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.
