Joseph DeLee

Joseph Bolivar DeLee (October 28, 1869 – April 2, 1942)^[1] was an American physician who became known as the father of modern obstetrics. He led a movement toward obstetric practice dominated by specialist physicians. DeLee was an early proponent of asepsis during childbirth. He also believed that mechanical intervention (such as forceps delivery) could prevent the poor outcomes that sometimes resulted from childbirth in the late nineteenth and early twentieth centuries. His advocacy of such active techniques is sometimes blamed for the rise in mechanical interventions during childbirth, a trend that persists in obstetrics today. DeLee founded the Chicago Lying-in Hospital.

Biography

Early life and education

DeLee was the fifth son and ninth of ten children of Morris and Dora Tobias DeLee, Jewish immigrants from Poland. His paternal grandfather was a French army surgeon who settled in Poland following Napoleon's failed invasion of Russia. DeLee was born in Cold Spring, New York, but the family moved to New Haven, Connecticut, New York City, and finally, in 1885, Chicago, Illinois, where DeLee graduated from South Division High School in 1888.^[1][2][3]

Despite his father's wishes that DeLee become a rabbi, DeLee attended Chicago Medical College. Of particular influence on DeLee was obstetrics professor W.W. Jaggard.^[1][2][3] His older brother Sol lived in Chicago and provided financial support to DeLee during his studies.^[2] He graduated in 1891.^[3]

Author Charlotte Borst noted that most women delivered at home in the 1870s through 1890s; medical students at Northwestern only witnessed deliveries at that time if they could bribe women into having their babies at the hospital's amphitheatre. DeLee felt fortunate to have observed two such births while he was a student.^[4]

Early career

After completing an internship and a trip abroad for postgraduate studies, DeLee was ready to set up a medical practice by the age of 25.^[2] Noting that obstetric care in Chicago was often inadequate, he opened a clinic on Chicago's Maxwell Street after consulting with Jane Addams. Early on, DeLee provided prenatal care to the neighborhood's women, but the babies were delivered by midwives in the area. Over time, hundreds of women began having their babies delivered by DeLee.^[3]

DeLee opened Chicago Lying-in Hospital in 1899. The hospital provided a larger space and it focused on providing obstetrical care and training of doctors and nurses.^[3] Sanfilippo and Uppal write that, after he paid the first month's rent at the new Ashland Boulevard facility and purchased the necessary equipment, DeLee was left with sixty-one cents to his name.^[5] In late 1899, the Chicago Tribune described one of the hospital's innovations, the first portable incubator.^[3] The device, which was sometimes known as a "hand ambulance", allowed premature infants to be transported to a hospital following a home birth.^[6]

Influential physician

In the early twentieth century, DeLee was one of the leaders of a movement that changed the view of childbirth from a normal physiologic process to a pathologic one. DeLee observed that that obstetric complications and deaths were so common that he "often wondered whether nature did not intend women should be used up in the process of reproduction, in a manner analogous to that of the salmon, which dies after spawning. Perhaps laceration, prolapse and all the evils are, in fact, natural to labor and in fact normal... If you adopt this view, I have no ground to stand on, but, if you believe that a woman after delivery should be as healthy, as well as anatomically perfect as she was before, and that the child should be undamaged, then you will have to agree with me that labor is pathogenic, because experience has proved such ideal results exceedingly rare."^[7]

Consistent with DeLee's belief that childbirth was pathogenic, he began to advocate for the early use of forceps and episiotomy. He reasoned that the episiotomy prevented perineal tears which could cause complications like uterine prolapse and vesicovaginal fistula. He said that the early use of forceps would avoid pressure from the pelvic bones against a baby's head, thus preventing complications like epilepsy and cerebral palsy; DeLee said that fatal complications occurred in 4-5% of labors managed with the traditional conservative approach.^[8]

In 1915, at the annual meeting of the American Association for the Study and Prevention of Infant Mortality, DeLee spoke out against the use of midwives for childbirth. DeLee said that midwives stunted the progress of the obsetrical profession and said that he refused to take part in the education of a provider that lowered the standards of the profession. If obstetrics were seen as dignified work that could draw more than the menial fees charged by midwives, DeLee said, many young physicians would be willing to deliver the patients that were then under the care of midwives.^[9]

