Dr. Friedrich Benjamin Osiander
Professor of Medicine in Göttingen
Announcement of Lecture Courses
to be given during the Summer Semester 1793
The Most Recent Developments in my Göttingen Practice [*]
|3| The eleven years I spent practicing as a physician and accoucheur in my fatherland were full of strange and interesting cases.  The five months during which I have practiced here in Göttingen among my fellow citizens in various capacities — as an instructor of the science of healing and midwifery, as a physician at the Royal institute, which I head, and as a general practitioner and accoucheur — have been no less so. The experiences of these few months have, however, been even more instructive because of the various unfavorable rumors that the thousand tongues of gossip have spread about me. . . .
|5| While the attention of many Göttingen residents was still focused on this particular female patient [previously discussed], a certain woman here died whom I had just assisted in childbirth not six days earlier. In this case as well, people are keen on attributing to me various mistakes that allegedly occurred before, during, and after this woman’s delivery. A physician and accoucheur, of course, like any other human being, can make mistakes, and acknowledging those mistakes once he has made them is not at all a disgraceful thing, since otherwise every physician and every accoucheur could not but stand before us in eternal disgrace. That said — because in this particular case my own conscience tells me that I left nothing undone that |6| a specialist in this field might otherwise demand or, being left undone, reproach, I am disinclined to allow rebukes to go unanswered that I in fact do not merit. I owe this justification both to my own honor and especially to the honor of that particular science that I both teach and practice at one of the premier universities in Germany.
What follows is a simple, faithful, and detailed account of this story. — Let the objective specialist determine whether and, if so, what oversights I may have committed.
Induced Delivery through My Assistance
At the beginning of this year, a gentleman whom I had hitherto never met came and entreated me to assist his wife, who was in the second half of her first pregnancy, during her coming delivery because he greatly desired that she not suffer at the hands of ignorant or uninformed midwives. In the meantime, he similarly wished for me to visit her from time to time, make the necessary arrangements for the coming delivery, and, when that delivery was imminent, permit him to have my birthing stool fetched beforehand. 
|7| The next day I visited the woman and found a diminutive, delicate, well-formed lady of twenty-something years with an animated rosy complexion and an extremely distended belly protruding in front. She told me that, apart from a bit of queasiness now and then, she had felt fairly good during the first half of her pregnancy and indeed still felt good, except that occasionally she did experience transitory pain that, based on her description, seemed to extend from over the base of the uterus beneath her stomach toward her right side. When I queried her concerning her bowel eliminations, she told me she had otherwise been quite subject to constipation, often having no bowel movement over a period of several days, but that now the opening was being easily managed by a mild laxative prescribed by the family physician. Her pulse was normal, that is, a bit high and intense, as is usually the case at advanced stages of pregnancy.
At my second visit, because she was still complaining about occasionally experiencing the previous pain, I suggested she use my abdominal binder, since I believed the pain to be caused by the pressure of her skirts on her strongly distended belly, this distension itself, however, by the position of the placenta at the front wall of the uterus. I was hoping the binder would lift the distended base of the uterus a bit, support the uterus itself, and protect the peritoneum and stomach muscles from excessive distension and pressure, thereby also preventing the child from being in an unfavorable position at birth. |8| This binder, which resembles the bottom half of a bodice, effectively encompasses the stomach and is worn quite to advantage before, during, and after delivery. A description and illustration can be found in my previously mentioned observations. 
The lady had two binders made after the pattern I gave her, a broader one to wear during pregnancy, and a narrower one to wear after delivery. When I visited her again, she told me, however, that she was unable to endure the binder, that the pain in fact seemed to become worse, she having afterward developed a constricted chest, and that she thus immediately removed the binder. My assessment was that she had simply fastened the binder too tightly around; I left it to her to decide whether she wanted to fasten it more loosely or dispense with it altogether.
Since her veins, although rather delicate and small, seemed to be quite full of blood, and since it seemed to me that her circulation was being all the more restricted the larger her pregnant body became, I suggested a round of bloodletting in her arm. She objected that her family physician was of the opinion that despite her florid complexion, she was in fact not plethoric, hence could not undergo bloodletting without running considerable risk of complications. Although I did concede that she may well not have as large a quantity of blood as one might normally suspect given her animated appearance, I pointed out that, as it seemed to me, under the present circumstances her extremely delicate veins could not well bear the increasing quantity of blood and that hence bloodletting might perhaps be the only way to eliminate the pain in her stomach.
Although she then seemed inclined to undergo bloodletting, I myself do not know how it came about that such was put off for a full week, for it was not until a week later, when I visited her again, that I first heard that on that very day, shortly before my own arrival at the house, bloodletting had been performed on the advice of the family physician to address the increasing stomach pain, dizziness, and headaches. If I remember correctly, blood had been let from the vein in her right arm, and I noticed that her cheek on precisely that side was quite pale, whereas the other exhibited its customary rosy tint.
A while afterward, she attested that the bloodletting had been quite salutary for her, that she was no longer suffering from dizziness or headaches, and was experiencing more tolerable and less frequent stomach pains. That notwithstanding, the larger her pregnant body became, all the more difficult was it for her to walk. Her belly was hanging over completely forward such that there was an empty space in both loins and such that the entire weight of the pregnant womb was resting solely on the peritoneum, stomach muscles, and abdominal skin. Because she became uncomfortable when she tried once to go for a ride, she generally stayed at home during the final weeks, |10| moving about only very little in her room and in a nearby garden.
