For the good of the nation: scientific discourses endorsing the medicalization of childbirth in Peru, 1900-1940

Over the course of the twentieth century, a series of changes occurred in the understanding of childbirth, which went from being a natural reproductive phenomenon belonging to the female, domestic sphere to a professional medical matter handled in an institutional setting. Through procedures like the use of anesthesia, Cesarean sections, ultrasound and other techno-scientific interventions, rapid and significant improvements and changes took place in the health and life of society and of women. The medicalization of childbirth in the early twentieth century was part of a broader process of constructing the state and institutionalizing the patriarchy that was common throughout the region.

[Women's complaint leadership in the Causa Kleinwächter. A contribution to patient history of the Innsbruck maternity hospital]

On the basis of the Innsbruck Maternity Clinic this paper deals with the individual and collective worlds of experience of obstetric patients. However, not only the patient's view on the proceedings in this specific medical space is being reconstructed, also the prevailing conventions surrounding the treatment of pregnant, parturient and puerperal patients serving as clinical material in obstetric research and education are critically scrutinised. At the centre of this paper stands Dr. Ludwig Kleinwächter's period of duty, who acted as professor for obstetrics and gynaecology in Innsbruck between 1877 and 1881. During this period numerous conflicts regarding the treatment of patients are documented. Concerned about the good reputation of the Maternity Clinic, the Tyrolean State Committee, as the Clinic's provider, tried to solve the crisis. The existing letters of complaint and protocols do not only give a voice to the women concerned, but also to the medical professions as well as the local political representatives involved.

Doris Gordon: foundation of a legacy

Doris Gordon Memorial Oration delivered to RANZCOG Annual Meeting, Wellington, 2 October, 2015.

[Historical Review of Cesarean Section at King's Maternity Hospital and Midwifery School Zagreb 1908-1918]

This article presents a historical review of the performance of 23 cesarean sections at the King’s Maternity Hospital and Midwifery School in Zagreb during the 1908-1918 period. Following prenatal screening by midwives and doctors in the hospital, deliveries in high risk pregnant women were performed at maternity hospitals, not at home. The most common indication for cesarean section was narrowed pelvis in 65.2% of women, while postpartum febrile condition was the most common complication in the puerperium. Maternal mortality due to sepsis after the procedure was 8.69% and overall perinatal mortality was 36.3% (stillbirths and early neonatal deaths).

[PROF. BESIM OMER PASHAS VIEWS ON POPULATION POLICIES DURING THE EARLY YEARS OF THE TURKISH REPUBLIC]

Dr. Besim Ömer Akalin, was a pioneer in modern obstetric and neonatal practices, and the founder of the first maternity hospital in Turkey. He established nursing as profession and promoted the development of modern midwifery. Besim Omer Pasha was also ins- trumental in the organization of the Turkish Red Crescent, the Institute for Protection of Children, and the Society for Tuberculosis Control. Professor Besim Omer Akalin chai- red the gynecology and obstetric clinics of the Medical Faculty, and was elected Rector of the Istanbul University. He also served as General Director of Health, and was a Member of the Grand National Assembly of Turkey in his later years. Together with his textbooks and treatises, Besim Ömer Akalin published booklets for the public where he addressed a wide range of topics on social health, hygiene and welfare.

[Introduction of the psychoprophylactic method and its influence on the prenatal care program for institutional parturition in Japan: the practice in the Central Hospital of Maternity of the Japanese Red Cross Society and Oomori Red Cross Hospital, 1953-1964]

The psychoprophylactic method is one of the methods for providing 'painless childbirth without drugs' and was invented by applying I. Pavlov's theory of higher nervous activity. In 1951, it was adopted as a national policy in the Union of Soviet Socialist Republics. This method was then introduced in the People's Republic of China in 1952. In 1953, it was brought to Japan by Masatomo SUGAI, an obstetrician, and was introduced into the Central Hospital of Maternity of the Japanese Red Cross Society with the support of the director, Naotarou KUJI. The practice of this method by the research team, which consisted of the obstetricians and midwives of the Central Hospital of Maternity of the Japanese Red Cross Society and Oomori Red Cross Hospital, resulted in the initiation and characterization of the prenatal care program to encourage the autonomy of the pregnant women for normal parturition in the institutions of Japan.

