University of Virginia Library

(c). The Obstetric Chair.

The positions we have so far considered have been almost

altogether such as required no artificial assistance and were instinctively assumed.

With the advance of the obstetric art, the support given the parturient woman by the bone and muscle of her kin, by husband or tenedora, was replaced by a form of wood; the thighs upon which she sat, the chest against which she rested, were replaced by the cut-out seat and the slanting back of the obstetric chair, which was formed so as to receive the patient in the same position which she was wont to occupy on the lap of a fellow being.

We now come to the semi-recumbent position assumed by the parturient woman whose labor takes places in the

obstetric chair, under the supervision of a midwife or physician.

The obstetric chair marks a decided era in the history of the art; but I must consider that period as a whole, and in speaking of the chair I have reference to its more characteristic features, to those points which are common to all obstetric chairs, as it is not my purpose here to describe the various obstetric chairs which were in use at different times,

marking the progress of midwifery; the modifications were too numerous. "As in our times,'' to use Dr. Goodell's very striking expression, "eminent physicians are seeking to improve the obstetric forceps, so in those days learned men did not disdain to perfect the sella lochæa obstetricia seu obstetrica.'' My intention is merely to refer to the obstetric chair as being an artificial means of placing the patient in that semi-recumbent position which I deem most advantageous to the progress of labor, and which uncivilized people of the present day, as well as civilized nations of the past, long before the day of the chair, assumed as most comfortable for the parturient woman. The subject has been exhausted by the able pen of one of our fellows, Dr. Goodell, in his article on "Some Ancient Methods of Delivery;'' and Dr. Ploss; in his work, gives so complete a history of this method of delivery that I need but refer briefly to the subject. The obstetric chair which flourished in the days of Greece and Rome was almost forgotten in the darkness of the earlier centuries of the Christian era, but seems to have survived in Italy, partly owing to the writing of Greek and Roman authorities, partly because the custom was handed down from generation to generation among the people; and from Italy it found its way across the Alps into Germany and France. By this time, however, the rude stool of ancient times had been greatly changed in shape, complicated and improved, until the low stool, as we still see it in the hands of the Cypriote midwife, is presented to us as the typical obstetric chair of the Middle Ages.

The chair is mentioned by Albertus Magnus in the thirteenth century, and in the German translation of this work, under date of 1589, an illustration is given which resembles the obstetric chair of Soranus and Moschion. In the seventeenth and earlier part of the eighteenth century the chair seems to have flourished in Germany, and also in England, and numerous modifications were introduced. Its supremacy, however, was not of long duration, and it soon yielded to the modern recumbent position, and was only retained by the more conservative people in the rural districts, who follow but slowly in the wake of any advance. Smellie[113] says: "In remote parts of England the patient sat upon a stool made in the form of a semicircle.'' This, of course, was during the time of the decline of the chair, when the dorsal and lateral decubitus had become popular.

In the seventeenth century it was to be found in the centres of medical learning, and had not yet been forced back into the rural wilds.

As a matter of curiosity. I will cite the title of a work published in 1637, in which it was warmly advocated, and I will add a brief description of the chair, in the quaint language of the book, kindly furnished me by Dr. Wise, of the Surgeon-general's Library, and it will answer for this as well as all other chairs, and will serve to show the importance attached to its various features.

"The Expert Midwife: or, an Excellent and most necessary Treatise of the Generation and Birth of Man. Wherein is contained many very Notable and Necessary Particulars requisite to be knowne and practiced: with Divers Apt and Useful Figures appropriated to this Worke. Also the Causes, signes, and Various Cures, of the most Principall Maladies and Infirmities incident to Women. Six Books compiled in Latine by the Industry of James Rueff, a Learned and Expert Chirurgion: and now translated into English for the Generall Good and Benefit of this Nation.''

"Let the stoole be made compassewise, under-propped with foure feet, the stay of it behind bending backward, hollow in the midst, covered with a blacke cloth underneath, hanging downe to the ground, by that meanes that the labouring woman may be covered, and other women sometimes apply their hands in any place, if necessity require. Let the stoole be furnished and covered with many cloths and clouts at the back and other parts, that the labouring woman receive no hurt, or the infant anywhere, strongly kicking and striving because of the paines, stirrings and motions of the mother. And after the labouring woman shall be set in her chaire about to be delivered, the midwife shall place one woman behind her back which may gently hold the labouring woman, taking her by both the armes, and if need be, the pains waxing grievous, and the woman labouring, may stroke and presse downe the wombe, and may somewhat drive and depress the infant downward. But let her place other two by her sides, which may both, with good words, encourage and comfort the labouring woman, and also may be ready to helpe and put to their hand at any time. This being done, let the midwife herselfe sit

stooping forward before the labouring woman, and let her annoint her own hands, and the womb of the labouring woman, with oile of lillies, of sweet almonds, and the grease of an hen, mingled and tempered together. For to doe this, cloth profit and help them very much which are gross, and fat, and them whose secret parts are strict and narrow, and likewise them which have the mouth of the matrix dry, and such women as are in labour of their first child.''

