Wednesday 27 November 2013

Childbirth in History - The Major Breakthrough

 Obstetrics was well developed on the mechanical side by the eighteenth century; however, the benefits were offset by the prevalence of childbed fever, or puerperal infection. This disease had been known from antiquity as an occasional occurrence but during the seventeenth, eighteenth and nineteenth centuries it became a fatal epidemic disease.

Between the years 1652 and 1862 there were two hundred epidemics of the disease, which were then attributed largely to the state of the weather. In 1773 a great epidemic of puerperal fever more than decimated the lying-in hospitals of Europe, and after three years culminated in Lombardy, where it is said that for a year not one woman lived after bearing a child.

Most of the lying-in hospitals, built from the seventeenth century to nearly the twentieth century and dedicated to the care of destitute child-bearing women, were humane in intention only. In reality most of them were deadly for the women who entered them as these hospitals were the breeding grounds for puerperal infection.

Puerperal fever starts within a few hours to a few days after the birth of the child. The following extract is from the record of a case described by a doctor practicing during an epidemic at Aberdeen, 1789 to 1792, and gives some insight into the course of the disease and the medical practice of the time:

"In the afternoon of the 19th August, 1790, John Low. miller of Justice-mills, came to my house, requesting me to go in immediately to his wife, who, he said, '.....was in great danger'. I accordingly went, and found her in a dangerous situation; she complained of an acute pain in the lower part of the abdomen, attended with a very great degree of fever, the velocity of the pulse being at the rate of 140 strokes a minute. The disorder commenced with a violent rigor at six o'clock in the morning, being about thirty-six hours after delivery....I accordingly ordered bleeding to the quantity of sixteen ounces."


The physician also ordered a physic and raised a blister on the patients abdomen, gave her opiates to relieve the pain in that location, and concludes."...the scene was soon closed." With his patient dead he philosophises on the ingratitude of the patient's friends and the hardships of medical practice.

"...On this, as well as many other occasions, I found that scientific practice and popular opinion very seldom correspond. According to a vulgar custom in this country, the women came from all quarters to see the patient, and to offer their advice. Several ladies likewise joined the crowd; and though they neither knew the nature, nor even the name of the disease, yet they gave their advice with great freedom! Some said it was wrong to bleed, others that it was improper to purge a patient in such a situation; some prescribed heating, and others astringent medicines; and seemingly actuated by other motives than the good of the patient, they proposed different practitioners.."

In the United States, in Colonian days, obstetrics did not receive the attention that it did in Europe. Childbirth in those early days of American civilisation was considered a simple physiological function, to be carried out in secrecy with a friend or midwife. The wife of Dr Samuel Fuller, who landed from the Mayflower, was the first midwife of the Colony. The next was Mrs Hutchinson of Boston, who was banished for her political heresy. She was succeeded by Ruth Barnaby, who lived to be one hundred and one. The first person to be executed in the Colony of Massachusetts Bay was Margaret Jones, female physician; she was accused of witchcraft.

 Incidentally, she is the only physician whose name was in any way associated ( her association was involuntary ) with the scandalous persecutions which were guided by those zealots, Cotton Mather and Samuel Parris.

The efforts of the Chamberlens to control midwifery in England and Mauriceau's innovation of conducting childbirth in bed did not influence the activities of the Colonies, but other things from Europe did. Syphilis entered Boston in 1646, ten years after Harvard College was founded. The appearance of diphtheria in Roxbury, Massachusetts, was timed closely with Louis XIV's ascension to the throne. While Hugh Chamberlen was trying to sell his obstetrical forceps in Paris, New York was busy with an epidemic of yellow fever, and Boston, soon after, with one of its numerous epidemics of smallpox..

Forty six years after Clement delivered the Dauphin of France and made male midwifery popular among the ladies of the court, New York City passed the first ordinance in America to control the activities of the midwives. In 1716 it was considered that midwifery needed some regulation; the ordinance reads:

" It is ordained that no woman within this corporation shall exercise the employment of midwifery until she has taken oath before the mayor, recorder or an alderman...to the following effect: That she will be diligent and ready to help any woman in labour, whether poor or rich; that in time of necessity she will not forsake the poor woman and go to the rich; that she will not cause or suffer any woman to name or put any other father to the child, but only him which is the very true father thereof; indeed, according to the utmost of her powers; that she will not suffer any woman to pretend to be delivered of a child who is not indeed, neither to claim any other woman's child for her own; that she will not suffer any woman's child to be murdered or hurt; and as often as she shall see any peril or jeopardy, either in the mother or child, she will call in other midwives for council; that she will not administer any medicine to produce miscarriage; that she will not enforce a woman to give more for her service than is right; that she will not collude to keep secret the birth of a child; will be of good behaviour; will not conceal the birth of bastards..."

