REMARKS ON THE WRITINGS OF LOUYSE BOURGEOIS. 
By Hunter Robb, M. D., Associate in Gyncecology. 
[Read before the Historical Club, May 8, 1893.] 
[ From The Johns Hopkins Hospital Bulletin, No. 83, September, 1«93.3 [From The Johns Hopkins Hospital Bulletin, No. 38, September, 1898.] 
REMARKS ON THE WRITINGS OF LOUYSE BOURGEOIS. 
By Hunter Robb, M. D., Associate in Gyncecology. 
[Read before the Historical Club, May 8, 1893.] 
Shortly after being asked by the President of onr Society to 
read a paper on Louyse Bourgeois I wrote to Prof. Goodell1 of 
Philadelphia, who was kind enough to send me a copy of a 
paper on the same subject which he prepared as the annual 
address before the Philadelphia County Medical Society in 
1876. Some of my hearers have no doubt read this address, 
and for those who have not done so there is a treat in store 
whenever they can lay their hands on a copy. They will find 
here not only an excellent sketch of the life of this celebrated 
woman and of her career as a midwife, but also a graphic 
picture of certain phases of court life as it existed at that 
time. 
The first edition of Louyse Bourgeois' works on Obstetrics 
appeared in 1608. A second edition in 1617 contains an 
additional book with a long list of clinical cases, and the 
account of " How she became a Midwife," being followed by 
" A true Description of the Births and Baptisms of the Chil- 
dren of France," and "Advice to my Daughter." Unden 
the date of 1626 there is another edition augmented by a 
third book. In 1634 the sixth edition appeared with an 
appendix, "A Collection of the Secrets of Louyse Bourgeois," 
of which last we may say, " Good had it been for that book 
had it never been published." The dates in the edition 
which I have been studying are 1652 and 1653. 
The life of Louyse Bourgeois has been so well put before 
us by Prof. Goodell, and he has given such an excellent and 
entertaining account not only of the woman but of the royal 
midwife, that there seems but little left for me to do. I 
11 have also to thank Prof. Goodell for the loan of the woodcut 
which accompanies this article. have therefore refrained from going over the ground which 
he has covered, and have contented myself with going a 
little more into detail in the discussion of her first and 
greatest book. It is only necessary by way of preface to say 
that Louyse Bourgeois was born in 1563 just outside the walls 
of Paris. She married Monsieur Boursier, a surgeon who was 
an assistant of the celebrated Ambrose Pare, many of whose 
precepts are no doubt embodied in this work. She was mid- 
wife to Marie de Medici, wife of Henry IV of France, and 
she was the first midwife to write a book upon the subject of 
obstetrics. She lived to a ripe old age, but the date and place 
of her death are unknown. 
The title-page of this work is adorned with an allegorical 
picture showing the Assumption of the Virgin and Child at 
the upper portion of the page, with the Pope kneeling on one 
side and a figure of John the Baptist on the other. Lower down on either side is a figure, one with a child in her arms 
and bearing a cornucopia with the legend "Timor Dei." The 
other, bearing the legend " Gratia Dei," has a palm in one hand 
and a basket in the other. Beneath the right-hand figure 
there is a child lying on a sheaf. Between these two figures 
is a scroll on which the name of the book appears; just above 
the scroll is the lily of France, just below the name of the 
bookseller. At the bottom of the whole picture is the inscrip- 
tion, " Natura humana fragilitas humana." 
The queen to whom she dedicates the book was Marie de 
Medici, wife of Henry IV of France. The work is divided 
into several parts. The first book is entitled-"Divers Obser- 
vations on Sterility, Loss of the Ovum after Fecundation, 
Fecundity and Childbirth, Diseases of Women and of Newborn 
Infants-amply treated of and practised with success by L. 
Bourgeois, called Boursier, midwife to the Queen. A work 
useful and necessary for everybody." The language through- 
out is very quaint old French and is at first more or less 
confusing. One is again and again reminded how closely the 
French is connected with the Latin ; for example, the modern 
word for bed, lit, no doubt is derived from the Latin lectus, a 
couch. In this book it is spelled lict, the c being retained, 
and similar instances occur throughout the work. In the 
edition I show you to-night the Observations are divided into 
three parts, and although there is no date on the title-page of 
the first book we have on the first pages of the other two books 
the date of 1652. To these three books there is added a work 
entitled "A Collection of the Secrets of Louyse Bourgeois," 
published in 1653. In the first book of the Secrets she gives 
the treatment for internal diseases-headache, hydrophobia, 
catarrh, for which she declares that she has a sovereign remedy 
but says it is very difficult to make, although this probably 
will not account for the fact that it is not used at the present 
time. Then comes a long chapter on the treatment of the 
eyes. For the treatment of deafness and the teeth she has quite 
a materia medica. She also considers diseases of the chest, 
coughs, pleurisy, etc. Fevers are then taken up. In speaking 
of the plague she says a piece of the root of enula campana, 
the size of a pea, held in the mouth is a certain prophylactic, 
and if one has the disease already it will cure it. She also 
considers the diseases of the liver and kidneys, dropsy, 
gravel and stone in the bladder, and next the diseases of the intestines, such as diarrhoea, or "flux of the belly" 
as she calls it; for the last she advocates the milk of a 
cow, goat or sheep, which should be milked on the day of 
St. John the Baptist, namely, on June 24th; of this cheese 
is made and it is given to the patient to eat. For hemor- 
rhoids she has a great many prescriptions, mostly salves. 
