MADAME BOIVIN. 
By Hunter Robb, Associate in Gynecology. 
[Read 'before the Johns Hopkins Hospital Historical Club, April 9, 1894.] 
[From The Johns Hopkins Hospital Bulletin, No. 40, May, 189-1.] [From The Johns Bopkins Hospital Bulletin, No. 40, May, 1894.J 
MADAME BOIVIN. 
By Hunter Robb, Associate in Gynecology. 
[Read before the Johns Hopkins Hospital Historical Club, April 9,1894.] 
Marie Anne Victoire Boivin, the famous midwife, was born 
in 1773 and died in 1847. Although her early education was 
not very complete, she must have made up for any deficiencies 
later on, for she was not only a voluminous writer, but her 
writings show a careful study of the subjects taken in hand. 
She was in the'Maternite, in Paris, from 1797 to 1811, where 
among others she had for her instructors Lachapelle and 
Chaussier. 
In her work entitled " Memorial de Part des accouchements," 
first published in 1812, and which had reached its third 
edition in 1824, she expounds the methods which were in use 
in the Maternite. The book, however, aroused the jealousy 
of Lachapelle, who compelled Boivin to give up her position. 
But by this time Boivin had attained to some celebrity, and 
she found a congenial field of work in the hospital of Poissy 
and the Maison de Saute, during which time she found leisure 
to translate some of the English writings upon gynaecology, 
and to write a monograph on "Hemorrhages of the Uterus," 
which was awarded a prize. 
Latei' on she published papers on " The Vesicular Mole," on 
Abortion, on the Measurement of the Pelvis, and upon 
Caesarean Section. Associated with Duges, a nephew of 
Lachapelle, she was the author of a work in two volumes 
entitled: "Traite pratique des maladies de 1'uterus et de ses 
annexes." This work was published in Paris in 1833, and 
was afterwards translated into English by G. 0. Hemming, 
who was consulting obstetrician to the St. Pancras Infirmary. 
She also appears to have written some other monographs and 
to have translated several works, among them a treatise by 
Barron on the subject of Tuberculosis. 
On account of her writings she was given the honorary title 
of Doctor of Medicine by the University of Marburg. 2 
Her " Memorial de l'art des accoutrements " was written, 
as we have said, while she was at the Maternite. She began 
it, she says, for her own benefit, and made drawings of the 
different positions of the foetus, principally for the instruc- 
tion of her niece, who had the intention of becoming a midwife. 
Being surprised by Chaussier while engaged in this work, and 
being asked by him whether she would not be willing to 
publish it, she replied that the main difficulty lay in the great 
cost of reproducing the plates, and that without these she 
thought that such a book would be comparatively useless. 
Upon this Chaussier offered to take the expense upon himself, 
for which great liberality she expresses her gratitude in the 
preface to the first edition. 
The second edition contains many chapters which were not 
in the first, notably those on the Circulation of the Blood in 
the Foetus, on the Nutrition of the Foetus, on Artificial and 
Natural Deliverance, on the Care of the Woman before, during 
and after Labor, and on the Care of the Newborn Infant. 
"The precepts contained in this work are," she says, 
"founded on the practice of the Hospital of the Maternite 
and on those of the most celebrated practitioners of our own 
as well as of foreign countries. We have had recourse to our 
own experience only in those cases where more reliable 
authorities have been wanting." 
The criticism of the General Council of the administration 
of the civil hospitals of Paris on the work is perhaps as good 
as can be found, and we therefore give a brief abstract of it. 
The Commissioner says: " All treatises on Midwifery are 
composed essentially (1) of the anatomical and physiological 
part necessary for the better comprehension of the develop- 
ment of pregnancy and the mechanism of labor; (2) of a part 
which explains the mechanism of natural labor, notes the 
different obstacles which are opposed to its course, rendering it 
more or less difficult, and indicates the proper means by which 
these are to be remedied; (3) of a description of the conduct 
of labor." 
