OBSTETRICS Lat. obstrtricitts, re lating to a from obsfriri.r, midwife, form obstnre, to stand before. from ob. before, toward stew, to stand ). MIDWIFERY, or xotol.Y. That branch of medicine which is concerned with the ea re of women pregnancy, and (hiring and after labor. whether natural or irregular, with the diseases peculiar to the puerperal state, and with the care of the new-born child. It also embraces a knowledge of the anatinny of the female generative organs and the physiology of reproduction in the human species. While among savages little or no as sistance is given to the parturient woman, and the process is left to unaided nature, among civilized peoples from the earliest times there has been a class Of persons—usually women— who have attended women during this trying periinl. The Jews had women (calh•il our j%1lerlr lb 1 who acted as midwives, as did the Egyp tians: and among the Greeks there was a sponding class of women known as Phanarete. the mother of Siicrates, was a mid wife: and Plato explains the duties undertaken by these women. 'Hippocrates gave considerable attention to midwifery., and the opera tion of turning the child in abnormal labors. -lniong the Romans both physicians and mid wives ((distil rice-) attended confinements. Caesa rian section was performed after the death of the mother. and Pliny mentions that Scipio Africanus and Manlius were born in this way. There was a royal law (l's- rugia) providing for the perfinan anee of this operation when necessary. Celsus and Paulus of Ephesus wrote of obstetrics during the first century. and a gradual increase in the knowl edge of the physiology and meehanism of labor can be triopil in the writings of Galen (second ventury). Aetius I fifth century), and Paulus .Egineta (seventh century). The latter advo cated the operation of craniotomy in suitable eases. During the Middle Ages there was little progress in obstodrie seienee in Europe. hut the Arabian and Persian schools made many im provements in this branch of medicine as well as in others. Midwives did most of the work, but physicians were called in abnormal cases. Rhazes of Bagdad (A.D. 800) first advised artifi cial rupture of the membranes when spontaneous rupture was unduly delayed; and Avicenna of Ispahan (A.D. 900) described an instrument some what like the modern forceps. The teachings of these two physicians became celebrated throughout Europe and the East, and were fol lowed for many years. With the revival of learn ing the science of midwifery began to receive the attention of the most famous physicians. Vesalius (q.v.) in 1543 first correctly described the bony pelvis, and Levret in France (1754) and Smellie in England (1751) completed his work 200 years later by taking exact measure ments of the several diameters of the pelvic cavity.
At the commencement of the•%ixteenth century Eneharins Rhodion published a little book which is remarkable as being the first book published on this subject in England. In 1573 Ambrose Pa r6 published a small work in which he showed that foot-presentations were not dangerous, and that in mal-presentations it was better to deliver by the feet than to attempt to bring down the head. Guillemeau and Mauriceau, his succes
sors, developed and improved his teachings. About 1640 Dr. Paul Chamberlin, an Englishman. invented the forceps with separate blades, 'cuch as are now used. The Chamberlins (father and sons) did not publish their discovery, and it was not until 1815 that the exact nature of the instrument became known. The first scientific book on midwifery was published in 1513 by Eucharius Ri3sslin; and Justine court midwife of Brandenburg, attained celebrity by her work on this subject. In 1668 Alaurieeau's Treatise appeared. and was for a long time the standard work on the subject. A point requiring notice in the history of midwifery in the seven teenth century is the discovery of the use of ergot of rye in accelerating parturition. In 1688 Camerarius stated that midwives in some parts of Germany were in the habit of employing it for this purpose; hut it is not till 1774 that we find any further reference to the use of this drug. Important contributions to obstetric knowledge during the eighteenth century were made by Smellie and Ould (1742) in England, who de scribed the engagement of the fcetal head in the pelvis; Levret (1747), de IIenhae (1771), Baudeloque (1781), and Madame Lacha pelle (1795) in France; and Boer and Schmitt in Germany. The first, however, to give a clear and correct explanation of the entire mechanism of labor was Naegele the elder (1819), who may be considered the founder of modern obstetric science. In the nineteenth century many notable improvements in the art of midwifery were made; among them may be mentioned the induction of premature labor (first in England about 1756; in Germany in 1804: in France 1831) ; the use of auseultation to detect the foetal heart-beat; the perfection of the obstetric forceps, and its more frequent use in place of e•aniotony; and the employment of general anesthesia in both normal and complicated labors. Partial anes thesia by the injection of cocaine into the spinal canal in the lumbar region has been introduced within a few years to take the place of general amestheties when these have been contra-indi cated. Obstetrics is now an important part of the curriculum of medical schools, and lying-in hospitals in connection with these schools have been established. Vienna has long been recog nized as the centre of obstetrical teaching. the hospital in that city confining about 10,000 Women annually. Good schools are also to be found in Paris, Berlin, Dublin. and New York. The latter city, on account of its large foreign population, affords unusual clinical advantages. On the Continent and to a less extent in Great Britain, regularly licensed midwives are still ex tensively employed. but in the United States and among the better classes of Great Britain confinements are intrusted exclusively to physi cians.
The science of midwifery may be considered under three main divisions: the anatomy of the female generative organs; the of these organs during the process of reproduction ; and the pathological conditions which may arise during this period.