Then make the incisions for the left side as above described.

After making the incisions in the right side, remove and'examine the quality and quantity of blood from the right auricle; then insert the left index and middle fingers from the auricle through the tricuspid opening into the ventricle, and endeavor to open this latter cavity. Remove the blood from the right ventricle, determine it as before, and do the same on the left side. Do not examine the valves at this stage, as adhesions, coagula, etc., may be disturbed. The contracted condition of the left side of the heart must be borne in mind, but this contraction, with the rigor mortis, may be overcome by gentle pressure.

To remove the heart, introduce the left index finger into the left ventricle, and the thumb into the right, through the already existing incisions; raise up the apex, and with it the whole of the heart, and with three or four long, free, horizontal incisions, made not too close to the heart, divide the vena cave, the pulmonary veins and artery, and the aorta, all together. After removal, examine the cut openings of the aorta and pulmonary artery, the size of these vessels, the thickness of their walls, and remove any and all coagula. Examine the capacity for closure of the arterial orifices by pouring water into the aorta and pulmonary artery, holding the heart freely sus pended in the air, so that the orifices will not be closed or the walls compressed by pressure of the hand. The points of the fingers should be applied to the vessels to be examined, or externally near the base of the valves, so that the plane of the orifice shall be exactly horizontal, and not drawn to any side. To prevent dragging, stretching, or valvular closure, both hands must be used,

to support the heart properly, and the water must be poured in by a second person.

In examining the aortic orifice, apply the tips of the fingers closely around it on the right and left auricles and pulmonary artery; for if applied simply to the edges of the aortic opening, the parts may be stretched unequally, and besides we have to divide the aorta again at a distance of four or five centimetres above the orifice by an incision parallel to the plane of the aperture. If the coronary arteries were divided when the left side of the heart was first incised, the water poured in may escape through them. In the case of the pulmonary artery it is different, and to test the pulmonary orifice the heart can be suspended by fixing between the fingers the edges of the opening into the vessel.

For thorough examination of the heart, after removal, place it exactly in the position it occupied in life, on a board or table. The parts to be examined are the auriculo-ventricular valves, with their chorda tendineæ and musculi papillares, the cavities themselves, their endocardium, the arterial valves, auriculo-ventricular septum, and muscular substance.

For the right ventricle, the incision is made in a straight line prolonged from the pulmonary artery, and near the base of the heart, with a long pair of scissors; one blade being inserted into the previous incision in the right border (p. 321), and carried towards the pulmonary artery, care being taken, by introducing the blade in front of the papillary muscle, and carrying the incision close to the base, not to cut through the muscle of the tricuspid valve with its chorda tendineæ, which would interfere with the demonstration of the tricuspid valves.

For the left ventricle, the incision, with similar scissors, is in a straight line prolonged from the ascending aorta,

and close to the septum ventriculorum; commencing at the apex and dividing the anterior wall of the ventricle and of the aorta. Care must be taken not to divide the base of the mitral valve. Avoid cutting through the valves of the pulmonary artery by drawing that vessel to the right when making the incision, and by continuing this to the left, close to and behind the artery; not too far to the left, as the right border of the base of the mitral valve is inserted quite close to this spot, and this valve is connected immediately with the left border of the aortic orifice. If the incision goes only a few millimetres too much to the left, that portion of the mitral valve will be cut off which forms this junction, and the result will be an aperture in that valve when the divided portions of the heart are put in apposition. Externally this spot corresponds exactly with the right border of the base of the left auricle, and should be the guide, the incision being carried through midway between the pulmonary orifice and the left auricle.

This completes the examination of the heart-all of which can be done in ten minutes-unless it be desirable, in exceptional cases, to open the auricles by cutting through their wall with the scissors, between the openings of the vena cava on the right, and of the pulmonary veins on the left side; or to make further incisions in the muscular substance or the coronary arteries.

THE LUNGS.-In examining the lungs we must take care not to injure the root, where the vessels, nerves, and excretory ducts occupy important relations, as it may be necessary to probe, dissect, inject, or use the blowpipe in the vessels or canals. As already stated, the lungs should not be removed until after the examination of the heart. Should it be desirable to remove the lungs and heart together, tie the trachea and vessels to

prevent the exit of blood and air. Then cut through the trachea, dissect it from the oesophagus, divide the great cervical vessels, and separate the heart from its remaining attachments to the diaphragm. We must examine whether the lungs float in water, whether they have breathed, and in adults, to see if there be consolidation, and also crepitation. If we cut the lungs in pieces, examine whether the pieces float. In opening the lung divide each lobe, by a perpendicular incision from above downwards, and from its thick border towards its inner (anterior, medial, sharp) border. Lay open the bronchial tubes, if necessary, by scissors introduced along the posterior wall of the trachea. Note any evidences of pneumonia, and examine examine the bronchial tubes, the parenchyma, bronchial glands, etc.

The larynx, tongue, etc., are sometimes removed with the lungs, and their condition examined, but not usually in private practice.

THE LARYNX.-Make an incision from the chin to the sternum, carefully dissecting back the skin, and then separate the floor of the mouth from the jaw, pulling the tongue down through the opening. Divide the pillars of the fauces, and the pharynx; and the tongue, pharynx and larynx may be brought down together, and, if necessary, separated from the lungs.

EXAMINATION OF THE ABDOMEN.

The usual order of sequence in the examination of the abdominal organs, except in special cases, should be as follows: The omentum; spleen; left kidney, suprarenal capsule, and ureter; the right ditto; the bladder, prostate gland, vesiculæ seminales, and urethra; the testicles, spermatic cord, and penis; or the vagina, uterus, Fallopian tubes, ovaries, etc.; the rectum; duodenum and intestinal

portion of the ductus communis; stomach; small omentum, gall-ducts, vena portæ, gall-bladder, and liver; pancreas and semilunar ganglia; mesentery, with its glands, vessels, etc.; small and large intestine; retroperitoneal lymphatic glands, receptaculum chyli, aorta, and vena cava inferior.

In regard to some of these organs no special directions are necessary, as they are removed without trouble or simultaneously with others of greater importance.

The mode of opening the abdomen has been already described (p. 319).

THE SPLEEN. This organ may be divided by a single long cut from above downward, over the middle of its outer or convex surface. The same precautions as to wounding the hilus are necessary as in the examination of the lungs (p. 324). Note the size, color, and appearance of the capsule and parenchyma.

The URINARY ORGANS should be examined in the following order: The kidneys, ureters, bladder, and urethra. The suprarenal capsules and generative organs will be examined in connection with them.

Kidneys.-Remove the organ with the suprarenal cap. sule, and take away the fat. Note the size, consistence, external appearances, etc. In opening the kidney, make a single cut from the external to the internal border; and examine the cortical and medullary substances, the pelvis of the kidney (for renal calculi), and if fatty degeneration be suspected make a microscopic examination. In removing the organ, divide the lumbar peritoneum, and draw the kidney forward, dividing the vessels and ureter. Label the organs, right and left, to distinguish them.

If deemed necessary, examine also the Suprarenal capsule and Ureters.

The Bladder. This organ is not usually removed.