2 30 E VISCERA TiON. 



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 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 locat- 

 ing the liver, isolate the 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 tube, with its contents, are withdrawn without difficulty, 

 as its attachments are feeble. The kidneys may also be re- 

 moved. 



Evisceration in the posterior presentation is preferably 

 performed through the pelvis, generally in connection with 

 ( 54) . 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 (54) . When admission has been gained to the abdom- 

 inal 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 comes away en- 

 tire with the central part of the diaphragm. 



Remove the heart and lungs as above directed. 