[The "secret book" of Dr Friedrich Benjamin Osiander: anonymous births in the Göttingen Accouchierhaus, 1794-1819]

The problem of anonymous or confidential deliveries, a subject of current controversy, has a long history. Some maternity hospitals offered the possibility for "clandestine" births as early as the 18th and 19th century. A recently emerged source about the maternity clinic of Göttingen University allows insight into the motives that led to keeping a birth secret and the consequences of such a clandestine birth for mother, father and child. The director of the institution, a professor of obstetrics, wrote case reports on the women, who paid a handsome sum for his help and the in-patient care they received. In return, these women could be admitted under a pseudonym, and thus falsify their child's birth certificate; moreover they were not used as teaching material for medical students and midwife apprentices, whereas "regular" patients had to give their names and, in return for being treated free of charge, be available for teaching purposes. The ten cases that have been painstakingly investigated reveal that the reasons that led the women and men to opt for an anonymous birth were manifold, that they used this offer in different ways and with different consequences. All of these pregnancies were illegitimate, of course. In one case the expectant mother was married. In several cases it would be the father who was married. Most of the women who gave birth secretly seem to have given the professor their actual details and he kept quiet about them--with the exception of one case where he revealed the contents of the case report many years later in an alimony suit. Only one of the men admitted paternity openly, but many revealed their identity implicitly by registering the pregnant woman or by accompanying her to the clinic. If the birth was to be kept secret the child needed to be handed over to foster parents. By paying a lump sum that covered the usual fourteen years of parenting, one mother was able to avoid any later contact with her son. In most cases contact seems to have been limited to the payment of this boarding money. One of the couples married later and took in the twins that had been born clandestinely out of wedlock. One mother kept close contact with her son through intermediaries. All of the women who gave birth in this clandestine fashion received practical as well as financial support, often from the child's father or from a relative. Few of them came by themselves. In those days, only women who used the maternity hospital free of charge would have been as isolated in the difficult perinatal period as are women today who choose to deliver their babies anonymously.

Charting the history of midwifery education

Despite the recent popularity of exploring the history of midwifery practice, there has been minimal attention paid to the history of midwifery education. The purpose of this paper is to display a visual map and timeline of midwifery education from the eighteenth century, when formal midwifery programmes were introduced, to the present day. The paper will be inclusive of the history of midwifery teaching through the use of the High Coombe College archives (Lorentzon et al 2008). Prior to the eighteenth century, processes for learning midwifery were informal and unregulated. Traditional apprenticeships were gradually replaced by formal, regulated educational midwifery programmes, which were assessed. Midwifery teacher training finally became established in the twentieth century.

Saving mothers' and children's lives?: the performance of German lying-in hospitals in the late eighteenth and early nineteenth centuries

Medical men, turning to midwifery in the eighteenth century, claimed that they were able to save the lives of mothers and children, jeopardized by "ignorant" midwives. Consequentially, modern scholars have tried to assess the progress of obstetrics and the merits of lying-in hospitals on the basis of maternal and, more rarely, perinatal mortality rates. The data and methodological problems involved, however, have been largely ignored. Here they are discussed in the light of a micro-study based on detailed archival evidence from Göttingen University's lying-in hospital, founded in 1751. Its mortality data are analyzed in comparison to those from other German and some foreign maternity hospitals. In a further step, perinatal and maternal mortality in hospitals is compared to that in normal home deliveries, attended by female midwives. By linking the findings to the eighteenth- and nineteenth-century debates about the pros and cons of lying-in hospitals, further questions are raised.

