Unlike male medical practitioners, midwives did not participate in guilds or attempt to organize themselves.[11] Green writes that medical licensure originated in the mid-fifteenth century. Typically the church or legislature mandated these requirements, and the earliest known example is from Regensburg in 1452.[12] Minkowski argued that the organization of midwives commenced once a medical "hierarchy" was constructed "with male doctors at the top."[13] Greilsammer notes that during this time period society aimed to implement midwives into this medical organization. Lawmakers hoped that regulation would improve the quality of care given by midwives.[14] Greilsammer further notes that "Brussels was in 1424 the first town in Europe to enact detailed regulations regarding the functions of midwives," with "similar measures... enacted in Bruges in 1509 and in Mechelen in 1536."[14]