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The Evolution of the Gynaecologist J Obs Gyn Brit Emp 1951 V-58 THE EVOLUTION OF THE GYNAECOLOGIST" BY A. LEYLANDROBINSON, M.D., F.R.C.S., F.R.C.O.G. Emeritus Professor of Obstetrics and Gynaecology, University of Liverpool THE Oxford English Dictionary defines man had some knowledge of surgery, there gynaecology as " that department of is no such unequivocal evidence of his medical science that treats of the functions attainments in gynaecology and we must and diseases peculiar to women " and thus look to more esoteric sources for informa- declares that obstetrics is an essential part tion on this stage of his development. We of the work of the gynaecologist. If may derive some help from the study of the this be so, "The Royal College of sex behaviour of modern savages who, Gynaecologists " would be a fitting descrip- according to the best ethnographical tion of our foundation, but the founders opinion, have never come under the had good reason for perpetuating in our influence of civilization and who for this polysyllabic and sonorous title a time reason must be placed farther back in the honoured name and a duality of purpose evolutionary scale than the earliest that is of great historical interest. It is the civilized communities of which we have fortunes of the gynaecologist in this dual any record. Among aborigines of this role that we are now to consider. type, man is lord and master and a firm His evolution may be said to have begun believer in a system that relieves him of in the garden of Eden and although uncongenial occupation while the women priority may be claimed by the thoracic do the work and look after the family. surgeon, or by the anaesthetist, for we read Under this system the women are the mid- that Adam was put to sleep, the wives and also the supervisors of many gynaecologist can afford to be generous for ceremonies relating to puberty and the operation upon Adam was never marriage. Among certain tribes they carry repeated, whereas the gynaecological out the operation of circumcision and also activities of Eve have continued to exert a the procedure known as fibulation, which profound effect upon the welfare of man- involves the removal of not only the kind ever since. If, therefore, the clitoris and nymphae but also a portion of Aesculapian symbol has a somewhat the labia majora and the mons veneris-a obscure application to medicine in general, mutilating procedure which results in a there can be no doubt that the serpent is degree of vaginal occlusion so complete as an emblem of peculiar significance to the to make coitus impossible until the vagina gynaecologist. has been re-opened by the operation of The earliest phases of his evolution are a defibulation. The tribal doctors or medicine matter of speculation, for although the con- men play little if any part in these operd- dition of neolithic skulls proves that ancient tions, either because they are excluded by a dominant matriarchal tradition or * William Meredith Fletcher Shaw Lecture because they consider such work beneath delivered at the Royal College of Obstetricians and the notice of those who are the friends of Gynaecologists on 29th September, 1950. the gods and the inasters of witchcraft. We 5" history-of-obgyn.com THE EVOLUTION OF THE GYNAECOLOGIST 51 must not identify the sex behaviour of gods and to confuse the gods with men is modern uncivilized man too closely with beautifully illustrated in Greek mythology the customs of his unknown pre-civilized in the legends of Apollo and Aesculapius. ancestors, but it is reasonable to infer that Apollo, the twin brother of Artemis, is of in prehistoric times midwifery was in the special interest to the gynaecologist, for at sole charge of women and that the pre- Delphi there may still be seen a monument historic physician played no part in either as old as the pyramids-the Omphalos-a midwifery or gynaecology. stone placed there to commemorate the separation of the umbilical cord of the I.itfluence of the Early Civilizations young god and to establish for all time the importance of this physiological, if fabu- It is a far cry from neolithic man to the lous, event. After Apollo as a prodigious Greek physician but during this long neonate had slain the monster which transition the progress of gynaecology can ravaged Pamassus, he founded the cult for be faintly discerned through the cuneiform which Delphi became famous, and it was inscriptions of the earliest writing and the here that Aesculapius is alleged to have papyri and the mummified remains of the practised the art of healing. Unhappily he ancient Egyptians. We learn that the was all too successful and his career was Sumerians in 4,000 B.C. were interested in cattle