Post-mortems; what to look for and how to make them with sections on infanticide, poisons, malformations, etc

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POST-MORTE

WHAT TO LOOK FORK

HOW TO MAKE THEM

WITH SECTIONS OH

Infanticide, Poisons, Malforniations, Etc.

LONDON.

EDITED, WITH NUMEROUS NOTES AND
ADDITIONS,

By F. W. OWEN, M.Di,

Demonstrator of Anatomy in the Detroit College
of Medicine.

published by

The Illcstbated Medical Journal Co.,

Detroit, Mich.

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PREFACE.

This Manual is intended to serve as a re-
minder to the busy practitioner, and a guide to
the student, of what is to be done and observed
in making 'poat-mortem examinations, and also
to assist them in describing and understanding
the various lesions which niay be met with.

It is not intended as a substitute for large
pathological works, but as a supplement to
them. Disputed points in pathology have
been specially avoided, and the lesions are
described as simply and concisely as possible.

Very few notes have been made on the mi-
croscopical appearances in disease, as they
would have increased the size of the work too
much, and also have exceeded its purpose.

The principal works consulted here have
been: Aitken — Seience of Medicine ; Chuech-
TLL — Diteases of Women; Manual of Michirifery ;
Delaiteld — Poet-mortem Examinations; Druit
— Surgeon's Vade-mecum; Gotjbert — Manual
de I'Art dee Autopsies; Gbat — Anatamy;
Gbben — Pathological Anatomy; Guy and
Ferriek — Forensic Medicine; Harlby and
Brown — Demonstrations of Microscopic Anat-
omy; Jones and Sieveking — Pathological
Anatomy; Obth — Diagnosis in Pathological
Anatomy; VlRCHOW — Post-mortem Meamina-
tions; Wilks and Moxon — Lectures on Patho-
logical Anatomy.

The Authors.

INTRODUCTORY.

Before commencing a necroscopy [vSKpo?,
death; (jkotisiv, to examine) it is necessary
to consider well the purpose of this examina-
tion. In medico-legal examinations it is of
course to assist in detecting crime, and hence
to determine whether death was the result of
disease or violence; and if the latter, whether
the circumstances preclude the possibility of
suicide or accident.

In disease, where there is no doubt as to the
cause of death, we have to consider from the
lesions not merely the settlement of patho-
logical questions, though these are import-
ant, but the determination of how far the dis-
ease might have been amenable to treatment.
We have to search for the remote cause of the
symptoms which had been observed during
life. It is not pretended, in our present state
of knowledge, that we shall as yet do much
in this respect; we have to collect, observe,
and collate facts, and then deduce results
from them. The necessity, therefore, of most
careful and extended necroscopies is obvious.

Everything should be conducted by method ;
all that is likely to be required must be duly
considered and prepared beforehand, for the
want of one little detail or necessary instru-
ment or appliance may vitiate the entire ex-
amination. Notes must be carefully made at

6 INTRODUCTORY.

the time; these may be elaborated subse-
quently, but the original notes are to be pre-
served. In describing the post-mortem le-
sions, it is essential to give as much as possi-
ble the actual appearances; and it is also
necessary to remember that as there are dis-
eases of which the lesions are as yet not
found, so there are lesions which do not cor-
respond to any known disease; and that most
of the lesions observed after death are sec-
ondary to the disease itself. This is import-
ant, as many mistakes have arisen from re-
garding the lesions as of primary significance.

\

P0ST-M0RTEM§5^£^

WHAT TO LOOK FOR AND HOW TO MAKE
THEM.

^/

EXTERNAL EXAMINATION OF THE
BODY.

This is necessary in every case, but espec-
ially in medico-legal enquiries, and must on
no account be carelessly passed over; the
omission of a slight detail may have very dis-
astrous consequences.

Surroundings, note objects lying near,

as well as position and state of the body;

contents of the hands, their condition,

whether horny, delicate, stained, clubbed-

fingered, «&c.

The nails often contain matter suggesting cause
of death and place where It occurred, as grass,
weeds, dirt, hair (may correspond with that of the
murderer), bits of clothing, &c.

The limbs may be fractured, dislocated,
bruised, &c.

The nostrils and mouth may contain for-
eign bodies and dust, which also may show
locality, &c.

Skin. — Look for burns, birth-marks, tattoo
marks, typhus spots, oedema, sordes at orifi-
ces of mouth and nose, pale yellow tint of
cancerous diathesis, bronzing, ulcers, &c.

Where there are purple strealcs along the courses
of the superficial vessels, the hning of the internal
vessels and heart will be deeply stained with blood
pigment, as well as the various orpjans, as liver,
spleen, &c. This state must not be mistaken for
Inflammation t it is a sign of decomposition, and
maslcs other appearances.

8 POST-MORTRMS.

Wounds. — Cuts, punctures, scars, &c.
Notice the shape of the wound, direction,
size (measure carefully, but remember that
contraction may have taken place), appear-
ance, edges everted or not, contain coagula,
contiguous effusion. Marks of strangulation,
bleeding from eyes, ears, vagina, &c.

Bruises may be produced immediately
after death; if caused during life there is
always extravasation; in post-mortem dis-
coloration the vessels are simply distended
or surrounded by serum stained with blood
pigment.

Serious injuries, as fractures, may be caused with-
out external signs. An abrasion of the cuticle ap-
pears dry and hard, whether produced before or
after death. It is often difficult to tell whether
wounds are inflicted before or immediately, or even •
some time after, death. If there are si^ns of inflam-
mation, cicatrization, or suppuration, it is easy to
say. If the wound is everted and coagula are near,
then it must have been done shortly before death.

If several are lying dead together,

try to find which died first, from circumstan-
ces, position, &c., as well as appearance of
the bodies. Estimate the period since
death, but do so guardedly; remember that
the condition is affected by the state of the
weather. The temperature of the body is
not always a safe guide, for it often rises as
putrefaction sets in, and varies according to
the state before death and the atmospheric
temperature.

Hair. — Notice the appearance of the hair,
it may give important evidence — color, con-
dition, pediculi, long and lanky (in wasting
disease), curly and crisp (in health) — pubic
hair and whiskers especially; in phthisis
much hair often grows on the chest (Wilks
and Moxon).

Bigor mortis, if present, is a sign of
recent death. The amount of fat on abdo-
men often shows the kind of life that has

EXTBUSTAIi EXAMINATION. 9

been led — sedentary, addicted to beer drink-
ing, &c.

Examine the mammse for milk; abdomen,
&c., for signs of pregnancy, recent or remote.

In suspected rape, look for semen in or
near vagina or on the clothes; put some on a
slide with warm serum, and examine under
the microscope.

Cause of death. — Sometimes the exter-
nal appearance will afEord some clue as to
the cause of death — thus, wasted in phthisis,
and especially in diseases of the abdominal
viscera, when there is often what is called
the "abdominal face." In pneumonia theie
is generally an herpetic eruption on the lips.
The abdomen is distended in ascites and peri-
tonitis (but decomposition produces disten-
sion). There may be the peculiar mulberry
rash of typhus fever (enteric shows none) ; the
skia is yellowish in pymmia, and the lym-
phatics are often affected (swollen, &c.) The
color of the skin will also show heart dis-
ease; a livid color Acnoi&s pulmonary affection.
Anasarca of arms, face, scrotum, &c., shows
heart disease or kidney disease; of abdomen,
liver disease; of one or both legs, that there
may be a thrombus in the femoral artery. In
general anasarca the blood is at fault.

In loobiDg for post-mortem lesions in particular
a£fectious it must be remembered that a disease or a
poison (as alcohol) takes possession of a person's
weakest organ, and shows its effect mostly there;
hence the differences of appearances from the same
cause.

SIGNS OF DEATH.

It is very important to attend to these —
firstly, because the person may not be actu-
ally dead; and secondly, because the question
might be put by some sharp counsel to the
medical man whether he was sure at the time
of making the necroscopy that the person

10 POST-MORTEMS.

was dead, and might request him to give

proof of this.

Vesalius was sadly troubled from having, as ho
fancied, noticed the heart beating after having
opened a body. In the Pall Mall Gazette for June
21, 1874, there is reported the case of a little girl who
was pronounced by the medical man as dead, and
placed in a mortuary. In the evening, when a necro-
scopy was about to be made, the heart was found to
be beating. Cases of presumed trance, or other un-
certainty as to death, may be easily settled by care-
ful attention to the signs of death. ^i-K.JB.siX

The hand being held up in a strong light,
and the fingers extended and closely approxi-
mated, the points where the fingers totrch
will show pinkish tinge during life, but pale
and yellowish in death.

The Eyes. — Dull, flattened, sometimes
wrinkled, soft, flabby, and covered with a
viscid mucus. After sudden death, as apo-
plexy, poisoning by carbonic dioxide, hydro-
cyanic acid, &c., the eyes may remain bright
and distended for some time.

Cadaveric Rigidity. — Not always pres-
ent, or only for a very short time; electric
stimulus may cause movements in those re-
cently dead.

Skin. — Peculiar pallor, livid or lead-col-
ored in parts; mucous membrane exsanguine
at natural orifices: palms of hands and soles
of feet yellow; green color in iliac fossae (this
is very characteristic if present) ; loss of tran-
sparency and of the naturally pink color in
thin parts, as web of finger, &c. If during
life the loba of the ear or a finger is con-
stricted by a tight ligature, there is a redden-
ing of the constricted part; this becomes
darker and darker till it is converted into a
bluish red: just round the ligature there is a
narrow white ring. After death these
changes do not take place, which are of
course due to the return of blood from the
part being hindered by compression of the

EXTERNAL EXAMINATION. 11

veins. This is a certain sign of deatli, and

is suggested by Dr. Magnus in Virchow's

"Arcliiv." for 1873.

The post-mortem change of color given here is sup-
posed to be due to the action of sulphuretted hydro-
gen on the albumin of the blood and tissues.

Dr. Danis advises cutting down on an ar-
tery — the temporal is the best — an empty state
would show death.

INFANTICIDE. — CHIEF MALFOKMATIONS.

Viability. — A child may live if born at
the sixth month. The signs of having reached
this age are: Length, from 8 to 13^ inches.
Weight, 1 lb. to 2 lbs. 3 oz. Skin has some
appearance of fibrous structure. Funis in-
serted a little above the pubes. Liver of a
dark red color. Points of ossification in the
four divisions of the sternum.

From this age the child increases in weight
and length; the skin becomes more fibrous,
and is covered with an unctuous matter, and
fat appears in the subcutaneous tissue.

6 to 7 months, Length, 11 to 12 in.'; Weight, 3 lbs.

7 to 8 " " 13 to 14 " " 3 to 4 lbs.

8 to 9 " " 15 to 16 " " 4 to 5 "

9 " " about 18 " " 6 to 7 "

Notice the measure from the vertex to the
umbilicus, and from thence to the soles of
the feet; state of the face (eyes, with or with-
out membrana pupillaris), limbs (nails), gene-
rative organs, position of testicles, points of
ossification in the davicle, maxillary bone, sa-
crum, pubes, OS calcis, asiernum, stragalus,
femur {lower end), &c. ,

The point of ossiScation is easily obtained by ex-
posing the end of the bone, and slicing the cartilage
gradually till the ossific point is reached, which is
of a deeper color than the cartilage.

Shape of the liver, and comparative size of
lobes; contents of gall bladder; length, color
and quantity (lanugo) of hair should be noted.

13 POST-MORTEMS.

Intra-uterine Maceration is distinctive.
Body is shrunlien, bones softened; tlie skin
appears as if boiled or poulticed, is slimy,
and readily comes oS in patches; face and
generative organs of a deep red color; the
subcutaneous tissue looks like gooseberry
jelly. The umbilical cord is straight and
flaccid.

Eespiration Test.— The proof of respi-
ration is a proof of life. But — 1, respira-
tion may take place before delivery; 2, it may
be so partial as to escape detectibn; 3, an
artificially inflated lung may give the appear-
ance of a respired lung.

An Uhrespired Lung is like a piece of liver,
of a uniform bluish-red color, and sinks in
water. It may float from putrefaction, but
pressure will easily expel the gases so formed
and cause it to sink.

A Respired Lung is nearly always pinkish —
mottled if respiration is imperfect; the lighter
patches are groups of air cells, which under
the microscope have a very characteristic ap-
pearance.

Hydrostatic Test.— Pat both lungs in a ves-
sel of water, then each separately; then cut
up into about twenty pieces, and test each of
the pieces Take the piece or pieces that
float, put it, or them separately, in a strong
cloth, and squeeze under a board; then put
in the water again. If they sink, the lung is
an unrespired or an uninflated lung.

Examine the Stomach for food; the In-
testines for meconium; the Bladder for
urine. Notice state of umbilical cord.

Other facts proving Mte.— Obliteration
of the umbilical arteries and vein, of the duc-
tus arteriosus and venosus; closure of the
foramen ovale. The patency of any of these

is no proof of sUU-birth, nor can any definite
period of survival be formed.

The Skin in a few days exfoliates as a fine
dust; this exfoliation is a decided proof of life.

The Umbilical Cord shrinks and withers
and becomes flabby, with sometimes a circle
of a distinct red color round its insertion;
this takes place in a few hours; in one or
more days it dries up, and about the fifth day
falls off; the wound cicatrizes about the
eleventh day.

"Violence. — Fontanelles may 'be punctur-
ed; instruments passed up vagina, rectum,
&c. Suffocation. — Notice marks of pressure.
Stomach may contain matters causing the
suffocation (as faeces, feathers, &c.) Strangu-
lation. — The cord may be twisted round the
neck during delivery; measure the length of
the cord, notice its state, see if it corresponds
with the marks on the neck. Look for finger
marks on the neck, and judge which hand
caused them. Fractures of the Skull may be
caused accidentally ; Contusions, too; contu-
sions and fractures may be produced during
labor.

Notice if the cord hasbeen properly attended
to; if not, if the body is exsanguine; if the
child has been exposed; if starved.

1. Large blood extravasations in the skin
are always the result of external violence.

2. Effusions of blood in the muscles of the
neck and in the course of the great vessels of
the neck point clearly to attempted strangu-
lation.

3. Hsemorrhages between the liver and its
capsule, and in the liver substance are always
the result of external violence.

In all these cases it is necessary to exclude difficult
labors, operative measures and attempts at resus-
citation.

14 POST-MOBTEMS.

4. Lesions of the peritoneal membrane, and
rupture of the liver, spleen and kidneys are
due to violence ; they may be caused by the
firm grasp of a hand round the child's body,
and are not uncommon after attempts at
artificial respiration.

5. Haemorrhages in the umbilical cord are
very rarely caused during the act of birth, or
during attempts at replacement in cases of
prolapse of the cord. They are almost al-
ways due to violence of some form, especially
to tearing th3 cord.

6. Thick, circular, blood extravasations on
the head or other parts of the body may be
due to either difficult labor or external vio-
lence.

7. Hemorrhages in the lips, muscles of the
tongue, palate or gullet, should raise a sus-
picion of violence (either operative or crimi-
nal); this vfill be confirmed if slight wounds
of the mucous membranes of the parts affected
are found.

8. Swelling of the lips — if not accounted
for by the position of the face during partu-
rition — must be considered a sign of the pres-
sure of a hand on the child's mouth.

9. Hemorrhage into the external auditory
meatus and external ear was not observed in
any of the oases. This is always due to exter-
nal violence.

10. Ecchymoses in the muscles, unless the
result of difficult labor, etc., are always due
to violence.

11. If asphyxia is caused by immersing the
child in some fluid medium, or in dust, this
will very frequently be found in the nose,
mouth, throat, stomach or lungs.

13. Blood in the trachea, bronchi and alve-
oli is usually due to aspiration from the ma-
ternal passages or from the child's nose.

EXTERNAL BXAMINATIOK'. 15

If the ecchymoses of the muscles are due to ope-
rative interference and not to criminal acts, we must
remember that the presentation of the child will
probably have been norma', and in this case the
caput succedaneum will not be on the head but on
some other part of the body; therefore, the presence
of a caput succedaneam on the head, with signs of
external violence, will malce us suspect criminal in-
terference.

The cases of death from asphyxia have the
following special features : In all the serous
membraDes and in the diflferent mucous mem-
branes, blood extravasations were found in
the greater number of cases, and almost with-
out exception, sub-pericardial and sub-pleural
hemorrhages were present.

Extravasations were also often present in the
spleen, isidneys, thymus gland, the connective tissue
surrounding the pancreas, and under the scalp, epi-
cranial aponeurosis and pericranium.

In the middle ear and nasal fossae there was
almost always a dark-red discoloration of the
mucous membrane, and in many cases also,
blood was exuded.

Hemorrhages into the conjunctiva and
retina, and in the form of small striations in
the vocal cords were of frequent occurrence.

Extravasation into the tissue of the lungs
was very rare, and blood was never found in
the alveoli or bronchi unless it had come from
the nose of the child, or from the genital
passages of the mother, through respiratory
efforts.

If death had not been brought about very
rapidly, oedema of the lungs, larynx and
nasal mucous membrane was found, and
sometimes interstitial emphysema; the latter,
however, being not uncommon even in cases
of rapid asphyxia.

In the bones and muscles there were no
changes except great fulness of the blood ves-
sels.

The above report is founded on post-mortem exam-
inations of 178 children bom at the ninth month; 138
between the seventh and ninth, and 142 foetuses born

16 POST-MOKTEMS.

alive between the fourth and seventh months, and
Is taken from Dr. Nobling'a report in Aerzliches In-
telligenzblatt.

CHIEF MALFORMATIONS OP FOETUSES AND
NEW-BOKN CHIIiDKBN.

Absence of Organs, acephale (absence of
head); anencephale (absence of brain and
spinal cord); congenital malformation (of
idiots, cretins, &c.), congenital effusion of
serum in the cerebral ventricles (with com-
plete or incomplete development of the
brain) or on the external surface; aprosopia
(absence of face); absence of eyes, eyelids,
iris, mouth, lips, tongue, ear, epiglottis,
penis, scrotum, testicles, vesiculse, ovaries,
uterus, vagina, certain ribs or vertebrae, a
part of a limb, hand, bladder, oesophagus,
stomach, liver, heart, lungs, diaphragm, pan-
creas, spleen, spinal cord (amyencephale), &c.

Want of Union in Similar Parts. —
rissure in the median line, involving the cra-
nium, the spinal column (spina bifida), the
lips, the maxillary bones, tongue, roof of the
palate, bladder, urethra, vagina, spleen, linea
alba (vyith hernia).

Inperforation of iris, eyelids, mouth,
anus, urethra, vagina, uterus, intestines,
oesophagus, valves of the heart, &c.

Joining together of Organs. — Eyes
(monopsia, cyclopsy); fusion of the lower
limbs (symelia) or of the fingers (syndactyle).

Atrophy. — Arrest of development in the
limbs; feet or hands inserted on the trunk
(phocomelia) ; incomplete limbs.

Augmentation of Organs.— Double or-
gans or increase in number (supernumerary
limbs, &c.), &c.

Heterogenesia. — Extra-uterine foetus ;
more than three foetuses at a time; foetus with
change in the ordinary situations of the or-

SIOXS OF DEATH FlliiM VIOLENCE, ETC. 17

gan; hernia of heart (fissure of sternum), of
the abdominal viscera into the thorax, &c.

Double Monsters.— By fusion together
of some part of the body; developed equally,
unequally, &c. ; contained in one another (foe-
tal inclusion).

II.

SlOIfS OF DEATH FROM VIOLENCE,
POISONING, ETO.

STARVATION.

Emaciation in chronic cases is extreme,
in acute cases less or even not at all.
Stomach and Intestines empty, fauces dry;
heart and blood-vessels generally empty; pu-
trefaction is rapid and sets in early, and the
body smells offensive. But disease may cause
all these appearances.

SUFFOCATION.

Necroscopic signs not satisfactory. The
Skin is generally of a uniform violet tint, with
blackish ecchymotic spots. The Lungs fre-
quently show punctiform ecchymoses and
partial emphysema. The other organs are
deeply congested.

Suffocation, right side of the heart auricle
and ventricle usually full of dark, clotted or
fluid blood; left cavities empty; the conjunc-
tiva may be congested or ecchymotic. The
mouth often contains frothy blood and mucus.

HANGING.

Signs after death are those of suffocation.
There is also the mark of the cord. This varies
in position, depth, and appearance, accord-
ing to the mode of hanging, struggles, weight
of body, and material used.

There may be only a depression, or the mark may
be, after exposure, of a deep brown color.

18 POST-MORTEMS.

Examine the vertebrse for fracture or dislo-
cation, as of the odontoid process.

The Tongue is generally swollen at the base,
injected, and sometimes protruded.

The penis is more or less erected, sometimes
with emission; in females the genital organs
are swollen and red. Faeces often expelled.

DROWNING.

Appearances vary very much, according to
the mode of death; this may be from apnoea,
exhaustion, syncope, apoplexy, shock, blow
on the water from projection, cold, &c. , or any
of these together.

The Tongue is swollen at the base ; the Shin
is pale, with violet or rose-colored patches;
Lungs, brain, kidneys, &c., congested; left
side of Heart empty, right side full of blood. .
These are signs of apnoea.

Special Signs of Drowning are— mud,
sand, water-plantS) &c., in the hands, nails,
ears, nostrils, &c. ; fingers often excoriated.
Water, &c., in the Lungs; this may, how-
ever, enter after death ; water in the Stomach
is a very strong presumptive evidence. Re-
traction of the penis, cutis anserina, froth in
the mouth and nostrils, may also be noticed.

A chemical analysis of the water might at times
afford valuable evidence.

Submersion during Life or after
Death. — Dr. Bougier, from experiments and
autopsies at the morgue, formulates the fol-
lowing conclusions:

1. The exterior aspect of the body is about

the same in both cases.

The appearance of moss on the body, weeds or
sand grasped, in the hands would be of some diag-
nostic vaiue.

2. Water and foreign bodies penetrate into
the air-passages and into the bronchial tubes
of those submerged before, as well as those

SIGNS OF DEATH FROM VIOLENCE, ETC. 19

submerged after death; hut in the latter the
foreign bodies do not go beyond the fifth or sixth
divisions of the bronchial tubes, and the liquid
is arrested at the bronchi of medium size by
the column of compressed air; whereas, in
the submerged during life, it penetrates down to
the small bronchial tubes.

3. The epiglottis is vertical in the sub-
merged ; it is only half open in the corpses
immerged,

4. Water penetrates in a pretty large quan-
tity to the stomach of the former, but never to
tliat of the latter (after death) ; and in making
a comparative analysis of the liquid found in
the bronchial tubes, one might arrive at a cer-
tain diagnosis.

5. The same is the case with the middle
ear.

G. The characteristic moss is found only in
the submerged.

7. If the fluidity of the blood exists in cer-
tain cases of poisoning by opium, it is easy by
the aid of the spectroscope, and by analysis,
to form the diagnosis.

8. In putrefied corpses, all the signs have
nearly disappeared, and the medical jurist
can only draw conclusions by presumptions.

POWDER MARKS IN CASES OP DOUBTFUL
SUICIDE.

Dr. Pisk (Boston Medical Journal) concludes
an able exposition of this perplexing subject
thus:

1. From a great distance the entrance

wound will usually be large and irregular;

there will be absence of any great degree of livid-

ity of its edges, and absence of powder marks.

The wound of exit, if one be present, will

usually be larger than the wound of entrance.

At any distance the edges of wounds of entrance
will usually be inrerted, those of exit everted.

20 POST MORTEMS.

2. From a short distance the entrance
and exit wounds will generally be nearly
equal in size; the edges of the former will be
blackened, and the powder grains will be im-
bedded in the skin, but there will be absence
of the scorchings and brandings of powder.

3. Close to the body the entrance
wound will generally be larger than the exit.
There will often be, in addition to the tattoo-
ing of the skin by unburnt grains of powder,
a mark or brand made by the flame of the
gases of the burning powder, by the soot of
the partly burned powder and by the residue
of ash of the wholly burned powder.

As a rule this hraad, which may consist of a burn-
ing alone of the hair, the skin, or of the clothing, or
of a burning and blackening of the skin or clothing,
wlil appear at one side of the bullet hole.

The position of the weapon is to be
determuied thus: When the brand appears
upon the hair, the skin or clothing at one side
of the bullet hole, hold the weapon with its
muzzle to the bullet hole so that the line of
its hammer and sight will meet a line drawn
from the centre of the bullet hole through
the centre of the brand and it will show the
exact position of the weapon when fired.

Accidental Wounds are generally near
wounds. When inflicted from a distance they
cannot be distinguished from homicidal
wounds.

In shots fired near by, when a person is
known to have been shot standing, an un-
natural position of the weapon, as shown by
the location of the brand, will tend to corrob-
orate the claim of accidental shooting. So
if one is known to have shot himself an un-
natural position of the weapon will show that
the shot was probably accidental.

The location of the wound and the course taken by
the ball may also characterize the wound as acci-
dental.

SIGNS OF DEATH FROM VIOI;BNCE, ETC. 21

To distinguish Homicidal from Sui-
cidal Wounds.— When the location of the
brand, relative to the bullet hole, shows that
the weapon has been held in a position of its
hammer and sight impossible or improbable
for a suicide, it is probable that a murder has
been committed.

Certain relatiTe locations of this brand may also
indicate that the victim has been shot while in a re-
clining position.

Multiple wounds are usually Twmioidal, but
may be either accidental or suicidal. Shots
fired beyond the u.sual suicidal limit are prob-
ably homicidal.

It is said thai the suicide rarely holds the muz-
zle of his pistol more than eight inches from his
body. Suicides generally Are at the side or
front of the head, next to the heart; some-
times at the back of the head.

The distance from the body at which
the weapon must be held to show the brand
plainly is very nearly as follows: For small
pistols and revolvers, not over four to six
inches.

For large weapons of this class, not over
twelve or fourteen inches.

The necroscopic appearances in cases of

poisoning are not always very decided, and

great care must be taken to avoid drawing

incorrect inferences.

In some cases there are no post-mottem signs at
all, and it is only when a strong corrosive poison has
been taken that they are at all decided.'

The necroscopy in these cases must be per-
formed with extreme caution in the presence of
one or Tnore competent witnesses. All instru-
ments, vessels, and appliances of every kind
mu^t be scrupulously clean.

The jars, bottles, or other vessels to con-

33 POST-MORTEMS.

tain the portions selected for chemical or
other analysis should be washed out with
water, then with strong sulphuric acid, again
with water, and finally with distilled water.

Stomach. — Both enda of the gtomaeh are to
be securely tied up with double ligatures, se-
cured by a pin to prevent slipping, and separ-
ated by cutting between these. It is well,
sometimes, to put it up whole in a jar for
more leisurely examining it, or for a more
competent person to do so ; it must be remem-
bered, however, that the gastric juice may act
on the coats and destroy them, it is therefore al-
ways best to put the stortMch and contents in
separate vessels.

If it is wished to examine it at once, put the
contents in a clean jar; lay the organ on a
clean flat surface, as a dish or piece of glass ;
open it along its smaller curvature. Look care-
fully for leaves and seeds of plants, powders,
&c.

