SYMPHYSEOTOMY. 509 



that, as far as possible, we shall not be compelled to extract the fetus 

 by the feet, because turning too frequently occasions its death; 3. 

 That the os uteri shall be largely dilated: for otherwise there could 

 be no certainty that the operation is indispensable, and moreover, we 

 might, after performing it, find it impossible to terminate the deli- 

 very with the necessary rapidity; 4. That the woman shall be 

 young enough to obviate all fears in relation to anchylosis of the 

 pelvis. 



1127. Manner of operating. The patient, being placed upon an 

 operation table, or on the bed, in the same manner as for the ap- 

 plication of the forceps, having her thighs and legs slightly flexed, 

 and pi'operly separated, an assistant must hold her shoulders, and 

 two others take charge of her knees, while a fourth stretches the skin 

 of the belly, and a fifth is prepared to hand the operator whatever 

 may be required. 



1128. Situated to the right or betwixt the legs of the patient, 

 the surgeon, with a convex and very sharp bistoury makes an inci- 

 sion, which should commence a little above the symphysis and ex- 

 tend close to the clitoris; this incision divides the skin, previously 

 shaved, and all the soft parts that compose the mons veneris; being 

 parallel to the median line, it ought to fall as nearly as possible upon 

 the centre of the articulation; at its lower part, however, it is well 

 to give it a slight inclination to one side, between the top of the 

 greater and lesser labium, and, even to separate one of the roots of 

 the clitoris from the ramus of the pubes, for the purpose of avoiding 

 dangerous lacerations at a later stage of the process. There can 

 be none but very small arteries to tie, unless the internal pudic 

 should be divided by incautiously carrying the incision too far down- 

 wards. For the purpose of dividing the cartilage, some have re- 

 commended that we should act from below upwards, others from 

 above downwards, and several from behind forwards, or from within 

 outwards, and most writers from before backwards. There are 

 some who have made use of a bistoury, a sort of scalpel en ron- 

 dache, of the pliable knife of Aitken, of a probe-pointed bistoury 

 or a common bistoury, the point of which M. Gardien recommends 

 to be covered by the point of the nail of the left fore finger, so as 

 to prevent any injury to the internal organs. In such a case every 

 man ought to be allowed to choose the instrument that pleases him 

 best; for my own part, I think that in this, as in other cases, regard 

 is rather to be paid to the hand that acts than to the shape of the 

 bistoury, and that the only essential quality of the operating knife 

 is strength and sharpness. The safest way is to cut the sym- 

 physis from above downwards, and from the cutaneous surface to 



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