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Evolución De La Tocurgia En El Siglo Xix a Ambos Lados Del Atlántico

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Evolución De La Tocurgia En El Siglo Xix a Ambos Lados Del Atlántico PROGRAMA DE DOCTORADO EN CIENCIAS DE LA SALUD POR LA UNIVERSIDAD DE CASTILLA-LA MANCHA EVOLUCIÓN DE LA TOCURGIA EN EL SIGLO XIX A AMBOS LADOS DEL ATLÁNTICO Tesis presentada por Esther Vanessa Aguilar Galán para optar al grado de Doctor en Medicina Dirigida por los Dres. María Isabel Porras Gallo, Francisco Javier Redondo Calvo, Rubén Villazala González Ciudad Real, 25 de agosto de 2020 1 2 LOS DOCTORES MARÍA ISABEL PORRAS GALLO, FRANCISCO JAVIER REDONDO CALVO Y RUBÉN VILLAZALA GONZÁLEZ CERTIFICAN: Que la presente Tesis Doctoral “EVOLUCIÓN DE LA TOCURGIA EN EL SIGLO XIX A AMBOS LADOS DEL ATLÁNTICO” ha sido realizada bajo su supervisión, por el Licenciado en Medicina, Doña Esther Vanessa Aguilar Galán, y que, habiendo revisado el trabajo, consideran que reúne las condiciones necesarias para optar al grado de Doctor. Y para que conste, en cumplimiento de la legislación vigente, firman el presente certificado en Ciudad Real, a 25 de agosto de 2020. Dr. D. María Isabel Porras Gallo Dr. D. Francisco Javier Redondo Calvo Dr. D Rubén Villazala González 3 4 DEDICATORIA A Valeria, por llenar mis días y mi trabajo diario de amor infinito. A Alberto, por su apoyo incondicional y por estar presente en todo momento. A mis padres, por ser un ejemplo constante y un pilar fundamental en mi vida. A Angelita y Julia, por su fe en mi y su cariño. 5 6 AGRADECIMIENTOS Son muchas las personas a las que debo agradecer la realización de este trabajo. Todas ellas no solo me han apoyado curricularmente, sino que han sido un aliento constante. En primer lugar, quiero expresar mi agradecimiento a Javier, Rubén y Maribel, que han trabajado en todo momento a mi lado dándome lo mejor de ellos mismos y confiando plenamente en mi. Han sido un apoyo fundamental y me han sabido guiar por este complejo camino, sin desfallecer y sin permitir que me rindiera. En segundo lugar, a mis amigos, que me han ayudado a clarificar mi mente y han llenado estos años de experiencias que me han servido para seguir adelante. En tercer lugar, a Carmen y a Prado por su infinita paciencia y por soportar mis eternas charlas. Y por último querría agradecer a los compañeros que me acompañaron en mi formación sus enseñanzas en el manejo del fórceps, especialmente a Gabriela. Me inculcaron el respeto y la admiración por el instrumento que rige mi práctica profesional. Igualmente agradezco los esfuerzos, desvelos y trabajos a los obstetras de todos los tiempos que dedicaron su vida y su profesión a perfeccionar el uso del fórceps, dando así una esperanza a aquellos niños que estaban abocados a otro fatal destino. 