Tie both jars over with gutta-percha tissue,
first putting a cork or stopper in if there is
one, then a piece of white paper over this,
and seal it so that they cannot possibly be re-
moved without breaking the seal, and use a
stamp that is not likely to be imitated; fasten
a label to each jar or bottle, with the name of
the contents, the date, and the signature of
the necroscopist.

The liver, kidneys, spleen, intestines
and brain, or portions of these, should each
be put in a separate vessel, and also carefully
sealed and labelled. Where, however, the
jars are taken straight to the analyst by the
necroscopist, there is not so much need to seal
them, yet it is far better to do so in all cases.

In making the necroscopy iJie intrusion of
foreign bodies must be carefully guarded against,
especially if they are of a metallic nature, as

SIGKS OF DEATH FROM VIOLBNCB, KTC. 23

pins, needles, nails, copper rings, bits of col-
ored paper, pieces of sealing wax, &c. The
accidental presence of any of these with the
part to be analysed might spoil the whole
analysis.

IS" Poisons may be introduced per rectum
or per vaginam, or endermically and hypoder-
mically.

1^" Kemember, Narcotics — as Opium,
Belladonna, Syoseyamus, Camphor, &c. — give
no satisfactory necroscopic appearances. Con-
gestion of the brain has been met with, and a
few other signs supposed to point to the cause
of death. Belladonna, hyoscyamus, and
camphor have each a peculiar smell, which
may be more perceptible after gently warm-
ing the contents of the stomach. The seeds
of belladonna and hyoscyamus may be dis-
covered.

Alcohol, ^Iher, Ghlwoform, Hydrate of
Chloral, &c , produce inflammation of the
stomach and bowels, and the characteristic
odor of each will serve to distinguish them.

Strychnia leaves no decided signs of its
presence ; the muscular spasm soon passes off,
but the hands may remain clenched, &c.

The Metallic Poisons show few post-
mortem signs. Nitrate of Silver is turned into
chloride, which adheres to the mucous mem-
brane in the form of curdy flakes, and the
oesophagus and stomach are eroded.

Copper causes inflammation, thickening,
and sometimes ulceration of the mucous mem-
brane, which is changed to a green color. The
skin is often yellow.

Antimony and Arsenic generally produce
inflammation of the stomach and intestines,
but not always. In arsenical poisoning the
solid metallic oxide may be seen adhering in
patches to the mucous membrane; this often

24 POST-MORTEMS.

turns yellow, when decomposition sets in, by
the formation of the sulphide. The contents
of the stomach are generally of a brown
color.

Phosphorus. — This also produces patchy in-
flammation, and particles of the substance
may be found (as heads of matches, &c.) in
contact. The skin is of a peculiar yellow tinge,
and there is frequently extensive fatty degen-
eration of the muscles, liver, &c.

Various Salts of an irritant nature, when
taken in large doses, may be poisonous, as
Potassium Nitrate, Sulphate, Acid Tartrate,
and Sulphide; Alum, Sodium Chloride, Chlor-
inated Soda, Lime, Potash, &c. ; Barium
Salts, also Iodine. These occasion inflamma-
tion of the stomach and intestines, with secre-
tion of a slimy mucus, thickening of the coats,
hypersemia of the vessels; sometimes ulcera-
tion. Potassium Sulphide deposits sulphur.

Alkalies. — Soda, Potash, Ammonia and
their Carbonates generally produce softening
and corrosion of the mucous membrane, with
inflammation and extravasation of blood in
patches; ammonia causes more extensive in-
flammation. Cyanide of Potassium is also a
caustic alkali.

Acids — as Sulphuric, Nitric, Hydrochloric,
Oxalic, Carbolic, &c. — occasion more or less
corrosion in tlie mouth, on the lips, chin, tfcc.
varying according to the amount and
strength of the acid. There is considerable
inflammation, often oedema and contraction of
the parts touched by the acid. The glottis
may be closed by this swelling and contrac-
tion.

The contents of the stomach are generally a
sticky liquid of a black, yellow, or brown
color, and it is distended with gas.

The mucous membi'ane of the (esophagus

INTEBNAL EXAMINATION. S5

and stomach may either be detached, shriv-
elled, or converted into a white (sulphuric
acid), yellow (nitric), or brown substance
(oxalic, &c.); sometimes the walls are per-
forated. (See Sections on the " Stomach " and
"Intestines")

Prussic Acid.— This can generally be
easily distinguished by the smell. The fea-
tures are often peculiarly lifelike — the eyes
glistening, the cheeks colored, &c. The
blood is of a bluish tint.

Carbonic Acid. — There are signs of suffo-
cation, bloated appearance, livid spots on
body, distension of abdomen; eyes glistening
and prominent. The blood is of a dark color,
and the right cavities of the heart are gorged.

III.

INTERNAL EXAMINATION OF THE
BODY.

Order. — 1, Abdomen; 3, Thorax and Neck ;
3, GrarUum; 4, Spine; 5, lAmbs.

Special vsrounds or other injuries, or parts

to be examined particularly — as vagina in

rape, throat in suffocation oT poisoning, &c. —

should receive the first attention; wounds

must be carefully probed and cut down upon.

In sudden death of children always carefully ex-
amine the mouth at an early stage for foreign bodies,
or for marks of compression of throat or mouth.

METHOD OF OPENING THE BODY.

There are several ways of opening the body,
but the best is by a longitudinal incision from
the symphysis pubis to the xyphoid cartilage,
passing to theleft of the umbilicus, and thence
to the sternal notch; in cases where the
throat is to be examined the incision on the
chest is to be carried on to the chin.

26 POST-MORTEMS.

The Incision may be made through the fat and
muscles to the bone, and, unless great care is re-
quired, right through the abdominal walls; then the
muscles, skin, and tat are to be dissected off the
chest, and turned aside.

T}ie position of the diaphragm, and its re-
lation sliould now be examined — this may
give some idea as to the cause of death,
especially in the case of new-born children —
and the position, abnormalities, appearance,
&c., of the abdominal contents, without dis-
turbing them.

Then proceed to open the thorax ; divide
the cartilages of the ribs as near the bone as
possible ; in cases of ossification use the bone
forceps ; ctt</rom within outwards, so as not to
injure the contents of thorax. Disarticulate
the sterno-clavicular joint, raise the sternum,
dissecting it from its connections, diaphragm,
&c. , and remove. Fold the skin of the chest
over the ends of the ribs, especially if the bone
forceps have been used, in order to protect the
hands and arms from injury by the ends of the
ribs.

Examine the pleurtB for hydrothorax, hsema-
thorax, and pneumothorax (do not mistake
post-mortem hssmorrhage from a wounded
vein for ante-mortem haemorrhage); also ex-
amine the pericardium and the mediastinum.

Remove the h^art, tying the principal ves-
sels first; then take out the lungs, either
separately or together.

To expose the tongue and back of the
fauces carry the incision to the symphysis
of chin and divide the lip, saw through the
lower jaw a little on one side, cut through
the muscles and the hyoid bone, and turn on
one side, when the whole cavity of the mouth
will be exposed. Or the incision may be car-
ried to an inch below the chin; the skin, &c.,
dissected off; the soft parts removed as much
as possible; the mylo-hyoid and other mus-

IXTEHXAL EXAMINATION. 37

cles divided close to tlie lower jaw, so as to
expose the mouth ; the tongue drawn down-
wards and forwards through the opening, the
pharyhx divided as high as possible, which,
with the larynx, is also to be drawn down.
The attachments are separated, and thus the
whole of the pharynx, larynx and trachea
may be removed en masse.

In some cases three or four o( the upper vertebrae
may be removed, and the pharnyx opened from be-
hind.

The contents of tlie abdomen should
be examined and removed in the following
order: — 1, omenta; 3, stomach (tying closely
both orifices first; a blunt pin or wire passed
through the cut ends prevents the string slip-
ping off); 3, spleen and pancreas; 4, intestines
(notice first the ductus choledochus and ver-
miform appendix; tic up both ends); 5, liver
(take care not to injure the connections; it is
sometimes well to remove it with the stomach
and pancreas); 6, kidneys, 7, uterus and blad-
der.

Some recommend removing the whole of the vis-
cera en ■masse, but it will generally be found most
convenient and satisfactory to examine the organs
in situ and remove separately, unless for special
reasons.

METHOD OP OPENING THE HEAD.

Notice the state of the scalp; shave if neces-
sary. Then make an incision from ear to ear
across the parietal bones, dissect the integu-
ments off the skull, and turn them over the
face and occiput.

Examine the skull carefully for fracture; rub ink
in if not very distinct; describe accurately the situa-
tion of injury, depression of bones, &c.

Cut a line round the head a little above the
occipital protuberance and the frontal sinuses
with the scalpel, as a guide for the saw. Then
saw through the outer table of the skull care-
fully, testing the depth occasionally with the

38 POST-MORTEMS.

handle of the scalpel; break the inner table

with the chisel and mallet. (If fracture is

suspected, It is better to saw completely

through.) Raise the skull cap by means of

the handle of the mallet, or an iron lever. If

there is adhesion of the dura mater, cut

through it and remove it with the top of the

skull.

In infants the scissors may be passed into one of
the fontanelles, and the bones cut with them. The
fontanelles must first be examined very carefully for
punctures, &c.

NOTA BENE.

In describing the morbid and other ap-
pearances of an organ notice :

Its position and relation to the surrounding
parts, adhesions, fluids, and other matters in
contact.

Its shape, size, weight, color and odor.

State of the surface — color, thickening, thin-
ning, or adhesion of its natural covering ; effu-
sion beneath it, &c.

Then notice the consistent, color, odor, ap-
pearance, &c., of the parenchyma on section;
contents of the organ.

If pale, wash with water and test with
iodine.

Scrape the surface of the section with a
knife and examine the scraping microscopi-
cally for cancer, micrococci, bacteria, hyda-
tids, &c. Inflate the lungs; use the hydro-
static test.

TO PRESEKVa TISSUES FOR MAKING MICBO-
SCOPIOAL SECTIONS.

The parts of the organs to be examined are
cut up into pieces about the size of a chest-
nut, and placed at once in Miiller's fluid,
which will be found most convenient for gen-
eral use.

INTERNAL EXAMINATION. 39

This solution is made by dissolving 20 to 30 parts of
potassium bichromate and 10 parts of sodium sul-
phate in 1000 parts of water. If Miiller's fluid is not
at hand, a solution of common salt in water is use-
ful to preserve, almost unchanged, the tissue for
some tinLe.

The solution is to be renewed in eighteen
hours, and every week subsequently for a
month or six weeks or more; the preparation
is then often hard enough to cut sections
from; but if not, it is to be put in spirit till
hard, or in chromic acid 1 part, water 30, and
rectified spirit (methylated) 180.

The best way to preserve and harden several speci-
mens is to suspend them in a large quantity or the
iluid. A very good plan is to have aleech vase or a
bell jar to contain the solution, and the pieces of tis-
sue, weighted if necessary, fastened to silver wires,
or silk cords or even fishing gut, of varying lengths,
attached to pieces of cork, which will float them.
The corks are to be numbered, and the numbers are
to correspond with a register of the pathological
specimens. The corks may be kept separate (if
necessary) by small strips of wood stuck in them.
By this means several hundred portions of tissue can
be kept to harden in a comparatively small space.
The fluid must be renewed occasionally, and fresh
portions of a stronger solution added frequently.

TO SEW UP THE BODY.

Fasten two curved needles one to each end
of a waxed piece of cord four times the
length of the part to be sewn. Begin at the
symphysis pubis, pass each needle through
the skin from within out, as near the edge
of the incision as possible ; let the middle of
the cord make the first stitch, then sew at
regular intervals, passing the needle through
the skin from within ; when several stitches
have been made, draw the edges of the in-
cision tightly, as in lacing, and fasten off by
tying the ends.

Head. — Place the skull-cap in position,
and keep it so by two stitches passed through
the ends of the temporal muscles and tied
tightly together; cover with the scalp, and
then sew this up.

30 POST-MOUTEMS.

IV.

ORQAWa OF OIBOULATION.
pericardium:.
Examine it in utu;\t may be adherent, per-
forated (from mediastinal abscess, aneurism,
&c.); congenital defects are rare and uncer-
tain; the membrane may be absorbed.

Open the pericardium and remove the heart, first
tying the large vessels and dividing them, cutting the
aorta as high up as possible.

Lesions of the External Surface. —

Thickened, covered with false membranes,
cartilaginous patches, '«w?A' spots (uncertain
what these are), ossiform plates, ulcerations
(tubercular or cancerous), serous cysts, ecchy-
moses, &c.

Internal Surface. — Dry, wrinkled,
sticky, roughened, granulated, adherent to
the cardiac layer; bright rose color (acute
pericarditis), punctated, coalescing into scar-
let patches (niore advanced pericarditis),
'exudation.'

Contents. — Serum (most common; there
is normally about one-7ialfoz. to one oz.); blood
— from rupture, inflammation, purpuric state,
&c. ; pus — generally laudable, sometimes
greenish; an albumino-flbrinous fluid, of a
sero-purulent or soupy nature, holding fibri-
nous flocculi in suspension, or cellules of
pavement epithelium, or fatty granules (gen-
erally associated with fatty degeneration of
the heart), &c.

The quantity of serum may vary from half an ounce
to two quarts, and the pericardium may then extend
up to the second rib. Bokitansky has met with soft,
yellow, beanlike bodies in the pericardium, but they
are extremely rare.

When there is much effusion, notice if the
heart is displaced, if it floats, its form, vol-
ume, &c.

ORGANS OF OIRCnLATION. 31

Hydropericardium, the result of general dropsy,
must not be confounded with effusion of serum from
inflammatory action; the serum in dropsy is of a
lighter color.

Pseudo-membranous Deposit.— Thick-
ening of the natural tissue, or the formation
of a fibrinous or cartilaginous (sometimes cal-
careous) deposit; frequently like the stomach
of a calf, or a honeycomb (long-continued
pericarditis).

Estimate the probable age of deposit by the extent
of its adhesion, its organisation, &c. When villous
it is of long Standing.

Pericarditis, Acute. — 1st stage, injection

with arborescent reddening, but this is seldom

seen post mortem. In a day or two 27id stage;

fibrinous effusion forming a layer over the

surface of the heart.

In inflammation of longer standing there is thicken-
ing of the fibrinous layer with serous effusion, and
the surface gets shaggy. Sometimes the effusion is
purulent.

Chronic Inflammation.— The effused
lymph organises, and several layers are
formed; there is often a fatty deposit on the
surface of the heart immediately beneath the
first layer. Sometimes there are calcareous
patches.

Adhesions, when simple, do not seem to

- interfere with the action of the heart much;

but when the pericardium is attached to the

heart by fibrous bands, then the muscular

structure is injured.

Cancer and Tubercle may be found, but they are
secondary deposits.

The n ormal «!z« and weight vary considerably ,
it usually weighs from 9 to 12 oz. in males,
and from 8 to 10 oz. in females; proportion to
body weight, as 1 to 169 in males, and 1 to
149 in females.

Thickness of right ventricle to left, as 5 to
13. Both cavities are of equal dimensions.

33 rOSTMORTEMS.

In order to distinguish the right side of the heart
from the left, it is useful to remember that the
tricuspid valve is on the right (deztral), and the mi-
tral valve is on the left (sinistral) side.

External Modifications. — Changes in
the form, situation, direction, relations,
weight, thickness of walls, &c.

External Surface. — Change in the color

of the fibres; they may be violet, red, grey,

pale yellow (signs of fatty degeneration), &c.

There may be ecc7ij/mo3is ffrom injury, &e.; post-
mortem staining not to be mistaken for this); 'miW
patches (probably from alcoholism or rheumatism,
though Dr. Wilks thinks they are due to attrition,
a kind of wart, as from pressure of a belt on the
chest).

Hypertrophy. — General or limited ;

eccentric, with dilatation of the cavities.

Aneurismal pouches.

Xormal contraction (Systole) of the heart must not
be confounded with hyjiertrophy, though it has
been describedas concentric hypertrophy; insystolic
contraction the muscular structure can easily be
stretched with the fingers, and the contraction passes
off with the rigor mortis.

Hypertrophy may be associated with fatty

or fibroid degeneration, disease of the valves,

aneurisms, disease of the lungs, pericarditis,

&c. ; any of these may be a cause.

. In granular kidney the heart is almost constantly
found enlarged.

Atrophy.— Simple, with dilatation, some'
times with contraction; in wasting diseases
or as a congenital defect.

Dilatation of the Heart, with atrophy,
is mostfreqiient on the right side, and chiefly
affects the auricles; often a result of endo-
carditis and disease of the muscular fibres.
It is a serious disease.

Dilatation with hypertrophy of the walls
is not so serious; it shows a conservative ten-
dency.

The state of diastole may be mistaken for simple
dilatation.

Partial dilatation, or aneurism/ contents of
the pouches vary according to length of the

ORGANS OF CIBCTILATION. 33

disease; they may be blood, coagula, lami-
nated fibrinous deposit, &c.

The Coronary Vessels maybe congested
or contain clots or purulent deposits; the walls
may be atheromatous (cause of angina pec-
toris), ossified, &c.

Nerves of the Cardiac Plexus should be carefully
examined.

BXAMINATION OF ENDOCABDIUM.

Open the heart by a V incision, with scis-
sors which are inserted near the apex, one
cut passing along the anterior groove,-the
other along the outer border, begin with the
right ventricle.

Examine the contents, and test the patency
of the valves either with a stream of water or
the fingers; aortic and pulmonary valves by
a column of water in the vessels. Measure-
ment of the orifices may be taken with a
graduated cone or the fingers.

Having examined the contents, state of the
valves, &c., pass one blade of a long pair of
scissors (enterotome) through the left ventricle
up the infundibulum into the aorta, and di-
vide where most convenient; the pulmonary
artery fnay be opened in the same way through
the right ventricle.

Contents. — Clots. — Post-mortem are black

or dark-colored, friable and humid, often

covered with a flbro-albuminous layer, not

adherent to the parietes, with red corpuscles

uniformly distributed through the clot.

In the right ventricle and auricle the blood is buff
anterioriy and red posteriorly: it is more fluid on the
left side.

Ante-mortem ('polypi') are discolored, grey-
ish or yellowish white, sometimes very white;
have a fibrinous texture; are elastic, tenacious,
resistent, more or less adherent to the walls,
may be grooved by the passage of blood,

34 POSTMORTEMS.

occasionally organised. Sometimes they are

softened internally to a creamy consistence.

The importance of clots in the heart is not very
great; ante-mortem generally show lingering death.
Asphyxia is incompatible with the formation of ante-
mortem clots. In sudden death the Wood is gener-
ally fluid. In apnaea the right side of the heart is
gorged, the left nearly empty.

Color of Endocardium. — When pink
shows acute endocarditis and must not be
confounded with post-mortem staining. Post-
mortem redness, from deposition of blood pig-
ment, is morediflfuse; there will be fluid blood
in contact, and the coloring matter may be
washed off or removed by maceration.

Sndocarditis. — Inflammatory redness
(seldom seen post-mortem) is generally in
patches, and remains permanent; there are
also other pathological effects, as softening of
the muscular structure, &c.

Diffuse inflammation causes a silvery opacity from
deposition ot fibrin. There may also be atheroma,
shown by opaque cheesy patches or calcareous
plates.

The endocardium in the left auricle is nat-
urally whitish, as it is thicker there.

The results of endocai ditis are serious, as embol-
ism, fibroid degeneration, and dilatation ; inflamma-
tion generally affects the valves.

'Milky Patches' are signs of localised
chronic inflammatory action, most probably
of rheumatic origin, or from alcoholism.
Granulations or Vegetations are formed
by a tilting up of the superjacent endothelium
from deposition of inflammatory products in
the connective tissue; they may become cal-
careous.

Endocardial Ulcer.— Eare, always be-
gins in a valve, may lead to perforation or
aneurism, very rarely to gangrene.

Is met with chiefly in cases of blood-poisoning, but
whether secondary or primary is uncertain.

State of the Walls.— Notice their thick-
ness, size of the cavity, &c. Muscular strue-

ORGANS OP CIBCULATION. 35

ture firm, friable, granular or lardaceoua,
fatty, &c.

The muscular structure should be macerated in
dilute acetic acid or alcohol, in order to examine it
under the microscope; fibres being teased out by
needles and placed in glycerine.

Tumours.— as lipoma, fibroma, carcinoma,
cystic, tubercular, &c. — are sometimes met
with, either embedded in the walls or project-
ing into the cavity or from the surface.

Fibroid Degeneration. — More common
on the right side; substance is firm, leathery;
cavity retains the form due to distension;
most frequently associated with hypertrophy;
it is generally a result of inflammation.

Fatty Deposition must not be con-
founded with fatty degeneration. The latter
is a serious affection; the former ('obesity of
heart ') is not so serious, and is consecutive
on general obesity; fatty deposition takes place
on the surface of the heart and bbtwbbn the fas-
ciculi, the muscular structure being histologi-
cally unaltered.

Patty Degeneration is always serious,
the fat being deposited within the muscular fas-
ciculi — it is, in fact, a retrograde metamor-
phosis of the normal structure, which is thus
more or less destroyed. The patient may l)e
thin, and yet have fatty heart. It is a cause
of angina pectoris.

This disease may be — 1. Qeneral; then usu-
ally only slight. Muscular fibres paler, more
flabby, break up easier, and leave a greasy
stain on the knife.

2. Partial; the degeneration is more ad-
vanced, but in patches, which cause a mottled
appearance, tlie degenerated parts being yellow
or buff-colored, soft, flabby, and rotten, with
tendency to rupture or aneurism.

Fatty degeneration occurs in alcoholism, some
forms of pleurisy and pericarditis, poisoning by
phosphorus (in the latter case all form of muscular

36 POST-MORTEMS.

structure may be lost, and its place taken by fat
globules).

Pigmentary Degeneration.— Muscular

structure friable and of a brown color. This
is a rare disease.

Myocarditis (Inflammation of the Mmeu-
lar Structure). — Muscular fibres dark, soft,
showing under the microscope at first num-
erous leucocytes within and around the fasci-
culi; in a later stage, pus.

Generally results from pyssmla and infectious dis-
eases, or from emboli in tne coronary arteries.

Ohronic Myocarditis is more common, usu-
ally as a result of rheumatism; it is often
clearly traceable to syphilis, and leads to
fibroid induration. The interior of the ven-
tricle shows patches of a grey or pearly white
color.

In gummaceous myocarditis (tertiary syphilis)
the majority of the muscular fibres are re-
placed by fibrous tissue, with gummaceous
tumours disseminated. These tumours are
sometimes of a firm, yellow, cheeselike con-
sistence, and may obtain the size of a pigeon's
egg.

'Cardiac Apoplexy.'— This term has
been given to cases where hasmorrhagic spots
and extravasations of various sizes occur in
the substance of the muscular tissue.

Bupture of the Heart. — Most frequent

on the left side, seldom at the apex ; generally

the result of fatty or fibroid degeneration;

sometimes caused by severe injury, as a blow

on the chest.

Gunshot wounds are not always immediately fatal ;
the patient may live for two or three weeks after.

Cancer and other tumours are occasion-
ally met with.

VALVES.

Auriculo-ventricular may be changed
into an inextensible ring, sometimes funnel-

ORGANS OF CIRCULATION. 37

shaped, &c , contracted transversely, adherent
to the walls, retroverted, &c. Structure may
be softer, atrophied, perforated (from ulcera-
tion, then the orifice is surrounded with vege-
tations); sometimes contains purulent matter
or fatty substance; may be calcified, hyper-
trophied, or granulated (vegetations); aneur-
ism of the valves; hsematoma, met with in
young children as small papillae containing
blood.

Contraction of the valves is generally caused by

Srolonged inflammation. There is a peculiar ten-
ency for the valves to become calcified, as the result
of long- continued disease.

Aortic. — Adherent to the walls or one
another, rolled up or thickened; free border,
rugous, cartilaginous, or cretaceous; covered
with warty vegetations (fibrinous or other
deposits beneath the endothelium); pierced
with small openings (fenestrated).

Aortic valvular disease is infinitely more dangerous
than mitral disease.

DepodUons of coagula on the valves may be
mistaken for 'vegetations;' they may be dis-
tinguished from them by being easily removed
with care, leaving the valve whole; coagula
often form on vegetations.

AVERAGE SIZE OF THE ORIFICES.

R. Auriculo-venlricular

(tricuspid) =■44 inches, or 54-4 lines

L. Auiioulo-ventricular

(mitral) =3H inches, or 44-3 lines
Pulmonic =3^ ,, 40 ,,

Aortic . . =3i ,, 35-5 „

These dimensions vary considerably in dif-
ferent individuals.

SHAPE OF THE HEART.

Globular — the right side larger than the
left, met with in pulmonary obstruction, as
emphysema or cirrhosis; also in mitral ob-
struction, but then the left ventricle is hyper-
trophied as well.

38 POST-MOBTBMS.

' Bovine ' Heart — left ventricle much en-
larged, seen in aortic obstruction.

General Enlargement does not arise
from valvular disease, but from obstruction
in some remote vessels, as those of the kid-
ney, &c.

MALFORMATIONS.

In rare cases there are only two chambers,
in other cases three ; origin of aorta and pul-
monary artery from left ventricle; transpo-
sition of vessels; absence of pulmonary artery;
obliteration or destruction of aorta and per-
sistence of ductus arteriosus; patency of the
foramen ovale.

None of these malformations has been proved to
be the cause of cyanosis, which is still uncertain,
though it may be associated with any of them.

ABTBRIES.

The vessels should generally be slit up (small ones
by means of a fine pair of scissors) and examined in-
ternally, aorta sometimes as far as the iliacs. Before
opening them, take the diameter either by the linger
or a graduated cone.

Iiesions. — Hypertrophy, atrophy, dilata-
tion (cylindrical, fusiform, or sacculated) or
contraction of the aorta; arteritis; black or
violet stains; atheromatous patches on the
internal surface of aorta, or floating white
cartilaginous plates in the arch ; aneurism of
the aorta, which may burst into the trachea;
sometimes the horizontal and vertical portions
of the arch of the aorta are united; clots
more or less obstructing the tube of any of
the vessels, &c.

Clots, when organized, should be carefully followed
along the course of the vessels; in puerperal fever
they often extend some distance.

Narrowing of the Calibre of an artery
may be congenital or from arteritis, pressure
of a tumour, thickening of the tunics or car-
tilaginous changes; it leads to gangrene of
the part supplied.

OKGATiS OF CIRCULATION. 39

NarrowinK of the calibre of an artery does not
necessarily lead to gangrene of the part supplied by
the vessel, unless it be a terminal branch. When the
trunk of an artery is destroyed, the circulation is
oftentimes restored through the anastomosing
branches above and below the seat of injury.

Arteritis. — (Bare), walls reddened, thick-
ened, or sometimes thinned and friable, struc-
ture being pulpy exudation of lymph blocking
up the vessel (this may be purulent, albumin-
ous, or fibrinous). Cavity narrowed, full of
soft clots, &c. General arteritis is unknown.

GTvronia Arteritis or Atheroma. — Frequently
associated with syphilis and as a result of old
age. \st stage, deposition of greyish translu-
cent material in the intima ; 2nd stage, fatty
or calcareous degeneration.

