The Revival of Interest in Obstetrics.—With Soranus, the early Greek writer on obstetrics, this science seemed to come to a standstill, and during all the intervening centuries, up to the sixteenth, not a single work of any special value was published on this subject; for it is safe to say that nobody would claim for the one or two obstetrical treatises that were written by teachers in the Medical School of Salerno during the ninth or tenth century, that they contributed materially to advance our knowledge in regard to this branch of medicine. It therefore seems fitting, as suggested by Haeser, that during the century which gave birth to such immortal works as those of Vesalius and Paré, there should appear somebody who possessed the inclination to stir once more into life the dying embers of the science of midwifery; and such a man was found in the person of Eucharius Roesslin, the elder, more commonly known—says Dezeimeris—by the Greek name of “Rhodion.” He lived during the first half of the sixteenth century, his death occurring about the year 1526, and his was the first modern treatise especially devoted to obstetrics. He began the practice of medicine in the city of Worms, in the central part of Germany, and then moved to Frankfort-on-the-Main, where he filled the salaried office of City Physician. Midwifery, at that time, was left entirely in the hands of ignorant old women; and it was only in response to the wishes of Catherine, the Duchess of Brunswick and Lüneberg, that Rhodion undertook to prepare a manual from which these ignorant and careless women might learn to conduct their midwifery work in a more efficient, safe and acceptable manner. This little treatise, which was first published at Worms in 1513, passed through a number of editions and was translated into Latin, French, Dutch and English. Von Siebold says that Rhodion compiled its text from various ancient sources, and added practically nothing from his own experience. The woodcuts, which are supposed to represent the different positions of the foetus in the uterus, are not at all in accordance with the truth, and show the most marvelous products of the artist’s fancy. Von Siebold states, however, that the prejudices which at that time existed in the minds of the people against the slightest participation of males in the operations of midwifery were so strong that Rhodion would not have been permitted to do anything toward learning the truth by the employment of direct observation and careful examination—the only possible way in which the actual facts might have been learned.
Rhodion’s book, notwithstanding the defects to which I have just referred, accomplished much good. It also restored the operation of podalic version to the position which it deserved, and it improved the service of the midwives,—which was what the Duchess chiefly desired,—and it undoubtedly emphasized the fact that the time had arrived when obstetrics should receive the same degree of scientific study that was being bestowed on all the other departments of medicine.
The title of Rhodion’s (or Roesslin’s) little book reveals the fact that he possessed no small degree of humor. It reads: “Garden of Roses for Pregnant Women and for Midwives,” Worms, 1513.
The Operation Known as Caesarian Section.—The following statements relating to the operation known as “Caesarian section” have been compiled from Haeser’s Geschichte der Medizin:—This operation, which owes its name to the erroneous idea that Caesar was brought into the world by its aid, is commonly believed to have been practiced on different occasions throughout antiquity, but there has not yet been found in the records of history any account which shows clearly that the operation was performed upon a living woman, and also that the incision extended not merely through the abdominal integuments, but also through the actual uterine wall. At Siegershausen, in Switzerland,—according to the report of Caspar Bauhin in the treatise (“Gynaecia”) which he published at Basel in 1586,—a man named Jacob Nufer performed (about 1500) what was believed to be a Caesarian section on his own wife, and delivered a living child. Both mother and child did well; the child growing up to the age of seventy-seven and the mother giving birth to living children, per vias naturales, several times afterward. In this instance it is generally believed that the case was one of abdominal pregnancy and that the wall of the uterus had not been incised.
The first separate treatise on Caesarian section was written by François Rousset, and in it are reported several cases in which the operation was said to have been performed successfully. But both von Siebold and Kurt Sprengel do not seem willing to accept these reports as genuine, and we are therefore compelled to assume that the first trustworthy account of a Caesarian section successfully performed by a Dr. Trautmann of Wittenberg (in 1610) is that given by Sennert in a communication which was printed early in the seventeenth century.
