. The science and art of midwifery . is are pnt uponthe stretch, and the exercise of a little force may be required to com-plete their rupture. The fibers of the periosteum which constitute the anterior sacro-iliac ligaments are the first to feel the effect of the disjunction at thepubis, especially those fibers which are farthest removed from the axis—i. e., from the cornua of the auricular surfaces: the separation be-gins, therefore, at the linea innominata, and thence passes a shortdistance outward.* It is confined to the ilia alone. Above and belowit is limited to the vicinity of the extre
. The science and art of midwifery . is are pnt uponthe stretch, and the exercise of a little force may be required to com-plete their rupture. The fibers of the periosteum which constitute the anterior sacro-iliac ligaments are the first to feel the effect of the disjunction at thepubis, especially those fibers which are farthest removed from the axis—i. e., from the cornua of the auricular surfaces: the separation be-gins, therefore, at the linea innominata, and thence passes a shortdistance outward.* It is confined to the ilia alone. Above and belowit is limited to the vicinity of the extremities of the articulation (). The stripping up of the periosteum may, however, be incnif at the beginning of rotation a tuberosity of the ilium upon eitherside comes into contact with a bony projection upon the sacrum. Experience shows that the pubic bones as they separate follow verynearly the plane of the superior strait. The sacro-pubic distance isincreased until a point opposite the sacro-iliac joint is reached. As the. Fig. 239.— Symmetric separation after symphysiotomy. The Bacro-pubic distance is incr by the outward rotation of the iliac. The chief gain is due, however, to the projection ofthe parietal boss between the pubic bones. When the separation of the latter equa inches, the available utero-posterior is augmented by more than an inch. axis of this rotation has an oblique direction, a marked descent of thepubic extremities results. To use a familiar illustration of Faraboenf,the movement is like that of the door of a street lamp upon hingesattached to a sloping side. An asymmetrical separation at the sacro-iliac articulations is indicated when the lateral halves of the pelvisoccupy different planes. An exaggerated difference of level in the * A few centimetres (Farabceuf). 726 APPENDIX. pubic bones, at times amounting to an inch and a half, may be pro-duced by forcibly flexing one limb while the other remains extended. The weight of the flexed th
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