Previous articleNext article FreePhantoms in the Classroom: Midwifery Training in Enlightenment EuropeMargaret CarlyleMargaret CarlyleUniversity of Chicago Search for more articles by this author University of ChicagoPDFPDF PLUSFull Text Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinked InRedditEmailQR Code SectionsMoreIn critiquing the replica of a pregnant woman used by her rival, the English midwife Elizabeth Nihell went so far as to describe it as a “wooden statue, representing a woman with child, whose belly was of leather, in which a bladder full, perhaps, of small beer, represented the uterus.” The rival she disparaged was the Scottish man-midwife William Smellie, who employed this replica to demonstrate birthing maneuvers in his courses. “This bladder was stopped with a cork,” added Nihell, “to which was fastened a string of packthread to tap it, occasionally, and demonstrate in a palpable manner the flowing of the red-coloured waters [and] in the middle of the bladder was a wax-doll, to which were given various positions.”1 For the Scotsman known as the father of British midwifery, use of such teaching mannequins was no laughing matter. By his own account, Smellie had trained some nine hundred students on his “automaton or machine.”In fact, what Nihell and Smellie disagreed on more fundamentally than the virtues of this demonstration dummy was if—and if so, how liberally—instruments like forceps should be used in childbirth. Nihell objected to Smellie’s “instrumentarian” approach and the credentialism male medical authority brought to a vocation traditionally understood to be the purview of women. Her critique also pointed to the disciplinary changes that were afoot in eighteenth-century medicine in general and midwifery in particular. Medieval certainties about the human body crumbled under the weight of new discoveries driven by the imperative of Renaissance anatomists to engage afresh with the “book of nature” through corporeal dissection. The experimental basis of medical inquiry flourished during the Enlightenment period and enlisted the development of new fields of expertise at the expense of traditional ways of knowing, such as midwifery. The eighteenth-century birthing chamber thus constituted a unique transitional battleground between “old” and “new” ways of knowing. It was a space in which competing epistemologies observed a gendered fault line: the female midwife, champion of nature’s in-built mechanisms to facilitate childbirth, was poised against the man-midwife, who promoted artificial assistance to laboring mothers in the form of surgical instruments.2It is tempting to view the widespread use of teaching mannequins like Smellie’s as the by-product of this seemingly paradigmatic polemic. In this script, such dummies represent another facet of male surgical ambition that encroached on traditionally female-led regimes of childbirth. The man-midwife, with his rational gaze and metal instruments, thus ushered in a new clinical age that sanitized any remnants of unorthodoxies like midwifery. This narrative is supported by the subsequent birth of the clinic, in the words of Michel Foucault, wherein the body was medicalized and disciplined in unprecedented ways.3This gendered narrative nonetheless overlooks other more compelling and less teleological explanations for the widespread use of medical teaching dummies. Drawing on French examples (in light of Paris’s role as Europe’s center for medical training), this essay contends that masculine intervention in birthing is not the primary context in which we should view their development or widespread use. Instead, the growing fashion for mannequins is better understood as part of the confluence of three interrelated developments. First, these models responded to genuine educational lacunae in the training available to male (accoucheurs) and female (sages-femmes) aspirants to the midwifery profession. For male apprentices, training on inanimate mannequins represented a key step in professionalization that allayed concerns over trainees’ titillating interactions with real women’s bodies. For female aspirants, these dummies presented invaluable opportunities to gain knowledge of reproductive anatomy that were not otherwise available. Second, these models both reflected on and contributed to a new mechanistic view of the human body. Explorations of the machine-like nature of man—and woman—that began in materialist philosophy soon found expression in new technologies devoted to artificial life. Around midcentury, mechanical ingenuity applied itself in the service of medicine in new ways. Third and finally, these models were big business. Their design, construction, sale, and use were inscribed in a growing medical marketplace powered by nascent bourgeois values of comfort and care. Makers and practitioners of mannequins competed for a share of the market in ways that defy the gender divide between midwife and man-midwife.Pilgrimage