In 1739 a special department for instruction in obstetrics was created in the University of Glasgow, while in America it was six years after that date that there was the first record of a 'man midwife'. The New York Weekly Post Boy of July 22, 1745, states: "Last night died in the Prime of Life, to the almost universal Regret and Sorrow of this City, Mr John Dupuy, M.D., Man Midwife; in which last Character, it may be truly said here, as David did of Goliath's Sword, there is none like him."

Later there is mentioned Dr. Attwood of the same city, who " is remembered as the first doctor who had the hardihood to proclaim himself a man midwife; it was deemed scandal to some delicate ears, and Mrs. Granny Brown, with her fees of two dollars or three dollars, was still deemed the choice of all who thought that women should be modest."

In 1762, the same year that New York was maintaining its modesty, Dr. William Shippen, Jr., was opening a school for midwifery in Philadelphia. Dr. Shippen had returned from abroad, where, after studying with John Hunter and his brother William Hunter ( he of the rusty forceps ), he had completed his medical studies at the University of Glasgow. Shippen brought back with him the advanced ideas of European obstetrics and at once opened a school. As Dr. Shippen provided 'convenient lodgings' for the accommodation of poor women during their confinement, it may be said that he established the first lying-in hospital in America. The following advertisement, inserted by Shippen, appears in the Pennsylvania Gazette of January 1st, 1765:

"Dr. Shippen, Jr., having lately been called to the assistance of a number of women in the country in difficult labours, most of which was made so by the unskilled old women about them ; the poor women having suffered extremely, and their innocent little ones being entirely destroyed, whose lives might have been easily saved by proper management; and being informed of several desperate cases in the different neighbourhoods which have proved fatal to the mothers as well as to their infants, and were attended with the most painful circumstances, too dismal to be related. He thought it his duty immediately to begin his intended Course in Midwifery, and has prepared a proper apparatus for that purpose, in order to instruct those women who have virtue enough to own their ignorance and apply for instruction, as well as those young gentlemen now engaged in the study of that useful and necessary branch of surgery, who are taking pains to qualify themselves to practice in different parts of the country with safety and advantage to their fellow citizens."

There is no evidence that any women had 'virtue enough to own their ignorance and apply for instruction', however three years after establishing his private school he joined with Dr. John Morgan of Philadelphia in organising the medical department of the Collage of Philadelphia, later the University of Pennsylvania. There he taught anatomy, surgery, and obstetrics.

The Collage of Philadelphia gave the first regular medical degree in America, granting the Bachelor of Medicine on ten men in 1768. The following year King's College of New York, later Columbia University, graduated two men in medicine, overcoming its regard for Granny Brown to the extent of teaching obstetrics.

Prior to the 'regular medical degrees' given by the two American Medical schools there had been two 'irregular degrees' granted. In 1663, by order of the court of Rhode Island, one was given to Captain John Cranston to " administer physicke and practice chirurgerie...and by this court styled Doctor of Physicke and chirurgerie by the authority of this the general assembly of the colony."

The other degree was given by Yale Collage. Although the Yale Medical School was not established until 1810, the Academic College in 1720 conferred the honorary degree of M.D. on Daniel Turner in acknowledgment of books that he had presented to the institution. 'Doctor' Turner's writings dealt largely with venereal disease, and he also succeeded in improving methods for contraception.

In 1845, one hundred years after Mr. John Dupuy, M.D., man midwife of New York died, Oliver Wendell Holmes read a paper entitled, 'The contagiousness of Puerperal Fever', before the Boston Society for Medical Improvement. In this paper he showed clearly that the disease which ravaged the women in the lying-in hospitals of Europe, and which in America also took its toll of lives, was an infectious disease, and that the infection was carried by the physician or midwife from one patient to another through lack of cleanliness. This paper, setting forth the essentials of the greatest discovery ever made in the care of the child-bearing woman, was received with indifference in Boston, and with heated condemnation in Philadelphia by Dr. Meigs, who had succeeded Shippen in the chair of obstetrics at the University.

