'Midwifery', prepaired by Slitherrr
(Notated/edited by me, but the work was Slitherrr's and he deserves the credit.)
Summary, pulled exclusively from the document located at,
http://www.indiana.edu/~ancmed/midwife.HTM,
Entitled,
"Midwives and Maternity Care in the Roman World"
Overview: Rough estimate of infant mortality rates gives a presumed rate of roughly 5% of all children born alive dying within the first month.
If late fetal and in-childbirth fatalities are included, the rate jumps to 8%.
The research cited in the paper was between two contrasting views on health care.
The first of those, described by Pliny, represent practices
of folk midwives and characterized largely by treatment based in superstition that did little to assist the mother directly (and were potentially harmful, generally by the potential for causing infection), but could have been
efficacious in reassuring the mother, which is not an insignificant factor in an effective birth.
The second set of practices was described
by Soranus, and reflects a more medical view of the profession.
In all likelihood, most mothers who received the attention of a midwife probably received care more along the lines of that described by Pliny, while the very wealthy were more likely to receive the attention of
midwives trained in the methods described by Soranus, if such midwives were available.
In general, midwives were most often probably of servile
origin, although the profession was respected enough that midwives born as slaves could commonly afford to buy their freedom through their practice.
In the East, the profession was well-regarded enough for papers to have been published that were read in the medical community.
Folk Medicine:
Pliny describes several recommendations regarding childbirth:
1) Boys are more easily delivered than girls.
2) Fumigations with fat from hyena loins induce immediate labor; placing the right foot of the hyena on the woman results in easy delivery, while the left causes death.
3) Sow's dung mixed with a drink will ease labor pains, and sow's milk mixed with honey wine will do the same.
4) Goose semen mixed with water, or the liquids that flow from a weasel's uterus through its genitals, are supposed to do the same.
5) Root of vervain (aka 'Verbena', *1*) in water, scordotis (*2*) in hydromel (*3*), and dittany (*4*, *5*)leaves are recommended for the lyingin woman (lyingin is used to describe a woman in a perscribed period of rest just before labor)
6) Amulets and other objects considered efficacious
7) Snake's slough (skin) tied to the thigh of the woman (removed immediately after delivery
"Stick with which a frog has been shaken from a snake" believed helpful
9) Vulture's feather placed under woman's feet.
10) Sneezing relieves difficult labor.
11) Drinking hedge mustard (*6*) in tepid wine on an empty stomach for difficult labor
12) Recommendations for (delivering) the placenta (*7*) in cases where it is retained:
Earthworms in raisin wine
Membrane [they probably mean amniotic sac--Slitherrr] covering newborn
goats, dried and taken in wine
Hare's rennet (stomach extract) applied with saffron and leek juice
Four measures of ammoniac salt or Cretan dittany dissolved in water
Pliny also makes some mention of post-maternal care, mentioning treatments for the engorgement of breasts. These treatments included:
1) Drinking mouse dung diluted with rain water and ass's milk, or
2) Rubbing the breasts with sow's blood, goose grease with rose oil and a spider's web to relieve swelling. For suppuration (aka pus), earthworms laid across the breast
to draw out pus are recommended, and earthworms drunk with honey wine are recommended to simulate the flow of milk.
Other mention of folk remedies are made (and denounced) by Soranus. In particular, many methods of cutting the umbilical cord are mentioned, including using pieces of glass, reed, or even dried crusts of bread.
Also, it was evidently common practice in folk medicine to cauterize the umbilical cord after it was cut.
In general, the methods described above were probably ineffective for their stated purposes, and potentially could increase the danger to the mother and her child. However, they could potentially have been effective in their placebo effects, easing the mental strain
on the mother, which cannot be discounted.
Obstetrics as practiced by recommendation of the medical community:
Soranus describes recommended procedures from the medical community, generally denouncing folk medicine as ineffective. He makes many specific recommendations to the midwife for care during and after delivery, and it
is assumed that midwives were commonly trained in these methods (if they somehow had or came into the means by which to be trained).
He mentions that a good midwife be:
1) Literate, to be able to expose herself to more knowledge of her practice,
2) Of sound mind, able to keep her wits about her and with a good memory,
3) Not handicapped with regard to her senses,
4) A hard worker,
5) Sympathetic,
6) Possessing soft hands,
7) Free of superstition.
The literature indicates that physicians may have attended particularly difficult births, but that generally the midwives were the primary source of natal care.
