Embryotomy 659 



The chisel may be brought into use, if required, in order to 

 divide the rib, the hand of the operator constantly guiding and 

 guarding the chisel blade. The operation is then to be repeated, 

 if required, upon the second and third ribs, until an opening into 

 the chest is secured, ample in size for the introduction of the ope- 

 rator's hand. 



Force one hand through the opening, and tear the mediastium 

 from the thoracic walls, above and below. Then grasp either the 

 trachea at its bifurcation, or the heart, and tear away the lungs 

 and heart, as nearly as possible in one mass. The heart, which 

 constitutes the greatest bulk of the thoracic viscera, is best 

 grasped in the palm of the hand, with the fingers engaging the 

 aorta and pulmonary arteries. 



When the thoracic viscera have been withdrawn, thrust the 

 fingers through the diaphragm, locate 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, in a normal fetus, constitutes the chief intra-abdom- 

 inal mass, and occupies more space than all the other organs com- 

 bined. After the liver has been removed, the intestinal tube, 

 with its contents, may be withdrawn without difiiculty, as its 

 attachments are feeble. The kidneys may also be removed. 



Evisceration of a fetus in the posterior presentation is prefer- 

 ably performed through the pelvis, generally in connection with 

 intra-pelvic amputation of the posterior limbs, page 653. 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 for that operation. 



When free entrance has been gained into the abdominal cav- 

 ity, 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 comes away entire, with the central part of the 

 diaphragm. 



Remove the heart and lungs as directed in the anterior presen- 

 tation. 



The efiiciency of the evisceration in decreasing the volume and 

 rigidity of the fetal body may be furthered by the division of the 

 fetal ribs as noted on page 656. 



