Madame du Coudray

by Allyn Bures (Vanderbilt University)

Angelique Marguerite Le Boursier du Coudray, midwife to the nation of France, holds a substantial position in the history of early modern medicine. Mme du Coudray is most famous for her revolutionary midwifery teaching techniques, including an incredibly detailed textbook and lifelike machines utilized to simulate childbirth (1).

As a practicing midwife in 18th century Paris, Mme du Coudray violated the majority of standards demanded of midwives; she had no children of her own, was not married (though possibly widowed), and believed in the organization of midwives (2).

In 1751, Mme du Coudray traveled to Auvergne, where birth survival rates were incredibly low, and was exposed to the horrors of untrained peasant midwifery. She dedicated herself to improving midwifery practices in rural France, designing child-bearing machines constructed from leather, dyed fabric, padding, and real pelvic bones, wicker, or wood to replicate deliveries (3, 4). Later models included sponges that released dyed liquids representing blood and amniotic fluid at proper moments (3).

In 1759, the same year that Mme du Coudray released the first edition of her midwifery manual Abrege de L'art des Accouchements, King Louis XV appointed her to spearhead a nationwide public health campaign educating female students and male surgeons in rural provinces (5). This campaign, the first of its kind, would counteract the low birth survival rates throughout the country and rebuild the soldier population that had been depleted in the Seven Years' War.

Mme du Coudray's teaching initiative was a huge success, lasting 30 years and educating an approximated 400,000 peasant women; in addition, a number of male surgeons taught her technique to later students. By the end of her career in the 1780s, approximately 2/3 of practicing French midwives used her techniques; success rates were reflected in the increased numbers of successful births that appeared in the 1780 and 1790 censuses (5, 6). Before her 1794 death, she ensured that her legacy was lasting by providing for her "niece" Marguerite Guillaumanche and her surgeon husband Coutanceau to continue teaching the du Coudray technique at France's first maternity hospital (5).

Image: "The Machine." Madame du Coudray's Machines. Musees en Haute Normandie.

Sources:

(1) Gelbart, Nina. "The Monarchy's Midwife who Left No Memoirs." French Historical Studies (19) 1996: 997-1023.

(2) Cody, Lisa. "Sex, Civility, and the Self: du Coudray, d'Eon, and Eighteenth Century Conceptions of Gendered, National, and Psychological Identity." French Historical Studies (24) 2001: 379-407.

(3) Riskin, Jessica. "Eighteenth Century Wetware." Representations (83) 2003: 97-125.

(4) Stanley, Autumn. Mother and Daughters of Invention. New Jersey: Rutgers UP, 1995.

(5) Marland, Hilary, ed. The Art of Midwifery: Early Modern Midwives on Europe. London: Routledge, 1993.

(6) Gelbart, Nina. The King's Midwife: A History and Mystery of Madame du Coudray. Berkeley: University of California Press, 1998.

Women's Medical Secrets

by Renee Hanemann (Vanderbilt University)

Queen Elizabeth I, the queen of England and Ireland in the late 16th century, was a public participant in what was usually considered women's secret, private household medical practice. She helped to create broader public recognition of women's medical knowledge with the publication of "Closset of Secrets." The "secrets" contained in the text were extensive, covering numerous aspects of women's health and beauty. In a segment entitled "The Child Bearer's Cabinet," the text exposed monthly medical instructions for pregnant women, including nutritional information and advice for avoiding imaginary and psychological traumas which might affect the fetus. Additionally, the segment contained post-birth medical instructions, both for the newborn child and the new mother. The main purpose of this selection was to ensure that women of the royal court (among other readers) would make no mistakes in childbearing due to their own ignorance. Thus the queen used her position as queen to educate other women.

Another segment of Elizabeth's "Closset" concerned the Black Plague and Smallpox. Epidemics in London created widespread fear and panic, calling for new medical knowledge. The selection "Treatise Concerning the Plague and the Pox" focused on presenting cures for both illnesses through the use of home remedies and recipes that could ward off contagions and keep the population healthy. In this way, Elizabeth I used her public position to draw connections between the queen's duty to share knowledge and protect her people, and the housewife's duty to use household wisdom to cure her family.

