220 INTRA-PEL VIC AMPUTA HON. 



sible to the long axis of the metatarsus. The proper direc- 

 tion of the chisel may at times be greatly favored by placing 

 the cord upon the metatarsus 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 fetus is in the lumbosacral position and it is 

 desired to amputate the left limb, the chisel should be held 

 in the palm of the left hand with its dorsal surface against 

 the vaginal walls and the instrument carefully guarded and 

 guided during the entire operation. The amputation should 

 preferably be through the lower section of the tarsus but 

 may be made through the head of the metatarsus. Do not 

 drive the chisel entirely through the hock without removal 

 as it may become caught and clamped between the divided 

 bones, but drive for a few inches along the lateral side being 

 sure that the skin at that point is severed along with the 

 bone, then loosen the chisel by rotation and lateral motion 

 and drive somewhat deeper into the tarsus until it is com- 

 pletely severed. Withdraw the severed metatarsus and re- 

 move any dangerous spicules of bone remaining on the 

 stump and see that the latter is safely secured 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. 



54- INTRA-PELVIC AMPUTATION OF THE POSTERIOR 

 LIMBS, BREECH PRESENTATION. 



Plates xxxviii and xxxix. 



Uses. The overcoming of dystocia due to a posterior 

 presentation with the hind limbs completely retained in the 

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

 eviation can not be readily corrected. 



Technic. Introduce one hand armed with the embry- 

 otomy knife through the maternal passages until the peri- 



