Obstetrics during the French Revolution: political and medical controversies around the new obstetrical surgery

ABSTRACT

During the French Revolution, obstetrics underwent substantial transformations in practice, teaching, and the physical spaces where it was conducted. The revolutionary authorities implemented reforms in French medical institutions that promoted an instrument-centred style and the dissemination of novel surgical techniques in obstetrics. The selection of professors for the obstetrics chair at the newly established École de santé and the appointment of chiefs for the new maternity ward in Paris favoured proponents of a mechanistic approach to labour assistance. This essay explores the theoretical principles and societal pressures that guided these transformative reforms and the remarkable changes they introduced in healthcare and in the practise of medicine and surgery. Furthermore, it examines the consolidation of new epistemological, ethical, and professional boundaries within the context of late eighteenth-century French obstetrics. A critical section of this study focuses on the debate ignited by the contemporaries who voiced concerns that the rise of surgical interventions on pregnant women's bodies might result in unwarranted violence, in a diminishing of midwives’ roles, and in a departure from the tradition of natural childbirth. These controversies among obstetricians highlight significant contradictions within the Revolutionary medical reforms.

KEYWORDS:

• History of obstetrics
• medical policies
• French Revolution
• obstetrical surgery
• Caesarean section
• women’s bodies

Acknowledgements

I wish to thank Prof. Marco Beretta and Dr. Nathalie Sage-Pranchère for their support in preparing and writing this study. I extend my gratitude to Prof. Mariacarla Gadebusch Bondio, Prof. Paolo Savoia and Dr. Francesca Antonelli for their generous advice and insight in improving this essay. I thank the anonymous referees for their most useful suggestions.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 The French expression art des accouchemens referred to the practice of assisting childbirth throughout the entirety of eighteenth century. Due to the absence of a direct English equivalent, I have opted for the phrase ‘art of deliveries’. I favour it to ‘midwifery’ as the latter carries gender-related connotations which sparked internal debates within the English childbirth professionals community as early as the late seventeenth century, as discussed by Schiebinger, see: Londa Schiebinger, The Mind Has No Sex? Women in the Origins of Modern Science (Cambridge, MA: Harvard University Press, 1996), pp. 106–08. I also prefer ‘art of deliveries’, or ‘art of childbirth’, rather than ‘obstetrics’, because during the historical period under examination the latter term was emerging but still remained relatively uncommon. Using ‘obstetrics’ in this context would be slightly anachronistic. Additionally, the term might evoke notions of medical and hospital care for contemporary readers, which may not align seamlessly with the specific case study presented in this essay. I do employ the term ‘obstetrics’ later in the article, and its usage will be substantiated in the course of the essay.

2 Classic studies of French clinic and Parisian hospitals include: Ackerknecht Erwin Heinz, Medicine at the Paris Hospital, 1794–1848 (Baltimore: Johns Hopkins Press, 1967). Michel Foucault, Naissance de la clinique (Paris: PUF, 2015). Dora B. Weiner, The Citizen-Patient in Revolutionary and Imperial Paris (Baltimore: Johns Hopkins University Press, 1993). Jean Bernard and others (eds.), L’acte de naissance de la médecine moderne : la création des Écoles de santé: Paris, 14 frimaire an III-4 décembre 1794 (Paris: Synthélabo, 1995). Caroline Hannaway (ed.), Constructing Paris Medicine, Clio Medica 50 (Amsterdam: Rodophi, 1999). These texts highlight fundamental aspects of the reforms of medicine during the Revolutionary period. However, central aspects considered in this article, such as the French statistical studies at the end of the eighteenth century and their influences on the medical and educational policies, critical consequences of the reforms for midwives, pregnant women, and the reorganization of hospital care for parturient women, are only confronted in passing.

3 Jean Imbert (ed.), Histoire des hôpitaux en France (Toulouse: Privat, 1982). Jean Imbert, Le droit hospitalier de la Révolution et de l’Empire (Paris: Sirey, 1954). Michel Foucault and others, Les machines à guérir (aux origines de l’hôpital moderne) (Paris: Institut de l’Environnement, 1976). Guenter B. Risse, Mending Bodies, Saving Souls: A History of Hospitals (New York: Oxford University Press, 1999). For a study on the medical functions (not only the charitable ones) of hospitals, and for an extensive bibliography that reconsiders the chronological coordinates of the presence of doctors in hospitals, see: Paolo Savoia, ‘The Book of the Sick of Santa Maria della Morte in Bologna and the Medical Organization of a Hospital in the Sixteenth-Century’, Nuncius, 31.1 (2016), 163–235.

4 Classics on midwifery and important historiography on obstetrics include: Jacques Gélis, L’arbre et le fruit: la naissance dans l’Occident moderne (XVIe-XIXe siècle) (Paris: Fayard, 1984). Jacques Gélis, La Sage-femme ou le médecin: une nouvelle conception de la vie (Paris: Fayard, 1988). Mireille Laget, Naissances: l’accouchement avant l’âge de la clinique (Paris: Ed. du Seuil, 1982). Jean Donnison, Midwives and Medical Men: A History of the Struggle for the Control of Childbirth (New Barnet: Historical Publications, 1993). Monica Helen Green, Making Women’s Medicine Masculine: The Rise of Male Authority in Pre-Modern Gynaecology (Oxford; New York: Oxford University Press, 2008). These books provide a rich picture of changes in obstetrical practices in the eighteenth century. Nonetheless, they do not provide a comprehensive discussion on the French debates within the midwifery community on the use of instruments and operations on pregnant women, nor do they consider the protagonists of the controversies on the concepts of natural or unnatural (contre nature or praeternatural) births, and the problems raised by the new medical and surgical gaze at the female pregnant body during the French Revolution.

5 Jacques Gélis, ‘La main et l’outil aux XVIIe et XVIIIe siècles: La réponse de deux accoucheurs: Paul Portal et George Herbiniaux’, in Accompagner l’accouchement d’hier à aujourd’hui (Érès, 2022), pp. 77–118. Nathalie Sage-Pranchère, ‘Sages-femmes et forceps: une liaison discrète mais durable (France, de la fin du XVIIIe au XXe siècle)’, in Accompagner l’accouchement d’hier à aujourd’hui (Érès, 2022), pp. 175–212.

