548 OBSTETRIC OPERATIONS. 



the vulva, and disarticulated ; this will enable the operator to find the 

 other leg. 



The foetus, when wholly retained in the uterus, has been divided, ac- 

 cording to the reports of several veterinarians, successfully ; but they 

 have not, it would appear, furnished us with any details as to the pro- 

 cedure they adopted. In particular circumstances it might certainly be 

 accomplished, but we scarcely see the necessity for it. 



Evisceration. 



When it is desired to reduce the volume of the thorax or abdomen, or 

 both, the organs they contain are removed. 



This procedure is generally adopted when, after removal of one or 

 more of the limbs, the body of the fcetus still remains fixed in the genital 

 canal ; by it we obtain a considerable diminution in the dimensions of 

 these regions, and perhaps next to the removal of the limbs it is the most 

 useful operation in embryotomy, and is to be highly recommended. 



As we have said, evisceration of either of the cavities may be practised, 

 according to circumstances. We shall, therefore, describe the mode of 

 reducing the volume of both — thorax and abdomen. 



Thoracic Evisceration. 



The chest is emptied of its contents first, when the anterior part of the 

 foetus is in the passage. The head and limbs should be corded — if one 

 of the latter is removed all the better ; if not, the cords should be pulled 

 well upwards, in order to make more room. Should the head be an 

 obstacle to the performance of the operation, it may be amputated ; but 

 if it is back in the uterus, then it may be left there. A strong scalpel 

 with a long handle, the finger-scalpel, or either of the two embryotoms 

 shown in Figs. 187, 188, is the best instrument. It is passed carefully 

 into the vagina until the hand reaches the breast of the foetus, when the 

 blade is thrust deeply into the chest, between the two front ribs, and as 

 close to the spine as possible, cutting down towards the sternum. 



The knife is now dispensed with, and the hand being re-introduced, 

 the fingers are pushed into the foetal chest and the two first ribs removed, 

 thereby allowing sufficient room for the whole hand to enter the cavity. 

 The lungs and heart are torn away from beneath the spine, and, with the 

 thymus gland, removed from the uterus. The chest collapses a good 

 deal, but if the foetus cannot yet be extracted, the hand may be pushed 

 through the diaphragm, and the contents of the abdomen carried away 

 through the chest. 



Some operators, instead of opening the thorax in front, incise from two 

 to five of the ribs close to the sternum, and pass the hand into the chest 

 by the aperture so made. Others divide the ribs on both sides, and 

 remove the sternum as well as the viscera. It will often be found that 

 the contents of the chest and abdomen can be removed without cutting 

 the ribs. 



Abdominal Evisceration. 



Evisceration of the abdomen may be effected, as just stated, through 

 the thorax, by tearing away the diaphragm. 



But in the posterior or abdominal presentations, and indeed in any 

 presentation or position in which this region is accessible to the hand. 



