238 INTRA- PEL VIC AM PL 'TA TION. 



of aponeurosis and anteriorlj', chiefly on the median line, 

 the prepubic tendon ; these are to be cut, if necessary, with 

 the chisel or knife. Vigorous traction may now be applied 

 by means of the cord, the operator in the meantime guard- 

 ing the most advanced end of the detached piece of pelvis 

 with the palm of his hand in order to prevent injury to the 

 maternal organs. Sometimes this detached piece of the 

 pelvis tears away from the femur when traction is applied 

 and comes away alone. In such a case the cord is to be 

 applied over the head and trochanter of the femur and 

 traction again applied drawing the limb away in a reversed 

 position, the skin being turned back or everted as it ad- 

 vances until the region of the hock is reached where the 

 integument does not so readily separate and only requires 

 to be cut loose and the member allowed to come away. 

 During the removal of the limb the operator is to con- 

 stantly note the progress with his hand and sever by tearing 

 of cutting any tendons or muscles which offer special 

 obstruction to the operation. Repeat the operation upon 

 the opposite limb in the same manner except that but one 

 incision need be made through the bone, that is, through 

 the shaft of the ilium. During the entire work the opera- 

 tion is carried out subcutaneously or rather intra-fetally 

 and the maternal parts are amplj^ guarded against injury. 

 The size of the fetal trunk may be further reduced if de- 

 sirable, by evisceration, (54), and followed still further by 

 the introduction of the chisel guided by the hand and the 

 ribs, on one or both sides, severed one after another until 

 the chest can completely collapse. Or the ribs may be yet 

 more conveniently severed by introducing the sector in the 

 body cavity, pushing it forward until the first rib is reached 

 catching the spherical end over the rib and drawing back- 

 wards, sever each rib in turn. If need be some of these 

 may be removed and one of the anterior limbs caught by a 

 cord around the scapula and extracted intra-fetally. The 

 remnant of the fetus is to be extracted by means of a cord 

 fastened about the lumbar region of the spine. 



