548 OBSTETRICAL OPERATIONS. 



made through the skin and muscles behind the hip-joint ; the hand 

 removes all the muscles around the upper part of the femur, round 

 which a cord is then fixed and pulled by two assistants, while the 

 operator cuts through the attaching muscles and ligaments — especi- 

 ally the capsular ligament. In this way the joint is disarticulated, and 

 a circular incision through the skin completes the task, as traction will 

 remove the limb. 



It may be remarked that Carsten Harms recommends symphsiotomy 

 to be practised on the foetus when the buttocks present at the inlet — the 

 symphysis pubis being cut through. By this means, the two borders of 

 the symphysis can be made to overlap, and the transverse diameter of 

 the pelvis is thereby diminished. The finger-scalpel and spatula are the 

 instruments he prefers. The saw might be advantageously used. 



In certain kinds of monstrosity in which the posterior parts of the 

 foetus are double, or when the hind-limbs are in the vagina, and in con- 

 sequence of the narrowness of the maternal pelvis, or wudth of the 

 croup or haunches of the young creature, birth cannot take place, then 

 amputation of the legs at the trunk may be necessary. Such an opera- 

 tion can be rarely required, however. It is performed in a similar 

 manner to that for removal of the fore-limbs— subcutaneously. K cord 

 is fastened to each pastern, and, one after another, the limbs are drawn 

 towards the vulva ; a circular incision is made through the skin above 

 the hock ; then a longitudinal incision is carried as high as possible on 

 the thigh, and the skin separated in the ordinary way by means of the 

 spatula — always ascending towards the croup ; the gluteal and other 

 muscles attaching the thigh to the pelvis are cut across, and the limb 

 is at last torn away by strong and sustained traction. 



Amputation of the hind-limb is a much more onerous and fatiguing 

 operation than the removal of the fore-extremity. The skin adheres very 

 closely to the subjacent textures, and more labour is needed to separate it 

 from them ; the muscles attaching the limb to the trunk are more numer- 

 ous and powerful, and when they are cut through there remains the 

 resistance of the pubio- and coxo-femoral ligaments (in the Foal — the 

 pubio-femoral ligament is not present in the Calf). Harms estimates 

 that if three assistants can pull away a fore-limb, four men will not in 

 every instance remove a hind one. However, the difficulties are not 

 always insuperable, and many cases are on record in which the opera- 

 tion has been successfully performed. 



After avulsion of the limbs, crotchets should be fixed in the cotyloid 

 cavities or oval foramina, and delivery completed according to the 

 directions already laid down. 



Detruncation or Division of the Body of the Fcetus. 



When one half of the body of the foetus has more or less passed 

 through the pelvic canal, and the other half is retained, so that it is im- 

 possible to extract or return it, it is recommended to cut the trunk in 

 two — division or detruncation. It has been shown that this retention 

 may be due to malposition or malpresentation, excessive development 

 or deformity of the hind-quarters of the foetus, as well as ascites, anasarca, 

 or emphysema {plijjsovietra). 



If the hind-parts are retained, and the head and fore-limbs are not 

 much beyond the vulva — if so far — cords should be placed on each 

 pastern and a head-stall on the head, and slow, gradual, but strong 

 traction exerted on them, so as to expose as much of the body of the 