6 Physiocracy was an economic doctrine developed in France in the second half of the eighteenth century in defence of agriculture, based on the concept of a pre-existing natural order. René Jean Grandamy Fourastié, La Physiocratie: Théorie Générale Du Développement Économique (Paris: Marton, 1973). The relation between economics and scientific sensibilities has been explored also in Tore Frängsmyr, J. L. Heilbron, and Robin E. Rider (eds), The Quantifying Spirit in the 18th Century (Berkeley: University of California Press, 1990).

7 Carol Blum, Strength in Numbers: Population, Reproduction, and Power in Eighteenth-Century France (Baltimore: Johns Hopkins University Press, 2002); Jacques Gélis, ‘L’enquête de 1786 sur les “sages-femmes du royaume”’, Annales de Démographie Historique, 1980.1 (1980), 299–343; Scottie Hale Buehler, ‘Aborted Dreams and Contested Labors: The Société Royale de Médecine’s 1786 Survey of Midwives’, Bulletin of the History of Medicine, 95.2 (2021), 137–68.

8 In 1785, a commission of eight members of the Académie Royale des Sciences was appointed to reshape the organization of the Hôtel-Dieu, by then the largest and most important hospital in France. Académie Royale des Sciences, ‘Rapport des commissaires chargés par l’Académie, de l’examen du projet d’un nouvel Hôtel-Dieu’, Histoire de l’Académie royale des sciences, 1785, 1–110. The members of the commission were Jean Sylvain Bailly, Charles-Augustin Coulomb, Jean d’Arcet, Louis Jean-Marie Daubenton, Joseph-Marie-François de Lassone, Pierre Simon de La Place, Antoine-Laurent Lavoisier, Jaques-René Tenon. See also: Phyllis Allen Richmond, ‘The Hôtel-Dieu of Paris on the Eve of the Revolution’, Journal of the History of Medicine and Allied Sciences, 16.4 (1961), 335–53.

9 Some argued that the Parisian hospitals were not only incapable of treating the sick, but also noxious and harmful factors for the health of their guests, and proposed their relocation. See: Claude-Philibert Coquéau and Bernard Poyet, ‘Mémoire sur la nécessité de transférer et reconstruire l’Hôtel-Dieu de Paris, suivi d’un projet de translation de cet hôpital, proposé par le sieur Poyet, architecte & contrôleur des bâtimens de la ville’ (Paris, 1785). Nicolas Chambon de Montaux, Moyens de rendre les hopitaux plus utiles à la nation (Paris: Chez l'auteur, Rue et Hôtel Serpente, 1787).

10 The Parisian hospitals had been in difficult conditions for many years. The situation had been aggravated by a fire at the Hôtel-Dieu that broke out in 1772 and kept spreading through its wings for 11 days, leaving an extensive section of the its building in ruins, and imposing the transport of 500 patients in the cathedral of Notre-Dame. Imbert, Histoire des hôpitaux en France.

11 Jacques Tenon, Mémoires sur les hôpitaux de Paris (Paris: Imp. du Roi, 1788).

12 Ibid., p. 230. Statistics on the Office des accouchées are at p. 459.

13 Irvine Loudon, The Tragedy of Childbed Fever (New York: Oxford University Press, 2000).

14 The projects were those of Alphonse Le Roy (1777), Bernard Poyet (1785), and two proposals of the Académie Royale des Sciences (1785 and 1786). The proposals are listed at the pp. iv–viii of the Préface of Tenon, Mémoires sur les hôpitaux de Paris.

15 Laurence W. B. Brockliss and Colin Jones, The Medical World of Early Modern France (Oxford: Clarendon Press, 1997).

16 Auguste Corlieu, L’ancienne Faculté de médecine de Paris (Paris: Delahaye, 1877).

17 There are 142 cahiers referring to health care issues. Jean-Pierre Goubert e Dominique Lorillot, a c. di, 1789, le corps médical et le changement: les cahiers de doléances des médecins, chirurgiens et apothicaires, Résurgences (Toulouse: Privat, 1984). Some cahiers suggested the institution of new schools and courses where surgeons and midwives could access a proper education, like that redacted by the community of Beauvoir-sur-Niot, cited in the mentioned work by Goubert and Lorillot: ‘[…] qu’il leur soit accordé une école pour enseigner le cours de couches, afin de soulager les malheureuses femmes qui périssent très souvent en couches dans les campagnes, particulièrement pas la faute ou le peu d’instruction de celles qui veulent leur donner des secours et qui n’ont aucune expérience.’ Since the 1770s, many midwives were educated by itinerant teachers like Angélique Le Boursier du Coudray (1712–1791). Recent contributions on the training of midwives are: Nathalie Sage Pranchère, L’école des sages-femmes: naissance d’un corps professionnel 1786–1917 (Tours: Presses universitaires François-Rabelais, 2016); Margaret Carlyle, ‘Phantoms in the Classroom: Midwifery Training in Enlightenment Europe’, KNOW: A Journal on the Formation of Knowledge, 2.1 (Spring 2018), 111–36; Scottie Hale Buehler, ‘Being and Becoming a Midwife in Eighteenth-Century France: Geographies of Pedagogical Practices and Objects’ (UCLA, 2020).

18 The two committees were presided by de La Rochefoucauld, Duc de Liancourt (1747–1827) and Joseph-Ignace Guillotin (1738–1814) respectively, two doctors with very different ideas of what medicine and medical assistance should have looked like in Republican France. The Comité de Salubrité was formed by deputies of the Assembly, and by 8 members summoned for their expertise. Among these, there was Jean-Louis Baudelocque (1745–1810), obstetrical surgeon. His profile and the trajectories of his career will be considered later in this paper. Jean-Charles Sournia, La médecine révolutionnaire: 1789–1799 (Paris: Payot, 1989).

