240 



EVISCERATION. 



tion is then to be repeated if required, upon the second and 

 third ribs in the same manner until an opening into the 

 chest is secured ample in size for the introduction of the 

 operator's hand. 



Force one hand through the opening and tear the medi- 

 astium above and below from the thoracic walls, and then 

 grasp either the trachea at its bifurcation or the heart and 

 tear them awaj'. The heart, which constitutes the greater 

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

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

 nary arteries. When the thoracic viscera have been with- 

 drawn, thrust the fingers through the diaphragm and locat- 

 ing the liver, isolate the diaphragmatic area to which it is 

 attached, and engaging both with the fingers remove the two 

 together. The liver constitutes, in a normal fetus, the chief 

 intra-abdominal mass, occupying more space than all other 

 organs combined. After the liver has been removed the 

 intestinal tube, with its contents, is withdrawn without 

 difficulty, as its attachments are feeble. The kidneys may 

 also be removed. 



Evisceration in the posterior presentation is preferably 

 performed through the pelvis, generally in connection with 

 intra-pelvic amputation of the posterior limbs, (53). It 

 may 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 

 53. When admission has been gained to the abdominal 

 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 removed by grasping the organ itself, but c'omes 

 away entire with the central part of the diaphragm. 



Remove the heart and lungs as above directed. 