to Paris: Training Women, Training MenBoth Elizabeth Nihell, who defended childbirth as a female domain, and William Smellie, who encroached upon it, made pilgrimages to Paris to learn the art of birthing from the best practitioners of the period. Both also returned to London to set up their respective schools with much success. But their training experiences while in Paris around midcentury were very different and reflected a new landscape of obstetrical pedagogy that was more gendered than ever before. In 1747, Nihell enrolled at the prestigious Hôtel-Dieu de Paris, a general hospital outfitted with a birthing ward that attracted students from across Europe. Each year since at least 1630, trainees vied for one of the coveted four hundred spots that would give them access to a twelve-week apprenticeship divided equally between practical and clinical training. The hospital’s reputation had nonetheless begun to falter by the time Nihell arrived for her course. Its infrastructure failed to keep pace with the growing demands of an enlightened city—it was old, overcrowded, understaffed, and known for high newborn death rates. Outbreaks of puerperal fever, a deadly postpartum condition, ravaged the birthing ward from 1745 to 1746 and contributed in no small part to the hospital’s decline.4Female midwifery aspirants who failed to make the cut at the Hôtel-Dieu were left to gain an education from one of the many practitioners who advertised their courses in Paris and the provinces. The French man-midwife Auchier was nonetheless of the opinion that the available instruction outside the Hôtel-Dieu was more harmful than helpful to students when it came to exercising their art. He concluded that because “the science of birthing is too complicated to be innate,” resources must be invested in educating trainees in the art of dissection, the anatomy of the pelvis, and the positions of the unborn child.5 Female midwifery trainees in Paris shared in Auchier’s grievances over the lack of education in both human anatomy and birthing techniques. This was exacerbated when female midwifery students were banned in 1733 from anatomy classes at the schools of surgery on rue des Cordeliers in the Latin Quarter, Paris’s hub of medical training since the Middle Ages. It comes as no surprise that some forty midwives addressed a petition to the Paris Faculty of Medicine on June 29, 1745, in order to demand access to “anatomical demonstrations for themselves and for their aspirants” on women’s body parts related to childbirth, “so that they may know with some certainty when they must ask for help they cannot give.” Female midwifery trainees also demanded readmission to the Faculty of Medicine’s courses devoted to the dissection of female cadavers.6The fair sex’s presence in crowded amphitheaters to observe autopsies was deemed an indecent presence for the purportedly flustered male apprentices. Growing expectations of professional conduct and competence in the medical milieu nonetheless challenged both government officials and practitioners to provide female and male trainees with more extensive and better quality training. Designs to address training inadequacies for female trainees in particular prompted debate over just how extensive their knowledge of human anatomy and medical theory ought to be. The overwhelming illiteracy of the female student population meant that oral rather than bookish knowledge was emphasized in midwifery apprenticeship. For a man-midwife such as William Smellie, the ideal midwife was well-versed in human anatomy but quick to call on a male surgeon for guidance in the event of intractable cases.7 Smellie’s hierarchical and gendered vision of roles in the birthing chamber reflected pervading prejudices across Europe, which understood the man-midwife as the proprietary expert of both theoretical and practical anatomy.This conception of the learned and skilled man-midwife was not readily achievable in the Parisian context, however, on account of male students being barred from attending births at the Hôtel-Dieu. A government proscription was issued in response to a series of documented complaints lodged by female midwives against male students for impropriety. Surgery apprentices were known for their raucous behavior at the best of times, and it was their “levity and indecent behaviour” on this occasion that prompted the ban, according to the English man-midwife A. Tolver, in his manual on The Present State of Midwifery in Paris.8 Men thus looked elsewhere for a practical education. The English author of Man-Midwifery Dissected (1793), John Blunt (pseudonym for S. W. Fores), argued that men ought to study the art on corpses in dissecting rooms and leave the practice of “touching” women—a bawdy take on the technical term for pelvic examination—for their marriages. Humor aside, the question remained: Was there a suitable teaching alternative for male apprentices? Blunt reckoned that “a machine