Of Manikins and Machines: The Evolution of Obstetrical Phantoms

In the spring, we ran a series of posts on Dr. William Smellie’s “birthing machine,” the obstetrical manikin he built to train man-midwives in the 18th century. The bizarre history of this–now vanished–device has always captivated me. How did it work? Where did it go?

And why was it called a “machine” at all?

William Smellie called the device a machine, possibly because mechanical automations of various sorts gained popularity in the eighteenth century. It was a way to set aside his “instrumental” engineering from the manikins of other teachers (including those used by women midwives). What on earth would that look like?  I spent 3 years and traversed three countries looking for answers, but without success. Then, somewhat unexpectedly, I happened across something truly surprising:

manikin-3What, you might rightly ask, is THAT? Allow me to introduce the manikin of Dr. Theophilus Parvin.

This strange device appears in the 1890 edition of the New York Medical Journal. Dr. Parvin, of Philadelphia, took issue with the obstetrical models of his predecessors and contemporaries because they were not mobile, full-sized, women. How could he instruct his students on different methods of delivery if the subject always presented in exactly the same way?

I’ll return to what Parvin’s model had to offer in a moment–but first, we must examine his competition. A variety of manikins had been used from the late seventeenth and eighteenth centuries. These might be as simple as a pelvic bone, or as complicated as Madame du Coudray’s cloth version… or the infamous (missing) “machine” of Dr. Smellie. However, the discovery and development of India rubber had changed a great deal and allowed even greater intricacy and flexibility of parts. Let’s have a look at some innovations:

manikin-1First, we have the Budin-Pinard, a French model. It is partly carved from wood, and exhbits the breasts as well as the birthing cavity. (Interestingly, nearly all the 19th century versions presented here have full or partial mammary–unlike the 18th century versions). The interior abdominal wall is made of rubber and can be inflated with air. It has a false sacrum held together with a thumb-screw so the vaginal opening may be dilated. Stranger yet, the manikin has a rubber rectum, a recent addition (in 1890) so students could practice rectal manipulation (a delivery method popularized by one Dr. Ritgen when the fetus head is low in the pelvic cavity). The model also came with–er–‘accessories’ of sorts. In addition to the rectum, a rubber uterus could be inserted–and it contained a special pocket to be filled with water to represent amniotic fluid.

***An important side note: The sac of fluid would also contain a fetal cadaver. Smellie and Coudray used fetal dolls, but many students of the 18th cand 19th centuries were required to deliver deceased fetuses from the manikin-machines.

The second manikin discussed in the 1890 issue is a German model developed by B. S. Schultze–and in facmanikin-2t, the Schultes-medacta company still manufactures obstetrical phantoms today! This model was a square box of wood, containing a bony pelvis and leather interior and exterior. Unlike the French model, which needed frequent repairs, the author considered it hardy and able to stand up to hard use. It didn’t have the fancy accessories, but then again, it could be fitted with a rubber uterus developed by Professor Winckel of Munich. It could also be fitted with a cervix (post purchase, of course–this was becoming quite the profitable venture for instrument manufacturers). The rubber cervix, says the author, is a brilliant addition!

Of course, the real star of the show was yet to come. The author reveals that he, along with Dr. Parvin, collaborated with instrument manufacturers to create a manikin superior to all others:

“The idea of producing an obstetric manikin in the shape of a complete human form, with movable joints that would permit the figure being placed in any position, originated with Professor Theophilis Parvin.”

That this is a new idea may be somewhat suspect (at least if we consider descriptions of Smellie’s machine, that apparently had legs and feet and wore stockings). But there are certainly some very new innovations. For instance, the pelvic bone is made of brass, from a bone cast and reproduced to be faithful to the original. Why of brass? Why not? The coccyx has a hinge and spring to allow the recession of bone about an inch, and a leather pelvic floor flexes to allow the passage of the fetus (or two). The rubber uterus is also used. As a complete human form, the mankin can be placed in various positions (see below).

manikin-4manikin-5

This returns us to where we began: the utility of the manikin in teaching. The “machine” of William Smellie was put forth for just such a purpose, mainly to allow students practice but without causing injury to actual women in labor. Smellie’s machine, perhaps not unlike Parvin’s, endeavored to mimic life as nearly as possible–so much so that the anatomist Campbell claimed he could scarcely tell the difference between the machine and a real, live woman (slightly terrifying, no?) But this claim to fame also had detractors. Elizabeth Nihell wrote in the 18th century that students should not become accustomed to life-like dolls, lest they think their real patients had no feeling and felt no pain. The 19th century author certainly had no such misgivings about the model he developed with Parvin, however, and recommends the device as the latest in manikins for training–a true “innovation”:

“With such material […] together with an abundant supply of fetal cadavers of various sizes–there is scarcely an obstetric operation or procedure that may not be performed.”

Interestingly, however, this unusual manikin does not appear to have had as lengthy of tenure as Smellie’s device (and certainly not so long as the Schultze/Schultes-medacta). Though at the time of publication, the manikin had been used for nearly two years, I have found no further reference to it–nor does it appear in any of the instrument sale catalogs I have encountered. And so, another midwifery mankin, rare in its form and mechanics, returns to obscurity!

REF:

Edgar. “The Manikin in Teaching Obstetrics.” New York Medical Journal, V. 52, D. Appleton & Company, 1890

Brandy L. Schillace, PhD
Research Associate | Guest Curator
Dittrick Museum of Medical History

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Brandy Schillace

Historian and author Brandy Schillace, PhD, is Editor for Medhum Fiction | Daily Dose, Research Associate and Public Engagement at the Dittrick Medical History Center and Museum, as well as Managing Editor of the medical anthropology journal Culture, Medicine and Psychiatry.

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