No. 1382: Symphysiotomy

Today, clockwork and surgery. The University of Houston's College of Engineering presents this series about the machines that make our civilization run, and the people whose ingenuity created them.

Cutting into the human body is terrifying business. Yet our neolithic forbears did brain surgery. Indian surgeons operated on cataracts 2000 years ago. And the cesarean section, as its name suggests, goes back at least to ancient Rome. But early surgery was limited by pain and infection, and neither could be helped until the mid 19th century gave us anesthetics and antiseptics.

Still, the clockwork rationalism of the 18th century triggered a new view of surgery. Just as a clock could be taken apart and repaired, so too might the human body. The science of anatomy was scarcely two centuries old, but now physicians and surgeons tore into the body with renewed purpose. The broken spring, the worn gear, should be fixable. Anatomy leapt forward as a science; and all kinds of new operations were attempted. Let's look at one:

Peter Camper, born in 1722, learned carpentry, design, and painting as a lad. Then he went to Leiden University to study medicine. He entered a field newly claimed by men. He became one of the new man-midwives who brought their new tools to the birthing process and displaced women midwives. Camper's early training made him a ready candidate for clockwork rationalism thinking. He went on to become a well-known physician, with his hand in every aspect of anatomy. It was Camper who suggested replacing the conventional cesarean operation with something called a symphysiotomy.

The purpose of a cesarean is to deliver a baby when it's badly presented to the birth canal. Midwives had many subtle tricks for turning and repositioning the child. Failing that, the only solution was to cut into the womb, remove the baby, and sew up the wound. In the 18th century, that was terribly painful. Then the mother survived only if she threw off the inevitable infection.

Camper tried a new operation on pregnant pigs. He cut the cartilage between the pubic bones. That enlarged the birth passage and let the piglets through. Camper never tried it on a human, but Jean Sigaud de LaFond, the son of a French clockmaker, did.

Sigaud de LaFond brought his own clockwork thinking to surgery. His French biographer credits him with a talent for self-promotion. He made money writing popular science books, which another biographer calls vulgar -- catering to popular taste. In 1777 Sigaud Lafond did the symphysiotomy operation on a woman and got away with it. In fact, the operation doesn't guarantee getting a baby out, as a cesarean does. He got a gold medal, but the operation quickly died out.

So the clockwork doctors of the clockwork age took their new knowledge of anatomy to the operating theatre with mixed results. Camper's wife died after a radical breast cancer operation in 1776. He went into a depression and took up politics. Sigaud Lafond lived to the age of 80, but all the fame he'd sought came to rest on one experimental operation that medicine soon put aside.

I'm John Lienhard, at the University of Houston, where we're interested in the way inventive minds work.

Lindeboom, G.A., Camper, Peter (Petrus). Dictionary of Scientific Biography (C.C. Gillespie, ed.), New York: Charles Scribner's Sons, 1974.

Bough, J.B., Sigaud de LaFond, Joseph-Aignan. Dictionary of Scientific Biography (C.C. Gillespie, ed.), New York: Charles Scribner's Sons, 1974.

Michaud, J Fr Joseph, Biographie Universelle Ancienne et Moderne. Paris, Madame C. Desplaces, 1854-[65]. See entry under Sigaud de LaFond, Jean-René.

[Note: Sigaud de LaFond's first name is given as Jean in all the French literature and in most references to him. Much of the medical literature identifies him simply as Sigault.]

Schiebinger, L., The Mind Has No Sex? Cambridge, MA, Harvard University Press, 1989. Chapter 4, Women's Traditions. (This chapter includes discussion of the 18th-century man-midwife movement.)

I am grateful to Drs. Stanley Reiser and Frank Moody, University of Texas Medical School, for their considerable counsel on the implications of the symphysiotomy operation.

For more on ancient surgery, see: Majno, G., The Healing Hand: Man and Wound in the Ancient World. Cambridge, MA: Harvard University Press, 1975. For more on early cataract operations, look up the works of 16th century surgeon Ambroise Paré in your library.

The pubic bones are the two arms of the pelvis that meet at the front center of the picture above, and which are joined by cartilidge. The pelvic bones define the near-circular passage through which the baby must pass. The symphysiotomy operation involves cutting that cartilidge and prying the pubic bones apart to widen the passage.

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