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Arthur H. Bill and the "new obstetrics" in Cleveland
To Arthur H. Bill (1877-1961), obstetrics in the early 20th century confronted a two-fold challenge. First, obstetrical procedures required substantial improvement and second, individuals needed to be trained in the application of these methods.
As Bill noted at the end of his career, "instead of bringing our art down to the level of general practitioners, let us bring our art up to a higher level and educate those who do obstetrics to that point." Bill promoted the methods of the "new obstetrics" pioneered by Joseph Bolivar De Lee of Chicago. As Bill observed, "the old plan [which] allowed nature to take its course, even in the face of abnormalities with the hope that eventually the abnormalities might correct themselves, has given way to far more scientific and humane methods of correcting abnormal conditions and thus assisting natural forces." The approach endorsed by De Lee, Bill, and their adherents revolved around such procedures as the use of scopolamine or "twilight sleep," prophylactic forceps delivery, and episiotomy. The "new obstetrics' was highly interventionist in character.
When entering the field of obstetrics, Arthur Bill was alarmed that many physicians lacked adequate training in the proper use of forceps. The consequence: damage to both mother and child. He worked to remedy this by carefully teaching his students the technique. Bill structured the obstetrics training program at Case Western Reserve University so that students did not simply witness confinements, but helped deliver as many as 40 babies and attend innumerable labors. By his retirement in 1948, Bill had trained over 2,000 obstetricians-gynecologists in this manner. Bill also developed the Bill Axis Traction Handle, which further reduced the chance of damage to the child and lacerations to the cervix of the mother. This attachment was placed over the front of the forceps handles and made the instrument more accurate in delivery by reducing and determining the force needed for a forceps delivery.
Arthur Bill employed the forceps and axis traction handle seen here during his tenure at MacDonald House, the maternity hospital of University Hospitals of Cleveland. For obstetricians, the choice of forceps could be overwhelming; some six hundred variants had been devised since the introduction of the instrument by the Chamberlen family in early-17th century England. For most forceps assisted deliveries, Bill preferred the Tucker McLane forceps, introduced around 1880-85: They were especially appropriate for outlet and low forceps deliveries, where the head is less than 45 degrees rotation from the occiput anterior position. The Tucker-McLane is distinguished from other forceps by its solid or non-fenestrated blades, prominent pelvic curve, and overlapping shanks, and articulating lock.
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