Embryotomy, 655 



the isolated segment of the pelvic girdle for a short distance 

 from each severed end. Attach a strong looped cord about the de- 

 tached pelvic segment, and tighten the noose. Have one or more 

 assistants apply traction as indicated in Fig. iii B. The chief 

 obstacle to the withdrawal 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 of the femur. This is best done while steady, 

 firm traction is being applied to the limb by an assistant, thus 

 tensing the muscle. 



Other important points of resistance are the attachments, pos- 

 teriorly, of the skin, vulva and anus to the ischium through the 

 medium of aponeurosis; and anteriorly, chiefly on the median 

 line, of the prebubic tendon. These should be divided with the 

 knife or chisel. Vigorous traction may now be applied by means 

 .of the cord-, while the operator guards the advancing end of the 

 detached piece of pelvis with the palm of the hand, in order to 

 prevent injury to the maternal organs. 



Sometimes the isolated piece of the pelvis tears loose from the 

 femur 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 exerted, drawing the limb away in a reversed position. 

 As it advances, the skin is turned backward or everted until the 

 region of the hock is reached, where the integument does not so 

 readily separate and only requires to be divided to allow the 

 limb to come away. 



During the removal of the limb, the operator is to constantly 

 note the progress by manual exploration, and sever by tearing or 

 cutting any tendons or muscles which offer special obstruction 

 to the operation. During the tearing away of the limb, the 

 operator largely or wholly counteracts the impact of the traction 

 upon the maternal organs, by applying repulsion toother portions 

 of the fetal pelvis, either with his hand or with the aid of a 

 repeller in the hands of an assistant. 



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 intra- 

 fetally, and, if properly performed, the maternal parts are amply 

 guarded against injury. 



