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Jacob Rueff (1500–1558) of Zurich and The expert midwife
  1. P M Dunn
  1. Department of Child Health, University of Bristol, Southmead Hospital, Southmead, Bristol BS10 5NB, UK
  1. Professor Dunnp.m.dunn{at}bristol.ac.uk

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Little is known of Jacob Rueff's early life except that he was born in 1500, some say in Rhyntal, others in Württemberg. Settling in Zurich he became prominent in many fields. Although primarily known as a physician, surgeon, and lithotomist, he was also a poet and writer of folk songs. He was a follower of Martin Luther and a great believer in religious freedom; indeed twice, at the age of 29 and 31, he served with the troops of Zurich against the Catholic cantons.1 2 His medical writings include a little book on tumours, astronomical notes for an almanac, and charts for blood letting. But easily his most important contribution was the publication of a practical handbook on midwifery in 1554. Published simultaneously in Latin and German, De conceptu et generatione hominis . . . 3 became the required reading for the midwives of Zurich, for whose instruction and examination Rueff was made responsible. A second edition appeared in 1559, and this was reprinted in Frankfurt in 1580. In 1637 an English translation was published in London with the titleThe expert midwife.4 The last edition of this work appeared in Amsterdam in 1670. Thus Rueff's book was for over a century a major source of information for midwives and doctors. As he wrote: “ . . .my labours I bequeath to all grave modest and discreet women, as also to such as by profession, practice either physicke or chirurgery. And whose helpe upon occasion of extreame necessity may be usefull and good both for mother, child and midwife.”

Much of Rueff's advice stems from that of classical writers or is taken from Rösslin's Rosegarten. A great deal is also very primitive to modern eyes. But it made a start at a time when midwifery had previously been strictly a woman's affair. The following extracts will give the reader an idea of the sort of advice he gave:

On conception4

“But after the wombe hath conceived the seede of man, it doth admix and mingle her seed also to it, so that of both the seeds of both sex, there may be made one mixture . . . Therefore both seeds mingled, blended together are soone compassed, and enclosed about, with a certain little coat or caule . . .”

On antenatal care4

“Hereafter we will give some wholesome and necessary precepts to women conceived with child . . . Before all things let them be of a merry heart, . . . let them give their endevour to moderat joyes and sports . . . let them use moderate exercise, let them not leape, or rise up suddenly, let them not runne also, neither dance nor ride, neither let them lace or gird in themselves hard or straight, or lift up any heavie burden with their hands. Sleepe especially is convenient. Againe, let them take heed of cold and sharp winds, great heat, anger, perturbations of the minde, fears and terrours, immoderate Venus, and all intemperance of eating or drinking . . . The first foure moneths from the conception, let them not open any veine, . . . let them take no pills or purge, without the counsell of an expert and skilfull physician . . .”

On constipation during pregnancy4

“But if it shall happen that they be bound and cannot goe orderly to stoole, let them take spinage seasoned with store of butter . . . But if those will not relaxe and unloose the belly, let them use suppositors, confected and made of hony and the yolke of an egg, or with Venice-soape. But if the constipation and binding shall be so great, . . . let them by the advice of a skilfull physician, use a potion of the decoction of the leaves of Sena . . .”

On delivery on the birthing stool4

“Let the Stoole (fig 1) be made compasse-wise, underpropped with foure feet, the stay of it behind bending backeward, 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 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 paines waxing grievous, and the woman labouring, may stroke and presse downe the wombe, and may somewhat drive and depresse 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 her selfe sit stooping forward before the labouring-woman, and let her annoint her owne 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 . . . Lastly, all these things thus prepared, let the midwife instruct and encourage the party to her labour, to abide her paines with patience, and then gently apply her hands to the worke as she ought, by feeling and searching with her fingers how the child lieth, and by relaxing and opening the way and passage conveniently for him, while the mother is in paine, and also where there is need by enlarging and stretching out the neck of the matrix warily, and if the infant stay from proceeding forth, and be stopped anywhere, with her fingers tenderly to direct the infant to lie and proceed forth directly and naturally, when hee lieth crooked and overthwart, and to further him to an easie birth. Let her conveniently receive the infant proceeding forth to birth, and let her presently cut the navell, about the length of foure fingers being left, and let her binde it hard with a double thread, as neere to the belly of the child as may be; which being done, let her have a care of the secundne or after-birth; let her move and stirre it, the matrix as yet being stretched out and open, before being shut it be closed together againe . . . The mother being delivered of her childe, and after-birth, let the midwife take a cleane sponge dipped in warme water, and gently bathe and wash her, as yet sitting on her stoole, where there is neede, and if any of the matrix doth hang and appeare outwardly, let her anoint it with warme oiles, of roses, violets, or camomile, and let her direct and reduce it againe being cherrished with warme clothes into her proper place, which being done, let the child-delivered-woman be brought to her bed, where the place and roome may be temperate, there let her lie on her backe, let her stretch out her legs, and hold them wide abroad, so much as shall be convenient, the other part of her body being so upright, that shee may rather seeme to sit, than to lie downe, because by that means, if any superfluous matter doth remaine, it may more commodiously passe away . . .”

Figure 1

A birthing stool (after Rueff).

One of Rueff's illustrations (fig 2) shows: “ . . .a stout, complacent woman sitting on a birth-stool and being delivered by a midwife whose obstetrical instruments are in a bag fastened to her girdle and hanging behind her. A tub of water stands on the floor in readiness for the child. Two neighbors support the patient. Scissors for dividing the umbilical cord and string for tying it are on a table nearby. In the background are two men observing through a window a new moon and the stars, ready to cast the horoscope of the new arrival.”5

Figure 2

A birthing scene (after Rueff).

Rueff was one of the first to appreciate the importance of anatomy in midwifery, and he also wrote about malpresentations and their management by internal version:

Management of the frank breech4

“But if the childe shall proceede forth to the birth with his buttocks first, let the midwife lift up the fundement with her hand annointed and conveyed in, and turne the head to the way of passage. She must not make haste in this case, lest he slide back into a worser forme or fashion . . .”

Rueff's book also contains illustrations of various instruments used to extract the dead fetus, and a large section on congenital anomalies which he considered that “God doth permit for the punishment and admonition of men” but added “ . . .yet afterward also the corruption and fault of the seed is to be acknowledged, to wit, which was either too much, or too little, or corrupted, from whence those monsters are ingendred . . .”

In summary, Rueff's book helped to prepare the way for the more scientific approach to childbirth of the late 17th century. He died in 1558, aged 58 years.

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