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Object lesson
Early obstetrics: for strong stomachs only
July/August 2010
by Randi Hutter Epstein ’90MD
Randi Hutter Epstein ’90MD is the author of Get Me
Out: A History of Childbirth from the Garden of Eden to the Sperm Bank.
For generations, giving birth was terrifying. Women
knew that when complications arose, there was little to do but hope for
survival. That began to change in the nineteenth century, when doctors
developed lifesaving tools. But for the most part, those tools saved either
mother or baby—not both.
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Photograph ©Mark Morosse
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An assortment of these heavy metal obstetrical
instruments is stored at the Cushing/Whitney Medical Library. The collection
includes a variety of objects made to mangle a fetus lodged in the birth
canal—easing its removal so doctors could save the mother from hemorrhage or
sepsis. There are perforators (to pierce the skull), crochets (to hook and tear
a dead fetus), and so-called blunt hooks (to tear off its head).
The Lusk Cephalotribe (above), from the 1880s, looks
like a gigantic pair of salad tongs with a long screw to clamp them together.
Cephalotribe comes from the Greek words kephalos, head; and tribein, to bruise. “Bruise” is an
understatement. The instruments were designed to crush the skulls of babies.
As Dr. William Lusk, designer of this version of the
tool and a midwife at Bellevue Hospital, put it in The Science and Art of
Midwifery (1881),
the cephalotribe’s advantage was that it could “crush in an instant the base
and parietes of the fetal skull, forcing the brain from the orbits, the
nostrils, and the mouth.” Whereas perforators sometimes flung pieces of bone
into the mother’s birth canal, the curved blades of Lusk’s cephalotribe cupped
the crushed head and prevented fractured bits of skull from “inflicting injury
upon the soft parts of the mother.” Lusk called it a “crusher and a tractor”—meaning
it held the skull tightly so the fetus would not slip.
As gruesome as the cephalotribe was, there was some
good in its brutality. Not only did it save women who would otherwise have died
in childbirth, but the instrument also paved the way for forceps that allowed
both mother and child to live. Around the same time Lusk was peddling his
cephalotribe, doctors popularized the modern forceps, with curved blades that
looked like the Lusk’s but allowed the baby to slide out with its skull intact.
Much of the difference was about technique: doctors had to learn how much
pressure it took to grab the head without crushing it.
As is the case with many medical devices, the
forceps, initially hailed as a breakthrough, would later be criticized. The
controversies over overuse of forceps simmered for decades, only to be replaced
with the controversy over increasing rates of cesarean sections. Amid these
heated arguments, it’s worth remembering that obstetrics has come a long way
since the nineteenth century. It’s a good thing the Lusk Cephalotribe is stored
at a Yale library and no longer in a doctor’s office. 
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