FIG. 37.—Delivery in the Obstetric Chair; after Ruegius. 1637.

[Description: Pregnant woman reclines in an obstetric chair, while a midwife and two friends attend her. Black and white illustration.]

The antiquity of the obstetric chair has been greatly overrated, owing to the misconception or misconstruction of the data in our possession. I have endeavored to give conscientiously the earliest positive references to the chair which we have, and that, I think, is by Moschion in the second century; but the votive group from the temple of Golgoi, in Cyprus (pictured and described above), and that famous passage from Exodus, both of which are quoted as evidences of the early use of the chair, will, I trust, cease to figure in that capacity.

The group from the Cesnola Collection has been fully

described in its proper place; and as regards that oft-quoted passage from Exodus i. 15 and 16, which is referred to by so many writers as indicating the use of the obstetric chair among the ancient Hebrews; it is translated by such, "When ye do the office of midwife to the Hebrew women, and see them upon the stool, if it be a son, then ye shall kill him,'' etc. I, however, believe, with Kotelman, that that word "ebnaim,'' which is made so much of, and is translated, as already stated, by many as chair or stool, means stones. So that the passage would read: "When ye see the woman upon the stones.'' This would prove, as is most probable, that it was the custom of the ancient Hebrews to be delivered, like the Arabs of the present day, as observed by Dr. Goguel and others, in the squatting posture, seated upon two stones. These details are more interesting than important, and it will certainly suffice, as far as the antiquity of the chair is involved, to state the fact that several Arab authorities recommended the obstetric chair in difficult labors, and that it was also advocated by Hippocrates and Soranus among the Greeks, who were usually confined in the semi-recumbent position, often in bed. These are the first authentic statements as to its use. Its history has been a checkered one. At the present day, the obstetric chair is popularly used only among the nations of the East, and, as Ploss says, "It is remarkable that it should be among the very people who rarely make use of a chair for sitting purposes.'' We find the chair now in use in Japan and China, in Turkey, Greece, Assyria, and Egypt. In Japan, it was still advocated by obstetricians in the last century; in China it is common even now, although physicians battle against it. In Turkey it is used occasionally by certain midwives, as stated by P. Eram.[114] Dr. Denham speaks of its use in the East at the present day.[115] In Syria, no respectable midwife or "diyeh'' is without her chair, as I am informed by Dr. A. J. A. Arbeely, of Damascus. The chair so used is different from any other I have seen described, and appears to be a most practical contrivance, enabling the woman to assume various inclinations of the body; it is like a rocking-chair with comfortable arms, the seat about two feet above the rockers, and cut out in a semicircle, so as to permit the expulsion of the child. An assistant holds the parturient woman by sitting behind her, or at her side, whilst the midwife remains in front to support the perineum with the palm of her hand, greased with lard or olive oil.

I have already called attention to the fact that those nations

who resort to the chair in obstetric practice rarely make use of it for ordinary purposes, and it appears highly probable to me that the absence of the rocking-chair from foreign homes may be accounted for by the fact that the only rocking-chair of which they had cognizance was the chair which the midwife carried from house to house, whenever her assistance was asked, for the relief of the child-bearing woman; this chair was then so intimately associated with the idea of suffering, of labor, and child-birth, that it did not appear as a desirable piece of furniture for parlor or sitting-room; it would have seemed improper and out of place. For similar reasons the comfortable arm-chair is an unknown luxury among certain Eastern people.

It is only within late years that the American rocking-chair has found its way across the ocean, and the increased facilities for intercourse, and the spread of a leveling civilization, will soon do away with these remnants of former times which still linger here and there. Amongst the modern Egyptians, the midwife makes use of a chair, "Kursee El-Wiladeh,'' which is covered with a shawl, or an embroidered napkin, and some flowers of the henna tree, or some roses, are tied with an embroidered handkerchief to each of the upper corners of the back; thus ornamented, the chair is conveyed before the midwife to the house. In the houses of the rich, the parturient is placed on a bed after delivery, and usually remains there from three to six days, whilst the poor women resume their ordinary occupation in a day or two.[116] I will add that Lane, like almost every other author, refers to that passage, Exodus i. 16, intending to compare the custom of using the chair among the Egyptians with that of the ancient Hebrews. In Palestine, the obstetric chair is still an honored institution, but much simplified in form, being sometimes nothing more than an old-fashioned arm-chair.