Releasing mother's burdens: child abandonment and retrieval in Madrid, 1890-1935

In nineteenth-century Europe, the foundling hospital grew beyond its traditional purpose of mitigating the shame of unwed mothers by also permitting widows, widowers, and poor married couples to abandon their children there temporarily. In the Foundling Hospital of Madrid (FHM), this new short-term abandonment could be completely anonymous due to the implementation of a wheel—a device on the outside wall of the institution that could be turned to place a child inside—which remained open until 1929. The use of survival-analysis techniques to disentangle the determinants of retrieval in a discrete framework reveals important differences in the situations of the women who abandoned their children at the FHM, partly depending on whether they accessed it through the Maternity Hospital after giving birth or they accessed it directly. The evidence suggests that those who abandoned their children through the Maternity Hospital retrieved them only when they had attained a certain degree of economic stability, whereas those who abandoned otherwise did so just as soon as the immediate condition prompting the abandonment had improved.

[A look into the past: improves in obstetrical and neonatal outcome in maternity since the 19th century]

OBJECTIVE

Evaluate changes in obstetrical and neonatal outcome of women who delivered in maternity hospital since the 19(th) century.

MATERIALS AND METHODS

Data from a historic cohort of 1022 women who delivered between 1871 and 1874 in the hôtel Dieu hospital of Marseille were compared to those from 1159 women who delivered from 2005 to 2006 in the level 3 maternity of Nord hospital of Marseille (contemporary cohort). Deliveries that had occured before 22 weeks and/or with a foetal birth weight of less than 500 g were excluded.

RESULTS

A total of 2131 pregnancies were included: 1011 and 1120 in historic and contemporary cohort, respectively. Despite comparable mean term of delivery, mean birth weight of neonates from historic cohort were significantly lower: 2971 g (550-4900 g) vs 3250 g (500-5375 g), respectively (p<0.001). Stillbirths were reported in 72 (7.1%) cases in historic cohort compared to nine (0.8%) in contemporary cohort (p<0.001). Neonatal mortality was 3.7% in historic cohort and 1.9% in contemporary cohort (p=0.012). A total of 99 (9.8%) maternal deaths were reported in historic cohort, while none in contemporary cohort (p<0.001). A wide majority of maternal deaths were caused by maternal infection (72.9%); 5.2% were caused by postpartum haemorrhage.

CONCLUSION

Our results illustrate the tremendous impact on maternal and neonatal outcome of advances in obstetrical management. The significant increase in the median foetal birth weight is likely to be related to wide changes in environmental conditions and behaviour.

[Robert Ziegenspeck (1856-1918), 'Don Quixote' of out-patient gynaecology. Amendment to my essay about Thure Brandt in this Journal, Vol 26]

In 2007 I described a massage method that was developed by the Swedish officer Thure Brandt (1819-1895) and promoted by German physicians, especially Robert Ziegenspeck. But all files about Ziegenspeck seemed to be lost until two of them were rediscovered by chance in 2009. They offer insight into the desperate situation of German gynaecological hospitals in the late 19th century and the consequences for the young reformer Ziegenspeck who wanted to protect women's health against his colleagues' arbitrariness.

[Women, the press, and hygiene: the medicalization of birth in Bahia (1910-1927)]

The article discusses the role played by the lay press in disseminating the hygienist agenda in the city of Salvador, Bahia, in the early twentieth century, when journalists were writing about medicalized birth and the new standards of attention to the female body and to newborns. The Climério de Oliveira Maternity Hospital enjoyed the unrestricted support of the press, which went out of its way to portray the facility as ideal for hospital births.

'Because of poverty brought into hospital: ...' A casenote-based analysis of the changing role of the Edinburgh Royal Maternity Hospital, 1850-1912

Although the shift from a social to a medical function which occurred in nineteenth-century general hospitals has been explored, the occurrence of such a change in maternity hospitals has not been considered. Recent analyses of such institutions have examined particular aspects only, and thus give a somewhat static picture. This paper uses analysis of patient records (themselves an under-exploited resource) to explore the changing function of the Edinburgh Royal Maternity Hospital from a provider of shelter during childbirth to the destitute to a source of skilled medical care. It concludes that, although the Hospital had adopted the outward features of a medical institution by 1890, its casebooks suggest that its purpose only decisively changed in the early twentieth century, and thus can perhaps be more appropriately linked with national anxiety regarding the health of babies and their mothers.

