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!^5^Ba(»»' 
 
 I 
 
SYLLABUS 
 
 OF 
 
 Post Mortem Methods 
 
 FOR THE USE OF 
 
 STUDENTS 
 
 IN THE 
 
 Montreal General Hospital 
 
 BY 
 
 WYATT JOHNSTON, M.D. 
 
 Pathologist to the Hospital. 
 
 C. ASHFORD. 
 
 Montreal. 
 
 1890. 
 
All medicl students should leave college prepared to per- 
 form an autopsy properly. This is especially necessary in a 
 country where, as yet, there exists no class of trained medico- 
 legal specialists, and where the youngest practitioner in the 
 district is usually the one called upon to perform autopsies for 
 the coroner. 
 
 The liest way for a student to learn to recognize pathological 
 changes in organs is by carefully studying normal organs 
 whenever opportunity offers. 
 
 By studying up the methods thoroughly before entering 
 the post-mortem room, students would derive far greater advan- 
 tage from the opportunities given them there. Comparatively 
 few students learn to dissect the brain and heart properly, 
 though the brains and hearts of animals can be bought at any 
 butcher's stall, and serve very well for practising the methods. 
 The method given here for the heart, though not a neat one, 
 is so simple as to require absolutely jio technical skill in carry- 
 ing it out. It is the one followed in the Munich Pathological 
 Institute. 
 
 The rest of the technique seems to be regarded as common 
 property in all text books. The diagrams were drawn by 
 Mr. A. Holdstock. 
 
 « J 
 
1 
 
DIRECTIONS 
 
 FOR 
 
 Performing Post Mortems. 
 
 1. By following a good method in mak- 
 ing poNt-mortenis every organ can be examined in 
 its turn without interfering with the examination of the 
 remaining organs ; the body is not disfigured and the 
 autopsy is completed in a reasonably short time. This 
 ensures much better results than when the examination 
 is conducted in a haphasard way, governed only by 
 the special clinical features the case may have pre- 
 sented. The method introduced by Virchow is readily 
 learned, and no great technical skill is required to 
 carry it out. '1 he one here described differs from it 
 only in unimportant details. 
 
 It will be seen that the autopsy begins with a care- 
 ful external examination of the body. Next the brain 
 is examined, though there is no serious objection in 
 most cases to doing this later on if preferred. Then 
 comes the opening and inspection of the abdomen, 
 followed by the opening, inspection and dissection of 
 the thorax ; lastly, the dissection of the abdomen. 
 The reason for making a preliminary inspection of 
 
6 
 
 A' 
 
 the great serous cavities as soon as they are opened, 
 is that their condition is Uable to be altered from 
 exposure to the air, entrance of blood, etc. Any 
 detailed examination of the extremities had l)etter be 
 deferred till the end of the autopsy. We examine in 
 sequence the different organs composing each system, 
 the examination of the urinary organs being finished 
 before that of the digestive organs is commenced, and 
 so on. 
 
 Virchow's n'.ethod is remarkably well suited for 
 medico-lcgal ca^es, though certain special prec. tions, 
 mentioned later on, have thtn to be observed. Other- 
 wise it will be found but seldom neccis;:r) to depart 
 materially from the routine here laid ccAvn. 'I'he 
 chief cases in which it is necessary to modify the 
 procedure, are those in whic:h the anatomical relations 
 of the parts are much altered, or whcie ihc organs are 
 matted together. In such cases it i^ l<esi lo examine 
 first such organs as are readily got at, remove the 
 more involved portions en /nasse and dissect tlitm 
 outside the body in the order found most convenient. 
 
 2. Ini^triiiiiciitH. A distinguished American 
 pathologist, wlio makes upwards of one thousand 
 autopsies yearly, found it convenient to limit his 
 outfit to a "vest pocket" })ost mortem case, contain- 
 ing merely a knife, a small saw and a needle. While 
 in the hands of skilful persons much can be done with 
 very few tools, beginners will do well to provide them- 
 selves with one of the well-filled cases sold by instru- 
 ment makers. These should contain a c ouple of large 
 " post-mo'-tem " knives, two or three dissecting scal- 
 pels, dissecting forceps, probe-pointed scissors, intes- 
 tine scissors, saw (with removable back), chisel, mallet, 
 (a very convenient form is that provided with a hook 
 at the end of the handle for wrenching off the skull- 
 
 I 
 
cap) bone forceps, and probe, as well as needle and 
 thread for sewing up. For ordinary purposes no 
 special brain-knife is required. 
 
 In addition to these a measuring rule, weights and 
 graduated glasses are indispensable where scientific 
 accuracy is aimed at. Some watery solution of iodine 
 (1%) in iodide of ])otassium is needed to test for amy- 
 loid degeneration. Plenty of water, a sponge and 
 some towels are essensial to cleanliness. 
 
 A microscope with the usual accessories is neces- 
 sary for the proper investigation of many cases, and it 
 should be borne in mind that a very simple micro- 
 scopic examination of the fresh material, made at the 
 time of the autoi)sy, may often yield more valuable 
 information than can r.fterwards be obtained by even 
 the most elaborate study of the same material when 
 altered by harc'^ning processes. In hardening por- 
 tions of tissue, the pieces should not exceed half an 
 inch in thickness, and should be placed in twenty 
 times their bulk of the hardening fluid, which is to be 
 renewed several times. 
 
 3. DiNsectioii of boily. Learn from the 
 first to hold the knife properly. (}rasp it firmly in the 
 closed fist. Do not hold it with the fingers as in the 
 dissecting room. What is wanted is i. rapid survey of 
 the whole body ; not a minute dissection. In cutting 
 use the whole length of the blade, not the point alone. 
 Do not press the knife into the tissues, but draw it 
 through them rapidly ; this leaves the cut surface 
 smooth. Make the cuts free and sweeping, so as to 
 expose as large a surface as possible. "A free incision, 
 even when made in the wrong place and direction, is 
 preferable to several small cuts correctly made — 
 smooth though wrong incisions are better than jagged 
 ones which are correct." (Virchow). 
 
8 
 
 Always put the tissues on the stretch before cut- 
 ting, either )iy pulling the neighbouring parts to one side 
 with the left hand, or in the case of elastic organs, by 
 supporting from below, l^y attending to these direc- 
 tions, the dissection can be made rapidly, and the 
 parts are exposed in good condition. 
 
 During the entire dissection, keep the fingers 
 constantly moist by dipping them fre(juently in clean 
 water, thus preventing any blood, etc., from drying on 
 them. It will then be but seldom necessary to do 
 anything beyond simply washing the hands at the close 
 of the autopsy in order to free them from all unpleasant 
 odour. In case this cannot be attended to, washing 
 with diluted Condy's fluid, will be found to remove 
 the odour promptly, though numerous other disinfect- 
 ants answer equally well. 
 
 4. Note taktni;. The notes of the autopsy 
 should be dictated at the time. When it is impossible 
 to do this, they should be written out in full immedi- 
 ately afterward. Describe each condition at the 
 time it is observed, nnd before proceeding with the 
 next step in the autopsy. Describe at length only 
 what is pathological. Notes concerning normal con- 
 ditions should be as brief as possible. It is usually 
 enough to state simj)ly that an organ is normal, but at 
 times it is better to state upon what grounds this 
 opinion has been formed. Make the description 
 entirely objective, stating only what is actually seen, 
 rather than the opinion formed of its nature. At the 
 close of the autoi)sy d:aw up a short summary 
 (anatomical diagnosis) of the conditions found. Ex- 
 clude all accounts of the technicjue from the report, 
 except where such details are necessary to make the 
 description intelligible. Observe the position and sur- 
 roundings of each organ before removing it ; the size, 
 external appearances, and any information obtained by 
 
 } 
 
9 
 
 ])alpaiion etc., before incising. Note the contents 
 aiul condition of tlic wall in hollow origans. Describe 
 with special care the appearance of the cut surface 
 after making an in( ision. The size, weight consis- 
 tency, texture, moisture, amount of blood present and 
 occurrence of any abnormal element, are points which 
 are easier to determine than alterations of color, beside 
 being more easily dc scribed, and less likely to mislead. 
 (Compare everything with the normal and judge it from 
 that standpoint. 
 
