Dr. Isaac Rand and the “Important Branch of Obstetrics”
Isaac Rand (1743-1822) went into medicine. He trained with Dr. James Lloyd, and like his mentor he sided with the Crown when war broke out and stayed in Boston through the siege. However, both men opted not to leave with the British military.
Within a few months of the evacuation, Rand was managing a smallpox hospital for the local authorities. He overcame suspicions about his political leanings by staying out of the fight and working hard for his patients.
After the war, Rand became a founding member of the Humane Society of Massachusetts, the Massachusetts Medical Society, and the Massachusetts Bible Society.
Dr. James Thacher wrote of Rand:
Previous to this period strong efforts had been made by the physicians of Boston, and more particularly by the late Dr. James Lloyd, to rescue from the hands of unqualified females, the important branch of obstetrics, and to raise it to an honorable rank in the profession. So great was considered the necessity of changing the practice in this respect, that Dr. L., even while engaged in the most extensive and lucrative business in the town, made a visit to Europe partly for the purpose of qualifying himself for the exigences which the practice of this highly responsible and important branch of obstetrics continually furnishes. His efforts succeeded; that business gradually fell into the hands of the physicians, and Dr. Rand and his contemporaries completed what had been begun by Dr. Lloyd. In this branch Dr. R. acquired a high and deserved reputation.That of course reflects a physician’s professional bias about who’s best at birthing babies.
The engraving of obstetrical forceps above originally appeared in André Levret’s Observations sur les causes et les accidens de plusieurs accouchemens laborieux, published in 1750. The image comes from this National Institutes of Health history of cesarean sections.
6 comments:
He says that doctors are better than midwives, but the opposite was true. The risk of the deadly infection known as "child-bed fever" was much higher with doctors (mainly because they dissected dead bodies with the same hands and didn't wash them.) Freaknomics Radio recently did an interesting episode about this:
http://www.freakonomics.com/2012/01/19/what-do-hand-washing-and-financial-illiteracy-have-in-common-a-new-freakonomics-radio-podcast/
The study the Freakonomics crew talked about was done in a Vienna hospital in the 1840s, and the same conditions didn’t necessarily apply in late-1700s Boston. As you note, the doctors in Vienna were tending to patients right after doing autopsies without washing their hands. The midwives didn't necessarily wash their hands more often, but they didn't muck about with dead bodies so much. Before widespread autopsies and maternity hospitals, there might have been less difference in the outcomes of births treated by midwives and those treated by physicians. But I doubt anyone did serious studies in early Federal Boston. Doctors probably won out with the top classes because they were modern, male, and more expensive, thus more prestigious.
I should add that this was also a period of professionalization within medicine: the founding of the Massachusetts Medical Society and the Harvard Medical School, and the examination and approval of young doctors by boards of older ones. That system replaced the apprenticeship training that Rand and most of his predecessors had gone through. Soon doctors were expected to have college degrees, and eventually licenses. And the college degree further separate them from female midwives.
One of the interesting things to note about obstetricians vs. midwifery is the beginning of birthing interventions. This holds true even today, and the illustrations of medical forceps and other tools that a doctor would carry (but a midwife in the 18thc. wouldn't) are still in use. Midwives that practice in a hospital have these available for use, too, but I believe many midwives who attend home births or low-intervention birthing centers would not use these.
I find birth fascinating no matter the time period, so thank you for posting this very interesting article!
Well, John, here I am in a hospital with my wife, waiting for this baby to come along, and I open your site to catch up....
How fortuitous!
Well, for goodness' sake don't show your wife that picture!
(Hope all's going well.)
Post a Comment