The role of the Doran Building in puerperal fever in Canada

The Doran Building at the Kingston General Hospital, opened in 1894, represents an early Canadian initiative to apply the principles of sanitation, antisepsis, and asepsis to prevent puerperal fever ina freestanding lying-in hospital. This initiative was a response to maternal mortality during the 17th and 18th centuries, when approximately half of maternal deaths were due to puerperal fever. During the 250 years leading up to 1890, an understanding of the clinical nature of puerperal fever, its cause, mode of spread, and means of prevention had gradually developed. Despite this progress, puerperal fever remained a major cause of maternal mortality in the latter part of the 19th century. The Doran Building is a compact example of a pavilion hospital,built as a freestanding facility for women and children, with its own staff. Kenneth Fenwick, who was Professor of Obstetrics and Gynaecology at Queen's University and a vigorous advocate of sanitation, antisepsis, and asepsis, established the principles of patient care in the Doran Building during the period 1894 to 1928.His goal was the prevention of maternal mortality due to puerperal fever. During this period, there was a modest increase in the number of deliveries each year to a total of 3111 by 1928. There were 26 direct and indirect maternal deaths, representing a maternal mortality rate of 8.25 per 1000 live births. Puerperal fever accounted for the deaths of three women: one who had delivered in hospital and two who had delivered in the community and had been admitted following delivery. The application of the principles of isolation, sanitation, antisepsis, and asepsis limited the mortality in hospital due to puerperal fever in a manner consistent with the best hospitals elsewhere at that time.

[Ethical dilemma in the Women's Hospital of Basle. Diaconesses took a stand on abortions]

In the 1940s there occurred an ethical conflict in the Women's Hospital of Basle. It arose in the context of a shortage of nurses, the introduction of the Swiss national criminal law, the change of the hospital director, the increase of abortion and the nursing ideal of obedience and serving. The conflict showed the social change towards measures of birth control such as abortion and sterilisation. Different political opinions and strong convictions clashed. The paper is focusing on denominationally affiliated nurses, the deaconesses of Riehen, who were standing between the religious conviction to protect unborn life and the professional principle of unconditional nursing. Finally they decided to leave the hospital.

Lying-in and laying-out: fetal health and the contribution of midwifery

This article considers the quality of midwifery skills and practice principally in eighteenth-, nineteenth-, and early twentieth-century England. It discusses the merits of assessing effectiveness via differentials and changes in late-fetal rather than maternal mortality. Evidence from the lying-in hospitals, both in-patients and out-patients, in terms of stillbirths and the deaths of mothers and children is set against what is known from demographic studies of the background levels of early-age and maternal mortality. The conclusions emphasize the value of taking a "fetal health" perspective, rather than viewing midwifery simply in terms of maternal well-being. They also note the apparent superiority of London's position compared with the provinces and the steady improvement during the eighteenth century, and lack of progress during the nineteenth; and they reconfirm the particular dangers to mothers delivered as hospital in-patients. Finally, the considerable methodological problems faced by such studies are emphasized.

[Childbirth without pain. Politics in France during the cold war. ]

Dr. Lamaze introduced Natural Childbirth (ASD) in France in 1951. While this event is significant to the history of obstetrics and women's experience, we would like to concentrate upon another aspect here: how it is situated within the political debates of the period. In the midst of the Cold War, Lamaze was a sympathizer, although not a member of the Communist Party (PCF). He ran a maternity clinic for the CGT, a union affiliated with the PCE During a trip to Russia in 1951, he discovered a new method to relieve pain in labour through a psychological technique inspired by Pavlov. Upon his return, when he dedicated his energies towards the popularization of ASD, he looked for support from the PCF and to draw upon their propaganda network; this subsequently aroused suspicion and hostility. A few years later, ASD received the blessing of women's groups won over by its improvements to birthing. At the moment of Lamaze's triumph, he fell victim to a resurgence of Stalinism. With his team, he denounced the Soviet invasion of Hungary and lost the financial support of the unions which owned the clinic. Exhausted and profoundly disappointed, he died in March 1957.

