The labours of the Prague obstetrician Johann Melitsch (1763-1837) : Contribution to the topic of the professionalising of obstetrics in the 18th century
Abstract
This study aims to present the physician Johann Melitsch (1763-1837) as a courageous re-former who presented a specific alternative to the étatist model of healthcare reforms implemented by the Habsburg monarchy in the 18th century. As obstetrics was the focus of Melitsch's reform activi-ties, the paper also contributes to the broader issue of the professionalisation of obstetrics at the turn of the 18th and 19th centuries.
In the 1780s, Joseph II decided to use the assets of the secularised monasteries and hospitals to form a state complex of various health and social care facilities in the capitals of the Habsburg "prov-inces". Where conditions and proximity to the university allowed, the first real "clinics", i.e. hospitals linked to the teaching of medicine (and therefore science), were established: this was the case, for ex-ample, in Vienna and Prague.
General hospitals formed the core of these complexes; maternity hos-pitals were also built, primarily for unmarried mothers, to prevent infanticide, but also as a source of female bodies for young medical students, who otherwise generally did not have the opportunity to learn about pregnancy and childbirth.At the same time, a young doctor who had just finished medical school in Prague, the twenty-four-year-old Johann Melitsch, the son of a cabinet-maker, decided to undertake another project: a Privat-entbindungsanstalt, ie. private outpatient maternity clinic. It was designed for married but poor wom-en and also offered the opportunity of midwifery practice to medical students. Thanks to a family inheritance and his wife's dowry, he was indeed able to found such an institution.
And with donations from wealthy patrons from the nobility, he was able to provide small financial rewards or medicines to his patients. His assistants were students.
Melitsch later extended his outpatient care, which was also improved by the "district doctors", to sick women and children in general and thus offered a counterpart to the "stationary" type of state gen-eral hospital. In 1793, he was finally appointed professor at the Prague Faculty of Medicine - but only after the intervention of Emperor Francis I himself, who also granted this institution a "public right".
In 1795 Melitsch drew up a proposal - also probably the first in the Habsburg monarchy - for health in-surance for low-income segments of the population. However, this system was never put into practice.In this predominantly Catholic monarchy, where hospitals had hitherto operated mainly on a church or municipal basis and where there was a clear tendency in Melitsch's time to create a pure-ly state-run health service, this was an exceptional case.
The paper is also a contribution to the broad-er issue of the professionalisation of midwifery at the turn of the 18th and 19th centuries. Besides that, Melitsch is considered to be the first doctor in the Czech lands to perform a successful caesarean sec-tion in which both mother and child survived