508 SYMPHYSEOTOMY. 



nevertheless must pass through, and, whether we extract it with 

 the forceps or by turning, or whether the contractions suffice for its 

 expulsion, nothing seems able to hinder the head, as it passes through 

 the contracted strait, from violently distending the posterior articu- 

 lations, and even lacerating them if its dimensions exceed those of 

 the circle through which it must traverse. 



I am, however, far from thinking, along with Denman, Lauver- 

 jat. Hunter, Osborn, and Dr. Dewees, that it ought to be rejected in 

 all cases; I merely wish to show that its partisans, in their represen- 

 tations, have singularly lessened its dangers, and exaggerated its ad- 

 vantages. 



It is the only means of safety that can be resorted to: 1. Where 

 the head is locked in the excavation, after having passed through a 

 very contracted superior strait; 2. Where the head has cleared the 

 OS uteri, and is arrested by the narrowness of the inferior strait; 3. 

 Where the trunk is delivered, the life of the child unquestionable, 

 and it is impossible for the head to get through the natural passages. 

 In these three cases, it is preferable to the cesarian operation, even 

 after the death of the woman; and that, because it would be almost 

 impossible to avoid killing the child by attempting to extract it by the 

 abdominal opening. 



1125. Further, it offers unquestionable advantages wherever the 

 contraction affects the transverse and oblique diameters; where it 

 exists at the inferior strait; when it depends on barrure, an exosto- 

 sis, any solid tumor situated laterally, or on a protuberance of the 

 acetabulum; the same holds good of locked-head, whether of the spe- 

 cies called by Roederer paragomphosis, or whether the head is pinch- 

 ed at the two extremities of its bi-parietal or occipito-frontal diame- 

 ter, or in any other way that prevents it from descending, and from 

 being easily pushed upwards; and lastly, whether this locked-head 

 be understood after the manner of Baudelocque, of Madame Lacha- 

 pelle, or of M. Desormeaux, provided always that the inferior strait 

 be not extremely contracted; it is manifest, further, that if the elon- 

 gation of the sacro-pubic diameter, produced by the section of the 

 pubes, must be so much the greater in proportion as the contraction 

 of the pelvis is so much the more considerable, as maintained by Gi- 

 raud and Ansiaux, the very contrary may also happen, as has been 

 well observed by Boer and by Madame Lachapelle. 



1126. To perform this operation, it is necessary: 1. That the 

 ftEtus shall be living; for, notwithstanding what M. Gardien says, 

 where symphyseotomy is indicated, should the child be dead, we 

 ought to prefer the operation of cephalotomy, which would always 

 suffice in that case; 2. That the presentation shall be natural, and 



