By Caitjan Gainty, PhD (King’s College, London)


The Science and Art of Obstetrics: The Forceps Operation and Episiotomy RepairAnatomical Illustration

DATE: 1934
LENGTH: 36 min [edited from full length of 64 minutes]
PRODUCER/PUBLISHER: Joseph B. DeLee, M.D.
CATEGORY: Educational & Instructional, Clinical & Surgical, Sound, Black & White

The Science and Art of Obstetrics: Laparotrachelotomy: Low Cervical Cesarean SectionAnatomical Illustration

DATE: 1936
LENGTH: 35 min [edited from full length of 69 minutes]
PRODUCER/PUBLISHER: Joseph B. DeLee, M.D., M. Edward Davis, M.D., Fox Movietone Scientific
CATEGORY: Educational & Instructional, Clinical & Surgical, Sound, Black & White


In November of 1927, the obstetrician Carl Henry Davis wrote to his Chicago colleague Joseph Bolivar DeLee to discuss a request he had received from a “Mr. Fleckles” of the International Medical Film Corporation. “Fleckles”—most likely Maurice Fleckels, who was well-known in Chicago filmmaking circles—had inquired as to whether Davis was interested in editing a collection of Viennese obstetrical training films, known as the “Wertheim Films,” for the American obstetrical community. [1] Recalling that like himself, DeLee dabbled in obstetric filmmaking, Davis suggested a collaborative effort.

But though the Wertheim films had been making the rounds of American obstetric groups throughout the mid-1920s, making a splash not least because they cost an astounding $100,000 to make, DeLee’s answer was a resounding no. [2] His response to Davis panned the films as “rotten” and, indeed, such a “disgrace to the city of Vienna,” that the “whole set including the negatives” ought to be destroyed. [3] Still, while he would not help with the salvaging of these films, DeLee did offer to make an entirely new “set of real American obstetric films,” to be used for medical teaching. What’s more, he informed Davis, he had already written directly to Fleckels to tell him so.[4]

Six weeks later, DeLee was already hard at work, apparently having left both Davis and Fleckels behind. In a scenario to be repeated over the course of his filmmaking career, DeLee rang out 1927 on the doorbells of potential backers for his own project. Late December found him at the doorstep of one of his most faithful patrons, Florence Spoor, seeking a letter of introduction to the film producer George K. Spoor, Florence’s cousin by marriage. DeLee had heard that Spoor’s briefly successful Chicago production company Essanay had closed, and he saw an opportunity to pick up a professional motion-picture camera on the cheap. The family introduction was made, and Spoor loaned DeLee two Bell & Howell 35mm cameras, generously including the services of his cameraman, the well-known Conrad Luperti, to run them.[5]

Photograph of an operating room with camera and lights.
DeLee’s first birth room/movie set as it appeared in his article, c.1933
Photograph from Joseph DeLee, ‘Sound motion pictures in obstetrics’, Journal of the Biological Photographic Association (1933–1934) 2, pp. 60–68, 65, used with permission of the board of directors of the Journal of Biocommunication.

DeLee was no filmmaking dilettante. In his follow-up letter to Florence Spoor, he noted that even before the arrival of the new equipment he had already, “fitted up the largest birth room…at the hospital as a complete moving picture studio, with Mazda and Cooper Hewitt lights and 16 mm film equipment.”[6]  His early works had included a film (which he reportedly screened at the Chicago Gynecological Society in 1928) showing a case of hydrocephalus, which concluded with a gruesome-sounding “picture of the baby with its head refilled with the two quarts of water removed at operation.” Another followed a woman with a uterine fibroid through late pregnancy and birth. There was also one in the pipeline which would, as he described to another correspondent, follow the pregnancy of a “rachitic dwarf,” a woman whose growth had been stunted by rickets. [7] DeLee explained that these “cinematographic case records” could be used for small classes or presentations, but their more important functions were as documentation, a visual remembrance of the unusual cases “nature had provided.”[8]

Upon the receipt of his new cameras and their operator, however, DeLee turned his attention primarily to making the “real American obstetric films,” that would, unlike the Wertheim films, truly convey “instruction from teacher to pupil.”[9]  He moved quickly; by 1929, he had finished his first talkie, called The Science and Art of Obstetrics. By the early 1930s, he had made five more teaching films, many for his Science and Art of Obstetrics series, and had five more in preparation. He had toured Hollywood sets, “cross-examined cameramen,” experimented with sound, animation, slow motion, microphotography, and color. He had written scripts, prepared title cards, held table reads and rehearsals, recorded sound, directed cuts and editing, improvised sound effects, and generally learned the ins and outs of producing and directing high-quality films. In fact, the only things that separated DeLee from professionals on Hollywood movie lots, as he told an audience in the early 1930s, were his nonexistent profit margins. DeLee estimated that while costs had already exceeded $30,000, profits—chiefly on rentals of his films—came to a dismal $800. “Therefore,” he explained, “I can still write for the Amateur Movie Makers although I work almost entirely with professional film and apparatus.”[10] DeLee’s assessment of himself as an underfunded film professional was widely shared: at the Detroit premiere of his talkie, on the “modern” method of the Caesarean operation, DeLee was lauded in the Detroit Times as nothing short of “the world’s foremost moving picture enthusiast” with knowledge of films equal to that of the “smartest young men on Hollywood movie lots.”[11]

The Pathologizer

Despite his notoriety as an obstetrician and filmmaker in his own time, DeLee’s films are not well-known today. Though this circumstance is in part a result of the common difficulties of preserving and transferring media from format to format over time, as well as the long disinterest of scholars in nonfiction medical filmmaking, it also mirrors the fate of DeLee’s obstetric reputation. Though in his own time, DeLee had been a well-known and celebrated practitioner, after his death in 1942, his exalted status tanked. By the late twentieth century, DeLee had emerged as a villainous champion—even sometimes the villainous champion—of the “pathologized” birth. He continues to be popularly remembered as a figure so intent on bringing legitimacy to the new professional specialty of obstetrics that he remade birth from a natural process into something fundamentally pathological, requiring intensive intervention and a parade of technologies that only obstetricians could employ and only in hospital settings. [12]

