180 SUBCUTANEOUS AMPUTATION OF ANTERIOR LIMBS 



cision with a kuife or the chisel. When these are well 

 divided, the remaining impediment to tearing the shoulder 

 away consists largely of the trapezius and rhomboideus 

 muscles at the top, the latissimus dorsi behind, and the great 

 serratus and the angularis scapula which only come into 

 action when the shoulder is nearly severed. It only re- 

 mains, therefore, to separate the skin from the limb and 

 divide the pectoral muscles in order to readily draw the 

 leg away by traction. Divide the skin around the pastern. 

 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 operator may in- 

 crease 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 almost any desired 

 degree by applying a corresponding amount of repelling 

 force to the sternum of the fetus. If the repelling 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 it to the thorax while moderate traction 

 is continued. 



Further diminution of the size of the fetus may now be had 

 by removal of the other limb in the same manner which is 

 especially desirable in the transverse presentation with all 

 four limbs in the passages, or the size of the trunk may be 

 reduced by evisceration as described under 59. 



This diminution suJBBces to permit the torso to be 

 withdrawn with the head deviated to the side, because the 

 total volume is then no greater than with the head 

 normally presented. It also renders the fetal body 

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

 rection of any deviations of parts. 



