Hip Dislocation and Dystocia in Early Medieval Times: Possible Evidence of Labor Maneuver.

BACKGROUND: In ancient times, maternal mortality would occur frequently, particularly during labor. Evidence of dystocia resulting in the death of a pregnant woman is very infrequent in paleopathologic literature, with only a few cases being demonstrated. CASE: In the early medieval site of Casserres, the skeleton of a young woman with a fetus in the pelvic region was found. Some abnormal findings of the maternal skeleton were evaluated, including a sacral anomaly, femoral head wound, the rare position of the lower left limb with the femoral head dislodged anteriorly and cephalad from the socket, and a fibular fracture. CONCLUSION: Examining the anomalies all together, a case of anterior hip dislocation related to a McRoberts-like maneuver performed during labor is a plausible explanation of the findings.

[Kaiseijutsu and obstetrics in Osaka during the Yedo era: focusing mainly on the development of surgical operations in obstetrics].

In the Yedo era, the Kamigata area was the place of dispatch of new cultures and was the seat of the economy. However, because natural disasters happened frequently, the economic differential between the central area and the provinces grew wider. The families who suffered poverty sold their daughters to the licensed quarters. Moreover, among the general public, there were a lot of foundlings and women who had abortions. Indeed, we can find these phenomena throughout the Yedo era. Early in the era, such cases were regarded as very common; for example, in IHARA Saikaku works, which describes scenes in Osaka early in the Yedo era, there are a lot of descriptions of foundlings and women who had abortions as common social phenomena. However, in the middle of the era, these phenomena came to be considered sins, as they were in Saikaku's works. This transition period of conceptions about foundlings or abortions coincided with changes in technology in obstetrics. Early in the era when dystocia occurred, both mothers and babies could only be expected to die, and in the middle, after the invention of Kaiseijutsu, which was designed by KAGAWA Gen'etsu, obstetricians could help a lot of women in childbirth. However, when abortions came to be regarded as a sin, people accepted Kaiseijutsu because of the concept of life and because it could help women in childbed and babies as medicine, before everything else.

The gynaecological-obstetrical practice of the renaissance physician Amatus Lusitanus (Dubrovnik, 1555-1557).

OBJECTIVE: A gynaecological-obstetrical causation review in Dubrovnik from 1555 to 1557. Extract from the book "Curationum Medicinalium Centuriae V et VI" Amatus Lusitanus. METHOD: A thorough life and work archive study of Amatus Lusitanus has been made and, for this review, extracted his gynaecological-obstetrical causation observations and annotations. RESULTS: Amatus Lusitanus was an undisputed, reputable and respected medical figure during the mid 16th century. He decisively focused on intern medicine, incorporating the gynaecological-obstetrical field. His work and skill, most assuredly, contributed to the better comprehension, acknowledgement and reputation of the gynaecological-obstetrical practice, thus leaving repute and respect in medical history latitude. CONCLUSION: All these cases occurred in Dubrovnik during 1555-1557 and Amatus is assuredly an excellent observer and exactist, extracting the "relevant from the non-relevant" even in Dubrovnik's gynaecological-obstetrical daily happenings. He thoughtfully concludes his inability to remedy a malignant, advanced illness of the uterus, presumes an utero-vesico-intestinal fistula and openly speaks of medical ineptness of this causation. Proud of his invention in treating "contracted nipples"; correct in his advice and recommendations of "long and difficult births". Impartial in his perception of puerperal sepsis and its unfavourable pathology outcome. His description of "hormone insufficiency" is concise and precise; the preferred procedure in an "abortus in tractu" is purposeful and meaningful. He closely works with other physicians living and working in Dubrovnik; conscientiously directing surgeons in procedures of stillborn child births. He explains and treats pyschosexual disturbances "without fault" and in concurrence with, not only, the contemporary knowledge of such sexual disturbances, but also in concurrence with contemporary psychiatric procedures that, even today, are applied in such pathology treatment.

[Historical observations on shoulder dystocia. 1) From the origin to Jacquemier]. / Considerazioni storiche sulla distocia delle spalle. 1)-Dalle origini a Jacquemier.

The result of a literature survey on shoulder dystocia from year 1609 to 1860 are presented. Operative maneuvers for the resolution of dystocia were mainly examined, as well as the development of knowledge about the pathogenetic mechanism of this serious complication.

[Recent recurrence of a Biblical case of complicated twin birth]. / Bibliai szövódményes ikerszülés ismétlódése napjainkban.

The authors present a case which appears to resemble the child-birth of Thamar described in the Bible. The arm of one of the sons of Thamar prolapsed during the process of delivery. The same complication occurred in a patient of the authors, involving laid a head the arm of a male fetus. In both instances, the other twin child was born first, in the case of Thamar by the vaginal route, in that of the authors, by cesarean section. The description of this birthing event in the Bible permits the conclusion that complication observed in contemporary obstetric practice already occurred 7000 years ago.

[Obstetrical study of the pelvis: a historical overview]. / De obstetrische bekkenleer: een historisch overzicht.

The female pelvis is fundamental to life itself, but it took ages to grasp this truism. During Antiquity, physicians had no need for the concepts of pelvic dystocia and cephalopelvic disproportion. When Aranzo (16th century), a practising physician, stated that a disproportion between the size of the fetus and that of the bony pelvis was the main culprit of difficult labor, his suggestion was overlooked, so much so that it was Hendrik van Deventer (1701) who came to be coined "father of the pelvic theory". The need for an accurate knowledge of the dimensions of the maternal pelvis and of the fetal skull became imperative in the middle of the 18th century, when forceps extraction had become popular. Levret, but above all William Smellie, made valuable contributions to the pelvic theory, which, however, were weakened by Baudelocque's fallacies concerning the intrinsic value of external pelvimetry. After the first quarter of the 19th century, the epicenter of scientific obstetrics moved to Germany and Austria, and German-speaking practitioners, e.g. Michaelis, Litzmann, and the Naegele, deepened our insight in the mechanism of labor. After the discovery of the X-rays (1895), the use of instrumental pelvimetry declined, but the clinical breakthrough of radiopelvimetry was delayed until the twenties of this century. Radiopelvimetry, a very valuable technique indeed, dispensed a large number of mothers from undergoing abdominal delivery. However, awareness of the hazards of fetal-maternal exposure to ionizing radiation pushed ante- and intrapartum radiopelvimetry from the scene. Thanks to the progress of chemistry, pharmacology and electronics, "dynamic pelvimetry" became the fad, heralded by what is called "active management of labour". The fetus now assumed the role of "dynamic pelvimeter". The historical circle was closed.

[That was already known in old Rome--care of brood animals in antiquity]. / Das wussten schon die alten Römer--Betreuung der Muttertiere in der Antike.

The paper gives an impression of the care for mother animals in antiquity, particularly in the course of Roman livestock farming (Varro, Columella). Especially noninfectious factors were held responsible for the redemption of the interruption of pregnancy and a complicated parturition. Therefore special attention was paid for the right and optimal livestock, grooming and nutrition of the farm animals. In the case of dystocia, the herdsmen and veterinarians reached for correction of presentation, traction and embryotomy during parturition. However, the placental retention was only treated with drugs. In the case of an uterine prolapse, Apsyrtos recommended for the first time the reposition at the casted animal and the triple closure of the vulva.