EVISCERATION. 229 



55. EVISCERATION. 



The evisceration of the fetus is frequently desirable in 

 obstetric practice and has a variety of uses. It decreases 

 the size of the fetal trunk considerably and permits its more 

 ready passage through the genital canal, as in the anterior 

 presentation ; with lateral deviation of the head it renders the 

 fetal trunk flaccid through the removal of the viscera sup- 

 porting the body walls and permits the body remnant to be 

 bent or moved more readily for the correction of any mal- 

 presentations ; it permits freedom of intra-fetal operations 

 directed against other parts, as for detruncation, or for the 

 destruction of the pelvic girdle in the anterior presentation. 



Technic. Evisceration may be variously performed, but 

 is generally demanded in either the anterior or posterior 

 presentation and a description of these will suffice. 



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, (49) . When these haVe been laid bare in the 

 manner described the operator can thrust the finger tips 

 through the intercostal muscles in the first space and enlarge 

 the opening thus made by tearing through the muscles up- 

 wards to the spinal column and downwards 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 operator con- 

 stantly guiding and guarding the chi.sel blade. The opera- 

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

 third ribs in the same manner until an opening into the 