19 Code français ou Recueil général des décrets de l'Assemblée nationale, sanctionnés par le roi. Partie 8 (Pairis: Gueffier, 1791), p. 177–80. ‘Art. III. Les particuliers qui ont obtenu des maitrises & jurandes, ceux qui exercent des professons en vertu de privilèges ou brevets, remettront au commissaire chargé de la liquidation de la dette publique, leurs titres, brevets & quittances de finance […]. […] Art. VII. […] il sera libre à toute personne de faire tel négoce ou d'exercer telle profession, art ou métier qu'elle trouvera bon ; mais elle sera tenue de se pourvoir auparavant d'une patente […].’ Article VII, which allowed the right for anyone to acquire a patente to practise any craft, inflicted ulterior damage to the surgical, pharmaceutical and medical communities. Quack doctors, charlatans and frauds became even more common than they already were. See also: Alfred Franklin, Dictionnaire historique des arts, métiers et professions exercés dans Paris depuis le treizième siècle, 1906. Richard L. Petrelli, ‘The Regulation of French Midwifery During the Ancien Régime’, Journal of the History of Medicine and Allied Sciences, XXVI.3 (1971), 276–92. Clare Crowston, ‘Women, Gender, and Guilds in Early Modern Europe: An Overview of Recent Research’, International Review of Social History, 53.16 (2008), 19–44.

20 The Collège de Chirurgie de Paris, founded in 1579 by the Confrérie de Saint-Côme et de Saint-Damien, the professional association of surgeons, had been a forefront institution for the education of surgeons. It was the first ever surgical institution equipped with its own anatomical theatre. Moreover, the Collège included the École pratique de dissection de Paris and the Hospice de l’École de chirurgie, a surgical ward with 22 beds, see: Pierre-Louis Laget, ‘L’amphithéâtre d’anatomie de la communauté des chirurgiens de Paris sis rue des Cordeliers’, Bulletin Monumental, 156.4 (1998), 369–84. Marie-José Imbault-Huard, ‘L’École pratique de dissection de Paris de 1750 à 1822 ou l’influence du concept de médecine pratique et médecine d’observation dans l’enseignement médico-chirurgical au XVIIIème siècle au début du XIXème siècle’ (École Pratique des Hautes Études, Lille, Université de Paris I, 1973).

21 A tentative of suppression of the métiers had already been attempted in 1776 by Turgot, contrôleur général des finances under Louis XVI. The decree was revoked after only two months, because of the stark opposition of both the corporations and the Parliament.

22 Both the Académie Royale de Chirurgie and the Société Royale de Médecine requested a deferment of their closure and they managed to obtain it in virtue of their research activities, but the extensions allowed lasted only one year. Their final dissolution was pronounced by the law of 20 Thermidor Year I (8th August 1793).

23 Toby Gelfand, Professionalizing Modern Medicine: Paris Surgeons and Medical Science and Institutions in the 18th Century (Westport, CT.: Greenwood, 1980). Serge J. Dos, French Surgery of the Eighteenth Century: The Royal Academy of Surgery (1731–1793) (Bloomington: Xlibris Corporation, 2021).

24 Gelfand, Professionalizing Modern Medicine.

25 Charles Coulston Gillispie, Science and Polity in France: The End of the Old Regime (Princeton, NJ: Princeton University Press, 2004). Bruno Belhoste, Paris savant: parcours et rencontres au temps des lumières (Paris: Colin, 2011).

26 Jean-Pierre Goubert, ‘L’art de guérir. Médecine savante et médecine populaire dans la France de 1790’, Annales. Histoire, Sciences Sociales, 32.5 (Oct 1977), 908–26.

27 Décret du 20 thermidor an I. Art. I: ‘Toutes les académies et sociétés littéraires, patentées ou dotées par la nation, sont supprimées’.

28 A decree drafted by the Comité de Salubrité based on the Plan de constitution de la médecine prepared by the Secretary Felix Vicq d’Azyr had been ready by July 1791. It was never formally considered, although Charles-Maurice de Talleyrand-Périgord had already been chosen as the rapporteur of the decree. Société royale de médecine, Nouveau plan de constitution pour la médecine en France présenté à l’Assemblée nationale par la Société royale de médecine ([Reprod.]), 1790.

29 In 1793, the future director of the École de santé de Paris, Michel-Augustin Thouret, denounced the anarchy that was unfolding in medicine and called for solutions to eliminate the disorders in practical medicine, see: Anain Larcan, ‘Ce 14 frimair an III de la République’, in Bernard et al., L’acte de naissance de la médecine moderne, pp. 17–28.

30 Scarlett Beauvalet, Naître à l’hôpital au XIXe siècle, Histoire et société. Modernités (Paris: Belin, 1999), pp. 54–58.

31 Law of the Convention nationale, on the basis of a project of the Comité de Mendicité. The nationalisation lasted from the 23rd Messidor of the year II (11th July 1794) until its suspension on the 9th Fructidore of the year III (25th August 1795). The measure soon proved unsustainable for the State coffers due to the terrible financial situation of hospices, nursing homes and hospitals.

32 The Office des accouchées had been the service for childbirth assistance and apprenticeship for sages-femmes trained under the guidance of the maîtresse sage-femme since the fourteenth century. Beauvalet, Naître à l’hôpital.

33 Paul Delaunay, La Maternité de Paris (Paris: Jules Rousset, 1909). Jean Émile-Bayard, Montparnasse, hier et aujourd’hui : ses artistes et écrivains, étrangers et français, les plus célèbres (Paris: Jouve, 1927), pp. 326–32.

34 Henriette Carrier, Origines de la Maternité de Paris. Les Maitreses sages-femmes et l’Office des accouchées de l’ancien Hotel-Dieu (1378–1796) (Paris: Steinheil, 1888). Births in the new Maternité were between 1800 and 2000 per year.

35 300 students aged between 17 and 20 in Paris, 150 in Montpellier, 100 in Strasbourg.

36 Convention nationale – Comité d’instruction publique, Procès-verbaux du Comité d’instruction publique de la Convention nationale. Tome 5 / publ. et annotés par M. J. Guillaume, vol. V, VI vol., 1891, pp. 281–83.

37 The Parisian École meaningfully occupied the buildings that had been the seat of the Académie and the Collége de Chirurgie in rue des Cordeliers, as an ulterior symbolic attempt to consolidate the blend between subjects. Roselyne Rey, ‘L’École de santé de Paris sous la Révolution : transformations et innovations’, Histoire de l’éducation, 57.1 (1993), 23–57.