resembling nature as nearly as possible, adapted to a real pelvis and spine” would train students on the art of “turning” an infant into a suitable birthing position.9 The French accoucheur Auchier, who like his English counterpart sought to found a midwifery school, concluded that the best education required “listening attentively to a man who has dissected and delivered, then operate under his eyes on what is called the phantom.”10This meant that when William Smellie traveled to Paris in 1739 to apprentice in midwifery, men had already been barred from observing deliveries in the Hôtel-Dieu’s birthing ward. Instead, he turned to a private course offered by father and son Grégoire on their new “machine” that Smellie described with some condescension as “no other than a piece of basket-work, containing a real Pelvis covered with black leather, upon which he could not clearly explain the difficulties that occur in turning children.” Another male apprentice offered a ribald description of what was probably also the Grégoire model: “Madam is a Piece of Basket-work, covered with a Kind of Silk, in Imitation of her Skin, and appears in her Buff.” Crude as Grégoire’s mannequin was, Smellie was struck by its pedagogical potential, believing “that there was a possibility of forming machines which should so exactly imitate real women and children, as to exhibit to the learner the difficulties that happen in midwifery.”11Mock-Women and the Mechanical TurnLearning the tricks of the trade on a phantom was thus equally attractive to male and female students from around midcentury onward.12 For most female trainees, a spot at the Hôtel-Dieu was not forthcoming, and opportunities for theoretical learning were sparse in light of both women’s exclusion from observing autopsies at the Medical Faculty and the practical orientation of courses aimed at transmitting knowledge orally to illiterate women. For male trainees forbidden from observing deliveries firsthand at the Hôtel-Dieu’s birthing ward, the phantom provided hands-on training in ways that also assuaged moral concerns, to the extent that even Elizabeth Nihell conceded that Smellie’s “doll-machine” was not, after all, a real body.13 Nor did the arrival of teaching phantoms signal the end of women’s role in training future practitioners given that midwives, as much as male surgeons, constructed, as well as taught and learned on, them.In fact, those fashioned by the French midwife Mme du Coudray were surely the most widespread and reputed teaching dummies. She was appointed King Louis XV’s midwife, receiving a royal brevet in 1759, and thereafter undertook a nearly twenty-five-year “mission” to educate male and female trainees across the provinces.14 Although Mme du Coudray occasionally ran up against male surgical authority, she more often than not gained respect and acclaim from the French medical community. She also gained a reputation abroad; the English woman of letters Ann Thicknesse eulogized Mme du Coudray’s “femme artificiel [sic], this ingenious invention … approved by the most learned of the faculty” on which she taught students at her school “the Theory of their profession.”15Mme du Coudray’s handcrafted “artificial woman”16 piqued the curiosity of the Paris Royal Academy of Surgery, which functioned as the de facto sounding board for ingenious new medical machinery. She was invited to present her mock-woman to its all-male members on May 6, 1746.17 Thereafter two academicians, the surgeon César Verdier and man-midwife Levret, provided a detailed and glowing report whose title began with the term “Fantome,” which was scratched out and replaced with “Mannequin,” as if to suggest ambiguity over the dummy’s ontological status.18 This “machine” was designed as a surrogate mother and reflected on how eighteenth-century modes of midwifery training embraced a mechanistic view of the body that pervaded the culture of birthing technology more generally. These machines were part of a broader experiment in applying mechanical philosophy to realms of technical achievement. French engineers such as Jacques de Vaucanson, for instance, perfected self-moving androids that included a flute player and the famous “defecating duck.”19 Medical practitioners shared an interest in harnessing mechanics to develop technologies for the benefit of their patients, and this period saw the emergence of novel machinery like adjustable beds for paralytics.20The popularization of the teaching mannequin should thus be seen as the outgrowth of a mechanistic turn in medical technology in ways that take us well beyond Nihell’s mocking critique of Smellie’s mock-woman. Yet these women were “mock” in a very real sense: they were never mistaken for real, animate bodies. This did not mean that their lifelike effects were lost on their users. Their artificial status in fact rendered them particularly virtuous for the trials and errors of classroom learning: detachable organs and the mechanical