H E N D R I K V A N D E V E N T E R (1651 — 1724) THE SILVERSMITH W H O BECAME THE CO-FOUNDER O F M O D E R N OBSTETRICS L. J.
BENEDEK-JASZMANN
The seventeenth century has often been called the "age of the modern physiology and anatomy" because o f the different kinds of fundamental discoveries i n this field. A l l these medical men sought the causes o f the illnesses and tried to find remedies for them by doubting and questioning all accepted ideas and beliefs. They represented the spirtit of the modern age of individualism, independence and criticism o f religions and politics. Their work were no longer being guided by metaphysical speculation as i n the past, but by a basically sound scientific approach o f their work. I would like to mention only few famous personalities: Willian Harvey (1578-1657) described i n 1616 the blood circulation, Robert Hooke (1635-1703) was the first to depict the biological cell, Reinier De Graff (1641-1673) at Delft opposed first the Aristotelian doctrine of the egg being formed i n the uterus and held that generation takes place from the ovum pre-existent i n the ovary. As a basis for the new anatomical concepts and knowledge is considered the inventor of the microscope Anthonie Van Leeuwenhoek (1632-1723) also living i n Delft, Holland. Marcello Malpighi (16281694) whose name stands highest in the field of microscopy i n the 17th century was the father of tissue studies o f descriptive embryology; his discovery of the capillaries and their circulation i n the lung completed Harvey's discovery of the circulation o f the blood. Hendrik Van Roonhuyse (1622-1672) practicing general surgery in Amster dam made a remarkable contribution to 17th century gynaecology when i n 1663 he published his work, often been referred to as the first textbook on operative gynae cology. The seventeenth century was also an important turnpoint i n the history of obstetrics, when the medical doctors started to take seriously the problems of obstetrics, first paying attention to physiological deliveries. I t is not surprising that surgeons were the ones who first became interested i n physiological deliveries. François Mauriceau (1637-1709) and Paul Portal (1630-1703) o f Paris were the most able accoucheurs of their time working in the famous hospital H ô t e l Dieu; they wrote the first modern textbook of obstetrics, later translated into many languages. I n this paper I would like to mention the life and medical activity of the D u t c h co-founder of modern obstetrics, Hendrik van Deventer (1651-1742). He lived at the time when the Netherlands was first founded from the "Seven Provinces" forming the "United Republic o f the Netherlands". A l l the relatively small provinces were independent restants of different territories i n the middle age which became i n t o power when the union was founded. Besides the troubles among the different provinces themselves, they had a common enemy i n the South, the mighty Habsburg Imperium.
This was also the time of the church reformation and contrareformation, a time of an evolution i n the sense o f freedom in religious and democratic principles. I n spite of the dangers o f political and religious quarrels the Federal Republic was expanding to a powerful nation w i t h a powerful navy. W i t h high standard of living the scientific
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life prospered too, this was also the time when there was a huge development i n the art and crafts. Famous painters like Rembrandt and his contemporaries, craftsmen organized i n guilds, army and navy made the relatively small Federal Republic an important nation o f this time. I n this rather precarious time lived Hendrik van Deventer. He was born in Leiden on the 16th M a r c h 1651. His parents moved very soon after his b i r t h to the Hague
and later i n the neighbourhood of Voorburg. We know very little about this man. Young Hendrik became a silversmith and a member of the q u i l d when he was 17 years old. His parents were wealthy, his father was a member o f the wine-sellers-guild, so Hendrik could be well educated. He was well trained to write and read Dutch, but he did not have a classical Latin school education needed for a study at university. Probably i n 1670 he started his, in that time customary "migratory time", leaving Voorburg and to see the w o r l d , learning more to became a skilled silversmith. I n the year of 1672, then 21 years old, he lived i n N o r t h Germany i n A l t o n a near Hamburg. He lived i n a turbulent time of religious reformers and he became a member o f the very orthodox protestant Labadies' sect. This sect formed