610 SYMPHYSEOTOMY. 



the pelvic surface of the symphysis. The incision ought to be ex- 

 tended upwards half an inch, or even a whole inch, along the linea 

 alba. To avoid the risk of wounding the bladder, or urethra, as 

 has happened with some surgeons who went at one stroke quite to 

 the head of the child, through the bladder and womb, I think it will 

 always suffice to hold the blade of the bistoury at some distance 

 from its point with the left finger and thumb, while we make its cut- 

 ting edge act with the right hand: with the view of still more cer- 

 tainly avoiding the bladder and urethra, the catheter should be intro- 

 duced early, or at least previously to commencing the second stage 

 of the operation. By this means the bladder is emptied, and the 

 catheter serves to push the urethra a little to the right, while the in- 

 cision is inclined slightly to the left side of the sub-pubal ligament. 

 When the ligamentous matter is almost divided, the precautions are 

 to be redoubled; the cutting should now be done almost wholly by 

 touches with the point of the knife, and it is to be laid aside as soon 

 as we find no more resisting and elastic material to divide. 



1129. Frightened with the imaginary disorders which might be 

 produced by the access of the air into the articulation, Alphonse 

 Leroy advised that the operation should be divided into two stages: 

 for that end M. Lescure, his pupil, thinks that an incision of nine 

 or ten lines should first be made through the skin, then, after having 

 divided one-third of the cartilage with extreme gentleness, that we 

 should return and prolong the section of the ligaments as far as the 

 clitoris, and afterwards proceed to divide the remainder of the carti- 

 lage, " without minding the blood that escapes from the small ex- 

 ternal pudic vessels, this section is performed, says he, very slowly, 

 and by carefully feeling the cartilage." 



Others have supposed they could more certainly attain the same 

 end, by dividing the skin only above and below the symphysis, or, 

 even only to the extent of a few lines opposite its middle portion, 

 which would surely render the section of the ligament very difficult; 

 but at the present day these ill founded fears are dismissed: it is uni- 

 versally known that the accidents that too often follow the operation 

 of symphyseotomy are unconnected with the action of the air upon 

 the cartilage; and further, that such modifications in the mode of con- 

 ducting the operation would in no wise prevent it. 



1130. Previously to commencing, it is important to make sure of 

 the spot occupied by the articulation; for when the pelvis is deformed, 

 it is not uncommon to find it deviated so far to one side as that the 

 operator has on more than one occasion fallen on the body of the 

 bone, instead of uncovering the cartilage itself. 



Should it so happen that the symphysis is found ossified, as in the 



