490 OBSTETRICAL OPERATIONS. 



Many authorities speak very highly of this instrument, from the fact 

 that it permits the displacement of the foetus much further forward 

 than the hand alone can effect, and thus allows a wider space between 

 the pelvic inlet and the body of the young creature ; consequently, 

 adjustment of the latter is more easily and promptly accomplished. 



An assistant can maintain the body of the foetus some distance from 

 the pelvis by this instrument, while the hand of the operator is making 

 the necessary rectifications ; the latter is therefore much relieved, and 

 to some extent he is also exempted from the difficulty and fatigue 

 caused by the uterine contractions. 



The ordinary repeller has some disadvantages, the greatest of which, 

 perhaps, is its being inapplicable to certain regions of the foetus which 

 may chance to be in an oblique line to its direction — such as the head, 

 limbs, etc. To remedy this defect, I have added a short, pointed spike, 

 which can be screwed into the middle of the crutch, opposite the 

 handle, when necessary (Fig. 150), and this effectually prevents its 

 slipping ; the part in contact with the foetus, when provided with this 

 tooth or spike, resembles a trident. While the instrument is being 

 employed— all propulsion should only be made during the intervals 

 between the pains — one hand of the operator must guide and maintain 

 it against the foetus, to prevent injury to the maternal organs. 



Some authorities, however, object to the employment of the repeller 

 — or, rather, assert that they have never required its services. Brunet 

 and Shaack observe that when their own strength is not sufficient, 

 they are aided by an assistant. Brunet has the hand and arm of the 

 latter acting on the foetus at the same time as his own — both arms 

 being in the genital canal ; while Shaack gets his assistant to seize his 

 right arm with one of his hands, resting the other on his left shoulder, 

 and pushing him forward — Schaack's right arm and hand in this way 

 playing the part of the crutch. 



In order to propel the head, Binz invented an instrument like a 

 goblet, furnished with a long handle ; the hollow portion fitted on the 

 muzzle of the foetus, and the head could then be pushed forward. 

 Solid rods to be fixed to the limbs of the foetus, in order to push them 

 out of the way, have been proposed, but their utility is questionable. 



It must not be forgotten that, after all, the hand is the safest and 

 most perfect of instruments, and should always be preferred — at least 

 at first — to such appliances as we have described. For it feels the 

 parts on which it is placed ; it adapts itself more exactly to the surfaces 

 with which it comes in contact ; it perceives the resistance they offer, 

 and warns the operator as to the amount of force necessary to effect a 

 certain object ; whereas the presence of a hard and rigid instrument 

 increases the uterine contractions, and however well adapted it may be, 

 it may suddenly glide off rounded and slippery surfaces, and cause 

 serious injury. 



Nevertheless, there may be, and often are, occasions when the hand 

 cannot accomplish what is necessary in the way of retropulsion, and 

 it is then that the repeller may be most useful ; it will generally 

 be found quite safe when employed by a careful and experienced 

 operator. 



The spasmodic contraction of the uterus, especially during the 

 labour pains, is a great obstacle to every kind of manipulation in the 

 interior of the organ ; the way to subdue them has been referred to. 



Eetropulsion, as we have said, should only be effected in the 