Dr. Holmes replied to the attack with a paper, 'Puerperal Fever as a Private Pestilence', and in it stated that one 'Senderein' had lessened the mortality from the disease by scrubbing his hands with chloride of lime. The 'Senderein' was Semmelweis who eventually got the credit for one of the most important advances in medical history. Holmes's papers were not even heard of in Europe until noticed as an historical curiosity over fifty years later. Holmes became professor of anatomy at the Harvard School of Medicine two years after the publication of his paper on puerperal infection.

Ludwig Ignaz Philipp Semmelweis,born in Budapest, Hungary, the fourth son of a prosperous shopkeeper but always inhibited by his lack of a good elementary education, therefore not considered worthy of note by the eminent medical elite, worked through a lifetime of oppression and persecution in the vile wards of the charity lying-in hospitals of Europe pursuing the cause of puerperal fever.

A brief description of the conditions existing in the lying-in hospitals throughout Europe provides an insight into the enormity of the task to which Semmelweis set himself in trying to eradicate childbed fever. England and the Scandinavian countries had at the time - middle nineteenth century - some ideas of cleanliness in hospitals, and in England childbed fever came as an occasional epidemic; in the hospitals in most of Europe it was a perennial epidemic.

Speaking of these epidemics and still bound to the idea of 'miasma' ( noxious air as a cause of contagion ), Oliver Wendell Homes said, "Now add to all this" (transmission of the disease by contact ) "the undisputed fact that within the walls of lying-in hospitals there is often generated a miasma, palpable as the chlorine used to destroy it, tenacious so as in some cases almost to defy extirpation, deadly in some institutions as the plague; which has killed women in an Old World hospital so fast that they were buried two in a coffin to conceal its horrors.".... The miasma in these cases was filth.

Bearing in mind that childbed fever is wound infection caused by the contamination of the raw surface left in the uterus after the birth of the child, consider the state of cleanliness in the Maternité of Paris as described by La Forte after his visit there in 1864.
"The principal ward contained a large number of beds placed in alcoves like English horse-stalls along each side. Ventilation was almost impossible. Floors and partitions were washed once a month...the ceilings showed that they had not been whitewashed for many years. Lying-in women who became ill were transferred to an isolation room regardless of the nature of their illness - puerperal fever cases and patients affected with diarrhoea, bronchitis, measles, or any other eruptive fever. Midwife pupils attended normal lying-in patients and fever cases alike, and performed all the necessary manipulations for every class of case."

La Forte speaks of the apparent aversion to water at the hospital, of the clouds of dust raised by dry sweeping the unwashed floors, and concludes: "It is not astonishing that the Maternity of Paris has furnished a mortality without example in any European country. From 1861 to 1864 the patients outnumbered 9,866 of whom 1,226 died; equal to a mortality of 124 in 1,000 births."

In 1858 Semmelweis, while advocating chemical treatment of the hands as a prevention of the spread of puerperal fever, received a letter from one of his students describing the conditions at Gratz: " Infection of all sorts occurs at the Gatz lying-in hospital...The dissection- room is the only place where the students can meet and pass the time when waiting for their midwifery cases, and they often devote their attention to dissecting or studying and manipulating preparations."
(The cadavers of the dissecting room at that time were not embalmed in antiseptics.)

"When they ( the students ) are summoned to the lying-in hospital, which is just across the street, they do not make any pretense at disinfection; some of them do not even wash their hands...The patients might as well be delivered in the dissecting- room. As it is, the students cross the street with their hands wet and bloody from dissecting; they dry their hands in the air, and stick them a few times in their pockets, and at once proceed to make examinations...It is no longer a riddle to me why, after a clinical meeting, the medical officer of Gratz exclaimed: 'The lying-in hospitals are really nothing but murder institutions !' "

Of the lying-in hospital of Budapest in 1850, it is said that the patients' view from the window was the burying- ground, varied on the other side by glimpses of the dissecting- room, with underneath the privies and an open sewer. In 1860 the hospital was moved to a new building, and of this the following is written in a publication of that time:

"While it is not to be denied that the institutions have obtained the advantages of more room, it must be admitted also that the internal fittings (furniture, beds, etc. ) are in the old wretched condition; the broken tables and the ragged and worn-out bed clothes, all brought from the old hospitals. Especially the lying-in clinic is in an indescribably pitiable condition; there poor lying-in women are to be found, some of them partly on straw spread on the floor, some of them on wooden benches, others crouching in any corner of the room, weary and worn out; only to a few is it vouchsafed to find a regular bed on which to stretch their weary limbs. Everywhere you find dirty bed linen, with bedclothes old and worn and almost in rags."