one special community, the members were living w i t h o u t any personal property. Lammers (1946) wrote a study about the world in which Hendrik van Deventer lived and he characterised his manner of life as "the communism o f today embodied in practicing the daily life as corner stone of Christ's spirit". This community needed a doctor. The intelligent young Hendrik was chosen by his idealists to follow a medical training by a practicing doctor, named D r . H . Walter, living also i n Altona. He could not follow university training because he had no clas sical education. Very soon Hendrik turned out to be an excellent apprentice o f his famous master. He was enthousiastic knowlegable in general medicine, surgery and in botanies. He became a self made man i n the medical practice and after few years he started himself practicing only in his religious community under the supervision o f his master. So, the demand of the community was now fulfilled, they had their own doctor. According to Lammers' study, the members of Labadies' sect were expelled from Germany by the Lutheran church, because of their "strange habits in religious and family affairs". The Labadies' sect had to move and they found a new home i n Wieuwerd i n Friesland. A t this time Fiesland was an independent small country and it did not belong as yet to the Federal Republic of the Netherlands. The medical activity was not bound to rules. This well come occasion suited for his purpose: practicing medicine without any limiting rule. Hendrik was for this way free to prac tice medicine, surgery and preparing medicaments. I n this unie position without any hinder i n his unlimited medical activity, this self made man became a famous doctor. His name was known very soon even outside o f Friesland. I t was an honour to h i m to be a consultant for the Danish king's family where different members were suffering from a bony disease, malformation of the vertebral column, probably due to rachitis. His former trade as a handy silversmith became now important. He constructed special corsets and his interest in orthopedic problems was also growing. This special knowledge of the bones and his interest in its malformations, drew him later to ob stetrics, i . e. to the bony pelvis and its importance. I n the mean time, he was about 30 years old, happily married and enjoying family life i n Friesland, his interest became more focused on obstetrics. He became familiar with the translated textbooks o f obstetrics of Mauriceau and Portal, he studied them with criticism. A t the same time he observed the poor results o f the practicing m i d wives i n Friesland who had no medical education. This fact inspired him to write a book to teach the midwives as well as the doctors engaged in obstetrics. Friesland was bound in the South by the province Groningen, belonging to the Federal Republic, where his name was already well known. A t the age of 53, he decided to follow an academic study and he went to the University o f Groningen. W i t h o u t a classical
education he passed the necessary examinations succesfully. Finally he became a qualified " D o c t o r M e d i c i n á é " w i t h the rights to practice also i n the Federal Re public. I n spite of his success at Groningen University, where his degree was signed w i t h the remark "dignissimus", he had later again some problems w i t h his medical qualification: he was examined n o t i n the customary Latin but i n his mother language. He served the Labadist's colony for twenty years i n Friesland; his wife died, his children were married and getting older. He longed to the times o f his youth; the Hague and Voorburg. He left the sect of Labadie and he decided moving to the Hague. His settlement i n the Hague was branded w i t h many difficulties. His name was very well known an the jealous "Collegium Medicorum Hagae Batavorum", a mighty medical association tried to prevent him from starting his medical practice. The only reason was: "he had no classical education, he did not master the Latin language, he passed his exams in another Provence". But Hendrik van Deventer w o n finally the case w i t h the medical association o f the Hague and after a few years became a respectable doctor i n obstetrics. He was at the age of 73 still practicing and w r i t i n g i n his diary: "on the 9th febr. 1724 on a very cold day I delivered a baby who was lying in a transverse position; it was a very tiering day for m e . . . " . He died in the same year and he was buried i n the reformed church at Voorburg as a world-wide famous doctor, where he started his career at the same place years ago as a young silversmith.
