74 
PATHOLOGY. 
once every week ; ftudents have accefs to it daily ; and, 
with a liberality ft ill more worthy of praife and of imi¬ 
tation, foreigners are admitted at all hours, and at the 
firft application. It is with aftonifhment we learn, that 
only fifteen years have been fpent in the accumulation 
of this admirable collection : for, in 1804, there were 
only 2u preparations. The very complete Mufeum of 
Berlin, colt: its founder, profeffor Walter, fifty-four 
years in its collection ; but it contains not more than 
2268 preparations. 
Three hundred bodies are annually at the difpofal of 
the faculty of Stralbourg. Such noble encouragement 
and opportunities of obfervation ; the co-operation of 
the profeffors and the practitioners of the town, who 
tranfmit, as to a common centre, the refult of their par¬ 
ticular pathological examinations; the rare and curious 
objeCts which flock from the neighbouring country; the 
intelligence and zeal of the profeCtors and ftudents ; all 
thefe circumliances combined, lead us to expeCt from 
this quarter ftill greater contributions to medical fcience. 
Since we have travelled out of Germany; and got again 
into France, vve {hall detain the reader a few minutes 
while we defcribe the prefent ftate of the obftetrical art 
in that kingdom ; which we are enabled to do by the 
very recent publication (1821) of the “Pratique des 
Accouchemens,” by a real mi dzcife, Madame Lachapelle, 
chief operator at the Lying-in Hofpital at Paris. 
This volume is one to which we have nothing fimilar 
in this country. It is the production of a female prac¬ 
titioner, placed by public authority in a molt important 
official fituation ; and is no lefs defervingof notice from 
the rare occurrence of fuel) publications, than from the 
juft views and accurate criticifms on the ftate of the 
fcience on which it treats. But thefe are fubjeCts on 
which it is not at prefent our intention to dwell, as we 
are inclined rather to take the opportunity of pointing 
out the ftate of public inftruCtion in this fcience in 
France, and to contrail it with the deficiency in this 
point, which all mull admit and lament as exifting in 
this country. 
From time immemorial, the only afylum afforded by 
the city of Paris j:o puerperal women, was a miferable 
ward in the Hotel-Dieu ; a principal midwife, with five 
or fix pupils, whofe ftudies lafted but for three months, 
ill fufficed for the number of births which occurred. 
The place was ftill more inadequate; the women admit¬ 
ted were heaped together, and commonly feveral lay at the 
fame time in one bed. Thefe inconveniences were of fo 
ferious a nature as to attradl the attention of the govern¬ 
ment. In the year 4 of the Republic (1797), the National 
Convention decided on building a houfe for theparticular 
purpofe of receiving parturient women. Madame La¬ 
chapelle, in conjunction with her mother, the principal 
midwife of the Hotel-Dieu, was charged with the direc¬ 
tion of the fervice of the new inftitution. The difpo- 
iitions for the arrangement and order of the whole efta- 
blifhment were formed in concert; and it is thus that 
the plan originally laid down has been more extenfively 
applied. The number of pupils as midwives has fince 
pone on increafing, as well as the number of individuals 
admitted. The former at prefent amount to 130 an¬ 
nually. This increafe, as well as the organization of the 
fchool, was owing to M. Chaptal, then minifter. M. 
Baudelocque was then made profeffor, and affilted to 
render the work more perfedt. M. Dubois, who l'uc- 
ceeded him, has preferved the order adopted by his pre- 
deceffor, which we proceed to defcribe. 
The pupils admitted at the School of Midwifery are 
expedted to employ themfelves as well with the relief of 
the patients as with their own perfonal inftruCtion : fuch, 
in fadt, is the principal objedt in view. This neceffity 
forces them to a practical ftudy, to which, in particular, 
they are indebted for their acknowledged Juperiority 
over the pupils of every other fchool. All pafs a w hole 
year at the hofpital ; and about a fourth part of their 
number twice this period, ferving in the fecond year to 
direCt the new pupils. The newly-arrived pupils are fe- 
parated into as many divifions as there remain old pupils 
who double the period of their flay. Thefe laft direCt 
the divifion entrufted to them, affift at funple labours, 
and point out to their companions the particularities of 
examination, &c. . 