Regarding the private practices of physicians among the more well off patients, childbed fever occurred in occasional cases, and sometimes in epidemics, but, as Holmes particularly noticed, it was apt to run in a few consecutive cases of some one physician and then die out for a time.

The maternity hospital of Vienna, where Semmelweis started his work, was in two divisions; in one the medical students were instructed and in the other the women who were to become midwives were trained. In the First Division, that of the medical students, there was an average of 99 deaths per 1,000 births over a period of six years. In the Second Division, that of the midwives, the average for the same period was 33 deaths in 1,000 births.

Fear was declared by some physicians to be the cause of the fever, for the dread of going to the First Division was very great; so great that it was thought that the women sickened and died for that reason. Semmelweis said: " That they were afraid of the First Division there was abundant evidence. Many heartrending scenes occurred when patients found out that they had entered the First Division by mistake. They knelt down, wrung their hands, and begged they might be discharged. Lying-in patients with uncountable pulse, meteoric abdomen, and dry tongue, only a few hours before their death would protest that they were quite well in order to avoid medical treatment, for they believed that the doctor's interference was always a precursor of death."

Religious observances were also accused of increasing the mortality; it was usual for the priests, arrayed in their robes, with an attendant marching before them ringing a bell according to Catholic ritual, to proceed to the sick woman to administer the sacrament. According to ordinary arrangement this should be done only once in twenty four hours, but in childbed fever it was required sometimes every few hours, adding to the distress of the women.

Semmelweis said, " it had a strange effect upon my nerves when I heard the bell hurried past my door; a sigh would escape my heart for the victim that once more was claimed by an unknown power. This bell was a painful exhortation to me to search for this unknown cause with all my might. During my first term of office I appealed to the sense of humanity of the servant of God, and without difficulty it was arranged that for the future the priests would take a roundabout route, without ringing the bell, so as to reach the sick-chamber in silence unobserved. The two divisions were made similar in this respect, but the difference in their mortality remained."




Death and the Physician', a woodcut by Hans Holbein. The priest is carrying the sacrament to some dying man or woman; attendants follow with tapers and holy water, and death leads the way with a lantern and a bell to announce the coming of the priest. It was the sound of this bell which distressed Semmelweis


Other and even more absurd reasons were given for the difference in mortality. "It was alleged that the reason for the great mortality was because patients were unmarried women of the most hopeless class of the community, accustomed to earn their bread in want and misery and amid conditions which produced great and constant depression of spirits. If this had been the cause of the mortality it would have been as great in the Second Division, for to it exactly the same class of patients were admitted. The higher mortality of the First Division was ascribed to the wounded modesty of the poor women going through the process of parturition in the presence of men. Most of the patients in the First Division certainly suffered from fear, but not many were troubled with a sense of shame. Truly it shows with what want of thought the whole question of the aetiology of puerperal fever has been discussed when the persons who at times are depicted as the most abandoned of the population, have attributed to them in the next sentence a tenderness of modesty such as the upper and highest classes of the community do not claim. Among the upper and even the highest ranks of society labour is conducted by physicians, and their patients do not die of puerperal fever in consequence of wounded modesty in the same proportion as is alleged of the inmates of the lying-in hospitals who, for the sake of argument, are often depicted as the most loose and abandoned of the community."

Semelweis goes on step by step to eliminate ventilation, dirty laundry, and improper diet on the grounds that these things were the same in the two divisions. yet as he eliminated these possible causes he knew that the real cause lay undiscovered before him in the hospital. This fact was proven by the observation that women who were overtaken with labour on the street while making their way to the hospital were not affected with childbed fever in the hospital, even though they might be taken into the First Division.

Constant criticism of the old orthodox opinions on the causes of childbed fever by Semelweis fell on deaf ears and caused him to be demoted from assistant in charge of the First Division, to that of provisional assistant; another physician was in charge. However, after six months he resumed his former position. At the same time the death of Dr. Kolletschka occurred at the hospital under circumstances which greatly impressed Semmelweis. Kolletschka, while performing a post- mortem examination, received a puncture wound on the finger from the knife of one of his pupils. In consequence of this slight wound he sickened and died. The general symptoms of this malady were those of childbed fever.