HIS M E R I T S AS A N O B S T E T R I C I A N Introducing his new concepts i n obstetrics, Hendrik van Deventer was already familiar w i t h the contemporary famous obstetrical works. He had such large experi ence that he d i d not accept all the theories and ways of practicing o f obstetrics. He de cided to write a book entitled "The A r t of Midwifery Improved", particularly to teach the midwives as well as doctors engaged in obstetrics. In the preface he writes, first he was looking and seeking for his own faults, reading the textbooks of Mauriceau and Portal. Later on he was getting the evidence that his theory and handling was the right one and not the established conception. Chapter for chapter he wrote his book based o n his own experience as well as using the knowledge o f obstetrics o f his time. I n his opening chapter he defined the qualifications required to make a woman fit to practice midwifery. H e exluded all malformed, diseased and obese women. He was also a good teacher. I n one of his last chapter he pointed special notes as questions to be answered by the midwife to test whether she had understood the basic principles o f obstetrics. One of his first statement was: look firstly to the bony pelvis; t h i n k secondly: w i l l this relatively narrow birth canal be able to allow the baby's head through?Even today these are statements o f great value. Here we would like to point out some of his most important discoveries and state ments : / . He was the first to make a study of the bony pelvis and he d i d the concept o f the pelvic inlet as a rigid achieve credence. H e described the importance first o f the bony pelvis not only with inlet contraction ("pelvis plana Deventeri") and pelvis w i t h
general contraction, but he made the first study o f its deformities. The importance of the bony pelvis as factor in a delayed and difficult labor was almost universally neglected, so much so that when he focused his attention in this direction, he did almost apologetically. I n the older text books we could find only a description, called: "The head which is not engaged because of the obliquely lying womb." Thus before his time was the importance of the bony b i r t h canal not yet known. Even he did his discovery w i t h hesitance. 2. His teaching methods and theories were not accepted without criticism. 3. He stressed first the difference between the normal and abnormal (pathological) deliveries. 4. He considered first the possibility o f brain injury to the newborn, noted elongatic o f the fetal head i n cases of general contracted pelvis. 5. He was aware o f the importance o f the axis of the birth canal and described it accurately. 6. A n important finding was the recognizing of the importance between the birth canal and the fetus (today called "discrepancy"). 7. Paying 30 pages for the vaginal examination, he drew the attention to dilatation of the cervix and the position of the head or recognizing another part o f the fetus in the inlet of the pelvis. 8. I n contrast to Mauriceau's w o r k (Fig. 2.), he illustrated all his drawings: the fetus in the womb and its position to the bony pelvis (Fig. 3-4). 9. W i t h Mauriceau he was a supporter o f version-extraction, but he was the first who clearly explained which hand has to be used at the operation. 10. He mentioned first the dangerous significance o f the prolapsed cord and he was already familiar w i t h the today called "Trendelenburg's" position. I have only mentioned few important new obstetrical concepts of the famous D u t c h obsterician. We have also discussed his errors in his w o r k . First, he described the bony birth canal and the importance of the head that has passed through and stressed the engagement of the baby's head in the bony inlet. A narrow inlet hinders the passage of the head, so the womb w i l l take an oblique position. That was what he actually said. On the other hand he mentioned the "obliquely lying w o m b " as a different pathological case, where the missing engagement of the head was thought to the "oblique lying cervix" turning the head i n a wrong position, out o f the axis o f the birth canal. He has just borrowed the conception of his contemporary collègues as a case of obstruction of the labor progress. W h y did he finally miss the clue o f his genious originally made statement ? W h y could not he realize that these two pathological conditions were the same? I t is to us an unexplained fact how it could it have happened that this very experienced obstetrician, clearly explained all the important basic o f obstetrical principles, writing about the "obliquely lying w o m b " and yet making a mistake. He was so near to the truth as accepted today. Fasbender (1964) writes a very appropriate remark on the w o r k and life o f van Deventer: "Bei keiner anderen hervorragenden Persönlichkeit in der Geschichte der Geburtshülfe, dürften Licht und Schatten, so unvereinbar nebeneinander hervortreten wie bei Hendrik van Deventer". There are few theories o f his "misser". As an excuse we could perhaps use one o f the wise words o f Virchow: "Historische Gerechtigkeit besteht darin, das man jede Arbeit im Lichte ihrer Zeit betrachtet".
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Hendrik van Deventer was a well experienced, skilled practicing obstetrician without university education, missing some basic theoretical qualities thinking logically to come to a convincing revolutionary conclusion. He had not the insight to be linked up the practical experience and the science. A n other explanation could be also plausible. I n his time there was only one solution to perform the difficult deliveries where the passage through the birth canal was not possible: a version combined with extraction i f the circumstances for this handling still were present; i n neglected cases or i n other pathological conditions there was no other choice than the mutilating operations with the dead of the newborn and some times damaging the mother, too. The Chamberlain's family had not yet revealed the secret of the forceps delivery. Van Deventer and his famous contemporaries were against to perform a caesarian operation for their time comprehensible reasons. I n spite of the errors of his work, mainly due to the time in which he lived, all things considered, he is still regarded as the most famous obstetrician o f his time and the co-founder o f modern obstetrics. "Manet post funera verum" was not only his motto, but his spiritual inspiration doing his work and to follow his vocation : " I waste away but truth shall overcome".
