Recovering the clinical history of the vectis: the role of standardised medical education and changing obstetric practice

This thesis explores the use, and later non-use, of the vectis – an instrument invented in the seventeenth century by the Chamberlen family, along with its sister instrument, the forceps. Both instruments were designed to deliver a living baby when birth was obstructed by the head, but their histories were very different. In Britain, the forceps came into the public domain in 1733, the vectis in 1783, after which their respective merits were debated for over a century. Throughout that time, it was clear that both instruments were effective in sufficiently skilled hands, yet the forceps took over so decisively that by the early twentieth century the vectis had disappeared not only from clinical use, but also from the historiography of obstetric instruments. The central question addressed by the thesis is: why did the vectis disappear from clinical use? The thesis argues that the answer to that question is to be sought in the characteristics of clinical practice, skills and training. The vectis required a subtle set of manual skills, and the teaching of such skills was best favoured by individual apprenticeship; the use of the forceps was more easily reduced to rigid rules, and could therefore be taught in large classes. Thus, the shift to such classes around the middle of the nineteenth century favoured the forceps. To reconstruct that shift, this thesis explores the developing debates around medical education in the first half of the nineteenth century, bringing out the hitherto-neglected theme of the importance of midwifery training as a desideratum for the reformers. The link between pedagogic processes and clinical practice reflects the co-construction of users and technology of the Social Construction of Technology (SCOT) model, but requires some modification of that model, not least because the technological consequences of pedagogic change were entirely unintended.