Biography of Pierre Budin

Biography of Pierre Budin (1846-1907)

by Paul L. Toubas, MD, Professor of Pediatrics, University of Oklahoma

Childhood 1846-1864

Pierre Constant Budin was born in 1846 at Enancourt-le-Sec, en Vexin, a very small village in the northwest part of France. The son of farmers (5) he attended grade school at the College of Beauvais located in an old Capucins convent, “where in Budin’s wards our parents, more concerned with our future than with our personal aspirations, had imprisoned our childhood” (1). The old college had thick walls “dripping sadness and boredom” and “the heavy door of the college closed on us with a noise which echoed painfully in our children’s heart”. In this institution, Budin’s friend Gallipe who remembered Pierre as “alert, lively, with a touch of teasing in the eyes.” He was constantly well groomed. Pierre did not fight, but “was tenacious and courageous if attacked” (1). Unfairness revolted him. Pierre was a good student , “bringing in his daily work order, accuracy and neatness.” He already had a regular , very small and somehow feminine handwriting. According to his friend, he already combined a strong character with charm, gentleness and happiness, in other words, “the gift to please, bind and retain.”

Pierre Budin describes his time in school as a “painful memory.” Thinking about it, he said “gives me chills up in my spine; I have been so stressed by it that for a while, one of my nightmares was that my family brought me back to the college of Beauvais.” Pierre, in one of his speeches forty years later, remembered a little room, “le petit local,” where students were punished by being confined, sleeping on wooden floors and engraving their names in by the window frame, like prisoners in a jail. “Some teachers brought unjust punishments on some students and we revolted”, Budin said, but “we already had critical minds (l’esprit critique) and did not want to always accept everything we were told as truth.” “At night, when all our comrades went back to bed, when we were left thinking in the dark about a bad night’s sleep, spent on the hard floor, we heard very light footsteps. A key opened the lock without noise. Lantern in hand, a tall, thin 27 or 28-year old young lady came in (we were about 12 years old ourselves!). She was the daughter of the principal; she gently reprimanded us about our conduct, tried to make us promise to be well behaved in the future, and finally brought us the pardon of her father. This is the way we first learned about the consoling woman; she was already the image of the “eternal woman.”

The Student 1865-1867

Budin was a bright student at the Lycee Napoleon and obtained a baccalaureate in philosophy. Lionel Laroze one of his schoolmates, indicates that Pierre was near-sighted and frequently importunated by an exchange of poetry written under the table by Richepin and Laroze and illegally transferred over his head. Budin did not write poetry and his friends doubted that he liked it. Despite a lack of artistic creation ,he was judged by his peers as a very good and dedicated man.

Medical School and Residency 1867-1877

Budin started medical school in Paris in 1867. He became a resident in 1872 spending part of his first year of residency at the Maternity Hospital, since from the beginning he had been attracted by obstetrics. When Budin was a resident, Puerperal fever was ravaging maternity wards, so in 1874 he travelled to Edinburg, like his friend Lucas-Championiere, and did a fellowship with Lister to learn antisepsy; then visited the great masters of Obstetrics in England and Germany. Back at the Maternity in 1875 as a fourth-year resident (residency in France is still four years), and worked under the supervision of Dr. Tarnier (the obstetrician who developed a means for using of egg incubators to help sick newborn infants). Dr. Tarnier was already impressed by the work of Lister but instead of phenic acid used sublimate for antisepsis at the maternity. By this time, Budin has found “his path” (2). He would dedicate his professional life to the improvement of maternity wards. At that time, obstetrical beds were part of general medicine wards. Budin requested special services for pregnant women and the creation of the specialty of obstetrics. During his residency period, he published work on obstetrics. The Ligation of the Umbilical Cord was published in the Progres Medical (3).