She also has remedies for neuralgia. In the next section she 
speaks of poultices of hot apples for inflammation or for curing 
tumors. For cancer she recommends egg-shells prepared in a 
peculiar manner and given to the patient to eat. She also 
gives an ointment for swellings and old ulcers and "things 
that have been pronounced incurable by other people." She 
also gives all sorts of remedies for dog-bites. In the third 
section she returns to the diseases of women. 
In speaking of the remedies for diseases of women before 
marriage and during pregnancy, during and after labor, she 
recommends that the breasts should be kept firm so that they 
never may hang down, by rubbing on them the egg of the 
partridge. She quotes Pliny in support of this treatment. 
Then she speaks of what she calls embellishments and gives 
her prescriptions for taking away smallpox marks and making 
the face beautiful and white, and for doing away with warts, 
moles and freckles, and which are also for beautifying the 
hands. She ends up with a list of remedies which are good 
for almost anything. She has a very fine pill which she 
describes as being good for many kinds of pains and poisons, 
and the frequent use of which preserves from syncope and 
trembling and renders the chest sound and well. 
She also has what she calls an eau celeste which has all the 
virtues and properties which are hereafter noted. The descrip- 
tion of its virtues and properties takes up about two pages, 
the recipe itself about one and a half. But I spare you. 
To return to her first book of the " Observations." After 
the usual references to adverse critics of which the writers of 
those times were so fond, she writes a preface to the Queen 
and to the reader, pointing out that her great aim is to enable 
the reader to regain the precious flower of health. Then there 
are a few verses to various persons, one to each of the several 
court physicians. 
She starts out by describing sterility and its causes. While 
recognizing the fact that it is possible that the man is at fault 
in some cases, she holds that the condition is usually due to some disease of the woman. The most frequent cause is the 
fact that the female sex is extremely humid but nevertheless 
choleric. Now the uterus is the receptacle to receive the life 
of the blood and to expel it from the body. Those women 
that abound more in choleric than in good blood are likely to 
produce moles or bad germs, because nature, wise as she is, 
cannot make a good garment out of bad stuff. Such women 
ought to be bled and purged, and should not allow themselves 
to give way to fits of anger. She says that in these cases an exter- 
nal examination will be of no use, for the malady is an internal 
one, and when recognized by the skilled physician can easily 
be cured. Now there are others again, she says, who are sterile 
from too great humidity of the uterus. The humidity coming 
from the brain and passing down the spine and back, 
moistens and cools the uterus until there is so little of the 
maternal heat left that the substance out of which the foetus 
is to be nourished cannot be preserved. She recommends 
medicines which will act by drying these up, and says that the 
physician should address his efforts to the stomach, as to a bad 
cook who neglects his duty and will not cook the food which 
can be made to serve for a nourishment of the whole body. 
" These remedies will cure the patient to the content of the 
physician and that of the patient as well." 
Then she speaks of leucorrhoea and the retention of the 
menses, the latter of which she thinks is likely to lead to 
cancer, and recommends internal rather than external remedies. 
She says that there are some women who have a cold humor 
which blocks up the entrance of the womb and sometimes 
causes displacements. 
Another cause of sterility she holds to be a long and hard- 
ened cervix, which instead of presenting the appearance of the 
mouth of a purse looks like a flageolet, and prevents the men- 
strual flow from getting out, the retention causing vapors in 
the brain and " marvelous suffocations of the uterus," in some 
women causing convulsions, and movements of the uterus as 
if there was something rolling about inside the body, and the 
women then think that they are pregnant and avoid anything 
that will tend to disperse the humor. A skilled midwife rec- 
ognizing this elongation of the cervix would know that it 
could not possibly be the cervix of a pregnant uterus, but that 
the enlargement is due to retention of the menstrual flow. 
