228 INTRA PEL VIC AM PUT A TION. 



the ischium through the medium of aponeurosis and anter- 

 iorly, chiefly on the median line, the prepubic tendon ; these 

 are to be cut, if necessary, with the chisel or knife. Vigor- 

 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 it advances until the region of the hock is reached 

 where the integument does not so readily separate and only 

 requires to be cut loose and the member 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 any tendons or muscles which offer special 

 obstruction to the operation. 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 opera- 

 tion is carried out subcutaneously or rather intra-fetally 

 and the maternal parts are amply guarded against injury. 

 The size of the fetal trunk may be further reduced if de- 

 sirable, by evisceration, (55), and followed still further by 

 the introduction of the chisel guided b3 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 

 these may be removed and one of the anterior limbs caught 

 by a cord around the scapula and extracted intra-fetally. 

 The remnant of the fetus is to be extracted by means of a 

 cord fastened about the lumbar region of the spine. 