7 8 1. INTRODUCCIÓN 15 1.1 CONTEXTO SOCIOCULTURAL Y CIENTÍFICO EUROPEO EN EL SIGLO XIX 19 1.1.1 Cambios polícos en el Viejo Mundo 19 1.1.2 La Revolución Industrial: cambio económico fundamental 21 1.1.3 Evolución cienfica en el Viejo Mundo 22 1.2 CONTEXTO SOCIOCULTURAL Y CIENTÍFICO DE NORTEAMÉRICA EN EL SIGLO XIX 31 1.2.1 Colonización, independencia y Guerra de Secesión: escenarios polícos 31 1.2.1.1 Colonización e Independencia 32 1.2.1.2 Guerra de Secesión Americana 34 1.2.2 Economía norteamericana 35 1.2.3 Evolución cienfica en Norteamérica 38 1.2.3.1 Desarrollo de patentes 38 1.2.3.2 “Usurpación” de tecnologías 40 1.2.3.3 Creación de Universidades y Sociedades 41 1.3 MEDICINA DEL SIGLO XIX EN EUROPA 45 1.3.1 Escuela anatomoclínica de París 45 1.3.2 Escuela Alemana: patología celular y medicina fisiopatológica 49 1.3.2.1 Patología celular 50 1.3.2.2 Mentalidad Fisiopatológica 52 1.3.3 Medicina en el resto de Europa en la segunda mitad del siglo XIX 54 1.3.4 Medicina, valoración social en Europa 55 1.4 MEDICINA DEL SIGLO XIX EN NORTEAMÉRICA 57 1.4.1 Pracca médica en el periodo colonial 57 1.4.2 Base sociosanitaria en Norteamérica 60 1.4.2.1 Farmacopea 61 1.4.2.2 Medicina a gran escala 63 1.4.2.3 Medicina no regular 67 1.4.2.4 Medicina oficial o cienfica, el informe Flexner 72 1.5 SIGLO XIX, APARICIÓN DE LAS ESPECIALIDADES MÉDICAS Y EVOLUCIÓN DE LA OBSTETRICIA 76 1.5.1 Desde la partera al obstetra 77 1.5.1.1 Prehistoria 78 1.5.1.2 Edad Angua 80 1.5.1.3 Edad Media 86 1.5.1.4 Edad Moderna 88 1.5.2 Nacimiento de la obstetricia 90 1.5.3 Confrontación obstetra versus comadrona 96 1.5.4 Triunfo del obstetra y modelos obstétricos en Europa a finales del siglo XVIII 102 9 1.5.4.1 Modelos obstétricos europeos 105 1.5.5 Cambio en la asistencia al parto en Norteamérica a principios del siglo XIX 108 1.6 FÓRCEPS EN LA OBSTETRICIA ACTUAL 113 1.6.1 Otros instrumentos obstétricos: Espátulas de Thierry 114 1.6.2 Otros instrumentos obstétricos: Ventosa obstétrica 117 1.6.3 Indicaciones e incidencia de parto instrumental 121 2. JUSTIFICACIÓN 127 3. HIPÓTESIS DE TRABAJO 133 4. OBJETIVOS 137 4.1 OBJETIVO PRIMARIO 139 4.2 OBJETIVOS SECUNDARIOS 139 5. MATERIAL Y MÉTODOS 141 5.1 FUENTES DE ESTUDIO 143 5.1.1 Fuentes primarias 143 5.1.2 Fuentes secundarias 144 5.2 MÉTODOS 145 5.2.1 EXAMEN DE LA HISTORIA Y REPERCUSIONES OBSTÉTRICAS DEL FÓRCEPS 145 5.2.1.1 Manuales de obstetricia seleccionados 147 5.2.1.2 Análisis cuantavo del material 149 5.2.2 EXAMEN DEL INSTRUMENTO 150 5.2.2.1 Criterios de Inclusión y Exclusión 152 5.2.2.2 Elaboración de la base de datos 153 5.2.2.3 Elementos de la base de datos 159 5.2.2.4 Análisis Estadísco 161 6. RESULTADOS 163 6.1 HISTORIA DEL FÓRCEPS 165 6.1.1 Familia Chamberlen, creadores del fórceps (siglo XVII) 165 6.1.2 William Smellie y Andrée Levret, introducción del fórceps en la obstetricia (siglo XVIII) 169 6.1.3 Controversias iniciales en el uso del fórceps 176 6.2 NORMAS GENERALES EN LA UTILIZACIÓN DEL FÓRCEPS EN EL SIGLO XIX 182 6.2.1 Indicaciones del uso del fórceps 183 6.2.2 Reglas generales del uso del fórceps 188 6.3 EXAMEN DE LOS FÓRCEPS DEL SIGLO XIX 194 10 