The most widely cited evidence of DeLee’s pathologizing tendencies is his 1920 description of his “prophylactic forceps operation,” in which he espoused a technologized forceps-centered process, to be used to head off the “lacerations, prolapse and all the evils” that made unaided labor more like having a “pitchfork driven through the perineum” than a natural process.[13] “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,” he concluded, “then you will have to agree with me that labor is pathogenic, because experience has proved such ideal results exceedingly rare.[14]

Though DeLee genuinely believed that the “hundreds of thousands of women [who] date[d] lifelong invalidism from apparently normal confinement” was clear evidence of childbirth’s intrinsic pathology, his interests in pathologizing childbirth were inevitably also related to the politics of medicine in this period.”[15] For the designation of childbirth as pathological also would serve, DeLee felt, as the legitimation for inclusion of obstetrics as a medical specialty.”[16] His investment in the “great pathologic dignity” of obstetrics, then, was part of a larger rhetorical effort to raise the medical profile of his own work.

Though we have tended to look back and conflate DeLee’s hyper-interventionist brand of obstetrics and his designation of childbirth as “pathological” with the outrageously high maternal and infant mortality rates of the period, in fact DeLee’s own statistics were excellent. Obstetrics was the solution, DeLee felt. The problem was the lack of appropriate skill among other non-obstetrically aware physicians, who simply did not know how to deliver babies and caused more problems than they solved, and midwives who, believing childbirth to be natural, had no ability to handle most childbirths, which were anything but. Indeed, much of the ire that DeLee felt toward the profession for not recognizing obstetrics as a real specialty came out in his attacks on midwifery. The persistence of midwives, who only increased morbidity and mortality in childbirth, he asserted, was the result of the medical profession’s refusal to acknowledge that obstetrics was a “major science, of the same rank as surgery…. If the doctors recognized the dignity of obstetrics,” he complained, “[the midwife] could not exist.”[17]

If one approaches DeLee’s films with this narrative in mind, they probably won’t have much to say that is new. Though they are not necessarily more graphic in content than other childbirth films, they are far more troubling to watch. While other well-known childbirth films like Stan Brakhage’s Window Water Baby Moving (1959) for example, or George Stoney’s All My Babies (1951), each in its own way celebrates birth, DeLee’s films by contrast depict birth as a deeply impersonal, mechanized affair, in which women in labor play little role apart from having babies pulled or cut out of their bodies. Here and there, we glimpse some touches that lend the films some vague humanity: some of DeLee’s films end with an image of a smiling mother and her baby. A film about the low cervical cesarean section (1936) finished with a rather awkward parade of the young children DeLee had delivered in years past by this method. DeLee called them “cesones,” a moniker he hoped would come to be associated with the health and vigor of the baby born by his version of the cesarean section. But on the whole, the contemporary viewer may well wonder whether these films are more appropriate to the teaching film genre in which DeLee placed them, or whether they would be better categorized within the dystopic traditions of science fiction.

Film still of a woman lying under a white sheet.
Woman awaiting delivery. Film still from DeLee’s The Science and Art of Obstetrics: Normal Labor at Term, undated.

Indeed, in DeLee’s motion pictures, glimpses of women in labor are few, and when they do appear, they are lying prostrate, unnaturally still. We rarely see their faces, even more rarely hear their voices. Instead, we become accustomed to a view shot between their legs, with only their perineum, their vulvas, their anuses exposed. With only one exception (at least among the extant films), the camera is there to capture not the labor and birth of the baby itself, but DeLee’s techniques, which repeatedly and often rather violently violate this space: poking and prodding, cutting and stitching, delivering babies by what looks to our contemporary eyes like gratuitous force and manipulation. The fact that DeLee’s films as a rule required more than one woman per film—his caesarean film, he said, required fifteen—further marks the films as viscerally troubling. In some ways so extraneous were the women and their babies to the birth process that they became interchangeable, all pressed into service instead to produce the perfect depiction of a particular DeLee procedure.

These films give full expression to the intellectual discomforts we have had with DeLee’s techniques and the loss of autonomy and authority over one’s own body, the displacement of the female body altogether, that they symbolize. The explicit interference in the process of birth that these works repeatedly show also plays on the worst features of medicine’s modern history. Even though by its very design modern medicine fundamentally works precisely because of its pathologizing proclivities, the costs have been high.”[18] Unavoidably, medicine’s pathologizing and objectifying tendencies have amplified, if they did not help to create, the problematic configurations of race, gender, and difference that have structured, and continue to structure, American life. And in childbirth and its history, and thus also in DeLee and his films, we find fully articulated one of the best-known and most challenging narratives of medicine’s twentieth-century history: as one of oppressive conflict, in which our bodies have hung, and continue to hang, in the balance.

At the same time, these films also point toward an interpretation of DeLee’s work and the nature of childbirth in the period in which he was working, which helps us to rework the bounds and aims of this conflict. This does not make DeLee’s films any less troubling, nor does it mean that DeLee’s films are not intended to be exactly what they are: films that train other physicians to view birth as pathological and thus subject to DeLee’s invasive techniques. But they also give what is perhaps fullest articulation of a way of birth that was both popular and welcome to the modern women of the 1920s and ‘30s. And in so doing, they also reflect the politics of childbirth in this period. In addition to this, Delee’s dedication to film as a medium, coupled with his seeming inexhaustibility as a filmmaker, open up a moment in medicine’s history, in which the motion picture camera came to be considered one of the most important medical instruments of the day.

