. The science and art of midwifery . the symphysis is accomplished bj (1) section be-tween the recti muscles, to sever as far as possible the hard, creaking bundles ol the fibrousin front a lint tween the reelcovering;, and tract- in trout a une corresponding to the groove of the guard, which isheld firmly againsl the ridge corresponding to the articulation behind. 2) By means of aShort, narrow blade, with a rounded extremity the operator then cttte through the symphysisfrom above downward, with the cutting edge of the blade directed forward,and under the protection of the grooved guard. 44 AP
. The science and art of midwifery . the symphysis is accomplished bj (1) section be-tween the recti muscles, to sever as far as possible the hard, creaking bundles ol the fibrousin front a lint tween the reelcovering;, and tract- in trout a une corresponding to the groove of the guard, which isheld firmly againsl the ridge corresponding to the articulation behind. 2) By means of aShort, narrow blade, with a rounded extremity the operator then cttte through the symphysisfrom above downward, with the cutting edge of the blade directed forward,and under the protection of the grooved guard. 44 APPENDIX. the sutures care should be taken to bring the pubic bones into closecontact—an action admirably accomplished by the fixation-forceps ofFaraboeuf. Caruso* gives the Italian method as follows: Prepare and disinfecteverything required for the operation (matting, gauze, sutures, a curvedblunt-pointed bistoury with solid handle, forceps, etc.). Place patientin obstetrical position at edge of bed ; shave the pubes and labia ma-. Fig. 257.—Mode of introduction of sutures. Thsc should be of strong silk, and should be In-serted from the outer borders of the longitudinal bands, keeping close to the bones, ii isbesl to begin on the right side, which presents the greatest difficulty. jora; disinfeel suprapubic region, vulva, perinaeum, and vulvovaginalcanal; introduce silver female catheter into the bladder. Then try todetermine the situation, the height, the width, and the direction of thearticulation. Feel the upper border and the sulcus between the spines,the lower border, the anterior and posterior fibrous coatings. Determinethe relief furnished by the interosseous fibro-cartilage. Commence in-cision L*5 centimetres above the symphysis; cui vertically downwardthrough the soft structures, directing the incision to the left when in the proximity of the clitoris: seven to eighl centimetres will the recti, and nick the insertions if necessary to facilitate acce
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