200 INTRA-PEL VIC AMPUTA TION. 



tarsus instead of the leg thus forcing the tarsus toward the 

 sacrum of the mother and tending to throw the metatarsus 

 straight across the pelvic cavity. When the foetus is in the 

 lumbo-sacral position and it is desired to amputate the left limb 

 the chisel should be held in the palm of the left hand with 

 the back of the hand against the vaginal walls and the 

 chisel carefully guarded and guided during the entire 

 operation. Do not drive the chisel entirely through the 

 hock without removal as it maj' become caught and clamped 

 between the divided bones, but drive for a few inches along 

 the lateral side being sure that the skin on that side is 

 severed along with the bone, then loosen the chisel by rota- 

 tion and lateral motion and drive somewhat deeper into the 

 tarsus until it is completely severed. Withdraw the severed 

 metatarsus and remove any dangerous spicules of bone re- 

 maining on the stump and see that the latter is safely se- 

 cured by a cord passing around the leg above the os calcis. 

 Repeat the operation on the other hock in a similar manner 

 using the right hand to guide the chisel. Extend the two 

 limbs into the passages by traction and effect a posterior 

 delivery. 



52. INTRA-PEIvVIC AMPUTATION OF THE POSTERIOR 

 LIMBS, BREECH PRESENTATION. 



PLATES XXXIII AND XXXIV. 



Uses. The overcoming of dy.stocia due to a posterior 

 presentation with the hind limbs completely retained in the 

 uterus, the so-called breech presentation, in cases where the 

 deviation can not be readily corrected. 



Technic. Introduce one hand armed with the embry- 

 otomy knife through the maternal passages until the peri- 

 naeum of the fetus is reached and make a free incision 

 through that region involving the anus in the male fetus 

 and the anus and vulv.a in the female and enlarge the 