Of this occurrence Semmelweis says: "In the excited condition in which I then was, it rushed into my mind with irresistible clearness that the disease from which Kolletschka had died was identical with that from which I had seen so many hundreds of lying-in women die. Day and night the vision of Kolletschka's malady haunted me, and with ever-increasing conviction I recognised the identity of the disease from which Kolletschka died with the malady which I had observed to carry off so many lying-in women."

Semmelweis was on the verge of his great discovery that childbed fever was wound infection, blood poisoning, which was transmitted to women by the unclean hands of the physicians and medical students who examined them during their childbirth.
" In the case of Kolletschka the cause of the disease was cadaveric material carried into the vascular system; I must, therefore, put this question to myself: Did, then, the individuals whom I had seen die from an identical disease also have cadaveric matter carried into the vascular system ? To this question I must answer, Yes ! "

All of the physicians and students attending the First Division of the hospital had frequent occasion to come in contact with and work upon the bodies of those who had died at the hospital. According to the usual method of washing the hands merely with soap and water, particles adhering to the hands were never completely removed, a fact demonstrated by the odour which the hands retained. In the examination of the women in the wards, any of the students were entitled to make internal examination for their instruction; the raw surfaces left at delivery were infected; childbed fever followed. Moreover, when one woman was infected the hands of the examiner, unwashed between examinations, carried the infection to the next woman examined.

With this discovery made, Semmelweis at once required each student to wash his hands in a solution of chloride of lime before making examinations. At that time in his division there were 120 deaths in 1,000 births; in the next seven months the deaths fell to 12 in 1,000, and for the first time in the history of the hospital were below that of the Second Division. In that year also there were two months in which not one single death occurred among the First Division.

In 1865 Semmelweis suffered an injury to a finger, which probably occurred during one of his last operations. He was infected with blood poisoning, identical with puerperal fever. He died August 13th, 1865, a victim of the infection which he had devoted a lifetime to eradicate from the wards of the maternity hospitals.





Three Kids Gripped By Evil By Polly Mullaney     
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Friday 22 November 2013

CHILDBIRTH PRACTICES AND DEVELOPMENTS

In the year 1588, the Chamberlen brothers (their father, the physician Chambellan had settled in England from France) devoted their attention to midwifery and invented the obstetrical forceps. However, they kept the invention a secret and attempted to control the midwives. The closely guarded secret was passed to the next generation, namely Peter Chamberlen who wrote a pamphlet entitled 'A voice in Ramah, or the Cry of Women and Children as Echoed Forth in the Compassion of Peter Chamberlen'.

 The secret was still kept in the family and in turn it was handed to Peter's sons of whom Hugh, 1630 - 1706, was the most important. In the words of Hugh Chamberlen, "My father, brother, and myself have by God's blessing and our own industry attained to and long practiced a way of delivering women in this case without prejudice to them or their infants." .....He still kept the secret.



Hugh Chamberlen Junior finally allowed his family secret to leak out and the instrument known as the forceps came into general use, however, the credit for the discovery of the obstetrical forceps is not always given to Chamberlen, but instead to a Belgian, Jean Palfyne, who developed an instrument which he presented freely to the Paris Academy in 1721.

The forceps originally were crude, particularly in the lock that held the blades together. Laurence Sterne in Tristram Shandy says: "Dr. Slop had lost his teeth - his favourite instrument (the obstetrical forceps) - by some misapplication of it, unfortunately slipping, he formerly, in a hard labour, knocked out three of the best of them with the handle of it..."

The purpose of the forceps is to assist in the extraction of the child when the pushing forces of the mother are lacking, or when it is advisable to terminate labour rapidly, however the forceps did not replace the podalic version. Each of the three procedures - podalic version, forceps and Caesarean section has its particular province. Podalic version makes it possible to correct the position of the child and to extract it by its feet, but the child must still be in the uterus and freely moveable. When labour has advanced and the child, in the normal position, has its head engaged in the inelastic ring formed by the pelvic bones it cannot be disengaged and pushed back into the uterus. If the strength of the mother fails, earlier practitioners could not assist in extracting the baby and could only wait for labour to proceed, which was often too late to save the child. The obstetrical forceps could overcome these difficulties.