Sometimes fatty degeneration produces what is
called an atheromatous abscess or ulcer.

Aneurism. — 1. Dissecting, from rupture of

inner and middle coats, due to atheroma.

3. Diffv^ or general dilatation.

3. Saccular or true aneurism. Causes: ar-
teritis, pressure, embolism, laceration.

4. Varicose, with or without a cyst.

The contents of aneurisms should be care-
fully observed; they may be soft clots or
laminated fibrinous deposits.

Intercranial Aneurisms. — Cause of convul-
sions, apoplexy, paralysis. Insanity, &c.

Look for aneurism in all cases of large heemorrhage
from mouth and nose; note carefully condition of
aorta. Arteries may rupture without dilatation, from
fatty degeneration, atheroma, stenosis, etc.

TEINB.

Examined chiefly in cases of phlebitis, spontane-
ous gangrene, varicose aneurisms ; they should also
be examined m subjects affected with varicose veins,
oedema, pulmonary embolism, purulent infection,
&c. Search for varicosities, and see if they are in-
flamed or softened: examine the venous network at
the upper part of the thigh; open the saphena. No-
tice the uterine sinuses, isolate the utero-ovarian
veins with the point of a knife, then open them; do
the same with the vascular plexus of the broad liga-
ments and the ovarian veins. Soft and discoloured
Phleboliths are sometimes found in the vessels here,
attached to their walls by a thin pellicle; sometimes
there is suppuration.

40

POST-MOKTEMS.

In Phlegmasia Alba Dolens there are
clots or pus in the iliac or hypogastric veins,
or in one of the principal trunks of the lower
limbs.

Phlebitis, Principal Alterations in.—
Coagulation of the Blood. — This is often a
cause, not a sign, of inflammation; there may
be coagulation without inflammation. These
Clots are various; wine color, grey or whit-
ish, fibrinous, adherent to the walls or not;
resistent or breaking down under pressure;
containing pus (second period), grumous
(later); pierced by a central canal.

Walls reddened at first, afterwards white,
swollen; cavity dilated; the vessel is some-
times moniliform; adherent to surrounding
cellular tissue, often with phlegmonous in-
duration (the vessel then feels like a cord).

Internal tunic may be red or white (accord-
ing to degree of inflammation), rough,
opaque, thickened, softened, friable, ulcera-
ted, &c.

Observed in pyaemia, poisoning (by dyes,
&c.), injuries, <fcc.

Thrombi from phlebitis, by forming emboli, are
often a cause of ' metastatic ' abscess, as in the liver,
kidneys, lungs, brain, &c.

Pus in Veins. — Suppurative Phlebitis, from
an abscess bursting into a vein ; in cases of
pysBmia, caries, bubo, &c. Primary suppura-
tive phlebitis is rare.

Adhesive Inflammation. — This may be
primary, as in old people, or from the pres-
sure of a tumour, but it is generally due to a
thrombus.

Phleboliths are calcareous particles which
obstruct the veins; they are derived from
degenerated coagula.

Thrombosis is of importance. A clot
ormed before death in situ is a tli/romJms;

ORGANS OF CIRCULATION. 41

may be distinguished from post-mortem clots
by — 1, adhesion to the walls; 3, organization;
3, decolorisation ; 4, deposition of leucocytes;
5, stratification. Met with in disease of the
heart, cholera, leuksemia, Bright's disease;
from pressure on a vein; varicosity; or en-
trance of pus from an abscess into a vein
(rare), &c.

The thrombus becomes lighter in color, drier,
flrmer, and more adherent, by age.

Embolism. — Obstruction of a vessel by
particles of coagulated matter from a distant
part. Originates from thrombi, ' vegetation '
from heart, portions of new growth, para-
sites, pigment granules, &c., escaping into
the circulation and being carried to some dis-
tant part. Produces either necrosis or en-
gorgement from obstructing the circulation.

Plugging of the basilar or other artery of the

brain causes paralysis and red softening of the

brain; of the pulmonary, asphyxia; of the

coronary, paralysis of the heart.

Collateral circulation may be established; if it be
not, then there is necrosis. The pare which has been
out off is surrounded with a very characteristic zone
of Intense bypersmia.

Hsemorrliagic Infarcts may form from
impaction of an embolus, escape of blood, and
formation of a thrombus; often met with in
the lungs, spleen, and kidneys. They are
firm, wedge-shaped masses of a dark red
color.

LYMPHATICS.

Inflamm.ation. — Red line and swelling
along the course of the vessel. This redness
generally subsides after death. Walls thick-
ened, opaque, less resistant; cavity dilated,
may contain clots or even pus; abscesses
sometimes form along the course of the ves-
sels. Surrounding cellular tissue infiltrated
with a sero-albuminous, half-concrete fluid.

43 POSTMORTEMS.

It is never primary, but always follows some
inflammation of the surrounding connective
tissue, as from metritis, abscesses, poisoned
wounds, &c.

Chronic affections of the lymphatics are
found in cancer, tubercle, scrofula, &c.

Lymphatic G-lands. — Morbid changes
are nearly always secondary. Hypertrophied
in phthisis, secondary and tertiary syphilis,
typhoid fever, glanders, &c., mostly in the
axillary, cervical, and thoracic regions; some-
times soft, sometimes hard (syphilis). Tume-
fied, red, soft and friable, or suppurated
(Acute inflammation). Swollen, adherent to
surrounding tissue, containing a caseous mass
like raw potato; this sometimes softens and
becomes like pus, or it may calcify (Tubercu-
lar degeneration).

Cancer. — Rare as a primary, but common
as a secondary, affection.

Syphilis. — Something like tubercular dis-
ease, only the glands are not so enlarged .

Other Changes.— Calcification, melanosis,
epithelioma, amyloid degeneration, &c.

IiymphsBnoma. — Enlargement of the

glands from hyperplasia of their elements;

they may be soft or hard. When associated

with anaemia and affections of the liver,

spleen, &c., it constitutes Hodgkin's disease.

The glands often retain pigments and poisons in-
troduced from without.

V
BE8PIRA TOR Y SYS TEM.

In penetrating wounds of the thorax

note first the size , shape and direction of the
wound in the skin and chest- wall ; second, the
exact location of the wound; third, the in-
ternal wound, structures injured; fourth, the

EESPIBATORY SYSTEM. 43

general direction of the wound compared with
the point of entrance; fifth, whether the
wound is recent or inflicted some days prior to
death.
Before removing the Lungs, notice the
/toTva of the pleural cavity; if encroached on
by the liver, stomach, &c. ; search for fistu-
lous openings, especially in pneumothorax.
If this was suspected before death, run a tro-
car in before opening the thorax, and notice
the rush of air.

The amount of this can easily be measured by
allowing it to escape into an inverted measure glass
filled with water and standing in a basin or pail;
press up the diaphragm to get as much air out as
possible.

If there is any fluid in the pleura, state its
nature, quantity, and appearance.

It may be measured by means of a glass tube with
an elastic ball at the end ; by compressing this ball,
and allowing it to expand, the smallest quantity of
fluid may easily be removed, and if the tube is grad-
uated it can be read off at once.

Examine the mediastinum for cancer,
hfemorrhagic effusion (from bursting of an
aneurism, &c.), acephalocystic tumours, ossi-
flc plates, air (as general emphysema of
infants), abscess of lung opening into the
pericardium, &c.

Feel carefully round the walls of the chest
for fracture of the ribs (and compare the seat
of these with disease of lung or pleura); look
for osteophytes (old standing pleurisies);
abscesses; tumours (as cancer) in the inter-
costal spaces, &c.

Remove the Lungs thus : — Divide the tra-
chea and ojsophagus as high as possible; sep-
arate all adhesions, drawing the lungs down-
wards and forwards ; then sever their connec-
tion with the diaphragm.

It the lungs are adherent to the walls, they must
not be torn away, but tbe costal pleura is to be care-
ully detached with them.

44 POST-MORTEMS.

Notice the external shape, appearance,
extent of hypersemia (post-mortem hypostasia
will give evidence of the position of the body
at and after death). Examine the edges, the
base, and the apex; press with the fingers, in
order to estimate the consistence, induration,
elasticity, &c. Attach a blow-pipe to the
trachea and inflate; see if the whole lung is
permeable to air; then let the air escape;
this will give an idea of the elasticity of the
tissue. Inflation- will also detect fistulous and
other openings between the lung and the
pleura, «&c.

.When the lung is suspected of being per-
forated, but no opening can be seen, put the
whole lung under water and inflate ; bubbles
of air will escape from the injured part. Pass
the long blade of a pair of scissors into a
bronchus and follow the ramifications of the
bronchi; this is better than simply incising
the lung.

LABTNX, TRACHEA, BRONCHI.

Mucous Membrane.— Red and swollen,
with raucbumcus (laryngitis, catarrhal, syphi-
litic, &c.), greyish, thickened with muco-pus
{chronio laryngitis); oedematous (cederiM glotti-
dis, in children especially, also in Bi'ight's dis-
ease, &c.)

CEdema is always less apparent after death than
during life, and the only eTidence of it may be a
wrinkling of the mucous membrane.

Suppuration (often secondary to erysipelas,
&c.); plastic exudation in the larynx or
trachea (croup, cynanche trachealis, diphtheria),
in the bronchi (plastic bronchitis; this is a
rare disease; the exudation may take a cast of
the bifurcations in an arborescent form).
Yellowish white, opaque and viscous or puru-
lent mucus (chronic bronchitis); surface vel-
vety or granular, bluish (a sign of suffocation).

' BBSPIRATORY SYSTEM. 45

reddish, violet, slate-colored (different forms
of bronchitis); thickened, thinned, softened,
&c.

Various Lesions.— Foreign bodies (with
inflammation); ulcerations, syphilitic — small,
rounded, yellowish nodules with much fibroid
formation, chiefly at the edges of the epiglot-
tis; if severe, there may be a shaggy or floc-
culent appearance; tubercular — in early stage
as small corpuscles, then ulcers which from
coalescence of small ones become large and
deep, chiefly near the glottis; typhoid — rare
in this country, situated at the back of the
larynx, generally a result of gangrene.

There may be dilatation, this being either
general or saccular; thinning; obliteration;
perforation; or contraction (from pressure
within or without) ; ossification of the carti-
lages (senility). Various tumours, as mucoid,
fibroid, chondroid, &c.

Bronchial Glands. — May be red, black,
tumefied, tuberculous, cretaceous, or cancer-
ous.

The Bronchi are opened by means of
very fine scissors with unequal blades (broneho-
tome), or by a director introduced into the
tubes and a blade of an ordinary pair of scis-
sors, or scalpel passed along it.

In Dilatation search for the cause; this is
generally obstruction from cretaceous or
scrofulous matter blocking up a bronchus, or
from condensation of lung tissue; it is often
met with in asthma.

Parasites are never met with in the air passages of
man as a disease; if found, they have been intro-
duced accidentally since death.

Bronchitis. — Redness of mucous mem-
brane, from a bright red to a purple color;
swelling. Secretion of viscid or purulent
mucus, this oozes from the tubes on section.

46 POST-MOnTEMS.

In infants death may be from sudden efiEusion,

causing suffocation.

Always open the bronchi, and especially examine
the smaller tubes, as these may contain purulent
matter, &c.

Chronic Bronchitis. — Mucous membrane

may be deep red, violet or slate-colored;

somelimes tliickened, at other times thinned

and reticulated. The bronchi are filled with

thick mucus or muco-pus; in long-continued

bronchitis this secretion may be offensive and

of a dark color. It is often associated with

emphysema and hypertrophy of the right side

of the heart.

PLEURA.

Color. — Red (costal layer in acute pleurisy),
citron, opaque (pneumonic layer in acute
pleurisy), semi-opaque, yellow (chronic pleu-
risy), greenish (last stage of phthisis).

Contents. — Clear serum (chronic pleurisy),
may cause carniflcation and atrophy of lung
from pressure; may be ascitic fluid (in general
dropsy); thin layer of lymph, easily peeled
off (early stage of pleuriny); thick layers are
generally superimposed layers of varying con-
sistence, sometimes it gets like cartihige (pld-
standing pleurisy); abscess — pus contained in a
sac formed by lymph; this may burst through
the chest or into lung; adhesions — from or-
ganization of lymph; ossijic deposits as true or
false bone; layer of fat (rare) ; canwr is always
secondary, as hard, white, flat, and smooth
scattered patches ; blood — from fractured ribs,
rupture of aneurism, purpuric state, &c. ; air
—pneumothorax, from dfsease mostly, as burst-
ing of a small abscess in, or injury to the
lung, often the cause of sudden death ; con-
tents of stomach from perforating ulcer;
tubercle (rare, always secondary), as miliary
granulations, which may become confluent
and cheesy by age.

EESPIKATORY SYSTEM. 47

LUNGS.

Hypertrophy ; this state is often uncertain
when one lung is wasted or destroyed, its fel-
low may become considerably hypertrophied ;
atrophy (from pleurisy, &c.).

Color. — The normal color is grey whenthe
lung is deprived of its blood; in disease it
may be greenish, bluish, livid, rose red (also
in infancy), pale yellow; slate color, from
breathing air loaded with carbon, as coal
dust; claret color; brown, from particles of
hEEmatoidin in passive pulmonary congestion.

Consistence. — Density and elasticity
diminished or augmented.

Condensation (ataUctasis, a return to the
foetal state) is either congenital or arises from
pressure, or want of power to expand, dis-
tinguished from hepatisation by the surface
being depressed and not granular.

Splenisation — lung substance softened, red-
dened, serous.

Hepatisation — red, solid, like liver, granular
on section, sinks in water; grey hepatisation,
or carnification, color paler, more solid.

Hyperasmia — lung solid, brown sometimes,
in long continued congestion, moister in more
recent (not to be confounded with post- mor-
tem hypostasia, which is darker and forms on
dependent parts). Friable, softened, en-
gorged,; more crepitant than natural, as in
emphysema.

Emphysema — may be either interstitial (sur-
face appears studded with beads) or vesicular
(projections from surface that on section are
like a sponge, met with in old-standing bron-
chitis and phthisis).

Induration or cirrfioiis — from fibroid chan-
ges, a result of chronic inflammation; fibroid
induration, with cavities and 'tubercles'

48 POST-MOKTBMS.

(sometimes called ' chronic pneumonic phthi-
sis,' but it is properly chronic pneumonia);
pigment induration — lung dark, dry, and firm,
in some cases of heart disease; gangrene —
lung broken up, fetid, fluid of a dirty green-
ish color.
Adherent to diaphragm, ribs, &c.

Morbid Products. — Miliary granulations;
cretaceous tubercles; tubercular or syphilitic
cicatrisations (it is difficult to distinguish
these from each other); gummata of tertiary
syphilis are grey, cheesy, irregularly shaped ;
ulceration, abscess (pyaemic, phthisic, inflam-
matory, &c.), perforations (from ulceration,
injury, &c.); cavities; mdema — the lung is
heavier, denser, and somewhat translucent, a
frothy fluid escapes on section (in dropsy and
Bright's disease); pigmentation, spurious
melanosis or miner's phthisis — the lung tissue
is quite black, either in patches or through-
out, from deposit of carbon, probably from
smoke or fine dust; the lung may also be in-
filtrated with powdered glass (in glass work-
ers), with metals (as in knife grinders), with
silica, &c.

Cancer, medullary (primary rare), epithelio-
ma (secondary); sarcomata, osteo-sarcomata,
enchondromata, lymphomata; hydatids (hav-
ing escaped from the liver through a perfora-
tion).

A.poplexy of the Lxmg.-

infa/rction. — Blood is effused in the pulmonary
parenchyma, coagulated, of a dark color; it
sometimes produces inflammation. The part
affected is of a globular or wedge shape, with
the base towards the surface, varying in size
from a pin's head to an orange, and consisting
of a cavity bounded by comparatively healthy
tissue.

RESPIRATORY SYSTEM. 49

Endeavour to trace the burst bronchus ; the artery
leading to the part will be found plugged by an em-
bolus or a thrombus from an inflamed vein or from
'vegetations' (clots) detached from the valves of the
heart.

Emphysema. — Interstitial or Interlobular
is rare, most frequently associated with gen-
eral emphysema; it is also seen in children
who have died of some long-standing bron-
chial affection. The lung surface appears
studded with beadlike bullae.

This condition is not apparently of very great im-
portance.

Vesicular is the most common form. It is due
to dilatation of the air vesicles. The lung feels
somewhat doughy on pressure, does not col-
lapse, and is dry and exsanguine. Bullae, or
apparent projections of lung substance, are
seen on the front surface of the lung; on
section these parts are like a sponge.

It is mostly associated with chronic bronchitis and
dilatation of the right side of the lieart.

Phthisis, Lesions in. — Lung changes are
found most and more advanced in the upper
part of the organ.

I. Lungs. Miliary Granulations. — First
stage, isolated or joined together, grey and
semi-transparent; 2d stage, yellowish white
and opaque; 3d stage, 'Tubercles' (caseous
matter), softened (with or without infiltration
of the pulmonary parenchyma), suppurated or
transformed into cretaceous, puriform, or
greenish yellow, souplike matter (gangrene).
Gcmties (vomicae), more or less large, nearly
empty, or filled with a white, yellow, grey,
green, purulent, sanious, inodorous, or fetid
liquid; their walls softened or indurated,
regular or broken up, or beset with pseudo-
membranous deposits ; with consecutive pneu-
monia around them; flstulse, etc.

II. Pleura. Concomitant Alterations. —
Adhesions to the lungs by cellular, fibrous, or

50 POST-MOKTEMS.

cartilaginous bands; pleuro-pulmonary fls-
tulse. Air passages in general. — Bronchi dila-
ted either uniformly or limited to small areas.
TJlcerated by tubercular granulations; bron-
chioles are sometimes closed and form hard
cords, traversing the vomicae.

III. Digestive OKaANS.— Mouth, pharynx,
and stomach inflamed; intestinal mucous
membrane thickened, thinned, softened, or
injected, covered with granulations (tubercu-
lar, semi-cartilaginous). Biliary Organs —
Liver fatty, hypertrophied, punctated with
red spots; bile pale, fetid. Bronchial and
Mesenieria Olands, hypertrophied, softened,
containing tuberculous granulations. Ner-
vous Centres. — Miliary granulations dissemi-
nated, or in layers, in the pia mater and en-
cephalon; also surrounding the vessels, and in
the choroid plexus.

PNEUMONIA, Lesions in.— Croup-
ous or Lobar Pneumonia. I. Stage (En-
gorgement). — Colour of the surface of the lung
is violet, livid, or claret color. Floats on
water and is permeable to inflation, but it is
more bulky, the density and weight are a
little augmented, there is crepitation, but less
than natural, and the elasticity is diminished,
the finger can easily be forced into the paren-
chyma (this distinguishes it from simple
oedema). Its cut surface yields a liquid which
may be serous, reddish, muddy, or spumous.

II. Stage {Bepatisaiion). — Color of the
surface of lung is a distinctly pronounced dull
red, uniform or marbled (from absorption of
blood or coloring matter). There is aug-
mentation of volume, it does not float, cannot
be inflated, and there is loss of crepitation,
the lung substance is hardened, carnified, of a
consistence like the liver, or the spleen (spleni-
salion); it is friable. When cut. — Clean, dry.

KESPISATOKT SYSTEM. 51

presenting red, hard, rounded, or flattened
granulations (these being the plugs in the air
vesicles). Liquid escaping from the Incisions
(especially by pressure), is small in quantity,
red, opaque, thick, and muddy.

III. Stage (Grey Sepatisation). — Colour of

the surface is grey or pale yellow ; darker in

old people, in children almost white.

This last state is generally congenital, and is almost
always due to syphilis.

Sinks in water, impermeable to inflation;

volume either augmented or decreased ; there

is induration with very great friability, but

less granular than in the last stage. Liquids

escaping from Incisions. — Matter resembling

pus; phlegmonous, reddish, inodorous, or

fetid pus. Sometimes there is slight pleurisy

with a layer of lymph.

IV. Eesults. — Abscess, with an unbroken
cavity, or irregular walls; simple or multiple
(pysemic, phlebitic). Oangrene, either diffuse
or circumscribed. Color in gangrene, vari-
ous shades of green, brown, or black; sur-
rounding parenchyma infiltrated with ill-con-
ditioned pus. Texture softer and moister.
Absorption. — Cells become granular and fatty,
then absorbed or expectorated. This gives a
purulent appearance to the sputa.

The lung substance in this state is often so soft as
to be broken up on removal.

V. Concomitant Altbrations. — Pleurm
almost always more or less inflamed. Bron-
chi full of mucosities or dilated into pouches
containing a purulent liquid. Bronchial
Olands swollen, red, softened. Heart with
fibrinous clots in the cavities (sign of slow
death). OastrO-intestinal Mucous Membrane
softened.

There is nearly always some pre-existing chronic
disease of one or more of the other organs in pneu-
monia. The absence of chlorides in the urine may
clear a doubtful case even post mortem.

52 POST-MOKTEMS.

Catarrhal or Broncho-pneumonia

{form of Inflammation of the Jjungs in Chil-
dren). — Inflammation is limited to single
lobules, or groups of lobules; the lung is
solidified only in patches; these have a ten-
dency to become chronic and are then yellow-
ish, dry, and crumbling, so that there is an
appearance of spots varying in size from a
pin's head to a pea, either yellow or purif orm ;
this is very characteristic.

Often met with as a sequel of measles, especially
in adults.

There is a peculiar form of pneumonia
caused by inhalation of particles of food which
decompose and cause inflammation or gan-
grene. This is chiefly met with in the insane,
and especially in those who have been fed
artificially.

Interstitial or Chronic Pneumonia.
{Cirrhosis). — There is an acute form of inter-
stitial pneumonia, but it is very rare. Gener-
ally unilateral. Lung is smaller, parenchyma
dark grey or yellowish, smooth, dense, firm
(almost cartilaginous), irregularly mottled
with black pigment; bronchi dilated. The
normal tissue is replaced by a dense fibrous
growth. May lead to ulceration and exten-
sive excavations, or gangrene. This was for-
merly termed 'chronic pneumonic phthisis.'

Generally a sequel of some affection of the bron-
chi, or pleuritic, phthisic, or syphilitic inflammation
of the lung.

Typhoid Pneumonia. — There is hyperse-
mia, and a spotted appearance of the lung,
both externally and internally; chiefly at the
posterior part, where there is also consolida-
tion.

Cheesy Pneumonia. — The lung passes
through the three first stages of pneumonia,
then the lobules are blocked up by ephithelial
elements which undergo fatty degeneration

DIGESTIVE APPAKATDS. 53

or caseation. In an acute form this consti-
tutes the so-called 'galloping consumption.'

LtTNGS IN NEW-BOKN CHILDREN.

Not Respired. — Lungs like liver, of a uni-
form colour; surface marked by slight fur-
rows.

Respired (or inflated). — Air cells are a bright
red colour if fresh and filled with blood; if
they contain less blood, and are examined
some time after death, they are of a lighter
colour.

Bydrosiaiic Test.— (Not entirely reliable, but
still valuable). An unrespired lung sinks;
but if decomposition has set in it may float
from the contained gases. On the other hand,
a respired lung may sink from disease; though
some parts would float. Press the piece of
lung firmly in a cloth, so as not to injure it;
if it still sinks it has never been respired or
inflated. Part of the lung may have respired.

VI.
DIGMSTIVB APPARATUS.

MOUTH.

Malformations, corrosions (poisoning by
caustics, etc.), injuries, marks, etc. The mu-
cous membrane is a dark purple colour in
cases of suffocation, etc.

Inflammation (stomatitis) — gums swollen
in nodules, coated with thick tenacious mu-
cus, papillae prominent.

In chronic inflammation the gums waste
and seem hard and polished; ulcerations;
diphtheritic and croupous exudations.

Aphthous ulceration due to a fungus (oidium
aXbieans).

54 POST-MOBTEMS.

Small-pox pustules.

Gangrene {canerum oris or noma), a foul-
smelling black patch, -which becomes grey
and sloughs.

Tamours. — Fibromata, sarcamata, osse-
ous, myeloid," angiomata, adenomata, papillo-
mata ('epulis' and 'ranula' are old, worn-out
terms), epitheliomata, polypi (local hyper-
trophy).

Examine the roof of the mouth for Assures,
ulcerations, tumours, etc., of the soft and
hard palate.

TONGUE.

Hypertrophy (macroglosm), atrophy.

Wounds caused by the teeth in spasms or
convulsions may furnish important evidence
as to the symptoms preceding death.

In inflammatioa (glossitis), it is swollen
with prominent papillae.

TJlceration is either simple or syphilitic; the
latter with condylomata or as deep superficial
ulcers with hard walls.

Cancer. — Scirrhous is nodulated; epithe-
lial has ragged, everted edges.

Hydatids are rare.

Ranula is a cystic tumour caused by ob-
struction of Wharton's duct and retention of
the secretion of the submaxillary gland.

PHARYNX.

Inflammation (cynanche tonsillaris, ton-
sils swollen); suppuration (quinsy).

The tonsils become permanently enlarged after re-
peated attacks of inflammation.

Syphilis. — Callous, well-defined, excava-
ted ulcers with a greyish floor (' secondary ').
Unsymmetrical, deep, more extended, with
gummatous thickening of the neighboring tis-
sue (' tertia/ry.')

Croup. — Mucous membrane in the early
stage is inflamed, then effusion of liquor san-

DISESTIVE APPARATUS. 55

guinis takes place, and afterwards a deposit
of a fibrinous matter, which forms the ' false
membrane ;' this often extends from the larynx
to the bifurcation of the trachea.

Diphtheria is not easily distinguished
from croup, except by being more severe,
sometimes causing sloughing, and by being
deeper seated in the substance of the tissue,
so that the false membrane cannot be removed.

(ESOFHAanS.

Lesions are not frequent, it may be
wounded from without or within.

Dilatation — either partial and sacciform
or general, sometimes like a second stomach.

Contraction arises from pressure of
tumours, cicatrisation of ulcers (syphilitic or
others), poisoning by caustics or cancerous
deposit in the walls.

Inflammation — mucous membrane is
swollen and granular, with uniform redness
(rare as an idiopathic affection).

The mucous membrane is normally a pale grey
colour.

TJlceration — generally in the form of clean
cat, round ulcers sometimes with jagged
edges; simple or syphilitic (in latter case with
gummata).

Perforation — often connected with an-
eurism of aorta, which bursts into the oesopha-
gus ; sometimes joined to the trachea.

Tumours. — Cancer — sometimes medulla-
ry, rarely scirrhous, mostly epithelioma.

This last appears as a circumscribed growth on
one side, sometimes of a warty nature.

Warty growths, cysts, myomata.
The oesophagus may contain foreign bodies as a
mass of food, bones, false teeth, etc., which may
pierse the aorta.

STOMACH.

The size of the stomach varies consider-
ably in health; the following table is the mean
of several measurements:

56 POST-MORTEMS.

Inches.

Transverse diameter 9 to lOH 1

Vertical diameter 4 " 5 ^Distended

Antero-posterior 3 "4 )

Inches.