On the evening of 9 March , this lady’s husband sent two manservants to me to fetch my birthing stool. Since, however, the crate containing the stool along with its cushions and other paraphernalia had been outfitted with legs according to my instructions and was now serving as a table, being, moreover, covered with books and papers, and because my own business matters made it impossible to clear it of these materials immediately, I told the manservants to relate to their master that were the stool not absolutely required at precisely this moment, I would prefer it be fetched another day, and that in the meantime, I would arrange the stool such that they could pick it up without further delay. One of the manservants quickly returned and told me that for the time being the stool was in fact not urgently needed, but that were it convenient to me they would like to pick it up in two days. And they did indeed come pick it up. 
When I visited the lady later, she told me her husband, worried that the birth might commence sooner than expected, had had the stool fetched early because for several days she had been experiencing occasional back pain and had sensed the child moving with unusual vigor. Both spouses expressed |11| their satisfaction with the birthing stool’s excellent outfitting, comfort, and low profile, and both mentioned that they had tried to set the stool up themselves and that the lady had sat down in it and found it quite comfortable indeed. Let me point out here that on the occasion of one of my visits, the lady turned the conversation on her own initiative to the subject of birthing forceps, remarking that she had absolutely no objection were such to be used during her own delivery if doing so might assist both her and her child, having heard from her sister-in-law that the use of such was not at all as painful as some women imagined.
When I visited this lady again approximately eleven days before her delivery, she told me she thought her delivery was now quite imminent because she was becoming quite ill while both walking and lying, was now wholly unable to lie on her back in any case, and that even when she was standing her distended belly was causing such uncomfortably heavy pressure on her uterus that she could not long endure it, so much so that the previous night she feared she might genuinely have to disturb me. I in my own turn also noticed that her pregnant belly was now hanging forward in a protrusion so steep as was possible only in the case of an extremely weakened stomach. Her facial features were similarly as tautly distorted as tends to the case in many bodies of lax musculature just prior to delivery. From this I concluded that her delivery might indeed be quite imminent, which is also why I visited her again the following day. She now |12| told me that the sensations in the small of her back were again occurring less frequently, and that she now believed the birth might yet not occur until the properly calculated end of her pregnancy, that is, toward the end of March. When at my departure I told her I intended to visit her again soon, she said I ought not go to too much trouble, that as soon as she herself sensed things were getting serious with the birth she would send for me. Her husband expressed the same assurance. In anticipation of this summons, I did not visit for another ten days.
Account of the Delivery
On the morning of 27 March at 10:00, on my way to visiting a different patient along a route that took me by this lady’s house, I suddenly decided to stop in and see how she was doing.
When I entered the foyer, her husband came toward me saying, “My good friend, you have come at just the right time, for my wife is just now sitting in the stool, which I myself set up, not wanting to summon you immediately since we know how busy you are.”
He accompanied me into the adjoining room while relating this to me, where I found the lady sitting up in the stool, the midwife in front of her. I remarked that the stool’s back rest needed to be |13| positioned a bit further back for the birthing procedure, and that given this lady’s overhanging belly this sort of deeper back positioning was particularly necessary. Since I had simultaneously noticed some confusion in the positioning of the cushions, I arranged them correctly and also put the back support in the proper position. The lady sat down in the stool once more, the midwife again in front of her, without my proposing an examination or mentioning the earlier promise that they had intended to summon me immediately and leave the delivery to me. Instead, I was seriously intending to withdraw as politely as possible as soon as was appropriate to avoid, first, the appearance that I was trying to force myself on them as accoucheur in case the couple had changed their minds in the meantime, and, second, the appearance that I was leaving in a huff because they seemed to be entrusting the lady solely to the midwife. In the meantime, I was informed that during the previous night as well as already during the preceding days, the lady had felt mild labor pains but that it was only this morning after 7:00 that the midwife had been summoned, who had then administered two clysters and had set a hot chamomile infusion in a wooden vessel on the floor to steam the lady’s body.
When I queried the midwife concerning the child’s disposition with respect to the birth, she gave the usual midwife’s answer, namely, “Everything is just fine.” I accepted this response and observed |14| for a few moments how the parturient was working through her labor pains, then explained to her how she should go about it. In the meantime, the family physician arrived, and after informing himself concerning how the parturient was doing, immediately left.
The labor pains now came powerfully and frequently but did not last very long. The midwife finally asked whether I myself might want to do an examination to determine how things were with the child’s birth, and since the parturient herself made it known that it was alright with her if I would like to inform her how things stood, I examined her. The birth organs were quite dry, the perineum uncommonly narrow, but the pelvis did seem to exhibit the appropriate breadth. Since even the most cautious examination seemed to cause her pain, I administered a syringe of olive oil, whereupon the examination became more tolerable. The uterine orifice was four finger-breadths open, the placental sack stretched taught amid the labor pains, the head positioned forward and quite moveable; the child also was incessantly rotating its head and moving its feet vigorously, something one could clearly feel through the thin covering of the lower abdomen and uterus. The labor pains were now both frequent and strong. Toward 12:00 noon, when I performed another examination, I found the uterine orifice completely open and the placental sack ready to burst; and when I syringed oil in again because the birthing parts were dry, the placenta burst and the water steadily drained |15| slowly out while I held my hand forward. The head immediately sank more firmly into the pelvis entry with the small fontanel positioned toward the joint of the left, unnamed leg. When the parturient asked how things stood with her and the child, I assured her that if the labor pains would remain as strong and enduring as they were shortly before the placenta rupture, she could well be successfully delivered by sometime after 2:00 and resting in her bed.
