SYMPHYSEOTOMY. 511 



pelvis mentioned by Wiedemann and Lauverjat, and as "Boer and 

 Madame Lachapelle inform us is often the case, there would be so 

 small a chance of obtaining even a tolerably large opening, that in- 

 stead of sawing the articulation, as was done by Siebold, I should 

 prefer to have recourse to the cesarean operation. By applying the 

 saw beyond the symphysis, upon the very body of the bone, accord- 

 ing to the counsel of M. Desgranges, the operation would not be ren- 

 dered either more or less dangerous; for the difficulty exists behind, 

 in the sacro-iliac articulations, and not in front. 



1131. Immediately subsequent to the division of the cartilage, 

 the posterior branch of the bent lever, formed by the coxal bone 

 being acted on by the elasticity of the posterior sacro-iliac ligaments, 

 occasions a separation of from six to twelve lines between the pubes. 

 This separation must necessarily vary, according to the degree of 

 contraction of the pelvis, and the rigidity or softness of the sym- 

 physes: if it is sometimes effected in equal proportions by both 

 of the bones, there must also be cases where one is much more con- 

 cerned in it than the other. Be this as it may, I find it difficult to 

 understand how it can go, spontaneously, to such an extent as to 

 prove dangerous, or that it is worth while to restrain it by securing 

 the hips previously to the conclusion of the operation. On the 

 contrary, to carry it to a sufficient extent, it is almost always requi- 

 site slowly and moderately to press the hips from within outwards, 

 and from before backwards, or carefully to separate the woman's 

 thighs. 



1132. Unhappily, when the operation is terminated, the delivery 

 is still far off. If the contractions are energetic and well sustained, 

 the delivery is entrusted to the natural powers, to which also it 

 would doubdess be better to refer the care of separating the divided 

 symphysis to the required extent; but if the womb does not react, 

 if the labor grows languid, or any circumstance arises demanding 

 the prompt extraction of the fcetus, we are obliged to apply the for- 

 ceps, or turn the child, and that conformably to the principles that 

 have already been laid down; remembering, further, that turning 

 causes the child to incur the greatest risks, and that it was for the 

 preservation of its life that the mother was subjected to the section 

 of the pubes. 



I should so greatly fear to bring down the feet in such a case, 

 that, unless they had originally presented, I would without hesitation 

 give the ergot to excite the uterine contractions, and would attempt 

 the employment of the forceps, even should the head, still engaged 

 in the superior strait, be found to be situated transversely. During 

 this part of the operation, it would probably be necessary to support 