She quotes the case of a woman between forty-eight and fifty years of age who never had any children, but had milk in the 
breasts, with great enlargement of the uterus, attacks of vomit- 
ing, and desire for strange foods, and thought she felt the uterus 
move. Louyse Bourgeois distinguishes between the movements 
of the foetus and these false movements-"A child will make 
a little movement just like the beating of the wings of a little 
bird." The movements of the non-pregnant uterus she com- 
pares to those of a cat sitting in front of the fire and arching 
its back. She says that women feel sick at the monthly periods 
because the vapors of the uterus are sent up to the brain and 
fall back again on the uterus, just as when a pot is boiling the 
lid is lifted up and allowed to fall again. The condition is 
relieved by clysters. She quotes the case of a woman whose 
abdomen was enlarged as if in the ninth month of pregnancy, 
who had such suffocations of the uterus that she had a convul- 
sion every hour. She was purged, bathed and bled till at last 
the doctors gave her up for lost. She remained two days without 
any medicines at all and the attacks got worse. At this time 
Louyse Bourgeois was called in and persuaded hei' to take a 
fumigation which attracted the uterus downwards. The 
patient then had labor pains, brought forth a thing which 
looked like clotted blood, half-decomposed and stinking so 
that no one could stay in the room, and soon became better. 
With great modesty Louyse Bourgeois attributed the cure not 
only to the fumigation but to the treatment received from the 
doctors beforehand. She then talks about cases of amenor- 
rhcea with vicarious hemorrhage from the nose. 
Another cause of sterility she attributes to the habit of 
drinking too strong wine and eating highly seasoned foods, 
which act by heating the blood too much and consuming the 
fluid. " Such women are subject to ulcers of the veins and 
uterus." She evidently has seen post-mortem examinations, 
because she says she has seen opened several bodies of patients 
who had died from this. She recommends all such women 
to apply at once to physicians or good midwives. Her account 
of chlorosis is excellent. She says that it was supposed to be 
very often due to being crossed in love. She cured a young- 
man of chlorosis who was in love with a girl and had one or 
two relapses until he gave up his hopeless suit. Still in many 
instances, more especially in girls, she confesses that the pati- 
ents were too young to know anything about love. She anticipated modern treatment by prescribing iron and pur- 
gatives. 
Among the causes of abortion she says the principal one is 
paroxysms of anger, and she warns such women to consider the 
evil that they bring about, in that they prevent the perfection 
of the work of God, having received a human soul from God to 
glorify it eternally which they have not guarded, and thus have 
done violence to the holy sacrament of baptism. There are 
some, she regrets to say, w'ho although this catastrophe has 
been brought about by their own fault, will argue that the 
child not having lived had no soul. For such sinners she 
has a fearful denunciation. "Although human laws condemn 
to death those who destroy the beings, which are not created 
but for the use of man and have only a vegetative soul, what 
punishment is meet for her who wilfully prevents the birth 
of an infant who has a vegetative, sensitive and reasonable 
soul ? Again, what might not the child become in the 
world?" Evidently the authoress is very much impressed 
with having assisted at the entrance of royalty into the world, 
and is deeply imbued with the extreme benefit which such 
personages confer upon mankind. " What is commonly called 
willful abortion is punished by the laws of man; and those 
who cause abortion from want of forethought or carelessness, 
though they escape punishment in this world, can they hope 
to avoid the just laws of God ?" Nor do those who lend them- 
selves to the production of abortion escape her condemnation. 
Pregnancy she points out is generally accompanied by some 
pathological symptoms, such as debility and perverted appetite. 
She warns hei' patients to control themselves lest they should 
produce abortion, or lest their children should be born with 
marks upon them. She warns against too great eagerness to 
know whether pregnancy exists or not. " Miscarriages have 
been caused by unskillful and over-anxious midwives, who have 
thrust their finger into the uterus and have caused hemor- 
rhages which resulted fatally to the foetus." She says that 
during the first and second months a competent midwife can 
diagnose pregnancy on finding the os open ; after this time a 
certain diagnosis is impossible, "because the mouth of the 
uterus being closed, the enlargement she feels may be due to 
retention of menses, and she must depend on other signs." 
" If the mother is full-blooded, and if the infant is not able 
to use all the menstrual flow for its nutrition, and the remain- der is too great to be absorbed by the breasts, it must find some 
outlet from the body." This she holds to be an explanation 
of the fact that some women appear to menstruate during 
pregnancy. In these cases she recommends bleeding at certain 
intervals. For those who are feeble and emotional she recom- 
mends wine and meat, but she begs them to try to control 
their emotions; for she says such emotions make the woman 
swell, so that the uterus being pressed upon opens and casts 
the infant out. She attributes miscarriages from falls, etc., 
to undue relaxation of ligaments of the uterus. Such a mis- 
fortune may also be caused by raising the arms too high up, 
and she therefore cautions ladies of quality to beware how 
they exert themselves in doing up their hair, and tells her 
more humble clients that hanging out linen is very often pre- 
judicial to their condition. She points out the difference in 
this matter between women bred in the country and those who 
are town-bred. For pregnant women who have fallen or who 
have otherwise injured themselves and are threatened with 
miscarriages she recommends rest in bed and a recipe which 
she says has been successful in more than two hundred cases 
of her own. 