The forceps consists of two wide flat blades curved to fit gently over the child's head. The blades are inserted and brought into position separately, then locked together, firmly gripping the head. By turning and gently pulling the child is extracted. Any opening through which the head will pass will readily allow the passage of the rest of the body, for the baby's head is of a larger diameter than is its shoulders or trunk or hips.

Neither the application of forceps nor podalic version will aid birth when the ring made by the bones of the pelvis is too small to admit the head of the child. The only procedure which could be applied in these circumstances was Caesarean section which was then far too dangerous.

Although it was clearly recognised, in the sixteenth century, that the child must pass through the ring formed by the pelvic bones, they did not know the exact structure or relation of these bones. Parè, in fact, believed, as did most other physicians, that the pelvis separated in the front and spread, as might a broken hoop, to make room for the child's head to pass. It was Andreas Vesalius who, in his book of anatomy, in 1543, first showed, although crudely, the true relation of the bones of the pelvis.

Anatomical study, as begun by Vesalius, gradually showed the fallacy of the separation of the pelvic bones during childbirth. An extract from a book on midwifery published in 1682 indicates both the passing of this fallacy and also the means for the study of anatomy used by men as eminent as Paré. This book is entitled, The English Midwife, Enlarged, Containing Directions to Midwives;…the Whole Fitted for the Meanest Capacities. It was published in London, where it was "Printed for Rowland Reynolds, next door to the Golden Bottle in the Strand, at the middle Exchange door."
The book was a plagiarism of Wolveridge's Speculum Matricis Hibernicum, a standard text of its time, but now the rarest book of its kind. The quotation in question, written a century after the time of Versalius and Parè, is as follows:

"...Ambroise Paré, a most famous Chirurgion in his time at Paris (quoting many witnesses to the thing), gives us an History of a Woman in whom (having been hang'd 14 days after she was delivered in Child-birth,) he found (as he saith) the share bone separated in the middle the breadth of half a finger, and the flanck-bones themselves disjointed from the hoop-bone. But we will not in this matter accuse him of an imposture as having too much respect, and a better opinion of so worthy a person, and believing him to be too sincere as to commit such a crime; but do indeed believe the good man might be mistaken in this separation; for we cannot probably conceive that being so at the time of her labour it would remain so a fortnight after, the breadth of half a finger; for then they would have been forc'd to carry this Woman to execution; (for they are executed at Paris within the City or Suburbs,) because she would not have been able to have supported her self, or climbe the ladder of the Gibbet; and keep her self on her Legs according to the custome of other Malefactors; because the body is only supported by the stability of these bones; wherefore we must believe, as most probable, that such a disjunction and separation were caused either from the falling of this Woman's body from the high Gibbet to the ground after execution or from some blow on that place from some hard thing."





                        
                                 TITLE PAGE OF  THE ENGLISH MIDWIFE, ENLARGED

Published in 1682. The text of this book is presented as a dialogue between the doctor and the midwife, and much sound practical advice is given. The book not only covers obstetrics, but also the diseases of children and the diseases peculiar to women; The type of women undertaking midwifery and the care of women and children is indicated by the statement on the title page, "The whole fitted for the meanest capacities."








NURSES SWADDLING A CHILD


In the seventeenth century, the period of this woodcut, the baby, at birth, was first bathed and then salted all over (in accord with the teachings of Galen), and its head tightly bandaged to shape it. Next it was bound round and round in swaddling bandages until it was unable to make the slightest movement. These bandages were usually taken off only once a day, when the child was allowed a few minutes of exercise. The swaddling continued for several months. About half of the children so treated died during the first year of life


.

Prior to the time of anaesthesia and asepsis, the woman with a deformed pelvis could have serious difficulties at the time of her delivery. Caesarean section with its then high mortality for the mother might be attempted, or the pelvic bones might be cut apart at their joint at the front of the body, or the resort of earlier times might be used and the child destroyed, but in serious deformity even this last procedure was far from successful. The induction of abortion, or later of premature labour, offered a solution to this difficulty.

Abortion had long been practiced and within the Greek and Roman cultures the procedure of inducing abortion was continued, being used by midwives extensively for any and all reasons. However, some of the more discerning physicians adopted a more restrained view; clearly outlined in the quotation given from Soranus: "...The fruit of conception is not to be destroyed at will because of adultery or of care for beauty, but is to be destroyed to avert danger appending to birth..."
With the supremacy of the Catholic Church in Europe the practice of abortion was forbidden under penalty of eternal damnation.

