All aboard!

Remember, dear reader, I said there would be tangents. Now we are embarking on a trip to Baltimore, Md., and childbirth will barely be mentioned for a while.

Locomotion

In his groundbreaking 1982 book, The Social Transformation of American Medicine, Paul Starr plumbs the source of mainstream medicine's authority. Simply put, it comes from the public's dependence on the doctor's superior competence, real or perceived.

As the title of Starr's book suggests, doctors were not always able to lay claim to that authority. Indeed, before the germ theory was proved and methods of administering anesthesia devised, making possible the development of effective surgery, physicians had very little to offer. (That didn't keep them from practicing, though.)

But in Baltimore, late in the 19th century, with new technologies and understandings developing rapidly on all sides, events were unfolding that would help solidify the medical profession's authority.

Image by permission  http://creativecommons.org

A Caesarean section in colonial Africa

Robert Felkin, a British physician and missionary, reported witnessing a Caesarean section performed by an indigenous healer in Kahura, Uganda, in 1879 that featured antisepsis, anesthesia, cauterizing and sutures.

The woman had been given banana wine, and had been secured to a table with bark cloth at her chest and thighs. A couple of men held her waist and ankles. The practitioner cleaned his hands and the woman's belly with banana wine and water, and then he made one quick, vertical incision through the skin, and a second through the uterus.

An assistant cauterized the wound when it bled with a red-hot iron. The baby was lifted out and the placenta removed. The woman was rolled over so the fluid could drain out of her abdomen, and then the abdominal wall, but not the uterus, was sutured with bark cloth and sharp skewers. A paste made of chewed roots was slathered over the incision and covered with a banana leaf and a cloth bandage.

The skewers were removed after a week. The wound had healed by the time Dr. Felkin left 11 days later, and mother and baby, who mostly had been nursed by a friend, were doing fine, he reported.