She then speaks of hydrocephalus, and attributes this to the 
same cause that brings about premature birth, namely, that 
the infant has found insufficient nourishment for its proper 
growth. She compares a premature infant to a good general 
of a besieged city, who, finding his provisions exhausted, 
accepts the situation and capitulates. She recognizes in certain 
cases the necessity of bringing on premature labor. She 
deplores the fact that certain midwives never call in a physi- 
cian until the case is practically lost. " Such women are those 
who prefer filthy lucre to true honor, and keep their establish- 
ments full of women who have no husbands." She thinks it 
only right to say that physicians attending midwifery patients 
should cease to attend cases of smallpox and other contagious 
diseases. 
In making the diagnosis of pregnancy she recommends 
the midwife to ascertain the date of the last menstruation, 
as well as the color and quantity of the flow. " Some women 
have amenorrhcea from fright and emotion, and we should 
inform these that there is no sign of pregnancy. Other 
women we should remember may suffer from amenorrhcea 
without being pregnant. We should inquire whether their appetites are changed or are capricious, and if they have desires 
for strange foods, whether, as is the custom in pregnant women 
in the first two and a half months, their bellies seem very flat 
so that they think their clothes are going to fall off of them, or 
whether they suffer from hypersensitiveness of the skin." She 
adds a list of other symptoms: (1) palpitation of the heart; 
(2) morning vomiting; (3) general irritability; (4) enlarge- 
ment and firmness of the breasts; (5) change in the color of 
the nipple, which becomes red in blondes and darker in color 
in brunettes; (6) enlargement of one side; (7) a feeling of 
heaviness aftei' eating. Lastly she recommends a digital 
examination in order to find out whether the mouth of the 
womb is shut " like the mouth of a bag through which you 
cannot push a grain of wheat." " Above all never try to push 
the finger into the uterus, and be sure that the cervix is not 
hard, because, as we said in the beginning, this occurs in 
sterile women." 
Talking of moles, she says that they absorb the blood like 
a sponge. Women in such cases grow large all of a sudden, 
and are more swollen at the end of a month than a pregnant 
woman at the end of three months. 
In case of an accident to a pregnant woman which would 
otherwise prove fatal, premature labor should be brought on, 
no matter at what period, in order to preserve her life. 
After speaking of the behavior of the midwife in case of 
premature labor, in the next chapter she goes on to speak of 
births at term where the infants do not present well, and of the 
various presentations, of which she mentions twelve. (1) The 
worst one of all is the presentation of the navel, when the 
belly comes first, the legs and arms being behind and the cord 
prolapsed. She suggests turning if possible, and says that 
such presentations are generally fatal unless the infant is 
small and the body, i. e. the pelvis, of the woman is large. If 
possible, the cord should be replaced. The accident is danger- 
ous " because the cord gets cold and the circulation is inter- 
fered with and the respiration of the child stops. For while 
in the body of the woman he breathes through the cord 
because he is swimming in water, and he cannot like a fish 
breathe through his nose without getting his mouth full of 
water." She suggests putting the woman across the bed with 
the head low and the hips elevated, so as to assist the present- 
ing part to go back, and then having greased the hand with fresh butter, to try and bring the legs down, pulling gently on 
the child during a pain. (2) For a transverse position, which 
she considers about as bad, she suggests also bringing down 
the feet. (3) In a shoulder presentation she recommends 
turning, and after allowing the patient to rest, that she should 
be placed in a convenient chair when she has pains, so that the 
weight of the head may bring it down. (4) When the arm pre- 
sents she says this must be replaced instantly, the best way being 
to have a bowl of cold water ready and to allow the infant's 
hand to rest in it, whereupon it will pull it back very soon. 
If, however, it is too feeble to do this, grease the arm before 
it has time to swell, replace it gently, and then turn by the 
feet. (5) If two hands present she recommends that these 
should be replaced in the same way, and the midwife must 
then decide whether it is better to bring down the feet or try 
to make the head present. (6) If one foot presents, and if the 
pains are strong, she tells the midwife to bring down the other 
foot as well. If the pains are feeble the patient should rest 
and a clyster should be given to produce a stool and at the 
same time to bring on the pains. (7) If the breech presents 
she says that it is very dangerous to allow an infant to come 
out doubled up, and recommends the midwife to bring down 
the feet. (8) The prolapse of the cord in front of the head 
she holds to be due to too much amniotic fluid. "On no 
account should the woman be allowed to stand up or sit in a 
chair. She should lie down with her head low, the cord should 
be replaced, and a pad of cotton should be thrust in where the 
cord is trying to come out, just like a cork into a cask." 