38 Convention nationale, Rapport et décret de la Convention nationale, sur les écoles de santé : de Paris, Montpellier et Strasbourg. Du 14 Frimaire, an 3 de la République française, une et indivisible (Paris: de l'Imprimerie du Comité de salut public, 1794), p. 19, by Antoine-François Fourcroy, ‘La médecine et la chirurgie sont deux branches de la même science ; […] les réunir et les confondre, c’est les éclairer mutuellement et favoriser leurs progrès. […] il n’y aura plus de distinction ridicule entre deux arts à qui la nature commande d’être inséparable. Les citoyens trouveront dorénavant toutes les lumières réunies dans les officiers de santé […].’

39 The Parisian school referred to the Grand Hospice de l’Humanité (ex Hôtel-Dieu de Paris, renamed during the Revolution) for external clinic and surgery, and to the Hospice de l’Unité (ex Hôpital de la Charité) for internal clinic and surgery. ‘Plan Général de l’enseignement Dans l’École de Santé de Paris’ (Imprimé par ordre du Comité d’Instruction Publique de la Convention Nationale – chez Ballard fils, an III 1795).

40 Weiner, The Citizen-Patient in Revolutionary. Dora B. Weiner and Michael J. Sauter, ‘The City of Paris and the Rise of Clinical Medicine’, Osiris, 18 (January 2003), 23–42.

41 It is to be noted that the clinical approach and the teaching in the hospitals were not a never-seen-before novelty. It had already been adopted in the medical education offered by several European universities. The first ones to implement it were the medical faculties in Padua, Leiden, Edinburgh and Wien, and more and more universities were on their way to taking up this didactic methodology.

42 Classes were attended by second-year students, the commencés. The first part of the course was devoted to the anatomy of the female pelvic region, the mechanisms of childbirth, and the different types of intervention by the obstetrician; the second to the health of new-borns; and the third to the health of pregnant women, women in labour and women who have recently given birth. The exercises for the management of complex deliveries were done on life-size manikins. ‘Plan Général de l’enseignement Dans l’Ecole de Santé de Paris’.

43 Alphonse Louis Vincent Leroy, Me. Alphonse Leroy, professeur en médecine, a Son Critique (Paris: Leclerc, 1776), p. 3. See also paragraph 1.1.

44 The cutting of the ligaments of the pubis had already been put forth as a theoretical operation by Séverin Pineau in De graviditate et partu naturali, in qui ossa pubis distrahi demonstrator (Paris: Prevosteau 1597). Pineau tested the operation only on cadavers.

45 The operation would consist in the cutting of the ligaments and the cartilage of the pelvic joint in order to widen the pelvis by two or three pouces (inches. It would allow a dilatation up to 7.5 cm of the pelvic bones), in order to allow an easier vaginal delivery. Jean René Sigault, Claude-François Grandclas, and Jean Descemet, Mémoire de M. Sigault, docteur-régent de la faculté de médecine de Paris, lu aux assemblées du 3 et du 6 décembre 1777, (Paris, 1777), pp. 2–3, ‘Ainsi, faute d’un moyen plus doux et plus facile, pour extraire le foetus, quand le bassin se trouve vicié ou trop petit, relativement au volume de l’enfant, la Société, la Patrie perdoint tous les jours une infinité de Citoyens […]. […] je pensai que la Section de la Symphise de ce os [os pubis], procureoit un écartement plus considérable et capable de rendre possible et même facile la sortie de l’Enfant. Ce moyen e parut préferable en tout point à l’Opération Césarienne ; sur-tout si l’on pouvoit se flatter d’assurer la réunion des os pubis.’

46 Alphonse Louis Vincent Leroy, Recherches historiques et pratiques sur la section de la symphise du pubis, pratiquée, pour suppléer à l’opération césarienne, le 2 octobre 1777, sur la femme Souchot (Paris: Leclerc, 1778), p. XII.

47 Sigault, Grandclas, and Descemet, Mémoire de M. Sigault. The operation also had a resonance in the medical gazettes and even daily newspapers of the time. See, for example, the announce of the first trial of the operation, by Sigault, in Le Journal de Paris, n. 285 (12 octobre 1777), p. 3.

48 Isabelle Coquillard, Corps au temps des Lumières: les docteurs régents de la Faculté de médecine en l’université de Paris au XVIIIe siècle (Paris: Honoré Champion éditeur, 2022).

49 While it is beyond the scope of this essay, the changing representations of female body and the pregnant body has been explored in many studies, see, for example: Yvonne Knibiehler and Catherine Fouquet, La femme et les médecins : analyse historique (Paris: Hachette, 1983). Ludmilla J. Jordanova, Sexual Visions: Images of Gender in Science and Medicine Between the Eighteenth and Twentieth Centuries (New York: Harvester Wheatsheaf, 1989). Emmanuelle Berthiaud, ‘“ Attendre un enfant ” : vecu et representations de la grossesse aux XVIIIème et XIXème siecles (France)’ (Doctorat d’histoire, Université de Picardie, 2011). Nahema Hanafi, Le frisson et le baume: expériences féminines du corps au siècle des Lumières (Rennes: Presses universitaires de Rennes, 2017).

50 Third son of the surgeon Jean-Baptiste Baudelocque (1718–1785), Jean-Louis Baudelocque often signed or was referred to as ‘Baudelocque l'Aîné’. Baudelocque presented his thesis in Latin at the Collège Royale de Chirurgie of Paris in 1776 on the symphysiothomy, the year before it was ever experimented. Jean Louis Baudelocque, An in partu propter angustiam pelvis, impossibili, symphysis ossium pubis secanda? (Paris: Regia Schola Chirurgorum, 1776). Baudelocque’s thesis was critical of the procedure. He maintained that a Caesarean section was preferable to a symphysiotomy: certainly more invasive and more dangerous, but capable of ensuring the extraction of the foetus in any case.

51 Within a few years, both textbooks were re-edited and expanded, became the reference texts of the subject and remained the books on which both professional groups continued to train until the 1840s. Jean Louis Baudelocque, Principes de l’art des accouchemens par demandes et réponses, en faveur des sages-femmes de province, I (Paris: Didot, 1775). The textbook for midwives was re-published in 1787, 1793, 1807 for Méquignon and in 1837, edited by Moreau, for Germer-Barlière. L’Art was translated into English in 1790 (A System of Midwifery, trans. John Heat (London: J. Parkinson, 1790)). In 1833, in Italian: Dell’arte ostetricia di J. L. Baudelocque professore nella scuola di medicina di Parigi, trans. Pasquale Leonardi Cattolica (Milano: Truffi, 1819).