" The first part is treated in this work excellently and 
systematically. All the parts referring to pregnancy and labor 
are written with great clearness and precision, as also are those 
treating of the development of the embryo and of the foetus. 3 
One sees with pleasure that Madame Boivin possesses a 
thorough knowledge of her subject. The mechanism of labor, 
which is the foundation and the key of the whole art, is well 
described. The third part, namely that which treats of the 
conduct of labors, is generally taught by means of a machine, 
or sort of manikin, which represents the woman in labor. 
It is the custom to demonstrate to the pupils all the possible 
positions which the child can occupy with relation to the 
canal through which it has to pass, and these the pupils are 
made to practice on the manikin. The different positions 
and the manipulations which they demand form the most 
important part of her work, and it is just this which distin- 
guishes it from the elementary books upon the art of mid- 
wifery. They are set forth in 133 plates, but after what I have 
just said it is easy to judge that this work ought to be more 
useful to those who have already finished their course than to 
those who are commencing it." 
A footnote by the author says: " It was this last remark 
which determined Madame Boivin to make additions to the 
book, so that it might be equally useful to those who were 
beginning as to those who had ended their course." 
We shall say very little more about the work itself. In 
speaking of the nourishment of the foetus she gives some very 
interesting experiments of Chaussier which were made to 
prove that the uterine vessels communicated, although indi- 
rectly, with the umbilical vein. 
In speaking of the different presentations she refers to 
Baudelocque's statistics, which contained 20,517 births. She 
also gives a table of cases reported by Dr. Samuel Merriman, 
accoucheur of the General Dispensary of Westminster, of the 
Middlesex Hospital, and of the Infirmary of St. George's 
Parish in London. This table is taken from his work which 
is entitled "A synopsis of the various kinds of difficult 
parturition." Every possible position is illustrated in the 
plates at the end of the book, and there are also figures which 
serve to illustrate the use of the lever and of the forceps, as 
well as showing the other different manipulations. 
The book closes writh the aphorisms of Mauriceau, who was 
an obstetrician of the 17th century, and of those of Orazio 
Vallota, the latter of which she translates from the Italian. 4 
Of these we shall not speak now, as we are dealing with the 
original works of Boivin. 
This smaller book which I now show you accompanied by a 
German translation, was published in Paris in 1828, and is 
entitled " Researches on one of the most frequent and least 
known causes of abortion," followed by a monograph on the 
pelvimeter. The work, which was commended by the Royal 
Society of Medicine of Bordeaux, consists of careful notes on 
a number of cases, some of which came to autopsy, and its 
purpose is to refute the opinions of those who held that 
" pregnancies, abortions and difficult labors are the most 
frequent causes of diseases of the uterus." " On the contrary," 
says Boivin, " it is the diseases of the uterus, and even more 
often those of the adnexa, which are the cause of abortion and 
of premature labor. (2) Among the many women whom we 
have seen suffering with diseases of the uterus, many confessed 
that they had had abortions, but very few had met with 
difficult labors." In an interesting footnote she adds: " At 
the moment of writing these pages I wras consulted by the 
wife of a druggist, aged 23, in whom on three successive 
occasions labor had come on at the end of seven months. 
During the course of the two last pregnancies she received 
the intelligent aid of Professor Gardien; but in spite of this, 
and in spite of general blood-lettings (repeated four or five times) 
and absolute rest, the labor came on in the seventh month. 
In this case we found upon examination that the adnexa on 
the right side were adherent to the uterus." 
This, then, is the most important proposition in the work, 
and we will content ourselves with a short summary of the 
conclusions at which she arrives. (1) Abortion is often the 
result of an organic lesion of the uterine adnexa, and these 
diseases are not, as is generally supposed, often caused by 
abortion. (2) Such lesions are seen more often than one 
would think in young patients. (3) They are generally due 
to a chronic phlegmasia, to irritation, or to the formation of 
accidental tissue which exposes the parts to an acute inflam- 
mation. (4) Such conditions are often brought about by 
neglect of the laws of hygiene. (5) The germs of these 
affections are seen in girls who are weak, of a lymphatic 
temperament, or of a scrofulous constitution, who are troubled 5 
with habitual constipation or diarrhoea, who have a bluish 
sclerotic and long eyelashes. (6) With these last menstrua- 
tion is premature and seldom regular. Leucorrhoea and 
constipation are ordinarily the cause of these diseases, but 
often these causes become effects. (8) Since the symptoms of 
this disease can easily be mistaken for those of another 
affection, the rational method of diagnosing such conditions is 
by careful examination. (9) The examination of the genitals 
should be made with the greatest care, and it should be 
especially noted whether the organs are fixed or movable. 
