Obstetrics

Obstetrics (from the French accouchement-childbirth), the discipline that studies pregnancy, the act of childbirth, and methods of rational assistance during childbirth in viviparous animals; modern O. can be considered a biological science that studies woman (from the side of her most important function-motherhood) and investigates the laws of intrauterine development of the embryo and fetus (more precisely-the ovum), i.e., O. is the embryophysiology of woman. In its historical development, O. can be noted to have two main epochs: the first-before Ambroise Pare (1509-1592), when O. was the "art of midwifery" and was entirely in the hands of women-midwives, and physicians were called to births only in exceptional cases; the second-from the time of Ambroise Pare to our time, when scientifically educated physicians gradually became more and more involved in the study of O. and O. finally became completely an equal discipline among other medical disciplines. The fate of O. in the first epoch was especially sad, because that little which had been created in the field of O. by the peoples of classical antiquity was almost completely forgotten during the difficult period of the dark Middle Ages. Medicine at this time was in the hands of the clergy, which, for religious reasons, avoided providing any assistance to pregnant women and parturient women. For religious reasons, O. and gynecology were also suppressed among Arab physicians. The extremely low level of obstetrical knowledge in the Middle Ages is best characterized by the widespread distribution and content of the book "De secretis mulierum", which appeared in the 13th century and was attributed to Albertus Magnus. The Paris hospital "Hotel-Dieu", founded in the 9th century, played an outstanding role in the history of O. In this hospital, as early as the 13th century, a ward was allocated for parturient women, and this ward subsequently became, as it were, the first clinic where surgeons began to study O. From here, the custom spread throughout France of inviting surgeons for operative delivery. One of them, the genius Ambroise Pare, introduced into the practice of delivery the completely forgotten operation-"version by feet"-which saved not only the mother but sometimes also the fetus. Before this, O. did not know operations by means of which the life of the fetus could be preserved in pathological births. The introduction of this operation into O. and the brilliant results it began to give in the hands of surgeons led to surgeons being invited to normal births as well, and in the 17th century we already see in France a whole galaxy of specialists-obstetricians, among whom the first place rightfully belongs to Francois Mauriceau (1637-1709). The development of obstetrics in France did not fail to affect the emergence of medical obstetric assistance in neighboring countries. From the 18th century, medical assistance during childbirth became widespread. The 18th century was in general an era of flourishing of obstetrics, thanks to the following main facts: 1) the publication by the Dutchman Deventer in 1701 of his book "Novum lumen" (New Light), where for the first time the problem of the narrow pelvis was raised, the study of which became a major undertaking of scientific O. to the present day; 2) the introduction into obstetric practice of the operation of applying obstetric forceps (see Obstetric operations); 3) the beginning of systematic teaching of O. as a special university science, with the opening of corresponding departments and clinics. Here the greatest merit belongs to Germany; in 1728 a special lying-in hospital-clinic was opened in Strasbourg; in 1751 the first university obstetric clinic was opened in Göttingen. In the 19th century, the study of O. and its development were broad and multifaceted, but the main moments must be recognized as two: 1) the introduction into obstetric practice of anesthesia by the brilliant Edinburgh obstetrician Simpson (1811-1870) (in 1846-ether, in 1847-chloroform); 2) the introduction into O. of antiseptics (Semmelweis, Lister), and later of asepsis. Both of these innovations fundamentally restructured obstetric care and led to the fact that lying-in institutions, which had previously been "antechambers of death" due to the enormous morbidity and mortality of parturient women, reduced both morbidity and mortality to minimal dimensions. At the same time, operative O., taking on an increasingly surgical trend, is currently in full bloom. In the field of theoretical O., the 19th century is characterized, mainly, by the study of the narrow pelvis and the mechanism of labor. With the development of the surgical trend in O., these two major departments of O. lose their significance and somewhat recede to the background. Instead, interest greatly increases in those processes that occur in the female organism in connection with the ovarian-menstrual cycle and pregnancy. These processes are studied both from the morphological point of view and from the neohumoral point of view. Not only the normal, physiological manifestations of the female organism are studied, but also the pathological deviations of these processes, which in recent years have received the collective name-toxemias of pregnancy. The development of O. in Russia can be characterized by the following dates: until the second half of the 18th century, O. did not exist in Russia at all. Books of obstetrical content circulated in manuscript lists in the form of Albertus Magnus's book ("Albertus-the book of surprising mysteries of women"). In 1754, by order of the director of the Medical Chancery P. Z. Kondoidi, an order was issued