 5. An opinion as to the significance of the 
 changes found, and their relation to one another, can- 
 not be formed until the examination is completed, 
 as some condition found at a late stage may upset 
 any oi)ini'^n i)reniaturely formed. A positive opinion 
 as to the imihediate cause of death is often very dit^- 
 cult to aiiive at, indeed quite impossible in a certain 
 proportion ot cases, a fact not taken sufficiently into 
 account in legal medicine. 
 
 G. Preparation^^. The autopsy should not 
 under ordinary circumstances be performed earlier 
 than 10 to 24 hours after death; the body during this 
 time being kept in a cool place. 
 
 Place the body on its back upon the table or 
 board of convenient height, in a well-lighted spot. 
 Autopsies should not lie done by artificial light whe^e 
 this can be avoided. 
 
 Ascertain if possible the name, age and occupa- 
 tion of the deceased, the clinical history and the 
 symptoms attending death. Note the time which has 
 elapsed since death. 
 
 See that everything is in readiness before commenc- 
 ing, and have clearly in mind the special points to be 
 determined by the autopsy. 
 
10 
 
 7. Inspection of body. Before beginning 
 the actual dissection of the hody, make a careful and 
 thorough external examination. 'I'his should on no 
 account be ])ostponed, as it cannot be done satisfac- 
 torily after the dissection has once been begun. 
 
 If the body is that of an unknown person, note 
 with special rare anything which may lead to its sub- 
 sequent identification. 
 
 Note the sex, apparent age, size, development, 
 and anything specially striking in its appearance. 
 
 Note the state of nutrition. 
 
 Note the signs of death : — rigor mortis, post 
 mortem lividity and any evidences of putrefaction. 
 
 Inspect in order the various regions of the body, 
 viz. : — Head, neck, chest, abdomen, back and extre- 
 mities, examining carefully the natural orifices,— mouth, 
 njse, ears, anus, genitals. Note any indications of 
 present or past disease, and any injury or foreign body. 
 If wounds are present, ascertain tiieir position, extent 
 and condition. In this examination the condition of 
 skin, hair, eyes and teeth, should be noted, but any 
 special disease of the skin is best described separately. 
 
 This completes the inspection. 
 
 8. Order in wliicli Uie organH Hboulil 
 be examined. The brain is usually examined first 
 of all, as otherwise it becomes anaemic through the 
 blood escaping from the veins on opening the heart. 
 
 The spinal cord may be examined either at the 
 beginning or the end of the autopsy. 
 
 The thorax and abdomen are next to be examined, 
 though in cases where the examination of the brain 
 is omitted, the dissection can be commenced here, in 
 the following orde^ : — (1) Open and inspect the 
 
 n 
 
11 
 
 abdomen. (2) Open and inspect the thorax. (3) Re- 
 move and examine the heart, lungs and organs of neck. 
 
 Examine the abdominal organs in the following 
 order : 
 
 Omentum ; spleen ; left kidney and ureter ; 
 right kidney and ureter ; bladder and urethra ; geni- 
 tals ; rectum ; small and large intestine ; stomach and 
 oesophagus ; duodenum, bile ducts, portal vein, gall 
 bladder and liver ; pancreas ; supra renals, coeliac 
 ganglia, mesentery, retro-peritoneal glands, vena cavn, 
 aorta, thoracic duct, etc. 
 
 Last of all, if necessary examine the extremities, 
 bones, joints, peripheral vessels and nerves. 
 
 9. Opening tlie liead cavity. Place a 
 block of wood under the head to support it, and make 
 an incision commencing close behind one ear, passing 
 directly over the vertex (top of the head) and ending 
 close behind the other ear, cutting down to the bone 
 all the way. If the hair is long it must first be parted 
 in the line of the incision, and tied up out of the way. 
 
 Next reflect the tvvo halves of the scalp forward 
 and backward with a knife or chisel, till the orbital 
 ridges and the occipital protuberance are exposed, 
 taking care to keep the point of the instrument direct- 
 ed against the bone so as not to injure the scalp. 
 Tuck the hair under the folds of the scalp to keep it 
 from being soiled. Note carefully the condition of 
 scalp and skull cap. 
 
 Draw a line with the knife around the skull where 
 the bone is to be sawn through, cutting the temporal 
 muscles. This line should pass just above the frontal 
 eminences in front and through the occipital protuber- 
 ance behind. Instead of a single circular cut it is bet- 
 ter to saw in two planes, shewn as the dotted lines 
 FT and OT in figure 1, intersecting at the mastoid 
 
 "fym 
 
 !' ffl»^e i ffu^g|vy^^^ ' 
 
1-2 
 
 region on each side. The skull-cnp is then easier 
 to retain in position when the body is sewn up. 
 
 
 
 Fig. 1. — Diagram to illustrate the method of re- 
 moving the skull-cap. The hone is first 
 sawn through in the i)lane K T and after- 
 wards in the plane O T. 
 
 In sawing, steady the head with the left hand, 
 which should be [protected with a towel in case the saw 
 should slip. In most cases it is sufficient to saw 
 through the outer table only and crack the inner by 
 a few taps with a mallet and chisel at different 
 spots ; but in cases where fracture of the skull is 
 suspected, both tables must be sawn completely 
 through, even at the risk of wounding the brain, lest 
 a fracture be artificially produced. IVst the dei)th 
 of the cut from time to time with the j)oint of the 
 saw, remembering that the bone is much thinner in 
 the temi)oral region than elsewhere. As the thickness 
 of the skull may vary from nearly half an inch down 
 almost to that of stout writing paj)er, it is often im- 
 possible to avoid injuring the brain to some extent 
 but as the sensation imparted to the hand becomes 
 quite different as soon as the bone is completely cut 
 through, the mishap should be recognised at once. 
 
 1 
 
 T 
 
T3 
 
 Wrench off the skull cap with the chisel or with 
 a hook made specially for the purpose. Where the 
 dura is very firm'y attached to inner surface of the 
 bone, it may either be removed together with the 
 skull-cap after dividing the falx, or else the brain itself 
 may be comi)letely removed with the skull-cap, a more 
 difficult method Examine the calvariun. Examine 
 the external surface of the dura. Slit open and ex- 
 amine the longitudinal sinus. 
 
 Divide the dura along the line of the saw cut on 
 one side, draw it gently over to the opposite side and 
 examine its inner suface and corres|)onding surface of 
 the brain. Do the same on the other sic .. Pass a 
 scalpel carefully between the hemispheres and cut the 
 falx antericrly, reflect the dura backward, and examine 
 the pia and brain along the convexity, carefully com- 
 paring the two sides. 
 
 The nature and amount of any fluid which may 
 have escaped should be noticed. , 
 
 10. To remove the braiiii, tilt the head 
 back and raise the frontal lobes. Support the hemis- 
 pheres with the left hand. Cut the optic nerves with 
 a sharp knife at their points of exit. Pass the knife 
 round the pituitary fossa, separating the pituitary body. 
 Divide both internal carotid arteries. Cut the third 
 nerves at their points of exit. Next pass the knife 
 along the sharp posterior border of the petrous bone, 
 dividing the tentorium together with the fourth and 
 fifth nerves, taking care not to wound the cerebellum 
 which lies immediately beneath. Divide the remain- 
 ing cerebral nerves at their points of exit. Finally 
 pass the knife deeply into the foramen magnum, 
 sever the medulla as far down as possible, cut the 
 vertebral arteries on each side and remove the brain, 
 separating it gently from the dura with the right hand. 
 
14 
 
 11. Exaiiiiiiatioii of* brain. The method 
 to be followed must depend upon whether it is wished 
 to determine accurately the extent and relations of a 
 lesion in the substance of the brain or simply to see 
 whether any lesion is present at all, being satisfied 
 with a rough idea as to its extent and location. 
 
 In the former case the best method consists in 
 making a series of transverse sections through the whole 
 brain at definite levels. This can be done with the fresh 
 brain by using a long-bladed knife (an ordinary carv- 
 ing knife answers very well) but the best results are 
 obtained when the brair; has first been hardened in 
 a solution of bichromate of potassium, the s;iiue fluid 
 being injected into the arteries so as to reach the 
 deeper parts. This process is very tedious and trouble- 
 some, and is only to be reconmiended when a specially 
 careful investigation is to be made. For ordinary pur- 
 poses the following method (Virchow's) is preferable: — 
 
 12. Bissectioii of brain. Place the brain 
 base upwards and examine the base, noting the state 
 of the pia and vessels. 
 