When the uterus is bound down, if conception takes place, 
abortion will result. (10) Adhesions of the peritonaeum to 
the surface of these organs hinder them from changing their 
position in the normal manner. (11) Marriage, which is so 
often recommended for this condition, in the majority of cases 
instead of curing, acts as an exciting cause of diseases of the 
uterus. (12) When only one tube or ovary is diseased, con- 
ception can take place, and can even go on to term. (13) But 
abortion will almost inevitably result, if the adhesions, no 
matter what their nature be, are extensive, because they bind 
down the uterus and do not permit it to expand. (14) Such 
abortions are very generally followed by grave accidents, by 
hemorrhage, metritis, peritonitis, ulceration, sometimes even 
by gangrene of the parts affected, and death. (15) At other 
times, ulceration follows abortion, and if the abscess breaks 
into the peritoneal cavity, the result is fatal for the 
patient, but if it discharges through the vagina or rectum 
she may recover. (16) One cannot judge of the condition 
of the uterus by the appearance of the utero-vaginal 
orifice. (17) The disease sometimes extends to the adnexa, 
but on the other hand sometimes it is at first limited to them 
and progresses from within outwards. (18) When the ovary 
is diseased, but is not bound down and can extend into the 
abdominal cavity, it may happen in such cases that the uterus 
preserves its normal situation and its natural volume. Some- 
times when the ovaries and tubes have increased in volume 
we find an atrophied uterus. (19) Fatal accidents are less 
common when the diseased adnexa are not bound down. We 
may have, however, compression of the lungs, and ascites. 
(20) Cyst of the ovary is only dangerous in itself when it 6 
has attained a considerable volume. The patient, however, 
generally succumbs to exhaustion. (21) In pregnancy the 
umbilicus goes towards the middle regions of the abdomen 
instead of descending towards the pubes, as it does in case of 
abdominal tumors and in ascites. (22) Many of these diseases 
can be prevented and many patients can be saved by an early 
diagnosis. 
The second series of cases are instances in which diseases of 
the ovaries have been mistaken for pregnancy. In speaking 
of the operations which have been practiced for diseases 
of the ovaries, she takes the opportunity of translating into 
French a letter on a case of successful extirpation of the 
ovary, addressed to a citizen of Philadelphia by Alban G. 
Smith, M. D., of Danville in Kentucky. She follows to some 
extent the literature on the subject of these operations and 
mentions McDowell's cases, quoting from the " Eclectic Reper- 
tory." She mentions the case of Dr. Nathan Smith, which 
was recorded in the Edinburgh Medical and Surgical Journal, 
as well as four cases of M. Lizars. Quoting from a number 
of the same journal in 1825, she says that the English are not 
in favor of this operation, and credits the editor of the 
"Review" with the following remarks: "It is impossible to 
believe that such an operation has ever been performed with 
success, and we do not think that one should ever undertake it." 
For herself she says: " We are more credulous than the author 
of the article in the Medico-Chirurgical Review; not only do 
we believe that the operation has been attempted, but that it 
has been performed with success, because there are circum- 
stances which accompany diseases of the ovaries which permit 
us to believe in a sort of cure; but since these favorable con- 
ditions can never be known until after the operation has been 
begun, the attempt we must admit savors of rashness, and the 
success obtained could not guarantee a lasting security. It is 
true that gastrotomies, gastro-hysterotomies, and other opera- 
tions where the peritonaeum has been opened, have often been 
attended with favorable results, and accidental wounds of the 
abdomen have frequently gotten well, but it must be remem- 
bered that disease of the ovaries which is not caused by 
abnormal pregnancy is almost always the result of some consti- 
tutional affection and of a scrofulous or cancerous idiopathy. 7 
In these latter cases, therefore, the resistance of the patient is 
diminished." She concludes by saying that such operations 
might prove more successful on savages and negresses, who 
from suffering in a state of slavery are almost indifferent to 
what would be fearful pain to Europeans, who have arrived 
at a high condition of civilization, and are consequently much 
more sensitive. In the case of the latter, she doubts whether 
such operations will be found to succeed as well as in that of 
" those poor wretches who are obliged to submit to the com- 
mands of the master who orders them to be disemboweled just 
as he orders them to work." 