Hempelian and Kuhnian approaches in the philosophy of medicine: the Semmelweis case

Semmelweis's investigations of puerperal fever are some of the most interesting in the history of medicine. This paper considers analysis of the Semmelweis case. It argues that this analysis is inadequate and needs to be supplemented by some Kuhnian ideas. Kuhn's notion of paradigm needs to be modified to apply to medicine in order to take account of the classification schemes involved in medical theorising. However with a suitable modification it provides an explanation of Semmelweis's failure which is argued to be superior to some of the external reasons often given. Despite this success in applying Kuhn's ideas to medicine, it is argued that these ideas must be further modified to take account of the fact that medicine is not a natural science but primarily a practice designed to prevent and cure diseases.

Living and dying in Georgian London's lying-in hospitals

This article uses previously untapped archival sources to revise the dominant, negative view of London's eighteenth-century maternity hospitals, by reconstructing daily life at the British Lying-in Hospital. Though the hospital in fact helped to support women's work as midwives, its institutional practices altered the experience of childbirth both negatively and positively, which inspired rumors, criticism, and inflammatory published attacks. The article illuminates how two unrecognized events in 1751-the hospital's first epidemiological crisis, and the arrival of a new man-midwife who used instruments-may have become intertwined in the public imagination and helped to shape the terrible reputation of lying-in hospitals, despite their overall positive eighteenth-century record.

[A watershed in Norwegian obstetrics]

BACKGROUND

Professional obstetrics in Norway developed during the 19th century. This paper analyses the development through the second half of the 19th century at the Maternity Clinic in Christiania (now Oslo).

MATERIAL AND METHODS

All patient files from the years 1852, 1872 and 1892, a total of 1231 records, were analysed. Socio-demographic and gynaecologic data were registered as well as data about the delivery and the child.

RESULTS

The number of deliveries increased nearly five times during the period. The proportion of married women increased from less than 20% to nearly 50%. Maternal mortality decreased from above 3% to below 1%, mostly because childbed fever became infrequent. The number of operative deliveries increased substantially, particularly the use of the obstetric forceps, in 1892 utilised in 6 % of deliveries. In the reviews published in those days, eclampsia and reduced contractions were the most frequently cited indications for the use of the obstetric forceps. Problems with the heart sound of the fetus were not mentioned. However, patient files demonstrate that a weak or missing heart sound of the fetus was also an important indication for the use of the forceps.

INTERPRETATION

Giving birth at the clinic was gradually becoming an alternative for other than poor women, because it was safer than before and in some cases the obstetricians could offer effective help. However, at the end of the 19th century, not more than about 15% of all deliveries took place at the clinic. This paper demonstrates the importance of scrutinising patient files as a supplement to register data, as is the case today, too.

'The pregnant women are here for the sake of the teaching institution': The lying-in hospital of Göttingen University, 1751 to c. 1830

Drawing on the admission records, the medical casebooks and the publications of its director, this article explores how the University of Göttingen's maternity hospital achieved its three official goals: teaching medical students, training female midwives, and providing shelter for needy parturient women. Since educating medical men was the most important aim of the hospital, the paper particularly focuses on how the demands of instruction shaped day-to-day obstetrical practices, especially under the directorship of Professor Friedrich Benjamin Osiander (1792-1822). He was a keen advocate of the forceps, whereas the first director, Professor Johann Georg Roederer (1751-63), had taken a moderate, that is a much less interventionist, approach to obstetrics. Osiander avowedly was determined to subordinate the parturient women to the demands of the clinic and to treat them as 'living manikins'. In spite of that, there is evidence that the pregnant and parturient women, most of whom were unmarried and from the lower classes, made use of the lying-in hospital for their own purposes, and that sometimes they refused to play the role assigned to them. The link between the maternity hospital and the rise of the man-midwife and of 'scientific' obstetrics appears to have been particularly strong in the case of Göttingen and other German university hospitals, compared with lying-in hospitals in other countries where the link was more indirect.

