SUBCUTANEO US AMPUTA TION. 207 



away from the body. The next most important obstacle is 

 the pectoral muscles which should be torn asunder by sep- 

 arating them into small bundles and tearing them through 

 with the fingers between the sternum and limb, or the pro- 

 cess may be aided by incision with a knife or with the chisel. 

 When these are well divided the remaining impediments to 

 tearing the shoulder away consists largely of the trapezius 

 and rhomboideus muscles at the top, the latissimus dorsi be- 

 hind and the great serratus and the angularis scapula which 

 only come into action when the shoulder is nearly severed. 

 It is only necessary then to separate the skin from the limb 

 and divide the pectoral muscles in order to readily draw the 

 limb away by traction. Divide the skin now around the 

 pastern and have two or three assistants exert traction upon 

 the limb while the operator places his hand against the 

 sternum and pushes in the opposite direction. The impact 

 upon the maternal organs due to the traction may be re- 

 duced to almost any desired degree by applying a repelling 

 force to the sternum of the fetus so that the impact upon 

 the maternal organs equals the difference between the trac- 

 tion applied upon the cord and the repulsion applied to the 

 fetal .sternum. If traction does not bring the limb away 

 promptly the operator should attempt to extend the division 

 of the muscles attaching the limb to the thorax while moder- 

 ate traction upon the limb is continued'. Further diminution 

 of the size of the fetus may now be had by removal of the 

 other limb in the same way which is especially desirable in 

 the transverse presentation with all four limbs in the pas- 

 sages or we may reduce the size of the trunk by evisceration 

 as described under 55. 



This diminution suffices to permit the remnant of the 

 fetus to be withdrawn with the head deviated to the side, 

 the total resistance being no greater than had the head and 

 neck presented normally. It also renders the fetal body 

 very flaccid, rendering it easy of repulsion and simplifies the 

 correction of deviations of any parts. 



