SUBCUTANEOUS AMPUTATION. 



217 



only come into action when the shoulder is nearly severed. 

 It is only necessary then to separate ttie skin from the limb 

 and divide the pectoral muscles in order to readily draw the 

 limb away by traction. Divide the skin now around the 

 pastern and have two or three assistants exert traction upon 

 the limb while the operator places his hand against the 

 sternum and pushes in the opposite direction. Or the op- 

 erator may increase his repulsion by using the repeller and 

 pushing upon the crutch with his hand while an assistant 

 pushes upon the repeller handle. The impact upon the 

 maternal organs due to the traction may be reduced to al- 

 most any desired degree by applying a corresponding degree 

 of repelling force to the sternum of the fetus. If the re- 

 pelling force applied to the fetal sternum equals the traction 

 upon the limb the impact of the fetus against the maternal 

 organs becomes nil. 



If traction does not bring the limb away promptly the 

 operator should attempt to extend the division of the 

 muscles attaching the limb to the thorax while moderate 

 traction upon the limb is continued. 



Further diminution of the size of the fetus may now be 

 had by removal of the other limb in the same way which is 

 especially desirable in the transverse presentation with all 

 four limbs in the passages or we may reduce the size of the 

 trunk by evisceration as described under 54. 



This diminution suffices to permit the remnant of the 

 fetus to be withdrawn with the head deviated to the side, 

 the total resistance being no greater than had the head and 

 neck presented normally. It also renders the fetal body 

 very flaccid, and easy of repulsion and simplifies the cor- 

 rection of any deviations of parts. 