(9) The presentation of the hand before the head. (10) A 
face presentation, she says, can be mistaken for a breech pre- 
sentation, and she recommends the hastening of labor by 
stimulants or, if necessary, by an injection. (11) When the 
head presents more on one side than on the other she says the 
condition is very annoying, because it may be mistaken for a 
normal presentation. The patient should be put on her side 
so that the weight of the head will bring it into the middle. 
If this is not successful some manipulation will be necessary. 
(12) Even in the real normal presentation, when the head 
comes down in the middle line, she holds that the aid of 
the midwife is necessary. Sometimes the cord is entangled 
about the neck and must be disengaged. If this cannot be 
done, the cord must be cut and disentangled and both ends ligated. The ligation of one end is necessary in order to pre- 
vent the infant from losing blood; to the other end a string 
must be tied, which is fastened to the thigh of the woman for 
fear of losing it. The midwife must be prepared for another 
accident, as sometimes after the head is born the shoulders 
are large, and it may become necessary to pass the finger under 
the armpit and make traction. 
In Chapter VIII, premature rupture of the membranes is 
described. She says: " I have seen cases in which the mem- 
branes ruptured twelve, eight, six or four days before labor. 
If labor does not come on two or three hours after rupture 
then it will not come on for at least twenty-four hours. The 
rupture is due to weakness of the membranes rather than to 
an excess of the waters." She deprecates the rupture of the 
bag of waters purposely, for several reasons-(1) Because it 
may produce prolapse of the cord, or (2) prolapse of the hand 
or foot. She prefers to try to give strength to the mother that 
she may rupture them by her own efforts. " This premature 
rupture is considered very dangerous to the child, but in cases 
where the rupture has taken place twelve hours before labor 
there remains sufficient amniotic fluid to moisten the natural 
passages. These can also be lubricated by means of fresh 
butter." She warns women, however, in whom rupture of 
the membranes has taken place, not to go out of doors for fear 
the air may enter the womb. She says that she has seen cases 
in which the air did enter the womb and compressed the ves- 
sels, and the woman had convulsions. She begs them " to 
remain in bed and await the hour of God." 
In speaking of false labor pains she says they are due some- 
times to colic, sometimes to other intestinal disorders. 
" Colicky pains, if they begin above, never pass below the 
navel, and if they begin below, never pass above it. For these 
pains try hot linen, and if they are colicky pains they will pass 
off; if a real labor pain, this treatment will increase it." She 
also advises a vaginal examination. 
As to the position of the woman during labor. "A 
woman who wishes to keep about and can do so until she is 
just ready to give birth to the child, may be allowed to stand 
with her legs apart, supported during the pains by two strong 
people, or she can have a low stool with a pillow on it, in 
front of a table, and can kneel on the pillow and put her arms 
on the table." Our author, however, prefers to keep the patient in bed unless the labor is too long, and does not think it 
advisable to let the woman leave her bed at any rate after the 
head has engaged in the os. With this limitation, if it com- 
forts the woman (and she thinks the woman needs comfort at 
this time), she allows her to do as she pleases, especially as she 
says that she has often seen patients made worse by being 
forced by too solicitous mothers to keep in bed. 
The bed itself ought to be high at the head and coming to 
a point at the foot. A large faggot placed in such a way that 
it will touch the feet when the legs are not fully extended 
should be used to hold the feet. There are some women who, 
on the best of beds, think they are going to be suffocated. 
These women she says she has delivered sitting or standing 
up. She has known cases where the child was delivered with 
the mother in this position in the absence of the midwife, when 
the woman was not expecting it, and falling on the floor, has 
been killed. 
She says although it has been denied by some that twins are 
ever of the same sex, this idea is contrary to her experience. 
" In the case of twins the laboi' is longer. Sometimes the first 
child comes well and the other badly. It is certain that the 
first born is the stronger because it has broken through the 
membranes first. In one case a second child was left to nature 
and was born twelve hours afterwards, and though it lived, it 
was at first very weak." In such a case she thinks that nature 
ought to be aided, the labor pains excited and the bag of 
waters ruptured. If the second child presents badly the mem- 
branes should be ruptured, and turning by the feet performed. 
The cord of the first child should be cut and ligated before the 
second one is born. 
