EVISCERATION 195 



Technic. Evisceration may be variously performed, but 

 is generally demanded in either the anterior or posterior 

 presentation and a description of these will suflBce. 



In the anterior presentation, unless the fetus is far ad- 

 vanced through the vulva, evisceration is best performed by 

 the removal of one or more of the anterior ribs. The ribs 

 are generally best reached by the removal of the shoulder, 

 as already described under subcutaneous amputation of the 

 anterior limbs (54). When the ribs have been laid bare in 

 the manner described, the operator can thrust the finger tips 

 through the intercostal muscles in the first space and en- 

 large the opening thus made by tearing through the mus- 

 cles upward to the spinal column and downward to the 

 sternum ; then grasping the posterior border of the rib near 

 its middle, fracture it by means of a sudden and vigorous 

 pull. The fractured ends may then be grasped and pulled, 

 broken, or twisted off. The chisel may be brought into use, 

 if required, in order to divide the rib, the hand of the opera- 

 tor constantly guiding and guarding the chisel blade. The 

 operation 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. 



Pass one hand through the opening and tear the medias- 

 tium 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 fingers engaging the aorta and pulmo- 

 nary arteries. When the thoracic viscera have been with- 

 drawn, thrust the fingers through the diaphragm and loca- 

 ting 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 



