Historical Sketch.—The origin of midwifery is lost in the mists of human origins. The learned Jean Astruc, who gave a lead to higher critics in their analysis of the Pentateuch by pointing out the presence of Elohistic and Jehovistic elements, exercised his imagination in fancying how the earliest pair comported themselves at the birth of their first child, and especially how the husband would have to learn what to do with the placenta and umbilical cord. His speculations are not in the least illuminative. The Mosaic writings let us see women of some experience and authority by the side of a Rachel dying in labour, or a Tamar giving birth to twins, and superintending the easy labours of Hebrew slaves in Egypt. The Ebers Papyrus (1550 B.C.), which Moses may have studied when he grew learned in all the wisdom of the Egyptians, is the oldest known medical production. It contains prescriptions for causing abortion, for promoting labour, for curing displacements of the uterus, &c. But there is no indication as to how labours are to be managed, and with regard to the child there are only auguries given as to whether it will live or die, according, e.g. as its first cry after it is born sounds like nī or bá.
The story of the rise and progress of midwifery is intimately bound up with the history of medicine in general. The obstetrician, looking for the dawn of his science, turns like his fellow workers in other medical disciplines to the Hippocratic writings (400 B.C.). Now the father of medicine was not an obstetrician. As with Egyptians and Hebrews, the skilled attendants on women in labour among the Greeks were also women. But since nothing that concerned the ailments of humanity was foreign to Hippocrates, there are indications in the writings that are accounted genuine of his interest in the disorders of females—in their menstrual troubles, in their sterility, in their gestation symptoms, and in their puerperal diseases; his oath forswears the use of abortifacients, and he recommends the use of sternutatories to hasten the expulsion of the after-birth. In the Hippocratic writings that are supposed to be products of his followers some of these subjects are more fully dealt with; but whilst the physician is sometimes called in to give advice in difficult labours, so that he can describe different kinds of presentation and can speak of the possibility of changing an unfavourable into a favourable lie of the infant, it is usually only with cases where the child is already dead that he has to deal, and then he tells how he has to mutilate and extract it. So these writings furnish us with the earliest account of the accoucheur's armamentarium, and let us see him possessed of a μαχαίριον—a knife or perforator for opening the head; a πίεστρον—a comminutor for breaking up the bones; and a ἑλκυστήρ—an extractor for hooking out the infant. The classical writers of Greece give the same impression as to the primitive stage of obstetrics. Women, like the mother of Socrates, have the charge of parturient women. Where divine aid is sought, goddesses are invoked to facilitate the labour. Gods or men are only called in where graver interference is required, as when Apollo rescued the infant Aesculapius by a Caesarean section performed on the dying Semele. Some midwives are known to history, and extracts from the writings of one Aspasia are embedded in the works of later authors. In the great medical school of Alexandria, when the science of human anatomy began to take shape, Herophilus rendered a service to obstetrics in giving a truer idea of the anatomy of the female than had previously prevailed; other physicians give evidence of their interest in midwifery and the diseases of women, and some experience was gradually being acquired and transmitted through the profession until we find from Celsus (in the reign of Augustus) that when surgeons were called in to help the attendant woman they could sometimes bring about the delivery, without destroying the infant, by the operation of turning. In the 2nd century Soranus wrote a work on midwifery for the guidance of midwives, in which for the first time the uterus is differentiated from the vagina and instruction is given for the use of a speculum. A contemporary, Moschion, wrote a guide for midwives which, with that of Soranus, may be said to touch the high-water mark of archaic midwifery. It is written in the form of question and answer, was much prized at the time of the Renaissance, and was used as the basis of the first obstetric work that issued from a printing-press. Philumenos wrote a treatise of some value at the same epoch, but it is only known from the free use made of it by subsequent writers, such as Aëtius in the beginning of the 6th century. Like Oribasius, who preserved in his compilation the work of Soranus, Aëtius draws largely on preceding writers. His treatises on female diseases constitute an advance on previous knowledge, but there is no progress in midwifery, though he still makes mention of turning. This operation has disappeared from the pages of Paulus Aegineta, an 8th-century author, the last to treat at length of obstetrics and gynaecology ere the night of the dark ages settled down on the Roman world, and it is not heard of again till a millennium had passed. During the centuries when the progress of medicine was dependent on the work of the Arabian physicians, the science of obstetrics stood still. We are curious to know what Rhazes and Avicenna in the 9th and 10th centuries have to say on this subject. But they know little but what they have learned from the Greek writers, and they show a great tendency to relapse to the rudest procedures and to have recourse to operative interferences destructive to the child. Interest attaches to the work of Albucasis in the 12th century, in that he is the first to illustrate his pages with figures of the knives, crushers and extractors that were employed in their gruesome practices, and that he gives the first history of a case of extrauterine pregnancy.
We come down to the 16th century before we begin to see any indication of the development of obstetrics towards a place among the sciences. Medicine and surgery profited earlier by the intellectual awakenings of the Renaissance and the Reformation. In anatomical theatres and hospital wards associated with universities great anatomists and clinicians began to discard the dogmas of Galen, and to teach their pupils to study the body and its diseases with unprejudiced minds. But the practice of midwifery was still among all people in the hands of women, and when in 1513 Eucharius Roesslin of Frankfort published a work on midwifery, it bore the title Der schwangeren Frawen und hebammen Rosengarten. Translated into English by Thomas Raynald with the altered title, The Birth of Mankynd, it is mainly compiled from Moschion, and the Soranus and Philumenos fragments of Oribasius and Aëtius, and is intended as a guide to pregnant women and their attendant nurses. It was illustrated with fanciful figures of the foetus in utero that were reproduced in other works of later date—as in the Rosengarten of Walter Reiff of Strassburg in 1546 and the Hebammenbuch of Jacob Rueff of Zurich in 1554, the latter of which appears in English dress as The Expert Midwife. The greatest impulse to the progress of midwifery was given in the middle of the 16th century by the famous French surgeon Ambroise Paré, who revived the operation of podalic version, and showed how by means of it surgeons could often rescue the infant even in cases of head presentation, instead of breaking it up and extracting it piecemeal. He was ably seconded by his pupil Guillemeau, who translated his work into Latin, and at a later period himself wrote a treatise on midwifery, an English translation of which was published in 1612 with the title Child-Birth; or, The Happy Deliverie of Women. The close of the 16th century is rendered further memorable in the annals of midwifery by the publication of a series of works specially devoted to it. Three sets of compilations, containing extracts from the various writers on obstetrics and gynaecology from the time of Hippocrates onwards, were published under the designation of Gynaecia or Gynaeciorum—the first edited by Caspar Wolff of Zurich in 1566, the second by Caspar Bauhin of Basel in 1586, and the third by Israel Spach of Strassburg in 1597. Spach includes in his collection not only Paré's obstetrical chapters, but the Latin translation of the important Traitte nouveaux de l'hysterotomotokie, published by the French surgeon Francis Rousset in 1581, which is the first distinct treatise on an obstetric operation, and advocates the performance of Caesarean section on living women with difficult labours. From this time onwards evidence accumulates of the growing interest
