy men (i.e. philanthropists) to read and become familiar with the politics of money in relation to modernizing and equipping of the 8,000 or so small privately, doctor-owned hospitals in the United States.

The “Twilight Sleep” book was based on an extensive collaboration between its author and Dr J. Whitridge Williams. Dr. JWW was by far the most famous and influential obstetrician in the country. Having been in eh employ of Johns Hopkins university since 1893, he was also the former Chief of Obstetrics at John Hopkins and then he was appointed Dean of the Johns Hopkins School of Medicine. As a result, Dr. Williams was acutely aware of that the dramatic change from medicine as a “healing art” to the medicine as a modern science was extremely disruptive to “the usual and ordinary” business practice of hospitals.

He knew that was particularly hard on the 8,000 or so small (2-to-10 beds) doctor-owned private for-profit hospitals that mostly provided 19th century “palliative” care to chronically ill patients (or family) who were able to pay for such services.

Before the turn of the century,  this was a reasonably stable and profitable economic model for small privately-owned hospitals. Then without warning lightning struck. In the blink of an eye, the private, low-key practice of medicine as personally defined by each doctor was suddenly been turned into the very public “modern medical science” that it still is today.

This was a massive game changer at many levels of society, as medical science began to immediately create a whole collections of what we now call medical “technologies” that every hospital worth its salt had to have at least one of. This was must-have, expensive equipment, like x-ray machines, industrial autoclaves, microscopes, ‘state-of-the-art’ ceramic-tiled operating rooms with big new overhead spotlights, etc. The list only grew longer with the passage of time.

What this meant for the 8,000 or so small hospitals sprinkled all over the country was sudden danger of going out of business unless they figured out how to “keep up with the Jones” by immediately upgrading and modernizing themselves.  But only a lucky few had their hands on enough money to do that. Most of these private boutique hospitals were economically marginalized businesses; it would be hard to convince the bank to front them a large amount of the money that would take many years (and much good business accume) to repay.

From his position at the very top of the food chain, Dr. JWW was very well aware of these facts. But he saw this as more of a political than a money problem. He knew the American Medical Association (AMA) would never permit funding for doctor-owned private hospitals to come from federal government. This was a no- no writ large, as AMA official insisted that government money would for sure open the door to the dreaded government “interference” in the sacred “doctor-patient relationship“. He’d have to find or invent a some kind of self-generating economic process that would produce a dependable revenue stream.

So Dr. JWW began looking a way to privately fund the modernization of these hospitals and also finance the purchase of the necessary  capital-intensive equipment such as the very expensive new x-ray machines, ceramic-titled operating rooms, and new laboratory equipment.

find or create

This also required These upgraded hospitals would to compete with larger hospitals, and in some cases, become fully-equipped general hospitals, which was Dr. William’s ultimate goal.  invented the revolutionary new idea of “elective hospitalization” of healthy patients.  Then he promptly applied his ideal to the hospitalization of healthy maternity patients, targeting white middle- and upper-class maternity patients as “paying customers” in order to generate a large and dependable revenue stream for the hospital.

His two-part plan first urged small hospital to put in new “lying-in” (i.e. maternity) wards and then specifically solicit the patronage (and return business) of well-off maternity patients. Maternity wards were naturally very profitable, since their patients were all healthy. Provide services to healthy women in the prime of life was more like running a bed and breakfast than a hospital.  With two million American women giving birth every year, the ‘baby business” would provide small hospitals with the much needed money to upgrade and modernize their physical facilities. It also allowed them to make capital intensive purchases, such as expensive new x-ray machines, new, ceramic-titled operating rooms, and laboratory equipment that would them to compete with larger hospitals, and in some cases, eventually become fully-equipped general hospitals, which was Dr. William’s ultimate goal.