for the establishment of midwifery schools in Moscow and St. Petersburg. At the head of the Moscow school were placed Prof. of Moscow University Erasmus and his assistant Pagenkampf. The latter translated (in 1764) the book by Horn "The Midwife, or Reliable Instructions through Questions and Answers, How to Assist a Woman, Blessed with a Fruit, in Childbirth." At the head of the St. Petersburg school was placed Andrei Lindeman. Almost simultaneously with the establishment of schools for midwives at the Moscow Foundling Home, the first obstetric institution in Russia was founded (1764). Teaching of O. in the newly opened schools was purely theoretical in nature. The same character it had in Moscow University, as well as in hospital schools and medical-surgical schools where future physicians received their education. Thus, it was impossible to receive proper training in O. in Russia. Nevertheless, in the second half of the 18th century, specialists-obstetricians also appeared among Russian physicians, but they received their education abroad. Among them, first place must be given to the St. Petersburg obstetrician Nestor Maximovich Maximovich-Aibodik (see) and Prof. of Moscow University Wilhelm Mikhailovich Richter. The teaching of O. improved somewhat at the beginning of the 19th century. However, even then, both in universities and in medical-surgical academies, it was purely theoretical, almost scholastic in character. Only in Moscow University, thanks to V. M. Richter, the matter was placed somewhat better: here in January 1806 the first obstetric clinic with four beds was opened. This situation continued throughout the first half of the 19th century, and only in the second half of the 19th century did Russian O. begin to flourish rapidly. The palm of primacy belongs here to the St. Petersburg Medical-Surgical Academy and is connected with the names of Prof. Kiter and, mainly, his student Anton Yakovlevich Krassovsky. The latter on December 23, 1862, for the first time in Russia, performed ovariotomy with a favorable outcome. In the last decades of the 19th century, O. reached a magnificent flourishing in Russia and became equal to Western European science. University departments were occupied by major figures who founded entire schools (in St. Petersburg-Slaviansky, Gorvits, Lebedev, Ott; in Moscow-Snegirev, in Kharkov-Lazarevich, in Kazan-Fenomenov, Gruddev, etc.). The scientific literature grew both quantitatively and qualitatively. In 1886 the St. Obstetric-Gynecological Society was founded, almost simultaneously similar societies arose in Moscow and Kiev. Subsequently, a Gynecological Society was opened in Saratov, and in addition, in recent years, obstetric-gynecological sections began to be formed in scientific societies in university and large provincial cities (Kiev, Odessa, Tashkent, etc.). Questions of scientific O. became the subject of lively discussion first at general medical (Pirogov) congresses, and from 1903-at congresses of specialist-obstetricians and gynecologists. There were seven all-Russian and all-Union and one all-Ukrainian (1927) such congresses, and at the last congresses questions not only of a scientific nature but also of social-organizational nature began to be debated. In addition to higher obstetric education, significant development was also received by secondary obstetric education in numerous feldsher-midwifery and specifically midwifery schools. In the very recent past, this education has been concentrated in midwifery technical schools or midwifery departments of medical polytechnics. The newly developed program makes it possible to provide students with a sufficiently broad education and in-depth practical training.

In accordance with the general tendency to integrate obstetrics with the work of institutions for the protection of motherhood and infancy into a single system of measures related to continuity and a common direction in the care of mother and child, a course on the protection of motherhood and infancy, on the care of the newborn and early childhood, and on methods of sanitary-educational work among the organized population around and outside institutions for the protection of motherhood and infancy—in factories and in the village—has been introduced into the curriculum of midwifery technical schools. The technical schools accept, mainly, women workers and peasant women; a level of knowledge corresponding to the second stage of secondary school (7 years) is required. This educational period was introduced in 1927, when the class-based selection in secondary schools made it possible to have cadres who had completed these schools from the proletarian and peasant layers of the population. To ensure that national republics and regions are provided with qualified workers from the local population, preparatory groups are formed at midwifery technical schools for representatives of national minorities, taking into account their low literacy. The duration of study is three years. In 1927, there were 35 midwifery technical schools in the USSR. The curricula of the reorganized medical technical schools were published by the NKP RSFSR in 1927 ("Curricula and Programs of Medical Technical Schools", 640 pp., GIZ, 1927). To raise the qualification of both the modern obstetrician and the midwife in recent years, the network of scientific institutions conducting refresher courses for medical personnel on scientific and practical issues of the protection of motherhood and infancy has been significantly expanded. Thus, at the present time, obstetrics in the USSR is highly regarded both as a scientific university discipline and in a purely practical sense.