MECHANICAL EXTRACTION OF THE FCETUS. 



523 



It will be seen that'the noose is not unlike the " fillet " used in human 

 obstetrics. 



The Employment of Force in Dystokia. 



In connection with the foregoing obstetric operations, a rather impor- 

 tant question to be considered is the employment oi force in the artificial 

 extraction of the foetus. For, as we have seen, more or less energetic 

 traction is very frequently needed to remove the fcetus from its parent, 

 and those who do not understand, or are inexperienced in animal obstet- 

 rics, are sometimes astonished, if not horrified, at hearing of the amount 

 of pulling which the foetus has to undergo, and the parent to sustain, 

 before delivery can be effected in some cases. Yet force is, as a rule, 

 absolutely necessary ; and, though some of the various points with 

 regard to it are not yet sufficently ascertained, and differences of opinion 

 exist with regard to them, yet it is a subject well deserving the attention 



Fig. 181. 

 Breulet's Noose fixed on the Fcetus. 



of the obstetrist, and especially the junior practitioner. Saint-Cyr has, 

 with his usual ability, discussed it carefully ; and we will therefore, to a 

 certain extent, follow him in noticing it. 



The direction, intensity, and nature or means of developing the force to be 

 employed, have first to be considered, after which it will be desirible to 

 compare manual with mechanical force, and point out their respective 

 advantages and disadvantages from an obstetrical point of view. 



Direction of Traction. 



Since the forceps was introduced into human obstetric practice, the 

 direction which the foetus should be made to follow in the pelvic cavity 

 of woman has been continually discussed, and has been acknowledged to 

 be a very difficult, as well as a very important problem to solve. This 

 difficulty is mainly due to the fact that -the pelvic canal in the human 

 female is not uniform in its dimensions, and that the head of the foetus 

 must pass through it by always offering its greatest diameter to that of 

 the cavity. Consequently, it must execute during its passage a rotatiofi 

 movement in one or other direction, according to the presentation — a 

 movement necessitated by the different planes of the cavity. In addi- 

 tion, the canal is curvilinear, its axis not being represented by a straight, 

 but by a curved line, whose form and direction are, besides, modified by 

 those deformities of the pelvis wdiich are so frequent and varied in woman, 

 and which constitute one of the principal indications for the use of the 

 forceps. Therefore it is, that all the difficulty in the question is to de- 

 termine, in a rigorous manner, the direction in which to exercise traction 

 with this instrument ; though it is generally agreed that it should be 

 made according to the pelvic axis. 