52 Jean Louis Baudelocque, L’art des accouchemens, II vol. (Paris: Méquignon l’Aîné, 1781). This work was re-edited and published in 1796, 1807 for Méquignon. The 7th edition dates 1844, for Germer Baillière.

53 Jean-Louis Baudelocque, Principes de l’art des accouchemens par demandes et réponses, en faveur des sages-femmes de la campagne. Ouvrage également utile aux jeunes chirurgiens qui de destinent à l’exercice de cet art, II (Besançon: Métoyer, 1793). In this edition, the third of the Principes, edited by Nédey, a professor at the Collège de chirurgie pour les accocuchemens, a commentary by Nédey himself at p. X of the Preliminary discourse provides an insight into the importance of by Baudelocque’s work for teachers: Baudelocque’s textbook was exceptional for ‘l'ordre, la clarté, la précision’.

54 Baudelocque was an advocate of the value of the forceps. He perfected Levret’s model by modifying its handle to give the surgeon a better grip and more control over the pressure of the instrument’s arms. Baudelocque, L’art des accouchemens, 1781, p. X, ‘Le forceps récemment connu, mais à peine ébauché, ayant reçu une nouvelle forme des mains de ces deux hommes célèbres & surtout de celles de M. Lévret, changea pour ainsi dire la face de cet art ; en faisant rejetter les crochets & autres instrumens de cette espece, qu'on se voyoit souvent dans la triste nécessité.’

55 In the first edition of L'Art des accouchemens (Paris, 1781) about fifty pages are spent on the pubic symphysis (pp. 230–78), and just over thirty on the Caesarean section (pp. 278–321). In the third edition of L'Art (Paris, 1807) the treatment of the symphysis extends to a hundred pages (pp. 292–402, vol. II) and just under forty to the C-section (pp. 402–39, vol. II). In contrast, in another important manual for obstetric surgeons by Astruc (1684–1766), a surgeon of the earlier generation, only five pages are devoted to the history and procedure of Caesarean section. Jean Astruc, L’Art d’accoucher réduit à ses principes, où l’on expose les pratiques les plus sûres & les plus usitées dans les différentes espèces d’accouchement (Paris, 1766), pp. 300–05.

56 Jean-Louis Baudelocque, L’Art des accouchemens, … quatrième édition, revue, corrigée et augmentée. Avec figures en taille-douce, IV, vol. I, II vol. (Paris: Méquignon, 1807), p. XXXIX. Quotation translated from French by the author.

57 Many surgeons complained about the non-pronouncement of the institution that was supposed to rule on the legitimacy and feasibility of the C-section. See, for example, Théodore Étienne Lauverjat, Nouvelle méthode de pratiquer l’opération césarienne et parallèle de cette opération & de la section de la symphyse des os pubis (Paris: Méquignon, 1788), p. VII: ‘Chacun a les yeux fixés sur l'Académie, pour qu'elle dissipe l'incertitude, & on l'attend avec d'autant plus de raison, qu'elle a déjà prouvé, dans un de ses Mémoires, la possibilité & les succès de cette opération pratiquée sur le vivant, & indiqué, dans un autre, les cas qui la nécessitent : mais cette Compagnie savante, qui ne se décide qu'après des preuves constatées & soutenues, n'a point encore prononcé sur la méthode à suivre, parce que celles en usage n'ont point mérité son suffrage.’

58 Historically, Caesarean section was only performed on dead women to try to save the life of the foetus or to bury the bodies separately, as had been the custom since the time of the Lex Caesarea, dating back to 715 BC. The first conception of the operation on a living woman is owed to François Rousset, a sixteenth-century French doctor, who first envisaged a lateral vertical cut on the belly of the expecting woman that would allow the baby to be extracted without jeopardising the mother's life. Rousset never performed it. Françoys Rousset, Traitte nouveau de l’Hysterotomotokie, ou Enfantement Caesarien (Paris: Denys du Val, 1581). For a history of the post-mortem Caesarean section and on the evolution of the operation on living women, see: Renate Blumenfeld-Kosinski, Not of Woman Born: Representations of Caesarean Birth in Medieval and Renaissance Culture (Ithaca: Cornell University Press, 2019). Mireille Laget, ‘La césarienne ou la tentation de l’impossible, XVIIe et XVIIIe siècle’, Annales de Bretagne et des pays de l’Ouest, 86.2 (1979), 177–89. Nadia Filippini, La nascita straordinaria: tra madre e figlio la rivoluzione del taglio cesareo: sec. XVII–XIX, Studi e ricerche storiche 198 (Milano: FrancoAngeli, 1995). Samuel Lurie, ‘The Changing Motives of Cesarean Section: From the Ancient World to the Twenty-First Century’, Archives of Gynecology and Obstetrics, 271.4 (April 2005), 281–85.

59 Jean-François Simon, ‘Recherches sur l’opération césarienne sur femme vivante (première partie)’, in Mémoires de l’Académie Royale de Chirurgie, vol. I, II vols. (Paris: Charles Osmont, 1743), 623–49. And Jean-François Simon, ‘Recherches sur l’opération césarienne sur femme vivante (seconde partie)’, in Mémoires de l’Académie Royale de Chirurgie, vol. II, II vols. (Paris: Le Prieur, 1743), 398–433. Simon’s census considered the period spanning from 1581, the date of publication of Rousset’s first proposal of an in vivo C-section, to 1743.

60 Astruc, L’Art d’accoucher réduit à ses principes, p. 299–300, ‘Quant à l'opération qu'il faut faire sur une femme vivante, […] c'est une des plus grandes opérations de la Chirurgie, & des plus dangereuses […].’

61 Heikki Mikkeli, Hygiene in the Early Modern Medical Tradition (Helsinki: The Finnish Academy of Science and Letters, 1999).