Just as I was making arrangements to depart for home, the lady’s husband requested that I remain, and had a midday meal served for me in the adjoining room. The labor pains seemed to dissipate entirely after the water rupture, the lady stood up from the stool, walked around a bit, sat down on the canapé, and worked through the labor pains there or in the stool.
After two hours had passed amid strong but brief labor pains, and the head had not descended any farther, withdrawing instead after each labor pain the same distance it had descended after the earlier ones — at about 3:00, when the parturient asked why the labor pains were now coming so infrequently and the delivery was not progressing, I said “I believe the head is being held back because of an entanglement by the umbilical cord, which invariably delays birth.” The midwife, however, believed that everything was going quite well and that one should simply wait out the good labor pains. I was certainly able |16| to wait them out, and quietly and calmly observed the lady working through them. The time in the birthing stool was becoming quite tedious for the parturient, and she wished sometimes to walk about, and sometimes to sit; I, however, requested that she instead remain lying in the stool because the overhanging distension of her belly absolutely required the supine position to promote a good and successful birth, remarking, moreover, that she would, after all, be lying on cushions there that were as soft as those on her sofa.
Toward 5:00 she absolutely insisted on getting out of the stool again, which I conceded as long as she would lie on her back on the sofa. She sat a while on the sofa, finally lay down, and took several sips of Hoffmann’s Liquor.  Toward 6:00 I said that my domestic obligations required that I go home. The parturient now asked me again what was causing the birth to be delayed so long, to which I replied that the explanation concerning the entanglement, which I had already given at 3:00, was becoming increasingly plausible. “Can nothing be done?” she asked in response. Her husband immediately joined the conversation, saying, “You can help with the forceps, can you not?”
She indicated she would gladly accept the use of forceps were there no other solution. I explicitly told her that one did not use forceps except in an emergency, and I myself least inclined to use it in this case, knowing full well from experience that the public, even in cases when the use of forceps is most necessary and indeed even successful, is invariably |17| wont to say, “Had one but waited a bit longer, nature herself would have brought the birth to just as successful a conclusion.” This, I added, was also the reason I had not yet suggested using the forceps, preferring to wait until it became obvious to everyone that the harmless use of forceps was absolutely necessary. At my departure, the lady called after me, saying I should nonetheless return soon. I was gone 3/4 of an hour.
I returned to the lady at 7:00, had my instrument satchel brought to me, and laid it quietly aside in the antechamber. I found the lady herself again in the stool, whose back, however, was positioned only two rungs backward. The midwife sat in front of her, and the labor pains seemed to be quite vehement, though they still lasted only briefly. I tried to explain to her that during this part of birthing, she needed to be lying back further, but during the entire birthing period she wanted to lie in a higher position, notwithstanding I had earlier made her period of working through the labor pains so comfortable that had she placed her small feet not in the stool’s stirrups, but rather on my hips as I sat before her. [5a] This is a considerable advantage for small parturients whose feet not only do not completely reach the usual stirrups when lying further back, but also do not fit well into the stirrups in the first place, their forefeet being remarkably bowed as a result of wearing high heels and their ankles unnaturally high. Such was also the case with this lady.
|18| I learned that during my absence the parturient had experienced extremely violent labor pains while lying on the sofa. She also told me afterward that this particular period was the most painful during the entire birthing process.
The midwife maintained that the head had in the meantime descended quite far and could be delivered after only a few more labor pains. I examined and found that the head genuinely seemed to have descended farther, for it had a lump with which it was now positioned toward the left ischium. I gave the parturient reason to hope that powerful labor pains might perhaps soon help the child into the world if the head might be appropriately assisted forward amid these pains. The midwife seemed disinclined to relinquish her seat, and I myself was unwilling to impose my assistance.
I waited yet another good half hour, the labor pains were now extremely violent, and the parturient’s yearning for help quite strong, and yet the midwife’s consoling insistence no less strong “that the child would come into the world quite successfully if one would just wait long enough.” Finally, both the spouse and the parturient having repeatedly indicated that they just wanted someone to help and for her to be freed from the pain, I declared myself willing and able to help if they would but entrust themselves to me. They were quite satisfied with the offer, and I first tried to use the Roonhuys lever, which was inserted without her being aware.  |19| Although I thereby tried to guide the head away from the ischium, I now clearly discerned that even after eliminating this hindrance, some other one was still preventing the head from progressing, for every labor pain was as if suddenly cut short, after which the head then again considerably withdrew. I now maintained there could be no doubt about an entanglement, and that the lady could be freed from her pain in a harmless, swift, and easy fashion solely by the use of forceps. She asked whether one could be sure that no harm would come to her child by this method. I assured her that would she but now allow herself to be delivered with the forceps, I would guarantee that her child would be brought into this world alive, whereas were she to wait several hours yet, it would perhaps eventually come into the world simply through the power of the labor pains, though in that case, she herself could doubtless see that the child, because of the lengthy pressure on the head and the increasingly tight entanglement of the umbilical cord, and she herself, the parturient, through the lengthy debilitation caused by the violent labor pains, might suffer harm.
She was completely satisfied with this explanation, and her husband himself then brought me the Levret forceps.  I applied them with no difficulty and, with three mild strokes and with the greatest of caution with respect to the perineum, which was not particularly stretched, I pulled the child’s head into the world after about three minutes (the final two pulls being effected by my left hand alone, the right hand |20| carefully supporting the perineum).
