SYMPHYSEOTOMY. 507 



only three or four lines of ampliation of the pelvis: now, is it right 

 that we should perform so serious an operation for the purpose of 

 gaining only three lines, and perhaps not more than two? This 

 argument at first seemed almost unanswerable: then it was said in 

 reply: doubdess we obtain an elongation of only three lines for the 

 antero-posterior diameter, but by engaging in the void space between 

 the separate pubes the parietal protuberance or projecting part of 

 the occiput will abstract at least three or four lines from the diame- 

 ters of the head, so that we gain at least half an inch. In speaking 

 after this fashion, authors have forgotten that the occiput or the 

 parietal protuberance is commonly found behind the body of the 

 pubis or acetabulum, and not behind the posterior face of the sym- 

 physis. But, further, this last disposition, in its turn, gives great 

 advantages in the operation,,and I am astonished that the authors 

 have scarcely mentioned it. I mean that, if the antero-posterior 

 diameter is augmented only two or three lines, the oblique ones will 

 be increased by at least six lines; and as the occipito-frontal breg- 

 matic and bi-parietal diameters are not directed from front to rear, 

 but obliquely, it follows, in fact, that the section of the symphysis 

 appears to be less limited in its applicability than has been generally 

 imagined. The researches of M. Desgranges prove that it permits 

 the oblique and transverse diameters of the pelvis to enlarge to the 

 extent of near an inch; that at the inferior strait particularly, it would 

 procure a considerable ampliation, and that upon this subject there 

 is, such is my opinion, a want of some additional experiments. 



1124. Advantages and disadvantages. The operation of sym- 

 physeotomy, therefore, seems to be applicable in all cases where an 

 increase of space to the amount of four, five, or six lines would per- 

 mit the head to pass; for example, in all cases where the forceps is 

 insufiicient, and where, nevertheless, the smallest diameter of the 

 strait exceeds two inches and a half. But as it is seldom possible, 

 in the living subject to ascertain how far the head is susceptible of 

 reduction under pressure, and whether the strait is two inches and 

 eight lines rather than two inches and a half, it has happened that 

 the accoucheur, finding a difficulty in marking the point where the 

 section of the pubes becomes indispensable, and that where it can 

 no longer suffice, has generally decided in favor of the cesarian 

 operation, whenever the absolute necessity of doing something to 

 save the child's life has been ascertained. As to the dangers of the 

 operation, it appears to me difficult to prevent them, where the volume 

 of the head requires a considerable separation of the pubes, and 

 wherever the pelvic articulations are naturally very little relaxed. 

 Even could we dispense with acting on the hips or thighs, the child 