Civilized Birth

Because of the power of our contemporary reading, those encountering DeLee now might wonder at the enormity of his popularity during the years that he practiced and filmed. This is amply illustrated by the fact that the bulk of his work, and nearly all of it at the beginning of DeLee’s career, was funded by a deep-pocketed network of prominent families. By the late 1920s, many of these families had come to know DeLee personally. But in most cases, coming into DeLee’s obstetric care wouldn’t have been their first introduction to DeLee’s work. DeLee had become well-known over the first decades of the twentieth century for his work as a kind of social activist who provided free prenatal and birth care to the city’s poorest families. Though DeLee is most often associated with his Lying-in Hospital on the University of Chicago campus—an image of which opens most of his films— DeLee’s other and, indeed, first institution was the Chicago Lying-in Dispensary, opened in 1895 to provide free prenatal and maternity care to the poor immigrant mothers of one of Chicago’s most desperate slums. The Dispensary, which came to be known as the Maxwell Street Dispensary and finally the Chicago Maternity Center, was geographically and ideologically quite near to Jane Addams’ Hull House. And in contrast to the hyper-mechanized birth that DeLee practiced on expectant mothers of society’s upper crust, DeLee did not employ interventionist methods at the Dispensary, except when emergency required it. Moreover, until the closing of this remarkable institution in the late 1970s, home birth was the rule. Hospital birth was the exception.

Though initially funders may have donated to show their support for this settlement movement-style social activism in particular, their willingness to expand this funding to DeLee’s later and far more interventionist birth ventures was not surprising: both were intertwined in the contemporary agenda of the social activist. DeLee’s particular focus on childbirth in the Chicago slums drew on the contemporary politicization of poverty and immigration that the settlement movement had brought forth, focusing the more general exploitation of immigrant populations as cheap industrial labor onto the bodies of pregnant women and new babies.[19] Outside of those slums, DeLee’s interventionist style drew on the politicization of birth in terms of equal rights, where his highly-interventionist, mechanized style was celebrated as a way for women to map the politics of equal rights onto their own bodies. To demand childbirth that was mechanized and painless, this narrative went, was to demand that women be treated equally. As contemporary textbooks on birth put it, the issue turned especially on the question of pain. If men should be relieved of their pain in surgery (adopted as the nearest proxy to childbirth), women should be relieved of their pain in childbirth. To demand this relief and receive it, was an embodied enactment of equality: arguably a more concrete articulation than could often be achieved in the more abstracted spheres of politics and society.[20]

DeLee’s ability to encapsulate the values concerning childbirth that percolated in the progressive-era United States, as well as the time he uniquely had with wealthy women who came to him for the birth of their children, made him something of a cause célèbre. This combination of social activism and childbirth probably helped him to earn the patronage of the colorful and charismatic Alice Roosevelt Longworth, the daughter of Teddy Roosevelt, who turned to DeLee for the 1925 birth of her daughter Paulina. And it was she who further propelled DeLee into the position of birth guru, with articles appearing in several women’s magazines of the period, in which he dispensed advice on all aspects of modern pregnancy and birth.[21]

A woman looks up at a small child she holds on her shoulder.
DeLee’s 1926 article in the women’s magazine The Delineator opened with this image of Alice Roosevelt and her “charming Paulina.”

The benefaction of Longworth and others of her ilk rested on the perception of DeLee as an activist working to make childbirth safer and better. Yet, at the conflicted heart of this activism, with its contradictory fixes for birth that broke down along class lines, was a eugenics-tinged fixation on the dangerously pathologizing tendencies of modern living.

As articulated by DeLee’s near contemporary, the British obstetrician Grantly Dick Read, this line of thought suggested that many of the problems associated with contemporary childbirth were specific to that class of women who had lost track of their “natural” selves amidst the hubbub of modern life.[22] In contrast, “primitive women,” those closest to nature—which included the poor, immigrant women that DeLee’s clinic served—generally experienced birth as painless and easy. On account of not having been modernized, these women were closer to their bodies. When the time came to give birth, they simply paused to do so. “Primitive” women—whether they lived in a Chicago slum or Read’s conjured up pastoral paradises—only rarely had difficulties in childbirth. And though the grime and dirt of the city threatened the urban primitive with the modern scourge of germs, which was exactly where DeLee’s Dispensary intervened, by and large it did not alter the more natural relationship that these women had with their bodies.

By contrast, modern women were hopeless by definition when it came to childbirth. “Parturition is almost invariably the first primitive, fundamental physical act which she is called upon to perform,” Read explained. So it was only natural that “she” would be ill-equipped to handle this “perform[ance].”[23] Like DeLee, Read recommended a thoroughgoing remedy, to artificially approximate the more natural state that made childbirth painless and easy. His intervention was psychological, which has curiously come to mean, in retrospect, that it must have been ideologically different from DeLee’s. But in fact their motivations were much the same. The need to intervene in birth was predicated on the notion that one must reproduce by some other means the “natural” states from which the modern woman had become so distant.

Because so many of DeLee’s funders were predisposed to accept this ideology as innately reasonable, the transition from funding DeLee’s settlement house-style organization to his state-of-the-art lying-in hospital, and from intervention only when necessary to intervention as a rule, was really no transition at all. Contemporary mores held both as valid at the same time.

More interesting, though, is that their support for DeLee extended to his filmmaking endeavors. DeLee had initially approached larger educational publishing and filmmaking corporations. But the publisher of DeLee’s very successful textbook on obstetrics was not interested. Nor, apparently, was Fleckels’ International Film Corporation.[24] If finances were their concern, these organizations were, of course, right to stay away. By DeLee’s own report, the films were a poor investment.[25] But this rather disappointing balance sheet did not deter his loyal network of funders from supporting his filmmaking endeavors.[26] They had no expectation of a return on their investments because, of course, these were not investments. They were donations, to a figure who had successfully encapsulated their political values in the real world terms of childbirth.