 Turn the brain over and examine the state of 
 the convolutions and fissures, removing the pia if 
 necessary by pinching up a fold between the thumb 
 and forefinger and rolling the brain substance away 
 from it with the remaining fingers. 
 
 Next open the roof of the left lateral ventricle 
 by a shallow incision made with the point of the knife 
 dividing the corpus callosum slightly (J") to the left 
 of the median raphe, and extended into the anterior 
 and posterior corniia. In making this incision the 
 roof of the ventricle should be raised by drawing 
 the hemisphere gently outward with the left hand, 
 thus avoiding injury to the basal ganglia, which lie 
 immediately beneath. 
 
 mpwnm 
 
 I 
 
15 
 
 Now make a deep incision into the white sub- 
 stance of the left hemisphere, cLirvinjjj outward so as to 
 pass just external to the great ganglia, and cutting; al- 
 most through the cortex all the way. Several similar 
 incisions external to this one, and parallel with it, will 
 exjiose the whole of the white substance of the left 
 hemisphere. 
 
 Make a similar dissection on the right side. (It 
 will be found convenient before doing this to turn the 
 brain end for end). 
 
 The lateral ventricles being now fully exposed, 
 note their size, contents, — including any fluid which 
 may have escaped in the process of opening, — and the 
 condition of the ependyma. 
 
 Expose the third ventricle by passing the blade 
 of the scalpel into the foramen of Munro and cutting 
 upwards. Reflect the posterior part forward with the 
 handle of the knife, and, after dividing the posterior 
 limb of the fornix on the right side, turn it over to 
 the left, exposing the choroid plexus, corpora 
 quadrigemina and pineal gland. 
 
 Next examine the fourth ventricle, exposing it by 
 cutting through the vermiform process of the cerebel- 
 lum, taking care to lift the left lobe slightly at the 
 same time so as to avoid injuring the floor of the ven- 
 tricle. 
 
 Now examine the basal ganglia by a series of 
 parallel transverse incisions, beginning anteriorly and 
 made about a quarter of an inch apart. In making 
 these incisions the knife should be held lightly 
 between the fingers and thumb and moved like a 
 fiddle bow, the blade being kept constantly wet and 
 the parts put upon the stretch by supporting the 
 temporal lobes from below, as otherwise the delicate 
 brain tissue will be torn. The incisions should pene- 
 trate to the cortex, exposing *he claustrum and the 
 convolutions of the island of k^il. 
 
 
 
10 
 
 ■ ■! 
 
 A more crude method of examininjj: the ginglia, 
 is by simply makini^ a couple of longiiiidina! incMsions 
 through the corpus striatum and oi)tic thalamus on 
 each hi ie, after o[)ening the lateral veiiiricles. 
 
 A few transverse cuts are now made into the cor- 
 poia (juadrigemina. 
 
 Examine the cerehellum by making a series of 
 deep incisions into each of the lateral lobes radiating 
 from the corpora (juadrigemina and exposing the sub- 
 stance of the cerebellum and cerebellar j)edunc!es. 
 
 Fold the hrain together and place it again with 
 the base upwards. Finish the dissection of the arter- 
 ies at the base and remove them. 
 
 Examine the crura cerebri, pons and medulla by 
 a series of parallel transverse incisions. 
 
 If the dissection has been i)roperly made, the 
 various parts of the brain will still be connected and 
 the whole organ can st'^ be folded together like a 
 loosely bound book, each part remaining in its normal 
 position, so that when hardened any ))ortion desired 
 can be examined micr()sc()[)ically. The points to be 
 attended to in examining a brain, are: (I) — to pre- 
 serve the relation of parts in the manner above des- 
 cribed, and (2) — by keeping the knife blade constantly 
 wet, to avoid tearing the brain tissue. 
 
 13. Bane ol'Hkull. After finishing the ex- 
 amination of the brain, examine the dura at the base 
 of the skull, slitting open the principal sinuses. Re- 
 move the dura by seizing the edge with a towel and 
 stripping it off. Fvxamine the bones at the base. By 
 chipping away the sphenoid bone, the course of the 
 carotid artery, cavernous sinus and jugular fossa can 
 be exposed. 
 
 14. Ear. The internal and middle ear can 
 be examined by simply breaking o[)en the petrous bone 
 
 mmm 
 
17 
 
 (- 
 e 
 
 d 
 
 m 
 
 :in 
 ne 
 
 in the region of the semicircular canals with the ham- 
 mer or chisel, and removing the fragments with for- 
 ceps. This affords an excellent view of the tym- 
 panic cavity. When, however, a thorough examin- 
 ation is desired, it is better to reflect down the skin 
 and external ear by extending the scalp incision 
 a short distance down the neck, and dividing the 
 attachments of the auricular cartilages subcutane- 
 ously. The whole petrous bone can now be removed 
 by two saw cuts intersecting at the sella turcica. 
 Holding (he bone in a towel or placing it in a vise, 
 saw in a plane extending from the posterior border of 
 the external auditory meatus, to the anterior border of 
 the internal. The drum membrane is exposed intact, 
 and the tympanic cavity, mastoid antrum and anterior 
 mastoid cells are laid open. 
 
 15. Eye. To examine the eye, break in the 
 bony roof of the orbit and expose the posterior half 
 of the eye-ball at the entrance of the optic nerve. 
 Cut away the posterior part of the retina with a sharp 
 pair of scissors, keeping well behind the ciliary region 
 to avoid disfiguring the parts visible from the front, 
 and remove it with the nerve attached. A piece of 
 common cotton wadding placed in the orbit,can after- 
 wards be made to give the eye a very natural appearance. 
 The whole eyeball should not be removed without 
 si)ecial pei mission. 
 
 16. Fiici?. To examine the parotid gland and 
 bones of the face, extend the scalp incision behind 
 the ear to the angle of the jaw, and dissect down the 
 soft parts, taking care not to cut the skin. The re- 
 moval of portions of the skull or face should not, as a 
 rule, be attempted without special permission, as it is 
 almost certain to disfigure the features, though by 
 filling in the defect left with plaster of Paris, moulding 
 
 T 
 
I 
 
 18 
 
 it to give the proper outline, and allowing it to 
 set before sewing up, a fairly natural appearance ran 
 be obtained. In no case must the skin of the face he 
 cut. (See Section 37.) 
 
 17. None. By chiseling out the ethmoid bone 
 a good view is obtained of the upper nasal passages 
 and frontal sinus. To examine the lower and anterior 
 parts of the nose, reflect up the upper lip, keeping the 
 knife close against the superior maxilla, sepnrating the 
 alae nasi subcutaneously and dividing the cartilaginous 
 septum. 
 
 18. Spinal cord. Place the body, flice down- 
 ward, with a block beneath the chest Make a deej) 
 incision from the naj^e of the neck to the sacrum, 
 passing close to the spines of the vertebrae the whole 
 way. Dis-^ect away the muscles on each side so as to 
 expose the laminae. Note anytiiing almormal about 
 the soft parts or bones. 
 
 Open the spinal canal by cutting through the 
 laminae near the articular i)rocesses. This can be 
 done with a saw, but it is better to use a rachitome 
 (chisel specially made for the i)ur|)ose), or simply a 
 pair of strong bone forceps. 
 
 Remove the laminae with bone forceps or hook, 
 and examine the j^osterior surfiTce of the sjjinal dura, 
 now lying exj)osed. 
 
 Slit open the dura along the posterior surface 
 with i)robe-i3ointed scissors, and examine the i)ia 
 mater and nerve roots. 
 
 Remove the cord by grasping the dura at the 
 posterior extremity, and cutting the spinal nerves in 
 succession at their points of exit. Divide the cord 
 obliquely near the medulla, or remove it entirely if the 
 brain has been previously removed. Slit up the dura 
 anteriorly and examine the pia in front. 
 
 I 
 
 ■ i '■'•'^ 
 
19 
 
 o 
 m 
 
 Letting the cord rest lightly over the left fore- 
 finger, make a number of transverse incisions — one or 
 two bc^tween each pair of nerve roots. These should 
 l)e made with a very sharp knife, held lightly in the 
 right hand between thumb and fingers and moved in 
 a sawing manner. 
 
 Note carefully the ap])earance of both gray and 
 wliite matter on both cut surfaces, as eacli section is 
 made. As the macrosco])ical appearance of the cord 
 is vety deceptive, if any portion appears abnormal 
 it is advisable to snip out a minute fragment with 
 scissor^, s])rcad it out on a slide by gently pressing a 
 coverglass upon it, and examine it at u.ice micro- 
 scopically. A thorough microscopical examination 
 can only be made after t)ie cord has been hardened. 
 