Arnold, Ken. Cabinets for the Curious: Looking Back at Early English Museums. Aldershot: Ashgate, 2006.

Evans, Robert John Weston. Curiosity and Wonder from the Renaissance to the Enlightenment. Aldershot: Ashgate, 2006.

Of Art and Anatomy

by Samantha Breakstone (Vanderbilt University)

Leonardo da Vinci wrote, "I counsel you not to cumber yourself with words unless you are speaking to the blind...how in words can you describe this heart without filling a whole book? Yet the more detail you write concerning it, the more you will confuse the mind of the hearer" (Richter). Understanding that many of the earliest writings on human anatomy did not include illustrations, da Vinci brought potent insight into the value of medical illustration. Da Vinci accurately identifies that visual material has the power to both transcend technical terminology and provoke interest that dry textual accounts cannot. Never wavering in its importance, medical illustration has undergone various evolutions throughout its history. However, the two most important influences on this evolution have been the gradual acceptance of human dissection and the advent of the printing press in the 15th century (Tsafrir).

Aristotle of Stagira (384-322 B.C.E.) is recognized by historians as the first to illustrate human anatomy based on legitimate scientific study (Singer). However, Aristotle's illustrations were inferences on human anatomy based upon the dissection of animals (Tsafrir). Since Greek religion problaimed that the corpse was a sacred entity related to the soul, human dissection was prohibited; as a result, Aristotle's theories on human anatomy were fatally flawed (Matuk). This is evidence of the crucial role that human dissection plays in the history of medical illustration.

When Alexander the Great finally sanctioned human dissection in Hellenic Alexandria, Hippocrates's theories of humors drove medicine and were believe to have a more holistic scope that didn't necessitate physical proof (Calkins). Dissection was therefore driven by spiritual and aesthetic motivations rather than scientific, as the Greeks saw the body as nature's masterpiece, each part held to define perfection in form and purpose (Matuk).

This treatment of the human body as an objective form of interest was reawakened by the same humanistic ideas that gave birth to the Renaissance (Roberts). Artists of the 15th century became increasingly interested in the human form for artistic purposes; meanwhile, the emerging spirit of critical inquiry also inspired scientific revolution in the field of human anatomy as anatomists hungered to dissect cadavers in order to investigate the structures of the human body (Sappol). Both art and science held claims on the human form, and neither could completely understand it without assistance from the other. Leonardo da Vinci (1452-1519) was the first artist to consider anatomy for reasons beyond its artistic applications (Tsafrir). He studied structure and function in depth through observation and careful dissection--completing approximately 30 within his lifetime (Smith). Da Vinci was unique in that he could dissect and illustrate from his own observations. Human dissections in the name of art were more respected in the public than those in the name of science; thus, most anatomists after da Vinci looked to accomplished artists to illustrate their dissections (Roberts). As a result, the boundary between art and science during the early modern era was permeable; medical illustrations emerged as a unique balance of accuracy, beauty, and entertainment such as those in Vesailius's De Humani Corporis Fabrica (1543) (Sappol).

Matuk, Camillia. "Seeing the Body: The Divergence of Ancient Chinese and Western Medical Illustration." Journal of Biomedical Communications (32:1) 2006.

Richter, Ian. The Notebooks of Leonardo da Vinci. Oxford: OUP, 1952.

Roberts, K. B., and J. D. W. Tomlinson. The Fabric of the Body: European Medical Traditions of Anatomical Illustration. Oxford: Clarendon, 1992.

Sappol, Michael. Dream Anatomy. NIH publication.

Smith, Sean. "From Ars to Scientia: The Revolution of Anatomical Illustration." Clinical Anatomy (19) 2006.

Tsafrir, Jenni, and Avi Ohry. "Medical Illustrations: From Caves to Cyberspace." Health and Information Libraries Journal (18:2) 2001.