Yet, though DeLee’s films seem as though they ought merely to be the dissemination arm of DeLee’s larger activist platform, and this is in fact what DeLee generally claimed the films would do, this is not always how he pitched the funding for his motion picture work to his funders.[27] He suggested, for example, to the prominent James Houghteling, who would later serve in Roosevelt’s New Deal administration, that he give a large donation to DeLee’s motion picture fund in lieu of payment for clinical services rendered. Perhaps the fact that DeLee was clearly so earnest in his belief that these were somehow interchangeable made Houghteling willing to overlook the fact that in essence DeLee was robbing his clinical services in order to fund his films.[28] And in his pursuit of the millionaire Edward Nash Hurley to fund a low cervical section film, DeLee pointedly reminded Hurley that this procedure had produced the safe delivery of his grandchild, as though funding the film re-make of this procedure might somehow be equivalent to funding the life-saving clinical version Hurley had benefited from itself.[29]

It’s possible that DeLee’s wealthy patrons had become so habituated to funding DeLee that they hardly noted these details. But for the observer looking back, these curious hints of clinical-filmic overlap point toward the more interesting role film seemed to play for DeLee. As he put it in 1930, they were actually more like “laboratory experiments” than pedagogical endeavors. In this rhetorical re-categorization, DeLee tacitly articulated a dual role for his films, as disseminators of information that were also and simultaneously integral pieces of the apparatus by which that information was made in the first place.[30]

Hollywood in the Operating Room

This is not to say, however, that DeLee’s films were not pedagogical. At least, DeLee’s films go out of their way to make explicit their educational focus. They begin as filmed lectures set in the lecture hall at the Chicago Lying-in Hospital. The lectures, given by DeLee, generally begin with a historical overview, often accompanied by slides. In his lecture on the forceps and episiotomy operation, for example, DeLee offered an illustrated examination of the development of the forceps over the last thousand years. DeLee had his clear favorites; he mostly pans the instruments of the past. And his historical interests seem limited to history’s usefulness as a foil for the present: modern-day obstetrics and the forceps currently in use.

After these historical overviews, DeLee would generally turn to performing various aspects of the film’s subject procedure on clay models before moving on to the birth room itself, where the viewer could finally watch the procedure in live action. Finally, the viewer is returned to the lecture hall, for conclusions and questions. Over time, the viewer gradually becomes aware that they are not alone in the audience. There are also students in attendance, who add to the educational impression of the films by sometimes appearing on camera, sometimes asking questions off camera.[31]

Despite attention to educational reference points, DeLee’s more general guide for the making of these films was not the growing genre of educational film. Though DeLee worked a bit with Eastman Kodak, which had a developing educational film concern in this period, it was Hollywood to which DeLee constantly referred when contextualizing his own work. And it was to Hollywood that DeLee directed others who were as serious as he was about making state of the art, “real American” medical films.[32]

There is no question that DeLee viewed himself as an honorary member of the burgeoning Hollywood elite. As he proudly announced on numerous occasions, he had actually been there, immersed himself in studio life, and learned from the best how to make films. Yet, it seems that this love affair was not reciprocal. DeLee’s attempts to break into Hollywood were unsuccessful. When he offered, the major studios showed no interest in hiring DeLee as a consultant. They were also not tempted by his fictional screenplays.The song lyrics he wrote about Big Ben similarly failed to gain him an audience with Irving Berlin.[33] And his later relationship with the famed documentarian Pare Lorentz, who made a film loosely based on DeLee’s Dispensary in 1940, was not convivial. DeLee could not resist giving Lorentz advice, from one accomplished filmmaker to another, and Lorentz could not resist ignoring it.[34] None of these experiences seemed to dampen his enthusiasm, however. And he considered it something of a truism to say that making a medical film required “a bit of Hollywood in the operating room.”[35]

What this meant for DeLee is worth exploring. It certainly required knowing—and slinging—the lingo with ease. In a 1928 screed on filmmaking, he dramatically interrupted his own discussion to give his audience an unexpected taste of how dramatic life on his movie set could be: “Lights! Camera! Fade out! Lights out!…Close up! calls the Director!” Interspersing an otherwise narrative description of his filmmaking for potential funders, he continued:

While the operator does a part of the operation not needed to show on the screen, the cameraman turns his 6 ¼” lens for the close up. Lights! Camera! Fade out! Lights out! At proper places in the operation the Director, following the script, calls for a fade, and later on we insert at that point an appropriate title or still, or animated drawing to show what was hidden from the eye.[36]

DeLee’s love for filmmaking’s technical ins and outs bordered on the fanatical. A 1933 article advising budding medical filmmakers on how to create their own “Hollywood in the operating room,” for example, exuded technical know-how. A good film started with the best equipment, he said. 35mm cameras were better than 16mm; “Mazda lights” alone, with no filters, were best; “superpanchromatic film” ought to be used for obstetric procedures and “ordinary panchromatic” for surgical operations “where the field [was] small.” DeLee preferred Eastman for general use, and Dupont for surgical operations. A trained surgical cinematographer was an absolute necessity.

 

Sound was especially on DeLee’s mind in the early 1930s. He found it of vital importance to include sound (of the 176 polled at one of the performances of his first talkie in 1928, 166 preferred it to the silent film, he told audiences), but it was technically quite challenging.[37] It was too difficult to record while filming, and so one had to learn how to dub it in and synchronize it after the fact. This required travel to a sound studio, where one sat in front of a microphone, screened the film several times as rehearsal and then, finally, recorded in sync with the film.

DeLee offered advice too on how to acquire the “slightly muffled quality which will imitate a voice covered by an operating mask” and how to avoid the sound of “crackling paper” the studio microphone might catch if the script were held too near to it.[38] Eager to ensure that the sound recreated the details as faithfully as possible, DeLee also held forth on the important of sound effects, describing how he had manufactured the “noise of a suction pump” or “the tinkle of a time bell” in the sound studio. He was particularly proud of the method he had employed to solve the problem of re-creating the first cry of the “neonatus,” unique among the cries of a baby in its first years, he explained, for its gurgling quality. For this, DeLee described, he had to improvise a bit, bringing a baby into the sound studio with him and “drop[ping] a teaspoonful of water into [the baby’s] mouth” while it was crying. “The effect was perfect,” he thought, adding hastily, lest anyone be concerned, that “the baby was none the worse for its experience, which is a very common one for babies during natural delivery.”[39]

The specificity of these technical details perhaps suggest already how tightly controlled DeLee’s obstetrical cinema activities were. And this extended far beyond just controlling for the technical challenges of medical filmmaking. As he put it in his 1933 article, before one even got started, one required:

a scenario, a script, properties, titles, work sheets for the cameraman, the property man, the director, the script girl—all these must be in readiness, and before the actual operation is begun, one or more rehearsals are necessary. These are for the silent picture, and if the film is to be a “talkie,” the words to be used must be written in the script opposite the motions they accompany. Sound effects, if there are any other than the speaking, must be appropriately allocated.[40]

