Identifier: textbt00hirs (find matches)
Title: A textbook of obstetrics
Year: 1899 (1890s)
Authors: Hirst, Barton Cooke, 1861-1935
Subjects: Obstetrics
Publisher: Philadelphia : Saunders
Contributing Library: Yale University, Cushing/Whitney Medical Library
Digitizing Sponsor: Open Knowledge Commons and Yale University, Cushing/Whitney Medical Library

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, and super-ficial fascia. The attachment of the recti muscles to the pubicbones is then severed by a transverse cut just sufficient toadmit the fore-finger behind the symphysis. The fore-finger otthe left hand is passed behind the symphysis and hookedunder it, while an assistant inserts a metal catheter in thewomans urethra, holding it down and a little to one side,usually the womans right. The curved or sickle-shaped knifeof Galbiati is then seized firmly in tin light hand and passedalong tin- index-linger of the left hand until it glides under the SYMPHYSEOTOMY. 777 symphysis. With an upward and forward rocking movement of the knife the symphysis is divided. It will almost invariablybe found that this incision has failed to divide the subpubicligament. To cut this, a smaller curved knife is inserted intothe wound and passed under the ligament, which is then severed,from below upward, without difficult). At this point in theoperation there is usually a good deal of hemorrhage, which
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Fig. 591.—Subcutaneous section of the symphysis. occasionally is most alarming. It can be checked at once, how-ever, by packing the wound firmly with a strip of iodoformgauze. During this part of the operation two assistants holdthe womans thighs equally flexed and at an equal distance apart.Each assistant should also support the pelvis by firm pressurewith a hand upon the trochanters. If the childs head is pre-senting, axis-traction forceps should be applied to it, and thehead slowly and interruptedly extracted along the parturientcanal, at each tractive effort the assistants being warned to exertfirm lateral pressure upon the pelvis to prevent too great separa-tion of the pubic bones, which would endanger the integrity o\ thesacro-iliac joints. As soon as the child is born, the knees ofthe woman are brought together and the thighs are somewhat 77* (> A.s / /•/ TRIC Ol A RATIO\ S. extended. The operator then cleanses his hands again, removesthe gauze packing from the suprapubi

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