History of Medicine

FRANCE’S MIDWIFE EXTRAORDINAIRE

     Plague ravaged Europe for the last time in Marseilles in 1720, causing an outbreak that cost around 50-100,000 lives. Some commentators, Montesquieu among them, worried that the population of France was seriously declining. This became a national concern, especially during the Seven Years War (1754-63) when typhus exacted a heavy toll. But the Age of Enlightenment was underway, emphasizing rational and scientific approaches to social problems. So, in addition to encouraging more babies, attention focused on improvements in what would today be called public health. Inoculation against smallpox was promoted and better methods of handling epidemics were encouraged. (Ironically, historians later determined that the population actually grew during the century.)

      Another population-enhancer aimed at better survival at birth. Unlicensed midwives were targeted as part of the problem; they were labeled old, crude, superstitious, poorly trained, and a reason for the falling population. The first volume of the Encyclopédie (1751) carried an article disparaging midwives. A new cadre, properly trained, was needed. Male “accoucheurs” had already been sanctioned by Louis XIV, and some surgical professors taught and wrote about obstetrics but the numbers were limited. In 1730 a national system of examinations for midwives administered by surgeons was introduced, though many midwives still slipped through the net. 

     In 1740 a twenty-five year old unmarried woman, Angelique

Angelique Marguerite Le Boursier du Coudray
(from Wikipedia)

Marguerite Le Boursier du Coudray, was licensed in Paris after she had finished her three-year apprenticeship, passed the rigorous midwife examination, and supplied testimony on her good morals and Catholic faith. Virtually nothing is known of her earlier life. At first she practiced midwifery in Paris. After eleven years she took on her first apprentice, who paid 300 livres for a three-year course. She also made the acquaintance of Jean Basilhac, better known as Frère Côme, a monk-surgeon well known for new approaches to surgery for bladder stones, for cataract surgery, for connections with court surgeons, and for his great humanitarian activities. He admired and supported du Coudray throughout her career, and on his recommendation she was invited to teach midwifery in

Jean Basilac (Frère Côme)
(from BIU Santé)

Auvergne, instructing young women from poor families and few resources.   

     She was a successful teacher, but two more steps cemented her reputation. The first was the creation of a “machine”, a model of a female pelvis, complete with reproductive organs, used for teaching. Wood or real skeletal bones formed the pelvis, the rest was constructed out of leather, cloth, and other materials. Various birth maneuvers were  demonstrated using a flexible doll as the baby. Du Coudray took the machine to Paris where court surgeons, including André Levret, Royal Accoucheur and inventor of improved forceps, examined and praised it. She appears to be the first to use such a device, and so clear were her presentations that even surgeons took lessons from her. She could now teach entire classes instead of one-on-one apprentices.

     Her other step was to publish a short text, the Abrégé (synopsis, summary) de l’Art des Accouchements. It was concise but

Abrégé,  ?fourth edition (from Internet Archives)

complete, and well received. She states clearly that this is not a text on obstetrics but a manual for women of less education, that she is not a doctor, and that midwife services are primarily for situations where doctors are not available or affordable.  Later editions were illustrated and included details on duties beyond delivery, such as ethical behavior, care after birth, etc. Forceps came into vogue during the mid-century, though midwives were prohibited from using them. They depended on manual maneuvers. 

Illustration of normal birth in the Abrégé
 (from Internet Archives)

     A midwife, in fact, had multiple duties. She took the newborn to the church for baptism. She was consulted in legal cases such as paternity suits, whether a baby died before or after delivery, determination of virginity, suspected rape, etc. Often the midwife concealed unwed pregnant women in apartments until they gave birth, sparing them humility or abortion, and took the unwanted child for baptism and subsequent nursing in a foundling home. Discretion was important and valued.

     During prenatal care various ointments were applied to the breasts and abdomen, the mother was bled frequently (today she receives iron), and enemas or laxatives given to prevent hemorrhoids.

     Du Coudray’s success at teaching midwifery, along with her machine and book, induced Louis XV to issue a brevet in 1759 commissioning her to go “wherever she judges appropriate” in France to teach midwifery. This carte-blanche enabled her to travel widely through France, teaching her art to thousands. Soon her students were training others. Though she met resistance from some in the surgical community, overall her program was a major success. She trained over 5,000 midwives and near the end of the century her trainees comprised about two thirds of the country’s midwives.

     By the time of the French Revolution Le Boisier du Coudray was retired on a pension granted by the king, living in Bordeaux with her niece’s family. Her niece had taken over the teaching duties and written her own manual. Unfortunately in the chaos of the Revolution her pension went unpaid and she lived in terror of arrest because of her former royal connections. She died quietly, however, in 1794 at age 79. Her intelligence, long hours of work, court contacts, and persistence combined with tact were crucial elements of her brilliant career.

SOURCES:

Gelbart, Nina R. The King’s Midwife: A History and Mystery of 

   Madame du Coudray. U of Calif Press, 1998.

Brockliss, L, Jones, C. The Medical World of Early Modern  

   France. Oxford U Press, 1997.

Hibbard, Bryan M. The Obstetrician’s Armamentarium: Historical

    Obstetrical Instruments and their Inventors. Norman Pub, 2000.

Hickey, B B. “Jean Baseilhac (Frère Côme)”. Brit J Urology 1953. 

    v25(3): 252.