 19. Vertebrae. When the examination of the 
 v'ertebrae is of special importance, the cord had better 
 be left alone till the thorax and abdomen have been 
 examined; the vertebral column can then be removed 
 and either sawn open by a median longitudinal 
 (sagittal) incision, or, if it is desired to examine the 
 cord as wtdl, the incision may be made sufficiently fiir 
 to one side. 
 
 A special set of chisels has been devised for the 
 puri)ose of removing the cord from in front, after the 
 removal of the thoracic and abdominal organs. 
 
 20. Kxaiiiiiialioii of the tliorax and 
 alHloiiieii. l-^irst o})en and inspect the abdomen, 
 then dissect the thorax ; finally return to the abdo- 
 men and finish dissecting it. 
 
 Place the body on its back with a block of wood 
 under the shoulders. Stand on the ri<j;ht side of the 
 body, hold the large knife firmly in the hand and make 
 a long straight incision from the episternal notch to 
 the pubis, passing to the left of the navel and cutting 
 
 1 
 
20 
 
 completely through the skin. This cut should be made 
 rapidly and with firm i)ressure on the knife. Open the 
 peritoneum by a small incision in the epigastrium. 
 Note the escape of any gas. Extend this opening to 
 the pubis, retracting the right edge of the cut with the 
 left hand, to avoid injury to the intestines. Note the 
 character and amount of any tluid in the abdominal 
 cavity. (Irasp the side of the incision firmly in the left 
 hand, divide the upper end of recti muscles and dis- 
 sect off the pectoral muscles, exposing the costal 
 cartilages and intercostal muscles with a few sweeping 
 cuts, putting the tissues always forcibly on the stretch 
 before cutting. 
 
 Note the amount and appearance of the subcuta- 
 neous fat and the state of the muscles, ribs and 
 sternum. The mammary gland can be examined 
 by incising it deeply from the inner surface, leaving 
 the skin intact. 
 
 21. Inspect the ailMloiiiiiial cavity, 
 
 noting the position and color of the parts exposed, 
 the presence of abnormal substances in the peritoneal 
 cavity, etc. This inspection should be made systema- 
 tically, observing the position of liver, stomach and 
 intestines, including the vermiform appendix, the posi- 
 tion of the ])elvic organs, the state of pelvic cavitv, 
 flanks, and hypochondria. The examination is made 
 easier by first dividing the recti muscl's subcutane- 
 ously just above the pubis and turning the abdominal 
 walls outward. A crucial incision extending across 
 the abdomen into each flank is sometimes necessary. 
 If rupture or ])erforation of one of the abdominal 
 organs is suspected, this point should be settled if 
 possible before proceeding further with the autopsy ; 
 if this is neglected, and some such condition is after- 
 wards found, a doubt mny rennin as to whether it 
 may not hav^e been made accidentally during the 
 examination. 
 
 ».i V >^Wi|1 ^ -i fl - 1Li »^ ■ a •■■ 
 
 I 
 
 ( 
 
21 
 
 22. Find llie lovt'l of llic (liapliraKiii 
 
 by plncing the right hand within the abdomen, and 
 noting on each side tlie highest rii) or S[)ace at which 
 the finger tips of the left liand can l)e felt through the 
 chest wall in the nipple line. '1 his must of course be 
 done before the thorax has been opened. If pneumo- 
 thorax is susjucted, fill the angle between the chest 
 wall and the reflected skin with water and punc ture an 
 intercostal space below the surface, when, if air is jire- 
 sent, it will be recognized by bubbles rising. 
 
 23. Open the thorax by dividing the costal 
 cartilages just at their line of junction with the ribs. 
 Make the opening as roomy as i)ossible ; remember 
 that the cartilages of the lower ribs extend outward 
 nearly to the axillary line. Cut the cartilages by 
 pressing forcibly on the knife near the blade, holding 
 it parallel with the chest so as not to injure the lungs 
 with the point. If the ribs are calcified, divide them 
 with the .saw or bone forceps. The cartilage of the first 
 rib should be divided from bel^w about half an inch 
 farther out than the second, on account of the width 
 of the manubrium sterni. Open the sterno-clavicular 
 articulation on both sides, holding the knife perpen- 
 dicularly to the joint and carrying the cut round the 
 head of the clavicle to divide the sterno-clavicular 
 ligaments. 
 
 Raise the lower end of the sternum with the left 
 hand and cut away the attachments of the diaphragm 
 on each side, by thrusting the knife point through it 
 and cutting outward. Diseect off the tissue of the 
 mediastinum, keeping the point close against the 
 bone. Open the right sterno-clavicular joint from 
 below and cut round the upper end of the sternum, 
 following the upper border of the bone into the left 
 sterno-clavicular joint ; the sternum may then either 
 be completely removed, or allowed to remain attached 
 
 
•)0 
 
 by the ligaments on the left side, being simply turned 
 over out of the way. In raising the sternum care 
 must be taken not to wound the great veins at the 
 root of the neck, as in that case the blood will escape 
 into the i)loural cavity. If the veins are wounded a 
 sponge should be placed over them to absorb the 
 blood. 
 
 Note the position of the thoracic organs. Ex- 
 amine the internal surface of the sternum. ICxamine 
 the anterior mediastinum and thymus or gland. Kx- 
 the pleural cavity on each side, noting the nature and 
 amount of any fluid which may be present. 
 
 Open the pericardium by pinching up a fold and 
 incising it with knife or scissors, extending the in- 
 cision "pward to the root of the vessels. 
 
 Note the nature and amount of any fluid in the 
 pericardial sac and t' e condition of parietal and vis- 
 ceral pericardium (epicardium.) 
 
 Note the position of the heart and the degree of 
 distention of its chambers. If it is wished to esti!:">ate 
 accurately the amount of blood in the heart cavities, 
 the heart should be incised i/i st'///, taking care to 
 make these incisions where the cavities are subse- 
 quently to be oj)ened. Feel the arch of the aorta to 
 ascertain if an aneurism be present, in which case the 
 aorta should be removed with the heart. 
 
 Remove the heart by grasping the ai)ex with 
 the left hand, lifting it outward and upward, and cuttiiiL; 
 across the vessels close to the pericardium. Cut 
 the aorta short enough for the valves to l)e seen, and 
 test their competency by pouring water into the vessel, 
 holding up the heart by the auricles. The compe- 
 tency of the tricuspid and mitral valves can be tested 
 by pouringwater through a tube passed into the pul- 
 monary artery and aorta, respectively. These tests are 
 not very reliable. 
 
 I 
 
 1 
 
23 
 
 25. Open aiMl exiuiiiiie the eavltlcH of 
 the heart, following the order of the circulation — 
 right auricle; right ventricle; left auricle; left ven- 
 tricle. The incisions are best made with the large 
 probe-pointed scissors used for o[)ening the intestines. 
 
 I. Op(in the right auricle by cutting from the 
 superior to the inferior vena cava. 
 
 II. I^ass the probe-pointed scissors down the 
 [)ulm()nary artery and into the right ventricle and 
 open it by an incision, passing between the segments 
 of the pulmonary valve and extended to the apex, 
 kee|)ing just to the right of the septum. P^xamine 
 carefully the (Uivity of the ventricle and the valves 
 before proceeding further. 
 
 III. Pass the probe pointed blade of the scissors 
 through the trie i)id orifice, and cut across the face 
 of the tricuspid valve, extending the incision to the 
 apex of the right ventricle, along the right border of 
 the heart. 
 
 'I'he left chambers are examined in a correspond- 
 ing manner. 
 
 IV. Slit open the left auricle where the pul- 
 monary veins enter. 
 
 V. Pass the scissors down the aorta into the 
 left ventricle, drawing the pulmonary artery over to the 
 right so as not to wound it, and cut behind it along 
 the left side of the septum as far as the apex. As one 
 of the aortic cusps lies directly in the track of this 
 incision it is difficult to avoid injuring it. Examine 
 the interior of the ventricle and the valves before 
 making the next incision. 
 
 VI. Make an incision from the left auricle to the 
 apex of the left ventricle, passing the probe-pointed 
 blade of the scissors through the mitral orifice, and 
 cutting along the left border of the heart. 
 
