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Gynecology and Obstetrics

Unlike most of the nascent fields featured in this exhibit, obstetrics and gynecology spent most of the early 19th century in a state of general stagnation.1 Except for the vaginal speculum, which went through several major iterations from 1801 to 1850, new technologies in these fields were slow to develop. Due to persistent taboos marking midwifery as 'women's work' (and more general taboos surrounding the handling of female genitalia by men), many male doctors eschewed these fields. Babies had been delivered almost exclusively by women for most of history—and, for most of history, women had been denied access to degree-granting medical institutions.2 However, some female midwife-obstetricians, like the inventor of the bivalve speculum, Marie-Anne Boivin, still earned recognition for eminent careers.3 A tradition of medically-trained male midwives called accoucheurs also existed in France from about the 17th century.4

In the second half the century, three Parisians delivered obstetrics into a new era. The first, Etienne Stephane Tarnier, observed that maternal mortality was a staggering thirteen times higher in hospital births than in home births; at the time, puerperal feverperinatal uterine infectionwas killing up to one in six women at the Maternité Port-Royal, where Tarnier worked. Tarnier correctly concluded that infections were being transmitted throughout the hospital via unwashed hands and shared linens, and instituted new hygienic practices which dramatically reduced maternal mortality.5 Over the course of a revolutionary career, Tarnier designed a new forceps (c.1877) which followed the pelvic curve, making them less injurious to both mother and child, and introduced the first closed, insulated incubators for premature infants (c.1881).6 One of Tarnier's students, Pierre Budin, helped lower the infant mortality rate in Paris by demonstrating the importance of supporting new mothers with access to professional care and up-to-date information; he maintained relationships with his patients after they had given birth (not a common practice at the time), conducting weekly examinations and infant weigh-ins at the neonatal clinic he established in 1892.7 Another of Tarnier's students, Adolphe Pinard, invented an obstetric stethoscope and laid out guidelines for cephalic version, a procedure for manually coaxing a fetus out of breech position.8 Also in the late 19th century, new types of gynecological surgeries were explored, particularly for the repair of vesicovaginal fistulae and the removal of ovarian and uterine cysts, fibroids, and tumors.9 Hysterectomies were occasionally performed in the 19th century but were usually fatal, especially before antiseptic practices caught on in the 1880s.10

Notes

  1. Gelis, History of Childbirth, 96-8.
  2. See O'Dowd, The History of Obstetrics and Gynecology, 169ff.
  3. O'Dowd, Hisotory of Obstetrics, 404; Burton, Napoleon and the Woman Question, 98-99.
  4. Drife, "The start of life," 312.
  5. Dunn, "Stephane Tarnier," 137; Drife , "The start of life," 313.
  6. O'Dowd, The History of Obstetrics, 144-5; Dunn, "Tarnier," 138; Rebovich, "Tarnier."
  7. Dunn, "Professor Pierre Budin," 193-4; Rebovich, "Pierre Budin."
  8. Dunn, "Adolphe Pinard," 231-2.
  9. O'Dowd, History of Obstetrics, 491-2.
  10. Lowy, A Woman's Disease, 26-34. See also the Cancer section of this exhibit.
  11. For a review of the ethical controversy surrounding Sims, see Ojanuga, "The medical ethics of the 'Father of Gynaecology."

Bibliography

    • Burton, June K. Napoleon and the Woman Question: Discourses of the Other Sex in French Education, Medicine, and Medical Law 1799-1815. Texas Tech University Press, 2007.
    • Dunn, P.M. "Adolphe Pinard (1844-1934) of Paris and intrauterine paediatric care." Archives of Disease in Childhood—Fetal and Neonatal Edition 91.3 (2006): 231-232. DOI: 10.1136/adc.2005.074518.
    • Dunn, P.M. "Professor Pierre Budin (1846-1907) of Paris, and modern perinatal care." Archives of Disease in Childhood—Fetal and Neonatal Edition 73.3 (1995): 193-195.
    • Dunn, P.M. "Stéphane Tarnier (1828–1897), the architect of perinatology in France." Archives of Disease in Childhood—Fetal and Neonatal Edition 86 (2002): 137-139. DOI: 10.1136/fn.86.2.F137.
    • Drife, J. "The start of life: a history of obstetircs." Postgraduate Medical Journal 78 (2002): 311-315. DOI:10.1136/pmj.78.919.311.
    • Gelis, Jacques. History of Childbirth. Boston: Northeastern University Press, 1991.
    • Lowy, Ilana. A Woman's Disease: the history of cervical cancer. Oxford University Press, 2011.
    • O'Dowd, Michael J. The History of Obstetrics and Gynecology. New York: Parthenon Publishing Group, 1994.
    • Ojanuga, Durrendra. "The medical ethics of the 'Father of Gynaecology', Dr J Marion Sims." Journal of Medical Ethics 19 (1993): 28-31.
    • Rebovich, Kelsey. "Etienne Stephane Tarnier (1828-1897)." The Embryo Project Encyclopedia. Published 19 July 2017. Accessed 9 June 2018.https://embryo.asu.edu/pages/etienne-stephane-tarnier-1828-1897 .
    • Rebovich, Kelsey. "Pierre Budin (1846-1907)." The Embryo Project Encyclopedia. Published 11 February 2017. Accessed 8 June 2018.https://embryo.asu.edu/pages/pierre-budin-1846-1907.