Photo credit: Metropolitan Museum of Art
What if you invented something that could save the lives of babies and their mothers during childbirth? Would you spread the technology freely, or ration its access to maximize your profits? The Chamberlen family, inventors of the forceps — a pair of tong-like instruments used to make difficult births more safe — chose the profits route.
If the job of an entrepreneur is to invent useful devices that solve major problems, the natural deaths of large portions of infants and children constitutes a large problem. Humans suffer from what you could call a design flaw: We all enter this world with big heads that must pass through a relatively small opening. In a state of nature, when the size of the head is larger than the opening, or the infant goes down the passage upside-down or otherwise crooked, either the infant dies, the mother dies, or both of them die.
Some scholars estimate that 1/3 of infants in medieval Europe died during childbirth. In some areas, half of all labors resulted in deaths. The death of infants and children were common. Up to ¼ of births may have also resulted in the death of the mother.
In the Chamberlen family’s day, members of the Catholic church and midwives helped women through the dangerous process of childbirth. The tools used were crude. If they used any tools at all, they used crochets and hooks in gruesome operations to remove the corpses of dead infants from their mothers, along with nooses of string. The primary goal of what passed for obstetric medicine was to keep the mother alive — preserving the health and life of an infant was beyond the available level of technology and knowledge.
At the height of the European civil wars following the Protestant Reformation, a family of French Huguenots (followers of John Calvin, the theologian and former lawyer) developed a contraption that, in skilled hands, could deliver newborns, even in the case of an obstructed birth: forceps.
William Chamberlen, originally an apothecary and barber-surgeon, fled France as the Bourbon monarchy began to impose regulations banning the employment of Protestants in the professions, which eventually culminated in the forced exile of the Huguenots to Protestant countries throughout Europe. He took his family to England — where he would soon invent his marvelous device, and his descendants would eventually serve kings and queens as trusted surgeons.
Photo credit: Wikipedia
When a difficult birth presented itself to the Chamberlens, they would take the utmost care to obscure their methods. They ushered out the expectant mother’s family and either applied a blindfold to the woman in labor or extracted the infant under a heavy sheet. Few were permitted to know the secret of forceps, and none saw the designs for the devices that they used. Their reputation for results eventually preceded them. The original device was made of iron, with the tongs likely covered by leather. By family tradition, the Chamberlens would carry the tools in an ornate box, inlaid with gold.
The family used secrecy to reap substantial profits from their invention. William Chamberlen’s son Peter would go on to serve both King James I and Charles I, among others. His nephew, also named Peter, served Charles II. As outsiders and Frenchmen, the family routinely ran into trouble with the Royal College of Physicians. Peter the Elder, the family’s patriarch, was thrown into Newgate Prison for a short while for practicing medicine without a license. But before long, his patrons sprung him free.
As time went on, controversy built up over the odd practice of having men deliver infants. Midwives and traditionalists became upset that barbers and physicians were beginning to displace them from their traditional professions.
Eventually, the Chamberlen family secret began to leak out into public knowledge after three generations of successful secrecy. Hugo Chamberlen, a serially failing entrepreneur and doctor whose ventures included a health insurance company and various banking schemes, published hints that his family had devised a marvelous tool that could aid in the safe delivery of newborn infants, even when the baby presented in breech — meaning feet-first. In need of funds, Hugh attempted to sell the invention to members of the French court for 10,000 gold crowns. He sensed a market opportunity, as Louis XIV had recently decided that male midwifery ought to be the fashion. Hugh failed to close the deal, as part of the condition of the sale was to demonstrate his skill by delivering a dwarf infant from a mother with a deformed Pelvis.
Except that he lied, and only sold the design for a one-armed forcep. No one who used the design could figure out what to do with it, as it was likely to be more harmful than helpful for any purpose except as a scoop. This design eventually spread to Jean Palfyn, a Flemish man, who through a long process of tinkering, produced functional forceps and helped to spread them throughout Europe.
A later adopter of forceps named William Smalley further popularized medical midwifery, taught many popular courses on the subject, and wrote extensively on the uses and misuses of new tools in facilitating childbirth. As he details, it took centuries for people to adopt the use of effective tools, and even longer for people to start using those tools properly. Additional tools like the vectis, a sort of lever, could cause catastrophic damage to infants. He charged about £2.2 for twelve lectures, plus an additional fee to students who wanted to watch him deliver infants in person. He used tools made of iron, with the tips covered in leather. His innovation was to introduce a replaceable cloth cover to prevent transmission of venereal disease. He also developed forceps that took into account the curvature of the pelvis, enhancing their utility.
Progress didn’t occur in an obviously linear fashion worldwide. In less-advanced parts of the world, like America, many half-trained doctors used forceps aggressively, even when not necessary, causing unnecessary damage and defects to both mothers and infants. Even though it’s a simple hand tool, the skill, knowledge, and discretion needed to wield forceps effectively was rare. The effective adoption of one of the most useful technologies in world history took centuries.
Hat tip to members of Hacker News whose discussion of the Chamberlen family and forceps inspired this post.