 The method of opening the heart will be under- 
 stood better by referring to the diagrams. 
 
 il 
 
 
24 
 
 Figure 1 is intended to shew the dissection neces- 
 sary for exposing the right chamhers of tlie heart. 
 The dotted hnes indicate the course of the incisions 
 and the arrows shew their (hrection. The numbers 
 I, II, III show the order in which the cuts are to L^e 
 made. 
 
 Figure 3 shews in a similar manner the incisions 
 for the left chamhers, the course of the incisions being 
 marked by dashes numbered IV, V and VI. The 
 pulmonary artery has been drawn over to the right. 
 
 In figure 4, the incisions for both sides are shewn 
 in the same diugram. 
 
 As each chamber is opened remove the blood 
 clot, observing its character, and the appearance of the 
 valves, endocardium and heart muscle, making incis- 
 ions into the muscle if necessary. Slit open the cor- 
 onary arteries and examine them. 
 
 Measure with a rule the circumference of the 
 different orifices after they are cut across, also the 
 average thickness of the ventricular walls. The dis- 
 tance from its apex to the base of the nearest sigmoid 
 cusp, is the best index of the si/.e of a ventricle. 
 Weigh the heart. 
 
 MEASUREMENT OF HEART. 
 
 5.V in 13 cm. 
 
 11 
 
 8 
 
 (( 
 
 7.5 
 
 Tricuspid orifice 
 
 Mitral '* 4^ 
 
 Pulmonary *' 3 J 
 
 Aortic " 3 
 
 Right ventricle length 3^ " 8 
 
 Left " " 3 " 7.5 
 
 Right '' thickness of wall J " 0.4 
 
 Left " " " " i " 1 
 
 20. I^uiigs. Remove each lung separately, 
 breaking down with the fingers any pleuritic adhesions 
 that may be present. If this cannot be done without 
 tearing the lung tissue, insert the fingers between the 
 
 a 
 
 a 
 
 (k 
 
 «( 
 
 (( 
 
 u 
 
 (( 
 
leces- 
 
 leart. 
 
 Iisions 
 
 mhcrs 
 
 to l}e 
 
 :isions 
 
 being 
 
 The 
 
 i,u;ht. 
 
 shewn 
 
 blood 
 ) of the 
 l; incis- 
 he cor- 
 
 ) of the 
 also the 
 The dis- 
 sigmoid 
 ventricle. 
 
 .13 cm. 
 .11 " 
 . 8 " 
 7.5 '' 
 
 . 8 " 
 
 T.r) 
 
 .0.4 
 
 . 1 
 
 a 
 
 a 
 
 a 
 
 eparately, 
 adhesions 
 e without 
 Aveen the 
 
 DIAGRAMS 
 
 TO ILLUSTRATE METHOD OF OPENING HEART. 
 
 Wig* 2* — The dotted lines represent the lines of incision for opening 
 the right chambers, .ind are numbered I, II and III, 
 corresponding to the order in which they should be made. 
 
 ao. 
 
 Fi|f . ;i.- The lines of dashes show the incisions for opening the left 
 chambers, the num!)ers IV, V and VI giving their order. 
 
I 
 
. ..o 
 
 I 
 
^o. 
 
 pv. 
 
 In Figure 4 the incisions for hoihsides are shown in a 
 single diagram. 
 
 The lettering is the same in all the figures : R.a., 
 right auricle; R.v., right ventricle; L.a , left auricle: 
 L.V., left ventricle ; P. a., jnilmonary artery; I'.v., pul- 
 monary veins ; S.c, superior cava ; I.e., inferior cava ; 
 A.o. , aorta. 
 
 . 'fr- .i- | lWM' » 'B » lg.«»»a»l3«llW.3g(B*^ ■» «^♦-«^.••« 
 
 I 
 
25 
 
 costal pleura and chest wall, strip it off and remove it 
 with the lung. Pull the lung forward out of the chest 
 and cut across the bronchi, cutting close to the root of 
 the lung so as to avoid wounding the oesophagus. 
 Weigh the lung. 
 
 Note the api »earancc of the surface and the results 
 obtained by palpation. Make a long smooth incision 
 extending from apex to base along the posterior bor- 
 der, exposing as large a surface as possible. This 
 incision is easily made if the organ is balanced on the 
 left hand, or still better if a Sj)onge is placed beneath 
 it. The incision should not sever the large bronchi 
 and vessels. Subsequent incisions can be made 
 parallel to this one or transversely to it. P^xamine 
 the cut suface as to color, consistency, texture, amount 
 of blood, air. fluid, or solid exudation, etc. FAamine the 
 opposite lung in the same way. Slit up and examine 
 the bronchi and vessels. 
 
 27. Organs of neck. Extend the original 
 incision u])wards to the level of the hyoid bone, or, 
 if permissible, to a point one inch below the tip of 
 the chin. Free the skin and subcutaneous tissue from 
 the deeper parts as widely as j)ossible on each side. 
 
 Puncture the floor of the mouth just behind the 
 symphysis of the lower jaw, and sever the attachment 
 of the tongue to the inferior maxilla on each side by 
 l^assing the knife along the inner surface of the bone 
 as far back as the angle of the jaw. Draw down the 
 tongue through the floor of the mouth with the left 
 hand. Cut across the soft palate, divide the posterior 
 wall of the pharynx as near the base of the skull as 
 possible and carry the incision behind the tonsils on 
 each side. By drawing the tongue downward, the 
 pharynx and cesophagus can be dissected off from the 
 vertebra), with the cervical vessels and nerves attached. 
 At the root of the neck the vessels of the arm should 
 
 \ 
 
 ■ -Vfr.'i-^f^ertrrt^Ti^'^-^-t^ii^.-^m 
 
 I 
 
 I 
 
26 
 
 be divided on each side, by cutting outward and back- 
 ward behind the head of the clavicle. 'I'he tesophagus 
 can either be divided above the bifurcation of the 
 trachea or just above the diaphragm. In some cases 
 it is convenient to ren ve the organs of the neck 
 together with the heart . iungs. 
 
 Examine the nerves aud vessels^ the tongue and 
 sub-maxillary glands and the thyroid gland. 
 
 With probe-{)ointed scissors cut across the soft 
 palate close to one of the tonsils and slit open the 
 pharynx and (oso|)hagus along the posterior wall. 
 Examine j)harynx and (esophagus, especially in the 
 region of the glottis. Slit up and examine the larynx 
 and trachea along the posterior wall, drawing the reso- 
 pifcagus slightly to one side. Examine the 'bronchial 
 glands. 
 
 28. I>iKHectioii of tibtloiiieii. Remove the 
 block from beneath the body and cut the diaphragm 
 on each side, this will cause the liver and stomach to 
 gravitate toward the thorax and so afford more s})ace 
 in the abdomen. Examine the peritoneum and omen- 
 tum, removing the latter. Draw forward the large 
 intestine, beginning at the sigmoid flexure, cutting 
 the peritoneum and the loose cellular tissue behind 
 it. After freeing the colon and coecum in this man- 
 ner, remove the ileum and jejunum, putting tlie mes- 
 entery on the stretch and separating it as near the gut as 
 possible by making sawing cuts across it with a sharp 
 knife. The duodenum is left to be examined later in 
 situ. The intestines may be simply turned out to the left 
 side of the body till the time comes for examining 
 them, or they may be completely removed by dividing 
 the commencement of the jejunum and cutting off 
 the rectum at the brim of the pelvis — first ligaturing 
 them if the contents arc fluid. It is well to remember 
 that the duodenum lies immediately under the ascend- 
 
 -*^^ 
 
 J 
 
 Tf, 
 
 '\A 
 
27 
 
 s 
 e 
 
 k 
 
 d 
 
 ►ft 
 
 ing colon on the right side, when the small intestines 
 are turned over to the left, and the commencement 
 of the jejunum is found at the left side of the mesen- 
 tery by turning the small bowel over to the right. 
 
 20. Spleen. Remove the spleen, freeing it 
 with the fingers from any attachments which may exist, 
 and dividing the vessels at the hilus. Weigh the organ, 
 examine its surface, and expose the pulp by a single 
 incision along the convex surface, in the long axis. 
 
 30. Kiflneys. Remove the left kidney by 
 cutting the peritoneum in front and shelling it out 
 with the fingers from the loose connective tissue (fatty 
 capsule) surrounding it. (]ut the vessels at the hilus. 
 Divide the ureter at the brim of the pelvis, unless it 
 is desired to preserve the continuity of the whole 
 urinary tract. 
 