62 Encyclopédie, ou dictionnaire raisonné des sciences, des arts et des métiers, etc., eds. Denis Diderot and Jean le Rond d'Alembert, ‘CÉSARIENNE (Opération) ou SECTION’, 2 (1752), 867–68. This entry was written by Antoine Louis (1723–1792), secretary of the Académie de chirurgie, an institution that had not officially given its placet to Caesarean section. In the Encyclopédie, the C-section is an operation suggested in cases where ‘on est sûr de l'impossibilité absolue de l'accouchement par les voies ordinaires’, due to the physical constitution of the mother or the child. That dedicated to the C-section is one of many entries on obstetrics, such as Accouchement, Dystochie, Embryulkie, Embryulkia, Hystérocele, Hysteromotocie.

63 This Paris-based association of physicians and surgeons was created in 1796 (year IV) to compensate for the closure of the Société Royale de Médecine. It was originally named 'Société de Santé de Paris' and then renamed 'Société de médecine de Paris' in 1797.

64 Jean Louis Baudelocque, ‘Recherches et réflexions sur l’opération césarienne’, in Recueil périodique de la Société de Médecine, vol V, 1798 (year VII).

65 The numbers collected by Baudelocque are not compatible with those published by Tenon in 1788, who counted 1 Caesarean section every 3445 births at the Hôtel-Dieu in Paris from 1772 to 1785 – all fatal for the women operated. Tenon, Mémoires sur les hôpitaux de Paris, pp. XXX and 489. See also: Filippini, La nascita straordinaria, pp. 204–06, who elaborates interesting hypotheses for these deficient statistics. The unreliability of the data is linked to the evolution of the term ‘Caesarean section’ and the different operations that this terminology could indicate: an operation to extract a foetus from a deceased woman, or from a living woman, or a lithotomy to operate an ectopic pregnancy. The precise data regarding C-sections and the calculation of the first statistics on incidence date to the first decade of the nineteenth century. Their numbers relate exclusively to hospital practice. Two examples of the collection of data on patients admitted, deliveries, their progress and births, and figures in the frequency of C-sections, are the works of the two chief midwives of the Maternité of Paris, see: Marie-Louise Lachapelle and Antoine Louis Dugès, Pratique des accouchemens ; ou, Mémoires, et observations choisies, sur les points les plus importans de l’art, III vols. (Paris: J.B. Baillière, 1821). Marie Anne Victoire Gillain Boivin, Mémorial de l’art des accouchemens, III vols. (Paris: Méquignon, 1824).

66 The curved scalpel used to perform the C-section was introduced by André Levret (1703–1780) in 1747 but the surgeon never used to perform this operation. Levret, Observations sur les causes et les accidens de plusieurs accouchemens laborieux […] (Paris: Osmont, 1780), pp. 162–280. Since then, there had been no other technical innovations, apart from a few proposals on different incision sites. For example, Lauverjat was the first and the only one, in this period, to propose a horizontal incision of the abdominal wall to perform a C-section. Lauverjat, Nouvelle méthode de pratiquer l’opération césarienne.

67 Jean-Louis Baudelocque, ‘Recherches et réflexions sur l’opération césarienne suivies d’une note sur l’accouchement de la femme Marville, … ’, in Recueil périodique de la Société de médecine, vol. V (Paris: Impr. de la Société de médecine, 1798), p. 89, ‘[La Société de Médecine de Paris] Est unanimement d’avis, qu’il est du devoir du médecin de recourir à l’opération césarienne dans les cas déterminés par l’art.’ The recommendation of the operation was suggested by Baudelocque at p. 35, ‘Loin de proscrire l’opération césarienne, d’autres loix devraient obliger de la faire ; si l’on parvient à démontrer que ce soit la seule qui puisse conserver l’enfant, sans être essentiellement mortelle pour la femme.’

68 Levret, renowned surgeon, obstetrician to the dauphine of France, had paved the way for the mechanistic study of obstetrics in L'art des accouchemens, démontré par des principes de physique et de méchanique (1753, 1761, 1766) in which he argued that childbirth was a natural mechanical functions, p. 88, ‘L'accouchement est une opération naturelle, véritablement méchanique, & susceptible de démonstration Géométrique […]. La connoissance des Loix Méchaniques de l'Enfantement est donc indispensablement nécessaire à tous ceux qui se dessinent à l'Art des Accouchemens. En effet, un Accoucheur dépourvu de ces lumières, ne peut absolument être en état d'aider la Nature avec connoissance de cause, lors qu'elle rencontre quelques obstacles à l'exécution des Loix fondamentales qui lui ont été imposées par le Créateur’.

69 Jean Louis Baudelocque, L’art des accouchemens, vol. I, II vols. (Paris: Méquignon l’Aîné, 1781), p. viii. Translated by the author.

70 Baudelocque, L’Art des accouchemens, quatrième édition, revue, corrigée et augmentée. Avec figures en taille-douce, p. XL, ‘Si l’on ne peut acquérir autrement, avec une précision mathématique, la connoissance de tous les diamètres du bassin, du moins en approche-t-on assez pour ne pas commettre de grandes fautes. Il est aisé sur-tout de déterminer la longueur de celui du détroit supérieur, qui va du pubis au sacrum, le seul qui soit presque toujours en défaut relativement à l’accouchement.’

71 Baudelocque’s pelvimeter was used for decades by obstetricians. However, the instrument measured the hypothetical ratios of the patients’ bone structure from the outside and its estimates were not valid. This conclusion was reached with the first X-rays on women’s pelvises. For a history of obstetrical instruments, see: Bryan M. Hibbard, The Obstetrician’s Armamentarium: Historical Obstetric Instruments and Their Inventors (San Anselmo, CA: Norman Pub, 2000).

72 Hucherard, Sausset, and Girault, Mémoire historique et instructif sur l’hospice de la Maternité (Paris: Imprimerie des hospices civils, 1808). Henriette Carrier, Origines de la Maternité de Paris. Les Maitreses sages-femmes et l’Office des accouchées de l’ancien Hôtel-Dieu (1378–1796) (Paris: Steinheil, 1888). Delaunay, La Maternité de Paris.

73 Marie-Louise Lachapelle came from a family of top surgeons and sages-femmes. Lachapelle left an important mémoire of her work as head midwife at the Hospice de Maternité, where she worked from its foundation until her death. Lachapelle, Dugès, Pratique des accouchemens; ou, Mémoires, et observations choisies, sur les points les plus importans de l’art (Paris: J.B. Baillière, 1821).

