Page:The New International Encyclopædia 1st ed. v. 14.djvu/847

OBSTETRICS. 719 OBSTETRICS. as in others. Miihvivcs did most of the worls, 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 (..D. 000) described an instrument scnne- 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. Vcsalius (q.v.) in 1.543 first correctly described the bony pelvis, and Levret in France (1754) and Smellie in England (17.51) completed his' work 200 years later by taking e.xact measure- ments of the several diameters of the pelvic cavity. At the commencement of the si.xtuenth century Eucharius Rhodion published a little book which is remarkable as being the first book published on this subject in England. In 1.573 Ambrose Part! 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 ilauriceau, his succes- sors, developed and improved his teachings. Alpout 1040 Dr. Paul Chamberlin. an Englishman, invented the forceps with separate blades, such as are now used. The Chamberlins (father and sons) did not publish their discovery, and it was not until 181.5 that the exact nature of the instrument became known. The first scientific book on midwifery was published in 151.3 by Eucharius Rijsslin; and Justine Siegemund, a court midwife of Brandenburg, attained celebrity by her work on this subject. In 1008 Mauriccau's Treatise appeared, and was for a long time the standard work on the subject. A point requiring notice in the history of miilwifery 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 flermany were in the habit of employing it for this purpose; but 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 8mellie and Ould (1742) in England, who de- scribed the engagement of the foetal head in the pelvis; Levret (1747), Solayres de Renhac (1771), Baudeloque (1781), and iladame Lacha- pelle (1795) in France; and Boer anil Schmitt in fJermany. 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 fomidcr 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 17.56; in Germany in 1804; in France 1831) ; the use of auscultation to detect the fietal heart-beat; the perfection of the obstetric forceps, and its more frequent use in place of craniotomy ; and the employment of general ansesthesia in both normal and complicated labors. Partial an:ts- 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 anesthetics wdien 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, ati'ords 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 physiology of these organs during the process of reproduction; and the pathological conditions which may arise during this period. Ax.TOMY. The generative organs of the female consist of the uterus; the two ovaries, connected with the uterus on either side by the Fallopian tubes, which open into its cavity; and the vagina, or canal leading from the uterus to the external parts. The breasts are also included^ although only active after the birth of the child. Phy.siology. Reproductive activity, including the functions of menstruation, conception, gesta- tion, i)arturition, and lactation, is limited in the female to a period of life beginning at about the twelfth year and ending about the forty- fifth. These limits vary by a few years, accord- ing to climate, an earlier maturity being char- acteristic of hot countries. When conception has taken place, the im])regnated ovum makes its way through one of the Fallopian tubes to the cavity of the uterus, where it lodges and develops through the agency of a convoluted mass of blood vessels called the placenta, from which a cord of vessels (the umbilical cord) runs to the abdomen of the fcetus. The duration of normal pregnancy varies from 27.5 to 280 days (nine calendar or ten lunar months), but gestation may be prolonged lieyond this time in very rare cases to 300 or 306 days. Pregnancy is ter- minated with the expulsion of the child by the contractions (labor pains) of the powerful mus- cular fibres of the uterus. The more important signs and symptoms of pregnancy are the per- ception of the ftetal heart-beats by the ear (aus- cultation) ; "quickening,' or active movements of the child in utero: passive movements (ballotte- meut) elicited liy manipulation; suppression of the menses, morning naiisea, gradual enlargement of the abdomen and breasts, and pigmentation of the area immediately surrounding the nipple. Of these only the first three can be considered certain indications of pregnancy, the existence of which can rarely be diagnosed w'ith precision before the third month. During gestation the fcetus floats freely in a sac of water called the amniotic fluid, and changes its position fre- ipieiitly. When parturition begins, however, the long axis of the foetus usually coincides with that of the mother, with the head downward, or presenting at the pelvic outlet. This is by far the most common presentation, occurring in about (10 per cent, of all cases. In about 3 per cent, the buttocks or feet present. About once in 200 labors what is known as a transverse presenta- tion ;s met with (that is, the long axis of the