2 1 o E VISCERA TION. 



chest is secured ample in size for the introduction of the 

 operator's hand. 



Force one hand througli the openitig and tear the medi- 

 astiuni 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 vi.scera, is best grasped in the pahn of 

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

 nary arteries. When the tlioracic 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 fingers remove 

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

 the chief intra-abdominal mass, occupying 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 moved the intestinal tube, with its contents, are withdrawn 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. 



Evi.sceration in the posterior presentation is preferably 

 performed through the pelvis, generally in connection with 

 52. 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 52. Wlien admission has been gained to th€ abdom- 

 inal cavity introduce the hand and withdraw the alimentary 

 tube, tlien 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 tlie organ itself, but comes away en- 

 tire with tlie central part of the diaphragm. 



Remove the heart and lungs as above directed. 



