[Obstetrics--a gear in the machinery of history]

It was not Julius Caesar who was born by Caesarean section, as generally assumed, but Scipio Cornelius Africanus, who subdued Spain 100 years before Caesar's time. In chambers with walls of porphyrite, the Byzantine empresses used to give birth to the heirs to the throne. In England, the infertility of Queen Anne, who suffered from porphyria, led to the succession of the Protestant House of Hannover following the Catholic Stuarts. Christina of Sweden, called 'queen of baroque, rebel and scholar', was born in the 'caul'. At the age of 39 years, Johanna of Pfirt, married to Albrecht the Lame, secured the continuation of the Habsburg dynasty by giving birth to Rudolf the Founder. Maria Theresia, who had 16 children, was called 'mother-in-law of Europe'. She was delivered of her first child at the age of 19. The death of her sister Maria-Anna in childbed was one of the reasons why Gerard van Swieten was called to Vienna. Elisabeth of Württemberg, first wife of Franz I of Austria, died, not as a consequence of. but after a forceps operation carried out by Johann Lukas Boër. In England, Princess Charlotte, daughter of George IV, and her baby son died at the delivery; Sir Richard Croft, who had not used the forceps, committed suicide after this tragic incident. Being the next in succession, Victoria ascended the throne. The term 'narcose au chloroforme' (first used by James Young Simpson) was changed to 'narcose à la reine' after this method had been used at the birth of Victoria's eighth child by John Snow. It was Queen Victoria, who passed on haemophilia in European dynasties. When Marie Louise of Habsburg had her first child, Napoleon's son, the later Duke of Reichstadt, Antoine Dubois had to perform a turning of the transverse presentation and use the forceps on the head following after. The birth of Napoleon himself was a case of precipitate labour. Johann Klein, the successor of Boër, applied the forceps when Archduchess Sophie was delivered of her first child, the later Emperor Franz Joseph I of Austria, the first of the four 'salt princes'. The later Emperor Wilhelm II of Prussia was delivered by Eduard Arnold Martin the Elder, the obstetrician of Princess Victoria, the eldest daughter of Queen Victoria; the breech presentation became even more complicated by the raised arms of the child. Both latter monarchs had been 'asphyctic' after their birth. Johann Wolfgang von Goethe was also among those who were apparently dead after their birth.

Spinal anesthesia for cesarean section. 1963

Safety in spinal anesthesia for cesarean section is achieved by strict adherence to the cardinal principles of proper evaluation and selection of patients, the use of prophylactic vasopressors, preanesthetic establishment of a reliable intravenous channel, small doses of the local anesthetic, close monitoring and maintenance of systolic blood pressure above 100 mm. Hg, and avoidance of ergot compounds in the presence of vasopressors.

[Obstetric anesthesia/analgesia in Spain. Study notes on its historical evolution during the 1st half of this century]

This historical review of obstetric analgesia-anesthesia in Spain covers the first half of the twentieth century. Following usual practice for researching medical history, we have performed an exhaustive review of Spanish medical literature published during the study period, followed by classification, study and critical analysis. We found that the first half of the century saw considerable change in the application of analgesic-anesthetic techniques for childbirth and obstetric procedures, indicating that practitioners were far from apathetic as had been obstetricians of the second half of the nineteenth century, who generally rejected any type of analgesia for use during labor and birth. The numerous techniques in vogue during that period under study are described, although analgesia-anesthesia by inhaled ether and chloroform was undoubtedly the most widely used by obstetricians until well into the 1950's.

[The first cesarean section in Norway]

The first reported caesarean section in Norway was performed on 20 August 1843 by a general practitioner, Lars Thalian Backer (1812-84). The operation took place in Lardal, Vestfold County, on a 27 year old woman who had been in labour for six days. The outcome was disastrous; she was delivered of stillborn twins and died 2 1/2 days after the operation. In the 19th century, infection, bleeding and thromboembolic disease made caesarean section a dangerous operation, and only 26 such operations are known in Norway, most of them performed outside hospitals. The first caesarean section in Norway resulting in a living child was performed in 1849, but no mother survived the operation before 1890. We recapitulate the caesarean section of 1843; Dr Backer and his qualifications for operative obstetrics; and the state of instrumental and surgical obstetrics in Norway at that time.

[Hemostasis hysterectomy in obstetrical practice. Evolution of ideas during a century (from Edoardo Porro until the present)]

The decision of hysterectomy during the per- and postpartum period is difficult. After an historical evocation, we discuss the literature and we relate the series of our department. The last indications of this intervention are then exposed.

[Champagne administered by spoon for peritonitis after cesarean section. From the history of obstetrics in Erlangen--data from about 60,000 deliveries in 100 years]

The University of Erlangen has been engaged in clinical obstetrics for approximately 170 years. During this time, Erlangen University's delivery house, opened in 1828 and at first having considerably less than 50 births a year, developed into a perinatal centre with approximately 1,700 births a year. For the period from 1880 to 1981, a group of MD students reviewed the existing records and evaluated 60,000 births with respect to more than 40 parameters. Part of the results obtained are shown with special reference to operative obstetrics. Apart from the general influence of the scientific development on decisions and results within obstetrics, individual factors were also recognizable, factors which are linked with the experiences, insights and specialized working areas of the particular head of the hospital.

["Born from the flank"--discussion concerning "cesarean section" in animals in the Talmud]

The origins of the performance of Caesarean section on living animals are not established. In the Talmud, the term "jose dofèn" (delivered by way of the flank, or delivered through the lateral abdominal wall) is mentioned several times, referring specifically to the performance of Caesarean section. The 7th century Babylonian Talmud however has the tracts Bechoroth (Firstlings) and Chullin (About profane slaughter). The biblical background can be found in Exodus 13,2, where The Lord speaks to Moses: "Declare the first-born of man and beast to be holy to God". This Commandment is discussed at length in the Talmud, where two references to unnatural delivery are to be found. The first, how to evaluate a live, or dead, foetus that is found during the ritual slaughter of a healthy animal, or on the emergency slaughter of a fatally injured animal, that has to be cut out by incisions through the abdominal wall and the uterus (cf. Digest. XI, 8, 2 of Justinian). The second, how to evaluate a foetus that has to be delivered by embryotomy as a consequence of dystocia. It is believed that, contrary to previous opinions in the History of Veterinary Medicine, there is no evidence of the performance of Caesarean section on living animals in the Talmud.