Soranus describes a list of materials needed by the midwife:
Olive oil (not previously used in cooking)
Warm water
Warm topical ointments, called fomentations (*8*)
Soft sea sponges
Pieces of wool and bandages, for swaddling the infant
A pillow, on which to place the infant
Things to smell, such as pennyroyal (*9*), dirt, spirits of ammonia, etc, for reviving a fainted person
A stool or chair (property of the midwife)
A hard bed for labor and a soft for post-partum rest
A room of moderate size and medium temperature
Special mention is made of the stool, which is used during delivery (not labor). In particular, the stool was designed to allow the mother to sit upright during delivery.
The seat was a crescent-shaped hole through which the baby would be delivered. The sides had armrests for the mother to grasp. It would have a sturdy back against which the woman giving birth would press her hips and buttocks. The back could be excluded; in such a case, an attendant stood behind the woman in labor for support. This arrangement was less desirable for the danger of slipping or reclining.
No mention is made of anything like an episiotomy (
http://en.wikipedia.org/wiki/Episiotomy) being performed.
One duty was instruction of the mother on proper breathing, and how to push downwards during a contraction.
The midwife took care that the umbilical cord was not distended, and that the placenta was removed immediately after birth. The midwife's hands
were instructed to be wrapped in cloth or papyrus to improve her grip on the slippery newborn--Soranus's thought was that it would prevent the midwife from squeezing the baby too hard.
Assistants would assist by gently pushing on the abdomen.
Instruction on breathing and pushing came during delivery, rather than in a pre-natal training program.
In a normal headfirst delivery, the midwife might stretch the cervical opening slightly to help the fetus's head and shoulders through. After the emergence of same, the midwife would gently pull the rest of the body through.
Soranus discusses difficult labor and delivery, both in terms of physical problems like small pelvic opening, malnutrition, or obesity, but also in terms of the psychological well-being of the mother, advising that the midwife work hard to allay the fears and anxieties of the mother.
He notes that anxious mothers have more difficulty, and that newer mothers are more likely to have troubles than more experienced ones.
Soranus recommends the sides of the chair from the seat to the floor be enclosed, with the front and back left open. If a chair is not available, the mother can sit on the lap of a particularly stout woman.
At the onset of labor, the midwife was summoned and the equipment readied. The mother initially lays on her back on the hard bed with support under her hips, her feet drawn up together and her thighs parted. The midwife
eased the pains of labor with gentle massage by a cloth soaked in warm olive oil laid over the adomen and genital areas, and bladders filled with warm oil placed at the woman's sides.
As the cervix dilates, the midwife was to encourage the process by gently rubbing the opening with a forefinger with a shortly cut nail, smeared generously with olive oil.
The mother was moved to the birthing stool when the cervix is dilated to the size of the egg, unless she is very weak, in which case the delivery is made on the hard bed in the reclining position.
During delivery, the midwife had three assistants stand on the back and sides of the mother. Their use was to steady the mother (especially from behind--in addition, this woman would hold a small piece of cloth at the anus to avoid hemorrhoids), and allaying anxiety.
Soranus deals in detail with instructions for various kinds of difficult delivery in which the fetus itself is a cause (including those in which a fetus is dead). The detail of the study indicates that midwives could expect a large number of complicated births. Many otherwise healthy
fetuses probably died during difficult delivery, even though the methods prescribed were sound.
Soranus's treatises on maternal care are mostly lost--the sole surviving section deals with breast care, recommendeding diluted vinegar and other "mildly contracting things" being sponged on the breasts to prevent engorgement. if swelling occurs, poultices of bread, water, olive oil or hydromel, or of linseed, wheat or fenugreek (*10*) and water should be applied.
In the case of breasts too tender for poultices to be applied, the fluids should be gently pressed out while the breasts are soaked in warm oil. There is also recommended treatment for stopping lactation.
It was the midwife who made initial recommendations about whether the newborn was healthy and fit to rear, based on the presence of congenital deformities and the like.
Criteria for fitness also include loud cries, suppleness of the arms and legs and a lack of obstruction on all the
bodily openings. The midwife is also recommended to take into account the health of the mother and the length of gestation.
Soranus recommends the umbilical cord be cut some time after delivery, with a knife. He also recommends ligature (tourniquet) of the cord, rather than cauterization.
Soranus recommends a mild astringent (witch hazel, etc) mixed with honey, olive oil, or a similar liquid (to reduce the chance that the granular astringents would abrade the newborn's skin), rinsed off with warm water, and
repeated once. The midwife is then to clear any mucus from the nose, mouth and ears, and to clear the anus of any membranes that could potentially impede bowel movement.
The umbilical cord is to be covered with a piece of wool or lint soaked with olive oil. He also takes some time to denounce many other groups' practices in this regard
as harmful to the infant.