With reference to medicines which are to be given to a 
woman in labor, she is not in favor of employing violent reme- 
dies unless in cases of extreme necessity, " as this procedure is 
apt to cause marvelous fevers after child-birth." The two 
extremes must be avoided, "repletion and inanition." Nour- 
ishing broths, the yolk of an egg, and ammonia water to 
fortify the heart are recommended. "Not too much, however, 
for fear of causing fever." She mentions other recipes, but 
prefers that the doctor should decide what the patient should 
or should not take. She gives recipes which are recommended 
by learned physicians, as in some cases the idea of sending for a physician frightens the patient unnecessarily or makes her 
believe that the midwife is incompetent. 
The Delivery of the Afterbirth.-To make the diagnosis she 
places the infant on the edge of the bed with the head and 
abdomen covered, taking care that nothing touches the face ; 
then with the hand on the abdomen of the woman she finds out 
on which side the placenta is situated. Friction being made on 
the side where the placenta is found, the woman is ordered to 
close her fist and blow into it, or put her finger into her mouth 
to produce nausea, or to strain as if she was going to stool. If 
this does not succeed, she is made to take the raw yolk of an 
egg. " The knowledge that the egg is raw produces nausea 
and excites the stomach, and often even the thought of it will 
have the same effect. Asafoetida and such like remedies may 
be useful." In two thousand labors she says that she has 
never had occasion to put her hand into the uterus to get the 
placenta except in two cases. The one case had been misman- 
aged by another midwife; the other one was of fever, where the 
uterus was so dry that the placenta could not be expelled. 
She gives three rules in which this procedure is justifiable- 
(1) If the woman is bleeding, (2) where there are convulsions, 
(3) when the woman has fever and the womb has become too 
dry. She has seen bad results in cases where doctors and mid- 
wives have been too hasty in this matter. 
Chapter XVI deals with the after-pains, which are said to 
be often due to rolling of the uterus in the belly and to 
displacements. 
Post-partum hemorrhages (she holds) occur in some women 
because they have too much blood, and in others because they 
have taken too many heating remedies during their labor, so 
that the blood is heated and hemorrhage occurs. This is 
followed by great weakness, which must be met by wine in 
small doses, and by a moderately tight bandage, which she 
thinks compresses the vessels. The white of an egg is recom- 
mended to restore the natural heat of the stomach, which is 
diffused all over the body, and at the same time along the 
spine, over the course of the vena cava, a napkin which has 
been wetted with a mixture of vinegar and water should be 
placed. She does not allow the woman to go to sleep while 
the bleeding is going on, because she thinks that she is more 
likely to die under these circumstances. When the hemor- 
rhage is partially controlled she orders that the astringent be taken off and a little of the blood allowed to come away slowly, 
so that it will not do harm by remaining in the womb. 
Chapter XVIII treats of the puerperal state. "As soon as 
the woman is delivered, after a hard labor she must be put in 
the skin of a black sheep which has been flayed alive. This is 
applied to the back. To the belly is applied the skin of a 
hare which has also been flayed alive. The animal having 
been flayed, its throat should be cut and the warm blood 
should be rubbed on the inside of the skin and applied to the 
body of the woman. This blood chases away the melancholic 
blood. In winter these remedies must be kept on two hours 
and in summer one hour." She then describes rather a com- 
plicated abdominal bandage which she was in the habit of 
using. "After this is taken off, hot linen should be applied to 
the breasts for about twelve hours before giving proper reme- 
dies for producing milk." " These galactogogues should not 
be put on till later, because the blood is still too excited." 
For women who have little blood she orders nourishment. 
She has found that those who lose but little blood are apt to 
persuade themselves that they would be better if they lost 
more, so that they want to be bled. She warns the doctor not 
to listen to the entreaties of such patients. " Some women 
whose discharges are white think there ought to be blood in 
them, whereas these white discharges are in reality blood 
which has gone to the breasts to be made into milk, and not 
having been utilized is returned to the uterus, whence it is 
discharged." 
She expressly states that the rules of life are not the same 
for every woman in the puerperal state, and that one cannot 
give the same diet to a society lady in town and the peasant 
woman in the country. " The stomach of the one is stronger; 
if you offer it soup it acts like a mill that is grinding without 
anything in it. To delicately nurtured women give very light 
diet, soups, jellies of veal and chicken, but not of mutton, for 
fear of fever, and the wine should be diluted. Combat insom- 
nia by barley water. After eight days the nourishment can 
be increased." 
For eight days after labor she recommends a daily injection 
of honey water with extract of roses, holding that milk is dan- 
gerous and is not so cleansing. 
Chapter XXIII treats of antigalactogogues. "There aro 
many such remedies. Some nurses use their favorite remedy on all their patients. This is just like applying the same 
saddle to many horses." " These," she adds with scorn, " are 
often secret remedies." She expresses the opinion that although 
some people say that a midwife need not be a nurse, no woman 
unless she is a good nurse can be a good midwife. Then she 
speaks of inflamed breasts and suppuration. She says that 
she has known cancer to come from unwise applications to the 
breasts. She mentions an autopsy in a case of cancer in which 
in the uterus were found great red tumors, which were caused 
by the milk which had been present since the birth of the last 
child, and having returned from the diseased breast to the 
uterus had brought with it some of the cancerous growth. 