The Physician – Curbing Maternal Mortality 1876-1892

Budin received his Medical Doctor degree in 1876. His thesis, titled “About Fetal head in Obstetrics,” has remained a classic (4). In 1878, he became Chef de Clinique (equivalent to assistant professor) of Pr. Depaul. Promoted associate professor in 1880, Budin was well known for his teaching to medical students, residents and physicians on the art of obstetrics. When the specialty of Obstetrics was finally recognized in France, he competed in 1882 for the position of Obstetrician of the Paris Hospitals. (5). Budin obtained the highest mark on this examination, and was appointed along with Porak, Boissard and Ribemond-Dessaignes. Pierre Budin became the Obstetrician in Chief of the Hospital de la Charite (1882) in which position he modernized the teaching of obstetrics. (6)

The Disease 1885

The career of Budin was interrupted by serious health problems, which deserve to be reported, because he submitted, for the times, to an experimental surgical treatment.

At age 38 , Budin who had already complained of hepatic crises and was treated without success by his peers, opted for a laparotomy, a rather risky procedure for those times.

Pierre himself organized an operating room on his property at Beaulieu sur Mer, a small town on the Mediterranean Sea. The surgeon who performed the surgery was Lawson Tait from Great Britain. French Surgeons from the Faculte de Medecine de Paris were upset and predicted the worse outcome. Pierre was anesthetized with chloroform. Phenic acid was used for disinfection. An hydatic cyst was removed. The surgery was a success and six months later Budin was back to work. During this period, Budin had delegated various parts of his work to his assistants, mainly Crouzat and Maygrier. Crouzat continued to correct the book de L’Obstetrique published under the direction of Tarnier, and Maygrier took care of the teaching (he even lived in the Paris apartment of Budin during this time) and the examinations of the students of the young specialty of Obstetrics. An abundant correspondence between these men documents in great details the support Budin received from his peers and also his courage ( and the courage of his surgeon) in affronting a risky surgery. Some of his colleagues were present in the improvised operating room and one mentions that he had scrubbed his body with turpentine and put on brand new clothes in order to prevent any contamination. Another friend from Montpellier had provided the gauzes ! From this time on, French physicians held British surgeons in great esteem. The Laparotomy technique of Lawson Tait was translated and published.

Creativity

Budin was so convinced of the importance of understanding infection that in 1889 he returned for a course at the Pasteur Institute, and, in the following year sent his assistant Dr. Chavanne to the same course. Concerned by the very high infant mortality rate, Budin founded the first clinic for “nurslings” in 1892 (5,8,9,10). Pediatricians and Obstetricians rapidly realized the importance of industrially sterilized milk but Budin and Soxhlet studied home sterilization of milk (11,12,13). He thought about the smallest details, including the rubber nipple and designed a smaller nipple for low birth weight infants (named “le galactophore”). He also designed an apparatus to pump the breast milk, so that premature infants could benefit from it (“teterelle bi-aspiratrice”).

Budin was not alone in promoting mother’s milk. It is interesting to note that in 1890 , in Nancy, Professor Hergott had created a follow-up clinic and rewarded breast feeding mothers for the their infants weight gains. This practice attracted a lot of women to the maternity of Nancy and greatly increased the number of breast-fed infants.

Budin succeeded Pr. Tarnier in 1895 and became Chairman of Obstetrics at the Port Royal Maternite ( an ex-convent transformed into a maternity) where , after forcing Mrs Henri, the powerful midwife-in-chief to resign, he developed the first specialized infant care center, the pavilion for “weaklings” (5). The latter included infants who were premature and small for gestational age, although it is felt that Budin figured out that there was a difference between the two groups. He became chief in 1898 of the Tarnier Maternity (a
state of the art facility for these times) located at rue d’Assas, next to the Luxembourg Garden in Paris.

The Academician

Budin became a member of the French Academy of Medicine in 1889. He belonged to numerous societies: Society of Biology, Anatomical Society, Society of Public Medicine and Hygiene, Society of Legal Medicine and the Obstetrical French Society which he founded in 1898. Very well known in France and in neighboring countries, he was an honorary member of the London Obstetrical Society, the Edinburgh Obstetrical Society and Boston Obstetrical Society. He was also a member of the Italian, Spanish and German obstetrical societies (14,15). He was one of the founders of the Progres Medical. Hefounded the Journal L’Obstetrique and, in addition, was the corresponding editor for France of the American Journal of Obstetrics and Gynecology. He was also an officer of the Legion of Honor (a very high distinction in France).