touches that mimicked birthing waters offered all the advantages of deliveries without their mess, risk, and unpredictability.These models were nonetheless vexing enough to generate a variety of descriptors: phantom, automaton, manikin or mannequin, (doll-)machine, mock-woman, artificial woman, and dummy. The sheer number of designations suggests the ambiguity surrounding their construction, use, and relationship to real bodies. The French word “mannequin,” derived from the Dutch term “little man,” came into use around 1730. It designated an artist’s or tailor’s lay figure employed in textiles, and its application in the obstetrical context underscores their doll- and toy-manufacturing origins—on which more shortly. Terms like automaton and machine presented the models as mechanical reconstitutions of living prototypes, while doll-machine matched their manufacturing history to mechanistic design. Finally, the terms phantom and mock-woman leveled concerns over the ontological and moral status of these models.Mme du Coudray’s “Innocent Artifice”The Enlightenment values of naturalism and verisimilitude in scientific representation embodied in these machines were not the limit of their appeal. Their utility was in churning out experts whose skills developed on a classroom dummy would seamlessly transfer into deliveries in the birthing chamber. It was said that Mme du Coudray came up with the idea of crafting a dummy as she stood before her students one day and realized “that it was to their eyes and to their hands that she must speak.” So was born her “innocent artifice” on which trainees repeated birthing maneuvers to her satisfaction.21 Teaching phantoms may have lacked in the accuracy and detail of the life-size anatomical waxworks that attracted a curious public to museums like the Florentine La Specola. But they adequately served their function as stand-ins for birthing mothers. Indeed, the skills honed on such machines were considered suitable precursors to real care of female patients. Through repeat visualization and hands-on engagement with models, students nativized maneuvers and gained the requisite dexterity to navigate the trials and tribulations of their practice.Mme du Coudray’s phantom provided object lessons. In one exercise, she placed the full-term infant inside the hide bag womb in order to judge if the student could be orally shepherded through the delivery. It was in the same spirit of guiding and testing the student that she positioned two rows of cords three inches apart at the back of the womb, which voluntarily altered the capacity of the uterus, in order to imitate the difficulties of introducing a hand into the birthing canal at the moment of contraction, when all parts of the child were compressed. Mme du Coudray’s demonstration supposed the infant would survive thanks to the manual dexterity of the midwife. But she also admitted the grim reality of infant mortality, and for this purpose, imagined modeling “the head of a child deceased for several days,” by depicting deformed cranial bones.22The increased reliance on phantoms in classrooms transformed the culture of midwifery training for initiates of both sexes. Demonstrations on dummies were integral to course curricula, and time practicing on them was coveted. Mme du Coudray’s students were each assigned a number and took turns of ten to fifteen minutes on the machine.23 Students also looked forward to receiving a certificate upon completion of a course, which validated their hard-earned expertise and provided female students in particular with the professional credentials they otherwise lacked given their subordinate membership status within surgeons’ guilds. The contents of these certificates reveal the integral role of dummies in a multifaceted apprenticeship, even when clinical training was also available. The man-midwife Jean-Louis Baudelocque at Bordeaux explained in the certificate conferred to his pupil, Antoine Roussillon, that he had run the gauntlet, by completing three courses, observing and assisting in numerous deliveries, and executing, “on machines or phantoms intended for this purpose, all the operations relative to the different kinds of birth—natural, unnatural, or laborious.”24 Meanwhile, students of Auchier’s (proposed) midwifery school would “undergo an exam and repeated maneuvers on the phantom,” with extra funds or prizes being awarded to the best demonstrators.25Mme du Coudray Builds a BrandCompetition between aspirants for prizes like those Auchier would offer to his students touch on another facet of these dummies: their place in a burgeoning marketplace of medical goods and the competition that arose between their makers in staking out a claim. During her royally sponsored travels across rural France to educate country midwives, Mme du Coudray taught over four thousand pupils under the auspices of the local governors known as intendants. These provincial officials usually greeted her