 \Veigh the kidney and examine the surface, after 
 incising the capsule and peeling it off. Make ah 
 incision along the convex border, extending the whole 
 length of the organ and deep enough to expose the 
 pelvis. In making this incision the kidney should be 
 held lightly in the left hand with the hilus toward the 
 palm. Examine the condition of cortex, medulla and 
 pelvis, and slit open the ureter. Examine the right 
 kidney in the same manner. 
 
 Make a small incision into the bladder and note 
 the character and amount of the urine. 
 
 31. Remove the eoiiteiits of* the pelvis 
 
 — first cutting through the i)eritoneum and cellular 
 tissue around the brim ; then, holding the bladder and 
 rectum in the left hand to put the tissues on the stretch, 
 pass the knife around the i)elvic wall close to the 
 bone, dividing all attachments; cut the rectum across 
 near the anus, and cut the urethra as (i\r forward as 
 possible under the pubic arch, depressing the handle 
 of the knife backward. 
 
 tT 
 
28 
 
 32. External genitaU orgaiiN. In foinalcs, 
 H" it is wished to remove the external genitals, together 
 with the pelvic organs, separate the legs widely and 
 make an elliptical incision i)assing from the pubis to 
 behind the anus on each side, including the pudenda 
 and the whole perineum. Bypassing the knife under 
 the pubic arch and separating the attachments to the 
 pubic bones, the whole of the external genitals, as 
 well as the j)erineum and anus, can be drawn into 
 the pelvis and removed. 
 
 In males, the penis can be removed by extending 
 the abdominal incision downward, dividing the penis 
 subcutaneously as far forward as may be necessary, 
 and drawing it under the pubis into the pelvis after 
 dividing the attachments. The testes can be removed 
 by enlarging the inguinal ring and pressing them out 
 from below, dissecting out the course of the vas defer- 
 ens if necessary. They can be returned to the scrotum 
 after examination. 
 
 i • 
 
 33. l>i8NCCtioii of pelvic or^aiiH. First 
 slit open the bladder and urethra along the anterior 
 surface and examine them. 
 
 In males, make transverse incisions in each lobe 
 of the prostate from behind. Examine the vesiculae 
 seminales, vas deferens and testicles. 
 
 In females, examine the external genitals. Slit 
 up vagina along the left side and examine. Dissect 
 the bladder free of the uterus on one side. 0[)en the 
 uterus by an incision anteriorly in the median line, 
 with lateral incisions into the cornua. ICxamine the 
 fallopian tubes, broad ligaments and ovaries, exposing 
 the ovaries by an incision along convex border. 
 
 Slit open and examine the rectum. 
 
 34. InteHliiien. Slit oi)en small and large 
 with the " intestine scissors " by inserting one blade 
 
 .^,:>^^smmMl^smsmmme'ii>*u0'^''*^-^ 
 
 / 
 
29 
 
 in the bowel and drawing the gut against the angle 
 formed by the other blade. The small intestine 
 should be opened along the mesenteric attachment ; 
 the large, along one of the longitudinal muscular 
 bands. Note the nature of the contents and examine 
 the mucosa. To prepare the mucosa for examination 
 after opening, draw the intestines between the first and 
 second fmgers of the left hand (which must be kept 
 wet), rinse in a pail of clean water and spread them 
 out on a tray or table. 
 
 Slit open the €liioclcnuiii along its anterior sur- 
 face. Note the contents and the state of the mucosa. 
 S(iueeze the gall bladder and see if bile flows from 
 the common gall duct. 
 
 Remove the Ntoinacli unopened, ligaturing the 
 upper part of the duodenum and the oesophagus, or 
 pinching the cut ends between the fingers. Cut the 
 oesophagus just above the diaphragm. Draw forward 
 the stomach and dissect off the attachments along 
 the lesser curvature. Cut the duodenum just beyond 
 the [)yloric ring. Ojicn with probe-pointed scissors 
 along the greater curvature, and examine the contents 
 and the state of the inner surface The stomach 
 { .n be opened in situ by continuing the incision from 
 the duodenum along the greater curvature. 
 
 Raise the anterior edge of the liver and dissect 
 the bile ducts, hepatic artery and portal vein. Open 
 and examine j?all hlsulder. 
 
 35. The rciiiaiiiiiiiif alKloiiiiiial organs 
 
 may be conveniently examined in the following order. 
 Remove the liver by dividing the suspensory 
 Hgament and the lateral ligaments on each side. Weigh 
 the liver and examine the surface. Make a deep trans- 
 verse incision into the up{)er surface of the liver, cut- 
 ting deeply into both lobes. 
 
 'I 
 
I 
 
 X. 
 
 30 
 
 Remove and examine the paiicreiiH, making a 
 longitudinal incision into it. 
 
 Examine the wiipra-rciiiilN, (whieh lie on either 
 side of the cceUac axis.) 
 
 Examine the mesentery. 
 
 SUt open tlie veiiat cava liift^rior. 
 
 Examine tlie semihmar gangha. (These are 
 found lying close to the coeliac axis after dissecting 
 up the vena cava.) 
 
 Examine the retro-peritoneal and retro-thoracic 
 glands. 
 
 Slit open the aortF 
 
 Examine the thoracic duct, (whi( h lies between 
 the aorta and oesophagus on the ri dit sidc; just above 
 the diaphragm.) 
 
 36. ICxaiiiliio llie extrcniitieH aiitl trunk 
 
 if necessary. The vessels are best examined by slitting 
 them up with prol)e-p()inted scissors after they have 
 been exposed. The incisions for the limbs should be 
 made in their long axis. 
 
 37. Ill ortler to saive time, when several 
 students are em[)lc)yed at once upon the same case ; 
 the following order will be adopted : — 
 
 1. Preliminary inspection. 
 
 2. Oi)ening of head cavity; opening of abdomen ; 
 removal of intestmes. 
 
 3. Opening of thorax ; dissection of brain. 
 
 4. Dissection of thorax ; examination of intes- 
 tines. 
 
 5. Dissection of abdomen ; removal of organs 
 of neck. 
 
 6. Dissection of organs of neck, and posterior 
 abdominal regions. 
 
 SCT 
 
 i 
 
31 
 
 38. Sewlnjc up. At the close of the autopsy 
 the body cavities should he carefully si)onged dry, and 
 all organs not needed for subsecjuent examination 
 should be placed in them before sewing up. As it is 
 impossible to return the whole brain into the head 
 cavity after it has once been taken out, only return as 
 much as will readily go in and place the rest in the 
 abdcjmen. When the whole brain is retained it is 
 l)etter to place ])art of the liver in the cranial cavity to 
 make up the i)r()per weight of the head. All incisions 
 are to be carefully sewn up, making the stitches at 
 regular intervals, not more than half an inch apart, 
 taking care to pass the needle from within to without, 
 as the thread is then less visible. This is called the 
 glovers' stitch. 
 
 Try to restore the natural outlines as much as 
 possible, securing the skull cap in position by boring 
 a hole in the skull cap on each side in the temporal 
 region, and uiaking corresponding holes just below the 
 line of the saw cut. By passing copper wire through 
 each pair of holes and twisting it tight on the outside the 
 skull cap will be retained firmly in position. The 
 sternum can be brought into position in a similar 
 manner by wiring the ends of the costal cartilage^. 
 Where portions of bone have been removed the 
 natural appearance may be restored by filling the 
 vacancy with i)laster of paris, moulded so as to give 
 the natural outline, and allowing it to set before sew- 
 i ng up. 
 
 After sewing up the body, it should be carefully 
 washed before being dressed and laid out in the coffin, 
 and it should be seen that there is no blood oozing 
 from any of the incisions. 
 
 39. Aiitopnio^ in private lioiises. The 
 
 preparations should be as simple as possible, so as not 
 to annoy the inmates. At the close of the autopsy 
 
 VtfPm- 
 
32 
 
 everything should be left exactly as it was fountl be- 
 fore comnicncing. A careful mental note should 
 therefore be made of the position of articles of furni- 
 ture, as well as clothini^, wreaths, etc., before they are 
 disturbed. Throughout the autopsy any noise, such 
 as hammering or sawing, should be avoided as far as 
 possible. The most scrujiulous cleanliness must be 
 observed throughout. 
 