The scientific work of Budin is considerable. He enriched obstetrics and pediatrics with numerous original clinical and experimental works; one is convinced of this by glancing at his publication list (See the extensive Bibliography of Dr. Budin in the paper entitled “The Founders of Neonatology”).

The Teacher

His teaching was marvelously clear; his lectures, seminars and conferences were always meticulously prepared. A man of a great erudition, he never spoke without bringing facts and examples to strengthen his assertions. A speaker of great charm and authority, Budin captured his audience.

During discussions he in the various societies to which he belonged, he displayed the same qualities exposing his opinions with firmness and courtesy and knew how to find the right balance in controversies. Most of the time he managed to have the opposition rally with him in key disputes.

Yersin, who discovered the bacterial agent responsible for the plague, was a student of Budin. In a letter to his mother written in 1887, he expresses his feelings about his attending:” I hold Professor Budin in great esteem. Each time, we attend a delivery, the next day we have to give him a report on every event. I made a delivery last Monday. It was very funny, except for the mother. A little girl was born under my direction (…) This week I attended two interesting cases of dystocia ( forceps application)”.

Family and Social Life

Pierre Budin married Marie-Therese Sasles (born November 3, 1870 at Flers, Orne). M.T. was an English teacher. She had studied at Caen in the Calvados and graduated July 11, 1889. Pierre and M.T. were engaged for 5 years, as mentioned by the long, pompous, boring blessing speech given by Bishop Patry, October 27, 1893.

She was 23; he was 47. Pierre was what the French call a “vieux garcon.” (old bachelor) The reason for this prolonged engagement was probably the young age of the bride. He loved his wife and called her “ma mignonne”. On July 19, 1896, he entered in his diary, “beautiful moon; back to Paris in a convertible buggy, the cabman does not know the way. It is so nice to breath fresh air and to feel a warm heart beating next to yours.” M.T. wrote about her husband that she loved him dearly. M.T. loved photography and wrote in a letter to her mother that she had taken pictures at the maternity. She processed her own plates and had a small laboratory in her apartment. Pierre and M.T. could not have children.

They both enjoyed high society life. They were close friends of the Rotschilds. They enjoyed theater and music as witnessed by letters of Rejanne and Monnet-Sully, famous French actors of the time. An exchange of thank you notes with Monnet-Sully about “un fauteuil” obtained at the Paris Opera or to the Theatre Antoine testified about their love for the arts. They obviously knew Jean Richepin, a poet and well known lecturer, as well as Lyautey, the future Marechal de France, who at that time was haunting the Parisian literary circles. Budin was very found of Tourguenief, a Russian novelist, who contributed to the diffusion of Russian literature in France. Kipling was among his favorite authors. Senators P. Strauss and Dr.Bourneville (the man who discovered the tuberous sclerosis was also a senator) were among their friends. Bourneville contributed, in fact, to the creation of the specialty of obstetrics. P. Strauss was one of the co-founders of the “ligue contre la mortalite infantile.”

During his professional life, Budin occupied successively three apartments in Paris. The first one, located on 129 Boulevard St. Germain was a very comfortable flat. After his marriage, he lived at 4 avenue Hoche, next to the Arc de Triomphe, and later moved to an hotel particulier located at 46 rue du Dr. Blanche in the middle of the 16e arrondissement, headquarters of the “haute bourgeoisie,” not far from the Bois de Boulogne. The Budin’s had four servants. In the morning, he attended patients at the hospital; in the afternoon he had a private clinic at his home. In the evening, he prepared lectures or wrote and revised papers. He was one of the first physicians in Paris to use a telephone.

n addition to his native language, Pierre Budin spoke English and German. With his wife, he travelled throughout Europe and attended the first European organized medical meetings (he mentioned in his diary a special bed made in Sweden for deliveries).

