Perspectives in Biology and Medicine

weeding out unfounded claims and speeding the payment of meritorious ones. Law and Polan reject screening panels as unsatisfactory, judging them to be biased in favor of doctors and unfair to patients. One serious cause of malpractice suits to which the authors give little attention is the "great expectation" which patients bring to doctors. Patients who observe a profession that has produced antibiotics and open-heart surgery cannot comprehend the failure of a physician to make them better than new. With this attitude, they cannot conceive that bad results can obtain from the best of medical practice. The attitude is further damaging because it negates the essence of informed consent. Patients about to be "etherized upon the table" believe that no matter how conscientiously their doctor may describe possible dangers to them, the dangers happen to someone else. Consent, therefore, is rarely truly informed . And so the claims of malpractice continue apace. Law and Polan have done much to illuminate the problem, but their next opus should strive for more neutrality. Marian F. Ratnoff 100 Public Square Cleveland, Ohio 44113 Women and Men Midwives. By Jane B. Donegan. Westport, Conn., and London: Greenwood Press, 1978. Pp. 316. $17.95. Creative teachers and authors are those who inspire the best questions. Richard Shryock was one of these individuals. In his classes and books, he stimulated his audiences to continue the search, to take the next path beyond the one he had followed. One of Shryock's observations—that Anglo-Saxon women abandoned female midwives for male physicians in an age of prudery—led Jane Donegan to write the book, Women and Men Midwives; Medicine, Morality, and Misogyny in Early America. Donegan examines "the development of maledominated obstetrics against the background of middle-class concepts of morality , reform movements, and emerging feminism." She reviews English and American documents between 1750 and 1860 concerning the proper attendant for childbirth, and includes selections from professional literature, popular health publications, feminist writings, and the mass of articles in periodicals by the general lay public. Such a wide scope of literary sources emphasizes the intensity of the problem to all sectors of society and clearly indicates the need for such a study. In the first chapters, the author reviews the traditional role of women as midwives and the gradual shift toward pregnant women accepting and then seeking men as attendants in delivery. The book deals primarily with midwives in Philadelphia, Boston, and New York; however, Donegan includes some background from England. While much of her material from the 1700s is derived from secondary sources (not all of which are trustworthy), she gives a lively picture of some of the most important figures in the eighteenth century, including William Smelile and William Hunter. She describes their role in developing the "new obstetrics," which stressed academic expertise. Although she mentions a few personalities from eighteenth- and nineteenth-century French obstetrical 314 Book Reviews history, the author does not adequately discuss the significance of the differences in the way women retained their role in midwifery in France as compared to England and the United States. Donegan suggests that the evolution from female to male midwives was "brought about by the technology developed by an emerging medical profession ." Thus, she emphasizes the use of instruments and improved anatomical studies as the means by which men gained entrance to the birthroom. Yet she mentions as a minor item (in a footnote) male physicians' use of anesthetics in the mid-nineteenth century, when they probably played as much or more important a part than any other technological development in encouraging women to seek male physicians for routine deliveries. While technology was only part of the motivation for women to choose male birth attendants, it was the most visible feature of their prowess. Certainly it influenced Queen Victoria when she chose John Snow to administer ether for her eighth delivery in 1853, and it probably played a part in Queen Charlotte's shift from Mrs. Draper to William Hunter as her attendant with her fourth delivery in 1766. In her review of the mid-nineteenth-century literature, Donegan brings out the rivalries between trained and untrained attendants, "heroic" and conservative male physicians, regular...