208 INTRA-PEL VIC AMPUTA TION. 



ous traction may now be applied by means of the cord, the 

 operator in the meantime guarding the most advanced 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 the limb advances until the region of the hock is 

 reached where the skin does not so readily separate from the 

 limb and onlj' requires to be cut loose and the limb 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 an}' tendons or muscles which offer 

 special obstruction to the work. 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 the 

 shaft of the ilium. During the entire work the operation is 

 carried out subcutaneously or rather intrafoetally and the 

 maternal parts are amply guarded against injury. The size 

 of the foetal trunk may be further reduced if desirable, by 

 evisceration, 53, and followed still further by the introduction 

 of the chisel guided by the hand and the ribs, on one or both 

 sides, severed one after another until the chest can completely 

 collapse and if need be some of the ribs may be removed and 

 one of the anterior limbs caught by a cord around the scap- 

 ula and removed intra-foetally. The remnant of the foetus 

 is to be extracted by means of a cord fastened about the 

 lumbar region of the spine. 