The Trial of Jacqueline Felicie: A Female Physician

by Jade Morales (Vanderbilt University)

The trial of Jacqueline Felicie, though not considered a monument in the history of medicine, is historically significant enough that many textbooks include an in-depth analysis of her 1322 Parisian trial. Jacqueline Felicie, referred to as Jacoba Felicie in the Charlutarium Universitarias Parisiensis, was accused by the Medical Faculty of Paris of practicing as a physician without a license. Felicie's trial is intriguing because it provides an insider view into the Parisian medical marketplace, into how women's roles were perceived within that marketplace, and into the university's power to effect medical culture (Barrett 10).

The trial itself was documented in the Charter of the University of Paris, and it includes arguments for and against Felicie. Felicie's accusers claim that she visited several patients, examined them, and claimed to cure them, despite being warned against practicing without a license. Along with the Medical Faculty, the Archbishop also expressed concerns that practicing without a license could result in the mortal sin of murder, which was punishable by excommunication. For this reason, her accusers claimed that preventing her from practicing was in the interest of her soul. Felicie's defense brought forth 6 witnesses that all attested to her experience and skill in curing them, even after many received unsuccessful treatment from well-known licensed physicians. So the natural question is: what were the motivations of the Medical Faculty of the University of Paris? Was the health of Parisians their main concern, or was this trail an attempt to slowly reduce the competition to university-trained physicians? (Green 15).

Non-university trained traditional healers, like Felicie, were the predominant practitioners of early 14th century Paris. Many women who were skilled through apprenticeship or practice acted as healers for lay people. Because women weren't admitted to the University, they were unable to obtain the licenses that the Medical Faculty mandated. Thus, academically trained physicians were all male, and women were at a disadvantage when the university began to regulate medical practice. Parisian medicine requiring university-training and licenses occurred at the expense of female traditional healers (Minkowski 4-5).

Felicie, though considered very wise and skilled by her patients, was found guilty. Her sentencing included excommunication and a fine of 60 Parisian pounds. It is not known with certainty whether Felicie continued to practice in secret or whether she moved away. What historians do know is that traditional healers continued to cure when academically-trained physicians could not. The population of Paris was bigger than the licensed physicians could accommodate, so the likelihood of Felicie staying in business was high. Her trial is not only an example of the attempt to regulate the Parisian medical marketplace; it also allows us to question the motivations of academic institutions.

Image: "Medicin examinant les dents d'un patient." Manuscrits occidentaux (1350). (Bibliotheque Paris)

Sources:

Barrett-Graves, Debra, Jo E. Carney, and Gwynne Kennedy. Extraordinary Women of the Medieval and Renaissance World. Greenwood Press, 2000.

Green, Monica H. "Women's Medical Practice and Health Care in Medieval Europe." Journal of Women in Culture and Society (14) 1988-89.

Minkowski, William. "Physicians' Motives in Banning Medieval Traditional Healers." Journal of Women and Health (1:2) April 1994.

Gerard van Swieten

by Julie Ann Fenstermaker (Vanderbilt University)

In 1740, when Maria Theresa inherited the Habsburg Empire, Austria was about 200 years behind its European neighbors in the medical realm. Maria Theresa acted fast and recruited knowledgeable people to her court. Gerard van Swieten was one of the most important people she brought to Vienna, Austria.

Van Swieten was educated at the Leiden University; he studied under Herman Boerhaave and became a well-respected physician. He actually compiled his notes from Boerhaave's lectures into a 15 volume set. In Austria, van Swieten was appointed as the Chief Physician, which meant he not only cared for the royal family, but he also managed the entire medical staff as well. He was also named the Director of the Imperial Library. As President of the Censorship Committee, van Swieten had access to all the new books being published. He documented the list of books that the committee read in Supplementum Librorum Prohibitorum. This record of 3,120 works, 595 of which were banned, provides insight to historians on the social and political sentiments of the time.

Van Swieten's legacy is in his reform movement. In 1749, he proposed a plan to completely reorganize the faculty of medicine. Maria Theresa agreed to this plan and provided funding to establish the Vienna School of Medicine. Van Swieten added professorships of botany, chemistry, and surgery to the university and personally taught a two year lecture series on the functioning of the human body and the pathology of diseases. He also reformed pharmacy inspections to make the apothecaries more accountable.