APPENDIX The following books were written by h i m , and his textbook of obsterics was trans lated i n German, French, English and in Latin version. 1696: Dageraet der Vroet-Vrouwen, has only 56 pages. I t was his first w o r k ; there exist only one copy at Leiden in the "Bibliotheek der Rijksuniversiteit" 1701 : "Manuele Operatien I " , ("Nieuw L i g t " ) The First Edition in D u t c h 1701 : "Novum L u m e n " , The First Edition in Latin 1704: "Hebammen-Licht", The First German Edition 1716: " A r t of Midwifery improv'd" (Novum Lumen), The first English translation 1719: "Nader Vertoog", The First D u t c h Edition 1724: "Novum L u m e n " (Nader Vertoog), The First L a t i n Edition "Hebammen-Licht, Anderer T h e i l " (Novum L u m e n I I ) , The first German Edition "New Improvements" (Novum Lumen I I ) , The First English Edition 1733 : "Observations I " (Novum Lumen), The First French Edition "Observations I I " (Novum Lumen I I ) , The First French Edition 1734: "Nieuw L i g t " en "Nader Vertoog", The Second D u t c h Edition w i t h his two works together "Observations I et I I " , The Second French Edition with his two works together For exact details see: Lammers, Edit. 1946, Assen, The Netherlands 1765: After his death, the 4th edition was translated i n Dutch with commets o f D'Ablaincourt, the French accoucheur and other persons 1790: De laatste Nederlandse uitgave van het "Nieuw L i g t " en "Nader betoog", uitgave and (The last D u t c h Edition o f the "Novum L u m e n I and I I " ) , this was a re production of the original edition of 1765.
REFERENCES Fasbender, H.: Geschichte der Geburtshilfe. Edit. Olms, 1964. Hendrik van Deventer: „Nieuw Ligt" en „Nader Vertoog", 1734, 2nd Edition Hendrik van Deventer: „Nieuw Ligt" en „Nader Vertoog", 1746, 3d Edition Hendrik van Deventer: „Nieuw Ligt" en „Nader Vertoog", 1765,4th Edition Lindeboom, G. A.: De Geschiedenis van de Medische Wetenschap in Nederland, 1972. Lammers, A. J. M.: Hendrik van Deventer, Leven en Werken, 1946. Cianfari Th.: A Short History of Obstetrics and Gynecology. Springfield, 111., 1960.
Összefoglalás A dolgozat Hendrik van Deventer (1651—1724), az első jelentős hollandiai szülész munkás ságát ismerteti. Előbb ötvösséget tanult, céhtag volt, majd 1672-ben, tehát 21 éves korában hallunk róla: Németországban, Altona városában az ún. „labadista" protestáns szekta tagja lett. A szekta tagjai szigorú kálvinista vallásos közösségben éltek. Minden tulajdonukat és jövedelmüket a szektának adták le. Az idealista szellemi világeszme földi kicsapongásokhoz vezetett, és a német lutheránus egyház a szekta tagjait zavart okozó életmódjuk miatt végülis Német országból kiűzte. Még a németországi tartózkodásuk alatt, szükségük volt saját orvosra. Hendrik van Deven ter, aki ebben a zavart szellemi világban is a szekta tagja maradt, egyszerre hivatást érzett, hogy betegeken segíthessen. Nem végzett egyetemet, hanem egy neves gyakorló orvos mellett, mint intelligens és ügyes kezű tanítvány, az akkori orvosi szakmában sok tapasztalatot szer zett. Nemcsak a testi ápolásban volt jártas, hanem a gyógyításban, a műtéti kezelésben is otthonos volt, sőt a gyógyszerészeinek is nagy ismerője lett. A később, Groningenben meg szerzett orvosi diplomájában szerepel: „in sua juventute, in arte Therapeutica, sub auspiciis D. Walteri, Medicináé