The Tensions & Controversy Surrounding
Physician Education and its Relationship with
Training Schools for Midwives

Historical Situation

~ "The story of medical education in the country is not the story of complete success. We have made ourselves the jest of scientists through out the world by our lack of a uniform standard. Until we have solved the problem of how NOT to produce incompetent physicians, let us not complicate the problem by attempting to properly train a new class of practitioners. The opportunities for clinical (i.e. "bedside") instruction in our large cities are all too few to properly train our nurses and our doctors; how can we for an instant consider the training of the midwife as well?" [1911-C, p. 207] ^16

~ "It is generally recognized that obstetrical training in this country is woefully deficient. There has been a dearth of great obstetrical teachers with proper ideals and motives but the deficiency in obstetrical institutions and in obstetrical material for teaching purposes has been even greater. It is today absolutely impossible to provide material." [1912-B, p. 226 ^16-B

~ "In all but a few medical schools, the students deliver no cases in a hospital under supervision, receive but little even in the way of demonstrations on women in labor and are sent into out-patient departments to deliver, at most, but a half dozen cases. When we recall that abroad the midwives are required to deliver in a hospital at least 20 cases under the most careful supervision and instruction before being allowed to practice, it is evident that the training of medical students in obstetrics in this country is a farce and a disgrace. It is then perfectly plain that the midwife cases, in large part at least are necessary for the proper training of medical students. If for no other reason, this one alone is sufficient to justify the elimination of a large number of midwives, since the standard of obstetrical teaching and practice can never be raised without giving better training to physicians." [1912-B, p.226] ^17

~ "I hold that is little less than criminal to permit (physician) practitioners of medicine to jeopardize the life and health of human beings by performing upon them operations which they have not done, and perhaps have never seen performed in their student days. The average practitioner who gains his experience in obstetric operating solely upon his own responsibility rarely ever learns to do it safely, and therefore, always remains a menace to his patients, and should he eventually become an accomplished operator, his knowledge as been gained at the cost of much invalidism and of a number of deaths." [1912-B, p.232] ^18

~ "After 18 years of experience in teaching what is probably the best body of medical students every collected in the country -- the student body at the Johns Hopkins Medical School for the years 1911-1912, being made up of graduates from 128 colleges and universities in this country and Europe -- I would unhesitatingly state that my own students are absolutely unfit upon gradation to practice obstetrics in its broad sense, and are scarcely prepared to handle the ordinary cases.” [1911-B; WilliamsMD p. 178] ^23

~ "In general, ...the medical schools in this country, the facilities for teaching obstetrics are far less that those afforded in medicine and surgery; while the teachers as a rule are not comparable to those in the German Universities. ...yet young graduates who have seen only 5 or 6 normal deliveries, and often less, do not hesitate to practice obstetrics, and when the occasion arises to attempt the most serious operations." 1911-B; WilliamsMD p. 178 ^24

~ "MEDICAL SCHOOLS: “(S)ufficient clinical material are urgently demanded. It is highly desirable that the lying-in hospital be owned by the university or if not, that it should be in the closest possible affiliation with the power of appointment vested in the proper university board. (P)ractical obstetrics must be regarded as a branch of surgery.”..1911-B; WilliamsMD... ^20

~ "The actual figures show that in 25 schools each student sees 3 cases or less; in 9 schools, only 4 to 5 cases, and in 8 others, 5 or more cases; while in some of the smaller hospital this is possible only by having 4 to 6 students examine each patient, and thereby subjecting her to unjustifiable risk of infection. ” 1911-B; WilliamsMD .p170 ^21

Ø "If such conclusions are correct, I feel that ...[we must] insist upon the ... radical reforms in the teaching of obstetrics in our medical schools and upon improvement of medical practice, rather than attempting to train efficient and trustworthy midwives.” 1911-B; WilliamsMD p.166 ^22-B

Ø "The ideal obstetrician is not a man-midwife but a broad-minded scientific man, with a surgical training, who is prepared to cope with most serious clinical responsibilities.... (if this were the case) no longer would we hear physicians say that they cannot understand how an intelligent man can take up obstetrics, which they regard as about as serious an occupation as a terrier dog sitting before a rathole waiting for the rat to escape.” [1911-B, p. ] ^19

Ø "Several professors frankly admit that they are not prepared to perform Cesarean section. Consider that such a condition of affairs means that the professor is merely a man midwife, who is unable to carry a complicated case of labor to its legitimate conclusion! Or imagine the effect upon a patient, ...when told that he can conduct the case satisfactorily [only] if it is ended by the unaided efforts of nature (i.e.spontaneous birth), or merely requires some slight interference, but in case radical interference is demanded he will be obliged to refer her to a gynecologist or surgeon. Think of the impression such an admission must make upon the student, who cannot be blamed for believing that obstetrics is a pursuit unworthy of broadly educated men, but suitable only for midwives.” 1911-B; WilliamsMD p. 174 ^22

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