184 DETRUNCATION 



two anterior limbs and the head, have one or two assistants 

 draw the anterior part of the fetus as far out as practicable 

 and safe, and then girdle the fetal body immediately against 

 the maternal vulva by making an incision through the skin 

 and skin muscle. If practicable it is best at this point to 

 remove one shoulder subcutaneously, and follow by 

 evisceration, in order to give greater operative room 

 and increased mobility of the fetus. Insinuate the hand 

 between the skin and the deeper structures and forcibly 

 separate the integument from the fetal body backward until 

 the last rib is passed, as shown at the curved line in Fig. 

 70. Force the finger tips through the abdominal wall be- 

 hind the last rib and passing along the entire border of 

 each posterior rib, separate the abdominal walls from the 

 ribs and sternum. After the abdominal muscles have been 

 detached, and the fetus has been eviscerated, rotate the 

 thorax upon its long axis which will cause a division of the 

 vertebral column near the dorsal-lumbar articulation and 

 the anterior portion of the fetus to fall away. 



Secure the two posterior feet with cords, unless this has 

 already been done, spread the detached skin, which has 

 been pushed back from the thorax, carefully over the 

 amputation stump of the lumbar vertebrae, repel these by 

 means of the hand while an assistant draws upon the cords 

 attached to the feet, push the remnant of the fetal trunk 

 into the uterus and advance the feet along the genital pass- 

 ages, thus converting it into a posterior presentation. 

 Ordinarily this would result in a dorso-pubic position. 

 This should be converted into the dorso-sacral position, 

 when its extraction can be readily brought about. 