In his book Diseases Incident to Armies, van Swieten describes a cure for syphilis. The concoction of mercury sublimate was called Liquor Swietenii. It was not invented by van Swieten, but he was the one who administered it on a large scale; therefore it was credited to him for over 100 years.

Van Swieten's efforts of reform made a powerful impact in Austria. The Vienna School of Medicine became a highly respected institution of learning, and he was able to recruit impressive physicians and scientists to Vienna. Van Swieten was commemorated on the Euro in 2007 and can also be found on the Maria Theresa statue near the Hofburg in Vienna.

Image: Gerard van Swieten

Sources:

Brechka, Frank T. Gerard van Swieten and his World, 1700-1772. The Hague: M. Nijhoff, 1970.

Kidd, Mark, and Irvin M. Modlin. "Van Swieten and the Renaissance of the Vienna Medical School." World Journal of Surgery (25:4) 2001: 444-50.

Men and Women in Midwifery

by Allison Nelson (Vanderbilt University)

In the early modern period, midwifery began to change from a female art into a male occupation. The shift was not a smooth one. Indeed, it began in 1522, when Dr. Wertt of Hamburg dressed up as a woman in order to observe midwives and learn about childbirth. When he was discovered as a man, Wertt was burned alive. Later in the mid-sixteenth century, however, the renowned surgeon Pare laid a more solid foundation for men's work in the birthing room; he did this by aiding in delivery by pulling babies out of the womb by their feet during difficult births.

A contributing factor in this shift of gender roles was Louis XIV's use of male midwives to deliver his illegitimate children. As men delivered his mistresses babies, male midwives gained popularity. A rapid population boom in Europe further encouraged these social changes; as the population grew and universities increased their study of reproduction and anatomy, childbirth became a medicalized and, thus, masculinized domain. Case studies, rather than oral tradition, became the preferred method for educating individuals about childbirth (1).

There existed three recognized distinctions between male and female midwives. First, the men held a monopoly over medical tools, which women were disallowed from owning. Second, the male midwives were more formally educated in universities; there they dissected bodies, read case-studies, and learned about classical theories. Women, on the other hand, were taught through experience; they apprenticed and learned through women's household manuals. Third, male and female midwives viewed patients differently. While women's manuals emphasize individual relationships and take a maternal tone, men's manuals stressed quantitative practices and medical causality (2).

Even as male midwives gained popularity, their acceptance was not unanimous. Some people believed that men did not belong in the birthing room; since men could never experience childbirth, some believed it was beyond the realm of male expertise. Such critics often cited the Bible, claiming the absence of men at recorded births. Other critics viewed male midwives as interlopers into other men's domestic territory. In a space where the husband or father was absent, the male midwife's presence stood out as inappropriate; it raised questions about the male midwives' potentially inappropriate behavior toward vulnerable female bodies. Thus issues of female modesty and male property emerged, and opponents called upon husbands to bar male midwives from their homes (3).

While gender issues caused debate, so too did suspicion about scientific instruments and their over-use in the birthing room. Frequently, male midwives used tools even in "normal" births that might not necessitate them -- and the tools posed additional risks. Not only did the tools threaten additional infections, but their misuse could harm the baby or its mother. Renowned female midwife Sarah Stone, for example, claimed that in her career she had only seen four cases that could have been safer through the use of tools (4).

Image: Fores, Samuel William. "A Man-Mid-Wife." From Man-Midwifery Dissected. London, 1793. (Wellcome Library, London)

(1) Schnorrenberg. "Is Childbirth Any Place for a Woman? The Decline of Midwifery in Eighteenth-Century England." Studies in Eighteenth Century Culture (10) 1981: 393.

(2)Fife, Ernelle. "Gender and Professionalism in Eighteenth-Century Culture." Women's Writing (11:2) 2004: 185-200.

(3)Blunt, John. "Man-Midwifery Dissected: or, The Obstetric Family Instructor." 1793.

