In  the  subsequent  treatment  of  the  wound,  it  would  be
well  to  attempt  to  obtain  closer  union  of  the  bones  than
that  obtained  by  the  ordinary  superficial  suturing  of  the


Symphysiotomy  at  this  Era.  289

soft  parts.  A  secure  as  well  as  an  easy  method  of  fixa-
tion is  by  the  oblique  insertion  of  double  needles  or
"  staples,"  to  which  additional  stability  can  be  given  by  a
ligature,  preferably  of  wire,  applied  around  the  projecting
extremities.
I  think  it  is  unnecessary  to  dwell  upon  the  limitations
of  symphysiotomy,  beyond  indicating  that  in  an  extremely
contracted  pelvis  it  is  not  likely  to  prove  successful.  In
some  instance,  as  in  ankylosis  of  the  synchondrosis,  it  may
be  necessary  to  substitute  Pinard's  operation  of  pubio-
ischiotomy,  in  which  the  line  of  incision  resembles  that
for  obturator  hernia.  In  ankylosis  of  the  symphysis,
pubio-ischiotomy  might  be  performed  on  both  sides.  I
shall  not  dwell  upon  the  operation  of  synchondrotomy,
as  it  entails  unjustifiable  mutilation,  and  I  refer  to  it  only
as  a  procedure  to  be  avoided.  I  shall  conclude  by  allud-
ing to  one  other  point,  the  possibility  of  utilizing  sym-
physiotomy in  some  cases  in  which  Cesarean  section  might
be  performed  successfully  were  it  not  that  the  head  of  the
child  had  become  impacted.  In  such  critical  instances
symphysiotomy  should  afford  a  rapid  solution  of  a  serious
problem.
Dr.  E.  H.  Grandin. — I  wish  to  present  here  to-night
two  patients  upon  whom  I  have  performed  the  operation
of  symphysiotomy,  in  order  to  show  that  the  operation
causes  no  ultimate  disability.  The  histories  of  the  cases
are  as  follows :

Case  I. — M.,  age  nineteen  years,  nullipara;  at  term.