Mothers' involvement in caring for their premature infants: an historical overview

BACKGROUND

Advances in technology have resulted in increasing survival rates even for extremely premature infants. While sophisticated medical management is vital to infant survival, research has found that social factors and care giving processes are important predictors of infants' later outcome. Consequently, evidence is accumulating to demonstrate the fundamental role of mothers and families to the optimal developmental outcome of premature infants.

AIM

The aim of the work reported here was to undertake an historical overview of premature infant care practices to increase neonatal nurse's knowledge of the crucial role of mothers and families in the care of their premature infants. Understanding past practice and current trends can provide neonatal nurses with critical insight which will assist in formulating current and future care.

METHOD

Research and historical articles focusing on maternal involvement in preterm infant care from the development of the incubator to the present time were examined. A search of the literature between 1960 and 2002 was conducted using the MEDLINE, CINAHL and PSYCLIT databases. The search terms were premature infant, neonatal intensive care, history, and maternal care.

FINDINGS

Three major themes were identified which reflect the development of neonatal care. Firstly, over the last century advances in medical and public health practice saw a decline in mortality rates for mothers and infants. Secondly, the application of this new knowledge resulted in the institutionalization and professionalization of obstetric and neonatal care which, in turn, resulted in the isolation of infants from their mothers. Finally, concurrent advances in infant research emphasized the importance of mother-infant relationships to infants' developmental outcome, resulting in greater flexibility in hospital practices regarding parental contact with their infants.

CONCLUSION

As biomedical advances in technology continue to help smaller, sicker premature infants to survive, neonatal nurses are strategically placed to promote positive outcomes for infants and their families through the integration of social science and behavioural research into nursing practice.

Mothers' health and babies' weights: the biology of poverty at the Melbourne Lying-in Hospital, 1857-83

Birth weight remains a major focus of medical research into the relationship between pre-natal growth and life course health, and historians have used mean birth weight to assess women's standard of living. However, there are intrinsic difficulties in inferring maternal health and nutritional status from birth weight, and some of the known data sets produce puzzling results. One rich data set comes from the Melbourne Lying-in Hospital, 1857-83, and the article discusses the complex institutional, social, and economic causes that may underlie its apparently counter-intuitive anthropometric results. This data set reveals the biological effects differential social conditions can inflict, even within an otherwise affluent society.

[Patients as "living manikins"? Göttingen University's maternity hospital ca. 1800]

The maternity hospital in Göttingen, founded in 1751, is considered to be the first in the world which was part of a university. Its main purpose was to train male medical students. Secondary aims were to instruct female midwives and to provide a haven for poor pregnant and lying-in women. The hospital was open to all women, without discriminating against foreigners, or any religion or race. Almost all patients were not married, and the overwhelming majority were servants. This article makes use of printed as well as archival material, mainly from the period when Professor Friedrich Benjamin Osiander was the hospital's director, i. e. 1792-1822, in order to show how the patients were used for developing and teaching 'scientific' obstetrics and man-midwifery.

["Where the doctors (...) handled the women beastly (...)". The Marburg lying in hospital from the view of the women]

In the statement she made in 1864, the housemaid, Elizabeth Gunkel, accused of infanticide, is reported to have said that she would have preferred to have drowned herself rather than look for a lying in hospital in which to give birth to her child. Even though they were feared by pregnant women due to the dubious--and often fatal--experiments performed there, lying in hospital continued to be the only places left for unmarried, abandoned or poverty-stricken women under financial or moral pressure to resort to. The lecture supplies a graphic illustration of the dynamics of interplay taking place in the process of medicalization within the system in which pregnant women became involved--state, legal system, church, science, traditional life-styles. As such is given a vivid picture of the daily life of women in the 19th century who became pregnant not by choice--their fears, hopes, despair and resistance to an environment in which they saw little real chance for themselves.

The Ladies Committee of the Women's Hospital, Castlegate, Nottingham, 1880-1900

This study co*siders the management of a small provincial and specialist hospital, the Women's Hospital, Castlegate, Nottingham, during the closing two decades of the 19th century. The unusual administration of such an institution by the Ladies committee is examined and the resulting conflict between female authority and the male medical hegemony is described. It is contended that the growing confidence of these women throughout these years in administration and organisation culminated in their renewed constitutional demand for suffrage in 1909.