 It is easier as a rule to remove the clothing from 
 the body and afterwards replace it, than to avoid soil- 
 ing it if it is left on. Shirts or gowns can be torn 
 down the middle 'I'he best plan is to secure the 
 presence of the undertaker and arrange that the body 
 shall not be put into the coflin till after the autopsy. 
 It is well to see also that no embalming lluid is 
 injected, as this alters the appearance of the tissues 
 materially. 
 
 The body should be placed in a good light. If 
 possible obtain a table or undertaker's trestle, but 
 when necessary the body can often be examined in the 
 coffin. Some newspapers or a sheet should be i)laced 
 beneath the body, to avoid soiling the clothing anil 
 floor. A jug of water, a couple of pails or basins, some 
 towels and a sponge, are also needed. 
 
 Before leaving sec personally that any blood- 
 stained or dirty water has been emptied out, and that 
 the room is well aired. 
 
 40. HfcMlico Ic^iil aiitop.sioH. As the 
 
 object here is to ascertain the cause of death with 
 special reference to the possibility of foul play, every- 
 thing bearing on this i)oint should receive s[)e(ial 
 attention. While any carefully performed autopsy 
 answers the requirements of the coroner's court fairly 
 well, there are certain special precautions not neces- 
 sary under ordinary circumstances, the neglect of 
 which renders the evidence worthless. 
 
 m 
 
 •WHItM'Tt-^'- 
 
 '1 
 
 Wl 
 
33 
 
 All details in the circumstances and surroundings 
 under which the body was found, which may have any 
 bearing on the case, sliould be carefully noted. 
 
 The body should be identilled before the exam- 
 ination is made. Where this is impossible note with 
 special care anything in its appearance, size, colour 
 of hair and eyes, condition and number of teeth, any 
 scars, tatoo marks, moles, etc., which may lead to 
 subsetiuent identification. A good photograph of the 
 body is of special value for this pur[)ose. A plaster 
 cast of any i)art may also be made and preserved. 
 
 The external examination of the body must be 
 made with extreme care, and if any wounds or injuries 
 are [)resent their exact nature and condition must be 
 stated. It is very im[)ortant, in medico legal cases, to 
 distinguish between discolorations of the skin due to 
 hemorrhages, and those due simply to one of the two 
 [)ost-mortem changes, gravitation of blood to depend- 
 ant parts, or from diffusion of the haemoglobin. In 
 h"i)ostasis the part becomes [)ale by simply pressing 
 on it ; in post-mortem staining it will readily be seen, 
 by making an incision, that the colouring mat< * has 
 simply stained the tissue about some small subcu- 
 taneous vessel. If on the other hand the discoloration 
 is due to the presence of extravasated blood, the 
 fluid blood or clot outside the vessels is easily recog- 
 nized. Doubtful spots should alivays be incised in for- 
 ensic cases. 
 
 The state of the i)Uj)ils should be noted. The 
 possible presence of any foreign body in the respira- 
 tory tract must always be borne in mind. WHien the 
 exact time of death is unknown, special importance 
 attaches to a minute account of the exact state of rigor 
 mortis or putrefaction present. 
 
 When the body is exhumed in an advanced state 
 of decomposition, it is better not to remove it from 
 the cotitin, in case it should fall to pieces. No amount 
 
34 
 
 mi 
 
 i:l 
 
 m 
 
 of decomposition is sufficient ground for declining to 
 perform an autopsy, as extensive injuries of the bones 
 and the presence of many poisons can still be 
 recogni/.'.^d. 
 
 Special attention should be paid to the examina- 
 tion of that part suspected of being immediately 
 concerned in causing death. This should be examined 
 as early as possible, but even when an apparently 
 satisfactory explanati n of the death is found, the 
 examination of the other parts should not be 
 omitted, and all the important organs should be 
 examined in every case. 
 
 The brain should always be examined first, unless 
 there is ground for supposing the cause of death to 
 lie elsewhere. 
 
 While a full and exact report of a medico legal 
 autopsy should always be made, it is usual to submit 
 only a brief abstract to the jury. In this . the 
 lesions found and the opinion formed are to be stated 
 in the simplest manner possible, avoiding as far as 
 possible the use of technical terms, and omitting from it 
 all extraneous matter likely to offer an opportunity for 
 raising side issues in case of a trial. 
 
 41. Ill caMeM Miiere poiHoiiiii)(: in hiih- 
 
 pected, it is well to be provided with a number 
 of large glass jars with ground glass stoppers. These 
 should be perfectly clean, and it is best to employ 
 new ones. If such jars cannot be obtained it must 
 be seen that no metal or rubber stoppers are used, as 
 these are liable to contain traces of arsenic. For the 
 same reason glazed earthenware should not i)e em- 
 ployed, though unglazed ware is free from this ob- 
 jection. In any case, one jar should be left unused, 
 to show that it is free from poisonous ingredients. 
 
 Care must be taken that the portions reserved 
 for chemical examination are not allowed to lie where 
 
35 
 
 they may be contaminated, but are put at once into 
 the jar without having come into contact with any- 
 thing else. 
 
 The stomach and duodenum should be ligatured 
 at the beginning of the autopsy. They are afterwards 
 removed together, unopened. When they are open- 
 ed it must be done over a clean glass jar, and as soon as 
 the mucosa has been examined, placed in the jar, 
 together with the contents, and the jar sealed. In 
 some cases, however, it is better to send the stomach 
 unopened to the chemist. Half the liver and one of the 
 kidneys should be placed in another jar, and half the 
 brain in a separate jar. If urine is found in the bladder 
 it should also be preserved in the same manner. 
 
 The jars should be sealed in the presence of 
 witnesses, and a label attached stating their contents. 
 They should be given at once into the charge of the 
 coroner, who should lose no time in sending them to 
 a chemist. 
 
 As the existence of the hydrocyanic acid poison- 
 ing may be revealed by the characteristic odor, the 
 moment the abdomen is opened this sign should be 
 carefully looked for. In such a case the stomach 
 should immediately be placed in a jar, made air-tight 
 by covering the stopper with wetted parchment paper 
 or bladder. 
 
 42. :New-born children. In examining the 
 bodies of new-born children it is necessary to determine 
 (1) whether the child could have lived, and (2) whe- 
 ther it actually breathed, in addition to finding out the 
 cause of death. Special attention must therefore be 
 paid to the signs of maturity, noting the length of the 
 child and of the different limbs, the measurement of 
 the fontanelles, the state of development of the extre- 
 mities, eyes and internal parts, the amount and nature 
 of the hair, the presence of vernix caseosa, etc. The 
 
36 
 
 ii 
 
 M 
 
 m 
 
 M: 
 
 ^i 
 
 centres of ossification present should be examined, 
 especially those of the lower epiphysis of the femur. 
 
 In detenninin,<^ whether the child has breathed, 
 the height of the diaphragm and the degree of 
 inflation of the lungs are significant. The trachea 
 should be ligatured before opening the thorax, and 
 the lungs and heart removed together. After care- 
 fully dissecting off the heart and examining it, the 
 lungs should be immersed in water to see if they float. 
 They are then cut into small pieces under water, 
 noting whether any portions float. The presence of 
 air in small tjuantities is revealed by small bubbles of 
 air rising. This test is open to too many fallacies to 
 be of much value in doubtful cases. 
 
 For the dissection the probe-pointed scissors will 
 be found most useful. Besides the examination of 
 the f<etus itself, the presence of any disease in the 
 umbilical cord and placenta should be looked for, if 
 they are attached, 'ihe condition of the fcetal orifices 
 should be noted in examining the heart. The ab- 
 dominal incision should be carried to each side of the 
 umbilicus, and the umbilical arteries and vein carefully 
 dissected. In some cases a congenital abnormality may 
 be found, sufficient to render life impossible. The 
 brain may be removed by cutting open the thin cranial 
 bones with strong scissors. 
 
 43. Dissection w<»iiiicls. All wounds re- 
 ceived in performing autopsies should be carefully 
 attended to. A trifling prick or scratch, which is not 
 noticed at the time, is more likely to cause trouble than 
 even a severe cut. l>eyond washing them well and 
 applying some antiseptic dressing, no treatment is 
 necessary. The a[)i)lication of caustics is more likely 
 to do harm than good. If it is necessary to continue 
 the autopsy, cover the part for the time with a strip 
 of rubber plaster after washing it thoroughly. Anthrax 
 
 / 
 
37 
 
 and p;landers are specially dangerous, otherwise 
 the chief danger is from septic cases. Typhoid fever, 
 dii)htheria and tuberculosis, do not seein to be com- 
 municable in this manner. 
 
