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Afbeelding uit een leerboek Verloskunde uit 1829

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The well-being of mother and child:
Dutch obstetrics and gynaecology 1775 - 1925

From 20 September until 28 October 1999

In 1983 the University Library held an exhibition about the history of midwifery and gynaecology in the 17th and 18th century. At the time it was a great success: the exhibition drew large crowds. For this reason it was decided to hold another exposition about the 19th century before the end of the 20th. There is not only a beautiful collection of medical literature, illustrations and models on display, but also an impressive variety of obstetrical instruments.

The 19th century is usually regarded as 'dull', but that does not hold for this branch of medicine, as becomes clear from the interview I had with Prof.Dr. O.P. Bleker, professor of Obstetrics and Gynaecology at the AMC and A.C. Schuytvlot, from the Rare Book department at the University Library and also the conservator of the library of the KNMG (Koninklijke Nederlandsche Maatschappij tot bevordering der Geneeskunst), the national medical society. Professor Bleker is also a member of the History working group of the Dutch Society for Obstetrics and Gynaecology. This working group has organized the exhibition, in collaboration with the University Library. The title comes from an engraved glass used at lying-in visits, which said To the well-being of mother and child.

How did the University Library acquire such an extensive collection of medical books?
"It all belongs to the KNMG, which was founded in 1849 and gave its collection on loan to the University Library in 1855. It is the largest collection of Dutch medical literature. We should here mention that its being housed in the University Library is of great importance to the continuity of the collection: the administration, conservation and all kinds of special conditions are thus safeguarded, there are reference works, and the collection can be consulted via Interlibrary Loan, which makes it nationally accessible."

Where did women in the 19th century have their babies?
"There were hospitals for the poor, where the deathrates were enormous because of the great risk of infection. Puerperal fever, a blood poisoning by streptococci and staphylococci, was greatly feared in the 19th century. Decent services did not become available until the end of the century. For the upper classes it was customary to have the baby at home and be looked after at home. Many children were born, so there was always someone at hand who had experience and could offer help. You can hardly imagine it nowadays, but in well-to-do families women were hired to breast-feed the new-born baby, so-called wet-nurses! The number of births at home is still very high in the Netherlands, compared to other countries. As a result of this attitude and because of the excellent midwives obstetrics has never become medicalized."

What is characteristic of 19th-century obstetrics?
"All things considered, there are enormous changes and improvements in those days. Not only in obstetrics, but in all fields of medical science. Education is being formalized, the government gets involved in medical practices by laying down all kinds of laws, a national standard is devised, handbooks, fixed fees for doctors, etc. In short, it becomes more professional. The foundation of the KNMG is then a logical step.
The most important change in 19th-century obstetrics is the growing awareness of the importance of sterility, hygiene. This awareness grew in all fields. For example, the drinking-water in Amsterdam was separated from the sewage, and the Amsterdam doctor and apothecary Samuel Sarphati saw his efforts for refuse collection in Amsterdam rewarded. This awareness had great consequences for obstetrics. In the 18th century half the children died before they were twenty years old, of the new-born babies a quarter did not make it. At the beginning of the 20th century infant mortality was down to 10%.
The pioneering work was done by the Hungarian obstetrician Ignaz Philipp Semmelweis. He was attached to the maternity clinic of the general hospital in Vienna, where he noticed a great similarity between puerperal fever and ptomaine poisoning, which he connected to the doctors who assisted at births immediately after coming from the autopsy room. His only condition was that anyone who gave obstetric assistance should disinfect their hands and nails, after a thorough scrubbing, with chlorinated water. The death rate in his clinic dropped from 12.24 to 1.27%. However, Semmelweiss found little appreciation for his successful measure. Nor does the first Dutch professor of obstetrics in the 19th century, Lehman from Amsterdam, believe in it: he thinks that washing the hands after an internal examination is a much better option... Of the 100 women he assists at childbirth, 17 do not leave his premises alive. Only since 1890 have the ideas of Semmelweis become generally accepted in obstetrics. You then see the mortality rate after a Caesarean also decrease steeply. Even though the Caesarean had been practised for ages, in 1800 100% of the mothers still died after this operation. In 1900 the number had decreased to about 30%. Nowadays less than 1 in 1000 women dies after a Caesarean."

What can visitors of the exhibition expect?
"Apart from a beautiful collection of medical literature, illustrations and models, there is also an impressive collection of 19th-century obstetric instruments. There were many kinds of forceps used: each professor had his very own forceps. The forceps consists of two 'spoons' which fit round the head of the unborn child. It is a secret invention from the 17th century, which has been further developped in the 19th century. For unborn children who had died in the meantime, a special kind of hook was used, to pierce the skull and 'hook' the baby in parts... The now well-known vacuum pump, which attaches itself to the head of the child by means of a suction cup and thus guides the baby out during birth, has only been in use since 1960."
Professor Bleker ends the conversation with the satisfied conclusion that Dutch women have never been so healthy as they are now, thanks to good food and hygiene, and that, fortunately, hooking children no longer occurs!
There is a beautiful, extensive brochure about the exhibition, which is for sale in the exhibition room for ƒ 10,-.

For more information:
Bram Schuytvlot - UB, Rare Book department, telephone: 020 - 525 2475/2473

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Last modified: 14 September 1999
Editor: Monique Kooijmans