Conclusions: Probably the vast majority of the populous received care much like those described by Pliny (if it could be afforded). The very wealthy probably could afford care from midwives whose practices were described by Soranus. This implies that infant survival rates also varied greatly with socioeconomic status.
*1* Vervain/Verbena
http://en.wikipedia.org/wiki/Vervain(From Wikipedia: Vervain has longstanding use in herbalism and folk medicine, usually as a herbal tea. Nicholas Culpeper's 1652 The English Physitian discusses folk uses.
Among others effects, it may act as a galactagogue (lactation inducer) and possibly sex steroid analogue. Prescribed against "over-enthusiasm.". The plants are also sometimes used as abortifacient.
The essential oil of various species - mainly Common Vervain - is traded as Spanish Verbena oil. Considered inferior to oil of Lemon Verbena (Aloysia citrodora) in perfumery, it is of some commercial importance for herbalism and it seems to be a promising source of medical compounds. Verveine, the famous green liqueur from the region of Le Puy-en-Velay (France) is flavored with vervains.
Verbena has long been associated with divine and other supernatural forces. It was called "tears of Isis" in Ancient Egypt, and later on "Juno's tears".
In Ancient Greece, it was dedicated to Eos Erigineia (the goddess of the dawn).
In the early Christian era, folk legend stated that Common Vervain (V. officinalis) was used to staunch Jesus' wounds after his removal from the cross. It was consequently called "Holy Herb" or (e.g. in Wales) "Devil's bane".
Other legends held it that vervain protects people from vampires, by mixing it in a herbal tea, keeping it near you, or using oil extracted from it in a bath.
Vervain flowers are engraved on "cimaruta"
http://en.wikipedia.org/wiki/CimarutaCimaruta are Italian anti-stregheria (stregheria, strega = witch) charms.
In the 1870 The History and Practice of Magic by "Paul Christian" (Jean Baptiste Pitois) it is employed in the preparation of a mandragora charm:
http://en.wikipedia.org/wiki/Touch_pieces*2* Scordotis is apparently a variety of catnip, or 'Nepeta'
http://en.wikipedia.org/wiki/Nepeta(From Wikipedia: Oil isolated from catnip by steam distillation is a repellent against insects, in particular mosquitoes, cockroaches and termites.
Research suggests that in a test tube, distilled nepetalactone, the active ingredient in catnip, repels mosquitoes ten times more effectively than DEET, the active ingredient in most insect repellents, but that it is not as effective a repellent when used on the skin.
Additionally, catnip and catnip-laced products designed for use with domesticated cats are available to consumers.)
*3* "Hydromel" = light mead.
http://en.wikipedia.org/wiki/Hydromel(From Wikipedia: Hydromel — Hydromel literally means "water-honey" in Greek. It is also the French name for mead. (Compare with the Spanish hidromiel and aquamiel, Italian idromele and Portuguese hidromel). It is also used as a name for a very light or low-alcohol mead.)
*4*="False Dittany"
http://en.wikipedia.org/wiki/Dictamnus(From Wikipedia
This plant grows about 60 cm high. Its flowers form a loose pyramidal spike and vary in colour from pale purple to white.
It normally grows in woods in warm places. It is a popular garden plant both for its flowers and for its fragrance. It bears large elegant flowers of various colours: red, white, striped or blue. Its leaves resemble those of an Ash tree. Outside its natural range it is planted in gardens and grows well in warm places. It can also be found in sheltered places in woodlands.
In the summer months, the whole plant is covered with a kind of flammable substance, which is gluey to the touch, and has a very fragrant smell; but if it takes fire, it goes off with a flash all over the plant.
The name "Burning-bush" derives from the volatile oils produced by the plant, which can catch fire readily in hot weather, leading to comparisons with the burning bush of the Bible, including the suggestion that this is the plant involved there.
Some use has been made of the plant (chiefly the powdered root) in herbalism. However, as the alternative name "False dittany" implies, it is unrelated to the Dittany found in Crete, which has a much more significant history of medicinal use.
Like 'Dittany of Crete' they were believed to be useful for cordial(*11*)
and cephalic ailments, to help resist poison and combat putrefaction, and to be useful in malignant and pestilential fevers. They were also used for cases of hysteria. While the volatile oil does have anti-inflammatory properties, it isn't used for such ailments today.
An infusion of the tops of the plant was also used as a pleasant and efficacious medicine in the gravel. It was believed to work powerfully by provoking urine and easing colicky pains which frequently accompany that disorder.
The root was considered a sure remedy for epilepsies, and other diseases of the head, opening obstructions of the womb and procuring the discharges of the uterus.
