Embryotomy 657 



nant still seem too large, because of emphysema or for other 

 reasons, to be safel}^ drawn through the pelvic canal, further 

 diminution in volume should be accomplished. The chisel may 

 be carried into the fetal cavity and placed against the last rib, 

 close alongside the spinal column. Light blows upon the chisel 

 by an assistant, the cutting end constantly accompanied by the 

 operator's hand, readily severs each rib succes.sivel3^ The oper- 

 ation can be applied on each side of the spinal column, .so that 

 all ribs are divided. 



The ribs may also be severed by means of the long-handled 

 sphere-pointed cutting hook, Fig. 106 h. The instrument is 

 introduced into the fetal body-cavity and hooked over the first 

 anterior rib, or the most anterior rib within reach, and the ribs 

 are cut one after another as the instrument is drawn backward. 

 The sphere upon the point obviates the danger of the instrument 

 penetrating the fetal skin and wounding the maternal organs. 



If neither of these instruments is at hand, the obstetrist 

 may destroy the ribs by manual force. The tips of one or more 

 fingers may be forced through the intercostal muscles between 

 the last two ribs, the intercostals then torn asunder from the base 

 or .spinal end down to the sternal cartilages, and the rib grasped 

 and broken. Rib after rib may be treated thus until all are 

 broken. This is a tedious operation, and there is constant danger 

 to the operator of wounds from the sharp broken rib ends. 



The division of the ribs is of very great importance. It allows 

 complete collapse and obliteration of the fetal body cavity, and 

 renders the fetal remnant very flaccid and pliable. More im- 

 portant perhaps, it permits the escape of the imprisoned gases of 

 emphysema under the pressure of the labor pains. 



When the ribs have been destroyed, further diminution may be 

 accomplished by securing a scapula from inside the chest, cording 

 it and drawing the leg out through the cavity of the fetal bod}'. 



The amputation of the hind limbs may be accomplished by 

 other means. The above plan offers the greatest decrease in 

 the volume of the fetus ; the manipulations are carried on ex- 

 clusively within the fetal body, insuring the greatest possible 

 safety to the patient, and when completed afford ready means 

 for evisceration. The operation is neither tedious nor difficult, 

 when compared with obstetric operations generally. 

 42 