She holds that this could have been avoided by proper appli- 
cations to the breasts. She recommends great care where the 
breasts have been fissured by the infant. She warns against 
the danger of catching cold in the breasts. 
The taking of drugs by the mouth in the first days of the 
puerperal state she thinks dangerous. 
The care of the newborn child. " It is the custom of learned 
doctors to give to the child as soon as it is born a teaspoonful 
of pure wine to revive it after the agitation it has gone through 
in being born. Others believe that wine cuts the phlegm which 
is ordinarily found in the throat. Others again believe that 
the vapor of the wine mounts to the head and makes the brain 
firm. Such children are thus protected from epilepsy in after 
life, since epilepsy comes from debility of the brain. The 
umbilical vein should be ligated firmly, and if it be full of 
blood it ought to be emptied, for fear that this should turn 
into pus. It should be ligated two finger-breadths away from 
the belly, and cut three finger-breadths below the ligature. 
If the cord is large and full of water and of winds, after the 
end has been wrapped in linen for half an hour it should be 
unwrapped and ligated afresh. It should be placed with the 
end upward, as there is thus less danger of bleeding. The 
infant should be washed in warm wine and water, walnut oil 
being employed for the face, throat, arms and hands. Ban- 
daging the head is a very bad practice common in Paris and 
ought not to be employed. The tongue should be examined 
to see if the child is tongue-tied, but the frenum should not 
be ruptured with the finger, because the nail is poisonous and 
may produce a canker or an ulcer." She begs the lady friends 
of the family not to interfere too much, but to leave the care of the child to the midwife. She deprecates the practice of 
trying to form the face or head by pressure, " as if the child 
were made of wax or putty." 
Chapter XXVII refers to the choice of a nurse. The follow- 
ing are her rules. (T) See that the woman does not squint, as 
the infant may catch it; (2) she must not have red hair, 
because the milk of such a woman is exceedingly hot; (3) let 
her have good white teeth ; (4) let her not have a family his- 
tory of phthisis; (5) she must have a pure breath, otherwise 
the lungs of the infant will be irritated; (6) she must have 
a good digestion; (7) there must be no family history of lep- 
rosy, epilepsy, or any other disease. She quotes the case of a 
child who caught epilepsy from a nurse, a child of very good 
family. She holds that the moral character and disposition of 
the infant depend on that of the nurse, and that therefore the 
disposition of the nurse must be good. " She must not be 
irritable, and she must have milk in abundance, but not too 
large mammary glands." She thinks that the nurse will not 
be so good if she has her menstrual flow or if she has connec- 
tion with her husband. 
After treating of colic and the minor ills of children she 
comes to cancrum oris and cases of prolapse of the rectum. 
To remedy the last the child must be put with its head low 
and the bowel reduced, and she tells us that as the infant 
grows older the anus becomes smaller and the intestine bigger, 
so that the condition is finally cured. She orders the applica- 
tion of a bandage to be kept on all the time except at night. 
After giving recipes for ointments for making the limbs 
strong she speaks of falling of the womb, a condition which 
she attributes to accidents, carrying heavy burdens, working 
too hard, and bearing large infants. " Sometimes part of it is 
pulled out by unskilled midwives in their attempts to deliver 
the placenta." She prescribes rest in bed, but says that it is 
no use to treat the symptoms without finding out and remov- 
ing the cause. She recommends astringents with suppositories 
(or pessaries). "The pessary should have a hole so that the 
vapors of the womb can come out. It should be taken out 
occasionally to be cleaned. Such women should not lace 
themselves tight, for after labor they will have a proportion- 
ately bad figure." 
She insists that a midwife should be acquainted with the 
anatomy of the uterus. " If she does not know this she may try to expel the uterus instead of the placenta, as has been 
done in this city." Therefore she begs of the doctors to allow 
the midwives to attend their lectures on the subject, the mid- 
wives paying for the same. 
In speaking of a case of hydrometra she tells of a woman 
from whom there came half a bucket of water three months 
before labor. At the end of six months of pregnancy she 
experienced great pain, extreme tension and hardness of the 
belly, which seemed as if it were going to burst. The author 
gave her a carminative enema with some relief, but a month 
later, having the same pains and while pacing the room, the 
woman felt a great flow of water come from her, as if she had 
opened a water-tap. Louyse Bourgeois happened to be in 
childbed at that time herself and could not go. Two months 
afterwards the patient was delivered. The bag of waters was 
intact, " which shows that the water that came from her was 
not from the bag of membranes, but rather from dropsy of the 
womb." 