with open arms and were duly impressed with her phantom and courses. Even surgeons’ communities that in other respects may have treated midwives as rivals applauded Mme du Coudray’s efforts to streamline and enhance pedagogy.26 The Surgeons’ College of Nantes in the western part of the country, for example, described how one midwife had given a particularly effective “Course on Birthing” using Mme du Coudray’s machine, which introduced students to “all the anatomical parts which midwives are obliged to know in order to decipher the mechanisms of birthing.”27Mme du Coudray received royal patronage to carry out her mission as the king’s midwife, but she was also a businesswoman who was keenly aware of the marketability of her goods. As machines like hers gained in popularity, the finished products exhibited greater naturalism and virtuosity thanks to ongoing design modifications. Mme du Coudray’s models became progressively more elaborate. Detachable sphincters, ligaments, and vessels were added, and one model included fifty-six components, each numbered so that the phantom could be easily dismantled and reassembled. The intendant of La Rochelle remarked in 1782, the year before Mme du Coudray retired from her mission, on the two prototypes she had perfected during her career: the original dry model and the modified model with liquid effects.28 Colored materials depicted birthing waters on dry machines, while on wet ones she had contrived real, colored fluids resembling birthing fluids. Such touches served as diagnostic tools by which students might determine the outcome of any given delivery.29The machine presented to the Royal Academy of Surgery in 1746 was a dry one, as was a machine in Reims described in 1773. This later career machine resembled the earlier one but was a more elaborate iteration of a life-size mother with two full-term infants and accessories.30 The only known extant machine, now conserved at the Musée Flaubert d’Histoire de la Médecine in Rouen, is part of this second generation of dry models. It was deposited at the local Hôtel de Ville in 1778 and was neither used nor intended as a machine for demonstration, but rather, prepared as an archival model, from which Mme du Coudray or other midwives might make future machines or repair existing damaged ones. This machine’s 300 livres tournois price tag reflects its more elaborate component parts and material touches when compared to her standard 200 livres tournois model.31This model is remarkably well conserved. It is a life-size female figure, from torso to mid-thighs, perched on a metal frame (see fig. 1). She is crafted from upholstered canvas stuffed with cotton, with taffeta, flesh-colored hide, and ribbons also incorporated. The real pelvic bones in the female doll and vertebrae in the accompanying infant provide a lifelike quality and shape. Accessories included fetus heads, organs depicting the phases of delivery and potential difficulties, and even a contraceptive diaphragm. Though a show-model, the machine’s components were constructed to withstand the wear and tear of repeated use. Tough cloth and stitching, hard bone, and frames of metal and wood suggest a robust machine, but by no means a foolproof one. The demonstrator Barotte de Chaumont complained to Mme du Coudray that “the pubic bones on the machine entrusted to me broke during my last class.” He supposed that “the pelvis used by Mme du Coudray to make this machine was relatively corrupt, or it had been taken from a cemetery, because a fresh pelvis would not have made this effect.”32 Procuring uncorrupted bones was not easy given nature’s bounty might disappoint and the provenance of Mme du Coudray’s bones is unclear: were they obtained illicitly from cemeteries, or legally, from discarded corpses at surgeons’ colleges? The German man-midwife G. F. Mohr refers to wood and cardboard pelvises as suitable alternatives to real ones in the context of church sanctions against grave looting.33Figure 1. Mme du Coudray’s “machine” at the Musée Flaubert et d’Histoire de la Médecine, Rouen, France. Author’s own photo.View Large ImageDownload PowerPointIf anything, such criticisms suggest that Mme du Coudray had built a brand over the course of her itinerant teaching career. When she packed up following the conclusion of her course in a given town, it fell to local officials to continue the enlightened project she had started. She tried to make it easier for them by depositing a model and illustrative textbook with the intendants. Her Abrégé de l’art des accouchements, first published in 1759, was later enriched with twenty-six color plates depicting the fetus in utero and various birthing positions (see figs. 2, 3, and 4). Her pupils-cum-practitioners would in turn impart their skills to new cohorts of trainees using her dummy and techniques. According to Mme du Coudray’s “niece” and travel companion, the future Mme de Coutanceau, scores of physicians and surgeons were hired