Doctor et Chymiae cultoris apud Hamburgum acerrimi, scrutanda operám strenuam collocavit..." Amikor a labadista szektát Németországból kiűzték, új helyet találtak a szomszédos Frieslandban, ahol Wieuwardben telepedtek le. Friesland nem tartozott akkor még a Németalföldi Köztársasághoz. Az orvosi gyakorlat, képzés és az ehhez kötött tanulmányok még nem voltak törvényileg rendezve. így Hendrik van Deventer minden akadály nélkül praktizálhatott. Orvosi tudásának a híre hamarosan Frieslandon kívül is ismert lett. Többször volt a dániai ki rályi családnak tanácsadója. Jó megfigyelőképessége mellett ügyes keze is volt, több orvosi műszert saját maga készített. Miután az áttanulmányozott szülészeti könyvek nem elégítették ki, szisztematikusan fel jegyezte tapasztalatait és végül 1701-ben kiadta az első tankönyvét, amit röviden „Nieuw Ligt"-nek, lefordítva talán nem „új fénynek", hanem „új nézetnek" lehetne nevezni, termé szetesen a szülészetre vonatkoztatva. Miután megszerezte a németalföldi törvényes orvosi diplomát (1694) és húsz éven keresztül Frieslandban a Iabadisták körében munkálkodott, elhatározta, hogy Hágában fog tovább praktizálni. Minden vágya az volt, hogy a már hírneves szülészeti tankönyvét latin nyelven ad hassa ki. Hiszen már németül, franciául, angolul is megjelent. 1724-ben, 73 éves korában ad ta k i a „Nóvum Lumen"-t, amikor még egy szülési jelentésben írta, hogy „1724. február 9-én, kemény téli időben fáradtságom ellenére is Rotterdamban még egy harántfekvést jó ered ménnyelfejeztem be... " Hendrik van Deventer 1724. december 12-én halt meg 73 éves korában, kedvenc lakásában „Sionlust"-ben, Voorburgben és ugyanott temették el a református templomban a kórus alatt vett családi sírboltban. Naegele, von Siebold, Fasbender szerint Deventer tankönyve „Het Nieuw Ligt voor Vroed. meesters en Vroed-vrouwen" az első tudományos és szisztematikus szülészeti szakkönyv.
Önálló szerkesztés, egyszerű és világos stílus, pontos leírás és ábrázolás jellemzi a könyvet. 1. Tantételeit nem vette minden kritika nélkül át az előző irodalomból. 2. Először hangsúlyozta, hogy van természetes és természetellenes szülés, amit időben kell felismerni. 3. Nagy érdeme, hogy a szülészetben először írt a normális és a pathologiás medencéről. A „pelvis plana" az ő nevét viseli. Először van szó a medence bemenetről és a kimenetről. 4. Anélkül, hogy a medence tengelyét említené, leírja a szülés mechanizmusát. 5. Felismerte a medence és a magzat közötti összefüggést. Mauriceau könyvében csak a magzatot látjuk, van Deventer ábráin a magzat fekvése és a medence látható. 6. A vaginalis vizsgálattal harminc oldalon keresztül foglalkozik. 7. Mauriceau-val együtt nagy híve a versio-extractiónak, de ő volt az első, aki azt ajánlotta, hogy először meg kell győződni a far és a lábak helyéről, és ettől függően vagy a jobb, vagy a bal kézzel kell végezni a műtétet. 8. Leírja, hogyan kell a méhlepényt eltávolítani anélkül, hogy az asszonynak sok fájdalmat okozzon. 9. Az elölfekvő vagy kiesett köldökzsinór kezelési módjáról ír, ismeri a Trendelenburg pozíciót, vagy különleges esetekben a könyök-térd fekvést ajánlja. 10. Először említi a szülészetben az újszülött asphyxiáját és a kezelés módját. L . J. BENEDEK - JASZMANN Dr. Med. Head. Dept. Obst, et Gynaec. Regional Protestant Hospital 6720 GA Bennekom The Netherlands
