TIME Magazine 1936 ~ Medicine & Childbirth: Nature v. Drugs

by faithgibson on September 3, 2012

in Contemporary Childbirth Politics

This is a reprint of an article on the 1936 convention of the American Medical Association (AMA) held in the spring of that year in Kansas City.  It was originally published in TIME Magazine on May 25, 1936.

One quote falls into the category of “the more things change the more they stay the same”.

Imagine these comments on Cesareans being made 76 years ago? Dr. Gertrude Siegmond Nielsen, 41, Norman, Okla. child specialist, wife of a University of Oklahoma physicist and mother of three said:

“The pains of childbirth have been grossly exaggerated in the minds of American women . . . by irresponsible allusions to the dangers of childbirth and by sensational magazine articles which have gone so far as to advocate Caesarean section as the only humane method of delivery.”

The other eye-opener was from Dr. De Lee himself:

Dr DeLee “thinks that “the increasing tendency to perform Caesarean section is to be condemned. There are too many of these operations being done by those who do not know how to do them or to discover reasons for their necessity.”

Medicine & Childbirth: Nature v. Drugs
TIME Magazine, Monday, May 25, 1936

^ ;-)^

More than 2,000,000 U. S. babies will be born to less than 2,000,000 U. S. women during 1936.

The majority of births will occur in the mothers’ own homes and in their own beds. Most of the confinements will be attended by some 100,000 “family” physicians, few of whom saw more than twelve deliveries while at medical school. These all-round doctors learned practical obstetrics mostly by watching Nature take its course with pregnant women. To them childbirth is a welcome commonplace which provides income of $50 to $150 per case.

To the average U. S. family, [childbirth] is an economic and emotional problem which occurs two or three times in a life span. To every nubile woman, it still evokes the Lord’s words to sinful Eve:”I will greatly multiply thy sorrow and thy conception. In sorrow thou shall bring forth children.”

The oldest Egyptian mummy known is a pregnant woman. After her gravid body was dried and bandaged, 4,600 years ago, her husband encased her in a tomb which was opened only last month. Ancient doctors used forceps (which killed the baby) and performed Caesarean sections (which killed the mother) in cases of difficult delivery. Hindus today often put a brazier of hot charcoal under the maternity bed to assist Nature. More primitive obstetricians help by jumping up & down on the pregnant woman’s abdomen.

Concern over the mothers’ comfort during confinement and health thereafter is a phenomenon so utterly modern that it caused a great splatter of headlines in the lay Press at the meeting of the American Medical Association in Kansas City last week (see p. 42).

The first doctor to soothe the pains of childbirth was Dr. James Young Simpson (1811-1870) of Edinburgh. In 1847 he used chloroform. Doctors and ministers denounced him for interfering with God’s will. Dr. Simpson persisted and died rich, knighted and famed.

In 1913 Drs. Bernard Kronig & Carl J. Gauss of Freiburg, Germany, invented twilight sleep, which they induced by injecting a combination of morphine and scopolamine into a woman who was about to have a baby. Lapsing into a dreamy state, the mother knows what is going on but feels little, gives no willful assistance to Nature.

In 1923 Dr. James Taylor Gwathmey of Manhattan proposed another combination of drugs for “synergistic anesthesia.” He produced drowsiness and anesthesia by injecting morphine and epsom salts into the mother’s muscles, quinine, alcohol and ether in olive oil into the rectum.

Last week at the A. M. A. convention, forward-looking obstetricians reviewed Krönig-Gauss twilight sleep and Gwathmey synergy and proposed other combinations of drugs to dull labor’s pangs. The doctors who rendered reports were enthusiastic about results. Their enthusiasm provoked Dr. Gertrude Siegmond Nielsen, 41, Norman, Okla. child specialist, wife of a University of Oklahoma physicist and mother of three, to pop up at an A. M. A. section meeting and cry:

“Child bearing is so essential an experience for a woman that the thwarting of its normal course by the excessive use of analgesics may cause great damage to her personality. If she is carried through delivery in an unconscious state, she is deprived of the experience of giving birth to her child and in some cases will pay for this escape from reality by nervous disorders.

“An analgesic that is perfectly safe for both mother and child has not been discovered. The use of anything that deadens sensation distorts the natural process of childbirth and depresses the respiratory functions of the child. Certainly no woman will wish to be relieved of pain at the risk of harm to her baby.

”Where fear causes pain, there is no cure. Even the use of drugs is ineffective. In childbirth, we are lucky because we have nine months in which to build up an understanding so that the mother-if properly instructed-will not have this fear. That is the modern physician’s duty.

“The pains of childbirth have been grossly exaggerated in the minds of American women . . . by irresponsible allusions to the dangers of childbirth and by sensational magazine articles which have gone so far as to advocate Caesarean section as the only humane method of delivery.”