David Hillis, one of DeLee's colleagues at the Chicago Lying-in Hospital, published a 1917 Journal of the American Medical Association article about his invention of the fetoscope, also known as the head stethoscope. By 1922, DeLee published a report of a similar device. Though DeLee published his findings several years after Hillis, he claimed that he had been openly discussing his idea for the device over many years. The device became known as the DeLee-Hillis stethoscope.^[10]

In 1929, a young woman named Beatrice Tucker came to Lying-In to complete her residency. Tucker said, "I sneaked in there to do my residency in 1929 when he was out of town, because he didn't believe in women doctors. When he came back, he was pretty sore about finding me there. But he got over it."^[3] Three years later, DeLee named Tucker director of the Chicago Maternity Center, where she worked for more than forty years and delivered an estimated 100,000 babies.^[3]

Later career

DeLee was employed with Northwestern University until 1929, when he aligned with the University of Chicago.^[11] DeLee authored several editions of Principles and Practice of Obstetrics, which was described as "unequalled in text and illustration."^[11] DeLee created Our Baby's First Seven Years, a book that parents could use to record various milestones of infancy and childhood. The book also provided child care advice. More than eight million copies of the book had been sold by 1987.^[12]

William S. Kroger, who DeLee successfully revived as a newborn in 1906, graduated from medical school in 1930 and served a residency under DeLee in obstetrics, gynecology and neuroendocrinology.^[13] Since his childhood, Kroger had been urged by his mother to follow in the footsteps of the doctor who had saved his life. Kroger became a well-known authority on the use of hypnosis in obstetrics and other medical specialties.^[13]

In 1933, DeLee noted with disappointment that while hospital births were increasingly popular, maternal complications and deaths were increasing. He identified infection as a major problem contributing to poor outcomes in hospital maternity wards. DeLee called for hospitals to construct maternity wards in separate buildings with their own staff members and laundry. Such proposals were met with great criticism by influential physicians such as J. Whitridge Williams of Johns Hopkins University, who said that DeLee's precautions represented "a degree of caution that approaches 'infectio-phobia'."^[14]

When DeLee's critics cited the cost of separate buildings and maternity staffs, DeLee replied, "Nothing compares in value with human life."^[14] Despite his belief that hospitals were taking inadequate steps to prevent infection, he believed that the hospital was the best place for a birth to be supervised. In a letter to journalist Paul de Kruif, DeLee even wrote that "I am perfectly willing to repeat that general hospitals are cesspools of infections, but only in a medical journal."^[14] He did not want such stories appearing in the popular press, as these reports might frighten women.^[14]

Personal

DeLee never married and he was said to live constantly at the hospital.^[15] DeLee's nephew, Dr. Sol DeLee, was a Las Vegas obstetrician who wrote several editions of the book Safeguarding Motherhood from the 1940s to 1980s.^[16]

Later life and legacy

In 1934, the University of Chicago recognized DeLee with its Rosenberger Medal,^[17] which is awarded for excellence in research, invention, authorship or other distinctions that benefit humanity.^[18] He was made an emeritus professor at the University of Chicago in 1935.^[11] In May 1936, he appeared on the cover of Time.^[19] He died at his Chicago home in April 1942.^[11] Author Harold Speert wrote, "Despite his wide professional acclaim, DeLee remained a lonely unhappy man, plagued by excessive sensitivity and by the compulsive tendencies of the perfectionist he was."^[15]

In 1948, a mothers aid group from the Chicago Maternity Center raised $30,000 to endow a professorship in obstetrics in DeLee's name at the University of Chicago.^[20] The board of directors for the Chicago Lying-in Hospital awards the Joseph Bolivar DeLee Humanitarian Award annually to an individual who has made significant contributions to the care of women and children.^[21]

References

Further reading

• Fishbein, Morris and Sol Theron DeLee (1949). Joseph Bolivar DeLee: Crusading Obstetrician. New York: E. P. Dutton.\

External links

• Joseph DeLee at Find a Grave