History of Medicine

 

OBSTETRICS COMES TO THE COLONIES

 

         Obstetrics in American colonial times was practiced almost exclusively by midwives, whose medical knowledge and skills were generally low. Though the rare physician performed deliveries, the first American doctor to have formal training in obstetrics was William Shippen, Jr. He was also the first American professor of anatomy, a position he held at the newly opened College of Medicine of the University of Pennsylvania.

         After graduating from the College of New Jersey (later

William Shippen, Jr.  (Wikipedia)

Princeton University), young Schippen apprenticed for four years with his physician father in Philadelphia. For further study, he embarked, in 1758, to London. Possibly through family connections, he secured a position as student at St. Thomas’ Hospital, across the street from Guy’s Hospital and near London Bridge. There he made rounds with the surgical and medical staff, read widely, and often traveled to St. Bartholomew’s Hospital to watch Percival Pott operate. He seems to have decided early on a career in obstetrics and anatomy. He took midwifery instruction from a Dr. Colin Mackenzie, a former student of William Smellie, one of the first in England to practice obstetrics (or man-midwifery, as it was called). Mackenzie, less well known today, was highly regarded and a friend of William and John Hunter. Shippen's training with Mackenzie included valuable hands-on experience in his extensive practice.

For anatomy studies, Shippen enrolled in William Hunter’s

William Hunter  (Wikipedia)

 

 

private anatomy classes, considered the best in London. He moved into Hunter’s house in Covent Garden where the lectures and dissection took place. The students not only dissected, they practiced surgical operations on cadavers and injected waxy or oily solutions into vessels to demonstrate vascular patterns, a technique borrowed from the Dutch. It was these injections, done mainly by John Hunter, that first

John Hunter  (Wikipedia

demonstrated the separation of the maternal and fetal circulations of the pregnant mother. William Hunter also taught midwifery to Shippen, though his private practice and duties as Physician Extraordinary to Queen Charlotte limited his time. Shippen also benefitted from long conversations into the night with John Hunter, who found the young American an apt pupil.

 

Anatomy lecture at William Hunter's Anatomy School (Wellcome Library)

Shippen did not neglect pleasure in London. He frequented theatrical performances, from David Garrick’s Shakespearian dramas to low comedy, at the Drury Lane and Covent Garden theaters adjacent to the anatomy school. He attended the coronation of King George III. His easy personality helped him win invitations to dinners or weekend stays. He dined with Thomas Penn, proprietor of the colony, and Benjamin Franklin took him to the Royal Society and presented him at court. Shippen easily fell in with Franklin’s friend, Dr. John Fothergill, one of London’s most respected physicians.

John Fothergill (Wikipedia)

Fothergill, a Quaker, had an interest in Americans and in promoting medicine in America. He encouraged William to open a medical school in Pennsylvania.

William skipped study on the continent (the Seven Years War curtailed travel) and traveled to Edinburgh for a year, absorbing the lectures of William Cullen and the Monros. After receiving an MD degree in 1761, he married a woman from Virginia and sailed with her back to Philadelphia. He carried a letter from Dr. Fothergill recommending that the Pennsylvania Hospital start a medical school with Shippen as professor of anatomy. Fothergill had sent over copious anatomical drawings and skeletal parts as an inducement. The hospital demurred on the medical school but allowed Shippen to begin a private course in anatomy. It was well attended by the local doctors.

In 1765, Shippen began a course in midwifery, the first of its kind, open to men and women. He had initiated a small lying-in facility for poor people and used this for practical instruction in addition to giving lectures enhanced by models of female anatomy.

Shippen's lectures, taken by a student (Nat. Libr. Med)

Lectures also covered the circulation and nutrition of the fetus, labor, use of instruments (he was conservative), and diseases of women and children near birth. To maintain dignity in the profession, he urged a “grave deportment” during accouchements and warned against alcohol use.

That same year, another Pennsylvanian, John Morgan, returned from medical studies in Edinburgh, London, and the continent. He presented a second proposal to the Pennsylvania Hospital to open a

John Morgan (Wikipedia)

medical school. This time the trustees, now possessing a letter from Thomas Penn recommending the school, agreed and the first medical school in America opened later in the year. The Professorship of the Theory and Practice of Physick went to Morgan and Shippen was soon appointed Professor of Anatomy and Surgery. The first steps toward formal medical education in America had begun. Shippen continued with his midwifery school. The Pennsylvania Hospital did not acquire lying-in facilities and a separate department until 1803.

The American Revolution interrupted work at the school. Unfortunately, considerable hostility developed between Shippen and Morgan during the war. Both were appointed, at different times, to head the Army medical services, both were accused of incompetence or graft, and Shippen underwent a court-marshal, though he was exonerated. After the war, both remained on the faculty and Shippen continued his extensive obstetrical practice, imparting skills to the next generation of doctors and midwives. His open personality attracted such dignitaries as Washington, Hamilton, and John Adams, who all stayed at “Shippen House” in Philadelphia. He continued to teach, to dispel many myths about childbirth, and to promote the profession of man-midwifery. He did not write papers or books or carry out research, however, as many pioneers in their fields do. Only lecture notes and reminiscences remain to testify to his stature as the first professional obstetrician in America.

 

Note: No essay in May. I will be traveling. See you in June.

 

SOURCES:

Corner, Betsy C, William Shippen, Jr.: Pioneer inn American Medical Education. 1951; American Philosophical Society.

Thoms, H, “The Beginnings of Obstetrics in America.” Yale J Biol Med, 1932; 4: 665-75.

Scheffey, L C, “The Earlier History and the Transition Period of Obstetrics and Gynecology in Philadelphia.” Ann Med History, 1940; 2(3): 215-224.