 44-. 'Hie following report of a case will give 
 an idea of how a report drawn up for clinical purposes 
 may be altered for medico legal use. 
 
 Ordinary report ot* autopsy:— 
 
 A. 1)., Aet 50. Died shortly after admission to 
 hospital. 
 
 Autopsy performed February 12th, 1890, 12 hours 
 after death. 
 
 Body that of a stout, heavily-built man. Post- 
 mortem lividity well marked on back ; slightly present 
 on face and neck. Rigor mortis well mnrked at all 
 joints. 
 
 Head examined first. No signs of injury to scalp 
 or skull-cap. A small reddish discoloration of the 
 skin is found on left temple ; tissues beneath it are 
 free from echymosis. 
 
 Pacchionian bodies large and numerous. Longi- 
 tudinal sinus contains a small blood clot. External 
 surface of dura normal. On removal of dura, vessels of 
 pia nearly empty. \ little bloody fluid lies beneath 
 the pia, chiefly in the sulci, less abundant over the 
 convexity than laterally ; the condition symmetrical on 
 both hemispheres. 
 
 On removal of brain, a large, soft, dark-red clot 
 is found covering the whole of the base. It lies princi- 
 pally beneath the pia, and extends a little way along 
 the sylvian fissure on each side. The clot is thickest 
 just anterior to the optic chiasm near the origin of the 
 anterior cerebral arteries. A large amount of extra- 
 vasated blood is found in the anterior part of the 
 longitudinal fissure. The frontal lobes are with diffi- 
 culty separated. A small aneurysmal dilatation, the 
 
 ^^^ ^^ m i i jg ^tt i m y^* , 
 
'■<} 
 
 l[ 
 
 f 1 
 
 38 
 
 size of a cherry, is seen in the region of the anterior 
 communicating artery. This adheres closely to the 
 inner surface of the right frontal lobe, and shows a 
 small rent 5 mm. long, with ragged edges, through 
 which a clot protrudes. 
 
 On dissecting the brain, both the lateral ventricles 
 as well as the third and fourth ventricles, are distended 
 with smooth, dark-red clot. This forms a complete 
 cast of all the ventricles. The brain tissure lying be- 
 tween the aneurysm just described, and the head of 
 the right corpus striatum is lacerated and infiltrated 
 with soft dark clot, the head of the right corpus stri- 
 atum itself being also infiltrated, but to a less extent. 
 The rest of the brain presents nothing abnormal. The 
 brain substance is firm and somewhat pale. 
 
 On dissecting; the arteries at the base, some 
 fibrous thickening is noticed in the pia about the 
 aneurysm, most marked on the right side. The whole 
 of the anterior communicating artery is found to be 
 dilated. The sac contains recent clot only and opens 
 directly into the right and left communicating arteries. 
 The orifice in the It ft side is large and circular in form, 
 measuring 5 mm. in diameter, the orifice on the right 
 side is 2.5 mm. in diameter. .Ml the cerebral arteries 
 are large and thin walled, their intima appearing free 
 from atheroiLa. Examination of the base of the brain 
 shows nothing abnormal. The sinuses contain a little 
 fluid blood and d.irk clot. 
 
 In opening abdomen, subcutaneous fat 5 cm. 
 thick in most places. Omental fat abundant, peri- 
 toneum normal. Diaphragm on right side at 4th 
 space, on left side at r)th rib, in mammary line. 
 
 In thorax pleura normal. Pericardium normal ; 
 contains a teaspoonful of clear serum. Epicardial fat 
 not in excess. Right chambers of heart moderately 
 distended with blood ; left chambers empty. Organ 
 feels firm, muscle pale, valves normal. Weight, 500 
 
 / 
 
 J 
 
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 39 
 
 enor 
 I the 
 
 vvs a 
 ough 
 
 rides 
 
 
 nded 
 
 
 iplete 
 g be- 
 ad of 
 
 
 trated ^ 
 
 s stri- 
 
 xtent. 
 
 
 The 
 
 
 some 
 
 '1 
 
 at the 
 
 
 whole 
 
 -»''^ 
 
 I to be 
 
 ■■{^1 
 
 opens 
 
 
 rteries. 
 
 
 1 form, 
 
 
 e right 
 
 
 irteries 
 
 
 ig free 
 e brain 
 
 
 I a little 
 
 
 5 cm. 
 
 
 t, peri- 
 at 4th 
 
 4^9 
 
 e. 
 
 '^ 
 
 lormal ; 
 
 
 rdial fat 
 
 
 derately 
 
 
 Organ 
 
 rht, 500 
 
 
 grammes, wall of right ventricle averages 5 mm. in 
 thickness; of left ventricle, 2 cm.; length of right ven- 
 tricle, 8 cm.; of left 7.5 cm Circumference of aortic 
 orifice 7.5 cm.; of pulmonary, 8 cm.; of mitral, 10 em.; 
 of tricuspid, 13 cm.; coronary arteries normal. 
 
 Aorta elastic and not atheromatons. 
 
 Lungs — Left weighs 600 grammes, crepitant 
 throughout. Bases contain a good deal of blood. 
 Bronchial mucosa reddened Right lung weighs 680 
 grammes ; is in same condition. 
 
 Oesophagus, larynx and trachea normal, thyroid 
 gland normal. 
 
 Spleen weighs 215 grammes, pulp dark and soft. 
 
 Kidneys — Left weighs 150 grammes, capsule 
 readily removed, surface slightly granular, a few small 
 cysts in cortex. Right weighs 155 grammes, is in same 
 condition. 
 
 Su])ra-renals normal. 
 
 Bladder contains 400 cc clear urine. Mucosa 
 normal. Lateral lobes of prostate slightly enlarged. 
 
 Intestine normal ; contains ordinarv bile stained 
 faeces. 
 
 Duodenum normal ; gall ducts pervious. 
 
 Stomach contains a little li{[uid food. 
 
 Pancreas normal. 
 
 Liver — Weight 1680 grammes. A few dark bluish 
 spots on upper surface beneath capsule. A small 
 angioma the size of a pea in right lobe. 
 
 Gall bladder full of dark bile. 
 
 On microscopical examination, no sign of fatty 
 degeneration nor miliary aneurysms in the small 
 arteries of the brain. 
 
 Anatomical diagnosis: Rupture of aneurysm of 
 anterior communicating artery ; hemorrhage into 
 cerebral ventricles. Angioma of liver. Interstitial 
 nephritis. Hypertrophy of left ventricle. 
 
 \ 
 
 ?1 
 
 '-*«««*»'i'««BSKe<»'' 
 
40 
 
 45. Report abrii^cil for coroner^i4 Jury. 
 
 Body identified as that of A. B. 
 
 Autopsy performed February 12th, 1890, at 2 
 p. m., 12 hours after death. 
 
 No sign of violence externally. Rigor mortis well 
 marked. 
 
 On examining the brain there was found an exten- 
 sive apoplexy arising from the bursting of a small blood 
 vessel in the brain. There was no evidence of this 
 having been caused by an injury. The kidneys showed 
 signs of chronic inflammation, and the heart muscle 
 was thicker than normal. The other organs showed 
 no changes of importance. 
 
 The autopsy shows that the deceased died a 
 natural death, from the bursting of a blood vessel in 
 the brain. This vessel was weakened from dilatation 
 of its walls, and the condition of the heart and kidneys 
 would tend to cause its rupture. 
 
 Signed, 
 
 AVERAGE WEIGHT OF NORMAL ORCiANS. 
 
 Brain 48 oz 1400 grammes. 
 
 Heart 12 " 300 
 
 Lung 20 " 600 " 
 
 Liver GO '' 1800 
 
 Spleen 6 " 170 
 
 Kidn. / 5 " 150 
 
 In temales the weight is about 5 or 10 per cent less. 
 
 
 \ 
 
 I 
 
fc^.*^plW7W,, 
 
 Jury. 
 
 0, at 2 
 
 rtis well 
 
 ,n exten- 
 lU blood 
 : of this 
 ; showed 
 t muscle 
 i showed 
 
 died a 
 vessel in 
 dilatation 
 d kidneys 
 
 )RGANS. 
 
 Ties. 
 
 cent less.