Establishing specialty jurisdictions in medicine: the case of American obstetrics and gynaecology.

The profession of medicine has evolved into an extremely specialised occupation. Yet, recent research has neglected the intra-occupational processes influencing medical specialisation. This article aims to correct this oversight. It develops an historical account of intra-occupational factors influencing the decision to establish gynaecologic oncology as American ob/gyn's surgical subspecialty in 1972. Working within the framework initially developed by Everett C. Hughes and his students, the article examines this development as the outcome of a three-party relationship among gynaecologic oncologists, American ob/gyns, and gynaecologic pelvic surgeons. Aggressive movement by the gynaecologic pelvic surgeons challenging the established élite's identity definition for the ob/gyn specialty helped spur official recognition of gynaecologic oncology, a less threatening subspecialty. The article draws theoretical implications from the case regarding the role of a threatening other in influencing the specialisation process.

The early days of ruptured ectopic pregnancy.

Today, when lives are routinely saved by early open or laparoscopic surgery, it is hard to imagine that young women suffering from ruptured ectopic pregnancy were left to their fate or submitted to procedures which had no possibility of dealing effectively with the haemorrhaging fallopian tube. As we shall describe, the first success in dealing with this emergency was not until 1883.

[Kaiseijutsu and obstetrics in Osaka during the Yedo era: focusing mainly on the development of surgical operations in obstetrics].

In the Yedo era, the Kamigata area was the place of dispatch of new cultures and was the seat of the economy. However, because natural disasters happened frequently, the economic differential between the central area and the provinces grew wider. The families who suffered poverty sold their daughters to the licensed quarters. Moreover, among the general public, there were a lot of foundlings and women who had abortions. Indeed, we can find these phenomena throughout the Yedo era. Early in the era, such cases were regarded as very common; for example, in IHARA Saikaku works, which describes scenes in Osaka early in the Yedo era, there are a lot of descriptions of foundlings and women who had abortions as common social phenomena. However, in the middle of the era, these phenomena came to be considered sins, as they were in Saikaku's works. This transition period of conceptions about foundlings or abortions coincided with changes in technology in obstetrics. Early in the era when dystocia occurred, both mothers and babies could only be expected to die, and in the middle, after the invention of Kaiseijutsu, which was designed by KAGAWA Gen'etsu, obstetricians could help a lot of women in childbirth. However, when abortions came to be regarded as a sin, people accepted Kaiseijutsu because of the concept of life and because it could help women in childbed and babies as medicine, before everything else.

[Mexican surgery in gynecology and obstetrics during the 19th century]. / La cirugía mexicana en ginecología y obstetricia durante el siglo XIX.

We present a historical framework for the initiation and development of obstetrical-gynecological (OB-Gyn) surgery during the 19th century in Mexico. The importance of a new vision is underlined, and the founders of medical science, the Romanticist surgeons who initiated the teaching of modern medicine and surgery, supported the change. The French influenced the advent of anesthesia, asepsis, antisepsis and transfusion, which has a major significance for the accomplishment of OB-Gyn Surgery. Important persons in this field of medicine are mentioned and we conclude with techniques of contemporary surgery in the next century, integrated with medical care.

Historia de la anestesia-analgesia obstétrica en España durante la segunda mitad del siglo xix. Su estudio a través de las tesis doctorales / The history of obstetric anesthesia-analgesia in Spain in the second half of the nineteenth century as reflected in doctoral theses

El motivo de este trabajo es el estudio de la evolución histórica de las técnicas de anestesia-analgesia obstétricas durante la última mitad del siglo xix, a la luz de las tesis doctorales presentadas durante aquellos años, en que la anestesia-analgesia obstétrica en España era motivo de acalorados debates, controversias y grandes polémicas. Una búsqueda en archivos, bibliotecas universitarias y de las academias de medicina, durante los últimos 25 años nos permitió la localización de un buen número de estos textos que ahora constituyen el corpus documental de esta investigación. Los doctorandos estudiaban en sus trabajos la problemática de la toxicidad de los anestésicos para la madre, el feto, la marcha del parto, el puerperio y la lactancia, llegando a la conclusión de que no ejercían ningún efecto tóxico siempre y cuando su administración se ajustase a las leyes de la anestesia, y no sobrepasara el segundo período de la narcosis. Otra cuestión debatida era la de la anestesia-analgesia en los partos fisiológicos o naturales, donde la unanimidad era menor, pues algunos autores la aceptaban y otros la rechazaban, muchas veces sin base científica alguna. Había unanimidad en el uso de la anestesia en los partos distócicos y las operaciones topológicas, y la anestesia-analgesia con el cloroformo era universalmente aceptada. Aunque se consideran las doctrinas de los doctorandos como poco resolutivas del problema planteado, se resalta su labor como una llamada de atención a una generación que, sin fundamentos científicos, se opuso al uso de los anestésicos en los partos durante muchos años

