764 Veteri7iary Obstetrics 



fully developed, its limbs are comparatively much shorter and 

 far more pliable, and consequently it may be forced through the 

 passage in almost any conceivable position, dependent upon its 

 size. When the fetus has reached its normal dimensions and at- 

 tained the degree of rigidity regularly shown at the time of birth, 

 the question of the correct position of each extremity becomes 

 one of fundamental importance, and whenever we attempt to 

 bring about forced extraction under these conditions we must as- 

 sume an extraordinary risk. If a fetus can be drawn away by 

 forced extraction when an anterior limb is completely retained, 

 it must be because it is a very small fetus, in which instance 

 there is no necessity for forced extraction, because the deviation 

 is easily corrected. 



3. Embryotomy. Except the amputation of the head, which 

 we always advise, embryotomy is rarely demanded in this devia- 

 tion. Fleming states : " Amputation of the head will not always 

 prove advantageous in retropulsion ; indeed, it will often be 

 found to be a disadvantage." Upon what clinical facts such an 

 opinion is based we are not aware, and cannot readily understand 

 how amputation of the head could in any case prove disadvanta- 

 geous in bringing about repulsion of the fetus. It is possible 

 that sometimes further embryotomy may prove desirable. If the 

 head has been removed, and, after repulsion, it is still impossible 

 or impracticable to correct the deviation, especially in cases of 

 emphysema of the fetus, it may become desirable to remove one 

 or both of the shoulders. This cannot be done by subcutaneous 

 amputation, described on page 645 ; but it would be necessary to 

 divide and detach the skin over the region of the shoulder and 

 follow this by a division of the muscles which attach the scapula 

 to the chest. 



These are chiefly the trapezius and rhomboideus, which would 

 free the superior end of the scapula and permit it to be secured 

 by means of a cord with a running noose. Then should follow 

 the division of the latissimus dorsi and the pectoral muscles, after 

 which the limb may be drawn out from the skin covering it, in 

 an inverted manner. After the one limb has been removed, the 

 chest of the fetus may be opened and evisceration, page 658, em- 

 ployed. Further diminution in size of the fetus may be prose- 

 cuted to any desired extent, and the remnant finally drawn away. 