breeding and thus had the rudiments brought to an end with a thunderbolt after Pluto, the God of the underworld, com- of genetics, and that the Babylonians 2,000 years later had an organized medical plained to Zeus that Aesculapius was profession with penalties for malpraxis. depriving his dominions of subjects by Medical literature made its appearance raising the dead to life. It may be that and some of it related to gynaecology Aeskulapius was not a purely mythical including the fragmentary Kahun papyrus character, for he has been identified with a priest who lived and practised the cult of (850 B.c.), which deals with uterine disorders and one of the Berlin papyri Apollo at Delphi in 1250 B.c., but whether mythical or mortal he became the God of (I ,450 B.c.), which consists of incantations for the protection of mothers and babies, Health and temples in his honour were built in various parts of Greece and the whilst the Ebers papyrus of 1,500 B.C. describes a test for pregancy that adum- Ionian islands, including the island of Cos, brates the principle of Aschheim and where Hippocrates was born in 460 B.C. Zondek. The conception of health as distinct from disease also took shape with InfEuence of the Hippocratic School Thoth as the God of Health and the lion- It was formerly believed that Hippo- headed Sekhet as the deity of childbirth. It crates was a son of a priest-physician of became traditional to associate the lives of the Aesculapian order, but this view is no great men with the art of healing and the longer tenable as it is now known that the celebrated Imhotep who was the Grand cult had not been established at Cos at the Vizier. of Egypt and the architect of the time of his birth. It is certain, however, Great Pyramid of Sakkarah, the oldest that he visited several of these temples, stone building in the world, was that he was steeped in their tradition and worshipped after death as the God of Heal- literature and fully conversant with their ing, although nothing is known of his methods and practice. After much work medical activities during his lifetime. This and wandering he settled in Thessaly and tendency to identify medicine with the spent the rest of his life in the vicinity of history-of-obgyn.com JOURNAL OF OBSTETRICS AND GYNAECOLOGY 52 Delphi practising medicine and gynae- last resort for dead or dying patients. The cology in the towns and villages that may Hippocratic Oath makes a direct reference still be seen in that neighbourhood. It was to the gynaecologist in the following words here during the first worId war that your -"I will not give a pessary to a woman memorialist may humbly claim to have to procure abortion "-and perhaps an established a link between the Father of indirect one where it says--" I will not cut Medicine and this College, when after visit- persons labouring in stone, but will leave ing the oracle at Delphi he performed an this to be done by men who are practi- operation for excision of the vulva in the tioners of this work". It may be that village of Suvalla on the foothills of Parnas- Hippocrates disapproved of procuring sus, and on another occasion met a Greek abortion on purely ethical grounds, a view physician in consultation over a gynaecolo- which is in keeping with the moral tone of gical case in the town of Lahrissa, which the rest of the oath, but in conjunction with Hippocrates frequently visited and where his reference to lithotrity the words would he eventually died. This link may be seem to imply that such a dangerous regarded as somewhat tenuous, but at least operation as procuring abortion should we may be sure that given the opportunity only be performed by those who in the Hippocrates would have lent his support to words applied to the lithotritist " are prac- the foundation of this College. In his day titioners of this work ". It is evident that gynaecology had lost much of its crudity Hippocrates recognized the importance of and had become an accepted part of medi- technical training and that, although he cine. The range of the subject was consider- would not accord to the specialist the able and in some ways surprising. For the full status of the physician, he regarded investigation of sterility attention was paid him as a necessary and acceptable member to the regularity of menstruation, the size of the profession. The Greek system of the 0s uteri and the position of the uterus, whereby physicians were responsible for and some cases were treated by the insuffla- medicine, most of the surgery and the diffi- tion of aromatic fumes conveyed to the cult midwifery, specialists cut for stone and uterus through a hollow tube inserted into sometimes operated for cataract and other the cervix.
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