74 Sage Pranchère, L’école des sages-femmes.

75 The course, from 1802 to 1806, lasted six months. Baudelocque taught four hours a week. Since January 1807 the course was extended to one year. The students were chosen by the prefects of each department. They stayed for the duration of the course in a boarding house adjacent to the École. A copy of Baudelocque's manual was given to each pupil on the first day of the course. Courses also included classes on vaccination, the art of bloodletting and the use of healing plants. Hucherard, Sausset, and Girault, Mémoire historique et instructif sur l’hospice de la Maternité.

76 Ibid., p. 63.

77 René Roland, Les Médecins et la loi du 19 ventôse an XI. Étude historique et juridique sur l’organisation de la profession médicale et sur ses conditions d’exercice (Paris: Arthur Rousseau, 1883). Jean-François Lemaire, ‘La Loi Du 19 Ventôse an XI, Texte Fondateur et Expédient Provisoire’, Bulletin de l’Académie Nationale de Médecine, 187.3 (2003), 577–89. Maurice Crosland, ‘The Officiers de Santé of the French Revolution: A Case Study in the Changing Language of Medicine’, Medical History, 48.2 (2004), 229–44. Sage Pranchère, L’école des sages-femmes. Nathalie Sage Pranchère, ‘L'Appel à La Sage-Femme. La Construction d'un Agent de Santé Publique (France, XIXe Siècle)’, Annales de Démographie Historique, 127.1 (2014), 181–208.

78 Jean-François Sacombe, Résurrection du Docteur Sacombe: étrennes aux dames, pour l’année mil huit cent dix-huit (Paris, 1818), p. 36, ‘J’étais provincial de croire que c’est le génie, les talents et l’étendue des connaissances quid ont la réputation de la plupart des hommes célèbres de la capitale et qui élèvent aux places éminentes … […] Désespéré de l’inutilité de mes démarches, je me déterminai à voir M. Baudelocque aîné, le roi des accoucheurs. J’ai abordai Baudelocque avec cette respectueuse admiration que commande une grande célébrité à un nouveau venu. Il […] me demande en quoi il peut m’être utile. À la réponse que cet fit à chaque nouvelle phrase que j’hasardai je reconnus bientôt que j’avais affaire à un homme illettré, à un mouvais logicien, à un accoucheur sans principe, enfin à un individu grossier qui cherche à se dégager brusquement des mains où il se trouve embarrassé je me retirai stupéfait, n’osant en croire mes yeux et mes oreilles.’

79 Sacombe’s viewpoints have been long excluded, when not ridiculed, by historians of childbirth, with only a few exceptions, namely Nadia Maria Filippini. See Filippini, La nascita straordianaria. And Nadia Maria Filippini, Generare, partorire, nascere: una storia dall’antichità alla provetta (Roma: Viella, 2017). However, Sacombe drew the attention of psychoanalyst Bernard This, La requête des enfants à naître (Paris: Editions du Seuil, 1982) and literature scholars Hugues Marchal, who dedicated part of his research to Sacombe’s literary work, and Jean-Christophe Abramovici.

80 Elizabeth Ann Williams, A Cultural History of Medical Vitalism in Enlightenment Montpellier, The History of Medicine in Context (London, New York: Routledge, 2016).

81 Among the many publications on Nature and the Enlightenment, see: Lorraine Daston and Gianna Pomata (eds.), The Faces of Nature in Enlightenment Europe (Berlin: BWV-Berliner Wissenschafts-Verlag, 2003); Peter Jones, Agricultural Enlightenment: Knowledge, Technology, and Nature 1750–1840 (Oxford: Oxford University Press, 2016).

82 Jean François Sacombe, Dissertatio medica de mastrupatione (Montpellier: Picot, 1780).

83 Jean-Francois Sacombe, Élémens de La Science Des Accouchemens (Paris: Coursier, 1802), pp. 200–22.

84 Sacombe, Lucine française, Tome I, ‘jaloux de profiter d’une occasion aussi favourable pour épier la Nature’; ‘comme si elle eut été seule au sein d’un bois’.

85 Ibid., p. 202, ‘[…] l’œil fixé, pour la première fois, sur le point le plus brillant de l’horizon. Je contemplais pour la première fois le grand phénomène de la Nature […]. Eh! qu’en ne pense point que j’exagère ; l’instant physique de la naissance du jour n’est ni plus important ni plus majestueux que celui que précède la naissance de l’homme.’

86 George R. Havens, ‘The Theory of “Natural Goodness” in Rousseau's Nouvelle Heloise’, Modern Language Notes, 36.7 (Nov., 1921), 385–394.

87 Jean-Francois Sacombe, Le Médecin accoucheur (Paris: Croullebois, 1791).

88 The French debate aver instrumental midwifery was a lot quieter than the one in England, where both midwives like Sarah Stone (1701–1737) and Elisabeth Niell (1723–1776) and physicians like William Douglas (c.1711–17??) were vocal against new surgical and instrumental midwifery methods. See William Douglas, A Letter to Dr. Smelle [sic] Shewing the Impropriety of His New-Invented Wooden Forceps; as also the Absurdity of His Method of Teaching and Practising Midwifery (London: J. Roberts, 1748). Elisabeth Nihell, A Treatise on the Art of Midwifery. Setting Forth Various Abuses Therein, Especially as to the Practice with Instruments: The Whole Serving to Put All Rational Inquirers in a Fair Way of Very Safely Forming Their Own Judgment upon the Question; Which It Is Best to Employ, in Cases of Pregnancy and Lying-in, a Man-Midwife or, a Midwife (London: Morley, 1760).

89 Baudelocque, L’art des accouchemens, 1781.

90 The polemic against the concept of contre nature returns again and prominentely in Jean-François Sacombe, Encore une victime de l’opération césarienne, ou le Cri de l’humanité (Paris: Maret, Desenne, Durand, 1796).