In the same volume is found a description of a new pelvi- 
meter with accompanying plates. The chief advantage claimed 
for her instrument is that by its use great accuracy is obtained, 
since one arm is inserted into the rectum and thus rests upon 
the sacro-vertebral articulation. 
We have referred somewhat at length to this one of the less 
important writings of Madame Boivin, but we now come 
to what is perhaps her greatest book, which, as we have 
said before, she wrote with the assistance of A. Duges, a 
nephew of Lachapelle, and which is entitled " Diseases of the 
Uterus and its Appendages." The very fact that the book 
was published as late as 1834, and was written in conjunction 
with a man who was a well-known writer and a professor of 
the faculty of medicine of Montpellier, besides possessing many 
other titles, would have led us to expect that we were dealing 
with a comparatively modern book on the subject of gynae- 
cology, and one which was fully abreast, if not ahead, of the 
times in which it was written. In fact, twenty years ago it 
might well have passed as a modern text-book, and it is only 
since bacteriology has introduced so many changes in the 
technique, and has consequently rendered more common and 
less dangerous operations which in Boivin's time were but 
rarely attempted, that hei' work has become really anti- 
quated. Whatever treatment she may have received from the 
hands of Lachapelle, it is evident that she bore her no ill- 
will, since the work is dedicated " to the memory of Madame 
Lachapelle, our first guide, our first teacher, the object of our 
common affection during life, of our admiration and of our 
regrets after her death," and to M. C. Dumeril, who was the 
physician in chief to the Maison Roy ale de Sante. 8 
All through the book it is evident that the literature of the 
subject has been thoroughly worked up, and all the important 
writers and their opinions are quoted in its pages. The French 
version with its numerous clinical cases is at times a little 
tedious, and we have therefore found it more agreeable to read 
the English translation by Hemming, this being admirable, 
and the footnotes which he adds being full of interest, more 
especially as he quotes frequently such men as Marshall Hall, 
for whom he had a profound respect and to whom he dedi- 
cates his translation. It is not necessary, then, to go through 
the work in detail, but it is still well worth reading. We will 
only mention a few minor points which for some reason or 
other especially attracted our attention. One point in con- 
nection with the use of the drainage tube struck us more 
particularly on account of the disfavor into which its employ- 
ment has lately fallen. In her chapter on wounds of the 
uterus, after speaking of a gunshot wound caused by a bullet 
which killed the child in utero, but which did not prove fatal 
to the mother, she speaks of a case in which the uterus had 
been penetrated and which was drained' by means of a tube. 
She says that the tube remained in for some time, and the 
wound continued to discharge freely until one day, as luck 
would have it, the tube was forgotten and the wound very 
quickly healed. 
Her subject is divided almost in the same way as in the 
modern text-books. 
Of extirpation of the uterus she says, after speaking of the 
occasional necessity for it in prolapsus and inversion, that the 
operation of total extirpation is so formidable that it will 
probably be ultimately interdicted in those cases in which the 
uterus is in its place. 
She then goes on to mention two cases of hysterectomy per- 
formed by ignorant persons which proved successful, and 
several by skilled men, all of which were apparently fatal. 