Curbing Infant Mortality 1892-1907

Budin spent a lot of time teaching and practicing the emerging specialty of modern obstetrics, while in fact, he was also mostly pre-occupied by the future of children. “When I was service chief at the Hospital de la Charite, I took care of the newborns and I was stricken by the response made by women I had previously delivered when they came back for another pregnancy. I asked them what happened to the previous infant they gave birth to, and often they told me: He died! In fact, after discharge from the hospital, their only guide was the vague experience of grandmothers, concierges, and herbalists (pharmacists). Mixed by various biases, they had made mistakes, so their children became sick and died.”

Budin studied the basic rules of hygiene and feeding of the newborn, arguing that “the high neonatal mortality was due to the lack of follow-up, good advice and special care; the obstetricians stopped taking care of them shortly after birth, and the pediatricians were not interested in their condition until they were two years old.” (5,17).

At the Federation of French Socialist workers in 1892, he shared his vision for infant health: “A revolution took place during the last few years. Puerperal fever decimated our maternities. Today, thanks to the work following Louis Pasteur’s discoveries, women in confinement should not die anymore. In well-kept obstetrical wards, maternal death has become an exception. We may hope that a similar revolution may happen for the infants.

Recent works, as a consequence of Pasteur’s research, with milk sterilization at home, have markedly decreased the high infant mortality rate. Poor and rich alike, will be able to keep their infants and experience happiness at home without the challenge of sadness. The nation and the world will benefit” (5). He also quoted President Roosevelt: “A nation losing its population is committing suicide.”

The mark of Budin to establish good infant care facilities and proper hygiene was encouraged by the government because low birth rates and infantile mortality were placing France in a dangerous situation, especially in the face of an expansionist Germany because of an insufficient population growth.

Furthermore, France was actively colonizing numerous territories and stretching its manpower very thin in Asia and Africa. The French government, a young republic, understood the consequences of poor birth rate combined with high infant mortality and simultaneously launched very structured education (school became mandatory) and health programs oriented toward preservation of children. This resulted in the creation of numerous modern hospitals and maternities.

Budin, with the help of his political friends, put all his strength in launching modern obstetrics, which included infant care. Puericulture became a non-stop endeavor. Two presentations on the results of maternal education and the sterilization of milk, were made at the French Academy of Medicine with Dr. Chavane (1892-1893). At the same time, he created the first infant clinic at the hospital of La Charite, in 1892. The goal was simple: encourage breast feeding by all possible means, provide mothers with good advice, and supply the help necessary to provide the best nutrition for the infant.

One day Budin had remarkable experience; while visiting the maternity a foreign physician told him, “Your clinic is not very interesting, all the infants are doing well!” (5). This colleague had not understood the benefits of preventive medicine. However, physicians with vision adopted the Budin’s ideas, and the clinic movement spread through France to Belgium, Italy, Hungary, Canada, and Spain.

The French Committee for Children subsequently recommended more regular follow-up visits of the small infant and a law (The Roussel Law ) was promulgated to make bi-monthly clinic visits mandatory. Private and public industry both recommended the creation of infant clinics . At the Brussel’s Hygiene Meeting , Budin recommended that the government and its administrative structures survey and monitor infants’ diets. He also advocated that at each wedding and infant’s birth, a pamphlet should be given about breastfeeding.

His beautiful book The Nursling was published in 1900, followed (with English translation in 1907) (18). In 1902, Budin and P. Strauss with the help of the philanthropist Th. Roussel, founded the “League Against Infant Mortality” (19), which emphasized concentrating efforts on preventing threats to the health of infants. Extremely good results were quickly obtained by a centralized effort rom various organizations working with a same principle. Numerous French counties reported that the infant mortality rate, which was as high as 288/1000 fell to 112/1000. How were these results obtained? By multiplying the infant clinics; improving the training of physicians, nurses and midwives; evaluating the help of the “prefets” (equivalent to our governors); and, by keeping track of the results so that constant modifications could be made.