Actors, directors, and the various production roles, DeLee went on in his advisory article, were all to be filled by his obstetric employees, a strategy that was in part a financial necessity, in part a nod to the tradition of filmmaking DeLee had probably already encountered. He might have known, for example, that at Spoor’s Essanay studio the actor Ben Turpin had also been the janitor. Perhaps in more direct parallel to DeLee himself was Essanay’s Gilbert “Broncho Billy” Anderson, who was the studio’s co-owner, one of its major stars, and a prolific writer and director. Like Anderson, DeLee himself wrote, produced, and starred in his films. His obstetric colleague Michael Davis ostensibly served as director, though his role seems to have been limited to reading the script aloud during rehearsals and filming so that the actors would be reminded where and when to point, look, walk, speak.

Film still of DeLee in a white coat standing akimbo.
Though DeLee expressed concern about the “awkward motions” of the camera-shy, he himself was hardly a natural on camera. Here he strikes a pose common to many of his films as he lectures on the forceps and episiotomy operation in Science and Art of Obstetrics: Forceps and Episiotomy.

Indeed, a good script was essential, and of course, rehearsals were obligatory: holding “table reads” and practicing the planned operation first on other patients with the camera looking on, “as if for a motion picture ‘take,’” were crucial to the film’s ultimate success. For the camera-shy, DeLee suggested first filming them using the 16mm camera (because it was less expensive to operate than the 35mm he would use for the actual film) so that they could see in advance “how their awkward motions appear on the screen.[41]

Consistent across all of DeLee’s descriptions of his movie work is the paucity of references to the technical aspects of the medical work that was the film’s very subject. In most cases, even the mothers and babies who appeared on his movie set were likened to actors. “No temperamental actress is more likely to spoil a ‘take’ than a patient under anesthetic,” DeLee noted. And as for newborn babies: “Let me say, more unconcerned, less camera-shy actors and actresses you will never find.”[42] DeLee did note that the mothers and babies involved in the filming had to be carefully looked after. But not really for obstetrical reasons. “The intense light and heat to which [the woman in childbirth] is exposed for perhaps an hour or more,” he described in his 1933 article “sometimes raised her temperature a degree or two, quickened the pulse 20 to 40 beats, and [produced] mild superficial burns.” And though DeLee would occasionally mention complications of the “not photographic” (by which he presumably meant obstetrical) kind, even these did not yield further comment from DeLee on the eventual outcome of the birth or the more general well-being of the individuals involved. Instead, his attention is drawn once more to a description of the problems these posed to the flow of DeLee’s work. But there were always solutions. Multiple women with multiple babies would have to comprise the subject matter, DeLee decided. And each would work in relatively short “takes.” This would keep superficial burns at bay and minimize the possibilities of obstetrical interruption.[43]

Duehrssen’s Incisions: Complications but why?

In its technical aspects, bringing Hollywood into the operating room seemed in many ways to indicate a prioritization of filmmaking over obstetrics. DeLee’s need to perfectly reproduce the muffled voices of mask-covered faces, his re-casting of mothers and babies, obstetricians and obstetrical nurses, and really anyone else within reach as part of the assemblage of actors, writers and production team needed to make a film suggest a man so obsessed with film that he was hardly concerned at all with the task ostensibly at hand, to teach students how to be obstetricians.

This restyling of obstetric experience as a cinematic affair can be glimpsed in the deeper recesses of DeLee’s obstetric storylines as well. To demonstrate what one needed out of a script, for example, DeLee included an extract of one of his most recent films in his 1933 article for fellow film enthusiasts. In this series of scenes, DeLee is interrupted in his lecture by “Dr. Davis” —though in the final edit, the interrupter is a nurse—to let DeLee know that he is needed in the birth room. By some great coincidence/script contrivance, it is to oversee a birth of exactly the sort that DeLee had just been lecturing on. He hurries off, telling his students to “study the indications for the forceps operation” that they had just been going over while he changes his clothes. The scene changes. We meet DeLee again after only a few seconds—wardrobe changed in a flash—in the birth room. Though we were hurried in here, because of the supposed urgency of the situation, in fact, the atmosphere and pace of what follows is rather relaxed. Time settles to make way for the new scene’s project, of showing the steps of the procedure on (a) live person(s).

A printed page defining text for sections, titles and voices.
A “typical script” taken from DeLee’s Science and Art of Obstetrics: Forceps and Episiotomy and republished as an example for budding medical filmmakers. “Sound Motion Pictures in Obstetrics,” the Journal of the Biological Photographic Association, 1933.

DeLee’s decision to include this particular set of scenes in his instructional article, scenes which have little obviously to do with the film’s obstetric content, is revealing. In their explicit highlighting of the artifice involved in changing one set for another, they recall DeLee’s other conventions: the artificial reproduction of the first cry of the baby, for example. But the choice to include this scene as an exemplary how-to for a group of medical filmmaking novitiates marks as intentional the message that this kind of purposeful and explicit manipulation, such that even the viewer could recognize it, was not just for the overly fastidious: it was essential to medical filmmaking.

Perhaps DeLee’s focus on using film to its maximum manipulative capacity reflected his desire to be taken seriously as a Hollywood filmmaker, driving him to demonstrate over and over again the skills he believed were essential to that role. But some of this focus also seems to reflect a kind of optimism about what the filmmaker’s apparatus could do as an obstetric tool. The total control over birth that filmmaking made possible, such that DeLee could change his outfit in the time it took us to read a title card, fit well with the contemporary understanding of obstetrics to which DeLee subscribed. Indeed, the notion that modern women were so distant from nature that childbirth itself had become pathological made an unusual demand on obstetricians. Their work was not guided by our conventional understanding that medicine should fix, heal, or cure what was wrong. Instead, obstetricians were successful when they had either effectively approximated childbirth as it had naturally been or circumvented the pathological childbirth that actually was. Either way, this suggested that it was the job of the obstetrician to shift the process and experience of childbirth as it was taking place. DeLee’s famous forceps operation was, after all, prophylactic: it took place in advance, seeking to take the place, not to right a wrong after the fact, of the pathological childbirth that would otherwise ensue.