Transverse diameter 7 to 8 )

Vertical diameter S% " 3M [■ Empty.

Antero-posterior Jfi " Ml

Before opening place a ligature at each
end, preventing it slipping off by passing a
pin through the coats; then Inflate; notice the
state of the walls.

Put the cotttents in a bottle, if for medico-
legal examination, and seal up at onee, or put
up the whole stomach without opening.

Never open if poison is suspected, Leave opening
for the chemist.

Open the stomaoh along the lesser curva -
ture, and spread it on a glass or porcelain
plate for examination, then wash with a fine
stream of water.

Appearance of the Coats. -Color.— The
mucous membrane at death is pinkish white
or ash-colored; about five hours after death it
becomes rose yellow. A hyperaemic state is
frequently seen independently of the action
of corrosive poisons, especially in heart dis-
ease; during digestion or alcoholism; bluish
white, grey, slaty or yellowish, from fatty
degeneration of the epithelium {chronic gastri-
tis); reddish brown, puckered {chronic gastri-
tis, pellagra, etc.); rugae studded with red or
brown spots in hsemorrhagic effusion and
yellow fever.

Mucous membrane transformed into detritus
of a chocolate, black, or yellowish color (poi-
soning by arsenic, etc.); mammfllated (chronic
gastritis, poisoning by ammonia.)

Thickness and CoTosistence.— Atrophy
— post-mortem thinning must not be con-
founded with disease. Inflamed — swollen,
intensely red (rarely seen post mortem), sur-
face covered with thick mucus. Catarrhal

DIGBSTIVB APPAKATTJS. 57

inflammation causes at first a slaty color, with,
swelling and softening; afterwards induration
and hypertrophy.

Morbid Productions.— Fungous vege-
tations. Mucous polypi {sarcomata); hyper-
trophy of the villi round the glands, and of
the glands themselves with hypertrophy of
the muscular tissue.

This state is often met with in drunkards.

Plates or mammillae of a reddish brawn or
slaty grey color (chronic gastritis or catarrhal
inflammation). Pus or blood injecting the
mucous membrane in an arborescent form.
Fibrinous exudation {croupous gastritis) rare,
met with in croup, typhus, pysemia, etc.
Gangrenous patches nd infiltration with can-
cerous or melanotic matter. Tubercle is ex-
ceedingly rare.

Cancer. — ScirrJius is the most frequent
form of cancer, distinguished from simple
induration (sarcomata or fibromata) — 1, by
the nature of the cells and cell loculi; 3, by
the submucous cellular tissue being increased
in substance ; 3, by affection of the lymphatic
glands.

Medullary is occasionally met with in the
form of bleeding fungous excrescences.

Epitlidioma only as extension from the
oesophagus

Colloid rarely.

Various Alterations. — Ulcers and scars,
either simple, with perforation, or multiple;
with adhesion to neighboring organs (cancer).

Hrnnorrlmgic Effusion into the mucous mem-
brane is very common, chiefly on the summit
of the rugse in the form of clots, which are
brighter or darker according to age.

Softening is not so important as was for-
merly thought, being generally post mortem
from the action of the gastric juice; if pro-

58 POST-MORTEMS.

duced during life it is seen chiefly where
food is (cardiac extremity and fundus); when
perforated during life, there are signs of in-
flammation and gradual thinning round the
hole (which is as if a piece had been punched
out). Death after perforation is either from
heemoiThage or peritonitis.

Hssmatemesis may be from' an exceedingly small
perforating ulcer.

Amyloid degeneration is occasionally met
with. •

Notice the changes in relation to other

organs; narrowing of orifices, etc.

There may also be distension by gas ; dilatation with
or without hypertrophy (chronic or rapid). Atrophy
and retraction; bilocular stomach, or partial stran-
gulation ; hernia through the umbilicus or diaphragm.

Abnormal Contents. — 1. Intoxicating
liquids; poisons; leaves of plants (as yew
tree, which are needle-shaped).

2. Pathologic Liquids — mucus, thick, viscid,
ropy or yellowish, more or less adherent to
the mucous membrane; black liquid like soot
(blood-clots); mixed with food or not; like
coffee (plague); sanious or fetid (cancer, phos-
phorus); lumbrici; foreign bodies, as sealing-
wax, nails, buttons, pipe shanks, etc. Torula
cereviauE (yeast plant); aphthae; aarcina ventri-
euli, etc.

Corrosive Poisons.— ^e^jon of Uehloride
of mercury causes a slate color of the mucous
membrane.

Arsenic, a yellow color, portions of the
poison may remain as a white powder.

Orpiment and Scheele'a green leave a green
stain, etc.

Mineral Acids. — Greenish, yellow, brown
or black glutinous secretion, rugae softened;
ulceration and perforation frequent.

Bulphurie Acid often bleach^es the mucous
membrane, which then appears as if coated
with white paint.

DIGESTrVB APPARATTIS. 59

Nitric Acid changes the mucous membrane
to yellow or green; perforation is less fre-
quent than with sulphuric acid.

Alkalies produce inflammation, abrasion,
and ulceration; and change the mucous mem-
brane to a dark or tawny pulp; perforation
rare.

Oxalic Acid, mucous membrane pale, free
from rugae, sometimes inflamed; vessels in-
jected.

Nitrate of Potash, inflammation and black
patches.

Alcohol, deep crimson or dusky red.

Carbolic Acid somewhat tans the mucous
membrane.

Post-mortem Softening and Perfora-
tion. — Thinning, with arborescent black ves-
sels running over the part affected; there is
usually a kind of water-mark limiting where
the contents have acted on the coats. The
opening is generally at the cardiac end; the
liquid efEused is chymous, and the organs in
contact are softened without surrounding
inflammation; the edges are thin, ragged,
shreddy.

CircumstaiDces producing these changes uncertain.

PERITONEnM.

Inflation. — Sometimes it is necessary to
inflate the lesser cavity of the peritoneum;
this is done by introducing a blow-pipe
through the foramen of Winslow thus: raise
the liver, carry the flnger from right to left to
the neck of the gall bladder and follow this up.

Contents. — I. Idquids.—'ULa.y be trans-
parent or not; limpid; frothy; flocculent;
albumino-flbrous (chronic peritonitis); of an
oleaginous consistence; yellow-citron color;
greenish, etc.

II. Liquids Mixed with other Matters — faecal ;

60 POST-MORTEMS.

stercoraceous (peritonitis by perforation or rup-
ture).

Bile, following wounds and rupture of the
gall bladder.

Urine, from rupture of the bladder.

Pus, chronic peritonitis, or by bursting of
an abscess of the liver, uterus, spleen, iliac
fossae, bladder, etc. •

Blood, liquid or coagulated, mixed with
serous effusion (hsemorrhagic peritonitis, or
from rupture of an aneurism, etc.).

Oases, air more or less rich in oxygen,
carbonic dioxide, or hydrogen sulphide.

Foreign Bodies. — Pathologic. — Miliary
tubercles as semi-transparent grey granula-
tions difEused generally, but more abundant
on the surface of the diaphragm and spleen.

Cancerous Tumors, encephaloid or colloid,
may spread over the entire surface. Fibrinous
bands, joining various parts into one mass.
Encysted abscess; blood cysts.

Superfcetation may take place — 1, in the
fallopian tubes; 3, in the ovaries; 3, in the
walls of the uterus; 4, in the vagina; 5, in the
peritoneal cavity.

Hydatids may be loose or encysted.

Biliary or urinary calculi, or intestinal
worms, may escape through the walls of the
abdominal organs into the peritoneum. .4m-
dental — received from without, as projectiles,
debris of instruments, etc., needles, etc.,
swallowed.

Chief Alterations. — Mesentery and Peri-
toneum. — Grey, slaty (chronic phlegmasia), red
(with injection of mesenteric vessels), brown,
blackish, bluish (certain forms of chronic peri-
tonitis), light and whitish; infiltrated with
serum, pus, blood, etc.; fatty; thickened,
thinned, covered with plastic exudations; dis-
seminate* miliary granulations (ttibercvXosts);

DIGESTIVE APPARATUS. 61

charged with black matter {melanosis, but
probably pigmentary remains of old inflam-
mation) ; cancerous patches; ecchymosed spots
(poisoning by phosplunibs); pus, urine, etc.
Hernia; shrivelled; cystic tumors; congeni-
tal deformities.

The Otaenta. — Adhesions to neighboring
organs, to abdominal walls, etc. ; red, violet,
wine color (peritonitis from hernia, omentitis);
black, tumefied, thickened, infiltrated with
plastic matters, blood, pus, etc. Gangrene.
Surface villous or granulated (simple acute
peritonitis). Herniae.

Simple Acute 'BevitomtiB.— Peritoneum
may be dry, sticky, humid; injected, of a
bright red color, especially along the intes-
tinal folds; softening; plastic exudations
causing adhesions, etc.

Liquids effused (especially on the posterior

walls), white, milky, yellow, green, muddy,

flocculent, sero-purulent or purulent, mixed

with bile, fsBcal matters or blood.

Try to trace the cause of the inflammation, gener-
ally it is from disease of some organ covered by the
membrane.

Puerperal. — Inflammation chiefly in the
lesser pelvic cavity or around the uterus and
its annexes. The peritoneal and sub-perito-
neal cellular tissue is red and infiltrated with
pus. Liquids effused are muddy, flocculent,
sanious, and fetid, nearly always purulent.
The peculiar odor is very distinctive.

Search for the cause in the uterus, uterine sinuses,
etc.; may be pieces of decomposing membrane or
placenta.

Consecutive Peritonitis— following in-
jury, etc; — redness less vivid. May be local,
as over syphilitic affections of the liver, uter-
us, etc., or over inflammations of the stomach,
heiniae, etc.

Chronic Peritonitis— more often idio-
pathic than the acute. There are formations

63 POST MOKTEMS.

of false membranes (mostly on the surface of
the liver); the peritoneum is thickened, often
matted together, greyish, blackish, soft, fri-
able. Liquids effused are sero-albuminous,
white, opaque, semi-purulent.

Tubercular Peritonitis.— Not so fre-
quent as was formerly supposed; it is gener-
ally secondary, but sometimes primary. In
the form of disseminated miliary tubercles
which are found mostly under the diaphragm.
Three forms — 1, with ascites; 8, with semi-
organized lymphatic effusion; 3, with consid-
erable adhesions to the intestines, and ulcer-
ations.

INTESTINES.

Notice all abnormal relations and condi-
tions carefully irt situ.

In cases of injury, or death from hernia,
open the abdomen first at these parts. Begin
the extraction with the duodenum ; sometimes
it is advisE ble to leave the rectum. Tie up
each end of the intestines, and let them fall,
as they are removed, into a pail of water.
When drawing them out to examine and open
them, pass one end under the handle of the
pail; this disentangles the intestines and lim-
its the section.

Some recommend filling the bowel with water
before opening — this is useful where perforation is
suspected, as in dysentery, enteric fever, etc. — but it
is not always well to do this, as it uisarranges the
contents, and must certainly not be done in cases of
suspected poisoning, nor where there may be ento-
zoSns, pus, blood, etc.

The exterior must be first carefully ex-
amined, and specially diseased parts removed.

In opening use an enterotome, and do not
out along the free edge, as Peyer's patches are
situated there, but cut along the insertion of
the mesentery. Take care also not to rub tbe
internal surface of the intestines.

The normal color of the intestinal mu-

DIGESTIVE APPARATUS. 63

C0U8 membrane is deep red in the jejunum,
pale rose in the ileum, and dull white in the
Iwrge intestines.

Examine attentively for all causes of intesti-
nal obstruction, etc. Thus, obstruction may be
spasmodic, or from narrowing of the walls, etc.

Where there is strangulation it is well some-
times to inject the mesenteric artery, and
then notice if the fluid penetrates freely into
the branches above and below the strangu-
lated part.

It is important to state the cause of the
obstruction — 1, foreign bodies; 2, alteration
of the coats; 3, pressure from without (ovary,
uterus, glands, etc.); 4, there may be internal
obstruction, or diaphragmatic, mesenteric
herniae, etc.

Mucous Membrane. — Appearance— May
be thickened, rugous, maramillated, or puffy,
with hypertrophy of the muscular coat
(Tiernia); granular (cholera) thinning, soften-
ing; ulceration (in acute tuberculization,
especially the mucous glands); gangrenous
(malignant pustule, etc.). destroyed, dried up
{peritonitis from hernia), friable, flabby (gan-
grene from hernia, etc.), roughened, ecchy-
mosed (malignant pustule, yellow fever);
punctated, injected with blood, pus, etc.
Cicatrices of typhoid fever; beset with small-
pox pustules (doubtful).

Color. — May be red (various forms of enter-
itis, cholera, etc.), livid, slate color, grey,
yellow (poisoning by ammonia, etc.), black
(melanosis, yellow fever, pellagra), blackish
brown (strangulated hernia), dead-leaf color
(gangrene from hernia). Portions like wash-
leather (amyloid degeneration), which turn
brown after washing and the application of
iodine; they are seen mostly in Peyer's
patches.

64 POST-MORTEMS.

Changes in the Cavity. — Follicles <n-
Glands (duodenal or Brunner's, solitary or
closed, agminate or Peyer's). — Swollen (scar-
latina, typhoid fever, cholera, erysipelas,
poisoning by ammonia, etc.); orifices dilated;
ulcerated (typhoid fever, sometimes in
cholera); tuberculous; obliterated; seat of a
confluent eruption (intractable diarrhoea).
Valvulm Conniventes. — Augmented in volume;
atrophied ; covered with ecchymosed patches.

Foreign Bodies. — 1. Developed in the
Canal. — Hard stercoraceous matter {entero-
liths); ribbon-like concretions of glairy mucus.

2. Substances Accidentally Swallowed. — Vari-
ous metallic plates, toy balls, marbles, knives,
scissors, spoons (especially in jugglers, etc).

3. Liquids. — Bloody, puriform, deep brown
(yellow fever, poisoning by phosphorus, etc.),
bluish green (altered thickened mucus), yel-
lowish serosity (strangulated hernia), glairy
mucus (dysentery), white creamy matter
(cholera), reddish mucus, blood more or less
coagulated and mixed with excrementitious
matters; meconium.

It is important to take not« of the appearances of
the faecal matter, and this should be mixed with
water in order to examine its composition .

Lesions of the Walls. — Narrowing (cir-
cular or moniliform), strictures by syphilitic
ulcerations, intestinal atresia; partial imper-
meability; intestine terminated in a cul de sac
or in a cord; dilatation; bends distended with
gas or liquids ; emphysema; pseudo-membran-
ous pellicles, false membranes; haemorrhage
and infiltrated blood (enterrhagia; in soften-
ing and apoplexy of the brain, with embolism
of the mesenteric arteries, etc.); ulcerations
of various origins; perforations of a simple
or multiple^haracter, of a typhoid, dysen-
teric, tubercular, and cancerous nature, and
in gangrene from hernia; opening of the in-

DIGESTIVE APPARATUS. 65

testine through the abdominal wall ; rupture
(from accumulation of faecal matters, etc.).
Pustular eruption; polypi and vegetations;
lymphomata; scirrhus, colloid and medullary
cancer, either affecting the structure or adher-
ent to the exterual face; fatty tumors; hy-
dated cysts adherent to the intestines; ento-
zoSns; diverticula of the intestines; cedema
of the intestines.

Invagination is best shown by a perpen-
dicular section. Notice the following in order
from the outside to the inside : 1, the serous
membrane of invaginating Intestine; 2, the
two mucous membranes in contact; 3, the
two serous surfaces; 4, the mucous membrane
of the invaginated intestine.

There may be double intussusception by another
portion o£ intestine being forced into the first invagi-
nation.

There is always peritonitis, arising from
congestion; this causes plastic effusion, tume-
faction, going on to softening and gangrene.

Volvulus is a twisting of the bowels,
most frequent in the sigmoid flexure.

Hernia. — Femoral, inguinal, umbilical,

obturator, pudendal, ischiatic (into the notch),

ventral, vaginal, rectal, diaphragmatic (rare),

retro-perineal.

This last is very rare, the intestine is forced down
behind the inferior mesenteric artery into the meso-
colon.

When a strangulated bowel sloughs, it does
so where it is strictured ; if injured in taxis,
it is at the most prominent part.

Incarceration. — By the vermiform ap-
pendix of the cascum, or by passing through
a hole in the omentum, etc.

Snteritis. — General (rare).

Catarrhal — mucous membrane pink, cov-
ered with semi-opaque mucus; in fevers,,
croup, etc. ; chronic catarrhal — surface dark-
ened.

66 POST-MOKTKMS.

Local iDflammations — duodenitis (after
burns), ileitis, colitis, typhlitis (inflammation
of caecum and Ihe appeodix), perityphlitis
(inflammalion of the cellular tissue surround-
ing the caecum).

These last may arise from foreign bodies in the
appendix; but, as Wilks and Moxon observe, hard
dark concretions may form in this situation from
chronic di.-iease, and resenibie date stones, etc.
Cohtis is often mistaken for dysentery.

Lesions in Typhoid or Enteric Fever.

— These are mostly situated at the end of the
ileum, near the ileo-csecal valve, at the free or
convex edge.

Glands or Follicles. — (Agminated or
Beyer's Patches). I. Stage — Softened or Reti-
culated Patches. — Surface slightly raised;
glazed, grained, mammillated; mucous mem-
brane softened, of a brain-like consistence,
rose red with grey points; submucous cellular
tissue thickened and depressed. Surrounding
mucous membraae exceedingly vascular.

II. Stage — Honeycomb Patches. — Patches
raised more considerably, harder, with elastic
resistaace; submucous cellular tissue (in the
whole extent of the patches) yellowish white,
firm, dry, and brittle or friable, glistening.
Solitary glands in the neighborhood of the
caecum are white or red, swollen, thickened
(rarely) or ulcerated.

III. Stage — Ulcerations. — Often succeeding,
on the ninth or thirteenth day, to the softened
patches, and still more often to the honey-
comb patches; they are due to necrosis and
separation of the diseased tissue, a. Form.
Oval, elliptical, or circular (a large patch pro-
duces an oval or elliptical, a small gland a
round ulcer, and partial destruction of the
tissues produces an irregular shape), b. Size.
— From a hempseed to a half-crown, e.
Color. — Red, brownish, slaty grey, or yellow
(this is peculiarly diagnostic), d. Edges. —

DIGESTIVE APPAIIATUS. 67

Hard, thick, raised, tliin, regular or dentated.
Perforations in consequence of the destruc-
tion of the mucous membrane and of the
cellular and muscular coats sometimes occur.
IV. Stage — Cicatrisation. — By the approxima-
tion and union of the undermined edges with
the floor of the ulcer. The cicatrix is slightly
depressed, and less vascular than the surround-
ing mucous membrane. There is no pucker-
ing or diminution in the calibre of the gut.

Sometimes the scar is the seat of seriondary ulcer-
atiou, which often leads to profuse heemorrhage.

Mesenteric Ganglions especially in the
neighborhood of the caecum, a. Color. —
Delicate rose, deep red, grey, brownish, or
violet, b. Consistence. — Soft, friable, infil-
trated with blood or pus.

Possible Seqaelse. — Alterations of the
blood, peritonitis, mesenteric adenitis, colitis,
splenitis, hepatitis, nephritis, laryngeal ulcer-
ations, meningo-cephalitis, anthracoid erup-
tion, internal haemorrhage, erysipelas of the
face, abscess of the iliac fossae, otitis, etc.

Tubercle. — Generally secondary, seated in
the submucous tissue, in the form of grey,
transparent granulations, changing to cheesy
matter. First affects Peyer's patches, then
the solitary glands, afterwards becomes more
general. The surrounding tissue is hyperae-
mic, red and swollen. Ulcers form after a
time, the floors and edges of which are thick-
ened and hard; then small nodules form on
the floors of the ulcers.

Tubercular differ from Typhoid ITlcerainthat
they extend beyond the confines of the follicles
and patches, gradnally implicating the whole
circumference of the gut; they rarely, if ever,
heal. If they are oval the long diameter is
generally transverse to the direction of the
gut; while typhoid ulcers keep to the shape
of Peyer's patches. The wall of the ulcer in

68 POST-MORTEMS.

typhoid is abrupt and overhangs the ulcer,
shown by squirting water on it; in tubercle it
rises gradually, and the floor is thicker than
the surrounding tissue. Surrounding parts
are implicated in tubercle. Tubercular cica-
trisation leads to contraction of the intestines,
typhoid probably never.

Dysentery. — Lesions are mostly in the
large intestines, and chiefly in the descending
colon and rectum. In the mildest forms the
chief appearances are a greyish white layer of
fibrinous matter on the summits of tlie folds
of the raucous membrane, which is also swol-
len, hypersemic, and softened. Solitary glands
are enlarged, and look like small ulcers.

In severer forms the appearances are more
aggravated; the grey matter extends; submu-
cous tissue becomes infiltrated, producing
protuberaaces (colitis polyposa); the solitary
glands slough and cause ulcers; the tube is
dilated with gas, blood, etc. Ulcers may
cause perforation and fatal peritonitis.

In a tJurd degree the mucous membrane is
partly converted into a slough of a dark red
or blackish brown or greenish grey color; the
contents of the tube are a dirty brown or red-
dish, fetid, flocculent, grumous matter.

Fourth Stage. — Gangrene; a large portion
of the mucous membrane is converted into a
black, dry, roughened mass.

Cicatrices. — The ulcer may heal by plastic
exudation, which often forms fibrous bands,
that encroach on 'the tube.

Cholera. — Rigor mortis strong; skin livid,
face sunken, lungs collapsed and dry though
dark. The large veins are gorged, and the
blood generally is like tar. The intestines are
shrivelled, flabby, and lie in a heap together;
they are of a rose pink color. The internal
surface is coated with thick mucus and with

DIGESTIVE APPARATUS. 69

a white creamy matter, which diluted causes

the rice-water evacuatioas. The solitary

glands are enlarged.

Cholera very much resembles poisoning by arsenic
in Its symptoms and post-mortem appearances.

Csecum. — It is always important to ex-
amine this, as foreign bodies often lodge here,
and inviigination of the colon sometimes takes
place. InQammation of the csecum {typhlitis
and perityphlitis) generally arises from accu-
mulation. Mucous membrane at first con-
gested, then ulcerated;, sometimes fistulous
openings are produced.

The Vermiform Appendix may be
inflamed, perforated (frequent cause of peri-
tonitis); may contain foreign matter, tuber-
cular deposit, etc. It is sometimes the seat
of catarrhal inflammation and ulceration.

Sigmoid Flexure.— Notice the trans-
formation, sometimes, to the right side in the
foetus and new born; this is of importance,
e3pecially in performing colotomy.

Bectum. — If necessary, fix it on a cork
plate in order to examine it.

Mucous Membrane may be thinned, thick-
ened, hypertrophied ; congested, anismic, or
mottled (catarrhal inflammation); infiltrated
with pus, blood, or cancerous matter; ulcer-
ated; covered with patches of false membrane
(croupous inflammation and in dysentery);
adenomata, as polypoid tumors, in children
chiefly.

Various Iiesious. — Hernia, vaginal recto-
cele; various fistulas and fissures; prolapse;
atrophy of sphincter; chancres and syphilitic
ulcerations spreading from the vagina; mu-
cous p.atchss; anal erythema; haemorrhoids
(these are varicose veins surrounded by loose
fibrous connective tissue); condylomata; vege-
tations; hypertrophy of mucous glands (mu-

70 POST MOBTEMS.

cous polypi); elephantiasis; cancer, epithe-
lioma; foreign bodies in the rectum; injuries;
dilatation.

Congenital defect!", as imperforate anus,
rectum replaced by a fibrous cord, existence
of a caudal appendix, &c. May be obstructed
by tumors, &c., pressing on it.

VII.
THE PORTAL SYSTEM.

lilVEB.

Abnormal adhesions by plastic exudations
to stomach, diaphragm, colon, &c. (signs of
perihepatitis or of hepatic peritonitiSj acute
or chronic).

Depressed below the limit of the false
ribs (in hydrothorax, empysemia, cirrhosis,
&c.), or elevated above them (ascites, ovarian
dropsy), with abnormal relations to other
organs, &c.

Notice the state of the round ligament; it

may be pervious and afford communication

with the systemic circulation.

May be changed in volume, deformed from stays,
&c. Congenital malformations are rare, the unusual
shapes often seen are generally the result of disease.

Take the dimensions as well as weight of

the liver. Average weight 50 to 60 oz.,

average measure 10 to 13 inches transversely,

6 to 7 inches antero-posteriorly, and 3 inches

at the thicliest part.

The liver may easily be ' washed out ' by injecting
a stream of water through the portal vein (by meang
of a small pipette and india-rubber tube attached to
the water tap): this tests its permeability, and also
shows certain lesions better, as basmorrhage into the
parenchyma, which remains unaffected.

In making an internal examination of the

liver, notice if the parenchyma is friable or

greasy; cut In thin slices and wash, examine

the structure afterwards, also the washings;

THE PORTAL SYSTEM. 71

press the substance and notice the fluid that
escapes.

Itosions. — Color. — Uniform darls red or
briclc red, punctated (aapliyxia by coal gas);
yellow with white streaks {tertiary syphilis),
opaque yellow {fatty infiltration), yellow
ochre {advanced jaundice), yellow green or
brown {cirrhosis), livid, earthy grey, slaty,
bronze; like the flesh of an eel; nutmeggy
{congestion, disease of the heart, yellow fever,
&c.), coffee color, mustard color, orange,
olive (these last in yellow fever).

Consisteuce. — Fibrous Structure and Peri-
toneal Layers. — Softened, adherent to neigh-
boring parts {perihepatitis), cartilaginous, with
protuberances wrinkled, &c.

Sometimes in syphilis (tertiary) the fibrous capsule
is roughened with miliary or warty products, which
are often very numerous ; at other times it is thick-
ened, hard, callous, adherent to the diaphragm by
numerous ligamentous cords (periliepatic form of
syphilis of liver).

Special Tissue. — May be homogeneous, rug-
ged or friable, dense, dry, bloodless. Indurated,
fibrous, (Edematous, flabby, softened, like
spleen, &c.

Iissioiis. — Congestion (in asphyxia — not to
be confused with post-mortem congestion);
inflammation; hypertrophy (first stage of cir-
rhosis, plague, jaundice, &c;but these are not
true hypertrophies); atrophy of one lobe or of
entire liver (second stage of cirrhosis, ad-
vanced jaundice, «&c.). Syphilitic induration
(lobular cirrhosis); lardaceous degeneration;
granular induration of drunkards (acinose
cirrhosis); abscess (pus collected in spots or
infiltrated), tubercle; cancer — epithelioma
(secondary), scirrhus, encephaloid, fungoid.
Hcemorrhage (in patches ; this is probably due
to a purpuric state). Adenomata; syphilitic
gummata; erectile tamors; hydatid and other
cysts; fluke worms; ulcerations; perforations

73 POST-MORTEMS.

(communicating with the peritoneum, pleura,

&c.); tearing and rupture (spontaneous (?)

and traumatic); emphysema; displacement,

&c.

Small-pox pustules have been said to be met with
on the liver.

