Medicine and Modernity: Public Health and Medical Care in Nineteenth- and Twentieth-Century Germany

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These are not recent issues, however, as women have been employing birth control methods and seeking abortion services for centuries. Historically, abortion as a term was used by obstetricians and midwives to denote not only the elected termination of pregnancy but miscarriages as well. The exhibit displays an assortment of pessaries, small ring-shaped devices used both to support the vaginal walls during prolapse as well as a means of contraception. The usage of pessaries as birth control dates as far back as B. Midwives have assisted women in childbirth as long as there has been the written record.

It was not until the 17th and 18th century that physicians began playing a more primary role in childbirth.

15 Medical Inventions And Discoveries of the 1800's That Have Come to Define Modern Medicine

At first, physicians only stepped in during emergency situations, leaving most cases to the midwife. As medical practice advanced and effective means of sanitation developed, however, physicians mostly male began systematically excluding midwives mostly female. Labor and delivery as we know it today in the United States was largely influenced by Joseph B. The famous article champions the usage of forceps during routine childbirth as well as the necessity of the episiotomy, cutting of the perineum, in order to reduce tearing.

Although still a routine procedure performed during hospital births, episiotomies are a controversial procedure, believed by many to actually facilitate tearing rather than reducing it. The usage of anesthetics during childbirth also has a complicated and controversial history. Ether and chloroform as an anesthetic was developed in the mids. As more women began seeking out the practice, including Queen Victoria who was one of the first to receive chloroform in for the birth of Prince Leopold, the usage of anesthetics for pain relief gradually gained acceptance.

Women still receive anesthetics for pain relief today, most commonly administered using an epidural anesthetic, allowing the woman to stay conscious throughout the delivery. Due to the numbing effect from the waist down, epidurals still, however, usually require women to deliver supine, in the lithotomy position, or on their sides. In response to the routine medical procedures of the early 20th century, natural childbirth and midwifery reemerged in the s and 80s.

This model of childbirth aims to intervene in the birth as little as possible, pain relief and labor inducing drugs not routinely administered and mothers encouraged to deliver in a position that is most comfortable. Mothers can also elect to have a nurse-midwife aid in childbirth within the hospital, too.

According to ACNM, over As natural childbirth both within and outside the hospital gained in popularity, the United States has also witnessed a significant increase in birth by cesarean section. Hospital labor and delivery units have also expanded to provide a more active birthing experience for women.

Birth Home, Inc. Established by a group of midwives, nurses, physicians, and other childbirth educators seeking to provide an alternative to hospital births, the Birth Home opened its doors in Nielsen also established Birth Center Melea in Harrisburg in Penni Harmon, CNM, worked for both birthing centers from to The Birth Home treats birth as a natural process. The home was also active in the reproductive rights movement in Portland.

Additionally, the Birth Home encouraged fathers to actively participate throughout the labor and delivery process, a radical departure from the solitary birthing experience of the 18th and early 19th centuries. Although the center was unable to maintain funding, closing its doors in the late s, the Birth Home and facilities like it, helped to empower women throughout the birthing experience.

The chart below focusses on the five most lethal infectious diseases. It shows the number of child deaths caused by these diseases from onwards. From onwards the deaths caused by each of these diseases is declining. Similarly to child mortality, maternal mortality provides important information regarding the level of health in a country. Maternal mortality is usually defined as the number of women dying from pregnancy-related causes while pregnant, or within 42 days of pregnancy termination typically expressed as a ratio per , live births. Further in-depth information on maternal mortality, including definitions, data sources, historical trends and much more, can be found in our dedicated entry on Maternal Mortality.

The visualizations above highlight the drastic long-term improvements that countries have made to reduce child mortality. But have these health improvements also materialized for mothers? The chart below shows long-run maternal mortality estimates for a selection of mainly high income countries. We can see that a hundred years ago, out of , child birth, between and 1, ended with the death of the mother.

Since women gave birth much more often than today , the death of the mother was a common tragedy. Today, these countries have maternal mortality rates close to 10 per , live births. The decline of maternal mortality to around 10 per , births can be attributed to our modern scientific understanding of the causes leading to maternal mortality.