Invention of the Obstetrical Forceps.—After the publication of Roesslin’s “Garden of Roses,” the book of which I gave a brief sketch on a previous page, nothing worthy of special note was done for a period of several years to advance the existing knowledge of midwifery or even to systematize that which had already accumulated. Then there began to appear evidences of an awakening among those physicians who recognized the importance of this department of medical science, and as a result there were soon placed upon record accounts of two or three advances of real and permanent value. One of the first of these gains, for example, was the revival and general acceptance of the practice of podalic version, or version by internal manipulations,—that is, the operation of changing the faulty position of the foetus in utero in such a manner that the feet shall be the parts which protrude into the vagina. Podalic version—as it appears from the account given by von Siebold—was known to the ancients, both Celsus and Aëtius having described it in their treatises, but it was afterward forgotten or neglected until Ambroise Paré, in 1550, again recommended it in one of his writings. At the same time Paré states, at the very beginning of his monograph on this subject, that his colleagues, Thierry de Héry and Nicole Lambert, had both of them already carried out the method in certain cases. This fact, however, does not detract from the credit due Paré for having been the first, after the lapse of several centuries, to bring the operation to the knowledge of the medical profession; and from that day to the present it has held a fixed place in the science of obstetrics. As will be readily understood, this is not the proper place in which to furnish details with regard to the operation itself. When Paré was asked whether it would be permissible for the midwives to undertake this operation of podalic version, he replied that it would be, provided the individual who assumed this responsibility felt convinced that she possessed the requisite degree of skill and experience in work of this nature, and provided also that—as soon as she began to suspect her inability to finish the operation successfully—she would promptly call to her aid a skilful surgeon, one who had acquired considerable experience in obstetrical operations. Paré’s favorite pupil, Jacques Guillemeau (1550–1630), a native of Orleans, France, made several important additions to our knowledge of the operation of podalic version, and he was also in other respects an important promoter of the science of operative obstetrics. His treatise on this branch of practical medicine, which was originally written in French and published at Paris in 1609, was soon translated into English (“Childbirth, the Happy Deliverance of Women,” London, 1612). In the opinion of von Siebold, podalic version may justly be considered the most important contribution that was made to obstetrical science during the sixteenth century.
One of the French midwives of this period, Louise Bourgeois (or Boursier), attained considerable celebrity by the excellence of the treatise which she wrote on obstetrics. She was born at Paris about the year 1564. In 1588 she began to fit herself for the career of midwife, and in the course of a few years, after passing successfully the required examinations, she was admitted by the authorities as a “sworn midwife” of the city of Paris. She gained steadily in experience and public favor, and the record states that already as early as 1601 she had the good fortune to officiate at the delivery of Henry the Fourth’s wife (Marie de Medicis) of a son—the Dauphin (later, Louis the Thirteenth). Her royal patrons were much pleased with the services which she rendered on this occasion, and, as a further evidence of the confidence which she inspired, they asked her—as each of these occasions approached—to preside at the births of five other children.
One of the meritorious features of the treatise which Louise Bourgeois wrote,[99] says von Siebold, is to be found in the fact that she championed most earnestly podalic version. The book was translated into both German (1644) and Dutch (1658).
François Mauriceau (1637–1709), who was indisputably the most distinguished writer on obstetrics of the seventeenth century, was born in Paris. During the early part of his career he was simply a general surgeon, but, after the lapse of a few years, he gave up all his other work and confined himself strictly to midwifery. For quite a long period he held the position of Chief Obstetrician at Hôtel-Dieu, and at the same time he conducted an extensive private practice in cases of confinement. Worn out by the excessive amount of work which he performed during the most active period of his career, he was finally obliged to retire from practice several years before his death.
Mauriceau did not invent any remarkable obstetric instruments or procedures, but he was the first to set forth in clear and precise terms the principles of this science and art and to expound the rules required for putting them into practice. The titles of his two most celebrated treatises are the following: “Traité des maladies des femmes grosses,” Paris, 1668; and “Observations sur la grossesse et l’accouchement,” Paris, 1695. In 1706, three years before his death, he also published “Dernières observations sur les maladies des femmes grosses.”