6.3.1 Caracteríscas generales de los fórceps estudiados 194 6.3.2 Características principales de los fórceps europeos vs norteamericanos 200 6.3.3 Caracteríscas de los fórceps europeos 206 6.3.4 Comparava fórceps europeos frente a norteamericanos 210 7. DISCUSIÓN 229 7.1 USO DEL FÓRCEPS EN LA OBSTETRICIA DECIMONÓNICA 231 7.1.1 Controversias en Gran Bretaña 237 7.1.2 Controversias en el resto de Europa 246 7.2 MECANISMO DE ACCIÓN DEL FÓRCEPS 248 7.2.1 Función prensora 248 7.2.2 Función rotadora 251 7.2.3 Función tractora 254 7.3 CONFRONTACIÓN FÓRCEPS VERSUS VECTIS 258 7.3.1 Indicaciones y forma de uso del vecs 259 7.3.2 Comparava del uso del fórceps y palanca en la obstetricia decimonónica 261 7.4 CATÁLOGOS DE INSTRUMENTAL QUIRÚRGICO 264 7.4.1 Primer instrumental quirúrgico 264 7.4.2 Desarrollo del instrumental quirúrgico en el siglo XVIII 266 7.4.3 Siglo XIX, diferencias cronológicas en la producción de material quirúrgico 267 7.4.3.1 Inicios (1750-1875) 268 7.4.3.2 Estandarización (1875-1914) 269 7.4.4 Siglo XIX, diferencias geográficas en la producción de material quirúrgico 271 7.4.4.1 Producción francesa 272 7.4.4.2 Producción británica 275 7.4.4.3 Producción norteamericana 277 7.5 ESTRUCTURA Y CURVATURA DEL FÓRCEPS 285 7.5.1 Variaciones en la estructura de los fórceps europeos a lo largo del siglo XIX 289 7.5.2 Variaciones en la estructura de los fórceps norteamericanos a lo largo del siglo XIX 293 7.5.2.1 Importación frente a fabricación propia 299 7.5.2.2 Tipos fórceps ulizados en la segunda mitad de siglo en EE. UU. 300 7.5.3 Diferencias en la estructura entre los fórceps europeos y los fórceps estadounidenses 302 7.6 CIERRE DEL FÓRCEPS 308 7.6.1 Variaciones en el cierre de los fórceps europeos y norteamericanos a lo largo del siglo XIX 313 7.6.2 Diferencias entre el cierre de los fórceps europeos frente a los norteamericanos 315 7.7 MANGOS DEL FÓRCEPS 319 7.7.1 Ganchos y borlón distal, variaciones principales de los mangos en el siglo XIX. 320 11 7.7.2 Finger ps, muesca proximal y sistemas de tracción axial; el fórceps como instrumento tractor. 323 7.7.2.1 Sistemas tractores básicos 324 7.7.2.2 Sistemas tractores complejos: tracción axial 328 7.7.3 Elementos para control de presión, el fórceps como instrumento prensor 339 7.7.4 Mangos forrados y la introducción de la ansepsia y la asepsia en la medicina 348 8. CONCLUSIONES 355 9. ANEXOS 359 10. ÍNDICE DE ILUSTRACIONES 365 10.1 FIGURAS 367 10.2 TABLAS 377 10.3 GRÁFICOS 379 11. BIBLIOGRAFÍA 383 12 ABREVIATURAS AAAS Asociación estadounidense para el avance de la Ciencia a.C. Antes de Cristo ACOG Colegio Americano de Obstetricia y Ginecología AIT Instituto Americano de Homeopatía AMA Asociación Médica Americana CEPAL Comisión Económica para América Latina y el Caribe. CFAT Fundación Carnegie para el progreso de la enseñanza d.C. Después de Cristo. Dcha. Derecha EE. UU. Estados Unidos EPHR Informe europeo de salud perinatal Izda.
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