The causes of difficult parturition, and the methods of remedying them, are more fully treated of by Aëtius than by any other ancient writer; but, as Paulus evidently copies from him, we shall merely supply a few things which our author has omitted. Among the causes of difficult labour, he mentions too compact a union of the ossa pubis. When the woman is too young or too old, he justly remarks that she wants strength to accomplish delivery readily. He mentions that in the delivery of twins, the two children may get entangled. He means, probably, that the head of the one may follow the delivery of the breach of the other. Of this singular complication, a fatal case was published in the ‘Edinburgh Medical and Surgical Journal’ some years ago. He expresses himself favorably with respect to feet presentations. All cross presentations are said to be difficult to rectify, but the child is to be brought by the head or the feet according to circumstances. When delivery is retarded by rigidity of the parts, he strongly recommends the warm bath. When fulness of the bladder occasions obstruction, he properly directs the urine to be drawn off by a catheter. When a foot or hand presents, he directs us not to pull down the part, lest it become more firmly impacted, or lest it should be fractured or dislocated; but the projecting part is to be pushed up and the position restored.
According to Eros, one of the most common causes of difficult parturition is heat and tumefaction of the external parts. In this and in other cases, he directs the patient to sit in a bath prepared with emollient herbs, and to get the parts about the belly rubbed with oil of violets or of roses.
Serapion treats this subject in nearly the same terms as our author. Like the Greeks, he approves of emollient oils and baths to produce relaxation. The same practice is recommended likewise by Rhases. When the membranes are tough, he advises us to tear them with the fingers, or to open them with a knife.
Avicenna has treated of difficult parturition with his usual accuracy, which exhausts every subject he handles. He states that the expulsion of the child is performed by the abdominal muscles. This was the opinion of Galen; and we are inclined, upon the whole, to think it pretty correct. He approves greatly of the bath, both before labour has come on and during the time of it. When delivery is difficult, owing to the size of the child, he directs us to apply a fillet round the child’s head, and endeavour to extract it. When this does not succeed, the forceps are to be applied, and the child extracted by them. If this cannot be accomplished, the child is to be extracted by incision, as in the case of a dead fœtus. This passage puts it beyond a doubt that the Arabians were acquainted with the method of extracting the child alive by the forceps.
Albucasis recommends us, when the membranes are tough, to perforate them by the finger or a spatumile. When the waters are discharged, he directs us to press down the woman’s belly so as to make the head descend. If it does not come down readily, he advises us to give a clyster, and afterwards to apply compression to the belly. Albucasis also approves of the tepid bath. To promote the delivery of the secundines, he recommends us to make the woman sneeze and retain her breath.
Alsaharavius (probably the same as Albucasis) treats fully of the causes of difficult labours. When occasioned by dryness and constriction of the vagina, he recommends baths, fomentations, and clysters, containing the decoctions of mallows, fenugreek, and linseed; and also directs the parts to be rubbed with warm oil. When obstruction of the rectum by fæces prevents delivery, he advises us to administer a clyster. When intense cold is the cause of the difficulty, he recommends clysters of hot oil, and the warm bath. When the membranes are tough and retard delivery, he directs the midwife to break them with a sort of reed or needle.
Haly Abbas mentions imperforate hymen among the causes of difficult labour. Such cases have been reported by modern writers on midwifery. See Baudelocque (§ 341), and Burns (Midwifery, x.) Fabricius ab Aquapendente relates a very curious case in which conception had taken place without rupture of the hymen. (Œuvres Chirurg. ii, 81.) When the difficulty arises from fatness and debility of the expulsive powers, Haly directs us to rub the parts with warm olive-oil, or other such emollients, and to make the woman sit in a bath prepared with chamomile, melilot, &c. He mentions, as an internal remedy, the infusion of a swallow’s nest (alcyonium?) When the difficulty proceeds from cold, he recommends the use of the tepid bath; and when from the contrary cause, he advises cooling things to be applied. According to Rhases, difficult parturition may arise from the mother, the fœtus, or the secundines. He appears to have considered all presentations unnatural except the head. In the other cases, he says, the life of the mother or child is endangered, although, he adds, many living children are born by the feet. When delivery of the head is found difficult, he recommends ligatures or fillets. When the feet or hands present, he directs us to restore the position, or if that is impossible, to bring down the feet. Many of his authorities mention the warm bath and lubricants.
From the sketch which we have given above, it will be seen that the Arabians have made mention of the forceps; but that most probably the Greeks and Romans were unacquainted with this instrument, as far, at least, as appears from their works on medicine which have come down to us. It is deserving of remark, however, that in the house of an obstetrix which has been excavated in Pompeii, there was found an instrument of art bearing a very considerable resemblance to the modern forceps. It is a well-known fact in the history of inventions that many useful discoveries have long been kept as family secrets. This was the case even of a late date with the Chamberlains, who were the first in modern times to use the forceps.