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PUBLISHED BY DIRECTION OF THE MEDICAL BOARD
EDITED BY GEO. W. KOSMAK, M.D.
LYING-IN HOSPITAL PRESS
Obstetrics as It was; as It Is; as It Should Be. By E. Gustav
Spina Bifida in the New-Born. By James A. Harrar, M.D.
Report on Two Cases of Accidental Hemorrhage. By Lucius A.
· 131 143
Report of a Case of Spontaneous Rupture of the Uterus. By Ross
Report of the Work Done in the Babies' Class from October 1st, 1914
Annual Report for 1915 of the Pathological Department of the
Book Reviews: Manual of Obstetrics. By Edward P. Davis, A.M.,
The Principles and Practice of Obstetrics, Second Edition. By
Bibliography of Obstetrical Literature
NOTE. Each number of the "Bulletin" will be designated by the date of actual
Bulletin of the Lying-in Hospital
of the City of New York
OBSTETRICS AS IT WAS; AS IT IS; AS IT SHOULD BE.*
E. GUSTAV ZINKE, M. D.,
UP to a little more than a year ago we prided ourselves on the marked progress which had been made in every department of science and art, in our mode of living, of work and of travel, in our national intercourse; indeed, in everything pertaining to the welfare, safety, comfort and enjoyment of our existence. Never has the historian been able to record such rapid and gigantic strides of progress as in the nineteenth and the beginning of the twentieth century. What seemed but a dream or fancy of past generations has been realized; that which appeared in the comparatively recent past, the product of imagination—aye, even of mental derangement-has not only become fact and truth unalterable, but the actual basis for further speculations, inventions and discoveries. Advancement has become so rapid and so marked, that it is impossible for one mind, however capacious, circumspective and well-trained, to master every department of medicine and surgery. But the student of history knows the path of civilization is marked by sad and serious fluctuations in the intellectual, moral, social and religious life of the different nations of the earth. Who does not know the story of the high intellectual attainments and the splendor of ancient Greece and of Rome; their subsequent downfall and return to barbarism? All we see and hear of these two, once grand and noble people, including their languages, is as but a relic of the past. Other nations before and since have met a like fate. History repeats itself. Let us be mindful of the past, and profit thereby.
The lesson to be learned from the study of the history of midwifery is not a trivial one. It is a sad story full of pathos; filled with untold woe and suffering of the mothers of the past; and replete with heroic
*Address delivered at a meeting of the Society of the Alumni of the Lying-In Hospital, November, 1915.
struggles against the densest ignorance, on the part of men who attempted to come to their rescue.
Prior to the year 400 B.C., little or nothing is known of the nature of the aid women received in the act of labor. Greece was at that period the center of learning and prosperity. Here we find Hippocrates, the so-called "Father of Medicine," who is said to have been the first to observe, teach and write scientifically and systematically upon the various phases of labor. In the Ayur Veda of Susruta we find sufficient evidence, however, to warrant the conclusion at least, that the practice of midwifery received some attention, as in the laws of the Buddhists, we learn women were confined in separate rooms and isolated buildings as early as 1500 years B.C.; but nothing can be found indicative of the existence of knowledge of the anatomical involvement and physiology of labor. The same may be said of the early Israelites. Among the orthodox Jews of the present generation we still notice the observance of rules and customs, (during and after menstruation, pregnancy and confinement,) which governed the conduct of Jewesses of that day.) All that can be gleaned from the records of early history, as sketched by Siebold and Bumm of Germany, Leishman of England, Parvin and Engelman of this country is, that women, unskilled, untaught and ignorant in every way, rendered assistance as best they could. Subsequently, the work was relegated to a special class of women-the midwives, none the better and often the worse, because they were mainly of an inferior type, devoid of learning, full of superstition, and not infrequently the victims of disease. This is true, in no small degree, of the untrained midwife of the present day, especially in the large cities of our own country.
Up to the middle of the sixteenth century, by custom and by law, men were excluded from the lying-in chamber; and, as late as the beginning of the seventeenth century, medical men who, prompted by the best of motives, by some connivance obtained admission to the precincts of the confinement room, were not only ostracised by society and debarred from following their profession, but sometimes even burned at the stake. Such was the fate of Dr. Wertt, of Hamburg (1522), who, for the purpose of study, attempted to attend a woman in labor. One hundred years later, Dr. Percivall Willugby, in order to assist his daughter, a midwife, in a difficult case of labor, was obliged to don the dress of a woman and crawl upon his hands and knees into the darkened room.
What the state of midwifery must have been in its infancy can. scarcely be imagined, unless we draw our inferences from what may still be seen among the savage tribes of this and other countries, especially among the negroes of Africa and our own Indians, and compare this with the crude and barbarous methods as observed during the many hundreds of years between the time of Hippocrates (400 B.C.) and modern civilization in the sixteenth century. The picture furnished by the
events during these almost 2,000 years in the history of midwifery is like a dark and dismal day: The sky obscured by heavy clouds, with an occasional ray of sun shining through, here and there, only to be obscured by another heavy, ill-foreboding carrier of adverse wind and destruction. But as we read on, there slowly appears "the dawning of a brighter day." The clouds at first gradually part, but soon they begin to chase each other until at last the sun appears in all its splendor, with all its beauty and beneficent magnificence. To say then, that no efforts were made towards the amelioration of suffering women during this long period, would not be exactly true. Here are the facts. Judge
Hippocrates taught that the head was the only natural presentation, and that the child could not be born alive in any other way. He compared the parturient act to the forcing of an olive, in its long diameter, through the neck of a bottle; should its long diameter be thrown across the mouth of the bottle, the olive will be crushed or the bottle broken. He failed to perceive the possibility that either child or olive could pass by either extremity of its long diameter. Notwithstanding that this doctrine was refuted by Aristotle, the theory was handed down as the only knowledge in stock from generation to generation, from century to century, for nearly 2,000 years. Through all this time, footling presentations were changed to that of the vertex. What was done or happened when this could not be accomplished, or if delivery by the breech or otherwise never occurred, remains a mystery. The lives lost and the suffering endured under the prevalence of this practice for fully 1,900 years, and throughout the most densely populated countries of the Old World, is beyond computation-beyond imagination. It is the darkest spot in all the known history of midwifery.
Aristotle, Celsus and Aetius are upon record as the only ones who did not fall into the same error. Aetius appears as one of the first of the stars on the obstetric firmament about 500 years after Hippocrates. In his work he mentions some of the causes of difficult labor, such as narrow pelvis, presence of polypi, obliquity of the womb, anchylosis of the pubic bones, faulty position or abnormal development of the child. He is the inventor of the first speculum, which he devised for the purpose of exposing the presenting part of the child, and to determine the cause of delay or obstructions. He also applied instruments to the sides of the fetal head by using two crotchets, and crowns his honest and laborious work by suggesting and advising the turning upon the feet in unfavorable positions of the head. Like the works and discoveries of those who preceded Aetius, his own precepts were discarded and forgotten. So true is this, that the turning upon the feet, when rediscovered in recent times, was long regarded as a modern method.
The Arabian school of midwifery furnished the names of Rhazes of Bagdad, of the ninth, and Avicenna of Ispahan, of the tenth century.