Book Review

The History of Obstetrics and Gynaecology

N Engl J Med 1995; 332:477February 16, 1995

Article

The History of Obstetrics and Gynaecology
By Michael J. O'Dowd and Elliot E. Philipp. 710 pp., illustrated. New York, Parthenon, 1994. $125. ISBN: 1-85070-224-1

It is difficult to summarize this book, because it is more than a history of obstetrics and gynecology — and also less. History can be written in different ways and for different reasons. The authors never define their goals, and this lack of definition affects much of the book.

The book consists of 44 chapters, a section of short biographies, and indexes of names and subjects. Each chapter contains a short narrative on a particular topic, followed by a chronology of pertinent events and appropriate references. The first two chapters put obstetrics and gynecology into historical perspective. They describe major changes in the medical management of pregnancy and of women's diseases from antiquity to the present. The remaining chapters deal with specific subjects — for example, cesarean section, menorrhagia, and sexuality. The reasons for the inclusion of a particular subject, the space given to it, and its place in the sequence of chapters are not always apparent. For example, the chapter on information technology appears between the chapters on sexuality and urology. The chapter on laparoscopy is just one page shorter than the chapter on surgery. Some important topics are absent; no chapter deals with the physiology of pregnancy, even though clinicians have drawn extensively from this branch of science since the last half of the 19th century.

The presentation of each topic is clear and easily grasped, an advantage for medical students and residents who may be exploring medical history for the first time. Each chapter tends to be self-contained; however, this approach adds needless repetition. For example, biographical material about Soranus of Ephesus appears in five places in addition to a note at the end of the book.

Unfortunately, the topical approach makes it difficult for readers to identify historical trends and relations among important areas. For example, neither the chapter entitled “Narrative-Historical Overview” nor the one entitled “Spreading Knowledge” gives a sense of the difficulties encountered by obstetricians of the 19th century, who fought to make obstetrics and gynecology a recognized specialty alongside surgery and medicine and to make obstetrics a required part of the medical curriculum. Similarly, separate chapters on the menstrual cycle, amenorrhea, menopause, the premenstrual syndrome, dysmenorrhea, infertility, and sexuality give no sense that observations of all these clinical phenomena gave rise to the discovery of many hormones and to our understanding of hormonal regulation of the ovarian cycle and pregnancy. There is not enough expository material to lead readers from one pertinent area to the next.

This book may be most useful to those who already know something about medical history and wish to explore a new area. The extensive chronologies and references will help these readers. Those looking for insight, however, may wish to supplement their reading with a textbook that deals with broader themes.

Donald Caton, M.D.
J. Hillis Miller Health Center, Gainesville, FL 32610