In England, in the eighteenth century, means of measuring the size of the pelvis were sufficiently established, so in cases of abnormality the pregnancy was brought to an end late in the seventh month or early eighth month, before the child had reached its full development. The smaller size of the child enabled its passage through a narrower than normal pelvis, and with good care the child could be nurtured.


French physicians did not follow the example of the English physicians, probably strongly influenced by the Catholic Church in France. However, despite the attitude taken by the medical profession of France, and also the civil and ecclesiastical decrees and proclamations, abortion was extensively practiced and had been for many years, but not for medical reasons. The great ladies of the day made light of the earthly and spiritual terrors held up to them and resorted to the crime to hide the consequences of their sexual irregularities. Bayles, actually, uses this fact to support the theory that fear of worldly shame is a stronger sentiment than that of religion.



The conditions existing in Paris at this time, seventeenth and early eighteenth centuries, can be gathered from a letter of Guy Patin, at one time dean of the Faculté de Médecine. Patin was a man of satirical humour and of keen observation, as may be judged from the fact that as early as 1657 he made the statement: "As to our publishers - I can hope for nothing from them. They print nothing at their own expense but novela utrisque " ( sex novels ).

At the time Patin wrote there was a large class of men and women who made a business of producing abortion; the women in this trade were chiefly the midwives. Patin's letter, written in 1660, comments on the case of Mademoiselle de Guerchi, who had been seduced by the Duc de Vitry and who had died from infection resulting from an induced abortion.


From Patin's letter:
" They make a great clamour here about the death of Mademoiselle de Guerchi. They had imprisoned the midwife at the Chatelet, but she had been taken from there to the conciergerie by order of the court. The curé of Saint Eustache has refused sepulture to the body of the lady. They say that it was carried to the hotel de Condé, and was there put in quicklime in order to consume it soon, so that it could not be identified if anyone came to see it. The midwife had defended herself well up to now...But I believe the question (torture) will be put to her. The vicars-general and the plenipotentiaries went to complain to the Premier President that in a year six hundred women, by actual count, have confessed to killing and destroying their fruit."

The midwife was later found guilty and hanged at Croix du Trahoir, as Patin says, " in good company."





INVITATION TO GUY PATIN'S FUNERAL


At the time the English physicians revived the practice of inducing premature birth as a means of avoiding difficult labour; midwifery had not been separated from surgery. In earlier times the physician's role was restricted to destructive surgical procedures, however, the arrival of podalic version and the use of forceps reduced the number of cases in which it was necessary to destroy the child. As obstetrics remained in the hands of the surgeons, they tended to make child-bearing a surgical operation and to use instruments whenever possible - a practice labelled 'meddlesome midwifery'.


It 
It was said at that time of one prominent German obstetrician that he employed instruments twenty-nine times in sixty-one births, and of another that he 'began to cut and slash' as soon as everything was not precisely normal, and in this way had a mortality of twenty per cent.
Blood-letting was also carried into the field of obstetrics, and the woman in labour was bled to prevent disease if everything seemed normal, and for treatment if anything seemed abnormal.


There was strong reaction to even beneficial surgical and instrumental procedures at child-birth, and for a time these practices were discarded. In the middle of the eighteenth century William Hunter, to emphasise his views of interfering with childbirth, was in the habit of showing his obstetrical forceps covered with rust, as evidence of the fact that he never used it. William Hunter was trained at the University of Glasgow - renowned for educating prominent medical practitioners - and was the leading consultant in midwifery in London. His views were extremely influential on the physicians in England.

The practice of avoiding the use of instruments and trusting the powers of nature went so far that in 1819 Sir Richard Croft, obstetrician to Princess Charlotte, upon whose life depended the hope of the dynasty, permitted the princess to remain in labour for fifty- two hours. The child was born dead and the mother died six hours later. Croft shot himself in remorse for his error of judgment.

In time, the reaction against operative interference caused obstetrics to be an art in its own right and not simply a branch of surgery. In the nineteenth century obstetrics became a recognised part of medical practice; the rational use of forceps and other operative procedures returned merely as necessary aids in difficult cases.











                                                         An etching by Daumier showing

                                                              the midwife and her sign
  




                                           




Three Kids Gripped By Evil By Polly Mullaney     
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