DISSECTING ROOM
Tools of the trade
An obstetric phantom
his model of the
T
female torso from
the 18th century is
almost life-size. Fashioned in
leather and wood, it contains
an extraordinary, doll-like fetus in
utero. It is an obstetric phantom—a
teaching device. The model came from
the Hospital del Ceppo in Pistoia, near rushing to educate the competition.
Florence (a second is still there) and
others exist in Bologna and Paris.
What was it for? At the most
obvious level, it was for teaching the
rudiments of childbirth. The “baby”
could be placed in any position and
delivery demonstrated. Obstructed
labour was a scourge of under-
nourished populations and a potent
cause of maternal and infant
mortality. Instrumental intervention
to deliver a live child was rare,
with caesarean section hardly ever
attempted in the 18th century.
Obstetric forceps had been
devised in the 17th century by
the Chamberlen family, Huguenot
barber-surgeons who treated the
instrument as a trade secret for
nearly 100 years (see Lancet 2001;
358: 1279). But news leaked out,
and others realised how the blunt 18th-century obstetric phantom
hooks and levers sometimes
resorted to in difficult labours might
be modified to deliver a relatively
undamaged child. Even if it was
available, however, instrumental
Artificially intelligent or autistic?
Autistic Thinking—This is the Title
Peter Vermeulen. London: Jessica Kingsley Publishers, 2001.
Pp 159. $18.95. ISBN 1853029955.
f someone asked a person with
I an autistic spectrum disorder, or
autism, to write a book review
chances are that they would do
just that; grab a pen and a bit of
paper and jot down “a book review”.
As a result of the way in which
people with autism interpret words
and actions, literally and directly,
“neurotypicals”, such as myself,
often find communicating effectively
with them difficult, frustrating, and
sometimes humorous.
In Autistic Thinking—This is the
Title Peter Vermeulen tries to explain
to us how the autistic mind works,
and succeeds in doing so through
the use of straightforward language,
humour, illustrations, analogies,
and many amusing anecdotes, for
example:
1916
For personal use. Only reproduce with permission from The Lancet Publishing Group.
were not so much between midwife
intervention was often con-
tentious. In Britain, midwives
claimed that the doctors who
took up obstetrics in increasing
numbers in the 18th century
were too quick to resort to
instruments. Doctors, on the other
hand, decried midwives as untrained
and ignorant and were not, in the main,
Rights were not granted to
include this image in
electronic media. Please refer
to the printed journal.
Elsewhere, divisions panned out
differently. Greatest use seems to have
been made of obstetric phantoms in
Italy and France. In Italy, the feuds
“Two carpenters are at work in a
carpentry shop. One loses his ear
in an accident. The other goes
searching around and finds the
ear. His injured partner says:
‘No, that isn’t mine. Mine had a
pencil stuck to it’.”
Unfortunately, Vermeulen gives little
introduction to the disorder itself; we are
not told how to identify someone with
autism, what might have caused their
disease, or how they can be helped by
us to live in our complex, fluid world,
where rules are often broken. In his
final chapter, Vermeulen frustratingly
mentions that central coherence, the
ability to integrate objects, instructions,
or people as part of a bigger picture, is
not something that you are born with
or without, but that it is something that
and doctor, as between church and
state. The activities of traditional,
sometimes illiterate, local midwifes
were controlled by the church. The
midwifes’ duties included baptising
ailing infants and the authority to do
so, bestowed by the local priest, was in
effect the midwive’s licence to practise.
It was in the interests of secular medical
authorities to produce well taught,
literate midwives, trained away from
home with fairly expensive teaching
devices such as the phantoms, who
would be less in thrall to the clergy.
And in France, where perhaps the
most famous obstetric phantoms
of all were owned by one of the
most extraordinary midwives of
the age, it also suited the state to
educate midwives. In response to
Science Museum/Science and Society Picture Library
a steadily declining population, and
at the express direction of King
Louis XV himself, Madame du
Coudray travelled the length and
breadth of France with her so-called
machine—a superior obstetric
phantom whose workings she
embellished with clear and red
fluids, sacs and sponges, the better
to simulate the process of birth. All
of which leads one to conclude that
the provision of educational facilities
for midwives depended heavily on
whose interests were being served.
Ghislaine Lawrence
Clinical Medicine, The Science Museum,
Exhibition Road, London SW7 2DD, UK
people develop. Yet throughout the
book Vermeulen emphasises that this
skill is what is missing in autism. Can
we therefore teach a person with autism
to recognise context? Is the disorder
eminently curable? Finally, the book
revisits topics, sometimes repeating ideas
clearly explained in a previous chapter,
as if Vermeulen lacks confidence in his
audience’s ability to grasp a particular
notion first time round.
There is no doubt, however, that
Vermeulen, who has worked with and
written extensively about autistic
individuals, both respects and under-
stands the autistic mind, into which
his short book offers a clear insight. He
has avoided, as far as possible, technical
language, and uses anecdotes and
everyday examples whenever possible,
making Autistic Thinking accessible to a
wide audience. Whether you are a parent
of a child with autism or a specialist you
should probably read this book.
Abigail Pound
The Lancet, London, UK
THE LANCET • Vol 358 • December 1, 2001