It was the physician Ignaz Semmelweis who first noticed the link between hygiene and the survival of mothers in the middle of the 19th century, but it was only until the germ theory of disease became known that appropriate practices became widely adopted. The visualization below also shows that different countries have achieved progress in maternal mortality at different points in time. Malaysia in contrast achieved this progress in only a few decades. Recent data on maternal mortality shows improvements around the world.

Globalization and Global History

The following interactive visualization presents a world map of maternal mortality rates for the period You can switch to the chart view to explore country-specific trends. As before, the conclusion here is that despite recent widespread improvements in the developing world, there are huge challenges ahead: in sub-Saharan Africa more than mothers die per , live births. This is more than 60 times higher than the figure for countries in the European Union.

In the preceding sections we discussed health outcomes, as measured only from data on mortality. Here we discuss a related, but different measure of health that accounts for the incidence and burden of disease. This variable is calculated as the sum of years of potential life lost due to premature mortality, and the years of productive life lost due to disability.

You can read more about the definition and calculation of DALYs in the technical report WHO methods and data sources for global burden of disease estimates. Further in-depth information on burden of disease can be found in our dedicated entry on Burden of Disease. The following visualization presents a map of Disability Adjusted Life Years. The source for the data is the Global Burden of Disease Project , which estimates that in , around 2. The map shows that a large part of these lost years of healthy lives are concentrated in sub-Saharan Africa. Rates of YLD [ years lost due to disability ] are declining much more slowly than mortality rates.

The non-fatal dimensions of disease and injury will require more and more attention from health systems. The transition to non-fatal outcomes as the dominant source of burden of disease is occurring rapidly outside of sub-Saharan Africa. The following visualization — produced by the Institute for Health Metrics and Evaluation IHME — presents a breakdown of burden-of-disease estimates for selected countries.

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A dedicated IHME website provides a fascinating interactive tool to explore all available data on burden of disease worldwide. As the chart below shows, different conditions contribute differently to health outcomes depending on the specific country and gender.

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Here we discuss trends showing how the fight against these diseases is evolving. The most common way of measuring the evolution of diseases is to estimate the number and frequency of deaths caused by the diseases; as well as the number of new people suffering from them. In , almost 3. After , the number of new diagnoses began to decline and in it was reduced to 2. The number of AIDS-related deaths increased throughout the s and reached a peak in , when in both years 2 million people died.

Since then the annual number of deaths from AIDS declined as well and a decade later it was almost halved when 1. The chart also shows the continuing increase in the number of people living with HIV. The rate of increase has slowed down compared to the s but the absolute number reached a peak in when Since the beginning of the 21st century, the WHO has published global estimates of the number of people dying from malaria.

Project MUSE - A Global Perspective: Reframing the History of Health, Medicine, and Disease

The following visualization presents these estimates. As we can see, in these 15 years the global death toll has been cut in half: from , deaths in to , in Africa is the world region that is most affected by malaria.

Importantly, however, Africa is also the world region that has achieved most progress: from to , African deaths from malaria were reduced from , to , The following visualization shows past and current malaria prevalence. It shows that malaria was formerly prevalent in many other world regions. As such, health is often thought of as an individual characteristic beginning with inherited conditions e.

Arguably the most important input to health is health care. Here we study cross-country evidence of the link between aggregate healthcare consumption and production, and health outcomes. The most common way of measuring national healthcare consumption and production is to estimate aggregate expenditure on healthcare typically expressed as a share of national income. More information about the provision of healthcare can be found in our entry on Financing Healthcare. Healthcare is one of the most important inputs to produce health.

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The following visualization shows the cross-country relationship between life expectancy at birth and healthcare expenditure per capita. This chart shows the level of both measures in the first and last year for which data is available and respectively. The arrows connect these two observations, thereby showing the change over time for all countries in the world.

As it can be seen, countries with higher expenditure on healthcare per person tend to have a higher life expectancy. And looking at the change over time, we see that as countries spend more money on health, life expectancy of the population increases.