Congestion. — General or partial, produces
nutmeg appearances; this is most characteris-
tic in chronic congestion. Long-continued
congestion produces structural changes from
pressure of distended capillaries; the liver
cells may undergo fuscous degeneration. In
chronic congestion there is fatty degeneration
or infiltration.

Moderate congestions during life do not show
themselves after death.

Inflammation. — Acute Hepatitis — little
known in this country — leads to abscess,
which is either solitary (tropical) or multiple
(pysemic); also arises from injury.

In Perihepatitis there is thickening of the
capsule, adhesions to other parts, &c.

Suppuration of the portal veins is some-
times met with.

Acute hepatitis and softening may result
from septicaemia from any cause; notably
from abortion, criminal or otherwise.

Chronic Inflammation leads to cirrhosis,
which is an increase in the connective tissue.
In Cirrhosis the liver is smaller, paler, puck-
ered, producing the hobnail condition; the
cut surface has a mottled, granular appear-
ance.

Color, opaque whitish yellow, passing to a

brown.

In the early stage of cirrhosis there may be even
enlargement, and the liver may appear normal mi-
oroseopically, but somewhat Arm and dense ; on mi-
croscopical section the interlobular tissue is seen to
be considerably increased.

The cause of cirrhosis is chiefly spirit-
drinking. It is often complicated with other
liver diseases. A thick coaling of membran-

THE POKTAIi SYSTEM. 73

ous substance on the surface is a strong evi-
dence of spirit-drinking.

Syphilis.— Some say fliat tlie liver is the
most frequent seat of syphilis, as the lungs
are of tubercle.

The surface is less glistening, and has the
color of cafe au lait; presents many scarlike
depressions or tumorj, which are whitish or
yellowish and puckered. On section there is
generally crepitation, and the cut surface is
clean, cheesy, of a yellow tint {fatly degenera-
tion), the parts affected are either surrounded
by a fibrous zone, or striated in white, fibrous
tracts. Often there are fibrous nodes {gum-
mata), like those in the lungs, of a pinkish,
slaty, gray, yellowish, or whitish color.
They may increase considerably in size; gen-
erally they range from the size of a hemp-seed
or a pea to a large plum.

Gieatrices, — These may form with or with-
out gummata, and are very charaeteristie of
syphilis; underneath them may very often be
seen small masses of fibrous or cheesy matter;
the depressions formed by these cicatrices may
be very deep, so as to make the liver appear
lobated.

Sometimes fibrous patches are seen on the
lefi; lobe, probably from attrition of a con-
stantly distended stomach.

In infants minute granulations, something like
miliarj tubercle, are often seen.

Tubarele of the liver is very rare, met
with as collections of small round cells (mi-
croscopical).

Yellow Atrophy.— This is rare; the liver
is very small, soft, lighter in weight, of a dull
yellow or yellow-red color, like wet rhubarb.

Microscopically the Cells appear broken up
and their place taken by granular debris.

OhemicaUy the liver contains excess of
leucin and tyrosin.

74 POST-MOBTEMS.

Brown Atrophy.— Something like yel-
low, only the parenchyma is firmer and of a
deep brown color.

Patty Infiltration.— Very frequent; liver
paler, softer generally, and larger. On cut-
ting it the knife is coated with oil, and a
greasy stain is given to paper. Hold a piece
over a lamp till the water has evaporated; the
fat will drop out and burn, or can be col-
lected on paper; by maceration in ether the
fat is dissolved, and left on evaporation of the
ether. But the best test is microscopic exam-
ination; the cells are seen filled with minute
globules, which after a time coalesce.

Cause, want of exercise, too much fatty
food, too little oxygenation of hydrocarbons,
as in phthisis, in habitual spirit-drinkers; after
long suppuration; in cases of poisoning by
phosphorus or ammonia; after yellow fever
(but it is doubtful whether this is really fat;
probably it is yellow atrophy), &c.

Iiardaceous or Waxy Degeneration.
— Liver larger, heavier, and paler than nor-
mal. Wash the sections and apply solution
of iodine (iodine 13 grains, iodide of potassium
24 grains, water 3 oz.); this stains the amyloid
parts brown, which changes to black or
violet by the cautious addition of sulphuric
acid.

Microscopically, the middle part of the lob-
ules and the inner coat of the arteries are af-
fected with structureless deposit. Nothing
satisfactory is known of this change either
chemically or indeed clinically.

Pigmentary Degeneration. — Liver

dark, greyish brown, sometimes nearly black,

larger in early stage, atrophied later on.

Chiefly seen iu cases of intermittent fever, rarely
in tliis country.

MicroaoopicaUy there is a deposit of round

THE PORTAI, SYbTEM.

or angular, blackish granules iu the centre of
the lobules.

Cancer. — Chiefly eacephaloid, of a harder
structure than usual, forming round tumors
about the size of a nut; the liver is enlarged.

Hydatids. — Cysts of various sizes, from a
pin's head to a child's head.

GALL BLADDER,

This may be atrophied, obliterated, or dis-
tended liy liquids. Ulcerated (typhoid fever,
retention of bile, &c.), perforated. May con-
tain cholesterine or other calculi; ascarides,
acephalocysts, distoma, bepaticura, &c. The
walls may be thinned, hypertrophied, or fibro-
cartilaginous.

Mucous and Submucous Tissue.--May
be inflamed (hepatic, or cholecystitis), swol-
len, opaque, friable, thinned; ulcerated (with
black borders, &c.); gangrenous; infiltrated
with altered liquids, pus, &c.

Bile. — May be yellow, deep green, brown,
dirty white, grumous, granular; of a thick-
ened, pitchy consistence, or fluid.

Inflammation. — Catarrhal. — Walls in-
jected and swollen, cavity full of viscid mucus
or mucus mixed with bile.

Croupy, same appearance but with solid
exudations taking the form of the vlscus.

Gall Stones. — Translucent crystalline
bodies (cholesterine); compound calculi, con-
sisting of a nucleus surrounded by cholester-
ine, either in crystals or laminse, sometimes
alternating with layers of a mixture of choles-
terine with the coloring matters of the blood
and bile.

They are generally deeply colored, and mostly
consist of cholesterine iu combination with lime or
lime salts.

76 POST-MOKTEMS.

PANCREAS.

This is not examined often, probably be-
cause its normal structure and uses are so lit-
tle understood.

It has been found indurated (tertiary sy-
philis, disease of the heart, &c.), softened
(typhoid fever, &c.), hypertrophied either
from increase of cellular tissue or endothe-
lium, atrophied (old age, chronic iaflamma-
tion, fatty degeneration), inflamed (rare), infil-
trated with pus; containing gummata.

Traumatic lesions are rare. In certain forms of
dyspepsia there is ulceration.

Tubercle and cancer sometimes affect it.

Calculi of phosphate of lime, phosphate of
magnesia, and oxalate of lime are occasionally
met with.

SPLEEN.

This ought especially to be examined in
fevers, and particularly those of an inter-
mittent type, also in leucocythasmia, &c.

Position, notice this — it miiy be transposed,
displaced by the hydrothorax, ascites, ovarian
cysts, diaphragmatic herniae ; may be adher-
ent to the diaphragm, stomach, &c. ; sur-
rounded by false membranes, clots, &c.

Supplementary spleens are occasionally met yritb,
they are due to division, not muUiplication.

The Capsule may be thickened, either
generally or in patches, sometimes granulated;
formation of cartilaginous (fibroid) plates.

Color. — Instead of the normal dark-bluish
red it may be violet, with traces of hsemor-
rhagic softening (chronic splenitis), marbled,
slaty, black, whitish (amyloid) ; at other times
it may be yellowish, from pus infiltrating ita
meshes.

Weight may be increased from 7 02. (nor-
mal) to 18, 20, or even 30 lbs. In children
and adults its proportional weight to entire

THE PORTAL STSTEM. 77

body -weight is from 1 to 320 to 1 to 340 ; in

old age 1 to 700.

The Size is increased during and after

digestion. ITormal size, 5 in. long, 3 or 4 in.

broad, and from 1 to 1^^ in. thick ; in disease

it may measure twice or four times this.

The size is chiefly increased in intermittent fevers,
also in jaundice, enteric (typhoid), and typhus fevers,
leucocythGemia, rheumatism, plague, scorbutus, ter-
tiary syphilis, acute glanders, asphyxia, insanity (T),
tuberculosis— in fact, in all cases where there are
much suppuration and alterations of the blood.

Internal Examination may show haem-
orrhagic infarcts, infiltration with pus from
inflammation, or metastatic abscess; hydrated
cysts rare.

Iiardaoeous or amyloid disease is generally
coincident with the same disease of other
organs ; this at first affects the Malpighian
corpuscles, producing the 'sago spleen.'

Hsemorrhagic Infarctions are the most
important lesions and are in the form of
fibrinous grey nodules. These are often met
with in disease of the heart, and are probably
caused by embolism ; they are also sometimes
associated with softening of the brain, both
l)eing probably from the same cause, viz.,
Vascular obstruction.

Cysts are occasionally met with, also cry-
stals of cholesterine, stearine, &c., from retro-
grade changes in fatty infiltration.

Leukssmla or Iieuoocythsemia.—
spleen enlarged, surface often mottled;
blood contains an excess of white corpuscles.

The disease has been described as a cancer of the
blood.

Melansemia (Melanosis). — Deposition of
black or brown pigment in various tissues of
the body, as in the mucous and serous mem-
branes, bone, brain, liver, lungs, &c.

It Is believed to be due to an affection of the spleen.

Hodgkin's Disease (LympTiadenoma).
Enlargment of the glands of the body, and

78 POST MOETEMS.

especially the spleen, which contains a num-
ber of yellowish- white, opaque, firm, irregular-
shaped bodies formed of gland structure.

The liver, kidneys, lungs, stomach, muscles, bone&
and subcutaneous tissue may also become affeoted
by this glandular hyperplasia.

VIII.
UBINABT APPARATUS.

Before removing the kidneys notice their
relations to other parts, their mobility, dis-
placement, fresh relations, perinephritic and
superficial abscesses, the pus of which often
infiltrates the lumbar muscles, &c.

Removal. — It is sometimes useful to
remove the entire urinary apparatus en bloo ;
in doing so it is simply necessary to remember
that the ureters run obliquely downwards and
inwards nearly to the borders of the sacro-
iliac symphysis ; from thence they pass down-
wards, forwards, and inwards to the base of
the bladder, entering between the muscular
and mucous coats for nearly an inch, and
finally opening into the two posterior angles
of the trigone.

The right kidney is generally lower than the
Uft.

They are both covered anteriorly with peri-
toneum ; this has to be cut or torn before
they can be removed.

SUPBA-BENAL CAPSULBS OB GLANDS.

Ttese are situated immediately in front of
the upper end of each kidney ; the right is the
shape of a cocked hat, the left somewhat semi-
lunar ; their size varies from IJ- to 3 inches
long, rather less in width, and 3 to 3 lines
thick ; they weigh from one to two drachms.

The Structure coLsists externally of a
cortical layer of a deep yellow color ; inter-

URINARY APPARATUS. 79

nally of a medullary substance of a dark
brown or black color : there is frequently a
space in the centre from breaking down of
the tissue, probably from post-mortem decom-
position.

The Principal Changes are congestion,
inflammation and suppuration, haemorrhage
(apoplexy), fatty degeneration, adenoma, pig-
mentation, lardaceous or fibroid degeneration,
containing caseous-like matter often indepen-
dent of tubercle, cancer, tubercle, serous
cysts, hydatids.

In syphilitic subjects the gland is often hypertro-
phied, and sometimes contains purulent or yellow
matter, £c.

Death may sometimes arise from pressure
of the enlarged supra-renal glands on the solar
plexus.

Addison's Disease. — Oap&ule enlarged,
fibrous envelope thickened, adherent to aur- ■
rounding parts ; substance hard, nodulated,
with no distinction between the medullary
and cortical parts. The new material may be
either like cartilage, of a grayish color, or
like ' crude tubercle ' — that is, of a white or
yellowish opaque appearance — sometimes it
is mottled, or the tubercular substance occu-
pies the centre and the pinkish grey matter
the cortex.

There is much difference of opinion on this disease.
Many authors think that bronzmg of the skin is due
to some afCection of the sympathetic nerve : the
solar plemts and the semilunar ganglia should there-
fore be examined, •>

KIDNEYS.

The normal size of the kidney is about
4X3X1 inches, the left somewhat the
longer and thinner. Weight varies from 4^
to 6 oz. in the male and 4 to S^in the female ;
the left is the heavier. Proportional^weight
to entire body is about 1 to 340.

The kidneys are rarely absent ; sometimes
there is only one by fusion of the two, form-

80 POST MOBTEMS.

ing the 'horse-shoe kidney'; they are occa-
sionally misplaced.

The Ureter of one or both kidneys may
be double. A specimen in my possession
presents the following peculiarities, viz. ; the
kidney (right) is divided by a central lobe into
three distinct lobes: upper, middle and lower;
the central lobe again divides the pelvis into
two pelves, with a separate ureter for each,
both ureters pursuing a similar course to the
base of the bladder, penetrating the outer coat
of the bladder at two points one-half inch
apart, and then uniting about midway through
the bladder wall into one trunk and opening
into the bladder by a single orifice. The
fellow ureter and kidney to this peculiar one
was normal. — [Ed.

The kidneys should especially be examined,

under the following circumstances ; —

In suspected traumatic lesions (rupture, contusion,
wounds) J pathologic rupture ; retention of urine ; .
anuria and other disturbances ; uraemia, stricture of
urethra ; vesical catarrh ;^ vesical calculi ; gravel or
gout ; diseases of the heart ; glycosuria (hypertrophy
and congestion of the kidneys) ; rheumatism (rheu-
matismal nephritis) ; scarlatina (scarlatinal nephri-
tis) ; hypochondria ; typhoid fever ; putrid infec-
tion ; alcoholism ; syphilitic cachexia ; oedema of
nevr-horn children ; poisoning by phosphorus, sul-

1>huric acid (tubules contain a grey detritus), and
ead ; in fat people ; every affection producing al-
buminuria (long-continued use of diuretics may pro-
duce this, as cantharides, arsenic, alcohol, &c.)

BXTBBNAL EXAMINATION.

Notice, before removal, the state of the
Peri-renal Cellular Tissue ; this may be
thickened and indurated (perinephritis), or
even ossiform (chronic nephritis), softened,
the seat of abscesses, &c.

Then examine the Renal Capsule, and
notice its appearance and the facility with
which it separates from the kidney. Some-
times there are reticulated markings on the
gurface, haemorrhagic effusions (as in poison-
ing by phosphorus, &c.), fibrinous plates and

URINAKY APPABATUS. 81

'milk ' patches (rheumatismal nephritis), puru-
lent pustules, &c.

Cysts under the capsule are frequently met
■with, which may contain serum, or a gelatin-
ous fluid, urine or pus. Disseminated loMte
patches, with hypertrophy of the cortical layer
of the kidney (simple chronic nephritis).

The structure of the capsule may be changed, and
it is frequently adherent to the kidney (chronic
Bright's disease).

The Eidneymay be displaced, malformed ;
atrophied or hypertrophied. Surface. — Ru-
gous, granular, sometimes with cicatrices in
chronic interstitial nephritis, and certain
syphilitic conditions ; in the latter there may
also be small disseminated gummata (very,
rare), and the envelope is in these cases thick,
opaque, and difficult to remove.

INTBKNAL EXAMINATION.

Open the kidney with a long thin knife, by
cutting from the convex border towards the
hilum ; it is sometimes useful to make several
incisions in this way.

The cortical substance in the normal state is
generally a little deeper colored than the
medullary, and in disease this distinction may
be more or less marked. Sometimes the sub-
stance is deep colored (venous congestion, as
in asphyxia, diabetes, &c.;, inflamed (nephri-
tis), marked with streaks (amyloid degenera-
tion, rheumatism).

There may also be pus, either in the form
of an abscess or diffused. It is sometimes
dilated with urine, from obstruction of the
ureter, and in retention of urine, when there
is generally more or less atrophy of the corti-
cal structure. It may also be indurated or
softened ; the seat of amyloid degeneration
(test with iodine), especially in tertiary syph-
ilis and where there has been long-standing
suppuration in some other part of the body.

POST MOBTEHS.

Oaneer is generally encephaloid, sometimes
hsematoid.

Tubercle aSects the kidney either in the
form of miliary granulations or as a hollow
cavity filled with tubercular matter (renal
phthisis). Heemorrhagic infarcts are met
with in cases of heart disease in the form of.
wedge-shaped plugs, as in the spleen.

Caleuli are sometimes found embedded in
the substance, and are readily detected.

Deposits of fat may form independently of
Bright's disease. Numerous cellules are often
met with containing clear or yellow-colored
serous fluid, mucus, pus or debris of false

membranes, or urine.

•

Oysts may attain a very large size ; some-
times they contain hydatids, cysticerci,
Strongylus gigas a (large round red worm),
Mlaria hominis sanguinis (when present in the
blood).

The cortical substance is often studded

with white granulations, surrounded with a

brownish red border ; they are about the size

of a pin's head ; in acute senile neph/ntis these

contain pus ; in traumatic nephritis they c6n-

tain plastic lymph or decolorised fibrin. In

some cases pus forms between the pyramids.

Disseminated crystals of urate of soda are

often met with.

Microscopical examinations of the kidney should
always be made, it possible.

Changes in Bright's Disease (Rayer).

I. Stage. — JBypermmia or Congestion. — Swell-
ing of the cortical substance, and thus increase
in volume and weight ; punctated appearance
of cut surface (this will be seen better after
soaking in water).

This coadition, without the punctated appearance,
may occur in fevers, as Febrile congestion ; it may
cause uraemia, but not dropsy.

II. Stage. — Greater iacrease of volume, but
there is a combination of ansemia and hyper-

tTRINABY i.PPAKA.T0S. 83

semia ; the aspect is marbled and injected in
an arborescent manner ; pale tint, with yellow
and red patches. Papillae separated by dis-
colored fissures.

III. Stage. — Yellow JOegeneration ; {latform
of Bright/ Anosmia). — The hypertrophy con-
tinues. Pale, uniform tint, with injection in
some parts ; granulations and irregularities
from deposit of plastic lymph.

IV. Stage. — The kidneys, still enlarged, are
pale ; their surface studded with milky, gran-
ular, star-shaped patches, compared to white,
creamy clots, and due to a deposit of a flbro-
albuminous matter.

V. Sta^e. — Granular aspect more marked ;
irregularity of the surface of the kidneys.

VI. Stage (Bright' s third forni). — The kid-
neys — sometimes smaller than normal — are
hard, cartilaginous, unequal, mammillated
with small yellow or purple projections.

English pathologists do not recognize -the above
stages ; but regard Bright's disease as of two dis-
tinct forms^l, acute (tubal or desquamative nephri-
tis) ; 2, chronic (granular degeneration).

Acute Bright's Disease {Tvhal Nephri-
tis). — The kidney is in the state as described
by M. Rayer in the first four stages.

The capsule readUy separates and the surface of
the kidney is smooth. At an early period of the (Jis-
ease the organ is large, dark, and soft (hyperaemia) ;
the blood drips from it on cutting it. Then the cor-
tex gets paler and patchy, from swelling of the tubal
epithelium ; the paleness increases until the patches
get white or yellowish white, from deposition of
molecular fat in the epithelium ; these f atfy elements
give a creamy appearance to the surface. The fatty
degeneration increases still more until the whole
organ is one large white mass of fat, vrithout a parti-
cle of proper kidney structure to be seen either
macroscopically or microscopically.

Chronic Bright's Disease {Interstitial
Nephritis). — Characterised by the Granulax
Eidney. In the early stage the kidney is
hypersemic and somewhat larger than nor-
mally ; then atrophy takes place in an irregu>
lar manner, cysts are formed, and the surface

84 POST MOBTEMS.

becomes granular and adherent to the capsule,
which is thickened. The color is often not
much changed, but the structure is altered ;
the cortex is thinner, paler, and sometimes
marbled from fatty deposition.

Suppurative Nephritis. — Small absces-
ses form in the substance of the kidney, which
sometimes coalesce. They arise from Pj/elitis
(inflammation of the pelvis of the kidney),
spreading from the bladder, or from a renal
calculus, stricture of tbe urethra, enlargement
of the prostate (retention of urine causes
abscesses), or, most frequently, from pyaemia.

Laxdaceous Kidney.— Secondary upon

amyloid degeneration of other organs. The

kidney is paler and larger, cortex smooth ;

but atrophy often takes place subsequently,

and it gets more like the granular state.

If iodine be applied it causes the Malpigbian bodies
to appear as brown specks, and some of the minute
arteries as streaks,

ITrinary Passages. — The TubuU Vriniferi
terminate in an expanded part of the kidney,
called the pelvis ; this is a continuation of
the ureter.

The calyces, pelves, and ureters have three
coats — fibrous, muscular, and mucous. The
surface internaJly is of a bluish white color
normally ; in inflammation (pyelitis) this is
swollen, injected, and villous. The inflam-
mation may cause deposits on it of a ' putty-
like ' -material, which flU the calyces, or a
renal calculus may form. There may also
be pus or muco-purulent matter mixed with
urine. The pelves frequently become dilated
from various causes, as stricture.

Cancer, tubercle, entozoons (strongylus gigas in
the ureters, distoma haematobium in the renal ves-
sels) ; these vaa,y be the cause of hcematuria and
albuminuria.

BLADDER.

Carefully notice its relations, adhesions,
external appearances, <fec. Inject with water

TJRINABY APPARATUS. 85

in order to observe rupture or flstulae, &c. ;
be careful to do this before removal, as the
force required to do so may lacerate it.
Extract entire, if necessary ; this is not diffi-
cult, especially if it is inflated first. The
bladder may be dilated in chronic stricture,
&c., and also from paralysis, as in fever,
injuries to brain and spinal cord; the import-
ance of noticing this dilatation in these cases is
evident.

3%« Vesical Mucous Membrane may be
roughened, discolored (chronic catarrh or
cystitis), dark-reddish, bright red, green-
ish grey, or even bluish black; speckled with
small ecchymoses, marbled like granite
(catarrh), slate-colored; oedematous, tumefied
(chronic cystitis), covered with mucus or
muco-pus ; mammillated ; the muscular coat
may be atrophied (in long-standing paralysis
with frequent micturition), hypertrophied
(in chronic cystitis and from stricture and
calculus) ; friable, rugous, indurated ; soft-
ened (chronic cystitis) ; gangrenous ; ulcer-
ated, or containing abscesses (acute cystitis).
There may also be exudation, in round spots
or striae, of a croupy matter ; tubercle, this is
nearly always secondary to disease of the
kidney, and is never met with in the female ;
cancer is also always secondary, met with as
scirrhus (rare), encephaloid, and as nodules,
or villous or cauliflower excrescences (most
common) ; hydatids, but they may be from
the kidney.

Vesico-vaginal, vesico-rectal and other fis-

tulse (the second may have been from puncture

for retention) ; communications with the

utenis, pelvis, perineum, &c.

The bladder may be injured b7 the catheter oppo-
site to the urethral orifice. Prolapse of the bladder
may occur durins parturition.

86 POST MORTEMS.

Calculi. 1. UrUs Acid. Round or oval,
smooth in layers, pink or yellow.

3. Oxalate of Lime. Mulberry-shaped, of a
dark color.

3. Phosphatie. Smooth, white, round or
oval, crumbling easily.

4. -CyHine (rare). Large, round or oval,
pale yellow, crystallised, smooth.

5. Compound Calculi, alternate deposition
of various salts.

IX.

THE GENERATIVE ORGANS.

MALE ORGANS.

The Testicle and its Envelopes. —

Notice position of the testicle ; it may not have
descended into the scrotum.

Undescended testicles geaeially coDtain no sperma-
ttozoa (Curling) ; therefore examine them ralnutely, as
this might have an important medi£o-legal bearing.

Envelopes. — Exlra-vaginal. — Wounds and
contusions ; ecchymoses ; extravasation of urine
in the scrotum and fold of the groin ; phlegmo-
nous inflammation and abscess; erysipelatous
inflammation (intertrigo); oedema (hydrocele
by infiltration) ; parietal hematocele by infil-
tration or effusion; gangrene; gummatous tu-
mors of the scrotum and consecutive ulcerations ;
subcutaneous fibromata, sarcomati.; fatty tu-
mours, cystoid tumors containing urine; der-
moid cysts; foetal inclusions; elephantiasis, fis-
tnlae and fissures; hypertrophy (without altera-
tion of the subcutaneous tissue); epithelioma -
melanotic cancer.

Tunica Vaginalis. — Inflammation (acute and
chronic, shown by thickening, injection, efiusion,
etc.), suppuration ; cysts adherent to tunic, hyd-
atid cysts; hsematocele (traumatic or spontan-

THE GENERATIVE ORGANS. 87

ecus ; an encysted hydrocele may be converted
into one) ; hydrocele, congenital (commanicat-
ing with peritonenm) encysted hydrocele, the
fluid is sometimes mixed with semen. Osteo-
cartilaginous tumors ; cancer ; foreign bodies ;
gas, etc. The internal surface may be reticu-
lated or vascular (inflammation); infiltrated
with pus, blood, or serous fluid. There may
also be fibrinous exudations (inflammation), fil-
amentous adhesions producing a partitioning
into cells, pseudo-membranous sheaths encyst-
ing blood, loose bodies (as in joints), etc.

A hydrocele may be found — 1, investing
the epididymis ; 2, between the testicular por-
tion and tunica albuginea; or 3, between the
reflected portions; difiuse hydrocele (fluid in
that part between the internal abdominal ring
and the upper part of the tunica vaginalis).

Testicles. — Malformations, congenital atro-
phy (often associated with imbecility), one or
both absent, there is no absolute record of more
than two; misplaced, undescended; pathologic
atrophy, hypertrophy.

Legimn. — Wounds and contusions; testicular
hsematocele ; hernia testis. Inflammation (acute
or chronic orchitis) — ^testis enlarged, indurated,
(syphilitic), smooth, general enlargement,
(scrofulous), nodular (fungous protrusion); atro-
phied (old age) ; hyperlrophied ; abscess (acute
glanders).

Tubercular affections are mostly In the epididymis
which ilien contains miliary granules.

Twmori. — Fibroma (rare), sarcoma, enchon-

droma ; encephaloid cancer (colloid and mela.

notic, very rare) ; epithelioma ; gammata, like

those found in the liver — yellow, fleshy, and

surrounded by a fibrous zone ; cystic sarcoma ;

hydatids ; entozoa ; fatty infiltrations (galacto-

cele; spermatocele; dermoid cysts containing

hair, teeth, fat, etc.

POST MOBTEMS.

Spermatic Cord. — Wounds, contusions;
funicular heematocele (infiltration or effusion of
fluid around the cord, encysted or not) ; abscess
'and inflammation of the cellular tissue sur-
rounding the cord (funicular orchitis, acute or
chronic funiculitis) ; hydrocele, difiuse (oedema
of cord), communicating with the peritoneum,
or with the tunica vaginalis (hydrocele of sac),
encysted, etc. ; variocele; hydatid cysts; adipose
or gummatous (syphilitic) tumors; tubercular
or cancerous degeneration; old hernial sacs
forming a tumor on the cord; hydrocele of
the funicular hernial sac ; hernia of the omen-
tum, of the intestine, etc.

