OBSTETRICS 



571 



the earliest attempt to formulate a practice of 

 obstetrics. While liis writings on this subject 

 show keen observation ami shrewd judgment, yet 

 his imperfect anatomical knowledge lea him into 

 grave errors. The presentation of the head was 

 the only way by which he considered it possible 

 that delivery could be effected, and then cephalic 

 turning was enjoined by him in all cases where the 

 head did not come first. When this was found 

 to be impossible, as in many cases it must have 

 been, embryotomy or Caesarean section were the 

 only alternatives. For over 300 years the teach- 

 in,' of Hippocrates was practically unquestioned, 

 until the study of anatomy in Alexancfria, under 

 the Ptolemies, served to clear up many of his errors, 

 and so advance the art. To the Knowledge of 

 anatomy gained here is due the great advance in 

 obstetrics shown by the Greek physicians who 

 practised in Rome about the beginning of the 

 Christian era. Chief among these is Soranus 

 (98-137 A.D.), who published a work 'on the 

 diseases of women,' which shows a wonderful 

 advance in the knowledge of the anatomy of the 

 female organs of generation. He further showed a 

 knowledge of obstetrics which is a long way abend 

 of Hippocrates. He insisted upon the safety of 

 foot and breech presentations, and recommended 

 and described the operation of podalic turning. 

 He showed the importance of posture in favouring 

 difficult labours, and gave careful instruction for 

 the performance of various destructive operations. 

 After Soranus came Galen (born 130 A.D.), who gave 

 an account of obstetric art as it existed at that 

 time, but whose anatomy was very defective as 

 compared with that of Soranus. His teaching and 

 opinions seem to have largely influenced the 

 Persians, and through them the Arabs, for their 

 practice all through the middle ages seems to have 

 been founded on Galen. Probably alxmt the 4th 

 century a remarkable book was published by 

 Moschion, Peri ton Gunaikeion Pu.th.6n, which is 

 sometimes, though not quite correctly, called the 

 first obstetric work published. It is based on 

 Soranus, and shows a much sounder anatomical 

 knowledge than Galen possessed. Three hundred 

 years later Paulns .'Eginetus published a work on 

 this subject which is really a compilation from 

 previous authors, and shows no advance on 

 Moschion. From this time until the beginning of 

 the 16th century it may be said that obstetrics 

 made no progress. Indeed, with the fall of the 

 Roman empire this, like other arts and sciences, 

 fell on evil days, and the knowledge was in 

 great measure lost and its practice degenerated, 

 gradually passing into the bands of the lowest 

 and most degraded women. All trace of the 

 earlier teaching was lost with the knowledge of 

 the anatomical principles on which it rested ; 

 practice was regulated by the grossest superstition 

 and ignorance, and the male practitioner was never 

 allowed to enter a lying-in room save as a last 

 resort. Indeed, the practice of midwifery by men 

 was for many centuries in Europe regarded as 

 a crime and an offence against morals, and so late 

 as 15M Wertt of Hamburg, who donned female 

 attire in order to permit his attending and studying 

 a case of labour, was detected and publicly burned 

 at the stake. And a hundred years later a Dr 

 Willtighby, an Englishman, whose daughter was 

 a midwife, crawledinto a darkened room on his 

 hands and knees in order to assist her at a difficult 

 labour I Nothing could have been more deplorable 

 than the state of obstetric practice during this 

 period, and the suffering and mortality resulting 

 from this condition of affairs could not be easily 

 estimated. 



The first indication of a neworder of affairs is found 

 In the training of midwives in the medical school 



of Salerno about the beginning of the 16th century. 

 Some time previously this school had inaugurated 

 the study of anatomy, and the light shed thereby 

 had its influence on the dark and degraded practice 

 of obstetrics. Progress was, however, slow, and its 

 practice still largely remained in the hands of 

 women, to whom clung the superstition of the dark 

 ages. Yet in the hands of anatomists like Vesalius, 

 Fallopius, Berengarius, and surgeons such as Pare, a 

 scientific basis was again being laid, and the know- 

 ledge of Soranns and Moschion being rediscovered. 

 And, while all ordinary lalK>urs were managed by 

 women, the surgeons were called in to assist when 

 a difficulty arose. By them turning was redis- 

 covered, and embrvotomy, Cipsarean section, &c. 

 were restored and developed on more scientific prin- 

 ciples. By-and-by, especially in Fiance, the prac- 

 tice of obstetrics by surgeons gradually gained 

 ground, though there, and still more elsewhere, 

 its practice by men lay under a reproach. The 

 invention of tlie obstetric forceps by the Chamber- 

 lens, about the beginning of the 17th century, gave 

 n great impulse to the art. In 1668 Mauriceau 

 published his Treatise, which ran through seven 

 editions, and wax fur long the standard work on the 

 subject. It was translated into English by Hugh 

 C'hamlicrlen in 1672, and it seems to be about this 

 time that men began generally to engage in the 

 practice of midwifery : Harvey, the Chamberlens, 

 and others took it up in England ; whilst La 

 Valliere, the mistress of Louis XIV., by employ- 

 ing Julian Clement, a surgeon of high eminence, 

 in her first confinement in 16C3, did much to estab- 

 lish the practice in France. 



Since the revival of the study of anatomy and 

 physiology the progress of scientific obstetrics has 

 lieen steady ami sure. The reproach under which 

 its practice so long lay has been entirely removed, 

 and the colleges of physicians, which at one time 

 refused their fellowships to any one engaged in 

 obstetric practice, now receive them on the same 

 terms as other physicians, and all medical licens- 

 ing bodies demand an adequate knowledge of its 

 theory and practice from every candidate for their 

 diplomas. The science and practice have been built 

 up by a hont of workers, the mere mention of whose 

 names here epace precludes. But it may be of use 

 to indicate some of the great advances and dis- 

 coveries on which the art rest*. 



(1) The Rediscovery of Podalic Version or Turn- 

 ing. In 1550 Pare described this operation, whose 

 value had been recognised and its method described 

 in the 1st century by Soranus. This had been 

 lost to practice since the 7th century. Par6 showed 

 how it could be performed, and pointed out its 

 advantages in saving foetal life ; and it is certain 

 many children were delivered safely by this means 

 whose lives could not have been otherwise saved. 

 The operation has been extended and modified in 

 various ways since, but that descril>ed by Pare is 

 at the present day the one most usually performed. 



(2) The Invention of the Forceps. About the 

 end of the 16th or beginning of the 17th century, 

 the forceps was brought into use by Peter Cham- 

 berlen, son of William Chamberlen, a Huguenot 

 refugee, living in England (see FORCEPS). The 

 secret, long kept, ultimately leaked out, and by 

 1747 the instrument was generally known and em- 

 ployed. The original instrument was modified by 

 Levret of Paris, Smellie and Simpson in Great 

 Britain ; and, more recently, its construction has 

 been elaborated by Tarnier of Paris on what is 

 called the ' axis-traction ' principle. It may safely 

 be said that no single invention has been more 

 successful in saving life and relieving suffering. 



(3) The Employment of Anesthetics. In 1847 

 Sir James Simpson first employed chloroform 

 anesthesia to relieve the pain of labour, and thU 