(4) Stone, Sarah. "A Complete Practice of Midwifery." 1737.

Syphilis in Early Modern Europe

by Jamie Whittenberg (Vanderbilt University)

Syphilis, a highly infectious sexually transmitted disease, sparked fear among the early Europeans. And for good reason.

Syphilis has three stages, the last being deadly and untreatable if advanced enough. First recognized as an outbreak in 1494 in Naples among the French mercenary troops, it quickly spread to all parts of Europe. Faced with such a contagious and disfiguring disease, the early Europeans quickly blamed one another or attributed it to external forces such as interspecies sex, the planets, or witchcraft (1).

Often, the men were most often depicted as victims of syphilis. The course of the disease: a woman, the carrier of death. The case of Bellina Loredana exemplifies this attitude. She was accused of inflicting the disease on a prostitute through witchcraft, until she was (partly) exonerated due to the prostitute's obviously promiscuous behavior. Still, the idea that women spread the disease by seducing men was prevalent (2).

As the disease spread, early modern Europeans began to turn to more naturalistic causes for syphilis. This evolved into two theories: Pre-Columbian and Post-Columbian. The former operated on the belief that syphilis was always present in Europe, possibly misdiagnosed as leprosy. Although the surge may have been noticed after contact with the New World, this theory states that it is just a coincidence. The Post-Columbian theory suggests that syphilis was a disease brought over from the Indians and that no European country was to blame, no matter how much they bickered among each other (1).

No consensus was reached on who was correct in this matter. Many seemed to offer contradictory views on the subject, such as John Smith. He at once called syphilis the "French pockes" as well as the "Indian disease" within one sentence. Both theories are present in his statement. Even looking retrospectively, bio-archaeologists have found it impossible to determine which theory is correct. They studied for syphilitic lesions on the bones in pre-contact Europe and America (1). Although they did find evidence of syphilis in early America, it does not have the characteristic dental pathology that is typical with syphilis. Therefore, it is still undetermined to this day whether syphilis came over from the New World, or if syphilis exploded into a potent form during the siege in Naples in 1494 (1).

Image: Gilman, Sander L. "AIDS and Syphilis: The Iconography of Disease." October (1987): (43) 87-107.

(1) Qualitiere, Louis F. & William Slights. "Contagion and Blame in Early Modern England: The Case of the French Pox." Literature and Medicine (2003): (22) 1, 1-24.

(2) McGough, Laura J. "Demons, Nature, or God? Witchcraft Accusations and the French Disease in Early Modern Venice." Bulletin of the History of Medicine (2006): (80) 2, 219-246.

The Chamberlen Family Secret

by Lani Goodman (Vanderbilt University)

In the 17th century, forceps were a new tool in obstetrics that were, interestingly enough, kept a secret for over 100 years by the Chamberlens, who invented them.

There were eight Chamberlen men, divided into five generations. Some speculate that William Chamberlen (first generation) was the family member to first develop the forceps during his stay in Amsterdam, while others consider his son, Peter Chamberlen II, to be the inventor. In either case, all following members of the Chamberlen family practiced obstetrics, attended to the Royal Family of England, and used their secret instruments in cases of difficult deliveries.

The forceps were revolutionary instruments in that they significantly reduced the mortality rate for women and their fetuses in difficult deliveries by changing the position of the fetus in the uterus, making the delivery safer and easier. Before the invention of forceps, difficult deliveries generally ended with an abortion of the baby, or the death of both mother and fetus. In very rare cases, Caesarian-sections were performed, which typically meant death for the mother.

In order to preserve their secret, the Chamberlens adopted a very particular method of delivering babies. They would arrive with a beautifully carved, extremely heavy wooden box that encased the secret instruments. Once entering the patient’s room, the Chamberlen would ask that everyone leave, so that only he and the pregnant mother were left. He then blindfolded her, and she would remain blindfolded throughout the delivery to guarantee she would never see the forceps. After delivering the baby, he would clean the instruments, replace them in the box, and only then could family and friends enter the room to see the baby.