Film was uniquely suited to this task. It could entirely transform the outcome of an obstetrical case in an instant. And it was endlessly editable, intrinsically malleable, so that the experience it offered of any one birth would vary depending, among other things, on how it was edited and pieced back together again. The renaturalized perfection of the process of childbirth that DeLee and others sought was given its ultimate expression in film. DeLee’s fastidious attention to technical detail helps to illustrate this, as does the explicit significance on artifice in medical filmmaking he advised was necessary.

And film saved lives. DeLee found in the tools of the cinema also the clinical ability to protect his mothers and babies from the threat of death—emergencies could easily, after all, be edited out of DeLee’s films— and the transference of childbirth to celluloid: a prophylactic shell imagined impenetrable to the wear and tear of the everyday. There was an erasure of individual identity here to be sure. The scores of mothers and babies who appeared in DeLee’s films are not allowed their own narratives. But there was also the promise of a kind of composite immortality that DeLee could offer via film to his new mothers and their babies.

One of the most interesting examples of this among the extant films comes in DeLee’s Duehrssen’s Incisions (undated). As usual, we are ushered into the lecture hall; DeLee offers a protracted discussion of the history of this procedure, which involved a series of “radial incisions” at 10, 2, and 6 o’clock “of the completely effaced but not sufficiently dilated cervix.” We then learn about the indications for it; we see it practiced on clay models; and then we go to the birth room to see the procedure performed on a woman in labor.
Because otherwise all is as typical for a DeLee film, there is nothing to prepare us for the interruption to the action that occurs about halfway through the procedure. In place of the birth itself, a title card reads: “The right side was cut and the baby delivered by forceps.” Immediately after this intertitle comes the startling news: “Patient had post-partum hemorrhage requiring manual removal of placenta and uterine tamponade.” Then, in a final leap past what seems as though it must have been an emergency, a two-word intertitle: “The Repair.” The viewer is not returned to the scene of the hemorrhage; instead, we are left to imagine the dramatic events of the interim while watching DeLee’s pointer poke around a clay model, charting the planned “repair” of the incisions he had made. The camera only returns to the mother at the conclusion. Her perineal area is entirely blood-free, and as far as we can tell, very little has happened, save the incisions themselves. Everything is neat and tidy. The baby’s birth (did it live?) and the mother’s possible near death (did she live? Is this the same mother? Or has a new one been edited in?) have been visually omitted. Time has been elided, skipping past the very stuff of life: births, possibly deaths, and definitely emergencies all take place under cover of the tidy font on the wood-grained background that DeLee favored for his intertitles.

In the hands of another filmmaker, this moment of crisis might have formed the film’s denouement. For DeLee, it seemed instead an opportunity to demonstrate film’s ability to leap straight past emergencies, to re-edit what had really happened into a much neater and less worrying trajectory, to preserve the lives of mothers and babies at all costs. Indeed, the film ends with the relatively unremarkable repair of the very incisions we saw DeLee create at the beginning of the film. Any loose ends have been quite literally tied up.

We might be content to take for granted that this is yet another of DeLee’s articulations of film’s obstetrical capability. And indeed, taking seriously the notion that film was an obstetrical, and not just representational or pedagogical, tool helps us to develop a more nuanced understanding of the epistemological framing of obstetrics in this period.

But Duehrssen’s Incisions also makes this all more complicated, offering us new and important questions to ask about the nature of film for medicine in this period. For one thing, given DeLee’s clear emphasis on the need to carefully manipulate these films so that we ultimately see just exactly what he wants us to see, shouldn’t we suspect at least that there had not been a hemorrhage at all?  If that’s right, what was it that the viewer was supposed to understand from the choice to conjure up an imagined emergency and to gloss it only with title slides? What does it suggest about the significance of film for medicine? What lesson are we supposed to have learned? If film is operating as an obstetrical tool, what insight does this sleight of hand offer to our reading of obstetrics in this period?

If DeLee’s work leaves us with nothing else, at least it begins to raise these kinds of questions, which challenge us to shift our perspective on what we think medicine looked like in this period; of what it was comprised; how it was rationalized and manipulated; how its goals and achievements were measured. And of course, these all circulate in a more general way around the now utterly nonsensical question that DeLee’s films and filmmaking career prompt: how do we understand a medical moment in which the culture and techniques of Hollywood held out the most attractive and effective treatments to the peculiar ailment of the modern expectant mother?

Caitjan Gainty holds a BA from Wellesley College, an MPH from Boston University, and a PhD from the University of Chicago. She is currently a Lecturer in the History of Science, Technology & Medicine at King’s College, London. Her research and writing have focused on the history of medicine and health care in the twentieth century, with a special interest in medical film and filmmaking. She is finishing a book on the ‘industrial’ history of American medicine, which examines how the early twentieth century radical redesign of the factory—the assembly lines of Henry Ford, the efficiency studies of Frederick Winslow Taylor—spilled over into medicine, critically and powerfully, but largely invisibly, reorienting its values, goals and trajectory.

Bibliography

Papers of Joseph B. DeLee, Northwestern Memorial Hospital Archives.

Bauch, Nicholas. The Geography of Digestion: Biotechnology and the Kellogg Cereal Enterprise. Oakland: University of California Press, 2016.

Brakhage, Stan. “Window Water Baby Moving” 1959 https://www.youtube.com/watch?v=7YvNVEyBNbs

Bowlby, John and James Robertson. A Two-Year-Old Goes to Hospital 1953.

Boyd, Mary and Marguerite Tracy. “More about Painless Childbirth,” McClure’s Magazine, October 1914, 56–69.

Brown, Vera. “Specialist Employs ‘Talkie’ to Depict Operation.” Detroit Times, June 1930.

