A Look Through Time: Historical Analysis of Obstetrics and Gynecology Texts Highlights Changes in Medicine

Our objective was to analyze systematically the preface and foreword of each edition of Williams Obstetrics and Te Linde's Operative Gynecology to gain insight into historical changes in medicine.

The preface and foreword from 24 editions of Williams Obstetrics and 11 editions of Te Linde's Operative Gynecology were obtained. Documents were assessed for the inclusion of predefined key words or topics, including sex-specific pronoun usage, insurance, fertility regulation, government regulation/laws, documentation burden, malpractice, race, medicine as "art" or medicine as "science," and others. Data were extracted and analyzed using Microsoft Excel.

Changing pronoun usage was evident across both texts. From 1941 through 1950, physicians were referred to as male 19 times and as female once. The ratio of male-to-female pronoun usage equalized in the 1990s. Medicine increasingly was referred to as a science rather than as an art within the last 2 decades. From the 1970s onward, emerging physician concerns, including malpractice, documentation burden, regulation, and insurance, were mentioned increasingly. The first mention of governmental regulation and evidence-based medicine occurred in the 21st century. Since 1903, race was never mentioned and "change" and "improvement" were cited almost universally.

The increase in female pronoun usage reflects the expanding role of women in medicine. Another trend noted relates to increasing external influence on and regulation of our profession. Previously less important concerns such as documentation burden have emerged in the last 2 decades.