The aim of the present study was to analyze the historical development of obstetric anesthesia-analgesia in the second half of the nineteenth century, through the doctoral theses presented during this time, when obstetric anesthesia-analgesia caused heated debates and controversies in Spain. A search of archives, university libraries and medical academies over the last 25 years retrieved a large number of theses, which constitute the bibliographic sources of this study. Doctoral students studied the problems of anesthetic toxicity in the mother and fetus, as well as its effects on the course of delivery, the puerperium, and breast feeding and concluded that anesthetic agents had no toxic effects so long as their administration followed the rules of anesthesia and did not exceed the second stage of narcosis. Another controversial topic was the use of anesthesia-analgesia in physiological or natural deliveries. There was less unanimity on this subject, with some authors in favor of and others against this practice, often for reasons without any scientific basis. There was, however, unanimity on the use of anesthesia in dystocic deliveries and obstetric interventions and the use of anesthesia-analgesia with chloroform was universally accepted. Although these theses did little to resolve the questions posed, they played an important role as a source of reflection among a generation that, with no scientific basis, was opposed to the use of anesthetics in deliveries for many years

A remarkable case in the history of obstetrical surgery: a laparotomy performed by the Dutch surgeon Abraham Cyprianus in 1694.

In 1700 the Dutch surgeon/medical doctor Abraham Cyprianus (1655/1660-1718) published his Epistola historiam exhibens foetus humani post XXI. menses ex uteri tuba, matre salva ac superstite excisi, a 94-page book in which several remarkable case histories are described and illustrated. The most spectacular case in the book is the accurate and detailed description of the delivery of a dead full-term child (ectopic tubar pregnancy) by a laparotomy he performed in a living woman in December 1694. The woman survived the operation and gave birth to three more children in following years. This remarkable, well-considered, brave and life-saving operation, performed in a time without antisepsis and anesthesia in a domestic situation is seldom mentioned by medical historians describing the history of obstetrics. This particular case is reviewed in this article.

Colored illustrations of obstetrics manipulations and instrumentation techniques of a Turkish surgeon Serafeddin Sabuncuoglu in the 15th century.

Serafeddin Sabuncuoglu (1385-1470) was the author of the first illustrated surgical textbook Cerrahiyyet'ül Haniyye (Imperial Surgery) in the Turkish-Islamic literature. In the obstetric section he gave detailed descriptions of normal and abnormal presentation, surgical manipulation of intrauterine foetal death and retained placenta. He wrote about previously described procedures and the obstetric culture of his time. Some authors have claimed that he only translated Abu Kasim-al Zahrawa (Albucasis)'s Al-Tasrif (Textbook of Surgery) and added the illustrations of the surgical techniques. Even if this is accepted, the illustrations are enough to entitle this work as a milestone. In this paper, we describe the contributions of this pioneer in obstetrics and compare his recommendations with the current practice.

Caesarean section: an historical riddle.

Etymologically, the word 'Caesar' originates from the Latin word 'Caedaere' meaning - 'to cut'. So cutting remains the core point, but little is known about the real origin of the history of Caesarean Section. There is evidence that, the ancient Hindus excelled in surgery and many operations were performed, including caesarean section. This operation was mentioned several times in the Mishnah of Rabbi Judah, the first large commentary on the Hebrew Bible. There are also several mythological anecdotes in Hindu, Buddhist and Greek mythologies. The myth of caesarean section did not even escape the keen eyes of William Skakespeare. The landmarks, treatises and the advancement in this operative procedure are presented in this article.