DeLee, Joseph. “Sound Motion Pictures in Obstetrics.” Journal of the Biological Photographic Association 22, no 2. (1933-34): 60-68.

de Kruif, Paul. The Fight for Life. New York: Harcourt Brace and Company, 1938 (1934).

DeLee, Joseph. “The Prophylactic Forceps Operation.” American Journal of Obstetrics and Gynecology 1 (1920): 34-44.

DeLee, Joseph. “Progress Toward Ideal Obstetrics.” American Journal of Obstetrics and Diseases of Women and Children 73 (1915): 114-123.

DeLee, Joseph. “The Use of Solution of Posterior Pituitary in Modern Obstetrics.” Journal of the American Medical Association 115, no. 16 (1940): 1320-1326.

Dick Read, Grantly. Natural Childbirth. London: Heinemann, 1933.

Gainty, Caitjan. “’Items for Criticism (Not in Sequence): Joseph DeLee, Pare Lorentz and TheFight for Life.” British Journal for the History of Science 50, no 3 (2017): 429-449.

Gauss, C.J. “Geburten in künstlichem Dämmerschlaf.” Archiv der Gynäkologie 78 (1906): 579-631.

“Joseph B. DeLee: Obstetrics that Sucks.” Birth Unplugged: An Ever-Evolving Understanding of the Power of the Divinely Designed Female. Nov 17, 2010. http://birthunplugged.blogspot.com/2010/11/joseph-b-delee-obstetircs-that-sucks.html

Kline, Wendy. “How to Train an Obstetrician: Lessons from the Chicago Maternity Center.” Process: A Blog for American History. Jan 26, 2017. http://www.processhistory.org/kline-train-obstetrician/

Leavitt, Judith. “Science Enters the Birthing Room: Obstetrics in America Since the Eighteenth Century.” The Journal of American History 70, no. 2 (1983): 281-304.

Leavitt, Judith. “Joseph B DeLee and the Practice of Preventive Obstetrics.” American Journal of Public Health 78, no. 10 (1988): 1353-1360.

Lemay, Celine. “Physiology Matters: A Letter to Doctor Joseph B. DeLee.” AIMS Journal 30. no 1. (2018) https://www.aims.org.uk/journal/item/physiology-matters-dr-delee

Lorentz, Pare. “The Fight for Life” 1940. https://www.youtube.com/watch?v=7YvNVEyBNbs

McEvoy, J.P. “Our Streamlined Baby.” Reader’s Digest, May 1938.

Michaels, Paula A. Lamaze: An International History. New York: Oxford University Press, 2014.

Münsterbeg, Hugo. The Photoplay: A Psychological Study. New York: D. Appleton and Company, 1916. http://www.gutenberg.org/files/15383/15383-h/15383-h.htm

Orgeron, Devon, Marsha Orgeron and Dan Streible, eds. Learning with the Lights Off: Educational Film in the United States New York: Oxford University Press, 2012.

“Praise the New Method” Boston Daily Globe, May 25, 1915, 16.

Rosenberg, Charles. “The Tyranny of Diagnosis: Specific Entities and Individual Experience” Milbank Quarterly 80, no. 2 (2002): 237-260.

Rushford, Matt. “The DeLee Protocols: the Pathologization of Childbirth.” Pathways to Family Wellness. March 1, 2017. http://pathwaystofamilywellness.org/Pregnancy-Birth/the-delee-protocols-the-pathologization-of-childbirth.html.

Schweinitz, Jörg. “The Aesthestic Idealist as Efficiency Engineer: Hugo Münsterberg’s Theories of Perception, Psychotechnics and Cinema.” In Film 1900: Technology, Perception, Culture, edited by Klaus Kreimeier and Annemarie Ligensa, 84-93. Indianapolis: Indiana University Press, 2009.

Spitz, Rene. Anxiety: Its Phenomenology in the First Year of Life 1949.

Stokes, Patricia. “Purchasing Comfort: Patent Remedies and the Alleviation of Labor Pain in Germany Between 1914 and 1933.” In Pain and Prosperity: Reconsidering Twentieth Century German History, edited by Paul Betts and Greg Eghigian, 61-94. Stanford: Stanford University Press, 2003.

Stoney, George. All My Babies 1951. https://www.youtube.com/watch?v=I2djFnp5h0w

Tracy, Marguerite, and Mary Boyd. Painless Childbirth. New York, Frederick Stokes Co, 1915.

Van Sweringen, Budd. “Motion Pictures of Obstetric Procedures” Journal of the American Medical Association 78, no 8 (1922): 602.

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“$100,000 Film.” The Dayton Herald, September 27, 1927.


Notes

[1] In another letter to DeLee from the then-editor of the prestigious Journal of the American Medical Association Morris Fishbein, the spelling is “Fleckels”. Fishbein to DeLee, August 30, 1927, Papers of Joseph B. DeLee: Manuscripts and Motion Pictures, Northwestern Memorial Hospital Archives (hereafter NMH Archives), Box 42. Maurice Fleckels was a well-known figure in the Chicago and then Hollywood film communities. He was also the brother-in-law (and long-time employee) of the founder of Universal Studios, Carl Laemmle. I am exceptionally grateful to Sue Sacharski, archivist at the NMH Archives, for her indispensable help in tracking down the Fleckles/Fleckels documents in the archive and for her astute suggestion that the “Fleckels” in question might be Maurice Fleckels.

[2] See e.g., “$100,000 Film” The Dayton Herald September 27, 1927. DeLee was not alone: in the 1922 Journal of the American Medical Association, an obstetrician bristled at the inaccuracies and inhumanity of what is almost certainly the same collection of films. Budd Van Sweringen, “Motion Pictures of Obstetric Procedures” JAMA 1922, 78(8): 602.

[3] DeLee to C.H. Davis, November 8, 1927, NMH Archives, Box 49, “Motion Picture Correspondence, 1927-42.

[4] Ibid.

[5] Joseph DeLee, “The Motion Picture in Obstetric Teaching” ab 1928. NMH Archives, Box 49, Folder 3.

[6] Ibid.

[7] DeLee to R.W. Green, January 10, 1928. Box 49, Folder 2, NMH Archives.