Vesiculse Seminales and i^acula-
tory Ducts. — Ought to be examined In all
cases of impotence.

In order to expose them saw through the
pubes ; the tubes should be opened, and some
of the fluid contents (mi-zed or not with a little
serum or glycerine) placed on a glass slide and
examined under the microscope.

They may contain calculi ; may be atrophied ;
tubercular, inflamed, etc.

Prostate Gland.— Can be reached by
cutting down on a sound previously passed into
the bladder.

It may be atrophied; undeveloped; hyper-
trophied (in advanced life) ; inflamed (acute
and chronic), suppurated, ulcerated; contain
tubercle, cancer or cysts (all these last three
are very rare) ; concretions very frequent) ;
fibroid degeneration.

Penis. — May be imperfectly developed, as
in cretins, etc. ; rudimentary penis ; phymosis,
paraphimosis; elongation of prepuce in those
who have suffered from calculi ; fissured (when
very 'small there is pseudo-hermaphroditism ;
then look for testicle).

THE GENERATIVE OKGAUS. 89

Fissure on the upper surface Is called epispadias; on
the lower, Appospamas.

Wounds and contusions; strangulated by a
ring or wire.

Inflammation gives rise to chordee from effu-
sion into and thickening of the corpora caver-
nosa or spongiosa ; serous infiltration ; abscess
and urinary fistulse ; peri-urethral abscesses ;
excoriations ; erysipelas ; cancer, chiefly epithe-
lioma ; elephantiasis ; scabs or ezanthematous
eruptions amongst those who work in chromates.

Syphilitic Chancres. — Hard or soft ; the pecu-
liar characters seen during life are absent after
death, and only hardness remains; phagedsenic
(in weak states), with or without buboes. Bal-
lanitis (inflammation of the mucous membrane
of the glans) ; Posthitis (inflammation of the
inner surface of the prepuce) ; acne, apthae and
herpes of the prepuce (vary in size from a pin's
head to a nut) ; warty vegetations (epithelioma)
on the inside of the prepuce.

Elephantiasis Scroti. — A simple hyper-
trophy of the cellular tissue of a chronic nature.

Urethra. — In some cases it is necessary to
examine this throughout ; this may be done by
sawing through the pubic symphysis, or by
cutting somewhat as for median lithotomy. It
may be slit up by scissors (bronchotome) or by
a knife on a director, along the superior wall,
and the sides pinned down on a board. Notice
the liquid contents, as blood, muco-pus (urethri-
tis), altered spermatic discharge (spermator-
rhoea), etc.

The urethra may open into the perineum,
scrotum or elsewhere ; if it is completely closed
it is called atreeia wethrcs; there may be con-
genital stricture.

Lexixms. — Dilatation is most frequent in the
membranous part, from obstruction or calculus.
Laceration, from mechanical injury or calculi.

90 POST MOKTEMS.

Inflammation (urethritis), sometimes catarrhal,
but generally gonorrhceal, acute or chronic;
mucous membrane swollen, injected and covered
with a muco-pus; sometimes there is plastic
exudation, croupons or fibrinous inflammation,
the tube is then blocked up by casta (rare).
Striclure is often the result of inflammation,
either long-continued granular or acute, urethri-
tis generally situated about 4 to 6J inches from
the meatus ; may be caused by thickening of
the walls or from a fold of membrane, or by
cicatrices from ulcers, etc., also from fungus ex-
crescences. Tubercle rare ; cancer is secondary
to growths near.

FEMALE GENERATIVE ORGATTS

1, Ovaries; 2, Fallopian tubes; 3, uterus; 4,

vagina; 5, vulvae; 6, mammas.

In important necroscopies the whole of the female
genital organs should be remoTed entire; this is not
difficult. It is needless to say that the organs should
first he examined in situ.

Remdial. — Eaise the uterus ; detach the liga-
ments carefully, preserving the Fallopian tubes>
and the broad ligaments as far as the ovaries ;
separate adhesions and divide the vagina just
below the neck of the uterus.

In cases where it is advisable to expose the whole of
the vagina as well, saw through the pubes on both
sides close to the obturator foramina, and remove the
symphisis pubis: in this way the whole of the contents
of the pelvis will be exposed.

Pelvis. — Notice irregularities and deformi-
ties — equable enlargement of the cavity {pdvis
ceqtujhililer justo majw), equable diminution (p.
esq. j. minor) rare ; various distortions.

The normal dimensions are —

Antero-posterlor (sacro-pubic), diameter 4 inches.

Transverse (bi-iliac) - - " 5 to 5U "
Oblique " 41^ to 6 "

The bones or ligaments may be softened or

eroded; these parts may be injured during

labor. Exostoses, either rachitic, scrofulous, or

THE GENERATIVE ORGANS. 91

syphilitic; false or cartilaginous exostoses; oste-
osarcomata may sometimes be met with. Lux-
ations of the hip joint occasionally encroach
on the cavity.

Ligaments.— Bound. — Lesions are : hy-
'pertrophy and lengthening; shortening and
adhesion (cause of version and flexion).

Broad. — May be altered in direction and
connection. Is sometimes the seat of peri-uter-
ine hcemaiocde, which is generally consequent on
ovarian haemorrhage or apoplexy, hsemorrhage
of the Fallopian tubes, or of the vessels of the
broad ligament, rupture of an extra-uterine
pregnancy, or retrograde migration or reflux of
menstrual blood, etc. Inflammation and sup-
puration may attack it.

' Cystic tumors of thd broad ligamODt may be mistaken
for ovarian cysts ; these are frequently due. to en^'arge-
ment of the 'organ of Eosenmuller* (parovarium) ftbe
remains of the Wolffian bodies, situated between the
Fallopian tube and the OYary in the folds of the broad
ligament.

Fibrous, encephaloid, tubercular, and other ,
tumors of the broad ligament, are sometimes
met with, cholesteatoma, small cystic tumors
containing scales of cholesterine, epithelium,
etc.

The veins are occasionally varicose or in-
flamed, as in purulent infection.

These organs shovid be carefully examined in
every necroscopy.

Notice, first of all, their situations and rela-
tions to the surrounding parts (they may
descend into the groin or labia). They are sel-
dom wanting, though occasionally rudimentary ;
there are never more than two.

The normal average size of each ovary is about
IJ inch in length, | in width, and J thick;
average weight from 60 to 120 grains.

They are covered in front by the broad liga-

92 POST MORTEMS.

ments, and are connected to the uterus by
special lipaments. They are of a whitish col-
or, and the surface is either smooth or uneven.
External Appearance. — They may be flattened,
shriveled, globular, covered with filiform cel-
lular excrescences {villoibs cancer), pseudo-mem-
branous flakes, or star-shaped excrescences, etc.

A smooth ovary ia evidence ofmeDStruation not having
commenced. At the catemenlal period there is rapture
of a Graafian vesicle ; the opening cicatrixes in about
eight or ten days.

They may be friable, softened, red, and con-
gested (ovaritis), slaty or black, oedematous,
covered with gangrenous patches (septicasmia),
crepitant, etc.

Internal Appearance. — The chief points to
notice are the,state of the Graafian follicles and
the number of the corpora lutea, as these show
the frequency of menstruation and impregna-
tion. At the menstrual period the ovary is
very hyperaemic, and also during pregnancy.

False Corpora Lutea (after menstruation only)
are small and angular, seldom present a cicatrix,
have no cavity, are usually soft, and with only
a thin layer of yellow matter or none at all.

V-ue Corpora Lutea are large (often the size
. of a marble or mulberry), round, project from
the surface of the ovary, have a triangular de-
pression or cicatrix at their summit, and con-
tain a small cavity, which becomes stellate
towards the end of pregnancy ; they are vascu-
lar, lobulated or puckered, firm and yeUow.

Ihoo corpora lutea are formed when there have been
twin pregnancies.

The stroma of the ovary may hypertrophy,
indurate, or soften.

In Acute Ovaritis, which is almost al-
ways puerperal, the organ is swollen, vascular,
and red or wine-colored ; sometimes it is soft-
ened, infiltrated with sanguinolent fluid or even
pus, or converted into a'grey and sanious pulpy

THE GENEEATIVE OKGANS. 93

matter. It may burst and produce fatal peri-
tonitis.

Chronic Ovaritis is much more frequent,
and is characterized hj a fibroid degeneration
and thickening of the capsule or of the whole
organ.

Ovarian Cysts are the most frequent afiec-

tions; these may be either — 1, simple or vmiloeu-

lar; 2, tubo-ovarian ; 3, compound or mvliUoeular ;

or 4 dermoid.

Notice the adhesions and relations of the cysts, state
of the Fallopian tubes (permeableor not), length ol ped-
icle, etc. They may burst Into the peritoneum.

Contents of the Oyits. — Clear hyaline fluid,
like water; citron or amber color (recent),
milky (from fat globules) ; thick, mucilaginous,
gelatiniform, flocculent, brownish, chocolate
color (from blood or decomposition).

The Dermoid or Pilferous Cysts
contain skin, fatty tissue, hairs, glands, teeth, or
bone (regular or irregular).

Cancer of the ovary, either primary or sec-
ondary, is generally intermediate between scir-
rhous and medullary; a peculiar form called
viUous cancer is occasionally seen.

Sarcomata, fibromata, angiomata, cartilaginous, bony,
and other kinds of tumors are sometimes met with.

FALLOPIAN TUBES.

Disease of these is more frequent than is gen-
erally thought. They may be adherent to the
uterus or ovary (from chronic inflammation or
old peritonitis) ; sometimes they are flexed, or
they may be distended (by foetus, blood, etc.)

Pass a, fine wire through the tubes to see if
they are permeable, or inflate them from the
uterine extremity.

Open them by passing a fine scissors (bron-
chotome) along them from the fimbriform end.
The mucous membrane may be red or swollen
(inflammation — ^in pelvic cellulitis), or gray

94 POST MOETEMS.

and discolored. Contents may be thick, wine-
like, purulent, or whitish, or mixed with tuber-
culous or cancerous matters (cylindrical cell-
ules).

Obliteratimi may be a cause of sterility. Fi-
brinous tumors are occasionally met with in
the tubes. Rupture sometimes occurs from over-
distension by the catamenia, by serum, or by
pus ; it may also be from tubal foetation, and
then takes place about the third or fourth
month of pregnancy. Acute inflammation, is
characterised by a swollen, reddened, and vas-
cular state of the lining membrane, which is
infiltrated with serum, lymph, or pus. Ohronie
inflammation may lead to fibroid thickening or
to a large accumulation of pus.

After impregnation it may be posBlble to And sperma-
tozoa In the tubes.

UTERUS.

Notice its relations to surrounding parts be-
fore removing it; cancerous and other adhe-
sions ; versions and flexions ; loss of substance ;
swelling of the various glands ; pompression of
the sacral plexus, sciatic nerve, iliac vein, etc.
Examine also the state of the neighboring
organs, as the rectum, bladder, etc.

Absence of the uterus is very rare. If
thought to be absent, search carefully for it or
its remains in the recto-vesical pouch, amongst
the muscles of the perineum, etc. ; rudimentary
bodies may be found.

The uterus may be bilooular and horned, or unicorn.

Size. — This varies considerably, even in
health ; sometimes the uterus continues unde-
veloped even in adult life, this arrest'of devel-
opment must be carefully distinguished from
premature atrophy.

At puberty it is pear-shaped, weighs 8 to 10
drachms ; subsequently it is larger, more vascu-
lar, of softer and darker substance ; during preg-

THE GENERATIVE OEGAlfS. 95

nancy it enlarges immensely. After delivery
it returns to nearly its normal size, and then
weighs about two ounces; the edges of the labia
are fissured, its cavity is larger, and its muscu-
lar structure is more apparent than in the vir-
gin state. In old age it atrophies, becomes
denser in texture, and the orifices are frequently
closed.

Usually stx months elapse after deliveiy before it
returns to normal size.

The uterus is opened either by cutting
it through from one side to the other, or by
a T incision, the long arm of which opens the
anterior wall half-way up, and the two shorter
extend from the two Fallopian tubes to the
first.

Iiesions. — Walk of the Uterus. — Pale, red,
hypertrophied or turgescent (infiammation) ;
black, shrivelled, friable, indurated, cartilagi-
nous (chronic inflammation) ; ossiform (rare) ;
flabby and spongy, softened, partially destroyed
(inflammation) ; ulcerated, infiltrated with pus,
fetid-sanious fluid (cancer); false membranes,
fungous and polypus growths, gangrenous

Veins and Sinuses. — Gaping, gorged with
blood, containing clots, in those who have died
at the puerperal period ; filled with a puriform
liquid (puerperal fever ?), gas (doubtful if ante
or post mortem).

Malformation. — Eudimentary, double, heart-
shaped, bicornous, bifid, divided into partitions,
unicornous, with occlusion of the orifices.

Versions — ante-, retro-, latere-.

Mexions — ante-, retro-, latere-.

Falling down and prolapse into the vagina or
vulva, with or without lengthening, with or
without hypertrophy""of the neck. '^

Prolapse may be due either to laxity of the ligaments
or to some change in the vagina.

Inversion may have occurred during labor

POST MOBTEMS.

or shortly after, either spontaneously or from
too strong a traction on the cord, or from the
presence of tumors.

Hernise of the uterus.

WWntfe.^Traumatic or surgical (Csesarian
section); pathologic rupture, perforation; it
may also be injured by attempts to procure
abortion.

Various Lesions. — Inflammation {metritis),
acute is shown by a swollen, softened, and red-
dened state; puerperal; chronic has two stages
— 1, infiltrated, hyperaemic ; 2, indurated, anse-
mic; in endo-metritis or uterine catarrh the,
organ is congested and softened, and the mucous
membrane red, or purple, or whitish; chronic
^ido-metritis (leucorrhoea) ; parametritis or in-
flammation of the subperitoneal connective tis-
sue ; false membranes in the cavity from croup-
ous infliammation ; bag-like cysts {dysmenorrJuea
membranacea) ; softening. Accumulation of fluid
(hydrometra), of blood (hsematometra), of pus
(pyrometra), of air (physometra) ; the obstruc-
tion in these cases may be either a tumor, cica-
trix of the neck, or a swelling from chronic
metritis. Cancer and cancroid (these begin to
form at the cervix — scirrhus, epithelioma, sar-
coma) ; ulcers (phagedsenic) ; moles, either
fleshy, fcetal, or hydatiform. Hyatids and other
foreign bodies. Twmors.^Cystic, flbrocystio
(myoma), fleshy (sarcoma) ; mucous polypi
(myozoma) ; glandular or follicular. The so-
called fibroid tumors (myomata) are very com-
mon, and often take the form of polypi. Gan-
grene. Betention of the placenta..

Metritis. — The most common form is endo-
metritis or inflammation of the lining membrane
or uterine catarrh, and is shown by the swollen,
injected, and velvety appearance of the mucous
membrane, which is sometimes detached; the
surface is coated with a viscid, straw-colored or

THE GENERATIVE ORGANS. 97

purulent discharge, which may be mixed with
blood.

Metritis, or inflammation of the substance
proper, is nearly always a result of pregnancy
or traumatism ; the walls are reddened, softened,
swollen, and contain much lymph. Sometimes
suppuration takes place, and the matter may
burst either into the cavity, or into the bladder,
rectum, or abdominal cavity ; it may become
absorbed. The inflammation may, though
rarely, terminate in gangrene. Chronic metritis
leads either to softening or induration.

Cancer. — This is in the form of schirrhus
chiefly, and is characterized by two stages. 1.
Hardening; the surface of the uterus is uneven,
indented but smooth ; when cut into, the walls
are of a whitish or greyish substance, of a
fibroid structure, the meshes containing cancer-
ous juice ; thin slices are semi-transparent. 2.
Softening ; this takes place sooner or later, com-
mencing at the cervix, and irregular ulcerations
form, which may gradually eat away most of
the uterus and vagina, sometimes perforating
the bladder or the peritoneum, or the whole of
neighboring organs and structures may be
destroyed. Sometimes large masses of gristly
substance, of a papillary nature, form in the
ulcers, resembling a "cauliflower excrescence."

Iiesious of the Os Uteri. — The normal
appearance of the os varies. It is generally a
smooth oval slit, but it may' sometimes be circu-
lar or triangular, like a leech-bite. In disease
it may be redder than normal (inflammation),
granulated (granular inflammation), unequal
and intented, friable, indurated (sequel of in-
flammation) ; prominent and hypertrophied,
atrophied, narrowed; softened and fungous;
ulcerated (tubercular, or syphilitic, or simple) .
cancerous encephaloid, scirrhous, hsematoid,
alveolar, or colloid cancer) ; epithelioma ; cov-

98 POST MOETEMS.

ered with fleshy protuberances (papilloma or
cauliflower excrescence — this is not cancer).

A tranBverse opening, or os, is not a necessary sign
of childbirth, as It baa been seen in infants.

Adherent to anterior or posterior walls of
yagina; lengthening of the os, sometimes so
much as to reach as far as the labia, etc. Show-
ing products of pregnancy as adhesion of pla-
centa, etc.; varicose veins, false membranes.
Syphilitic ulcerations (chancre is rare), gum-
matous tumors. Narrowing , of the internal
orifice ; occlusion of the os by a pediculated or
sessile fibrous body, by a plastic plug organized
during gestation. Bupture of the os is either
spontaneous or traumatic from injury by instru.
ments during accouchement, etc.

Malformations. — Double, bifid, or multiple os ;
.congenital obliteration of orifice; absence of os;
conical os (may prevent conception).

The Uterus and its appendages should be espec-
ially examimed in thefoUomng cases : — Phlegmasia
alba dolens ; abortion ; extra-uterine pregnancy ;
purulent infection (pysemia after labor, etc.);
afiections of the uterine annexes, as inflamma-
tion of the ovaries, broad ligament, etc. ; ster-
ility; menstrual irregularities; obstinate con-
stipation; uncontrollable vomitings of preg-
nancy, and other obscure symptoms after con-
finement.

During Menstruation the uterus is con-
gested, enlarged, and softened; the mucous
membrane is swollen, reddened, punctuated'
with bloody spots, and covered with menstrual
fluid, which may be more or less watery. This
state must not be mistaken for inflammation.

Appearance of the Uterus after
Parturition.— The organ is flaccid, softer
than usual, nine to twelve inches long ; cavity
may contain much clotted Wood, pieces of pla-
centa, decidua, etc. : generally there is a green-

THE GENERATIVE OKGANS.

ish-red fluid coTering the internal surface, and
a soft, pulpy, raw spot where the placenta was
attached, with semilunar openings on its sur-
face. The mucous membrane of the os is gen-
erally of an orange color after a recent delivery ;
this is a very characteristic appearance if pres-
ent.

The Signs of the utents having been pregnant
are : — the organ is larger and the walls are
thickened, the fundus is longer than the cervix ;
in the virgin womb these are about equal, while
in children the neck iis the longer ; the sinuses
and vessels are enlarged, and the os is marked
irregularly by cicatrices.

Puerperal Fever. — There is inflamma-
tion and extreme softness of the uterine walls,
which may contain pus either in their substance
or the cavity. The adjacent peritoneum is
inflamed, and there is pelvic cellulitis. The
uterine sinuses are often seen gaping, or
blocked up with puriform matter or thrombi ;
there is secondary affection of the lymphatics,
and also of the liver, spleen, kidneys, etc., but,
unlike general pysemia, the lungs mostly escape
Infection.

VAGINA.

Mueovs Membrane.— 'Bnght red (vaginitis),
brownish, swollen, oedematous (effects of inflam-
mation) ; covered with granulations due to fol-
licular or papillary hypertrophy ; eroded super-
ficially (effects of vaginitis), ulcerated, gangre-
nous, etc. Vaginitis is usually gonorrhoeal.
The liquid covering the mucous membrane
may be greenish-yellow (vaginitis), sanious,
diphtheric, 'fetid, purulent, sanguinolent, or
mixed with clots.

Variaue Lesions. — Vesical, urethral, or rectal
fistulee; stricture following inflammation, etc.;
presence of foreign bodies ; su])erficial or deep
follicular cysts ; polypi, as fibrous, sarcomatous.

100 POST MOETEMS.

or myomatous excrescences, pediculated or DOt ;
cancer, encephaloid or cancroid. Syphilitic
ulcerations : inversion of the vagina, in falling
down of the uterus, and prolapse of the vulva ;
efiusion of blood under the walls (vaginal hsema-
tocele). Projection into the vagina of various
internal tumors, as vaginal hernise, vaginal cys-
tocele (bladder prolapsing with vagina), rec-
tocele (rectum prolapsing with vagina); abscess
in the walls or the peri- vaginal tissues. Fibrous
hypertrophy, vegetations. Various kinds of
injury may be met with, as from forceps in
delivery or instruments used to procure abor-
tion. Poisons, as mercury or arsenic, may be
feloniously or accidentally introduced per vagi-
nam.

Malformations. — Abnormal opening; congen-
ital stricture; complete absence; obliteration
and imperforation {atresia), impermeability,
divided by a more or less complete partition,
bifidity (with or without double uterus.).

VULVA, PEBITONEUM, ETC.

Vtllva. — May be wounded ; rupture of four-
chette; tearing of the hymen, of the meatus
(these injuries may arise either during labor
from careless use of forceps and other instru-
ments, or from attempted rape). Swelling from
effusion of blood (thrombus) or luBmalama vulvoe
and oedema of vulva. Eczema, herpes, erythe-
ma, erysipelas, etc. Gangrenous inflammation
{noma of infants) this must not be mistaken for
venereal disease; it is of a deep, dusky red col-
or, and the ulcers are greyish with a most fetid
discharge; it generally arises from a constantly
dirty state of the parts. Abscess and vulvitis
of little girls (simple, ulcerated, diphtheric, or
gangrenous) are often met with.

In examining for suspected rape on a cliild
it must be remembered that diseases are fre-

THE QENERATiyE ORGANS. 101

quently seen in children which may be easily
mistaken for gonorrhoea. Bape on young chil-
dren, which may be without penetration, is
generally followed by inflammation ; then an
abundant secretion takes place, at first of a
sanious mucus, then of muoo-pus of a yellowish-
green color and glutinous consistence.

Lesions. — Non-syphilitic ulcerations ; follicu-
lar cysts (from obstruction of the sebaceous
ducts), met with especially in the neighborhood
of the urethra ; vulvar folliculitis (inflamma-
tion of the mucous follicles). Warts (eondylo-
mala), sometimes forming by aggregation caul-
iflower excrescences; " mucous patches," these
are something of the nature of a wart, and are
characteristic of syphilis; they appear as rose
or purple-colored, circular or oval elevations,
flat and covered with a very ofiensive ichorous
secretion ; they may coalesse and form larger
patches. Cancer, chiefly epithelioma. Fibrous
and encysted tumors; hypertrophied lichen
(mycosis). Oxyurides may escape from the
rectum. Elephantiasis is an hypertrophy of
the skin, and must not be mistaken for enlarge-
ment from deposition of fat. Obliteration of
the posterior commissure and separation of the
labia majores by vaginal or uterine tumors.
Vesico-labial hernise.

Clitoris. — May be confounded with the
labia split in two, absent, or developed in an
extraordinary manner. Hypertrophy has no
connection with excessive sexual indulgence.
The meatus urinarius may be situated on the
summit of an hypertrophied clitoris which
might be easily mistaken for a penis. There is
the case of a woman who was thought to be a
man, and married as such; her real sex was
only discovered after death by the presence of
a uterus.

102 POST MORTEMS.

Perineiuu. — May be thinned and narrowed
from disease; enlarged; absent (ei her from
rnptnre <r as a congenital defect) ; contused,
wounded (rupture and tearing) from labor,
attempted rape, etc. Fistulse, excoriations,;
intertrigo, eczema, urinary tubercles; perineal
hernia and prolusion of the perineum by vari-
ous internal tumors, as hsematocele, cystocele,
etc.

MAMM^.

Before proceeding to open these, it is always
well to make a physical examination first, in
order to estimate their hardness, softness, mo-
bility, etc.; by pressure milk or pus may escape.
In order to open them, divide the skin by three
or four lines radiating from the nipple to the
circumference, and reflect the triangular pieces
of skin; or remove the breast entirely by one
or two semi-elliptical incisions. Having ex-
posed the organ, notice the state of the lacteal
tubes, adhesions to neighboring parts, etc.

Lesions. — Eczema, syphilitic induration and
gummata ; ahscesses, these are termed eiiro-mam-
mary or superficial when situated between the
skin and the breast, post or sub-mammary when
behind the gland, true or intra-mammary when
the glandular structure itself is affected. Fis-
tulse; partial or general hypertrophy (the
breasts generally enlarge at the menstrual
period). Tumors — adenoma or formed of gland
structure; nodulated, elastic or hard (cystic
sarcoma), these may be mistaken for cancer;
cartilaginous (enchondroma), rare; fibroma
(fibrous tumor) ; fatty (lipoma) ; mucous (myx-
oma), rare; spindle-celled sarcoma (this was
formerly mistaken for cancer, with which,- in
fact, it may be associated ; milk tumors or
obstruction of the ducts with natural secretion
(galactocele) ; cystic tumors (ecchinococus, hyd-
atid, etc.) ; tubercle, rare ; calcareous deposits,

THE NERVOUS SYSTEM. 103

probably from tte retention of milk. Atrpphy,
in old age and wasting diseases.

Cancer. — Most common form is scirrlms,
which is a hard lobulated tumor at first,-Vrith
affection of the neighboring parts and glands.
It afterward nicer ites, and the sore has everted,
raised, and puckered edges, with fetid secretion.
Medullary cancer — brain-like in appearance — is
met with in early life. Colloid has been -very
rarely seen.

Adenoma of the breast (simple glandular
tumor) is very often with great diflBculty dis-
tinguished from true cancer, especially in the
early stage of ihe disease.

In Man diseases of the breast may occasion-
ally be met with, such as cancer and fibromata.
In dropsical or fat men the breasts are often
very large, but they have no gland structure.
Cases are reported of men having true mam-
mse which secreted milk, but they are doubtful.

X.

TBE NERVOUS SYSTEM.

HEAD.

For the method of opening the head, see
Chapter III. Before doing so the Scalp must
be carefully examined. Notice the color and
state of the hair. Look for fresh wounds and
cicatrices, as cuts, bruises, abrasions; echymoses
with subcutaneous effusion or sanguineous swell-
ings ; punctures through the fontauelles or tem-
poral bones (these may be very minute) Var-
icose aneurisms, oedema, pneumatocele (from
communication with the frontal sinuses or mas-
toid cells), diffuse inflammation of the cellular
tissue; erysipelas (see if there is a wound as
well, and look for evidences of a debauch); pro-

104 POST MOBTEMS.

trusion of the brain through an opening in the
skall, from a trephine wound or separation of
the sutures (encephalocele).

The head of a new-horn child may be Injured daring
labor by instruments or pressure, etc., or by a fall, as on
to the ground accidentally. Sanguineous tumors on the
heads of new-born children (cephalhEematoma) arise from
pressure during labor.

SKULL CAP.

