Note 451 — PHYSIOLOGICAL ILLUSTRATIONS CONNECTED WITH THE FOREGOING SUBJECTS.

Cases of such difficulty as to render the use of instruments absolutely necessary are so rare as not to occur more than once in six, or, at most, five hundred labours. Midwifery, as a practice, must have been nearly coeval with the creation, but during the first ages it probably consisted in little else than a knowledge of the method of dividing the navel string; as difficulties, however, arose, this knowledge, of necessity, was gradually extended to that of affording mechanical assistance in the exclusion of the fœtus; but it would seem that for many ages those artificial means consisted almost entirely in anointing the pudenda with oil, and in placing the women in hot baths, as we learn from the writings of Hippocrates, Avicenna, and other ancient writers, who appear to have attributed the whole of the difficulty to a rigidity of the muscles, and to have entirely overlooked that formidable obstacle to child-birth, the mal-conformation of the pelvic basin. Hippocrates and Celsus, however advise, that upon the failure of the ordinary means above alluded to, the head of the child should be opened with a scalpel, and then extracted with strong iron pincers or hooks; but it appears that the advice of Hippocrates was rarely followed, and that, in such cases, the child was mangled by the scalpel, and brought away piece-meal. See Albucasis, Methodus Medendi Lib. ii, and Ruett de Conceptione et Generat. Hominis.