My conviction was that the perineum remained untorn; nothing was damaged or harmed either there or in the uterine orifice. The umbilical cord was wrapped around the child’s neck, extending from the right shoulder across the back and down toward the left hip, and had also entangled the left arm near the wrist. Before freeing it, I showed all present this entanglement, specifically to the lady’s husband, his sister, the maidservant, and the midwife. The child itself, a well-formed, fully developed, and compared to its mother rather large girl, cried, was quite frisky, and exhibited only slight marks from the forceps. The lady, now suddenly freed of her pain and delighted by a lively infant, was quite pleased, and both parents expressed their ardent thanks to me.
The wife, however, now wished to be brought to her nearby bed. I informed her that such could not happen until the afterbirth had dissipated. She asked how long that might take, I responded perhaps a quarter hour, or perhaps an hour or longer. Since, as is well known, the Stein birthing stool can be arranged as a bed, and is, moreover, equipped with soft cushions, she could lie there as comfortably as in a bed, hence there was no real hurry in this regard.
|21| The afterbirth remained fixed in place; the uterus had sufficiently contracted. After the lady repeatedly asked to be taken to her bed, I tried through gentle pulling to see if it could be easily separated, and when this was unsuccessful, I again urged the lady to be patient. On my advice, she herself rubbed the base of the uterus with the palm of her hand. The long umbilical cord hung down over the perineum and was, of course, constantly in motion as a result of the base of the uterus being rubbed. Had the perineum ruptured, she would doubtless have complained about the pain in that area, being extremely sensitive as she already was; but neither now nor as long as I afterward attended her did she complain about even the slightest pain in the birthing parts.
The midwife finally sat down on her own initiative and pulled on the umbilical cord. She suddenly stood up again and said that the afterbirth was now free. — Blood now profusely poured out. — When I felt the area myself, the umbilical cord extending into the lower edge of the placenta was split, the placenta itself violently severed and drawn out of the uterus and into the vagina, while the other half was still fixed in place. I now had to extract this completely, something I did with the most extreme caution and without inserting my hand completely into the uterus; and I brought the afterbirth out all at once, but such as it had been severed and separated by the midwife. I did not want to reproach her in front of the parturient for having effected this separation in this unauthorized and incautious fashion. |22| After having carried the lady to her bed, however, I looked around for the afterbirth, and behold! it had already been thrown out at the behest of the midwife. I asked her why the afterbirth had already been taken away. She answered, “That is always done here immediately after the delivery.” When I checked the lady’s pulse, I noticed it was sinking even though the flow of blood was now no longer that strong. My opinion, however, was that no more blood should flow out of what were in any case quite delicate veins than had already been lost in the stool lest the lady become dangerously weak and faint. Although I wanted to use the binder to support the lady’s slackened stomach, whose bowels the clysters had completely evacuated of thick excrement and were now filled by excessive drink and bloating, one of the two binders that had been prepared was too narrow, the other too broad. I prescribed a remedy made from an extract of willow bark, alum, Arabic gum, and raspberry and cinnamon water, and requested a pail of cold water. The husband did indeed arrange for such to be fetched immediately, and from it I prepared cold compresses and applied them to the lower abdomen of the parturient, whose pulse immediately rose and whose uterus, which had previously become more slack and extended, noticeably regained its capacity for contraction. I continued with this line of treatment until I noticed that the pulse, rather than remaining steady, was threatening to fall; I then remarked that pieces of ice |23|would be even more effective than cold water and that one would, moreover, likely not have to change the compresses as frequently, which the lady herself was applying without objection and without the least complaint that they were making her uncomfortable. The husband immediately had ice fetched from the nearby pond, and its application was so effective that the lady’s pulse stabilized, her feet and hands warmed up, and she fell gently asleep. When she awoke approximately a quarter hour later, the ice was removed. She indicated that she felt quite good; her pulse was gentle, strong, and steady, and her entire body was noticeably transpiring.
At her request, I positioned her slightly on her side. Despite the compress wraps, the bed had become only slightly wet. She slept long, gently, and quietly, having frequent difficulty only in trying to pass the flatulence. Her body was bound as effectively as possible with a towel, and the prescribed medicine now administered more slowly than during hemorrhaging. To ensure nothing was neglected or omitted, I remained there the entire night; when I departed at 5:00 am the next morning, her condition gave reason to be extremely optimistic concerning her childbed recovery. Except for the bloating and understandable fatigue, she did not complain about even the slightest pain. Not even the soft linen towelettes dipped in tepid wine, which I placed before and inside the reproductive parts to strengthen them, caused her the least bit of pain, proving yet again that those reproductive parts in general and the perineum in particular were unharmed.
Childbed Recovery, Illness, and Death
|24| I returned to see her toward noon on 28 March. She still had a strong pulse and complained about absolutely nothing except passing flatulence. I advised her to have a clyster administered as soon as might be convenient and then to apply my binder, which in the meantime had been correctly arranged.
When I visited her again that evening, she was doing so well that she tried to put her child to her breast. She was willing to nurse the child herself, since she had good, fully formed breasts that, moreover, at the end of her pregnancy were already producing milk. She still was complaining solely about the bloating and exhaustion. No clyster was administered, though I know not why. Although I had long indicated that I would not presume to take over the internal cure, which was the task of the family physician, the husband did ask that I come after all, visit his wife during her childbed recovery, and offer my advice.
