192 INTRA-PELVIC AMPUTATIO N OF POSTERIOR LIMBS 



throiigli the ischium aud pubis at this point. Revolve the 

 chisel upon its long axis and separate the isolated portion of 

 the pelvis as completely as practicable from the surrounding 

 tissues. Separate the muscles w^ith the fingers from the 

 detached pelvic bone for a short distance from the severed 

 ends on either side. The most important point of resistance 

 is the attachment posteriorly of the skin, vulva and anus to 

 the sciatic ligament and the ischium and anteriorly, chiefly on 

 the median line, the prepubic tendon to the pubic brim ; 

 these are to be cut, if necessary, with the chisel or knife. 

 The next most important obstacle to tearing away of the 

 limb is the great gluteus muscle which should be sought for, 

 identified and torn through with the fingers at a distance of 5 

 or 6 cm. from its attachment to the great trochanter. Carry 

 a cord in, pass the loop over the ends of the severed section 

 and, tightening it, secure the isolated portion of the pelvis 

 and have one or more assistants exert traction as indicated in 

 Fig. 74. Vigorous traction may be applied by means of the 

 cord, the operator in the meantime guarding the most ad- 

 vanced 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 advances, 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 constantly note the progress with his hand and sever 

 by tearing or 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 