Mention of magazine articles on maternity stirred A. M. A. obstetricians to angry outbursts. Indignantly recalled was the fact that U. S. mothers first heard of twilight sleep through the enterprise of McClwe’s Magazine in June 1914.* Now running in Ladies’ Home Journal is a series of blatantly emotional articles called “Why Should Mothers Die?” by Bacteriologist Paul de Kruif.

Cried Kansas City’s Dr. Buford Garvin Hamilton last week:

“American obstetrics seems to be becoming a competitive practice to please American women in accordance with what they read in lay magazines.”

At that, Chicago’s honest Dr. Rudolph Wieser Holmes, 66, stood up to declare:

“I was the man who first brought scopolamine to this country. I wish to God I hadn’t done it! I didn’t know what I was doing. I have seen hundreds of women die on the delivery table because of the wrongful use of drugs. The Utopia when physicians have a drug that is safe for both mother and child will come. But it will take a long time.”

When the emotions of the obstetricians subsided for a moment, Chicago’s Dr. Joseph Bolivar DeLee, generally rated the best obstetrician in the U. S., reverted to Dr. Nielsen’s point that the pains of childbirth are largely psychological. Said sage Dr. DeLee, a bachelor who has brought some 8,000 into the world with his own hands and supervised the deliveries of 100,000 more:

“It is not illogical to assume that the conditions of the mind affect the muscles active in childbirth. The best and safest aid to mothers will come when the obstetrician learns how to use suggestion. On occasion I have given a woman small doses of an innocuous substance, assuring her in doing so that the substance would put her to sleep. In such instances the woman actually did go to sleep, pure suggestion taking the place of drugs.”

Most physicians concede that childbirth is the most painful experience endured by human beings. Yet last week’s A. M. A. discussions on the alleviation of that physical agony were largely academic for the practical reason that two out of three normal births in the U. S: today are accomplished without any form of pain-killer for the mother.

Because the great majority of women bear this natural ordeal bravely, they have made no concerted demand for relief in childbed, nor have more than a handful of pioneer doctors attempted to give them any.

After last week’s debate a fair-minded physician would probably come to the following conclusions:

1) Semi-narcosis is still a perfectly reasonable, safe and feasible obstetric help, provided the doctor knows how and when to administer the necessary drugs;
2) Most doctors are ignorant of the uses and possible after-effects of childbed analgesics.

Dr. Joseph Bolivar DeLee, 66, ranks as No. 1 U. S. obstetrician because he founded Chicago’s great Lying-in Hospital, helped make obstetrics a learned and respected profession, demonstrated methods to prevent women from dying in childbirth.

Dr. De Lee (originally d’Lee) founded Chicago’s Lying-in Hospital in 1895 when Chicago’s poor mothers could get no decent midwifery care [i.e. when MDs provided care for normal childbirth, they were referred to as man-midwives and the form of care was referred to as “midwifery”] when he was abysmally poor and four years out of Chicago Medical College (now part of Northwestern University). After the Women’s Christian Temperance Union had ignored him, he turned to Chicago Jews who gave him a total of $500. A Christian doctor gave him a stove, a table, some chairs and an old carpet. His family supplied linen. From a second-hand store he got two beds.With that he started Chicago’s first maternity dispensary in $12-a-month flat in a Ghetto tenement.

“Constant poverty threatened to close the place,” reminisced Dr. DeLee, who later charged $2,000 to $3,000 for a delivery, in Kansas City last week. “On one occasion 13¢ and half a loaf of stale bread represented the floating assets of the institution. I went home and borrowed $10 from my father.”

At the turn of the Century Frederic Adrian Delano, uncle of Franklin Delano Roosevelt, gave Dr. DeLee’s pinched institution a big fillup by taking an interest that has never flagged. Dr. DeLee subsequently delivered four of Mr. Delano’s grandchildren.

Other high-born “DeLee babies”: Alice Roosevelt Longworth’s Paulina; Ruth Hanna McCormick’s (Simms’s) Katrina, Medill, Ruth. Such clientele helped Dr. DeLee prosper personally to such an extent that he could give Lying-in Hospital his check for $55,000 during a money-raising campaign. The Hospital is now affiliated with the University of Chicago. Dr. DeLee’s dream is to have associated hospitals affiliated with Chicago’s other great medical schools, Northwestern and Illinois, with Dr. Joseph Bolivar De Lee grand chief obstetrician for all Chicago.

In his time Dr. De Lee has taught obstetrics to more than 3,500 nurses, 7,000 medical students, and 540 postgraduate doctors. In Lying-in-Hospital, where babies are kept in glass cubicles to protect them from infection, 2,881 babies were born last year. Of them only 62 babies died*. Death came to only 15 mothers** at Lying-in. No other busy maternity hospital on earth can meet that record for low mortality.