by intendants to teach obstetrics courses using her models. Mme de Coutanceau would know. She oversaw the construction of Mme du Coudray’s machines and ultimately followed in her “aunt’s” footsteps to become a teacher at the Maternité de Paris, founded by the revolutionary-era National Convention in 1795. She, too, published a midwifery manual wherein she acknowledged her debt to Mme du Coudray: “it is with phantoms of her invention that I gave my courses jointly with my husband.”34Figure 2. Frontispiece engraving of Mme du Coudray. From Angélique Marguerite Le Boursier du Coudray, Abrégé de l’art des accouchements (Paris: Chez Debure, 1777). Courtesy of the Special Collections Research Center, University of Chicago Library.View Large ImageDownload PowerPointFigure 3. Illustration of a normal, “natural” delivery. From Angélique Marguerite Le Boursier du Coudray, Abrégé de l’art des accouchements (Paris: Chez Debure, 1777), plate VIII, p. 69. Courtesy of the Special Collections Research Center, University of Chicago Library.View Large ImageDownload PowerPointFigure 4. Illustration of how to negotiate a difficult birth in which the placenta is attached to the wall of the womb. From Angélique Marguerite Le Boursier du Coudray, Abrégé de l’art des accouchements (Paris: Chez Debure, 1777), plate XXIII, p. 139. Courtesy of the Special Collections Research Center, University of Chicago Library.View Large ImageDownload PowerPointCommercial CompetitionMme du Coudray was an able self-promoter, but her imprint on rural France may have provided an opening for the ambitions of local surgeons wishing to encroach on her seeming monopoly of the teaching market. A letter written by intendants of De Soissons reprinted in the Gazette de santé in May 1774 indicated the success of her courses and dummies, and the importance of providing a form of “permanent instruction” in the region. The local physician and king’s pensioner Augier du Fot was assigned the task of teaching courses in the Hôtel-de-Ville de Soissons.35 Du Fot’s resentment of midwives oozed in his Catéchisme sur l’art des accouchements, in which he outlined the training program he was spearheading in the towns of Laon and de Soissons. Mme du Coudray’s name was notably absent from his manual. Nor were her mannequins used in his courses. Du Fot instead turned to two artisans in Paris, Mme Riel and Mlle Lenfant, “whose intelligence and dexterity have perfected these marionettes on which students practice with ease the various births which were the object of instruction that day.” He went on to say, perhaps to undermine Mme du Coudray’s authority, that “[u]seful people deserve the esteem and recognition of the public when their talents turn to the benefit of society.”36Du Fot indicated that these “matottes”—a variation on “marotte” and precursor to the term “marionette”—would also be represented graphically in life-size tableaux.37 Wall hangings of three-dimensional medical models were in good company. The set of plans produced around 1760 depicting a “study of a mannequin in wood, left profile, of face, of back” was most likely the handiwork of a student enrolled at the Ecole de dessin et mathématiques of Reims. These were intended as patterns for life-size mannequins crafted from wood—or other materials, including textiles—that were known as “mannequins d’artiste.”38 Diderot and d’Alembert’s great Encyclopédie provided an in-depth look at the artists’ studio, where the lay figure featured so prominently that readers were provided with a construction pattern, in keeping with the ethic of artisanal transparency at the heart of this Enlightenment project.39 From the middle of the eighteenth century, Parisian makers monopolized the market of artists’ lay figures. These stand-ins for living models were draped in male or female clothes, and their joints could be articulated in stop-motion fashion, which contributed to their functionality as reference tools. Louis François Roubiliac’s life-size model stuffed with cork, horsehair, and wool over a bronze skeleton and enveloped in a silk stockinette was used in his drawing and sculpting classes.40The proximity of midwifery phantoms to artists’ lay figures and toy marionettes speaks to the flourishing manufacturing tradition in Paris during Mme du Coudray’s many years of absence from the French capital. Her erstwhile collaborator, the above-mentioned Mlle Lenfant, resided on the rue des Mathurins and began to produce her own mannequins from around 1770 to 1780. Like her mentor’s, Mlle Lenfant’s dummies were constructed from cloth and “the natural proportions, in both the pelvis and the foetus, are exactly observed.”41 An almanac of medical progress produced in 1776 known as the État de médecine explained that Lenfant’s prototypes included “wombs to mimic the progress of labor when the waters break.”42 For her part, Mme du Coudray identified Lenfant as a rival whose trade secrets she wished to know, with a view to