234 



INTRA-PEL J 'IC AMPUTA TION. 



neum of the fetus is reached and make a free incision 

 through that region involving the anus in the male fetus 

 and the anus and vulva in the female and enlarge the 

 incision sufficiently to admit the operator's hand into the 

 fetal pelvis. Locate the great sciatic ligament and with the 

 knife divide the ligament from end to end, thus enlarging 

 the pelvic cavity and giving ample operating room. If the 

 pelvis of the fetus is too small to admit the hand of the 

 operator at all before severing the sciatic ligament, this 

 may be accomplished by cautiously cutting from behind 

 forward with Colin's scalpel or with the chisel. When this 

 has been severed and sufficient operating room attained, 

 carry the chisel with the hand and place it against the shaft 

 of the ilium as shown between I' I' in Plate XXXIX as 

 nearly perpendicular to the long axis of the iliac shaft as 

 possible and keeping the hand in touch with the chisel blade, 

 have an assistant drive it through the bone until it and its 

 periosteum are completely severed. Revolve the chisel on 

 its long axis and force the cut ends of the bone apart. Dis- 

 engage the chisel and place it against the symphysis pubis 

 or against the ischium opposite the obturator foramen and 

 drive it through the ischium and pubis at this point. Using 

 the chisel as a lever, separate the isolated portion of the 

 pelvis as completely as practicable from the surrounding 

 tissues, and with the fingers separate the muscles from the 

 detached pelvic bone for a short distance from the severed 

 ends on either side. Carry a cord in, pass the loop over the 

 ends of the severed section and tightening it secure the iso- 

 lated portion of the pelvis and have one or more assistants 

 exert traction as indicated in Plate XL. The chief 

 obstacle to the withdrawal of the limb is the great gluteus 

 muscle which should be sought for, identified and torn 

 through with the fingers at a distance of 5 or 6 cm. from 

 its attachment to the great trochanter. Other important 

 points of resistance are the attachment posteriorly of the 

 skin, vulva and anus to the ischium through the medium 