It is unknown exactly which of the Chamberlens was the first to leak the family secret, but it is generally thought to be a member of either the fourth or fifth generation. Another theory is that one of the craftsmen who constructed the forceps for the family was the person to let the secret out.

Prioleau, William H. "The Chamberlen Family and the Introduction of Obstetrical Instruments." Proceedings of the Huguenot Society of Great Britain & Ireland 27.5 (2002): 705-714.

Rushen, Joyce. "The Secret 'Iron Tongs' of Midwifery." Historian (1991): 12-14.

Dunn, P. M. "The Chamberlen Family (1560-1728) and Obstetric Forceps." Archives of Disease in Childhood : the Journal of the British Paediatric Association : Fetal and Neonatal Edition. 81.3 (1999): F232-F234.

Richardson, Ruth. "Chamberlen's Forceps." From the medical museum. Lancet 358.9289 (2001): 1279.

Colonial Midwifery

by Heather Whaley (Vanderbilt University)

Colonial Midwifery began with the Mayflower's journey in 1620. Bridget Lee Fuller delivered three babies during the two months long voyage and continued practice as a midwife in Plymouth for 44 years until her death in 1664. In addition, it is documented that one birth took place aboard the Arabella by a midwife that was brought on board from the Jewel. (1)

Among the many women pioneers in Colonial Midwifery a handful stand out. Anne Hutchinson was both a pioneer in civil liberty and religious toleration and a well respected midwife. One of her students, Jane Hawkins, delivered a "monster" baby and was suspected to worship the devil and practice witchcraft. Jane was later exiled along with Anne who was ultimately massacred by Native Americans. (2)

Many less known midwives were highly respected by their communities and their services were greatly appreciated. Ann Eliot was not known for anything new or controversial; however, she birthed over 3,000 children and garnered the respect of her community resulting in eight families making her the executor to their estates as they felt so indebted to her. Her epitaph reads "be ye blessing of God,…brought into this world above three thousand children." (3)

The first to employ a town midwife was New Amsterdam in 1660. The midwife was paid 100 guilders per year for attending the poor. In the south, plantations usually had a slave that acted as a midwife to both black and white mothers. As time went on, in the south, the majority of midwives were black. The further north, the more white midwives there were serving both the upper and lower classes. If she was a paid community employee she was given a house but could not refuse to help anyone who called upon her. (1)

Many of the midwives in early America acted under the supervision of Protestant bishops. This was considered important with the high infant mortality rate of over 50% in order to baptize the infant before its passing. Complications with childbirth were quite common and survival with some was rare. Puerperal fever was the most common, and became increasingly common as men entered into Obstetrics. This was because men employed more interventions and vaginal exams. In a time before the germ theory this was the cause of great infection. In the 18^th century the only relationship that was made was that hemorrhage led to the Childbed fever. This was in fact happening as materials that were not clean were used to stop the bleeding. Another common complication, "milk leg," was swelling in the leg of the mother that happened on the third of fourth day and was thought to be caused by "bad" milk coming in; as women were confined to bed for up to weeks after their birth they were actually developing clots in the legs that caused them to swell.

Going into the 19^th century, midwifery was dominated by men in America. In the late 18^th century William Shippen established the first lying-in hospital in America in Philadelphia. He also participated in the founding of the University of Pennsylvania School Of Medicine, becoming their first professor of anatomy, surgery and midwifery, quite a mix!

The beginning of formal instruction geared towards men led to the swift demise of women in midwifery and the dawning of a more scientific era in healthcare. (4)

Image: John Ashton, Chap-books of the Eighteenth Century (1882). Prints and Photographs Division, Library of Congress.

¹ Chaney, Judith A. "Birthing in Early America". Journal of Nurse-Midwifery March/April 1980: 25(2) p. 5-13.

² Litoff, Judy B. American Midwives. Westport: Greenwood Press, 1978

³ Packard, Francis. History of Medicine in the United States. New York: 1931.

⁴ Donegan, J. Women & Men Midwives. Westport: Greenwood Press, 1978.