Madam, - As the person who drew attention to the attempt by the Irish medical profession to revive the operation of symphysiotomy during the 1950s, may I be permitted space to comment on Dr Boylan's letter of June 17th? Bjorklund's research is interesting, but its applicability to the Irish situation is questionable.
Bjorklund produced a statistical round-up of all reported research on the subject from 1900 to 1999. The value of research from the early part of the 20th century is highly debatable, as Bjorklund himself notes.
The later statistics stem largely from research done in developing countries, in which women cannot be guaranteed access to modern hospital facilities. Such women often reach medical care in advanced obstructive labour, and suffering from severe intra-uterine infection. They then face surgery in poor conditions.
In such cases, an argument has indeed been advanced for the use of symphysiotomy as an alternative to the more complex Caesarean section.
Bjorklund's own final recommendations are within the cautious bounds of other recent research, envisaging the use of the operation for "the woman with obstructed labour where Caesarean section is not available, or not available in time for her baby to survive and for herself to escape in good health". Such circumstances are far removed from those of Dublin women in the hospitals of the 1950s and 1960s.
Attempts at comparison bring the added complication that later medical research from the National Maternity Hospital proved conclusively that the vast majority of those who had this operation were not, in fact, suffering from the diagnosed problem of disproportion at all.
The research done by the NMH during the 1940s and 1950s was included in Bjorklund's statistics. This did, indeed, conclude that the operation was without complications for the women concerned.
The enthusiastic advocacy of the operation in Dublin at this time was criticised for its lack of scientific rigour, with visiting medical commentators noting the lack of consistent comparative statistical data or of data on long-term possible complications. I cannot comment on its use in hospitals outside Dublin.
A number of women who had the operation have now come forward believing themselves to be suffering from complications of a type which had been traditionally associated with the operation, including locomotory and urinary problems.
I do not speak for the Survivors of Symphysiotomy organisation (SOS), and so cannot comment on how it is pursuing their investigation. I would certainly agree with Dr Boylan that close scrutiny of individual medical records would be required in order to prove such a link, and that disinterested medical advice would be useful in this process.
If such a link is established, however, the focus of attention will be on the nature and implementation of the operation in Ireland in the period from the 1940s to the mid 1960s, not on its use anywhere in 1900, or in remote parts of Africa today. - Yours, etc,
JACQUELINE MORRISSEY, c/o Women's Education Research and Resource Centre, UCD, Dublin 4.