The Sad Death of Dr. Budin 1907

In 1907, Pierre Budin was stricken with pneumonia while at a conference in Marseille. From the first day of the sudden illness he understood that the situation was critical and he gave to Dr. Perret very coherent instructions for the continuation of his work. He dictated the following letter (20), which was given after his death to his friend P. Strauss and to his students and colleagues: Maygrier, Boissard, Bar, Bonnaire, Mace, Perret, Jeannin and Devraigne:

“My dear friends,
The fate of French children rests on you. I count on you to be the first to do the necessary work to develop infant clinics and later delegate this task to your students”. — Budin.

Dr. Budin closed his eyes forever on January 22, 1907 in a hotel room in Marseille.

Marie-Therese Budin, his wife of 14 years, continued his work, and the Foundation Pierre Budin (21) was created (It later became the “Ecole de Puericulture”). A model infant clinic was opened to the public on May 24, 1909 by Emile Loubet (ex-French President).

On March 5, 1923, Marie-Therese Budin received the high distinction of the “Legion d’honneur.” In her response to Paul Strauss who placed the red ribbon around her neck she said, “Everything I did, I did for love of my Husband; then for love of infants and their mothers who are frequently admirable”.

Bibliography

1. Banquet offert au Dr. Pierre Budin par ses eleves et amis a l’occasion de sa nomination de Professeur. Octave Doin, Paris 1897.
2. BONNAIRE, A: Le Professeur Budin. Presse Medicale No 8, jan 26,1907.
3. BUDIN, P. : Ligature du Cordon Ombilical , Progres Medical , Paris
4. BUDIN, P. De la Tete du Foetus au point de vue de l’Obstetrique (Doctorate Thesis 1876)
5. TOUBAS P. L. : Personal archives of Dr Pierre Budin. Private collection.
6. BUDIN, P. La Ville de Paris et la Mortalite Infantile . Paris, Masson, 1904, 40p., 17 fig.
7. BUDIN P. La mortalite Infantile dans les Bouches du Rhone. Obstetrique 1907; 304-45.
8. BUDIN, P. Les Consultations de Nourrissons, Arch gen de Med., Paris 1905, 1, 1234-1257
9. BUDIN, P : Les Consultations de Nourrissons, Ann. de Med. et Chir. inf., Paris, 1905, 618 – 645
10. BUDIN, P. Des Consultations de Nourrissons, leurs resultats, V.1 Ibid 11 289 -305 Bull. Acad. de Med. Paris. 1906.
11. BUDIN, P. Allaitement et Hygiene du Nourrisson. L’obstetrique, Janvier, 1906.
12. BUE (V.), L’ Oeuvre de Budin en puériculture . sse méd., 107, nø 19, p. 147-148 1907
13. BUDIN , P. : Le Nourrisson: alimentation et Hygiene. Enfants debiles et enfants nes a terme. 1900. Doin Ed. Paris.
14. BAR (P.), Pierre Budin. Chaire de clinique obstétricale. Leçon inaugurale. Paris, Capiomont, 1908, 55 p.
15. MAUREL (P.), Les Prs de clinique de la Faculté de médecine de Paris. Paris, Steinheil, 1907, p. 57-61 – C 760 –
16. MOLLARET HH, BROSSOLET J. Alexandre Yersin ou le vainqueur de la peste, Paris: Fayard ed. 1985; p321.
17. BUDIN, P. L’Allaitement Paris. Lecrosnier er Babe, 1892, 23p, 10 fig.
18. BUDIN , P.: The Nursling . London. Caxton Publishing Co.,1907.
19. Ligue contre la mortalité infantile. La Revue philanthropique, 1907, p. 251-263
20. GAUTIER (A.), Décés de Pierre Budin. Bull. Académie de médecine, 1907, no. 5, p. 163-166
21. Statuts de la Fondation Pierre Budin. Paris, Doin ed. 1911