HOW TO CONDUCT A POST-MORTEM

EXAMINATION.

THE practitioner must so conduct these investigations as to leave behind no offensive traces of his work, and must avoid wounding in any way those whose suscepti bilities at that time are particularly impressible. To insure a satisfactory performance of a post-mortem examination, certain preliminary arrangements necessary.1

are

What to Provide.-The undertaker must have the body ready. The carpets must be thoroughly protected from injury from the dripping of fluids, discharges, etc. The family must provide hot and cold water, a waste bucket, and basins, sponges, bran, a small funnel, oil for the hands if necessary, or preferably collodion, which is also useful in gangrene, etc., a small water pitcher, towels, and rags. In order to label specimens for preservation, the operator should provide himself with slips of wood on which he can write with a lead pencil, as the lead is not acted on by the fluids.

Instruments. Under ordinary circumstances, the physician will be able to perform a post-mortem examina

1 Many of the facts detailed in this chapter have been arranged and condensed from the following sources: R. Virchow, A Description and Explanation of the Method of Performing Post-mortem Examinations in the Dead-house of the Berlin Charité Hospital, translated by T. P. Smith, Philadelphia, 1877 (from Med. Times and Gazette, 1876); C. Heath, Manual of Minor Surgery, etc., Philadelphia, 1875; and manuscript notes of Lectures on Pathological Anatomy in Jefferson Medical College delivered by Dr. W. W. Keen, and kindly loaned by him.

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tion satisfactorily if provided with a case of instruments containing two large knives, two small knives, a saw, rachitome, scissors, a hammer, forceps, needles and thread, and a pocket measure; or an ordinary dissecting case plus a saw, rachitome, hammer, needles and thread.

Important suggestions, however, as to instruments, have been made by Virchow for the more satisfactory performance of these operations.

The blade and handle of the ordinary dissection-knife are made by him thicker and broader; the anterior part of the blade rounded off, the very broad surface termi nating with a considerable curve in the slightly projecting point, thus lengthening the cutting edge and diminishing the risk of pricking one's self or others. On the back part of the knife the blade is narrow and strong near its insertion, the handle flatter posteriorily, and much curved inwards from both edges, to lie more conveniently in the hand. In its original condition, before being ground down, the knife is twenty-three to twenty-four centimetres long, of which nine and a half belong to the blade. The incisions with this knife should be with a traction movement, rapid rather than forcible, to avoid crushing, as in the brain. Place the handle between the thumb and forefinger only, so that great pressure is impossible. If pressure be required, use a knife with a stronger handle than the ordinary cartilage knife, a thicker and more bulging blade, and a broader back, to which the forefinger or thumb may be conve niently applied; the handle made of two strong plates of wood or horn, one of them being applied to each side of a flat prolongation of the blade, reaching the entire length of the handle; the back of such a knife being sixteen millimetres broad, the free end of the handle flattened and broad. To sum up-the operator

requires a section knife for dissecting large viscera; a strong cartilage-knife for coarser work, such as dividing cartilages, large incisions through skin, muscles, joints, etc., and a dissecting knife for the finer parts, vessels, nerves, etc.

The operator should also have a bag for his instruments, or to carry away specimens for preservation. In the bag, he should carry oiled silk and tin seidlitzpowder boxes, and a bottle of Lugol's solution, to detect amyloid degeneration. In winter, the overcoat pocket will form a convenient receptacle for various articles. In medico-legal examinations, additional caution is necessary that clean glass jars be used. Sealing wax, a seal, and string should also be provided.

What to Observe.-In medico-legal cases special care must be exercised to ascertain three distinct points:1. Was the individual viable, and did he live? 2. If he has lived, how long has he been dead? 3. The cause of death.

In medical cases, the latter inquiry alone is necessary, together with

4. The pathology of the disease.

Notes of Cases.-In noting, on the instant, the appearances revealed, state the exact time of the examination, and how long after death it is made; enter only facts observed and not inferences. Measure everything; guess at nothing. If nothing abnormal be found in any organ, state the fac. If desirable, take specimens home for microscopic examination.

External Examination.

Special care is needful even to the smallest particulars.' 1. Position of the Body.-It has a marked bearing as to question of violence and mode of death.

2. Clothing.-Important in relation to identity; if torn, it may prove violence. After and closer examination may detect spots of blood, or semen (rape), fecal matters in infanticide, etc.

3. Condition of the subject as to putrefaction, etc. Important as bearing on date and cause of death, or on identity. Even in case of advanced putrefaction, the examination must be conducted, for the hair, nails, teeth, lesions of the bones, arteries, foreign bodies, poisons, pregnancy, etc., afford data to guide judicial examinations.

4. Age. In children recognized by extent of ossification, especially of the lower end of the femur, at the ninth foetal month.

5. Sex. Not always easily determined, by reason of anomaly or putrefaction or destruction. The presence of the uterus, beard, breasts, parting of the hair, etc., will or may assist us.

6. General Conformation, Constitution, Emaciation, etc.These have a bearing on previous state of health, identity, strength necessary for the crime, etc.

7. Warmth of various parts and Rigor mortis to be noted; cause of the latter may be coagulation of the muscular substance. If death is sudden it is delayed.

8. Color of Skin, white or negro. Hypostasis is not to be mistaken for congestion or violence. All livid spots

1 Casper relates a case wirere the body was exhumed three times, the second time to determine about some cicatrices which had not been fully reported, and the third time to examine the teeth-these bearing on the identity.