DISEASES OF THE GENERATIVE ORGANS. 205 



structure of the limb, and when it has been removed the entire limb 

 can be easily detached; (b) the tough skin left from the amputated 

 limb may be used as a cord in subsequent traction on the body of the 

 calf; (c) the dissection and separation of the limb are far more 

 safely accomplished under the protection of the enveloping skin than 

 if the operator's hands and instruments were in direct contact with 

 the walls of the passages or womb; (d) the dissection can be much 

 more easily eifected while the skin is stretched by the left hand, so 

 as to form a comparatively firmer resistant point for the knife, than 

 when it is attempted to cut the soft, yielding, and elastic tissues which 

 naturally oifer little solid resistance but constantly recede before the 

 cutting edge of the instrument. The preservation of the skin is 

 therefore a cardinal principle in the amputation of all parts in which 

 it is at all feasible. 



The presenting foot is inclosed in a noose and drawn well out of 

 the passages. Then a circular incision through the skin is made 

 around the limb just above the fetlock. From this the skin is slit 

 up on the inner side of the limb to the breast. Then the projecting 

 part of the limb is skinned up to the vulva, traction being made on 

 the foot by an assistant so as to expose as much as possible. The 

 embryotomy knife may now be taken (PI. XXI, fig. 2), and a small 

 hole having been cut in the free end of the detached portion of skin, 

 that is seized by the left hand and extended while its firm connections 

 with the deeper structures are cut through. The looser connections 

 can be more quickly torn through with the closed fist or the tips of 

 the four fingers held firmly together in a line or with the spud, of 

 which there are several kinds. Much of the upper part of the limb 

 can be skinned more speedily without the knife, but that must be re- 

 sorted to to cut across tough bands whenever these interrupt the 

 progress. The skinning should be carried upward on the outer side 

 of the shoulder blade to the spine or nearly so. Then with the knife 

 the muscles attaching the elbow and shoulder to the breastbone are 

 cut across, together with those on the inner side of the shoulder joint 

 and in front and behind it so far as these can be reached. Steady 

 traction is now made upon the foot, the remaining muscles attaching 

 the shoulder blade to the trunk are torn through with a cracking 

 noise, and the whole limb, including the shoulder blade and its in- 

 vesting muscles, comes away. If the shoulder blade is left the bulk 

 of the chest is not diminished, and nothing has been gained. Before 

 going further it is well to see whether the great additional space thus 

 secured in the passages will allow of the missing limb or head to be 

 brought into position. If not, the other presenting part, limb or 

 head, is to be amputated and extracted. For the limb the procedure 

 is a repetition of that just described. 