The night of the 29th she experienced slight fever frost followed by febrile heat and sharp pains in her breasts, i.e., the usual milk fever, after which several clumps of blood were emitted accompanied by sensations resembling afterpains. When I visited her the next morning, she had a moderately feverish pulse, a clean tongue, no headache, and her purgation flowed as copiously as could and should be expected after a loss of blood. Her stomach was soft, causing no pain when palpitated, |25| but distended from bloating. Although I again advised applying the binder, the family physician, who had arrived before me, had already prescribed applying warm wrap compresses of chamomile infusion to her entire lower abdomen and for her to take a Rivière potion.  On his orders, about 36 hours after the cold, fortifying compresses, warm, relaxing compresses were placed on the lower abdomen, which had already relaxed. When I returned that evening, I learned that because she had drunk very little of the Rivière potion, the family physician soon prescribed a different one consisting of tincture of rhubarb and Hoffmann’s liquor, and ordered continued diligence in applying the warm compresses. I indicated that, though I did indeed believe the family physician was proceeding with these treatments according to what in his opinion were very sound reasons, I myself could not in good conscience agree with them. I said that, first, I believed the warm compresses were relaxing the abdomen even more, which was already relaxed, and directing into the lower abdomen the milk that was trying to proceed into the breasts, thereby causing afterpains and potentially causing a renewed round of blood discharge. And, second, I believed that the tincture of rhubarb with the liquor would cause overheating, increase the fever, and ultimately perhaps even cause more stools than necessary. My own advice, I continued, would be to voice these concerns to the family physician, to cease with the warm compresses, to administer the potion extremely sparingly, but to administer a clyster, bind the body, and put the child to the breast. On the morning of the 30th I learned that throughout the previous night only dry warm |26| towels had been placed on the lower abdomen, that the parturient had taken all but a quarter of the tincture of rhubarb, had had three bowel movements, but had perhaps caught cold while doing so because out of the neglect the fire in the room’s stove had not been sufficiently kept up during the night. — The milk had completely disappeared from her breasts. — In the meantime, just as I was about to leave a written statement for the family physician concerning what I thought should be done now, he himself arrived. He asked about her condition, from which he learned that she was experiencing pain neither in the form of headaches, nor in her reproductive parts nor while urinating, did not have a coated tongue, nor was her stomach hard or painful when touched, though it was quite distended, soft, and apart from during palpitation only occasionally the source of pains similar to gripes; she also had a rather strong, slightly feverish pulse, and was still experiencing difficulty with the bloating. He asked whether the warm compresses had been continued during the previous night. I told him I had advised cutting back on those, explaining my reasoning in the process. He countered that he considered them an excellent remedy for bloating, cramps, and stoppage in the lower abdomen, and that they should be continued. He also discussed the status of the illness with me, and believed that the pulse might to the contrary suggest the presence of some sort of inflammation in the lower abdomen, which is why his opinion was that cooling, dilating medications be administered, oil with camphor be rubbed into the lower abdomen, and that such |27| should be further bathed and warmed up by means of warm compresses. He genuinely did prescribe a pound of tamarind whey  to be taken internally, and externally an ounce of chamomile oil with 1/8 ounce of camphor.
Although I expressed doubts concerning the tamarind whey because of its tendency to promote bloating, he maintained that the bloating now existed more in the extremely fretful lady’s imagination. And although I objected that the camphor would drive even more milk out of the breasts, which had already lost milk, suggesting instead mixing the oil with an ammonia solution prepared with anise, the family physician believed that the camphor in fact did not cause such an effect, since it was not applied directly to the breasts.
Because I was disinclined to enter into a medical dispute, the order remained to rub in the oil, apply the compresses, and administer the tamarind whey. The lady’s mother said, “So the binder is now to be taken off?” (My abdomen binder had genuinely been applied with the help of the parturient herself and quite to her satisfaction shortly before the arrival of the family physician.) The family physician maintained that the binding was similarly not really necessary now, or the binder could instead be applied each time over the compresses. The parturient, however, believed that this constant binding and unbinding would probably become extremely difficult for her.
|28| When the family physician had left, I spoke yet again with the lady and her mother, telling them that given my principles, I could not agree with the prescribed treatments, especially with the compresses, and that because I had absolutely no inclination to raise these objections simply for the sake of reproaching, neither was I particularly adamant in defending those objections to the family physician, but that according to the obligations of an honest man I was not shy about saying openly what I considered not to be beneficial.
When I departed, the lady’s mother requested that I please return immediately after dinner. When I returned, I found that everything had been done that the family physician had prescribed. The sick lady now had an extremely feverish pulse, a coated tongue, headaches, and an extremely distended stomach.
I now believed I owed it to myself to withdraw from the treatment of an ill lady whom I could no longer help because my solicited advice had been rejected and a different treatment fully implemented with which my own principles did not concur. At my departure, I said as much to the husband and asked that he release me now, since he could doubtless see that I had become an utterly useless person here. The family physician, I pointed out, disagreed with me and I with him, a situation that was extremely unpleasant for the ill woman and her family; when the one rejected what the other recommended, one could not know whom to follow. It would be |29| much better in any case to entrust oneself to a single physician, and since I had always indicated I never intended to function as his wife’s personal physician, I now wished least of all to be such. I told him that I did, however, wish for him and the public to know that I did not agree with the family physician’s course of treatment because I wanted neither to be responsible for the ill consequences that might result nor share undeservedly in the gratitude and honor should the case have a successful outcome. We parted in an extremely cordial and moving fashion.
Although I never saw the lady alive again, I soon learned that people were spreading all sorts of rumors about me. What I did yet learn about the lady’s illness is the following: The warm compresses had been continued; on the 31st, the ill parturient began violently vomiting on her own, whereby a great deal of grass-green fluid came up. The family physician prescribed Ruland’s emetic wine,  Senna infusion,  etc. To effect cleansing, syringing in the uterus was undertaken, clysters administered, and the warm bathing of the lower abdomen continued.