91 Jean François Sacombe, Les Douze mois de l’école anti-césarienne. Ouvrage périodique, vol. I, II vols. (Paris: Möller, 1797), p. 32. ‘[…] rendre à l’art son antique splendeur en le forçant de rendre dans le sentier de la nature, riser des instruments meurtriers, affranchir le beau sexe de mille affreuses et inutiles manouvres en un mot, régénérer l’art des accouchemens.’ Translation of the author.

92 On the relations between male and female practitioners of midwifery, see: Gélis, La Sage-femme ou le médecin. Laget, Naissances. Schiebinger, The Mind Has No Sex?. Green, Making Women’s Medicine Masculine. Sarah Knott and Barbara Taylor (eds), Women, Gender, and Enlightenment (Houndmills, Basingstoke, Hampshire; New York: Palgrave Macmillan, 2005).

93 Jean François Sacombe, Avis aux sages-femmes (Paris: Croullebois, 1792), p. 6.

94 Ibid.

95 It is imaginable that Sacombe’s livor was fuelled by his envy of his colleagues and by his marginalization from the scientific discussions on the new ways of the art of childbirth. However, personal jealousies and sense of exclusion take a small space in his work compared to medical arguments and a taste for a captivating style used to flaunt his erudition and, at the same time, to humiliate his ‘ignorant’ rivals.

96 Jean-François Sacombe, La Luciniade, poëme en 10 chants sur l’art des accouchemens, (Paris: Courcier, 1798). The first edition was published in 1792, and a second one dates 1795. For interesting considerations on the originality and the editorial success of La Luciniade, see: Huges Marchal, ‘Poésie et controverse scientifique dans La Luciniade’, in Littérature et médecine: approches et perspectives, XVIe-XIXe siècle (Genève: Droz, 2007), 65–86. Huges Marchal, ‘“Le poète raconte et ne discute pas”: Poetic and Medical Codes in Jean-François Sacombe's Obstetric Epic, La Luciniade (1792–1815)’, in Medicine and Narration in Eighteenth Century, ed. by Sophie Vasset (Oxford: Voltaire Foundation, 2013).

97 Jean-François Sacombe, Encore une victime de l’opération césarienne, ou le Cri de l’humanité (Paris: Maret, Desenne, Durand, 1796). Antoine Dubois (1757–1837) became Baudelocque's successor at the École and at the Maternité, see: Pierre Huard, Marie-Clément Imbault-Huart, ‘L’ouvre scientifique d’Antoine Dubois (1756–1837)’, Gazette medicale de France, Tome 80, 39 (1973).

98 Jean-François Sacombe, Plus d’opération-césarienne, ou Le voeu de l’humanité (Paris: Perronneau, 1796).

99 Jean-François Sacombe, Protestation du citoyen Sacombe contre l’arrêté de la Société dite de médecine de Paris inséré sans date dans un ouvrage intitulé : ‘Recherches et réflexions sur l’opération césarienne, etc.’ …  (Paris, 1798). The pledge was fulfilled in 1802 when he initiated a series of legal proceedings that pitted Sacombe against Baudelocque. Sacombe accused Baudelocque of incompetence and homicide in the case of decollation, emergency Caesarean section, and consequent death of Madame Tardieu and her unborn child.

100 Les Douze Mois de l’Ecole anti-césarienne. Ouvrage periodique. An VI. Directed by Jean-François Sacombe. Students of the École also participated in the theatrical productions staged by Sacombe, such as Jeanne Seymour, premiére victime de l’opération césarienne and Térée, roi de Thrace, both dedicated to obstetrical violence and its relationship with power and authority. These productions garnered attention and consensus among the people of Paris. Sacombe claimed that Jean de Seymour died as a result of a Caesarean section imposed by Henry VIII. He often compared the actions of the ‘Caesarian’ surgeons to the tyrannical brutality of the English king. Sacombe, Protestation, p. 3, ‘à l'exemple du chirurgien-accoucheur, complice du féroce Henry VIII.’

101 Jean-François Sacombe, Mémoire du citoyen Sacombe, … au Ministre de la Police générale de la République. 26 frimaire an VI, 1797, p. 2, ‘[…] une femme n'est jamais dans l'impossibilité physique d’accoucher par la voie naturelle.’

102 Jean-François Sacombe, Lucine française, ou recueil d’observations médicales, chirurgicales, pharmaceutiques, historiques, critiques et littéraires, relatives à la science des accouchemens (Paris: Bidault [Lefebvre], an XI, 1802).

103 The review reached England and Germany, where a similar publishing initiative called Lucina was published. It ended up being more long-lived than Sacombe’s. A.E. von Siebold, Lucina : eine Zeutschrift zur Vervollkommung der Entbindungsjunst (Leipzig: Jacobaer, 1802–1811).

104 Sacombe, Plus d’opération-césarienne, p. 110. Quotation translated by the author.

105 Jean François Sacombe, Plaidoyer du docteur Sacombe, défendeur: en réponse à celui de M. Delamalle, défenseur de M. Baudelocque, demandeur (Paris: Lefebvre, 1804). Gaspard-Gilbert Delamalle, Réplique pour le Sieur Baudelocque contre Alexandre Tardieu, graveur de la Marine ; Jean-François Sacombe, se disant Médecin-Accoucheur ; La femme Bridif ; et le Sieur Lefebvre, Imprimeur ; prononcée par Mr. Delamalle, à l’audience du 5 fructidor an XII ; recueillie par le sténographe. (Paris: Delance et Lesueur, 1804). See also: Le Journal de Paris, 18th November 1804. The conviction sentenced him to a public apology to Baudelocque, the injunction not to publish any other offensive texts, a fine of 3000 francs to donate to the poor, the payment of the printing of 300 copies of the sentence, and of the legal costs of the proceeding.

106 See Filippini, La nascita straordianaria. Baudelocque spent the last years of his life as the personal obstetrician to Empress Marie-Louise and Caroline Bonaparte, the wife and the younger sister of Napoleon. Baudelocque is still considered the doctor that made obstetrics a science, the ‘external obstetric conjugate’ is still often called ‘Baudelocque’s diameter’ in contemporary gynaecology, and the maternity ward of the Hôpital Cochin, in Paris, is named after him.

107 Barbara Duden, Disciplining Reproduction: Modernity, American Life Sciences, and the Problems of Sex (Cambridge, MA: Harvard University Press, 1993).