SYMPHYSEOTOMY.
Morisani, of Naples, read a paper on the subject before the London International Medical Congress, 1881. To quote from this Symphyseotomy has been practised fifty times at Naples, twice on the same woman, with the following results: 40 women saved, 10 dead, 20 per cent; 41 infants saved, 9 dead, 18 per cent.
Kilian, in 68 cases, found a maternal mortality of 32 per cent., and a foetal of 63 per cent.
In 45 instances the vertex presented with 4 deaths; in 3 the pelvic ex tremity, with 3 deaths; in 2 the trunk, with 2 deaths. In 50 cases the conjugate measured: In 12, 3.3 inches; in 16, 2.9 inches; in 7, 2.7 inches; in 13, 2.6 inches; in 2, 2.4 inches.
Where the measurement was over 3 inches expectation was the rule, and even the forceps was used before resorting to symphyseotomy. The lowest limit of the operation is placed at 2.6 inches. Unfavorable results are often obtained because this lowest limit is disregarded.
Comparing the statistics of embryotomy in Italy by Tibone and Chiara, and those from the Porro operation, Morisani makes the following state ments:
.Embryotomy, Tibone, . Mat. wort. 21% 44 Chiara, . 24% Symphyseotomy, Morisani, " " 50% (41 living infants.) Porro operation, 13 out of 27 mothers, and 24 out of 27 infants saved. [By reference to the results obtained from the modified Caesarean sec tion, in particular, it is at once apparent that symphyseotomy has nothing in its favor. Of the last 18 operations, Harris points out that 8 mothers were lost, and 5 children.—Ed.; Morisani uses a blunt-pointed curved bistoury, with the cutting edge on its concave surface. " We make an incision about 2 inches above the symphysis down to the articulation. The bistoury cuts through the in terosseous cartilage from below upwards. We then wait for spontaneous delivery, unless the pains are feeble, or the head does not engage, in which event we extract with the forceps." Whatever the results obtained by Morisani, we do not believe that many obstetricians are prepared to return to symphyseotomy.