[The Leipzig University Gynecologic Clinic (Trier Institute) from its establishment in 1810 to 1945]

At the beginning of the 19th century the childless couple Trier gave a plot of land to Leipzig University with the impost of founding a maternity hospital (Accoucheur Institute) and demand to take their family name as clinic name. The institute was erected in 1810 and later (1892) extended as a department of obstetrics and gynecology. The Women's Clinic of the University ("Triersches Institut") developed very favorably through the 19. and 20. century, including the difficult time of national socialism and the years after World War II. This is documented by it's expansion with several enlargements and new buildings. The institution acquired a remarkable national and international reputation due to prominent scientific and clinical results of the famous professors working at the place such as Jörg, Credé, Zweifel, Stoeckel, Sellheim and Robert Schroeder.

The foundation and evolution of the Middlesex Hospital's lying-in service, 1745-86

The Middlesex Hospital was founded in 1745, and opened the first British in-patient lying-in service in 1747. Men-Midwives were instrumental in founding and supporting the service. The hospital's lying-in service featured prominently in its fundraising literature, and the level of demand from benefactors suggests it was popular. From 1764 the hospital also provided domiciliary services, initially to cope with excess demand and later to compete with domiciliary charities. In 1786 it closed the in-patient services, and from this date provided only domiciliary lying-in services. From 1757, in common with the London lying-in hospitals, the Middlesex Hospital faced competition from a domiciliary charity: The Lying-In Charity for Delivering Poor Married Women in Their Own Homes. Later in the century it also faced competition from dispensaries. This paper describes the foundation and evolution of the Middlesex Hospital's lying-in service, including quantitative information about admissions and about the hospitals income and expenditure during the eighteenth century. It compares the characteristics of domiciliary and in-patient services, to analyse why in-patient services were supported by men-midwives and by benefactors.

[The research on the premature brain as a multidisciplinary model at the Baudelocque de Paris Clinic, 1942-1962]

Studies on the premature brain started in France in the Baudelocque clinic in Paris. It was the opportunity for a new clinical and epistemological paradigm: the pluridisciplinary model. The need to save and prevent premature babies led the founder of this research, Alexander Minkowski, to gather together, in the same laboratory, biochemistry, anatomo-pathology, electrophysiology and developmental science. The models of the premature brain helped establish a scale of biological maturation, the degrees of neurobiological development, and the electric intensity of mental states.

[The Charity (La Caridad) Hospital in Coruna. Foundlings and secret deliveries]

The ideas of the Age of Enlightenment brought about an important advance in the attitudes regarding education and the importance that children have in society. This made it possible to start opening dispensaries, to paying more attention to child care, to contemplating special measures in the care for foundlings and for those mothers who were not able to give birth to their children inside a family structure. This article analyzes the cases of foundlings in La Coruña during the 18th and 19th centuries bearing in mind the care provided by the Charity Hospital in La Coruña and in the Maternity Center in Lugo. A summary of this article was presented as a open communication at the 16th National Congress of Nursing for Neonatal and Pediatrics Intensive Care.

[Maternity in Geneva (1874-1907), a new entrance portal into life?]

Geneva's maternity hospital was set up in order to answer the needs of the new medical school in the 1870's. The early years of the Geneva maternity hospital illustrate the heterogeneity of the first generation of teachers as well as the difficulties of the school to gain control of appointments and autonomy in the management of clinics and courses. The sources used allow insights into two apparently separate fields: the social organisation of childbirth and the difficulties of a generation of doctors and teachers to adapt to rapidly changing medical knowledge.

Harsh lessons of history

Reading Janet McCalman's history of the Royal Women's Hospital, Melbourne, is a humbling, emotional experience. It tells us so much about women--as nurses, as patients, and as childbearers, wives, victims, sufferers, champions. For nurses, and particularly for those of us who are midwives, it presents a remarkably unsanitized--and at times confronting account--of our profession.