On 1 April she began losing consciousness, and they thought the end was imminent, which, however, did not come about until the 2nd after midnight.
What I predicted and what I tried to explain had now genuinely happened. She died |30| not quite five and a half days after the successful delivery from an illness that had lasted hardly 4 days. But now hear the accusations directed at me because one believed that I, as a stranger, sooner deserved to bear the burden.
I was allegedly fully responsible for the lady’s death because:
1. I importuned my way into the delivery. And yet the fact of the matter is that the lady’s husband himself came to me and asked me to deliver his wife’s child. A science as salutary to humankind as is midwifery need not resort to importunacy, and thank God I myself am not in a situation in which I find it necessary to importune my assistance onto someone.
2. I allegedly sent my birthing stool to the house several weeks before the lady’s delivery date, thereby unduly and negatively stimulating the lady’s fretful imagination.
And yet it was the husband himself who requested my birthing stool and had it fetched on his own initiative and by his own people.
3. I confined the lady in the birthing stool without any urgent need to do so.
And yet the lady was already in the stool when I came to her, and I left it up to her where she wanted to recline. She was merely not to stand, walk, or sit upright, since the former was impossible for her and the other two harmful.
|31| 4. I forcefully brought about the delivery without having any urgent reason to do so.
And yet the reason why the woman was dealing so unsuccessfully with such severe labor contractions, namely, the entanglement, which I had predicted five hours earlier, was confirmed.
5. I allegedly tore her body with the forceps.
And yet the lady, who was so sensitive, complained neither immediately after the delivery nor as long as I came to see her of even the slightest pain in her female organs.
6. I administered the cold compresses without any urgent reason to do so, thereby repressing her bowel cleansing.
Had the midwife not caused the hemorrhaging by incautiously pulling on the umbilical cord, thereby making it necessary to apply the harmless anti-hemorrhaging remedy, namely, cold water and ice, that has been tested by so many experienced accoucheurs? And was the cleansing not still flowing on its own at the commencement of the milk fever?
7. It was I who ripped the placenta and left a piece in place.
Was it not the midwife who ripped the placenta? Would she have had to get rid of it so quickly had she been confident in what she had done? Would the uterus have been able to contract so small amid these cold circumstances had a piece of the placenta remained in place?
|32| 8. They requested that I leave the lady because they saw that I did not understand the treatment.
At my next-to-last visit, would they have entreated me to return to the parturient soon after my meal had they believed I did not understand how to treat her illness? Would not every reasonable physician in my position, however, have had to withdraw in precisely the fashion that I myself did quite on my own initiative?
Now, every physician and accoucheur must suffer such vile and outrageous lies being |33| spread about him!  — Yet any objective reader, even those who are not specialists, can assess from the above account — which is true even down to the tiniest detail of circumstance — whether I merit even a single of these accusations, or whether they all bear the stamp of the most outrageous slander.
I openly expressed my desire for an autopsy to be performed on the body. On that very day, 2 April, the deceased lady’s husband returned my birthing stool with an accompanying note asking whether I might be so kind as to be present at the autopsy of his wife the next morning. I thanked him for the note and appeared on 3 April at the designated hour.
A surgeon performed the autopsy in the presence of the family physician; a famous anatomical dissector, who directed the autopsy; a practicing physician; and myself. Confident of my assessment in the matter, it was I who requested that the autopsy findings be committed to writing.
Here is a faithful copy of what the gentleman who directed the autopsy wrote down and what I myself noted and pointed out:
|34| Primary findings of the pathological autopsy of the deceased Madam ***.
1. The lower abdomen was quite unnaturally distended and elevated.
2. One found the perinaeum separated and ripped up to the edge of the rectum.
3. In the cavo abdominis one found approximately four or five ounces of reddish water.
4. The entire intestinal tract was covered over with a suppurating, whitish-yellowish material, as is customary in the case of milk displacement.
5. The large peritoneum was extremely inflamed.
6. The large and small intestines are extremely inflamed.
7. The external reproductive genitalia [are] extremely gangrenous.
8. The size of the uterus approximated the periphery of a man’s balled fist.
9. The broad uterine ligaments and the alae vespertilionum [Fallopian tubes] were extremely inflamed in both places; no inflammation was discernible on the external surface of the uterus.
10. The rear wall of the uterus down into the cervicem was inflamed and covered by a blackish bloody liquid. Where the placenta had been positioned one could still see several small, hard clumps.
11. The liver was abnormally large, also paler in color, and in several places whitish-brown.
|35| 12. The gall bladder was still filled with a dark yellow bile.
Thus the assessment of the directing dissector. When he departed, I noted the following additional points in my own copy:
13. When the intestinal tract was cut open, an extremely ill-smelling air and thin, greenish-gray material came out.
14. The entire inner surface of the peritoneum and in general the entire cavum abdominis were almost everywhere inflamed.
15. When the flaccid breast was cut open, there was no milky substance at all to be seen, but rather only a bit of thin yellowish liquid.
I immediately voiced the following objections to several of the points made in this report, e.g., to point number 2, concerning the tear in the perineum. The directing dissector spread out the corpse’s feet with such obvious violence so far apart that her legs almost no longer formed any real angle. Hence I retorted that no perineum could keep from tearing if subjected to this procedure, especially if, as was here the case, the reproductive genitalia were gangrenous. That this perineum had, however, not been previously torn is sufficiently proven by the fact that only the external, not the inner fibers were separated, which, after all, during a rupture are first torn from the inside out; and, further, that this otherwise so fretful and sensitive lady never complained about pain in her reproductive genitalia or uterus, which the family physician, who was present here, and |36| the chambermaid could not but attest; and, further, that no sizable tear could have come about during the delivery without extending all the way into the rectum, since the perineum was already unusually narrow beforehand. Yet even assuming the perineum was torn during delivery, a tear that according to the previously mentioned circumstances would be of negligible size — does such ever constitute a cause of death in any case? — These gentlemen loudly attested that no woman dies of such a cause.