The plant is known to have emmenagogic (stimulates menstration, sometimes used as an abortifacient) properties, but the use of such plants to procure onset of menses is generally considered obsolete today.
Modern medical uses:
Today the plant is not used much, but is classified as a stomach tonic. A simple infusion of the leaves may be used as a substitute for tea and as a remedy for nervous complaints.
The powdered root combined in equal parts with Peppermint has been administered in doses of 2 drams (4 g) for epilepsy.)
*5* "Dittany of Crete"
http://en.wikipedia.org/wiki/Origanum_dictamnus*6* "Hedge Mustard"
http://en.wikipedia.org/wiki/Hedge_mustardThe Greeks believed it was an antidote to all poisons. In folk medicine it was used to soothe sore throats - indeed one name for it is singer's plant.
Hedge mustard is a diuretic, expectorant, tonic and laxative. Herbalists use the juice and flowers to treat bronchitis and stomach ailment, among other uses, and as a revitaliser. In Tibetan medicine it is used to repress the symptoms of food poisoning.
This plant is widely cultivated across Europe for its edible leaves and seeds. It is widely used as a condiment in Northern Europe (particularly Denmark, Norway and Germany).
The leaves have a bitter cabbage-like flavour and they are used either in salads or cooked as a pot herb (in cultivar versions). The seeds have been used to make mustard pastes in Europe.
*7* Placenta, medieval name "Caul"
From Wikipedia:
In medieval times the appearance of a caul on a newborn baby was seen as a sign of good luck. It was considered an omen that the child was destined for greatness.
Gathering the caul onto paper was considered an important tradition of childbirth: the midwife would rub a sheet of paper across the baby's head and face, pressing the material of the caul onto the paper. The caul would then be presented to the mother, to be kept as an heirloom.
Some Early Modern European traditions linked being born with the caul to the ability to defend fertility and the harvest against the forces of evil, particularly witches and sorcerers.
Over the course of European history, a popular legend developed suggesting that possession of a baby's caul would give its bearer good luck and protect that person from death by drowning.
Cauls were therefore highly prized by sailors. Medieval women often sold these cauls to sailors for large sums of money; a caul was regarded as a valuable talisman.
*8* "Fomentations" used in Hydrotherapy:
http://en.wikipedia.org/wiki/HydrotherapyNote, there's quite a bit of good material here, and in the links on this page. Could be of a lot of use, if dwarfs get spa technology.
*9* "Pennyroyal"
http://en.wikipedia.org/wiki/Pennyroyal(From Wikipedia:
The herb Pennyroyal (Mentha pulegium, family Lamiaceae), is a member of the mint genus; an essential oil extracted from it is used in aromatherapy.
Crushed Pennyroyal leaves and foliage exhibit a very strong spearmint fragrance. Pennyroyal is a traditional folk medicine, poison and abortifacient. This oil is high in pulegone, a highly toxic volatile organic compound, which harms the liver and can stimulate uterine activity.
Pennyroyal essential oil is extremely concentrated, it should not ever be taken internally because it is highly toxic; even in small doses, the poison can lead to death.
Complications have been reported from attempts to use the oil for self-induced abortion. The oil can be used for aromatherapy, a bath additive and as an insect repellent. There are numerous studies that show pennyroyal's toxicity to humans and animals.
*10* "Fenugreek
http://en.wikipedia.org/wiki/Fenugreek(From Wikipedia:
Fenugreek seeds are a galactagogue-aka substance that induces lactation-that is often used to increase milk supply in lactating women.
Because the maple syrup-like flavor is strong and not always liked, the seeds are ground to a powder and administered in capsules.
Many lactating women who take fenugreek in the quantities required to increase their milk supply notice that their skin exudes a distinct "maple syrup" odor.)
*11* "Medical Cordial"
http://en.wikipedia.org/wiki/Cordial_(medicine)
A cordial is any invigorating and stimulating preparation; e.g., peppermint cordial. The term derives from obsolete medicinal usage, as various beverages were concocted which were believed to be beneficial to one's health, especially for the heart (cordialis in Latin).
From the Renaissance onwards, cordials were usually based on alcohol in which certain herbs, spices or other ingredients were allowed to steep. Examples of such cordials include:
Rosa Solis or Rosolio, derived from the carnivorous sundew plant; it was believed to not only invigorate the heart, but to be an aphrodisiac as well.
Royal Usquebaugh (from a Celtic word meaning life-water, which also gave rise to the word whiskey), a spicy concoction containing flecks of gold leaf thought to capture the sun's golden radiance.
Precious ingredients like gold, pearls and coral were sometimes added. These were believed to revive the spirit and to preclude disease.
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Topic: Surgery/Medicine in DF (Read 25103 times)