Maria Theresa: the pragmatic health reformer

Maria Theresa with family

In today’s edition of our miniseries, marking the 300th anniversary of the birth of the Empress Maria Theresa, we look at one of the many novelties she introduced during her reign - the reform of health care. The empress herself initiated some significant changes in the health sector, including obstetrics.

Maria Theresa
In the 18th century, during the reign of Maria Theresa, women still gave birth at home, usually with the assistance of midwives. Maternity hospitals as we know them today did not yet exist and the mortality rate among newborns and mothers was very high.

According to historian Daniela Tinková, this was one of the reasons which prompted Maria Theresa to modernize the system of health care, following the example of hospitals in Paris and London. Along with her private doctor Gerard van Sweeten, a foremost health care reformer, she initiated the establishment of the first department of obstetrics in Prague and Vienna.

“The first departments of obstetrics were founded in 1750s at the medical faculties in Vienna and Prague. They were established with the aim to serve doctors and surgeons. But they were not supposed to become obstetricians, who would regularly assist at births, as we know them today. They were supposed to receive the necessary knowledge to assist during complicated births. However, midwives were still expected to assist at 95 percent of births.”

At the time, midwives continued to educate themselves by passing on their knowledge and skills from one generation to the next. A mandatory course for midwives was introduced in the 1770s, but it took several decades to enforce this practice. And it was only under the reign of Maria’s successor, Joseph II, that midwives were required to pass a special course at the university.

The first maternity hospital for single mothers was established Prague’s Soukenická Street in 1762. It served mainly as a shelter for women, who might otherwise dispose of their child, and it was connected to a nearby hospital for foundlings. It was only in 1789 that the first maternity clinic of St. Appolinaire was built in the city as part of a huge hospital complex at Karlov.

Maternity clinic of St. Appolinaire in Prague,  photo: Olga Vasinkevich
So why was Maria Theresa so keen on reforming health care? Historian Daniela Tinková says she was driven by pragmatic motives, having to put together a crumbling monarchy and army:

“When conscriptions were launched, for instance, she found out that the population was in a very bad shape and that young boys were not suited for military service. So her motivation to improve health of her people was that of a stateswoman and didn’t have much to do with philanthropy.

“At that time, most enlightened rulers were interested in healthcare, including obstetrics. It became part of a larger socio-economic agenda. Explaining her motivations by the fact she was herself a woman and mother would be a huge oversimplification.”

Empress Maria Theresa was also a strong supporter of inoculation against smallpox, which at her time was one of the most dangerous diseases. The disease claimed several victims in her own family. Historian Petr Svobodný:

“The 18th century was the peak of the spread of smallpox. It was highly contagious and had a very high death rate. According to statistics from around 1800, there were between 2,000 to 17,000 victims of the disease in Bohemia alone. So there were millions of people in the world who were killed by the disease during the 18th century.”

Maria Theresa with family
Prior to the introduction of the modern day vaccine, discovered by the famous English physician Edward Jenner, doctors used a so-called variolisation. That involved the use of material taken from human smallpox pustules, which was naturally very risky. Yet, despite warnings, Maria Theresa had her own children inoculated by this method.

“There were many victims in the broader family of Maria Theresa, including several of her children. She herself survived the disease but it left scars on her face. So eventually she decided to have her two youngest children inoculated with the real smallpox material, a method which was slightly dangerous and not as effective as the modern-day vaccination, but luckily, both of the children survived.”

The modern-day vaccine, discovered by the famous English physician Edward Jenner, was introduced in 1796 and it was only in 1978 that smallpox was eradicated on a global scale.