Chapter XXXIX is interesting as it gives us the signs by 
which the death of the foetus was diagnosed. It treats of a 
woman who was supposed to have labor pains at seven months, 
but Louyse Bourgeois diagnosticated a colic. After this there 
were no movements of the child. On examination the cervix 
was found to be slightly opened. She concluded on account 
of the colic that the infant had attempted to come from the 
womb and had died in the attempt. Two physicians and 
Madame Franqoise, who was a midwife, were called in consul- 
tation. It was concluded that the infant was dead from the 
following signs:-(1) the woman's breath was bad; (2) her 
excrement was very strong-smelling; (3) her eyes were dim; 
(4) her belly was cold; (5) when she turned on her side the 
belly all went to that side in one mass. Caesarian section was 
suggested, but the physicians decided " to leave the affair to 
God and to nature." The patient was in bed six weeks. " Two 
months afterwards she came to me saying that a large quantity 
of water as cold as ice had come away from her. I found the 
cervix dilated and she gave birth the same day to a fine female 
child. Her trouble was caused by drinking cold water, which 
gave her the colic and chilled the child." 
Our author sometimes performed surgical operations herself, 
for she states that once she extracted a stone as long as a 
man's finger from the neck of the bladder. She then narrates several cases. "A lady was delivered of 
two children, one dead and half rotten, and the other alive and 
well. The waters of one infant were all black, and the infant 
was dead and much disfigured and a hprrible sight, and had 
no epidermis. She then bore a live child immediately after- 
wards." 
The second is a case of lithopsedion. "A lady was delivered 
of a dead child from whom she had felt no movements for 
several months and which was born dead. The woman had 
felt no movement for a month. Heat was applied to the 
abdomen and something was felt to move up inside. This was 
undoubtedly the uterus, which being chilled by the dead child 
moved towards the heat. The woman had none of the ordi- 
nary signs of the death of the child, which is explained by 
the fact that the waters being cold they hardened the child 
and there was no putrefactive process." 
Third case. "A lady in her first labor bore a dead child and 
was badly nursed. Five or six days afterwards she became 
insane, and in spite of her husband, ran about the streets naked. 
Four years afterwards she recovered a little and bore a child 
without any accident. Ten years later she bore two children, 
one dead and one alive. On the fifth day she became insane. 
On the fifteenth day, as she seemed somewhat better, her 
guardians relaxed their watchfulness. She escaped and flung 
herself down a privy, a thing which in her previous attacks 
she had tried to do. She was caught by the scaffolding and 
saved. After ten months she got better and again became 
pregnant. I had her milk drawn, as she had never nursed her 
children. On the fifth day she showed signs of insanity. I 
attended her breasts, gave her an enema, and. the next day she 
was better. I have no doubt that the insanity was caused by 
the abundance of milk. In these cases there is acute fever. 
The heat goes to the head, the body gets cold, and the patient 
has chills. The lady became again pregnant, and following 
my advice (that is to say, by the use of enemata) she avoided 
all evil results." 
The next case is that of a woman who died from eating ice. 
"Attempts were made to bleed her, but no blood was obtained. 
She died within twenty-four hours. At the autopsy all her 
blood was found to have gone between the epiploon and the 
intestines, a vein having ruptured. This was brought about by over-distension caused by the ice. Except in the abdomen, 
not a drop of blood was found in the body." 
With respect to premature births at the seventh and eighth 
month, she thinks that some infants are born too soon from 
healthy women simply because the uterus is small, and that 
in other cases the accident is brought about by falls. If the 
placenta is broken off so that the child cannot breathe, he is 
drowned in the waters or is suffocated for want of air. 
The story of the woman who bore on her nipple a serpent 
for ten months, as well as the long list of infallible remedies 
which are scattered all through the work, proves that Louyse 
Bourgeois, with all her good sense, was not entirely free from 
credulity. But it is not only in the works of our author, or 
indeed those of others of the older writers, that chaff is to be 
found mingled with the wheat. To those who are inclined 
to criticize too severely, and who would dwell upon the 
credulity of the woman (a thing by the way which exists 
even in our times), and on her too ready belief in the infalli- 
bility of her own remedies, we would say, " Let him who is 
without sin cast the first stone." 
Throughout we can see the sound common sense, the pati- 
ence and, what is quite as important, the earnest desire to deal 
with cases not in any routine way, but to look at each by itself 
and seek to remove the cause rather than attend only to indi- 
vidual symptoms, which gave to Louyse Bourgeois her well 
deserved pre-eminence in her profession, and make her work 
not only interesting, but of much practical use to us of the 
present day ; for without these qualities, in spite of our better 
opportunities, we cannot expect to obtain good results.