[**editor’s note: Neonatal mortality for Dr De Lee’s Lying-in Hospital in 1936 was 1:47, or rate of 21 per 1,000 live births. MM ratio of 1:192 or 520 per 100,000 births. To contrast this with modern times, NNM rate for PHBs attended by licensed midwives in California in 2007 was 0.86 per 1,000 and the maternal mortality was zero.]

Dr. DeLee holds his death rate down by compelling pregnant women who have any infection to have their babies in a building widely separated from his regular maternity rooms. He also avoids maternal deaths by forbidding “meddlesome midwifery” {*ED: a reference to physicians interfering with normal labor and birth}.  He always waits for the baby to be born through the mother’s own efforts unless some accident of parturition or pelvic malformation compels him to use drugs or forceps.

His use of forceps was his chief reason for attending the convention of the American Medical Association in Kansas City last week. One of the twelve speakers at the general scientific meetings, he was asked to present his mile-long talking cinema called “The Forceps Operation”. One of 16 films in which Dr. DeLee shows the various ways in which a baby may be born, The Forceps Operation was the most popular event at the A. M. A. convention. Some 5,000 physicians attended the screening, heard Dr. DeLee clear his throat, saw Dr. DeLee, who once wanted to be an actor, perform with no camera shyness.

The action begins in Dr. DeLee’s lecture room. A nurse enters, asks,

“Are you ready, doctor? Dr. [Morris Edward] Davis thinks there may be a forceps case in the birth room.” Dr. DeLee reads the mother’s hospital chart, looks up, announces, “Forceps may really be needed. . . . Gentlemen, this is a forceps case. Let us proceed to the amphitheatre.”

There a woman, asleep under ether, is ready for delivery. Dr. DeLee surveys her, murmurs,

“Hm! Looks like a nine-pounder.”

Swiftly he nicks the woman’s vulva so that it will spread and prevent the birth from tearing the perineum. Deftly he inserts the forceps, engages the baby’s head, pulls with all his cleverness. The baby is born, apparently little disturbed by the greatest strain it ever will undergo the rest of its life.

Back in Chicago last week Dr. DeLee looked about for material for a new cinema to be called Local Anesthesia in Obstetrics. He performs Caesarean sections under local anesthesia, but thinks that:

“the increasing tendency to perform Caesarean section is to be condemned. There are too many of these operations being done by those who do not know how to do them or to discover reasons for their necessity.”

Other DeLee obstetrical aphorisms:

“The lack of prenatal care is responsible for many deaths, despite some improvement. It is safe to say that not 25% of American women get proper prenatal care. Puerperal infection still causes about 4,000 deaths a year in the U. S.” [one maternal death from infection following childbirth for every 500 deliveries ]

The frequency of operations which are followed by infection is a contributing cause. Many women get infections in hospitals when they are not properly isolated-they may be mixed with pneumonia or erysipelas. A small proportion of cases of puerperal infection is of course, unpreventable-women who catch colds or other infectious diseases.

“About 15% of deaths reported as infections are due to abortions. Every day in the U. S. at least three women die from abortion. Dr. [Frederick Joseph] Taussig told me that he guessed there are 700,000 abortions a year in the country [TIME, March 16]. My own hazarded estimation is nearer two million. Abortion, that is, the average criminal abortion, is more dangerous than having the baby. Instead of condoning abortion we should give people better methods of birth control.”

Like many another notable Dr. DeLee has his quirks. He always wears the kind of white pique ties and stiff collars which were fashionable in Chicago when he was a medical student. During office hours he wears a white surgeon’s jacket and carries a gold-plated stethoscope. In his office are floodlights for taking pictures, a small dark-colored desk and a narrow four-poster bed. On a wall is a picture of the Boy Christ in the Temple.

On Dr. De Lee’s birthday (Oct. 28) the adoring Mother’s Aid Club salutes him with the following ditty to the tune of The Man on the Flying Trapeze:

There once was a doctor whose name was DeLee
Best of obstetrical doctors was he.
Expensive for rich, for the poor he was free
This wonderful Dr. DeLee.
A wonderful doctor is Dr. DeLee
Bringing in babies by one, two and three,
His movies will show to all posterity
The marvels of Dr. DeLee.

*Authors: Constance D. Leupp & Marguerite Tracy. Said Mrs. Constance D. Leupp Todd last week: “My own twilight-sleep son is now 20 and a dandy.”


Tags: 1936, DeLee, Dr, Magazine, Sleep, TIME, Twilight, childbirth, forceps, pain

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