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2017 July Mauriceau’s Diseases of Women with child

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Traité des maladies des femmes grosses et de celles qui son accouchées

(Paris, 1694).

 

Portrait of Mauriceau, Traité des maladies des femmes grosses et de celles qui son accouchées (Paris, 1694), frontispiece.

 

François Mauriceau (1637-1709) was one of the leading surgeons of the seventeenth century from the famed Hotel Dieu in Paris. Hotel Dieu was the leading maternity hospital of all of Europe. The first edition of Traité des maladies des femmes grosses et de celles qui son accouchées was published in 1668, using some 700 deliveries he had observed as his data. His writings on obstetrics focused on how to deal with difficult births. Diseases of Women with child (London, 1683), as translated into English by Hugh Chamberlen (1664-1728), was created for an audience of midwives and surgeons. The latter were employed in areas where there were fewer midwives or in situations of abnormal deliveries. Both Mauriceau and Chamberlen were paramount to the transition to male-midwives. These male-midwives were often licensed as surgeons, creating a more skilled profession that focused on anatomy and study rather than just experience. Midwives who were trained in the old way were not allowed to use things such as forceps or anesthetics. Mauriceau and Chamberlen both practiced as accoucheurs (male-midwives) to the populace of France and England respectively. Both writer and translator emphasised the need to combine academic theory and evidential practice.

 

 

Traité des maladies des femmes grosses et de celles qui son accouchées (Paris, 1694), p. 3.

 

The book itself is split into two parts with an additional preface on the anatomy of women. This initial treatise has figures of female anatomy and attempts to show that if the anatomical parts of the female cannot be understood then one cannot understand their usage. This is shown through detailed anatomical drawings, which display the internal operations of women’s bodies. Medical institutions by this time had been studying female cadavers for centuries. Though the female form is described quite accurately, practitioners were unable to study the effects of pregnancy on the organs unless a woman died in the early stages of pregnancy. This created an absence of understanding of uterine and fetal development.

 

Hugh Chamberlen, Diseases of Women with Child (London, 1683), pp 240-1.

 

It is worth noting, that there area many side-notations from Chamberlen that refute the statements of Mauriceau. For example, in the initial edition, Mauriceau claims that the ovum and testes are of similar creation and act in the same way. However, in 1683, when Chamberlen translated the work, there was a greater understanding of how the “seed” existed within these two parts. The fifteen years between publishing and translation show the progress in knowledge. Mauriceau continued his research and published four editions over the years along with assisting in numerous translations into the varied languages of the continent.

 

Book I discusses fertility and sterility in women. Most of the discussion focuses on the production of “typical, good courses” from ages 13 to 50. They argued that there were various afflictions that could cause infertility, from ill-fated humors to fluctuations of the womb and the vagina’s shape. These range from issues with thickness of cervical mucus and the thickness of the uterine walls. The women’s health and the hospitality of the womb were the key elements affecting female fertility. There is no mention within the text of any attempts to increase male fertility. There are brief references at the end of the fertility section to the subject of surrogates. Mauriceau views this in a biblical context and cites Sarai and Hagar as examples.

 

Chapter 2 of Book I focuses on conception, but does not speak explicitly of the act, instead discussing how quickly after impregnation an expert surgeon can see the conception. Mauriceau notes that though signs of conception can only be immediately seen by expert midwives, some signs include “nothing flow[ing] down from the womb after copulation”. He argued that there would be no specifics until a few months of incubating and the resulting quickening:

“some few months after perceives also a small pain about her navel and some little commotions in the bottom of her belly caused by the womb’s closing it self to retain the seeds and contracting it better to contain them, and embrace them the closer.”

The quickening is said to be pain from the bladder, which Mauriceau suggested was agitated by the movements of the fetus. It was difficult to understand the entirety of conception and the development of embryos at this point, as the only available scenes of fetuses in development were those that were miscarried.

 

Book II focuses on the action of labor, performing natural and abnormal deliveries. After the seventh month of pregnancy it was thought to be acceptable to deliver as the fetus had a greater chance of survival and was easier to remove. There are noted differences in the delivery months but Mauriceau claims that women can carry for up to 11 months. The chapters mostly vary on specifics of delivering of children in differing positions, e.g. headlong, breach etc. The more gruesome chapters focuses on the removal of stillborn and caesarian sections that only occurred once the life of the mother had already been lost. These were necessary for the surgeons who were reading this, as they were often called in for difficult deliveries that the midwives could not handle.

 

Mauriceau’s work was widely known across Europe and he acted as an accoucheur to royalty and upper class citizens. Due to his status in society, there are many references to his presence at Parisian births. Mauriceau’s popularity and success encouraged acceptance of accoucheurs in European cities. The translator, Chamberlen, was a well-known accoucheur in his own right. The Chamberlen family was famous for their obstetric lineage. Hugh the Elder was one of seven physicians in his family, many of whom were royal obstetricians. Multiple sources discuss an incident in the early 1670s in which Mauriceau and Chamberlen met in Paris. Chamberlen attempted to demonstrate the family secret of forceps to Mauriceau but failed to deliver the child. The preface of the 1683 translation briefly mentions these forceps and it is thought to be the first mention of the Chamberlen forceps published.

 

Mauriceau’s Traité des Maladies des Femmes, translated by Chamberlen, is a work by two of the seventeenth century’s obstetrics elite. Mauriceau’s studies within the field of obstetrics legitimized the study of childbirth as a science rather than something that was provincially taught. This text provided an authority on childbirth, a field that had had little written on it previously. The translation by Chamberlen ensured that the text was in the common vernacular, providing knowledge to the people who were in need of greater understanding of obstetric health. The popularity of Traité des Maladies des Femmes throughout the continent indicates the beginning of the rise of sanctioned study of labor and women’s health that would continue through the seventeenth century.

 

Chamberlen, Diseases of Women with Child (London, 1683), foldout plate 1.

 

Sources:

 

Chamberlain, Geoffrey. From witchcraft to wisdom: a history of obstetrics & gynaecology in the British Isles. London: RCOG Press, 2007.

Drife, J. “The start of life.” Postgraduate Medical Journal, no. 78 (2002): 311-15.

Dunn, Peter M. “The Chamberlen family (1560-1728).” Archives of Disease in Childhood, Neonatal Edition, no. 81 (1999): 232-35.

Karamanou, M., G. Creatsas, T. Dementriou, and G. Androutsos. “Practising Obstetrics in the 17th Century: Francois Mauriceau (1637-1709).” Journal of Obstetrics and Gynaecology 33, no. 1 (2013): 20-23.

King, Helen. “Chamberlen, Hugh, the elder (b.1630×34, d. after 1720).” Oxford Dictionary of National Biography.

O’Dowd, Michael J., and Elliot Elias Philipp. The history of obstetrics and gynaecology. New York: Informa Healthcare, 2011.

 

 

Text: Ms. Mallory McFall (University of Kansas, 2017)

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