[8] Joseph DeLee, “Sound Motion Pictures in Obstetrics” Journal of the Biological Photographic Association 1933-34, 2(2): 67.

[9] DeLee, “The Motion Picture in Obstetric Teaching.”

[10] DeLee “The Motion Picture in Obstetric Teaching.”

[11] Vera Brown, ‘Specialist employs “talkie” to depict operation’, Detroit Times, June1930, NMH Archives, Box 49, Folder 4.

[12] See e.g., “Birth Unplugged: An ever-evolving understanding of the power of the divinely designed female” Nov 17, 2010, http://birthunplugged.blogspot.com/2010/11/joseph-b-delee-obstetircs-that-sucks.html; Celine Lemay, “Physiology Matters: a letter to Doctor Joseph B. DeLee” AIMS Journal 2018 30(1). https://www.aims.org.uk/journal/item/physiology-matters-dr-delee; Matt Rushford, “The DeLee Protocols: the Pathologization of Childbirth” Pathways to Family Wellness, http://pathwaystofamilywellness.org/Pregnancy-Birth/the-delee-protocols-the-pathologization-of-childbirth.html.

[13] Joseph B. DeLee, “The prophylactic forceps operation” American Journal of Obstetrics and Gynecology. 1920, 1: 34-44.

[14] Ibid, 41.

[15] This comes with an important caveat, of course, which is that DeLee also ran and funded the Chicago Maternity Center, a charitable organization which offer free home births to the poor population of Chicago’s near west side. For more on the film made about this Chicago Maternity Center, see Caitjan Gainty, “’Items for Criticism (Not in Sequence): Joseph DeLee, Pare Lorentz and The Fight for Life,” British Journal for the History of Science 2017 50(3): 429-449. Wendy Kline’s blog posting on the Chicago Maternity Center helps to put this matter in perspective: “How to Train an Obstetrician: Lessons from the Chicago Maternity Center, Jan 26, 2017. http://www.processhistory.org/kline-train-obstetrician/ For a measured and thoughtful accounting of DeLee more generally, see the several works of Judith Leavitt which address DeLee, e.g., “Science Enters the Birthing Room: Obstetrics in America Since the Eighteenth Century” The Journal of American History 70, no. 2 (1983): 281-304; and even more specifically, “Joseph B DeLee and the Practice of Preventive Obstetrics,” American Journal of Public Health 78, no. 10 (1988): 1353-1360.

[16] For example, in a letter to a prominent obstetrical colleague, DeLee complained that “the fundamental reason why obstetrics is on such a low plane in the opinion of the profession and reflected from the profession in the minds of the public is just because pregnancy and labor are considered normal, and therefore anybody, a medical student, a midwife, a neighbor, knows enough to take care of such a function.” DeLee to J Whitridge Williams, Box 50, 1923 Correspondence folder, NMH Archives.

[17] Joseph DeLee, “Progress toward ideal obstetrics” American Journal of Obstetrics and Diseases of Women and Children 1916 73: 409.

[18] See e.g., Charles Rosenberg, “The Tyranny of Diagnosis: Specific Entities and Individual Experience” Milbank Quarterly 80, no. 2 (2002): 237-260.

[19] Indeed, this explains the celebration of DeLee in Paul de Kruif’s Fight for Life, 1938 (1934) which later became the film Fight for Life, dir. Pare Lorentz, 1940.

[20] Marguerite Tracy and Mary Boyd, Painless Childbirth New York, Frederick Stokes Co, 1915.

[21] Joseph B DeLee “Before the Baby Comes” Delineator October 1926, 35.

[22] DeLee was a fan of Read’s, which he described to Paul de Kruif and as recorded in de Kruif’s Fight for Life Harcourt Brace and Company, 1938 (1934).

[23] Grantly Dick Read, Natural Childbirth (London: Heinemann, 1933), 86.

[24] DeLee, “Motion Picture in Obstetric Teaching.”

[25] Brown, “Specialist employs ‘talkie’ to depict operation.”

[26] DeLee, “Motion Picture in Obstetric Teaching.”

[27] DeLee, “The Motion Picture in Obstetric Teaching.”

[28] Houghteling to DeLee, July 11, 1929. Box 49, Folder 2, NMH Archives.

[29] DeLee to E.N. Hurley, December 14, 1928, Box 49, Folder 2, NMH Archives.

[30] DeLee, “The Motion Picture in Obstetric Teaching.” These hints of ambivalence concerning the function of these films track onto the more general porousness of the category of pedagogical films in this period. See e.g., Devin Orgeron, Marsha Orgeron and Dan Streible, eds Learning with the Lights Off: Educational Film in the United States (New York: Oxford University Press, 2012).

[31] DeLee noted elsewhere that the inclusion of students in these films was especially helpful, because they could serve as a kind of visual proxy for the viewer. See Gainty, “Items for Criticism.”

[32] See e.g., Learning with the Lights Off: Educational Film in the United States. In what was either an accidental or entirely intended misquoting of Riciotto Canudo’s 1921 essay on cinema, “Reflections on the Seventh Art,” DeLee repeatedly referred to his own filmmaking work as the “eighth art.”Ricciotto Canudo, Manifeste des Sept Arts (1921).

[33] “Play scenarios” 1932. Box 49, Folder 6. NMH Archives. See also Lasker to DeLee, Nov 4, 1932 and the possibly sent unsent letter from DeLee to Irving Berlin, 1940. Box 50, NMH Archives.

[34] Gainty, “Items for Criticism.”

[35] DeLee, “Sound Motion Pictures in Obstetrics” Journal of the Biological Photographic Association, 61.

[36] DeLee, “The Motion Picture in Obstetric Teaching.”

[37] Ibid.

[38] DeLee, “Sound Motion Pictures in Obstetrics” Journal of the Biological Photographic Association, 66.

[39] Ibid, 67.

[40] Ibid, 61.

[41] Ibid, 62-63.

[42] DeLee, “The Motion Picture in Obstetric Teaching.”

[43] DeLee, “Sound Motion Pictures in Obstetrics” Journal of the Biological Photographic Association, 62.


 

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