THE FILET.—THE SERICEPS.
Etracting the Amand, in 1714, devised a hood destined to remove from the uterus the decapitated head. About one hundred years ago, Mead, in England, thought of using a cloth loop to be placed between the chin and the thorax, and Playfair mentions, only to condemn, the filet of Earldly Wilson. Precisely the same instrument was used in Japan, in 1812, by one of the Bangawas.
In 1875, Poullet invented an instrument which he calls the sericeps, and a new mechanical tractor to be adapted to the sericeps to increase the force of the tractions. The following is the description of the sericeps: " It is composed of : 1. A piece of cloth 9/ inches long. 2. Four ribbons inserted along the inferior border of this cloth, and united to gether in pairs to make two loops. (Fig.110.) The transverse band is placed around the foetal head, and the borders are laced together. When the ovoid of the head has been well grasped, and we pull on the loops, the head is obliged to descend. The transverse band and the ribbons are doubly lined, making fingers in which are slipped the metallic rods which place the apparatus over the head. When the head has been grasped the metallic rods are withdrawn, and the apparatus is ready for traction. (Fig. 111.) " In case greater traction is needed than can be applied through the loops, the tractor is to be adjusted." (Fig. 112).
By means of the sericeps Poullet has succeeded in ten cases, but we doubt its utility in the obstetric armamentarium, and we believe it is des tined to be relegated to the obscurity of the retroceps of Hamon, the leni ceps of Mattel, the filets of Mead, Kangawa, Wilmot and others, and the air extractor, that monstrosity devised by Simpson.
Poullet has lately devised another sericeps, and he has given us the description and the illustrations. The new instrument is a modification of the old, which was very difficult to insert, especially between the head and the promontory, and the head and the pubes. The new instrument aims at facilitating this. It is composed of two flexible steel blades, un equal in length, the one to be applied to the left, and the other to the right of the pelvis. The longer blade consists of two narrow flexible steel blades, 51 inches in length, united superiorly by a steel plate, which is movable. They are curved on the flat, about like the cephalic curve.
At their inferior extremity, the one is attached to a steel tube 7 inches long, the other to an inner steel rod. A screw on this rod fixes the two blades. (Fig. 113.) The short blade is like the other, only it is but 31 inches long, and the extremity of the two blades which compose it are united by a silk loop 21 inches long. Applied over the face, this loop will not act on the neck.
The completed instrument in position is shown in Fig. 114.
The instrument requires more time for application than the forceps, but this is not difficult at the superior strait. Its advantages are: 1. It exercises no compression transversely in the pelvis; on the con trary, it slightly reduces the head in the longest diameter.
2. It pulls on the entire occiput, and does not engage the head till it is flexed; and further it does not in the least interfere with rotation.
3. The entire transverse portion of the pelvis is left free to the head, and it may, therefore, as in version, slide along the linea innominata, and may engage in the contracted part of the pelvis in a diameter approaching the bi-temporal.
The Japanese were not content with devising filets for the extraction of the foetal head, but also endeavored to facilitate delivery, in case of shoulder presentation, by passing a filet over the pelvic extremity. Latterly, Wecbecker-Sternfeld has re•advocated this measure in case of breech presentations. Rejecting blunt hooks as dangerous, he follows the example set by Hecker and Grigory, and uses the filet introduced by means of the instruments represented in Figs. 115, 116, 117.
Of the 21 children born of primiparx, 8 were asphyxiated, and 7 of these lived. Of the 9 born of multipara, 2 were asphyxiated but survived, and one other lived for I hours, and at autopsy showed evidence of vis ceral syphilis.
In one case the humerus was fractured in disengaging the arms; twice the femur, once in the endeavor to bring down a foot, once during ex traction with the filet.
As for the mothers, the introduction of the filet did no damage. The perineum was lacerated eight times in the primiparte, through rapid ex traction of the head. The puerperium was invariably normal.