The fetus has never been considered a separate patient but
rather an integral part of the pregnancy. It was thoroughly
protected from any diagnosis or manipulation; nothing could
be done to alter the course or condition of the fetus. It was a
passenger, not a patient.
If we can define a patient as someone about whom we can
make a diagnosis and treat so as to alter that individual’s
course, then the fetus became a patient in the period between
1500 and 1600. In 1500, Jacob Nufer, a swine gelder, performed
the first recorded successful Cesarean section on his
wife. Rousset published a book on Cesarean section in 1588,
and in the first Italian book on obstetrics, Mercurio advocated
Cesarean section for patients with contracted pelvises.1 Peter
the Elder of the Chamberlen family invented the obstetric
forceps.2 Both of these methods of delivering the fetus,
although developed primarily to assist the mother during a difficult
delivery, had the potential to alter the fetal environment
and thus could be said to treat the fetus, albeit indirectly. The
first attempts at fetal diagnosis can be attributed to Marsac,
who, in the seventeenth century, first heard the fetal heart beat.
In 1818, Mayor, a Swiss surgeon, reported the presence of fetal
heart tones; 3 years later, Kergaradec suggested auscultation
would be helpful in the diagnosis of twins and the fetal lie and
its position.3 In 1833, Kennedy4 suggested that the fetal heart
rate was indicative of fetal distress. Such distress, if diagnosed
late in pregnancy, could be treated using forceps for delivery;
however, it was not until relatively recent times that Cesarean
section was used to treat fetal distress during the first stage of
labor. Douglas and Stromme,1 in their 1957 text Operative
Obstetrics, state that “fetal distress was virtually nonexistent
as a cause for Cesarean section on our service [New York
Hospital] until 10 years ago.”