Fractures. — These must be carefully ex-
amined, in order to judge the direction, extent,
nature of the cause, etc. ; where they are indis-
tinct or doubtful it is well to rub some ink in.
The bone may be depressed or protruded, or
radiated from the point of contact, etc.

Always try to determine from the appearance If the
injury is from a blow or a fall ; take some of the part
injured and examine It carefully — microscopically, if
necessary — ^it may retain some particles^ as dirt, pieces
of wood, metal, etc., which may afford important evi-
dence.

Perforations, as in infanticide, may be very
small. Exostoses, osteophytes, and periostoses ;
these may serve to explain some cases of paral-
ysis; notice carefully their exact situation.
Premature closure of the fontanelles may be a
cause of epilepsy, cretinism, etc.; they may
remain open longer than natural, as in hydro-
cephalus. Irregular development of the skull ;
not proportionate to the stature. Malforma-
tion, aa flattening (not traumatic); increase in
the basal circumference, rotundity of the cra-
nium (sometimes peculiar to idiotism or epilep-
sy), general volume increased or decreased
externally ; take the measure by means of a
pair of calipers.

Remove the skull cap as directed in Chapter
III; if there is a fracture, the greatest care
must be taken in sawing through the bones, and
it is well, if possible, to first remove the-frac-
tured part entire. Now examine the interior,
and see if the abnormalities on the outer have
any corresponding state on the inner surface,
and also if lesions affect the dura mater as well.

THE NERVOUS SYSTEM. 105

In Buspected blows examine the side opposite to the
presumed injury for &acture by contre covpj as at the
base of the skull.

The inner table of the skull may be exten-
sively fractured without any signs of much ex-
ternal injury. If the blow has been from a light
weapon sharply applied, the fracture is confined
to the seat of the injury ; if from a large body
moving slowly, the injury is diffused.

DURA MATBE.

Carefully examine the external surface as far
as it is exposed ; notice the adhesions, transpar-
ency or opacity, redness, effusion of blood; then
judge whether it was produced before or after
death, and look for corresponding injury to the
bones and scalp, either near the seat of effusion
or at some distant part.

The efihsed blood maybe more or less absorbed, some-
times only a thin layer of decolorized fibrin remaining.

The color of the dura mater is often of a more
or les8 deep yellow, as in jaundice or yellow
fever and poisoning by crude carbolic acid. In
syphilis there is frequently a peculiar yellow-
ish grumous deposit either in the form of gran,
ulations or as a pseudo-membrane. In deaths
from prussic acid, or cyanide of potassium, or
acute alcoholism, the odor of cyanogen or spirit
is distinctly perceptible.

The Pacchionian, bodies may be en-
larged, frequently forcing \heir way through
the pia mater ; the nature of this enlargement
is uncertain ; or they may be disseminated and
must not be mistaken for tubercles.

Divide the dura mater either along the edges
of the sawn bones or across the vertex, or by a
longitudinal incision a little to one side of the ^
longitudinal sinus ; then divide the falx cerebri
as near the crista galli as possible, and turn the
membrane aside or back, or remove entirely.

Lesions of the Dura Mater. — Dis-
tended with serum (hydrocephalus), with blood,

106 POST MOBTEMB.

from rupture of a vessel, but see if this is ante
or post mortem. Depressed, with wasting of
the brain beneath ; adherent to the skull, as in
inflammation from injury or meningitis; in-
flamed (nearly always from injury); vessels tur-
gid, showing the mode of death, as poisoning by
narcotics, apoplexy, etc. ; tubercular and syph-
ilitic granulations, the former as miliary bodies,
chiefly at the base, the latter as round, flattened,
hard masses; fungoid growths; epithelial and
fibrous tumors (notice the exact seat of these);
dermoid cysts, containing hair, fat, etc. Patches
of purulent matter, efiusion of blood between
its layers or true bony deposits ; cancerous tu-
mors ; hydatids. Defects are rare.

Inflammation of the Dura Mater.—
Acute. — in the early stage it is pinky and softer
than normal ; then there is infiltration and sup-
puration or efl\isi9n of lymph, giving rise to
adhesions and new formations.

Ghronic. — Characterized by the formation of

a false membrane on the arachnoid surface,

which becomes vascularized, and attached more

or less in patches to the brain substance.

Many of these false membranes are, no doubt, old
blood effusions whicli have become organized.

Sj/philitic Injlammation is shown by a pink or

red sarcomatous swelling, generally adherent to

the brain, from one'third to half an inch thick

and of a roundish flattened form.

ARACHNOID AND PI A MATER.

it is generally well to dtooribe these two together,
especially as modern physiologists regard the 'outer
layer' of the arachnoid as the endothelium of the dura
mater, and the 'visceral layer' as belonging to the pia
mater ; the pia, is also the more important, as it is (A« via-
cuiar membrane of the brain.

Lesions. — The membranes may be dry
(from undue pressure of the brain), injected
(acute inflammation), milky (chronic inflam-
mation); distended with serum (inflammation),
blood (if coagulated it is a sign of ante-mortem

THE NERVOUS SYSTEM. Ip7

hsemorrhage ; if fluid it may have been efiased
post mortem) or pus (from injury, seldom or
never from disease).

In idiopathic inflammation of tlie arachnoid the effu-
sion has been described as being between it and the pia
mater; in traumatic inj^ammation it is between the
arachnoid and the dura mater.

The pia may be adherent to the dura mater
or the brain, either generally or in large or
small patches from inflammation ; this is often
seen in general paralysis and other affections of
the insane, etc. Thickened, softened, infiltrated
with pus (cTiiefly along the course of- the ves-
sels), or covered with miliary granulations;
these latter are nearly always confined to the
base and the fissures ; if they are seen on the
vertex, they have spread upwards from the
base. Tumors of various kinds may be met
with, as angioma, sarcoma, fibroma, papilloma,
small epithelial growths, steatoma, hyatid cysts,
pigmentary deposits, etc.

Meningitis. — Simple. — The first stage of
active hypersemia is seldom seen ; there is then
greatly increased vascularity, more or less dif-
fuse. Afterwards effusion takes place; this
may be of various kinds, from a greenish watery
fluid to an opaque milky deposit ; in rare cases
pus has been found.

Tubereidar. — This is characterized by the

deposit of grey, miliary granulations about the

size of millet seeds, chiefly in the membranes at

the baee of the brain. They are met wi^h most

abundantly in the fissure of Sylvius, and are

generally situated in the peri-vascular spaces ;

they are always associated with inflammation,

and nearly always with general tiibercvilosisi ' i

The disease is well shown by putting the membrane
In a glass vessel of water over a dark surface, when the
tubercles appear as white dots.

Tubercular differs from simple meningitis

not only by the presence of the tubercles, but

also by the effusion being chiefly at the base.

108 POST MOBTEMS.

rarely or never at the vertex. The hemispheres
of the brain are generally flattened from pres-
sure ; the ventricles are distended with serum,
and their walls are softened.

VESSELS or THE BKAIN.

Sinus of the Dura Mater. — May be
inflamed ; obstructed by clots, especially at the '
'Torcular HerophUi;' in cases of poisoning, suf-
focation, etc., these clots are black and soft; in
apoplexy, typhus, certain forms of insanity, etc.,
they are-fibrinous, adherent, and of a yellow or
brown color. In some cases of brain-softening,
meningitis, otitis, etc., a thrombus may be found
~ in the sinus.

In death after erysipelas, pycemia, etc., these Teasels
are sometimes affected with purulent deposits.

Arteries. — May be dilated (aneurisms), im-
permeable from atheroma or other changes or
obstructed by clots ; they may be rigid, tortu-
ous, sometimes calcareous.

Affections of these arteries are met with mostly in old
people, drunkards, rheumatic subjects, etc., and are Cre-
quently a cause of brain-aoltening or of apoplexy.

Air in the Vessels.— This is generally a
consequence of the manner in which the head
has been opened, and then of course has no
pathological significance; it may sometimes be
due to post-mortem decomposition of the blood.
Its presence, hcjwever, should be stated, and the
cause for it deteriiiined if possible.
^ Congestion of the Vessels is mostly a
sign qf the ynotfe of death, and ought not to be
conMdered as a comse ; it is also often due to the
position of the body at and after death. Ab-
sence of congestion of the vessels of the brain
would suggest the probability that death was
not from asphyxia.

Serous Apoplexy.— Sudden effusion of
serum has never been known to take place, and
hence there is no such thing as serous apoplexy.
Serous effusion is generally an accompaniment

THE NERVOUS SYSTEM. 109

of brain-wasting, and is not always an inflam-
matory product.

UBiEMIA.

In cases of sudden death, with symptoms' of
brain disease, there may be no apparent lesion,
death being due to ursemic poisoning; then
look for disease of the kidneys, and test for urea
in the blood and brain ; it is also important to
do this in cases of suspected poisoning.

Test for Urea. — 1. In the Blood or Senm-
— Acidulate with acetic acid ; evaporate to dry-
ness over a water bath (small evaporating dish
or watch glass in a large beaker of boiling wa-
ter, with a piece of paper or wood so placed as
to let the steam escape); dissolve the urea in
boiling alcohol. Then evaporate again to dry-
ness, add a little water, put it Jn a freezing mix-
ture (or place on a piece of lint saturated in
ether), add a few drops of nitric acid. If there
is urea the nitrate will form, and can be distin-
guished by its peculiar form of crystals.

2. In the Brain. — A good-sized piece of brain
substance is to be cut up into small pieces, and
placed in a convenient vessel. Ten ounces of boil-
ing distilled water are put on them and allowed
to stand for six or eight hours, the brain being
frequently broken up with a glass rod during
this time. The water is then carefully poured
off into a clean vessel, and the brain is digested
with another ten ounces of boiling water, al-
lowed to stand the same length of time, and
again poured off; this is repeated four times.
The solutions are all mixed together, filtered,
and evaporated to dryness. The dry residue is
powdered and treated four times exactly as the-,
brain was in the first instance, with a smaller
quantity of water, however. The evaporated
residue is dried in an oven, and then boiled in
successive portions of ether. This ethereal ex-
tract is evaporated to dryness, treated with a

110 POST MOBTEMS.

little tepid water, filtered, and again evaporated
to dryness. The residue is to be put on a glass
slide with a drop of nitric acid, covered with thin
glass, allowed to stand awhile, and then examined
under the microscope. Crystals of nitrate of
urea will show themselves if urea is present
{from Dr. Todd'i Clinical Lecture), quoted in
AUken's 'Practice of Medicine').

THE BRAIN.

Notice all that can be seen as to the state of
this organ while it is in situ; then remove it
thus : — Having removed the dura mater, draw
back the anterior lobes, divide the tentorium
eerebdli from within outwards along the petrous
bones, and cut the spinal cord as far down the
canal as possible; then divide the various
nerves and remove the brain, letting it fall into
the left hand. Examine the base of the skull
carefully; there may be fractures, caries, tu-
mors, etc. Now weigh the whole brain en
masse; afterwards divisions of it may be taken
and weighed separately. The normal braim
weight is — males, 46 to 53 oz.; females, 41 to
47 oz.

Now thoroughly and carefully examine the
whole surface of the brain ; notice the state of
vessels (the basilar and meningeal arteries, etc.,
for atheroma, emboli, etc.), adhesion of the
lobes : look for tubercle or other deposit in the
fissure of Sylvius. Notice the shape, symmetry,
and depth of sulci, the flattening or prominence
of the convolutions, etc.; estimate the consist-
ence, fluctuation, softening, firmness, etc., of the
.brain substance. Sometimes small patches of
effused blood will be seen at various parts of the
brain; state exactly their situation, the same
with tumors.

It is of extreme importance in coonection with the
localisation of brain function to notice accurately the
exact Beat of pathQlogic states of the brain.

THE NEKVOUS SYSTEM. Ill

The under sarfaxie of the base of the brain con-
tain?, in order from before backwards — 1, lami-
nacinerea ; 2, olfactory nerves ; 3, anterior per-
forated space; 4, optic commissure; 5, tuber
ciiferum; 6, infundibulum and pituitary body ;
7, corpora albicantia; 8, posterior perforated
space; 9, crura cerebri, with the third nerves
(motor oculi) on their inner sides, and the fourth
nerves (trochlear) on the outer sides. Then
comes the pons, with the fifth (trifacial) em-
bedded in it; and behind this is the medulla,
with the following nerves: — in front is the
sixtli (abdiuiens omUi) ; at the side is the seventh,
a double-nerve (portio dura, or motor of the
face, and pc/rtio mollis, or auditory); farther
back are the three separate nerves forming the
eig'hth — the ^osso-pharyngeal, the pneumogas-
tric, and the spinal accessory; and between the
pyramidal and olivary bodies is the ninth or
hypoglossal nerve.

Remove the arachnoid and pia mater, noting

any adhesions and their exact situation, as this

shows localised indammation ; they may be so

adherent as to drag out the brain substance on

being stripped ofip, or they may be separated

from the brain by efiusioh.

Some of the vessels, carefully pulled out with the pia
mater, may easily be ' examined microscopically, and
often furnish important testimony as to disease of the
brain. ^

There are several methods of examin-
ing the brain substance; the most gen-
eral is to slice the brain in successive layers
from the vertex to the base, cutting from within
outwards, and leaving the slices partially at-
tached on the outside, so as to preserve the nor-
mal relations. But a better plan is to separate
the two hemispheres, and cut from within out-
wards and slightly downwards, just above the
upper surface of the corpus callosum. This
will expose the roof of the lateral ventricles.

112 POST MOBTEMS.

Before opening the ventricles examine the
state of the grey and white substance, the num-
ber of the puncta sanguinea, both absolutely
and relatively ; if very numerous and dark this
may suggest the mode of death (asphyxia, etc.),
the white part then often appears pink.

The White Substance may be denser
than usual, in patches or diffused {sclerosis), or
it may be softened, sometimes pulpy. Soften-
ing (ramoUiasement) -is either red, or yeUow, or
white: the first is due to inflammation, embol-
ism, or injury ; the second to fatty degenera-
tion, and is frequently an evidence of syphilis ;
white-softening is probably a post-mortem
change.

The brain substance is often more watery than
usual (cedema), and serum runs fr6m it on sec-
tion ; this is probably a sign of brain atrophy,
the serum being compensatory.

The Grey Matter maybe paler or darker
than normal — sometimes almost black (melan-
aemia) — firmer or softer, or the layers of vary-
ing consistence; the layers may be more dis-
tinct than usual; and the whole grey matter
may be wider or narrower.

A good method of examining the grey matter is to
cut as thin a slice as possible, place it between tvo
pieces of glass, and hold it up to the light.

Cerebral Hemorrhages, forming cyst-
like cavities in the brain substance, are fre-
quently met with in various situations, and
arise either from injury, or disease of the ves-
sels; in the former case they are generally
found directly opposite the seat of injury; in
the latter case they are chiefly in the basal
ganglia. Their size varies from that of a pin's
head to a large orange. In cases of cerebral
haemorrhage the blood-vessels should be exam-
ined microscopically, as it is often due to dis-
ease of the walls of the vessels. The effused

THE NERVOtrS SYSTEM. 113

blood may after a time be changed into a brown
clot, or even into a decolorised fibrinous mass.
Apoplexy is often associated with disease of the
kidneys.

Cerebritis is rarely met with as aij aeute
affection; the brain substance. is redder and
softer ; sometimes the white substance is indis-
tinguishable from the grey.

Ohronie inflammation is generally attended
with disease of the vessels, and is ipore local ;
it often gives rise to sclerosis.

Pits may form from inflammation, and is

met with either diffused through the substance,'

or as an encysted abscess, or as ragged ulcers

on the surface. These ulcers are frequently

multiple, of pysemic origin, and generally affect

the grey matter.

la old stasdisg abscesses the pus is green. It gener-
ally is very offensive and has an acid reaction.

Lateral Ventricles. — In order to open
the lateral ventricles a small incision is to be
made in the roof, and the handle of a scal-
pel passed into the ventricle as a guide for the
knife for the further division of the roof ; the
fornix is divided by passing the knife through
the foramen of Monro and cutting upwards
and forwards; the brain substance, including
the roofs _of the ventricles and the fornix, are
now turned back, when the whole of the inte-
rior will be exposed.

Notice the state and relations of the various
parts: the chief of these are — 1, the fifth ven-
tricle'; 2, velum interpositum ; 3, the choroid
plexus ; 4, the corpus striatum : 5, the optic
thalamus; 6, the corpus fimbriatum; 7, the
hippocampus major and minor; 8, the pineal
gland; 9, the corpora ' quadrigemina ; 10, the
valve of Vieussens apd the fourth ventricle.

Divide the corpus striatum and the optic
thalamus so as to expose their internal struct-

1J4 POST MORTEMS.

ure. The remainder of the brain may be
divided as is thought suitable; perhaps the
better way is to cut it as much as possible in
the direction of the fibres, that is, perpendicu-
lar to the surface.

The Ventricles in acute hydrocephalus and
tubercular meningitis are distended with fluid,
■ which is often turbid, and the walls of the ven-
tricles are sometimes softened. The effusion '
ma^ cause, atrophy of the hemispheres. Fre-
quently the epithelium lining the cavities is
granular, like sand ; this is considered a sign
of chronic inflammation. Sometimes there are
granulations which may be as large as hemp
seeds.

The ventricles are occasioDally found full of blood ;
in this case the ruptured Teasel should be sought for.

Various tumors are also met with, as warty
growths, carcinomata, earthy concretions, hy-
datids, lipomata, enchondromata, etc.

The Choroid Plexus is of a venous na-
ture, and probably assists in regulating the
central circulation ; it is often the seat of vari-
ous lesions. It may be varicose, tumefied by
serous effusion; the seat of hydatids, erectile
(angioma), osseous, encephaloid, and other
tumors; sometimes peculiar hard yellowish
bodies are fopnd in it of a concentric structure,
varying from a microscopic size to that of a
small pea or nut. They have been called cor-
pora amylaeea by Virchow, and concentric eor-
pasdes by H. Jones. Some give a brown^ some-
times bluish, tint with iodine; others, however,
do not show this reaction. Cysts, cystoid for-
mations,^ and fatty tumors are also occasionally
met with. '

The Fornix is very frequently softened:
this may be from post-mortem change or dis-
ease ; the latter must not be too hastily assumed.

Tumors. — The most common form of tu-

THE NERVOUS SYSTEM. 115

mors met with in the brain are the gliomata,
which are composed of a soft, finely granular
material; they are generally, multiple and
extremely vascular. .

Psammona is a tumor composed of lime salts,
and is of a sandy nature; Cholettama is of a
pearly lustre, consisting of closely set, glisten-
ing scales of cholestearin. Hyalid eysts often
attain a large size, and consist of a bag con-
taining layers of a gelatinous membrane, on
which appear a number of small white dots,
presenting under the microscope the heads and
booklets of the eMnococcus.

To preserve the brain for microscopic
Section put it in spirit, colored brown with tinct-
ure iodine, for four to six days, adding iodine
occasionally; then keep in Miiller's fluid till
hard.

In studying the morbid anatomy of the brain
it is useful and important to have a chart of
the convolutions at hand for reference; in the
mortuary there should be a cast of the brain,
with the convolutions marked and named.

The pathology as well as the physiology of
the brain is still in a very unsatisfactory state,
and one can only use, general terms in describ-
ing the lesions that are met with.'

It is of course unnecessary to say that affections of
one side of the brain show themeelyes on the other
side of the body.

Injuries of the brain are always serious, but it
must be remembered that even very severe
injuries are not necessarily fatal. A case has
been noticed where some brain 'matter escaped
from the external meatus after fracture at the
base of the skull, and recovery took place. For
some years an editor of a paper in one of the
Channel islands performed his duties with a
bullet in his brain, and at his death one hemi-

116 POST MORTEMS.

sphere was found to be completely destroyed.
Injuries to the basal ganglia are more serious
than affections of the vertex.

Cases are on record where a small crow-bar and gas
pipe have been driven through the head, yet the patient
lived; pistol and rifle balls have passed through the
head, the patient living.

The Brain in Insanity.— Every possi-
ble lesion has been observed in insanity, but
none as yet has been found to distinguish it as
a peculiar affection; all those lesions thathave
been described as having been met with are
also seen in health, or apparent health; but
then, as Dr. Moxon observes, most people are
suspected by their intimate friends of having
some mental flaw. It is possible that, as the
study of insanity becomes more exact and the
localization of brain-function more definite,
special lesions may be discovered. But it is
probable, however, that we may have to look
to other organs, especially those influencing
the state of the blood, for the causes of insan-
ity; and it is not at all unlikely that as the
sympathetic nerve exercises a great influence
on mental processes, so some affection of this
will be found to be a potent factor in insanity.

SPINAL COKD.

In cases of locomotor ataxy, progressive muscular
paralysis or atrophy, sclerosis, etc.. the whole extent of
the spinal canal has to be opened; this Is a difScult
and tedious process.

In order to remove this for examination the
subject has to be laid on its face, an incision
made in the median line, and the skin and sub-
cutaneous tissue reflected. The muscles, fat,
and tissue in the vertebral grooves have to be
dissected out, so as to expose the spinal lami-
nae ; these have then to be broken with a chisel,
or sawn through either with an ordinary or
with a special saw (roAihitome), and the spinous
processes of the vertebras removed. The cord

THE NEEVOHS SYSTEM. 117

will now be seen lying in the vertebral canal,
covered by the dura mater, etc., which is not
to be opened, but removed with the cord by
division of the various spinal nerves. In ex-
amining it to state its consistence, etc., remove
the membranes first, as a soft, swollen cord
may seem hard in its resisting membranous
covering.

Lesions of the Spine.— Curvature. —

Either angular (Jkyphosis), from disease of the
bodies of the vertebrae; lateral [sholiosia), the
cause of which is obscure; or forwards (lordosis) .

Fracture of the Spine.— When above
the third cermcal, death is instantaneous ; in
sudden death of children always look for dislo-
cation or fracture of the odontoid process, and
in other cases of sudden death from severe
injuries a fracture in this part may pass unno-
ticed unless care^fuUy sought for.

When fracture is high in the back, but below
the third cervical, there is palsy of the arms,
difficulty of breathing, and j)aralysis of the
bladder and lower limbs ; the patient may live
for two or three days, when death arises from
. some affection of the respiration.

When the injury is in the dorsal region,
there is paralysis of the bladder and lower
extremities; death is then generally due to
pyemia or ursemia from retention of urine, and
may not takeplace for some weeks.

Cancer affecting the bodies of the vertebrae
has the remarkable effect of considerably short-
ening the stature of the individual.

Lesions of the Dura Mater.— The
spinal dura mater is only an investing mem-
brane, and no' a periosteum, as, is the cerebral
dura mater, and therefore not so liable to dis-
ease. It may be thickened, inflamed (acutely
rare); seat of spina bifida or abscess (from

118 POST MOKTEMS.

injury, psoas abscess, bed sores, scrofulous dis-
ease of vertebrae, etc); may contain morbid
growths, as cancer, fatty tumor, etc.

Arachnoid and Pia Mater Lesions.
— Inflammation {$pinal meningitis), a cause of
convulsions in children, with effusion of lymph
or pus (this effusion gives an appearance of
irregularity to the cord); haemorrhage (spinal
apoplexy); tumor8,^bony plates (these are very
common and have no particular importance;
they might, however, be a cause of tetanus or
Convulsions, tubercle, etc.; tubercular inflam-
mation renders the membranes of the cord
opaque from deposit).

The Cord. — Atrophy, hypertrophy; hy-
persemia (but this may be post-mortem hypos-
tasia, from position of the body); inflammatioti
(myelitis — rare) produces red, yellow, or white
softening ; sclerosis (general- or local), from
chronic inflammation. Tumors (cancer, tuber-
cle, etc.); cyslicerci, hydatids (rare).

Hydrophobia and Chorea. — No defi-
nite morbid appearance.

Tetanus. — Generally the appearances are
only microscopic, and then unsatisfactory ; there
may be hyperaemia, enlargement of the central
canal, proliferation' of epithelial elements arid
leucocytes, etc.

Sclerosis. — Cord looks like white of egg,
of a grey color; this is due to loss of the white
sheath of the nerves. Two forms, one as dis-
seminated granular masses, the other extending
ribbon-like through the tissue.

Locomotor Ataxy. — Induration and dis-
integration of the posterior columns of the
cord, etc.

Signs of Concussion (as after railway
accident). — Haemorrhage in the dura mater,
injury to the ligaments and cord itself; inflam-

ORGANS OF SPECIAL SENSE. 119

matioD, suppuration; after a time, softeniDg or
sclerosis.

' NERVES.

Atrophied { after injur/, etc., or lesion of
nerve-centre); hypertrophied ; inflamed (effu-
sion into the sheath, etc.); neuroma — ^two kinds,
one true nerve increase, the other a tumor
(fibroma, myxoma, etc.) pressing on the nerve ;
cancer (rare).

Oliomaia are tumors which often spring from
the retina, especially in children.

Skin diseases are sometimes associated with
some affection of the sympathetic or cutaneous
nerves.

XL

ORGANS OF SPECIAL SENSE.

The most important changes in these are
noticed in surgical works ; therefore only a few
need be given here.

EYE.

To remoye the eyeball and expose the orbit and con-
tents, carefully break away the orbital plate. -

Syelids. — ^Hordeolum (stye), ophthalmia
tarsi, syphilitic ulcers; trichiasis^eyelashes
growing inwards; entropion-^ eyelids turning
inwards ; ectropion — eyelids turning outwards ;
ankyloblepharon — union of the lids to the
globe.

Tumors. — Naevi, hydatid cysts, tarsal tumor
(enlarged Meibomian glands).

Conjunctiva. — Inflammation — catarrhal,
chronic, purulent, gouorrhoeal, scrofulous (with
pMyctenulce, or small opaque pimples, at the
margin of the. cornea), granular (membrane
roughened), pterygium (thick, red, elevated,
triangular fleshy formation).

Ihmors. — Warts, enchondromata, fibromata,
polypi, etc.

120 POST MOBTEMS.

Cornea. — Inflammation (keratitis) — syphi-
litic (like ground glass), strumous with nodular
elevations).

Ulcers. — Leucoma, opaque cicatrix; onyx,
suppuration between the layers of the cornea ;
staphyloma, protrusion of iris, etc.

Sclerotica. — Inflammation — rheumatic,
syphilitic, etc. Tumors.

Chambers. — Lining membranes inflamed ;
may contain blood, pus, hydatids, etc.

Iris. — Inflammation (iritis )^-syphilitic, with
nodules of a reddish or dirty brown color along
the margin; traumatic, from penetrating
wounds ; rheumatic, dull and discolored with-
out nodules; scrofulous. Cysts, melanomata, etc.

Xiens. — Inflammation (very rare), opacity -
(cataract) with induration, softening, or a gela-
tinous or fluid state. v^

Glaucoma. — [Infiammaiion of Choroid).