The patients admitted are firft examined by the prin¬ 
cipal midwife, wdio rejeCts or retains them according to 
circumliances. The period fixed is the end of the eighth 
month. Simple deliveries are all performed by the pupils, 
in the prefence of the divifion, and under the direction 
of the elder one, who ferves as chief. Each pupil has 
the fubfequent care of the woman whom fhe has deli¬ 
vered. On the occurrence of the leaft difficulty, the 
principal midwife is called in. If the ufe of inftruments 
fhould be required, it is fhe who operates ; if the deli¬ 
very .be difficult, although the hand alone fuffices, fire 
ftill has the charge of it; but eafy manual deli veries are 
terminated, under her infpeCtion, by one of the old 
pupils, fo that almoft all have, before the end of their 
fecond year, performed an artificial delivery. Very com¬ 
plicated cafes, fuch as require the ufe of a cutting 
inftrument, call for the prefence of the profeffor. 
Peritonitis too often prevails in the wards : a hoft of 
other difeafes may alfo attack parturient women. It is 
then that, after being carried to the infirmary, they are 
entrufted to the care of the experienced and learned pro¬ 
feffor Chauffier, principal pbyfician. Under his infpec- 
tion, feveral female pupils note daily, and with 1110ft 
fcrupulous exaClr.efs, the fymptoms, periods, termina¬ 
tion of the difeafes, and the effeCts of remedies; they 
thus become accuftomed to recognize danger, to prevent 
it, and, if not to remove it, at leaft to have recourfe 
early to the affiftance of medicine. Three times in thg 
week the profeffor explains the theory of the fcience of 
midwifery. A lecture is given every day by the principal 
midwife ; and a fimilar one by Mademoifelle Hucherard, 
for eight years acquainted with the principles of the art, 
and honoured with the title of “ principal pupil,” wdio 
alfo exercifes the others on the model, in the ufe and 
application of inftruments. Amongft the old pupils, 
thofe who have molt facility in expreffing themfelves, 
and capacity for inftrudtion, are charged with giving re¬ 
petitions to the new comers, of the lectures of the pro¬ 
feffor, the midwife, and principal pupil. Amidft all 
thefe attentions to the principal objedt, the acquifition 
of acceffory knowledge is not negledted. Under the di¬ 
rection of the principal phyfician, the apothecary lays 
down to the pupils the general principles of botany, and 
makes them acquainted with the molt important plants 
and drugs. In the fame manner the leudent in medicine 
attached to the inftitution makes fome demonftrations on 
general anatomy, on that of the vifeera, on the principal 
functions, on the mufcles of the abdomen, and, laftly, 
on vaccination and venaefeCtion. For thefe two opera¬ 
tions the inftrudtions are not folely theoretical; the pu¬ 
pils bleed and vaccinate as often as there is an opportu¬ 
nity, but alw’ays in the prefence of the ftudent in medi¬ 
cine. Such are the means of inftrudtion prefented to the 
pupils in midwifery; the wifdom of the adminiftration 
lias added ufeful encouragements. At the end of each 
fcholaftic year, feveral prizes are given by competition, 
on fubjedts relating to the fcience of midwifery ; the 
principal is a golden medal: prizes are alfo given for 
clinical vigilance, the obfervation of patients, the ftudy 
of botany, and for vaccination. 
It is a circumftance perhaps only to be underftood by 
the confideration of the inconfiftency of human proceed¬ 
ings, that, while laws and regulations were early devifed 
for the protedtion of the public from the pretentions of 
the ignorant and unprincipled in the pradtice of medicine 
and lurgery, midwifery, a fcience connedted as it is with 
the tendereft feelings and belt interefts of fociety, fhould 
be left in the hands of the loweft and moft uninformed 
people, 