I immediately had the practicing physician who was present attest with his signature that I protested that this account implied the tear was deeper than it actually was, and explained that it was caused by the violent outward spreading of the thighs.
Concerning point number 3, I pointed out that far more than merely 5 ounces of released liquid was found in the cavo abdominis, which everyone present also conceded.
Concerning point 4, I pointed out that the milk displacement I predicted had now been confirmed.
Concerning point 5, I pointed out that the peritoneum was not, as in the case of true childbed fever, consumed, dissolved in pus, or shrunken into a clump, but rather was found appropriately spread over the intestines.
Number 7 was noted at my explicit request.
|37| Concerning number 8, I pointed out that the size of the uterus approximated that of a small man’s fist.
Concerning number 10, I pointed out that the inflammation on the inner surface of the uterus, where the placenta had been, and the black mucus, was to be found in all deceased parturients who had died from an inflammation of the bowels, and that the modest remnants at the location of the placenta, which was on the front wall of the uterus, were the usual remnants of the membrane caduca Hunteri,  and not pieces of the placenta.
Concerning number 12, I pointed out that the gall bladder was not found to be empty or with a bile of the wrong color, as might have been expected had the released green fluid really been merely bile; that by contrast, the milk material displaced into the bowels generally takes on a greenish color, and hence also the excrement has a greenish color whenever a critical case of diarrhea occurs after such milk displacement; which is also why according to number 13 the greenish-gray material was found in the intestines.
But this can suffice to demonstrate to any objective person that it is only unjustly that I can be accused of any mistake or oversight. 
Ed. note: Although Osiander does not include illustrations in this book, such have been inserted from his and other publications when mentioned in the discussion.
Portrait of Osiander reproduced here from Max Voit, Bildnisse Göttinger Professoren aus zwei Jahrhunderten (1737–1937). Festgabe des Universitätsbundes zum Jubiläum der Georgia Augusta (Göttingen 1937).
At issue was Osiander’s employment of a birthing stool rather than one of the more traditional methods, e.g., allowing the mother to give birth while still in bed as shown in this illustration from the late seventeenth century (Christoph Völter, Neueröffnete Hebammen-Schul/ Oder Nutzliche Unterweisung Christlicher Heb-Ammen und Wehe-Müttern/ wie solche sich vor/ in und nach der Geburt/ bey Schwangern und Gebährenden/ auch sonst gebrechlichen Frauen zu verhalten haben [Stuttgart 1687], plate following p. 176):
Birthing stools are attested prior to Osiander’s use, and it seems that his methods of employing the stool and of otherwise treating the expectant mother were at odds with the midwife who was present at the beginning of the episode (see note 14 below). Back.
 Osiander was born in Zell in Württemberg, studied in Tübingen, and practiced in Kirchheim unter Teck from 1780 till 1791, participating in 168 deliveries (ADB); he had been in Göttingen in 1792. Back.
It is a somewhat altered version of the Stein birthing stool that I publicized several years ago through my own detailed description. See my treatise Abhandlung von dem Nutzen und der Bequemlichkeit eines Steinischen Geburtsstuhls. Geburtshelfern, Hebammen und Gebährenden zur Belehrung (Tübingen 1790) [here plate 1 between pp. 43 and 44]:
The version Osiander himself developed was depicted a few years later as a supplementary plate at the end of his book on midwifery, Lehrbuch der Hebammenkunst: Sowohl zum Unterricht angehender Hebammen als zum Lehrbuch für jede Mutter (Göttingen 1796), plate after errata page:
 See Friedrich Benjamin Osiander’s, Doktors und Praktici der Heilkunde und Geburtshülfe in Kirchheim unter Teck, Beobachtungen, Abhandlungen und Nachrichten welche vorzüglich Krankheiten der Frauenzimmer und Kinder und die Entbindungswissenschaft betreffen (Tübingen 1787), table 1:
Here from the same plate the view of how the two versions were worn, as Osiander explains in the next paragraph, “a broader one to wear during pregnancy, and a narrower one to wear after delivery”:
 Osiander’s footnote: “Later the reader will see why I must mention what may appear to be a trivial circumstance in this story.” Back.
 Spiritus aetheris sulphurici compositus, “Hoffmann’s anodyne liquor,” concocted by Friedrich Hoffmann (1660–1742). See John Redman Cox, The American Dispensatory, Containing the Natural, Chemical, Pharmaceutical, and Medical History of the Different Substances Employed in Medicine; together with the Operations of Pharmacy (Philadelphia 1830), 33:
Take of Spirit of sulphuric ether, one pint; Ethereal oil, two fluid drachms; Mix them. This preparation is intended as a substitute for the liquor anodynes mineralis of Hoffmann, although its composition was never revealed by him. . . . In the Dict. des Sciences Med., v. 13, p. 382, it is said to be composed of equal parts by weight of alcohol and ether, add to this twenty-four drops of sweet oil of wine. It is supposed by many practioners to possess an anodyne property, and to allay irritation more effectively than any other preparation of ether.
Roselyne Rey, The History of Pain, trans. Louise Elliot Wallace, J. A. Cadden, and S. W. Cadden (Paris 1993), 152, remarks that “the properties of ether were not unknown because it was an ingredient of the famous ‘Hoffmann’s soothing liquor’ which aimed to calm people down particularly in cases of hysteria.” Back.