Eyeball hard, cornea dull, iris slate-colored.
Muid contents of the orbit idcreased and tur-
bid

Ketina. — Inflammation — increas^ vascu-
larity, exudation, dulness, sometimes extrava-
sation of blood ; suppuration ; displac'ement by
injuries, sub-retinal eflusion, etc.
. Tumors — scrofulous and others ; glioma.
.Amaurosis may be due to an ansemic state
of the retina, embolism of the central artery'
of the retina, detachment of the retina (from
injury), inflammation of the optic nerve (shown
by swelling and vascularity),' tumors in the
brain, syphilitic deposits, hemorrhage, abscess,
atrophy, softening, etc.

Cancer. — Scirrhus rare; most frequent is
colloid or melanotic.

Glioma is not really cancer ; it is formed
of round-celled sarcoma.

ORGANS OF SPECIAL SENSE. 121

. EAB.

Auricle' — Hypertrophy, inflammation, tu-
mors, etc, gouty deposit (urate of soda); hsema-
toma — effusion of blood (no doubt from injury),
this may be absorbed, and then leaves the- car-
tilages in a wrinkled state.

There is a peculiar fungus disease liable to affect the
subcutaneous cellular tisfiuCj from inoculation, and pro-
duce extensive disorganization.

Meatus. — Foreign bodies ; inflammation
(lining membrane swollen and vascular); ab-
scesses (follicular), sometimes they produce nec-
rosis of the bone ; myxomata (polypi); eczema.

Internal !Ear. — In all cases of deafness
the internal ear should be examined by break-
ing away the roof with a chisel. There may
be ankylosis of the stapes, disorganization from
inflammation, caries, or various deposits; ob-
struction' of the Eustachian tube from thicken-
ing of the mucous membrane, etc.

NOSE.

The interior of the nostrils may be easily exposed,
without disfigurement, by raising the upper lip, sepa-
rating tlie mucous membrane from the superior maxilla
and. diyidlng the fleshy part of the columna.

Iieslons. — Hypertrophy, inflammation, ul-
ceration (syphilitic, etc.), lipomata, polypi and
other tumors; worms or larvse sometimes get
up the nose.

In sudden unaccountable death look for for-
eign bodies, as piece of "tobacco pipe, etc., poked
up the nose into the brain, through the eth-
moid bone.

SKIN.

Hypertrophy. — Hpmy growths, corns,
ichthyosis (thick and rough, like fish skin);
elephantiasis (as of the scrotum, etc.) Atrophy
in old age, syphilis and various cachexise (thin,
dry appearance; surface chaffy or brawny, or
greasy and lustrous) .

Change of Color. — Addison's disease
{melasma suprarenale), skin of a deep brown or

122 POST MOBTEMS.

greenish brown hue. This disease is thought
to be dependent on some affection of the sym-
pathetic nerve.

Skin Diseases. — Psoriasis (the red, scaly
patches become pale after death); lichen; pity-
riasis rubra, general redness with slight ap- ,.
pearance of excess of epidermic scales ; pityri-
asis versicolor {chloasma), buff-colored patches.
Purpura, peleehice (small effusions of blocd).
Eczema, herpes, lupus, etc.

Sderiasis (Fagge), formerly called Keloid, a
swollen or brawny appearance of the skin,
something like a cicatrix, for which it may be
mistaken.

Syphilitic Tvhereleg. — Solid swellings of the
skin ; in size from a lentil to a hazel nut, and
covered with epidermis.

Condylomata. — Generally near the genital
organs; they. are warts.

Xanthelasma (Vitiiigoidea). — Two forms — 1,
X. Plana, as an opaque,'yellowish-white patch,
not elevated, most on the palms of hands, scro-
tum, ears, eyelids, etc. ; 2, X Tuhtrosa^ tuber-
cle-like knots on the elbows, knuckles, etc.
Associated with jaundice.

Cancer. — Epithelioma, in form of warts ; epi-
dermis thickened, opaque, yellow, cheesy and
brittle; it may be ulcerated, and then takes
the form of a deep irregular excavation sur-
rounded by fungous warty growths.

Desquamation of the skin takes place in more
or less large patches in scairlatina, gangrene,
from blisters, erysipelas, etc. Post-mortem
separation from decomposition must not be
mistaken for these pathologic effects; there
will in this case be other signs of decomposi-
tion.

THE BONES.

The chief affections in which it is necessary
to examine the bones are — injuries causing

ORGANS OF SPECIAI- SENSK. 123

inflammation, necrosis, nodes, fracture, etc.;

syphilis, scrofula, osteomalacia (mollities os-

sium); rachitis (rickets); caries (of the bodies

of the vertebrae produce spinal curvature).

The most conTenient bone to take for examination is
the femur, the thigh being opened in the course of the
vessels, that is, from the centre of Poupart's ligament to
the middle third of the thigh. To find the centre of
ossification, open the Icnee joint, expose the end of the
femur, and gradually pare down the cartilage, till a col-
ored point is noticed ; the size of this must be carefully
measured.

Periosteum. — May be red, swollen with
effusion (acute periostitis); less red, more swol-
len, denser, and generally adherent (chronic
periostitis); pus under the periosteum; circum-:
scribed thickenings (nodes are signs of syphi-
lis); a dense, hard, heavy tumor, like tendon,
osteoid chondroma (or cancer), very malignant.

Bone. — Bare, white or yellow ochre (color
result of periostitis); necrosed, sequestrum en-
closed in a shell of new bone, with or without
doacse; caries; indurated; more porous (rare-
factive inflammation).

Inflammation within the medullary canal
(osteomyelitis), deep redness, small suppurating
patches or abscesses (frequent cause of pysemia).
Thin scale of bone detached, surrounded by
sinuous grooves formed of eroded bone (as on
the skull in syphilis).

Hypertrophy. — Either from deposit on
the surface or condensation of tissue.

Atrophy from inflammation, injury to nu-
trient artery, want of use, etc. — Absorption and
expansion of tissue, sometimes producing a
porous state (osteoporosis); or there may be
softening of the tissue by absorption of the min-
eral matter and substitution of fatty or gelatin-
matter (osteo-malacia).

Fracture. — Callus is formed where bones
do not meet evenly. This will give the prob-
able age of the fracture. At first lymph is

124 POST MOKTEMS.

effused, which hardens; then bony spicules
appear, and so a spongy mass is formed ; the
ossification commences about the third week;
the "modeling" takes three or four months
to complete. In deciding as to fracture of the
neck of the femur regard must be had to the
natural changes incident to old age.

Tumors. — Exostoses, osteomala (growing
from the bone), osteophytes (more superficial,
not continuous with the bone, from which they
differ in texture); enchondromata are lobulated
cartilaginous tumors, non-malignant ; fibromata
(rare, chiefly in the jaw); sarcomata, of a soft,
"fleshy, or tough consistence, may ossify and
produce osteo-sarcomata.

Endosteal sarcomata and myeloid tumors grow
within the medullary canal ; they are generally
of a deep crimson color, dry and soft ; myxomata
(tumors like jelly); angiomata (nature uncer-
tain). Hoematoma (from efl^usion of blood).

CephalhtBtnaioma is a tumor met with on the heads of
new-born children during labor.

Cancer (rare), generally secondary as a soft

tumor within the medullary canal; tviercle

(doubtful); hy daiid (lAie).

JOINTS.

Inflammation. —jSJmp/e Arthritis.— Rei-~
ness (injected), effusion, often containing flakes
of lymph, pus (in severe cases); pulpy degen-
eration, the effusion having formed a soft thick
tissue.

Chronic Arthritis {Rheumatic). — Follows in-
jury or rheumatic fever. In its early stage as
a simple inflammation; after a time nodular
masses form round the edge of the joint; then
the cartilage is destroyed ; the surfaces of the
bone are polished and gradually worn down.
This disease is frequently mistaken for old-
standing fracture or dislocation.

Gouty Arthritis is shown by a white, chalk-

SIZ?^ OF THE DIFPERENT OBOANS. 125

like deposit of urate of soda in and around the
joint. Phosphate of soda may also deposit in
the same way.

IiOOSe Bodies often form in the joints,
frpm a millet seed to a small almond in size ;
they are composed of fibrous tissue ; their path-
ologic import is undetermined.

Bheumatism. — Acute (morbid appearances
have not been observed much). — Sometimes at
first little change, at other times there is a pink
color ; or there may be effusion, with flakes of
lymph. Chronic. — Swollen condition of the
membrane, otherwise not much change.

Scrofulous Inflammation {White Swell-
ing). — In its early stage it has been seldom
seen, but then as acute inflammation. Later
Stage. — Synovial membrane is of a deep red
color, eroded in parts; this increases till all
of it is destroyed ; the pus is most offensive.

Pyaemic, e:onorrh(ieal, puerperal, and scar-
latinal "rheumatism" are all inflammations
due to septicEemia.

For the first few'days the joint contains thin, dirty-
colored pus ; then destruction of the synovial mem-
brane takes'place.

XII.

VABIATIONS IN THE SIZES OF THE

DIFFERENT ORGANS.

Prof. Beneke has reached the following con-
clusions, which have been published in a re-
cent circular of the War Department :

1. Before puberty the aorta is smaller^ than
the pulmonary artery; after this period the
relation begins to be reversed, and in advanced
life the aorta is always the largest.

2. The aorta and pulmonary artery are ab-
solutely smaller in the female than in the male,
but relatively to the length of the body there
is scarcely any difference between the circum-

126 POST MORTEMS.

ference of the arteries in the two sexes, while
the heart in females is abEolatelj as well as rel-
atively smaller than in males.

3. In adult males the volume of the lungs is
greater than that of the liver ; in adult females
the reverse seems to be true.

4. In men the volume of the two kidneys is
nearly equal to that of the heart; in children
it is greater,

5. Children have relatively larger intestinal
canals than adults.

6. Sudden increase in the size of the heart
occurs at the age of puberty.

7. The iliac arteries diminish in size during
the first three months of life.

8. The cancerous diathesis is in the majority
of cases associated with a large atod powerful
heart and capacious arteries, but a relatively
small pulmonary artery, small lungs, well de-
veloped bones and muscles, and tolerably abun-
dant adipose tissue.

Pulmonary tuberculosis is often associated
with an unusually small heart.

10. In constitutional rachitis, the heart is
generally large and weU developed ; the arte-
ries are also large.
«

THE POST-MOBTEM APPEARANCES IN NEW-
BORN CHILDREN VCHERE DEATH HAS BEEN
CAUSED BY SUFFOCATION.

Nobiling, in the Arizliches InttUigenzbhU,
gives the following'summary as the results of
his investigations:

1. Extensive hemorrhages into the skin are
caused by external violence— difficult labor,
operative procedures and endeavors to resusci-
,tate being excepted.

2. Hemorrhages into the muscles of the neck
and along the great vessels always point to

SIZES OF THE DIFFERENT ORGANS. 127

attempts at choking, with the same exception
as in 1.

3. The following likewise always indicate
external violence : Hemorrhages between the
capsule and substance of the liver, or in the
organ itself; tearing of the peritoneal covering
or the parenchyma of the liver,^spleen or kid-
neys (not a rare occurrence when restoration to
life has been attempted). Furthermore, hem-
orrhages into the umbilical cord occur very
rarely during labor or the performance of arti-
ficial respiration ; they are caused, for the most
part, by tearing or attempting to tear the cord.

4. Hemorrhages of great extent into the skin
arise from difficult labor or external violence ;
hemorrhages into the lips, tongue, gums or
mouth are always suspicious. Swelling of the
lips — apart from its occurrence in face presen-
tations — is always to be considered an indi-
cation of violence; so should be considered -
hemorrhages into the external auditory canal
or auricle.

6. Effusions of blood into the muscles except
the muscles of the heart, eye and tympanum, ~
are always caused by external violence. The
same exceptions are to be made here as in 1.

6. The substances, fluid or solid, through
which suffocation has ensued are usually to be
found in the respiratory and digestive tracts,
in the drum of the ear and the Eustachian
tubes — indeed almost always in all of them.

7. Blood in the larynx, trachea, bronchi and
alveoli has been sucked in by inspiration ; it
has come from the nose of the child or the par-
turient canal. To a similar source is to be at-
tributed blood found in the mouth, oesophagus
or stomach.

128 POST MOKTEMS.

XIII.
POST-MORTEM WOUNDS.

It is hardly necessary to say that the utmost
care must be taken during a necroscopy not to
prick or scratch the skin, especially so if the
subject has died of peritonitis, puerperal fever,
erysipelas, scarlet fever, and other zymotic dis-
eases ; also when the body is in a state of de-
composition.

If the skin is injured before commencing the
examination, apply Friar's balsam, tincture of
tolu, or collodion ; then cover with several lay- :
ers of sticking plaster, and grease or wax this
well, so as to make it water-proof.

If the skin is injured whilst performing the
necroscopy, wash in cold water. Suck well, and
afterwards bathe or soak it in a mixture of
dilute sulphurous and carbolic acid, as strong
as can be borne. It must be remembered, how-
ever, that strong carbolic acid will produce a
painful sore, and that both these acids in dilute
form, applied for some time, will destroy the
epiderm; but this last effect is not of much
consequence.

The Editor has always used a pencil of nitrate of silver
pressed well down into the wound.

The painful inflammations which often arise
from post-mortem wounds are relieved by paint-
ing the part with strong perchloride of iron
solution. If constitutional symptoms show
themselves, as inflammation of the lymphatics
these are best met with hyposulphites, of which
the magnesic are the most efficacious; they should
be taken very frequently, as every two hours.
The sulphurous acid applied locally and the
hyposulphites taken internally are so powerful
in counteracting septicaemia that by their use
blood-poisoning may be almost entirely pre-
vented.

INSTKUMENTS BEQTTIBED. 129

XIV.

INSTRUMENTS REQUIRED.

The fewer instruments the better when the
necroscopist has to carry them all with him,
but in a well-appointed mortuary everything
that can assist, even in minute details, should
be provided.

1. Scalpels. — Three or more of moderate
size, with rather broad blades, the cutting edge
curved and the points blunted. Two or more
of the usual kind for special purposes, and a
large one for cutting the cartilage of the ribs.
A long, thin, moderately wide-bladed knife,
for slicing the brain, kidneys, etc. A Valen-
tine's knife is very useful for making micro-
scopical sections,

2. Saw. — This may be an ordinary meat or
dove-tail saw, with or without a movable back ;
a special saw or rachitome, for opening the
spine, is often required.

3. Scissors. — Straight and curved, also a
pair for catting the intestines, one blade hook-
shaped (enterotome); it is useful also to have a
a bronchotome, or narrow, unequal-bladed scis-
sors, for opening the bronchi and blood-vessels.

4. Forceps. — These should be longer and
stronger than the ordinary dissecting forceps.

5. Hooks. — Best mounted in handles ; those
on chains are dangerous; hooks may be extem-
porized out of bent wire or pins with string
attached. In fact, pliable copper wire will be
found very serviceable for various purposes.

6. Mallet and Common Chisel. — A
layer of leather or rubber on the striking part
of the mallet serves to deaden the sound of the
blows.

7. Tape Measure.— Made of stiff cloth.

8. Spring Balance — or beam scales— to
weigh from a quarter of a pound up to ten

130 POST MOBTEMS.

pounds. In the mortuary a larger one should
be provided for taking the weight of the entire
body.

9. If eedles. — These must be strong, curved
and with cutting points 3 to 5 inches long. A
few smaller ones are sometimes needed.

10. Cord. — Nothing answers better than
the coarsest crochet cotton, or very even string,
which should be well waxed before using.

11. Fins with and without guarded points.
These last are serviceable for fastening up holes
in the intestines, stomach, etc.

12. Bone Forceps. — Large and powerful,
hawk's-beak shaped are best.

13. An Iron Ring, with three screws to
fasten to the head to guide the saw, and with a
handle to steady the head.

1'4. Several Blocks of Wood to sup-
port the head; in the mortuary, however, a
head-rest should be attached to the table with
adjustable screw slide. A modification of the
iron ring and head-resfcombined is very good.

15. Various Minor Necessaries.—
Sponges, calico rollers, cloths, pieces of oiled
silk or gutta-percha tissue (for taking away
specimens), blow-pipe. India-rubber gloves,
Coddington or Stanhope lens, hone, pots and
jars for specimens, etc^ In a well-appointed
mortuary provision should be made for pho-
tography.

16. Disinfecting Solutions. —Perman-
ganate of Potash, or Candy's Fluid; Sir W. Bur--
netts, or Chloride of Zine. — This latter solution
is colorless, inodorous, and, diluted, preserves
tissues almost for ever.

Sulphurous Acid is the most valuable, remov-
ing the cadaveric odor and preventing post-
mortem sores; this, combined with about a
fourth part of carbolic acid to ten parts of
water, is perhaps more efficacious.

ORDER OF EXAMINATION.

131

BoncCs Terebene Bprinkled over the body
removes much of the unpleasant smell.

Oarbolate of Soda and dilute Garbolic Add are
vecy useful.

The Illustrated Medical Journal Co.,
Instrument Dealers, Detroit, Michigan, oiTer
the following compact Post-Mbrtem Chse for
$10.50. It contains:

1 Large Knife and Saw in one Handle; 1
Tenaculum ; 3 different sized Scalpels; 1 An-
eurism Needle; 1 Pair Forceps; 1 Pair Scis-
sors ; 1 Set Chain Hooks ; 1 Blow Pipe ; 1 Post
Mortem Needle ; 1 Chisel. Knives, etc., have
ebony handles. All in polished Mahogany
Case, with Lock and Key.

XV.

ORDER OF EXAMINATION AND TA-
BLE FOR NEOROSCOPIG RECORD.

preliminary observations.

Place where necroscopyjwas conducted — dat,e
— name of deceased — age — place where seen —
persons present — remarks on their behavior,
etc. — state of locality — objects near. Measure-
ments of distances to be accurately made.

132 POST H0BTEM8.

^ EXTERNAL EXAMINATION.

Appearance of Body. — Condition-
position — clotliing — height — weight — muscu-
larity—proofs of death. Objects likely to have
caused death, as knives, cords, bottles, etc.,
notice how and where they are placed. Pre-
serve any vomited matters, also blood-stains.

State of the Skin. — Clean or dirty, nat-
ural or acquired color. Signs of decomposition.
Marks of injury, disease, tattooing, neevi, warts,
scars, etc.

Condition of mammae ; silvery lines of preg-
nancy on abdomen and breast.

State of the Natural Orifices.- Eyes,
ears, nostrils, mout^, anus, urethra, vulva. Look
for foreign bodies, signs of wounds, etc., in these.

State of the Iiimbs. — Position; rigor
mortis. Size of hands and feet; delicately or
coarsely formed, showing signs of handicraft.
Special marks. Condition of the nails; con-
tents (blood, dirt, grass, etc.)

Features. — Eelaxed or contracted ; eyelids
closed or open ; condition of cornea and pupils.
Mouth ; contents, position of tongue, state of
the teeth.

Carefully examine the Spine for disloca-
tions, fractures, punctures, etc.

INTERNAL EXAMINATION.

Thorax uncovered (not opened), abdomen
opened. Amount of fat or its absence on chest
and abdomen. Wounds. State and position
of the undisturbed abdominal contents, perito-
neum, mesentery, etc. Foreign bodies ; disease.
Position of the diaphragm.

Thorax Opened.— Position of thoracic
organs. Pericardium; mediastinum; pleura
(undisturbed).

OBBEB OF EXAMINATION. 133

Heart. — Shape, appearance, weight. Stale
of coronary vessels. Bulging of auricles and
ventricles; fat.

Cavities. — Clots; muscular structure; valves.

Veisels. — Aorta, pulmonary artery, vena cava,
etc.

Larynx, Trachea, Bronchi, etc.— Ab-
normalities, foreign bodies, disease, etc.

IiUngS. — Pleura — adhesions, contents.
Bight and left lungs — color, consistence, ap-
pearance, weight, etc.

ABDOMEN.

Liver. — Form, weight, consistence.

Gall Bladder.

Pancreas. Spleen.

Kidneys. — Bight and left; appearance of
cortical and medullary substance ; weight.

Supra-renal Capsules.

Semi-lunar Ganglion.

Stomach. — Size, appearance, contents. Tie
up both the ends before removirg ; and, if nec-
essary, seal the whole up at once in ajar.

Peritoneum, mesentery.

Intestines.^-Duodenum, ileum, ileo-csecal
valve, appendix cseci, caecum, colon, sigmoid
flexure, rectum. Appearance, position, con-
tents, disease, etc.

Bladder. — FuU, empty, state of mucous
membrane. Prostate ; urethra ; penis, testicles,
etc.

Uterus, vagina, etc., poisons may be intro-
duced per vaginam ; ovaries, state of the G-raa-
fian vesicles, etc.. Fallopian tubes, etc.

Scalp, bones, fontanelles.

Brain. — Dura mater and arachnoid ; pia
mater — superior surface, base, fissures. Grey
matter, white; ventricles — 1st and 2nd, 3rd,

134 POST MORTEMS.

4th and 5th. Ciorpus striatum, optic thalamus.
Velum interpositum, choroid plexus, etc.

Base of skull, fractures, caries, tumors, etc.

Spinal Cord. — Marks of injury, disease,
etc., in the vertebrse and in the cord ,itself.
Dislocation of the atlas.

OEGANS or SPECIAL SENSE.

Ear. — External mmlu», disease, injury, for-
eign bodies. Inner ear. Eustachian tubes.

TSoae. — Disease, foreign hodies, punctures
through the ethmoid bone.

Eyes. — Eyelids, orbit, cornea, lens, cham-
bers, retina, optic nerves.

Bones. — Fractures, dislocations, shape, col-
or, length, disease, etc. Centres of ossification
in clavicle, maxillary bones, sacrum, pubes, os
calcisj sternum, clavicle, femur. Examine the
shape, size, etc. of the pelvis.

INDEX.

. PAGE

Air in Veins 108

Addison's Disease 79

Ai'£chnoid 106

Asphyxia 15

Atrophy of Liver 78

Bladder .' 8)

Body, External Examination 7,25

Bones ." „.122

Brain 110

-Bright's Disease 82, 83

Bronchi 44

Cadaveric Rigidity 10

Cancer of Stomach...'. 57

Cancer, Uterine .- 57

Cholera 68

Circulation, Organs of 30

Clitoris 101

Death, Signs of. 9-17

Digestive Tract 53,

Disinfecting. Solutions 130

Drowning '..... 18

Dura Mater 105

Dysentery , 68

Ear 121

Embolism 41

Emphysema •. 49

Endocardium 33

Examination of Body...... 25,131

Eye and Lids 119

Fallopian Tubes 93

Gall Bladder 75

Generative Organs, Male 86

" Female 90

Hanging 17

Head, Examination of. 27,103

Heart 31

Hepatitis 72

Hernia 65

Bodgkin's Disease 77

Hydrocele 87

Infanticide 11

Injuries of Brain 115

Insanity 116

Instruments Required 129

Intestines 62

Invagiqation 65

Joints „ 124

Kidneys ". 79

Lateral Ventricles 113

Larynx... 44

Leukaemia : 77

Ligaments, Uterine. 91

Liver 70

Lungs u 47

Lungs in Newly Born 53

Lymphatic 41

MalfDrmations 11-16

Mammse 102

Meningitis 107

Menstruation 9S

Mouth ; 63

Nerves , 119

136 INDEX,

PiGB

103

Nose

121

55

37

Organs, Variations in Size ....

Ovaries

; 125

...91

105

76

Parturition .-.

98

Pelvis Female

90

Penis

88

30

102

59,100

106

54

Phlebitis

. 40

Phlegmasia Alba Dolens

40

Phthisis

49

Pleura _

46

50

Poisons, Signs of.

21

58

Portal System

70 ,

Powder Marks

128 .

19

28

Prostate Gland . .

88

Puerperal Fever ,

99

100

12

Respiratory System

42

125

Scrotum

86

29

Shape of Heart

37

Signs of Death

17

Skin ,

121

104

Solutions, Disinfecting

130

76

88

116

Starvation

17

Stomach

55

.....17-126

78

Suicide

19-17

73

Testicle

; 86

Tongue

54

Trachea (.

44

Typhoid Fever Lesions

66

109

Ureters

80

Urethra, Male -.

89

78

Uterus ■ .'.

94

Vagina „...

99

Valves of Heart

37

Veins

39

ViabiUty

11

Vulva....

100

Waxy Liver

74

Wounds, Post-mortem

^9.

Z1TSTSIT7ME2TTS

We Discount usual Catalogue Prices of SURGICAL or DEN-
TAL INSTRUMENTS, BATTERIES and APPARATUS and
BOOKS, from 15 to 50 Per Cent.

^Vrite us for LOW Prices on Instruments, etc., that you vrish.
Get your HIGH Prices elsewhere.

• A FE^W OFFERS:

TiTCllPrTINfi. rilWI Leonard's "Ever Ready," $2. Contains
mOOEiVjlinU IjAOJIO ]Scalpel;lpr. Scissors; 1 pr. Forceps; 1
Tenaculum; 1 Cartilage Knife; 1 bet of Chain Hooks; 1 Blow Pipe.
All in Wood Case and sent post paid.

l)ftriri("P rJIU Leonard's "Multum in Parvo" Pocket Case,
rUVfAIii \jl\oa (20 instruments) $8. Contains 1 Scalpel; 1 Tenae-
. ulum ; 1 Gum Lancet; 1 Sharp-pointed, curved Bistoury ; 1 Thumb
Lancet; 1 Combined Spatula and Tongue Tie; 1 exploring Needle
in Case; 1 Combined Male and Female Catheter and Caustic Holder;
1 Combined Torsion, Polypus, Artery and Needle Forceps; 1 Flam
Artery Forceps; 1 Pr. Probes; 1 Combined Director and Aneurism
Needle; SNeedles; ITabletof Silk; 1 Probe-pointed Bistoury. All
iu a neat, two-fold, Silk and Velvet-lined Morocco Case.

'PnifPllirftllirTJTUP'! a warranted, accurate, self-registering, inde-
lODIUIlUlttlilLIlk) structible index, latest pattern, in a hard
-rubber case, post paid, $1 00.

TrtrtTTI T7ftRri7T)Q Nickel-plated, octagonal joints, warranted.
lUUia lUniiHirO Four pair for $5; three pair for $4; two pair
for $2 70. All post paid.

WWUlViOnWi Bi-aural, soft rubber tubes, postpaid iZ 00

DlliinUOVfUrfiO Cammom's bi-aurrJ, '' $1 75

TJAnprpO Elliott's Obstetric, with Fcrew in handle, nickel-plated,
lUnuUrtJ post mid, $5 00; Thomas', $4 50, post paid; Hodges',
$4 SO, post paid. ITteriue, long dressing, $1 15, post paid.

nVOftTirPMir' QVPTUfTJC in a neat case, with bottle and»'two
nirUl/uniUlV OininUI^t] gold-plated needles, screw-heads;
fenestratedmetalbarrel, washers, etc.,. post paid, $1 J5. • -

Uterine Applicators, post paid, 60c.

Panquelin'3 Thermo-Cautery, 3 points Complete, in Case, $88.
Stomach Pump, Aspirator and Syringe Combined, $12.
THE ILLUSTRATE Q MEDICAL JOURNAL COT,
Surgical Instrument Manufacturers and Dealers,

Leonard B ock, i8 John R. St,, Detroit, Mich.
All the above "offers" post p lid on receipt of price.

VJ.

m