210 E VISCERA 770 N. 



chest is secured ample in size for the introduction of the 

 operator's hand. 



Force one hand through the opening and tear the medi- 

 astinin above and below from the thoracic walls, and then 

 grasp either the trachea at its bifurcation or the heart and 

 tear them away. The heart, which constitutes the greater 

 bulk of the thoracic viscera, is best grasped in the palm of 

 the hand, with the ringers engaging the aorta and pulmo- 

 nary arteries. When the thoracic viscera have been with- 

 drawn, thrust the fingers through the diaphragm and 

 locating the liver, isolate the area of the diaphragm to which 

 it is attached, and engaging both with the ringers remove 

 the two together. The liver constitutes, in a normal foetus, 

 the chief intra-abdomiual mass, occupving more space than 

 all other organs combined. After the liver has been re- 

 moved the intestinal tube, with its contents, are withdrawn 

 without difficulty, as its attachments are feeble. The kid- 

 neys may also be removed. 



Evisceration in the posterior presentation is preferably 

 performed through the pelvis, generally in connection with 

 52. It ma}' be performed without destruction of the pelvic 

 girdle by making an incision through the perineal region 

 and then severing the sacro-sciatic ligament as directed 

 under 52. When admission has been gained to the abdom- 

 inal cavity introduce the hand and withdraw the alimentary 

 tube, then rupture the diaphragm about the liver and tear 

 away the latter organ in the same manner as in the anterior 

 presentation. The liver is so friable that it cannot well be 

 torn away by grasping the organ itself, but comes away en- 

 tire with the central part of the diaphragm. 



Remove the heart and lungs as above directed. 