[5a] Here an illustration of the birthing stool used normally with the woman’s feet in the stirrups, from Osiander’s Abhandlung von dem Nutzen und der Bequemlichkeit eines Steinischen Geburtsstuhls. Geburtshelfern, Hebammen und Gebährenden zur Belehrung, plate 2 between pp. 41 and 42:
Note the forceps laid out on the floor with other instruments; here an in llustration from Osiander’s later Neue Denkwürdigkeiten für Ärzte und Geburtshelfer, vol. 1:2 (Göttingen 1799), plate 4:
 A midwifery lever named after Roger Roonhuysen; see Encyclopédie, ou Dictionnaire raisonné des sciences, des arts et des métiers, ed. Denis Diderot, 1st ed. (1751), vol. 3, s.v. “chirurgie,” volume plates in Recueil de Planches sur les sciences, les arts libéraux, et les arts méchaniques, part 2b (Paris 1763), 119, here fig. 3 (instrument at top) along with examples of another single-blade lever and a pair of double-handled forceps (also visible on the floor next to the attending physician in the illustration from Osiander’s book in note 5a above):
 See Johanne Mulder, Historia litteraria et critica forcipium et vectium obstetriciorum (Lugdun 1794), end plates (also visible on the floor next to the attending physician in the illustration from Osiander’s book in note 5a above):
 An anti-emitic named after its inventor, French physician Lazare Rivière (1589–1655), allegedly explained in his Praxis Medica cum Theoria (Lugdunum 1660); see William Dease, Bemerkungen über die Entbindungskunst in langwierigen und schweren Geburten, nebst sehr unterrichtenden Leichenöffnungen sowohl vor, als nach der Geburt verstorbener Personen, trans. Christian Friedrich Michaelis [ed. note: not Caroline and Lotte’s half-brother] (Zittau, Leipzig 1788), 4:
1/8 ounce wormwood salt; 3/4 fluid ounce of lemon juice; a fluid ounce of cinnamon water; 20 grains of white sugar.
This recipe is not adduced as such in the original, William Dease, Observations in Midwifery (Dublin 1783), 2–3, which speaks only of “effervescent draughts,” the latter elsewhere described as “an effervescing drink produced by combining a solution of citric acid with one of sodium or potassium bicarbonate” (W. A. Newman Dorland, The American Illustrated Medical Dictionary, 11th rev. ed. [Philadelphia, London 1922], s.v. “potion, Rivière”). Back.
 “The coagulation of 100 parts milk is effected with 4 parts of tamarinds, and the strained whey has a brownish color” (Alfred Stillé and John M. Maisch, National Dispensatory, containing the natural history, chemistry, pharmacy, actions and uses of medicines [Philadelphia 1880], 805). Back.
 Aqua benedicta, also “antimonial wine,” “tartaric antimonoxide,” “vinum stibiatum,” an emetic and laxative conconted by the Bavarian physician Martin Ruland (1532–1602), made of “crocus of metals” boiled in water, wine, and beer. Back.
infusion of Senna, with Tamarind; or Infusum Sennae Compositum. Macerate an ounce of tamarind pulp, half a drachm of coriander seed, and half an ounce of brown sugar, with a drachm of senna leaves, in eight ounces of boiling water, agitation occasionally for four hours, and then strain. A mild and cooling purgative, particularly adapted to delicate habits, and inflammatory diseases, taken from two to four ounces at a dose. Back.
Nor are these even the most impudent lies about me that were spread around Göttingen. The following story proves even more trenchantly the extent to which such audacious slander is carried. — It was publicly alleged that I cut through the scrotum of a child during birth!! — But now hear the truth. Several weeks ago I was summoned to a parturient in Nörthen. When I arrived, the woman had already delivered through natural means, and they grievously lamented to me how the ignorant midwife thought the child’s rear end, which had entered the birth canal, was its head, and the swollen scrotum the skin sack in front of the head, and thinking she was opening the skin sack, instead cut into the scrotum with her scissors. This pathetic woman really had cut out a piece out of the skin of the scrotum approximately 1 inch long and 1/4 inch wide. I comforted the worried parents, telling them how they should treat the wound, had a wet nurse for the child sent from the Royal Accouchement Infirmary, and several days ago received the pleasant news from the child’s father that the wound had completely healed and that both mother and child were doing perfectly well. Other malicious people keen on criticizing my predecessor and the Royal Accouchement Institute allege |33| that this midwife had received her instruction here at the Royal Accouchement Infirmary. Absolutely not. — She never received any instruction at this institute; instead, a local surgeon instructed her, and that cut is the sad proof of her coarse ignorance. — I now hear she is to be relieved of her office, something my predecessor tried in vain to bring about after the first mishap she caused.
 A uterine membrane formed at pregnancy and sloughed off after birth. See Francis H. Ramsbotham, “Lectures on the Theory and Practice of Midwifery; Delivered at the London Hospital,” The London Medical Gazette 13 (1834), Saturday, January 18, 1834, 577–84, here 577–78:
Membrana Decidua. When we cut through the gravid uterus, after having completely divided the parietes, we first come to an opaque membrane lining the organ through its whole extent, somewhat of a reticulated appearance, divisible into two layers, both together being, at full time, not thicker than the nail, possessing a tenacity between true and false membranes, and very vascular, called after Hunter the membrane decidua, or caduca. These terms were applied to it because it is shed from the uterus immediately after labour, or flows away with the lochia. Back.
Translation © 2013 Doug Stott