Her chapters on fibroids, polypi and cancers are in accord 
with the best teachings of those times. Of cancer she says: 
" The term cancer has been expunged from the vocabulary of 
pathological anatomy, owing to the want of precision in its 
use. By cancer we shall designate every affection which by 
converting in its progress the texture of the uterus, has a 9 
natural tendency to increase, to propagate itself on all sides, 
and ultimately to be itself destroyed by ulceration beginning 
at its centre. We shall hereafter distribute them into four 
chapters under the titles of the scirrhous, the fungous, the 
ulcerous, and the haematode." 
In her chapter on puerperal fever she says that the causes 
are still unknown. "Cold operates more frequently as the 
occasional rather than the exciting cause, but all the facts go 
to refute the so-called humoral pathology." 
She speaks of the success of ergot in hemorrhages of the 
uterus, but says it is difficult to state what are the particular 
cases in which it should be used. She discusses the two con- 
tradictory opinions which existed as to the origin of hysteria, 
and although she agrees that the theory that hysteria proceeds 
from a disease of the brain is not unreasonable, she thinks 
that as the state of the uterus so distinctly modifies the nervous 
symptoms, its primary and real source may be fairly traced to 
that organ, especially when we consider that undoubted though 
slight hysteria always exists at the time of the menopause." 
She describes minutely various paroxysms, (1) suffocating 
paroxysms, (2) apoplectic paroxysms, (3) syncopal paroxysms, 
(4) cardiac paroxysms, (5) pertussiform paroxysms. Of the 
fourth variety she gives two examples, one being the case of 
no less a person than Madame Lachapelle herself. " Madame 
Lachapelle was affected with symptoms which had been 
attributed to aneurism of the cceliac artery, and spasmodic 
dysphagia, which in one of her attacks almost precluded the 
use of food and drink for fifteen hours. In 1812 the case 
assumed the form of palpitations accompanied by dyspnoea, 
excessive anxiety and extreme debility, with general trembling 
and oppressed respiration. These symptoms were always 
attended by a profound sense of coldness, alarm, and appre- 
hension of aneurism. After continuing for a quarter or for 
half an hour the paroxysm subsided, and repeated eructations 
announced its termination." 
She gives nothing new or very strange for the treatment, 
but says that the cough can be cured by the syrup of mor- 
phine, a therapeutical hint of doubtful value. 
In speaking of diseases of the ovaries, she raises the ques- 
tion whether it would not be safer and easier to remove a 10 
diseased ovary through an incision in the vagina. She cites 
a case of labor during which a scirrhous ovary came down 
and projected from the anus together with a portion of the 
rectal wall; this was cut off and the woman died. But she 
questions whether, if the case had not been complicated by the 
labor, and the incision had been made through the vagina, 
the result would have been equally fatal. 
She devotes separate sections to diseases of the Fallopian 
tubes and those of the ovaries. In speaking of the ovaries she 
again mentions the operations of N. Smith and Ephraim 
McDowell of Kentucky, and after giving various others, 
reaches the following conclusion : " There are then 15 cases of 
this operation, namely extirpation, of which 6 have been attended 
with at least temporary success, 5 with neither good nor bad 
results, and 4 with death. In five cases the operation could 
not be completed. Extirpation will therefore be indicated 
only when the diagnosis is distinct; when the mobility and 
recent date of the tumor preclude the probability of adhesions, 
and when the absence of hardness after examination by punc- 
ture removes all fear of serious complications. Even then we 
should hesitate, but if we do decide upon the operation, the 
incision should be as small as possible, the sac should be first 
evacuated by puncture and afterwards drawn out in its empty 
state." 
Several pages are devoted to injuries and inflammations of 
the pudenda. She recognizes three kinds of lacerations of the 
perinaeum, the anterior, the central or posterior, and the com- 
plete laceration. She concludes by giving cases of faecal fis- 
tula which opened through one of the labia majora. 
The plates which accompany the book are excellent. 
We do not pretend in this short paper that we have done 
full justice to the works of Madame Boivin. It is evident that 
she not only understood her subject, but she also knew how 
to write lucidly. Even if her own modest assurance is true 
that her works contain little that is original, at any rate we 
owe her a great debt of gratitude for collecting and putting 
in a readable form the combined knowledge of the majority of 
the principal authorities of her time.